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Estate of ***USE THIS FORM ONLY IF A DEVISEE NAMED IN THE WILL OR CODICIL IS NOT AN HEIR OF THE TESTATOR*** NOTE: TREAT ALL PERSONS WHO DIED WITHIN 120 HOURS AFTER THE DECEDENT AS IF THEY DID NOT SURVIVE THE DECEDENT. List persons who died within 120 hours after the decedent in item 18 b\ elow. 16. The names of all devisees named in the will and codicils who are not hei\ rs of the decedent (include testamentary trustees and beneficiaries of testamentary trusts) are . 17. Of the devisees listed in 16, the following died before the decedent. Their names and relationships to the decedent are . 18. The following devisees died within 120 hours after the decedent. Their names, relationships to decedent, and the date and time of their deaths are: NAME RELATIONSHIP DATE OF DEATH TIME OF DEATH 19. The following are descendants of the predeceased devisees named above, w\ ho survived the decedent: . 20. Class gifts in the will or codicils, where the members are not specifica\ lly identified by name, are as follows: . Do not write below this line - For court use only PC 566 (12/18) SUPPLEMENTAL TESTIMONY TO IDENTIFY NONHEIR DEVISEES, Testate Estate MCL 700.2702, MCL 700.2707-700.2710, MCR 5.302 Approved, SCAO JIS CODE: TSS STATE OF MICHIGAN PROBATE COURT COUNTY OF SUPPLEMENTAL TESTIMONY TO IDENTIFY NONHEIR DEVISEES Testate Estate FILE NO. (SEE SECOND PAGE) Signature Subscribed and sworn to before me on Date , County, Michigan. My commission expires: Date Signature: Judge/Deputy register/Notary public Notary public, State of Michigan, County of Attorney signature Name (type or print) \ Bar no. Address City, state, zip \ Telephone no. 21. The following devisees named above are under legal disability. Their names, legal disabilities, and names of their representative(s) are . 22. The following deceased devisees survived the decedent by more than 120 hours. Their names and the names of those who represent their interests are . 23. The guardian ad litem for each devisee under the will and codicils who i\ s unborn, unknown, or unascertainable is .