Free 5. Petition to Probate Will in Solemn Form - Georgia

GEORGIA PROBATE COURT STANDARD FORM

Petition to Probate Will in Solemn Form
I. INSTRUCTIONS Specific Instructions 1. 2. This form is to be used when filing a petition to probate will in solemn form pursuant to O.C.G.A. §53-5-20, et seq. It is permissible, but not mandatory, to use this form in connection with a petition to probate a copy of a will in lieu of a lost original pursuant to O.C.G.A. §53-4-46, provided that appropriate interlineations are made, and additional information is given to overcome the presumption of revocation. Check with the court in which the petition will be filed. This form may, but is not required to, be used where service by registered or certified mail with return receipt requested, is requested by the petitioner in lieu of personal service, in accordance with O.C.G.A. §53-11-3(e). Appropriate changes would be required in the order for notice, notice and certificate of service. Signatures of heirs who acknowledge service must be attested by a notary public or the clerk of any probate court of this state. It is not necessary that all acknowledgments appear on the same page. An attorney at law may acknowledge service on behalf of an heir; however, the attorney must certify that he or she currently represents that heir with regard to the pending matter and, in order to comply with O.C.G.A. §53-11-6, the attorney's signature must be attested as provided above. With respect to a power of attorney, the attorney-in-fact may acknowledge service on behalf of the donor of the power, provided that the power of attorney grants such authority, the signature of the attorney-in-fact is attested, a copy of the power of attorney is attached, and the attorney-in-fact certifies that the copy is a true copy and is still in effect. O.C.G.A. §53-5-22(c) provides that service of notice, when made personally or by mail, shall include a copy of the petition and of the will for which probate is sought. The same is true when service is acknowledged. Paragraph 5 requires a definitive statement that the list in Paragraph 4 includes each and every heir of the decedent, and that there are no heirs of the same or closer degree according to O.C.G.A §532-1. Provide the date of death for any deceased heirs. NOTE: If you are uncertain how to determine the heirs of a decedent, please refer to the "Heirs Determination Sheet" available from the probate court or at www.gaprobate.org. Examples of such statement would be: (a) "decedent was or was not married at the time of his death and had no children born, adopted, living or deceased, other than listed herein"; (b) "decedent had no other siblings half or whole other than those listed herein"; (c) "the decedent's brother who died previously, had no other children born, adopted, living or deceased, other than listed herein." Page 6 Guardian/Conservator's consent to serve should only be completed in the event there is a Testamentary Guardian or Testamentary Conservator named in the will according to O.C.G.A. § 29-2-4 and/or § 29-3-5. As to pages after 6, according to Probate Court Rule 22 (A), unless the court specifically assumes the responsibility, it is the responsibility of the moving party to prepare the proper citation and deliver it properly so it can be served according to law. The documents which are labeled court documents are to be completed by the moving party, unless otherwise directed by the court.

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General Instructions General instructions applicable to all Georgia probate court standard forms are available in each probate

Effective 7/09

GPCSF 5

Petitioner

GEORGIA PROBATE COURT STANDARD FORM

IN THE PROBATE COURT OF STATE OF GEORGIA IN RE: ESTATE OF DECEASED ) ) , ) )

COUNTY

ESTATE NO. ______________________ PETITION TO PROBATE WILL IN SOLEMN FORM

TO THE HONORABLE JUDGE OF THE PROBATE COURT: The petition of , whose mailing

address is/are ________________________________________________________________________ ___________________________________________________________, shows: 1. On , 20
Street

, _____________________________________________
First Middle City County Last Name State

whose place of domicile was ____________________________________________________________ departed this life owning property in Georgia. 2. While alive, decedent duly made and published a Last Will and Testament dated , which is herewith offered for probate in Solemn Form. Your petitioner(s) is/are named as the Executor. 3. Listed below are all of the decedent's heirs, with the age or majority status, address and relationship to the decedent set opposite the name of each: Name Age Address Relationship (Or over 18) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

4. (initial if applicable)

