PROBATE COURT OF _______________ COUNTY, OHIO ESTATE OF ________________________________________________________, DECEASED CASE NO. _________________________ CERTIFICATE OF TERMINATION [R.C. 2109.30] I certify I am the executor or administrator and the sole legatee, devisee or heir. I further certify: (1) all debts and claims presented to the estate have been paid in full or settled finally; an estate tax return, if required under Chapter 5731 of the Revised Code, has been filed, and any estate tax due under that chapter has been paid; all attorney fees have been [check one] waived by counsel of record, paid to counsel of record in the amount of $ ____________________; all fiduciary fees have been [check one] waived by the fiduciary; paid to the fiduciary in the amount of $ ___________________; all assets remaining after completion of the activities described above have been distributed to myself as the sole legatee, devisee or heir. (2) (3) (4) (5) ___________________________________ Attorney for Fiduciary ________________________________________ Fiduciary Attorney Registration No. ______________ ENTRY Based upon the above certification it is ordered that the fiduciary and surety, if any, are discharged. ____________________________________ Probate Judge Print Form 3/1/96 FORM 13.6 - CERTIFICATE OF TERMINATION American LegalNet, Inc. www.FormsWorkFlow.com