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Notice To Administrator Of Estate Recovery Program (Stark) 7.0 - Ohio
| Notice To Administrator Of Estate Recovery Program (Stark) Form. This is a Ohio form and can be used in Estate Probate Stark County (Court Of Common Pleas) . |
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PROBATE COURT OF STARK COUNTY, OHIO ESTATE OF , DECEASED CASE NO. NOTICE TO ADMINISTRATOR OF ESTATE RECOVERY PROGRAM [R.C. 21 17.061] 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 51 11 of the Revised Code. 0 Executor 0 Administrator 0 Commissioner 0 Person who filed pursuant to 21 13.03 of the Revised Code for release of administration. CERTIFICATE OF SERVICE 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 the day of ,200__. Person Responsible for the Estate Typed or Printed Name Address City, State, Zip Phone Number (include area code) American LegalNet, Inc. www.USCourtForms.com FORM 7.0 - NOTICE TO ADMINISTRATOR OF ESTATE RECOVERY PROGRAM 4/8/04
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