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GPCSF 5

Petitioner

As shown in paragraph 3. above, the decedent was survived by (a) minor child(ren), and: a. (initial if applicable). The Will names a Testamentary Guardian of the minor child(ren) of the decedent. Petitioner shows there is no living parent of said child(ren). The following individual(s) who has/have consented to serve is/are named as Testamentary Guardian in the decedent's Will: Name Address ________________________________________________________________________ ___________________________________________________________________ b. (initial if applicable). The Will names a Testamentary Conservator of the minor child(ren) of the decedent for property passing under the decedent's Will. The following individual(s) who has/have consented to serve is/are named as Testamentary Conservator(s) in the decedent's Will: Name Address ________________________________________________________________________ ___________________________________________________________________ c. (initial as applicable). There is/are now a court-appointed Conservator(s), who is/are identified as follows: Name Address ________________________________________________________________________ ___________________________________________________________________ 5. Additional Data: Where full particulars are lacking, state here the reasons for any such omission. Make a definitive statement which will show to the court that those persons named in Paragraph 3 constitute all of the heirs of the decedent and that there are no heirs of similar or higher degree according to O.C.G.A. §53-2-1. Provide the names of any deceased heirs and include the date of death for each. (See instructions for further clarification.) Also, state here all pertinent facts which may govern the method of giving notice to any party and which may determine whether or not a guardian ad litem should be appointed for any party. If any heirs listed above are cousins, grandchildren, nephews or nieces of the decedent, please indicate the deceased ancestor through whom they are related to the decedent. If any executor nominated in the will has an equal or higher priority to the propounder, but will not qualify, indicate the name and reasons.

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Petitioner

6. (initial one) To the knowledge of the petitioner(s), no other proceedings with respect to this estate are pending, or have been completed, in any other probate court in this state. The probate of another purported Will of the decedent is pending in this state, in the ________________County Probate Court. The names and address(es) of the propounder(s) and the names, addresses and ages or majority status of the beneficiaries under the other purported Will to whom notice is required under O.C.G.A. §53-5-22(b) are listed on the attachment hereto, which is expressly made a part hereof, as if fully set forth herein. WHEREFORE, petitioner(s) pray(s) 1. leave to prove said Will in solemn form, 2. that due and legal notice be given as the law requires, 3. that said Will be admitted to record on proper proof, 4. that Letters of Testamentary Guardianship and/or Letters of Testamentary Conservatorship issue, if applicable, 5. that Letters Testamentary issue, and 6. that this Court order such other relief as may be proper under the circumstances. ______________________________________ Signature of second petitioner if any ______________________________________ Printed Name ______________________________________ Address ______________________________________ ______________________________________ Telephone Number ______________________________________

Signature of first petitioner

Printed Name

Address

Telephone Number Signature of Attorney:

Typed/printed name of Attorney: Address:

______________________________________ ______________________________________ ______________________________________

Telephone:

State Bar # __________

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Petitioner

VERIFICATION GEORGIA, COUNTY

Personally appeared before me the undersigned petitioner(s) who on oath state(s) that the facts set forth in the foregoing petition are true. Sworn to and subscribed before me this day of

, 20

.

______________________________________ First Petitioner

______________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires ________________ -----------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed before me this day of

, 20

.

______________________________________ Second Petitioner, if any ______________________________________ Printed Name

NOTARY/CLERK OF PROBATE COURT My Commission Expires _________________

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GPCSF 5

Petitioner

ACKNOWLEDGMENT OF SERVICE AND ASSENT TO PROBATE INSTANTER GEORGIA, IN RE: PETITION OF THE WILL OF IN SOLEMN FORM COUNTY TO PROBATE , DECEASED,

We, the undersigned, being 18 years of age or older, laboring under no legal disability and being heirs of the above-named decedent, hereby acknowledge service of a copy of the petition to probate said Will in solemn form, purported Will, and notice, waive copies of same, waive further service and notice, and hereby assent to the probate of said Will in solemn form without further delay. SIGNATURE(S) OF HEIRS Sworn to and subscribed before me this day of , 20 . ______________________________________ ______________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires _______________ -----------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed before me this day of , 20 . ______________________________________ ______________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires ________________ ------------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed before me this day of , 20 . ______________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires _________________ ------------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed before me this day of , 20 . ______________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires________________ ---------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed before me this day of , 20 . ______________________________________ ______________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires__________________ ------------------------------------------------------------------------------------------------------------------------------Effective 7/09 GPCSF 5

