Waiver And Consent - Wrongful Death And Survival Claims

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PROBATE COURT OF ________________ COUNTY, OHIO
ESTATE OF ____________________________________________________________, DECEASED
CASE NO. _______________________
WAIVER AND CONSENT
WRONGFUL DEATH AND SURVIVAL CLAIMS
The undersigned waive notice of the hearing and consent to and approve the settlement and distribution as
set forth in Form 14.0, Application to Approve Settlement and Distribution of Wrongful Death and Survival
Claims, a copy of which I have received.
________________________________________
_______________________________________
________________________________________
_______________________________________
________________________________________
_______________________________________
_________________________________________ _______________________________________
_________________________________________ _______________________________________
_________________________________________ _______________________________________
_________________________________________ _______________________________________
Print Form
FORM 14.1 - WAIVER AND CONSENT WRONGFUL DEATH AND SURVIVAL CLAIMS
4/1/97

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