Fill and Sign the Closing Statement of Form

Name:_________________________________________________ Address:_______________________________________________ City, State. Zip:_________________________________________ Telephone:_____________________________________________ State Bar Code:_________________________________________ Client:_________________________________________________ IN THE SUPERIOR COURT OF T HE STATE OF ARIZONA In and for the County of ___________________ ___________________________________________ IN THE MATTER OF THE ESTATE OF : CASE NO. ____________________________________, CLOSING STATEMENT OF PERSONAL REPRESENTATIVE Deceased. __________________________________________________________________________________PB10INT 1. On _____________________________ , more than four months ago, I or my predecessor was appointed Personal Representative of this Estate. I file this verified Sta tement for the purpose of closing this Estate pursuant to ARS 9 14-3933. 2. This Estate is not being administered in supervised administ ration, and closing of this Estate is not prohibited by Court Order. 3. I have, or a prior personal representative whom I have succeeded has: a. Published Notice to Creditors as provided by ARS 14-3801. The first publicati on of this Notice occurred more than four months prior to the date of this Statement. b. Fully administered this estate by making payment, settlement or other disposition of all claims which were presented, expenses of administration, and estate, inheritance and other death taxes, excep t: c. Distributed the assets of this estate to the persons entitled thereto: d. In regard to any claims that remain undischarged, [ ] Distributed the estate subject to possible liability with the agreement of the distribute es, [ ] Made other arrangements, detailed as follows, to accommodate outstanding liabilities: e. Sent a copy of this Statement to all distributees of this esta te and to all creditors or other claimants of whom I am aware whose claims are neither paid nor barred. f. Furnished a full account in writing of the administration of this estate to the distributees those interests are affected thereby, including guardians ad litem appointed pursuant to ARS 14-1403 (4), conservators and guardians. I have read the foregoing document and know of my own knowledge that the fact s stated therein are true and correct. STATE OF ARIZONA ) )ss _____________________________________ County of ______________ ) Signature of SUBSCRIBED AND SWORN before me this date:_______________________ Notary Public __________________________________________ ( seal )