Application For Summary Release From Administration - Probate Court Of Stark County
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1
2PROBATE COURT OF STARK COUNTY, OHIO
DIXIE PARK, JUDGE
ESTATE OF
, DECEASED
CASE NO.
APPLICATION FOR SUMMARY RELEASE FROM ADMINISTRATION
[R.C.2113.031]
Applicant states that decedent died on
.
Decedent's domicile was
.
Street Address
County
City or Village, or Township if unincorporated area
.
State
Post Office
Zip Code
[Check one of the following]
The applicant is decedent's surviving spouse entitled to one hundred percent of the allowance for
support and decedent's funeral and burial expenses have been prepaid or the surviving spouse
has paid or is obligated in writing to pay decedent's funeral and burial expenses and the value of the
assets does not exceed the $40,000 allowance for support under R.C. 2106.13(B) plus an amount not
exceeding $5,000 for decedent's funeral and burial expenses.
The applicant, who is not the surviving spouse, has paid or is obligated in writing to pay decedent's
funeral and burial expenses and the value of the assets is the lesser of $5,000 or the amount of
decedent's funeral and burial expenses.
[Check if applicable]
Decedent was fifty-five (55) years of age or older at the time of death and was a recipient of medical
assistance under Chapter 5111 of the Revised Code. SPF 7.0 - Notice to Administrator of Estate
Recovery Program has been filed.
Attached hereto is a receipt, contract or other document that confirms the applicant's payment or obligation
to pay decedent's funeral and burial expenses or if the applicant is the surviving spouse, the prepayment
receipt, if applicable.
The decedent's surviving spouse, next of kin, legatees and devisees known to applicant, are listed on attached
Form 1.0.
Applicant states that there are no pending proceedings for the administration of decedent's estate or relief of
decedent's estate from administration under R.C. 2113.03.
All known assets with date of death values of the estate are as follows:
Motor Vehicles (include year, make, model, body type, manufacturer's vehicle identification number and
Certificate of Title number)
$
$
FORM 5.10- APPLICATION FOR SUMMARY RELEASE FROM ADMINISTRATION
8-19-2011
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