Petitioner

TESTAMENTARY GUARDIAN AND/OR TESTAMENTARY CONSERVATOR CONSENT TO SERVE (To be completed only in the event a Testamentary Guardian/Conservator is named in the will) GEORGIA, IN RE: PETITION OF THE WILL OF IN SOLEMN FORM COUNTY TO PROBATE , DECEASED,

I/We, the undersigned, being 18 years of age or older, laboring under no legal disability and being named as Testamentary Guardian(s) and/or Testamentary Conservator(s), hereby consent to serve. I/We understand that once appointed, I/We will have the same rights, powers, and duties as set forth in O.C.G.A. §29-2-4 and 29-3-5. SIGNATURE Sworn to and subscribed before me this day of , 20 . ______________________________________

______________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires______________ -----------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed before me this day of , 20 . ______________________________________ ______________________________________ NOTARY/CLERK OF PROBATE COURT Printed Name My Commission Expires ________________ ------------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed before me this day of , 20 . ______________________________________ ______________________________________ Printed Name

NOTARY/CLERK OF PROBATE COURT My Commission Expires________________ ------------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed before me this day of , 20 . ______________________________________ ______________________________________ Printed Name

NOTARY/CLERK OF PROBATE COURT My Commission Expires________________

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GPCSF 5

Petitioner

GEORGIA PROBATE COURT STANDARD FORM

Petition to Probate Will in Solemn Form

NOTICE: THE FOLLOWING PAGES ARE TO BE COMPLETED BY THE PETITIONER (MOVING PARTY) UNLESS OTHERWISE DIRECTED BY THE COURT. SEE PROBATE COURT RULE 22 (A).

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Court

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GEORGIA PROBATE COURT STANDARD FORM

PROBATE COURT OF STATE OF GEORGIA

COUNTY

IN RE: ESTATE OF , DECEASED

) ) ) )

ESTATE NO. _____________________ PETITION TO PROBATE WILL IN SOLEMN FORM

ORDER FOR SERVICE OF NOTICE AND APPOINTMENT OF GUARDIAN AD LITEM, IF NECESSARY The foregoing Petition to Probate Will in Solemn Form having been filed, and it appearing that the following heirs did not acknowledge service, it is Ordered that: (Initial any and all which apply:) Notice must be served personally, together with a copy of the petition and the purported Will, at least ten days before the Will can be probated on the following heirs who reside in Georgia: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Notice must be served by registered or certified mail, return receipt requested, together with a copy of the petition and the purported Will, upon the following nonresident heirs whose current residence addresses are known: __________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Notice must be published once a week for four weeks in the newspaper in which sheriff's advertisements are published in this county, before , in order to serve by publication the following heirs whose current residence addresses are unknown: _____________________________________________________________________________________ _____________________________________________________________________________________ IT IS ORDERED that is appointed guardian ad litem for (minor)(unborn heir)(and the unknown heir), and that said guardian ad litem be duly served with a copy of the foregoing Notice, petition, purported Will and notice of this appointment, and that upon said guardian ad litem's acceptance of same, said guardian ad litem shall make answer hereto. This appointment is limited to this proceeding only and it shall cease when a final order is entered on this petition. SO ORDERED this day of , 20 .

