Fill and Sign the Account Informal

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF THE ESTATE OF             Amended Interim Final Supplemental Estate Account Informal Administration Formal Administration Case No.       UNDER OATH I VERIFY: I am the personal representative special administrator of this estate and this estate account is true and correct. The following is my account of the administration of this estate from (Date of Death or Date of prior account)       to (Date)       . List interested persons on page 2. RECEIPTS TOTAL DISBURSEMENTS TOTAL Net Value of property, subject to administration from Inventory (or assets on hand as of last account) $ Funeral Expenses Schedule (F) $ Added Property to which the decedent was entitled to on Date of Death not included in Inventory or Prior Account Schedule (A)       Debts of Decedent (G)       Dividends (B)       Claims (including those by judgment) (H)       Interest (C)       Taxes Paid (I)       Capital Gains (Losses) (D)       Interest Paid (J)       Other Receipts (E)       Administration Expenses (K)       Other Payments (L)       Distributions Paid to Date (M)       TOTAL DISBURSEMENTS $ Assets on Hand (N) $ TOTAL $ TOTAL $ Totals in each column must be the same. Proposed distribution of Assets on Hand (Schedule O) $       Total Fees Paid during Administration: $       $      Personal Representative Guardian Ad Litem Special Administrator $       Attorney $       State of       County of       Subscribed and sworn to before me on       Notary Public/Court Official       Name Printed or Typed My commission/term expires:       ► Personal Representative/Special Administrator       Name Printed or Typed       Address             Telephone Number       Date PR-1814 , 11/12 Estate Account (Informal Administration and Formal Administration) §§862.01, 862.05, 862.07, 862.11 and 865.16(1)(c), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 Estate Account (Informal Administration and Formal Administration) Page 2 of 3 Case No. State of       County of       Subscribed and sworn to before me on       Notary Public/Court Official       Name Printed or Typed My commission/term expires:       ► Personal Representative/Special Administrator       Name Printed or Typed       Address             Telephone Number       Date Form completed by: (Name)       Telephone Number       Bar Number (If any)       Address       ESTATE ACCOUNT SUPPORTING SCHEDULE List of Interested Persons The names and mailing addresses of all interested persons are as follows: (For any person with disabilities, also list any guardian of estate; for any person in the military, also list attorney or attorney in fact; and for any minor, list date of birth.) Name Mailing Address If Minor, Date of Birth                   PR-1814 , 11/12 Estate Account (Informal Administration and Formal Administration) §§862.01, 862.05, 862.07, 862.11 and 865.16(1)(c), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 Estate Account (Informal Administration and Formal Administration) Page 3 of 3 Case No. Schedule (A - O) Estate Account Supporting Schedules (List details of each schedule) Amount             $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $                   $       PR-1814 , 11/12 Estate Account (Informal Administration and Formal Administration) §§862.01, 862.05, 862.07, 862.11 and 865.16(1)(c), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3