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THE UNDERSIGNED CERTIFIES THAT THE WILLS ON DEPOSIT HAVE BEEN EXAMINED AND NO
LATER WILL WAS FOUND ON DEPOSIT FOR THIS DECEDENT.
________________________________
DEPUTY CLERK, PROBATE COURT
WILL ONLY
TAX ONLY
GARY E. HORN
Address
MAUMEE, OH 43537
(419) 555-1212
Phone Number
Print Name
Phone Number
0016297
REV. 01/2012
LUCAS
TOLEDO
______________________________________________________________________________
City or Village, or Township if unincorporated area
County
______________________________________________________________________________
OH
43613
Post Office
State
Zip Code
A document purporting to be decedent's last will is attached and offered for probate, and applicant waives
notice of probate of this will.
Decedent's surviving spouse, children, next of kin, and legatees and devisees, known to applicant, are
listed on the attached Form 1.0.
_______________________________________
Attorney for Applicant
_______________________________________
GARY E. HORN
Typed or Printed Name
_______________________________________
1796 INDIAN WOOD CIRCLE
Address
MAUMEE,
OH 43537
_______________________________________
_______________________________________
Applicant
_______________________________________
OREN JOHNSTON FARRELL
Typed or Printed Name
_______________________________________
913 GARTH STREET
Address
_______________________________________
TOLEDO,
OH 43613
(419) 555-1212
_______________________________________
Phone Number (include area code)
_______________________________________
Phone Number (include area code)
0016297
Attorney Registration No. _________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
_______________________________________
FT3/16
12/01/02
_______________________________________
Judge Jack R. Puffenberger
Have waived notice of the application for probate of this will or of a contest as to jurisdiction.
Have waived notice of this wills admission to probate. The waivers are filed herein.
Have not been notified because their names or places of residence are unknown and cannot with
reasonable diligence be ascertained.
___________________________________________
Fiduciary
Applicant for the admission of this will to probate
Applicant for a release from administration
Other interested person
Attorney for any of the above
12/01/02
The following are decedents known surviving spouse, children, and the lineal descendants of deceased children.
If none, the following are decedents next of kin who are or would be entitled to inherit under the statutes of
descent and distribution.
_____________________________________________________________________________________ ______
Name
Residence
Relationship
Birthdate
Address
to Decedent
of Minor
913 GARTH STREET TOLEDO, OH 43616
Surviving
Spouse
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
[Check whichever of the following is applicable]
The surviving spouse is the natural or adoptive parent of all of the decedents children.
The surviving spouse is the natural or adoptive parent of at least one, but not all of the decedents children.
The surviving spouse is not the natural or adoptive parent of any of the decedents children.
There are minor children of the decedent who are not the children of the surviving spouse.
There are minor children of the decedent and no surviving spouse.
FT2/13
PAGE 1 OF FORM 1.0 SURVIVING SPOUSE, CHILDREN, NEXT OF KIN, LEGATEES AND DEVISEES
12/01/02
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
[Check whichever of the following is applicable]
The will contains a charitable trust or a bequest or devise to a charitable trust, subject to R.C. 109.23 to 09.41.
The will is not subject to R.C. 109.23 to 109.41 relating to charitable trusts.
____________________________
Date
_____________________________________________
Applicant (or give other title)
_____________________________________________
PAGE 2 OF FORM 1.0 SURVIVING SPOUSE, CHILDREN, NEXT OF KIN, LEGATEES AND DEVISEES
12/01/02
_________________________
Date
____________________________________
Judge Jack R. Puffenberger
FT3/4E
EST 2.3 ENTRY ADMITTING WILL TO PROBATE
_____________________________________________________________________________________________
TOLEDO
LUCAS
City or Village, or Township if unincorporated area
County
43613
______________________________________________________________________________________________________
OH
Zip Code
Post Office
State
The assets are $ 15,000 or less and decedent died on or after January 1, 1976.
The assets are $ 85,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or
after September 14, 1993.
The assets are $ 100,000 or less; the surviving spouse is entitled to all of the assets and the decedent died on or
after March 18, 1999.
The assets are $ 25,000 or less and decedent died on or after October 20, 1987.
The assets are $ 35,000 or less and decedent died on or after November 9, 1994.
The assets are $ 50,000 or less; and the surviving spouse is entitled to all of the assets and the decedent died on
or after April 16, 1993.
Applicant asks that the estate be relieved from administration because the assets do not exceed the statutory limits.
A statement of the assets and liabilities of the estate is listed on the attached Form 5.1.
The decedents surviving spouse, next of kin, legatees, and devisees known to applicant, are listed on the attached
Form 1.0.