____________________________________________ Probate Judge

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Court

-1-

NOTICE PROBATE COURT OF COUNTY RE: PETITION OF TO PROBATE IN SOLEMN FORM THE WILL OF , DECEASED, UPON WHICH AN ORDER FOR SERVICE WAS GRANTED BY THIS COURT ON , 20_______
(Strike the following paragraph if not applicable:)

TO:__________________________________________________________________________________
(List here all heirs having known addresses in the continental U.S. to be served by certified or registered mail)

This is to notify you to file objection, if there is any, to the above referenced petition, in this Court on or before the thirteenth (13th) day after , 20 (the date of the mailing of this Notice to you by certified or registered mail, return receipt requested); provided, however, that if a return receipt for such Notice is actually received by the Court within such 13 days, the deadline for the filing of any objection shall be ten (10) days from the date of receipt shown on such return receipt.
(Strike the following paragraph if not applicable:) TO:___________________________________________________________________________
(List here all heirs having known addresses outside the continental U.S. to be served by certified or registered mail)

This is to notify you to file objection, if there is any, to the above referenced petition, in this Court on or before the thirtieth (30th) day after , 20 (the date of the mailing of this Notice to you by certified or registered mail, return receipt requested); provided, however, that if a return receipt for such Notice is actually received by the Court within such 30 days, the deadline for the filing of any objection shall be ten (10) days from the date of receipt shown on such return receipt.
(Strike the following paragraph if not applicable:)

This is further to notify
(List here all heirs who reside in Georgia to be served personally)

,

who are required to be served personally, to file objection, if there is any, to the above referenced petition, in this Court on or before the tenth (10th) day after the date you are personally served. BE NOTIFIED FURTHER: All objections to the petition must be in writing, setting forth the grounds of any such objections. All pleadings/objections must be signed before a notary public or before a probate court clerk, and filing fees must be tendered with your pleadings/objections, unless you qualify to file as an indigent party. Contact probate court personnel at the following address/telephone number for the required amount of filing fees. If any objections are filed, a hearing will be (held on __________ _____________20 ) (scheduled at a later date). If no objections are filed, the petition may be granted without a hearing. ___________________________________ PROBATE JUDGE By: __________________________________ CLERK OF THE PROBATE COURT _____________________________________ ADDRESS ______________________________________ ______________________________________ TELEPHONE NUMBER

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Court

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NOTICE PROBATE COURT OF RE: COUNTY

PETITION OF TO PROBATE IN SOLEMN FORM THE WILL OF , DECEASED, UPON WHICH AN ORDER FOR SERVICE WAS GRANTED BY THIS COURT ON , 20
(For use if an heir is required to be served by publication:)

TO:__________________________________________________________________________________________
(List here known heirs having unknown addresses to be served by publication)

_____

all interested parties and all and singular the heirs of said decedent, and to whom it may concern: This is to notify you to file objection, if there is any, to the above referenced petition, in this Court on or before , 20 . BE NOTIFIED FURTHER: All objections to the petition must be in writing, setting forth the grounds of any such objections. All pleadings/objections must be signed before a notary public or before a probate court clerk, and filing fees must be tendered with your pleadings/objections, unless you qualify to file as an indigent party. Contact probate court personnel at the following address/telephone number for the required amount of filing fees. If any objections are filed, a hearing will be (held on _____________ _________________20 ) (scheduled at a later date). If no objections are filed, the petition may be granted without a hearing.

______________________________________ PROBATE JUDGE By: __________________________________ CLERK OF THE PROBATE COURT _____________________________________ ADDRESS _____________________________________ _____________________________________ TELEPHONE NUMBER

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Court

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PROBATE COURT OF STATE OF GEORGIA

COUNTY

IN RE: ESTATE OF , DECEASED

) ) ) )

ESTATE NO. _____________________ PETITION TO PROBATE WILL IN SOLEMN FORM

RETURN OF SHERIFF I have this day served _________________________________________________________ personally with a copy of the foregoing petition, purported Will and notice.

____________________________________________ Date Deputy Sheriff, County

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Court

-4-

CERTIFICATE OF MAILING This is to certify that I have this date forwarded by registered or certified mail, return receipt requested, in a stamped, addressed envelope, a copy of the foregoing petition, purported Will and the notice, to heirs who reside out of state at known current residence addresses. ____________________________________ PROBATE CLERK/DEPUTY CLERK

DATE

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Court

-5-

IN THE PROBATE COURT OF STATE OF GEORGIA IN RE: ESTATE OF ) ) , ) )

