ONTARIO SUPERIOR COURT OF JUSTICE APPLICATION FOR CERTIFICATE OF APPOINTMENT OF ESTATE TRUSTEE WITH A WILL (INDIVIDUAL APPLICANT)

at Welland This application is filed by (insert name and address) Nancy Bellantino Barrister and Solicitor 105 Garon !en"e Welland# Ontario $%B 1B& Tel' (05)&**)%**1
Complete in full as applicable First .i!en na/e Second .i!en na/e

Fa+' (05)&**)%**5

,ET I$S BOUT T-E ,ECE SE, PERSON

T0ird .i!en na/e S"rna/e

FRE,

RUBB$E

And if the deceased was known by any other name(s), state below the full name(s) used including surname. First .i!en na/e Second .i!en na/e T0ird .i!en na/e S"rna/e

,ate o1 2irt0 o1 t0e deceased 3erson# i1 4no5n' (day, month, year) Jan"ary 11# 1(50 ddress o1 1i+ed 3lace o1 a2ode (street or postal address) (city or town) (county or district) * East 6ain Street City o1 Welland Welland# Ontario $%B %W% Re.ional 6"nici3ality o1 Nia.ara If the deceased person had no fixed place of $ast occ"3ation o1 deceased 3erson abode in Ontario, did he or she have Crane O3erator property in Ontario? No Yes N7 Place o1 deat0 (city or town; county or district)
City o1 Welland in t0e Pro!ince o1 Ontario %1 Oct 801%

,ate o1 deat0
(day, month, year)

,ate o1 last 5ill (marked as Exhibit !"

(day, month, year) 0% Oct 801%

#as the deceased person $% years of a&e or older at the date of the 'ill (or ($ years of a&e or older if the 'ill is dated earlier than )eptember $, $*+$"?

No

Yes

If not, explain 'hy certificate is bein& so,&ht- .ive details in an attached sched,le,ate o1 codicil (marked as Exhibit /!"
(day, month, year)

,ate o1 codicil (marked as Exhibit 0!"

(day, month, year)

N7 6arital Stat"s 1nmarried 2arried

N7 #ido'ed No 3ivorced Yes

3id the deceased person marry after the date of the 'ill? If yes, explain 'hy certificate is bein& so,&ht- .ive details in an attached sched,le#as a marria&e of the deceased person terminated by a 4,d&ment absol,te of divorce, or declared a n,llity, after the date of the 'ill? If yes, &ive details in an attached sched,leIs any person 'ho si&ned the 'ill or a codicil as 'itness or for the testator, or the spo,se of s,ch person, a beneficiary ,nder the 'ill? If yes, &ive details in an attached sched,le9 $UE OF SSETS OF EST TE

No

Yes

No

Yes

3o not incl,de in the total amo,nt5 ins,rance payable to a named beneficiary or assi&ned for val,e, property held 4ointly and passin& by s,rvivorship, or real estate o,tside OntarioPersonal Pro3erty
6 158#850:00

Real estate# net o1 enc"/2rances 6 %85#000:00

Total
6 ;&&#850:00

Is there any person entitled to an interest in the estate 'ho is not an applicant?

No

Yes

If a person named in the 'ill or a codicil as estate tr,stee is not an applicant, explainN7

If a person not named in the 'ill or a codicil as estate tr,stee is an applicant, explain 'hy that person is entitled to applyN7

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If the spo,se of the deceased is an applicant, has the spo,se elected to receive the entitlement ,nder section ; of the !amily "aw Act? No If yes, explain 'hy the spo,se is entitled to applyYes

FFI, 9IT<S= OF PP$IC NT<S=

(Attach a separate sheet for additional affida#its, if necessary)

I# an a33licant na/ed in t0is a33lication# /a4e oat0 and say7a11ir/' $- I am $% years of a&e or older8- If I am not named as estate tr,stee in (- The exhibit(s" referred to in this the 'ill or codicil, consents of persons 'ho to&ether have a ma4ority interest application are the last 'ill and each in the val,e of the assets of the estate codicil ('here applicable" of the at the date of death are attacheddeceased person and I do not kno' of <- any later 'ill or codicil;- The information contained in this application and in any attached I 'ill faithf,lly administer the deceased sched,les is tr,e, to the best of my person=s property accordin& to la' and kno'led&e and beliefrender a complete and tr,e acco,nt of my administration 'hen la'f,lly re>,iredNa/e (surname and forename(s)) RUBB$E# WI$6 ddress (street or postal address) * East 6ain Street
(city or town)

Occ"3ation ,o/estic En.ineer

(pro#ince) (postal code)

Welland

Ontario

$%B %W%

)'orn: ffirmed before me at the City of Welland in the Pro!ince of Ontario this 1* day of No!e/2er , (9 1% )i&nat,re of applicant Wil/a R"22le

0ommissioner for takin& ffidavits (or as may be)

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of

Na/e (surname and forename(s)) ddress (street or postal address)

(city or town)

Occ"3ation
(pro#ince) (postal code)

)'orn: ffirmed before me at the of in the of this day of , (9

)i&nat,re of applicant

0ommissioner for takin& ffidavits (or as may be)

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