Fill and Sign the Summary Administration Form

Name:_________________________________________________Address:_______________________________________________City, State. Zip:_________________________________________Telephone:_____________________________________________State Bar Code:_________________________________________Client:_________________________________________________ IN THE SUPERIOR COURT OF THE STATE OF ARIZONA In and for the County of ___________________ ___________________________________________IN THE MATTER OF THE ESTATE OF : CASE NO. CLOSING STATEMENT OF PERSONAL REPRESENTATIVE ( Summary Administration ) Deceased._________________________________________________________________________________PB19IN1. I am the Personal Representative of this Estate. I file this verified Statement for the purpose of closing this estate pursuant to ARS 14-3974.2. This Estate is not being administered by supervised personal representatives, and the closing of this Estate is not prohibited by Court Order.3. To the best of my knowledge, the value of this entire estate, less liens and encumbrances, did not exceed the allowance in lieu of homestead, exempt property, family allowance, cost and expenses of administration, reasonable funeral expenses and reasonable necessary medical and hospital expenses of the last illness of the decedent.4. I have fully administered this estate by disbursing and distributing it to the persons entitled thereto.5. I have sent a copy of this Statement to all the distributees of this estate and to all creditors or other claimants of whom I am aware whose claims are neither paid nor barred.6. I have furnished a full account in writing of the administration of this estate to the distributees whose interests are affected. I have read the foregoing Statement and know of my own knowledge that the facts stated therein are true and correct. STATE OF ARIZONA ) )ss ____________________________________ County of _____________) Signature of SUBSCRIBED AND SWORN BEFORE ME THIS DATE : __________________Notary Public_______________________________________________ ( seal )