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JIS CODE: PAC

STATE OF MICHIGAN PROBATE COURT COUNTY OF

PETITION FOR ADJUDICATION OF TESTACY AND COMPLETE ESTATE SETTLEMENT

FILE NO.

Estate of 1. I am the personal representative appointed on
Date

by

the court.

the register.

2. Testacy has not been formally adjudicated. 3. The interested persons, addresses, and their representatives are identical to those appearing on the initial application/petition except as follows: (for each person whose address changed, list the name and new address; attach separate sheet if necessary)

4. The time for presenting claims that arose before the decedent's death has expired. 5. All claims properly presented have been paid, settled, or disposed of. A schedule for payment of properly presented claims is filed and served with this petition. 6. The decedent did not leave a will. 7. The decedent's will, dated is/are offered for probate and is/are , with codicil(s) dated attached to this petition. already in the court's possession.

Neither the original will nor an authenticated copy of a will probated in another jurisdiction accompanies the petition. The will is lost, destroyed, or otherwise unavailable, but its contents are: (attach additional sheets as necessary)

8. The decedent's will was informally probated on

in

County.

9. To the best of my knowledge, I believe that the instrument(s) subject to this petition, if any, was/were validly executed and is the decedent's last will. After exercising reasonable diligence, I am unaware of an instrument revoking the will or codicil(s). 10. After exercising reasonable diligence, I am unaware of any unrevoked testamentary instrument relating to property located in this state as defined under MCL 700.1301. 11. A final account has been served on all interested persons. is filed and served with this petition. (PLEASE SEE OTHER SIDE)

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MCL 700.3402, MCL 700.3952, MCR 5.311(B) PC 594 (9/07)

PETITION FOR ADJUDICATION OF TESTACY AND COMPLETE ESTATE SETTLEMENT

12.

All estate assets have been distributed as set forth in the final account. A schedule for the distribution of all remaining assets of the estate is filed and served with this petition. No Michigan estate or inheritance tax is due. Any Michigan estate tax or inheritance tax has been paid in full (evidence of full payment from the Michigan Department of Treasury is attached).

13.

I REQUEST: 14. An order determining heirs and that the decedent died is/are valid and admitted to probate. 15. intestate. testate and the document(s) stated in item 7

The final account be approved and that any fiduciary fees and/or attorney fees set forth in the final account be approved. The distributions previously made and/or all distributions as set forth in the schedule of distributions and payment of claims be approved. The personal representative be discharged.

I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Date Attorney signature Attorney name (type or print) Address City, state, zip Telephone no. Bar no. Petitioner signature Petitioner name (type or print) Address City, state, zip Telephone no.