COUNTY

ESTATE NO. _____________________ PETITION TO PROBATE WILL IN SOLEMN FORM

DECEASED

ANSWER OF GUARDIAN AD LITEM I hereby accept the foregoing appointment, acknowledge service and notice of the proceedings as provided by law, and for answer say:

DATE

_____________________________________ GUARDIAN AD LITEM ____________________________________ ADDRESS

TELEPHONE_________________________

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Court

-6-

PROBATE COURT OF STATE OF GEORGIA

COUNTY

IN RE: ESTATE OF , DECEASED

) ) ) )

ESTATE NO. ____________________ PETITION TO PROBATE WILL IN SOLEMN FORM

ORDER It being shown to the Court in the matter of the alleged Last Will and Testament of the abovenamed decedent, propounded by _______________________________________________________ ______________, named as Executor(s), that the said decedent died domiciled in said County; and that due notice of the intention of said propounder(s) to proceed with the proof in solemn form has been served on all of the heirs of said decedent, all in accordance with the laws of this State, and all other requirements of law having been fulfilled, and the said Will having been (self-proved) (proved by one of the witnesses) thereto to be the Last Will and Testament of said decedent as alleged by the propounder(s); and no objection having been filed; IT IS ORDERED by this Court, that said Will be established as the Last Will and Testament of said decedent; that the same be admitted to record, as proved in solemn form; and that said Executor(s) have leave to qualify as such by taking the required oath, and upon so doing, that Letters Testamentary issue to said Executor(s). IT IS FURTHER ORDERED that said Executor(s) shall disburse all property according to the terms of the Will and shall maintain all records of income and disbursements until they are discharged. IT IS FURTHER ORDERED that the clerk/deputy clerk shall serve the Executor(s) with a copy of this Order by first class mail and shall file a certificate of service showing such service. (initial if applicable) IT IS FURTHER ORDERED that Letters of Testamentary Guardianship and/or Conservatorship shall issue to the individuals so designated in said Will.

SO ORDERED this

day of

, 20

.

____________________________________________ Probate Judge

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Court

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PROBATE COURT OF STATE OF GEORGIA

COUNTY

IN RE: ESTATE OF , DECEASED

) ) ) ) OATH

ESTATE NO. ____________________ PETITION TO PROBATE WILL IN SOLEMN FORM

I do solemnly swear (or affirm) that this writing now being presented to this Court is the true Last Will and Testament of , deceased, so far as I know or believe, and that I will well and truly execute the same in accordance with the laws of Georgia. So help me God.

Sworn to and subscribed before me this day of

, 20

.

____________________________________ Executor ____________________________________ Printed Name

CLERK OF PROBATE COURT

-----------------------------------------------------------------------------------------------------------------------------Sworn to and subscribed before me this day of

, 20

.

___________________________________ Executor ____________________________________ Printed Name

CLERK OF PROBATE COURT

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Court

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STATE OF GEORGIA COUNTY OF LETTERS TESTAMENTARY (Relieved of Filing Returns) By KNOW ALL WHOM IT MAY CONCERN: That on the day of , 20 , at a regular term of the , , of , Judge of the Probate Court of said County. ESTATE NO. ______________

Probate Court, the Last Will and Testament dated

__________________________________________________________________deceased, at the time of his or her death a resident of said County, was legally proven in_____________________ form and was admitted to record by order, and it was further ordered that _____________________________________ __________________________________named as Executor(s) in said Will, be allowed to qualify, and that upon so doing, Letters Testamentary be issued to such Executor(s). NOW, THEREFORE, the said ,

having taken the oath of office and complied with all the necessary prerequisites of the law, is/are legally authorized to discharge all the duties and exercise all the powers of Executor(s) under the Will of said deceased, according to the Will and the law. Given under my hand and official seal, the day of , 20 .

_____________________________________ Probate Judge
NOTE: The following must be signed if the judge does not sign the original of this document:

Issued by:

(Seal)

____________________________________________ PROBATE CLERK/DEPUTY CLERK

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Court

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STATE OF GEORGIA COUNTY OF ESTATE NO. ___________________ LETTERS TESTAMENTARY (Not Relieved of Filing Return) By , Judge of the Probate Court of said County.

