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Certificate Of Termination

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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;

(2)

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;

(3)

all attorney fees have been [check one]

waived by counsel of record,

paid to counsel of record in the amount of $ ____________________;

(4)

all fiduciary fees have been [check one]

waived by the fiduciary;

paid to the fiduciary in the amount of $ ___________________;

(5)

all assets remaining after completion of the activities described above have

been distributed to myself as the sole legatee, devisee or heir.

___________________________________

________________________________________

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

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FORM 13.6 - CERTIFICATE OF TERMINATION

3/1/96

Certificate Of Termination

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