PROBATE COURT OF COUNTY, OHIO _, JUDGE ESTATE OF CASE NO. , DECEASED JUDGMENT ENTRY OF INSOLVENCY [R.C. 2117.15, 2117.17, 2117.25] This matter was heard on the day of Representation of Insolvency and Insolvency Schedule of Claims. , 20_ on the The Court finds that notice was properly given to all creditors, claimants and other interested persons. The Court finds: that there were no exceptions filed as to the allowance or classification of any specific claim, or that any exceptions filed were addressed and resolved by the Court. The Court finds: that the fiduciary acted properly in classifying, allowing or rejecting claims on the Insolvency Schedule of Claims. that the Insolvency Schedule of Claims is amended as follows: _ The Court finds that the claims against the estate exceed the assets of the estate, and that the estate is insolvent. It is Ordered that the fiduciary shall pay the claims in the order and in the amount as proposed. It is Ordered that the fiduciary shall pay the claims in the order and in the amount as proposed, except as follows: FORM 24.6 - JUDGMENT ENTRY OF INSOLVENCY Effective Date: January 1, 2012 American LegalNet, Inc. www.FormsWorkFlow.com CASE NO. It is Ordered: that all claims in Class are to be paid in full, that all claims in Class are to paid pro rata at % per attached computation, and that all claims below Class _ are disallowed in that there are no funds available. It is Ordered that the fiduciary shall file a Final and Distributive Account within thirty (30) days of this Order. It is Ordered that the fiduciary shall file a Certificate of Termination within thirty (30) days of this Order. _ , Probate Judge FORM 24.6 - JUDGMENT ENTRY OF INSOLVENCY PAGE 2 Effective Date: January 1, 2012 American LegalNet, Inc. www.FormsWorkFlow.com