KNOW ALL WHOM IT MAY CONCERN: That on the day of , 20 , at a regular term of the Probate , , of

Court, the Last Will and Testament dated

_____________________________________________________________________, deceased, at the time of his or her death a resident of said County, was legally proven in_______________form and was admitted to record by order, and it was further ordered that ___________________________________ ___________________, named as Executor(s) in said Will, be allowed to qualify, and that upon so doing, Letters Testamentary be issued to such Executor(s). NOW, THEREFORE, the said ____________________________________________________ having taken the oath of office and complied with all the necessary prerequisites of the law, is/are legally authorized to discharge all the duties and exercise all the powers of Executor(s) under the Will of said deceased, according to the Will and the law; and is/are hereby required to render a true and correct inventory of all the goods, chattels, rights and credits of said deceased, and make a return of them to this Court; and further, to file a proper annual or final return with this Court each year until the Executorship is fully discharged. Given under my hand and official seal, the day of ,20 .

______________________________________ Probate Judge
NOTE: The following must be signed if the judge does not sign the original of this document:

Issued by:

(Seal) PROBATE CLERK/DEPUTY CLERK

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Court

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STATE OF GEORGIA COUNTY OF ESTATE NO. _________________ LETTERS OF TESTAMENTARY GUARDIANSHIP OF MINOR From the Judge of the Probate Court of said County. TO: RE: , Testamentary Guardian(s) , Minor

Pursuant to the Last Will and Testament of , deceased, you have been appointed Testamentary Guardian of the minor. You have assented to this appointment by taking your oath. In general, your duties as Testamentary Guardian are to protect and maintain the person of the minor and your power over the minor shall be the same as that of a parent over a child, the guardian(s) standing in place of the parent(s). A guardian shall at all times act as a fiduciary in the minor's best interest and exercise reasonable care, diligence, and prudence. Special Instructions: 1. 2. 3. 4. It is your duty to see that the minor is adequately fed, clothed, sheltered, educated, and cared for, and that the minor receives all necessary medical attention. You must keep the Court informed of any change in your name or address. You should inform the Court of any change of location of your minor. You shall, within 60 days of appointment and within 60 days after each anniversary date of appointment, file with this Court and provide to the conservator of the minor, if any, a personal status report concerning the minor. You shall promptly notify the court of any conflict of interest which may arise between you as guardian and the minor pursuant to O.C.G.A. §29-2-23. The guardianship automatically terminates when the minor dies, reaches age 18, is adopted, or is emancipated. You shall act in coordination and cooperation with the minor's conservator, if appointed, or if not, with others who have custody of the minor's property. Please consult your attorney if you have any questions. Your authority to act pursuant to these Letters is subject to applicable statutes and to any special orders entered in this case. day of , 20 .

5. 6. 7. 8.

Given under my hand and official seal, this

Probate Judge NOTE: The following must be signed if the judge does not sign the original of this document:

Issued by:

PROBATE CLERK/DEPUTY CLERK

(Seal)

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Court

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STATE OF GEORGIA COUNTY OF ESTATE NO. _________________

LETTERS OF TESTAMENTARY CONSERVATORSHIP OF MINOR (To be completed only in the event a Testamentary Guardian/Conservator is named in the will)

From the Judge of the Probate Court of said County. TO: RE: , Testamentary Conservator(s) , Minor

Pursuant to the Last Will and Testament of the below-named decedent, you have been appointed Testamentary Conservator of the minor's property. You have assented to this appointment by taking your oath. In general, your duties as Testamentary Conservator are to protect and maintain the property of the minor and utilize the minor's property solely for the benefit of the minor. Please consult your attorney if you have any questions. These Letters of Testamentary Conservatorship empower the above testamentary conservator to hold, for the minor, only property which passed through the estate of , Deceased.

Given under my hand and official seal, this

day of

, 20

.

______________________________ Probate Judge

Note:

The following must be signed if the judge does not sign the original of this document:

Issued by:

(Seal) PROBATE CLERK/DEPUTY CLERK

Effective 7/09

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Court

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