Form 4.0 - Application For Authority To Administer Estate Page 2
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1
2CASE NO. _______________________
Applicant is a trust company duly qualified in Ohio, and bond is dispensed with by law.
Applicant is decedent’s surviving spouse, and is entitled to the entire net proceeds of the estate, or is the next of kin
entitled to the entire net proceeds of the estate and there is no will, therefore bond is dispensed with by law.
Applicant offers the attached bond in the amount of $__________________________________.
[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.
Applicant accepts the duties of fiduciary in the estate, imposed by law, and such additional duties as may be
required by the Court. Applicant acknowledges being subject to removal as fiduciary for failure to perform such duties
as required, and also acknowledges being subject to criminal penalties for improper conversion of any property held
as fiduciary.
____________________________________________ ____________________________________________
Attorney for Applicant
Applicant
_________________________________________________ _________________________________________________
Typed or Printed Name
Typed or Printed Name
_________________________________________________ _________________________________________________
Address
Address
_______________________________ ________________________________
_______________________________ ________________________________
Phone Number (include area code)
Phone Number (include area code)
_________________________________________________ _________________________________________________
Facsimile Number (include area code)
Facsimile Number (include area code)
_________________________________________________ _________________________________________________
E-mail Address
E-mail Address
Attorney Registration No. ____________________________
WAIVER OF RIGHT TO ADMINISTER
[R.C. 2113.06]
The undersigned being persons entitled to administer decedent's estate, and whose priority of right to do so is equal or
superior to that of applicant, hereby waive appointment to administer the estate.
_________________________________________
___________________________________________
_________________________________________
___________________________________________
_________________________________________
___________________________________________
_________________________________________
___________________________________________
ENTRY SETTING HEARING AND ORDERING NOTICE
The Court sets __________________________________, at __________________ o’clock _________.M. as the date
and time for hearing the application for authority to administer decedent’s estate. The Court orders notice to take or
renounce administration to be given those persons entitles to administer decedents estate, whose priority of right to do so
is equal or superior to that of applicant, and who have not waived appointment to administer the estate.
___________________________________________
______________________________________________
JAMES A. FREDERICKA
Date
Probate Judge
9/26/03
FORM 4.0-APPLICATION FOR AUTHORITY TO ADMINISTER ESTATE
1/1/02
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