Fill and Sign the Kentucky Summary Administration Petition for Small Estates Form

lexet justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE Case No. ____________________ Court ____________________ County ____________________ Division ____________________ District/Probate AOC-830 Doc. Code: PDA & ODA Rev. 12-16 Page 1 of 2 Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 391.030; 394.145; 395.455; 396.095 P etition /order to d isPense W ith AdministrAtion (Surviving Spouse/Children/Preferred Creditor) IN RE: Estate of _______________________________________________________________________ Address: ________________________________________ Date of Death: _____________________________ ________________________________________ ________________________________________ Date of Birth: _____________________________ Social Security Number: ____________________________ PETITION Comes the Petitioner, being �rst duly sworn, and states as follows: 1. Decedent died [ ] testate [ ] intestate with residence at the above listed address and on the above date. 2. At the time of death, decedent left no estate to be administered with the exception of the following assets ( include value for each asset listed ): _____________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 3. In relation to the above named decedent, I am the (check all that apply) [ ] surviving spouse [ ] only surviving child [ ] surviving child whose surviving siblings have signed a waiver herein or attached a waiver [ ] preferred creditor [ ] preferred creditor of the decedent whose surviving spouse has signed a waiver herein or attached a waiver [ ] assignee of the preferred creditor. 4. [ ] (check if applicable) Petitioner applies for Probate of Decedent's W ill, �led herewith, which is his/her Last Will and Testament. 5. As a preferred creditor/assignee of decedent, I have paid the following claim(s) against the estate in the following order Claim Payee Amount a. Cost and Expenses of Administration __________________________________ ____________ b. Funeral expenses __________________________________ ____________ c. Debts and taxes with preference under federal and Kentucky Law __________________________________ ____________ d. Other __________________________________ ____________ 6. I certify that there has been no previous administration of decedent's estate within Kentucky or elsewhere. (Name of Decedent) (attach receipts): Subscribed and sworn before me by petitioner on _________________________________, 2_______. My commission expires _____________________. ______________________________________ _______________ Name/Title Because the exemption given to the above surviving spouse/child(ren) and/or claim(s) of the above preferred creditor/ assignee equals or exceeds the value of the above estate asset(s), I ask this Court to dispense with the administration of the above estate and to transfer the above personal property to me or my designee, ________________________________. ____________________________________ _______ _____________________________________________ Name of Surviving Spouse Waiving Preference Age Signature of Surviving Spouse Waiving Preference(Please Print) (If Petitioner is not Decedent’s Spouse) Address/P.O. Box Address: _________________________________________________________________________ _______________________________________________________________________________________________ _____________________________________________ ____________________________________________ Signature of Surviving Child Waiving Preference Signature of Surviving Child Waiving Preference __________________________________________ Petitioner’s Signature Address: _______________________________________________________________________________________ _______________________________________________________________________________________________Phone Number: __________________________________ ORDER [ ] Upon hearing, the Will offered was proven by ______________________________ and ORDERED PROBATED as the Last Will and Testament of Decedent this _________ day of __________________________________, 2________. The Will shall be probated only and no letters of administration shall be issued. Upon veri�ed petition of the above pet itioner, IT IS HEREBY ORDERED that the petition be granted to dispense with the administration of the estate of the above decedent, and the above personal property is transferred to petitioner or his/her designee, _____________________________________________________________________________. ________________________________, 2_______ ____________________________________________ Date Judge’s Signature AOC-830 Rev. 12-16Page 2 of 2 CERTIFICATE I certify that this petition and order were prepared in accordance with CR 11. ___________________________________________ _____________________________________________ Attorney for Petitioner Address and Phone Number Distribution: Court File Petitioner