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PR-1963 , 10/10 Petition for Transfer of Residue (Ancillary Administration) §868.03, W isconsin Statutes This form shall not be modified. It may be supplemented with additional mate rial. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Amended Petition for Transfer of Residue (Ancillary Administration) Case No. UNDER OATH, I STATE: 1. I was issued ancillary letters. 2. The following is an inventory and an account of the decedent’s property in Wisconsin from [Date] to [Date of death or Date of prior account] . See attached Inventory Value at Date of Death $ See attached Additional Items Received Amount $ See attached Items Disbursed Amount $ 3. All claims allowed in Wisconsin were paid. 4. All taxes and charges levied or incurred in Wisconsin were paid. 5. The following assets remain for transfer to the representative in the domiciliary jurisdiction : See attached Assets Remaining to be Transferred Amount $ 6. Other: Petition for Transfer of Residue (Ancillary Administration) Page 2 of 2 Case No. PR-1963, 10/10 Petition for Transfer of Residue (Ancillary Administration ) §868.03, W isconsin Statutes This form shall not be modified. It may be supplemented with additional mater ial. Page 2 of 2 I REQUEST THE COURT: 1. Allow the account. 2. Authorize the transfer of any movable assets on hand to the representative in the domiciliary jurisdiction. as follows: 3. Terminate ancillary letters and cancel any bond in W isconsin. 4. Other: State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: ► Local Representative Name Printed or Typed Address Telephone Number Date Form completed by: (Name) Address Telephone Number Bar Number