PROBATE COURT OF COUNTY, OHIO ESTATE OF , DECEASED CASE NO. RECEIPTS AND DISBURSEMENTS [Attach to fiduciary's account] Page of pages Following is an itemized statement of receipts and disbursements by the fiduciary in the administration of his trust. Item Voucher No. Value or Amount Value or Amount $ $ FORM 13.1 - RECEIPT AND DISBURSEMENTS American LegalNet, Inc. www.FormsWorkflow.com Page Item of CASE NO. pages Voucher No. Value or Amount Value or Amount $ $ Fiduciary FORM 13.1 - RECEIPTS AND DISBURSEMENTS American LegalNet, Inc. www.FormsWorkflow.com