PROBATE COURT OF WOOD COUNTY, OHIO DAVID E. WOESSNER, JUDGE ESTATE OF _____________________________________________________________, DECEASED CASE NO. ______________________ SCHEDULE OF CLAIMS REVISED CODE SEC. 2117.15, 2117.17, 2117.25 [Use extra sheets if necessary] The fiduciary says that to his knowledge this schedule lists all claims against decedent or his estate. Such claims are recapitulated as follows: Claims allowed…………………………………………… $ Claims rejected, contingent, or in suit……………………. $ 0.00 TOTAL…………………………………………………… $ [Check if applicable] – [ ] The surviving spouse is the sole legatee and devisee under decedent’s Will and has not manifested an intention to take against it. It is therefore unnecessary to cite the surviving spouse to make an election. Fiduciary [Under “Footnotes” opposite an item requiring explanation, place the number of the appropriate footnote. Such notes should be included on the reverse to explain: any security for claims; maturity dates of claims not due; contingent claims; claims in suit; and dates of rejection of rejected claims.] Name and address of Claimant Amount Claimed Payment Class Date Presented Date Allowed FootNotes $ 1.2 Schedule of Claimsc h e d u l e o f C l a i m s American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. ______________________ Name and address of Claimant Amount Claimed Payment Class Date Presented Date Allowed FootNotes $ FOOTNOTES Orders on Filing of Schedule of Claims – Confirming Without Notice In the Court of Common Pleas, Probate Division,Wood County, Ohio In the Matter of the Estate of , 20 This day the Schedule of Claims in the above captioned estate was filed in this Court by the fiduciary of said estate. It is ordered that hearing on said Schedule of Claims be dispensed with , (“Dispensed with” or “had forthwith”) that the action of the fiduciary herein, in allowing and classifying claims, be confirmed; and that the same be recorded. Judge David E. Woessner I, _______________________, Attorney-at-law, hereby certify, that the within instrument was prepared and/or examined by me, and that the same, in my opinion, is correct and proper. 1 1.2 Schedule of Claimsc h e d u l e o f C l a i m s American LegalNet, Inc. www.FormsWorkFlow.com