Ohio > County (Court Of Common Pleas) > Cuyahoga > Probate > Estates
Notice To Administrator Of Estate Recovery Program 7.0 - Ohio
| Notice To Administrator Of Estate Recovery Program Form. This is a Ohio form and can be used in Estates Probate Cuyahoga County (Court Of Common Pleas) . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Proba te Co urt of Cuyahog a Cou nty, Ohio John J. Donnelly, Presiding Judge John E. Corrigan, Judge ESTATE OF __________________________________________ _____, DECEA SED CASE NUMBER: ______________________________________ NOTICE TO ADMINIS TR ATOR OF EST ATE RE COVE RY PR OGRAM [R.C. 2117.061] The undersigned gives notice to the Administrator of the Estate Recovery Program that the decedent was fifty-five (55) years of age or older at the time of death and has been determined to have been a recipient of medical assistance under Chapter 5111 of the Revised Code. ______________________________________________ 9 Executor 9 Administrator 9 Commissioner 9 Person who filed pursuant to 2113.03 of the Revised Code for release from administration CERTIFI CATE OF S ERVI CE This is to certify a true copy of the above notice was served by certified U.S. mail, postage prepaid to the administrator of the Estate Recovery Program, on ________________________ . __________________________________ Person responsible for the Estate Form 7.0 - notice to administrator of estate recovery program 10/03
|
|||||||
