Automobile Surviving Spouse Affidavit

Anthony J. Dattilio Columbiana County Clerk of Courts Automobile Surviving Spouse Affidavit Section 2106.18 - 4505.10 Date In the Matter of the Estate of Deceased State of Ohio )SS County of ) The undersigned, being duly sworn, says that he is the surviving spouse of who died on the day of , 20 ; that said decedent owned the automobile(s) described below. If two automobiles are to be transferred under this secti on the combined approximate value of the two automobiles is less than $40,000.00; said automobile(s ) is not otherwise disposed of by Will; and the affiant is entitled to said automobile(s) pursuant to Ohio Revised Code Section 2106. 18. The following are the only automobile(s) to be transferred under this section: Auto 1 Auto 2 Year Y ear Mfg. Serial no. Mfg. Serial no. Make M ake Body Type Body Type Model Model Ohio Cert. of Title no. Ohio Cert. of Title no. Approximate Value Approximate Value Surviving Spouse Sworn before me and subscribed in my presence this day of , 20 Clerk, Deputy Clerk of Courts - Notary American LegalNet, Inc. www.USCourtForms.com