PROBATE COURT OF WOOD COUNTY, OHIO David E. Woessner, Judge IN THE MATTER OF THE: Wrongful Death Trust Inter Vivos Trust Testamentary Trust Special Needs Trust Of _________________________________________________________________________________, Deceased, Grantor Case No. ______________________________ Date:______________________ TRUSTEE'S BOND Amount of bond $_________________________ Amount of additional bond $_________________________ The undersigned principal and sureties are obligated to the State of Ohio in the above amount for payment of which we bind ourselves and our successors, heirs, executors, and administrators jointly and severally. The principal has accepted in writing the duties of fiduciary in the trust estate including those imposed by law and such additional duties as may be required by the Court. This obligation is void if the principal performs such duties as required. This obligation remains in force if the principal fails to perform such duties, or performs them tardily, negligently, or improperly, or if the principal misuses or misappropriates estate assets or improperly converts them to his/her own use or the use of another. [Check if personal sureties are involved.] ! The sureties certify that each of them owns real estate in this county, with a reasonable net value as stated below. Date Principal Surety Surety by Attorney in Fact by Attorney in Fact Typed or Printed Name Typed or Printed Name Address Address City, State, Zip Code City, State, Zip Code Telephone Number (including area code) Telephone Number (including area code) Net value of real estate owned in this county Net value of real estate owned in this county $__________________________________ $__________________________________ FORM 143-B - TRUSTEE'S BOND Crenshc$\forms\143-B 6/20/01 American LegalNet, Inc. www.USCourtForms.com