__________________________________________
__________________________________________
Attorney for Applicant
Applicant
__________________________________________
__________________________________________
GARY E. HORN
OREN JOHNSTON FARRELL
Typed or Printed Name
Typed or Printed Name
913 GARTH STREET
__________________________________________
__________________________________________
1796 INDIAN WOOD CIRCLE
Address
Address
__________________________________________
__________________________________________
TOLEDO, OH 43613
MAUMEE, OH 43537
__________________________________________
(419) 555-1212
Phone Number (include area code)
__________________________________________
Phone Number (include area code)
Ftu6/1y
PAGE 1 OF FORM 5.0 APPLICATION TO RELIEVE ESTATE FROM ADMINISTRATION
3/99
WAIVER OF NOTICE
2012EST9999
CASE NO. _________________
The undersigned surviving spouse, heirs at law, legatees, devisees, and other persons entitled to notice of
the filing of the application to relieve decedents estate from administration, waive such notice.
_____________________________________
_______________________________________
_____________________________________
_______________________________________
_____________________________________
_______________________________________
_____________________________________
_______________________________________
ftiI
9
MAY 15, 2012
The Court sets _____________________________________,
at _________
0clock ____.
A M., as the date
and time for hearing the application to relieve decedents estate from administration.
[Check one of the following]
Notice by publication to interested parties is dispensed with as unnecessary. Written notice shall be
given, as provided by law and the Rules of Civil Procedure, to those persons entitled to notice, who
have not waived notice.
Written notice is dispensed with as unnecessary. Notice by publication shall be given to interested
parties as provided by law and the Rules of Civil Procedure.
Written notice shall be given to those persons entitled to notice, who have not waived notice, and
notice by publication shall be given to interested parties, as provided by law and the Rules of Civil
Procedure.
_____________________________
Date
___________________________________________
Judge Jack R. Puffenberger
Value
Other assets
SAVINGS ACCOUNT
XXXX
15000.00
XXXX
XXXX
15000.00
Value
Appraised
100000.00
15000.00
30000.00
CERTIFICATE OF DEPOSIT
JEWELRY
400.00
CLOTHING
200.00
Total Assets
$
145600
ftu6/28
PAGE 1 OF FORM 5.1 ASSETS AND LIABILITIES OF ESTATE TO BE RELIEVED FROM ADMINISTRATION
REV 4/1/97
Nature of Debt
Amount
$
ELDER-BEERMAN
5000.00
175.00
Total Debts
5175
CERTIFICATION
The undersigned appraiser agreed to act as appraiser of decedents estate, and to appraise the property
exhibited truly, honestly, impartially, and to the best of the appraisers knowledge and ability. The appraiser further
says that those assets whose values were not readily ascertainable are indicated above by a check in the
Appraised column opposite each such item, and that such values are correct.
The undersigned applicant determined the value of those assets whose values were readily ascertainable
and were not appraised by the appraiser, and that such values are correct, and to applicants knowledge the above
list of decedents debts is correct.
_______________________________________
Date
_______________________________________
Appraiser
________________________________________
Applicant
PAGE 2 OF FORM 5.1 ASSETS AND LIABILITIES OF ESTATE TO BE RELIEVED FROM ADMINISTRATION
REV 4/1/97
Upon hearing the application to relieve decedents estate from administration, the Court finds that:
Decedent died [check one of the following] [] testate [ ] intestate. The date of death and
domicile are as stated in the application, and the Court has jurisdiction over the estate;
Notice to the surviving spouse, heirs at law, legatees, devisees, and other interested persons was
duly effected or dispensed with by the Court as unnecessary;
The values of the several assets in the estate, given in the application do not exceed the statutory
limits.
The Court therefore relieves the estate from administration, and orders [check and complete
whichever of the following are applicable]:
[ ]
[ ]
That the following debts of decedent shall be paid to the extent of the assets:
$5,000.00 TO EDLER-BEERMAN
$175.00 TO KEN'S FLOWER SHOP
[]
That the statutory family allowance be paid to the [] surviving spouse [ ] minor
children of the decedent [ ] apportioned between the surviving spouse and the minor children of the
decedent who are not the children of the surviving spouse. Attach Form 7.2A if necessary.
[ ]
That Certificate of Transfer No. _____,
attached to the application and describing
1
decedents real estate, issue and be preserved in the records of the Court and that authenticated copies of
the certificate be delivered as required to the persons entitled to them;
[]
That the financial institutions holding accounts in decedents name as set forth below pay
the same upon proper tax release [check one of the following] [] to the commissioner [ ] to
[]
FT6/7]
PAGE 1 OF FORM 5.6 ENTRY RELIEVING ESTATE FROM ADMINISTRATION
2012EST9999
CASE NO. ______________________
Name of Distributee
Property
Value or
Amount
SAVINGS ACCOUNT
CERTIFICATE OF DEPOSIT
JEWELRY
400.00
CLOTHING
200.00
TOTAL $
15000.00
30000.00
45600
___________________________
Date
___________________________________________
Judge Jack R. Puffenberger
Print Packet
I, GARY
_______________________,
E. HORN 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.
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