Fill and Sign the Other Proceedings Concerning the Estate of the Decedent Form

PR-1801, 02/18 Application for Informal Administration §§851.21, 856.09, 865.06 and 879.01, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Name Amended Application for Informal Administration Case No. UNDER OATH, I STATE : 1. The decedent, with date of birth and date of death , was domiciled in County, State of , with a mailing address of . 2. I am interested as . 3. Other proceedings concerning the estate of the decedent are are not pending in this state or elsewhere. Explain: . 4. The estimated net value of decedent's property requiring administration is $ . 5. The decedent did did not receive Medical A ssistance /Medicaid . did did not receive Family Ca re and/or Partnership benefits (through a Managed Care Organization – MCO/ CMO ). did did not receive benefits from the Community Options Program (COP). did did not receive benefits from Wisconsin Chronic Disease Program. was was not a patient or inmate of a state or county hospital or institution, or responsible for any person owi ng an obligation to the state or county. Explain: I lack information to complete this section. 6. If the decedent was ever married, complete the following: (If more than on e spouse See attached .) Name of spouse ( living or deceased) . Married to decedent Divorced from decedent at time of decedent’s death. The spouse did did not receive benefits from the Community Options Program (COP). The spouse did did not receive benefits from the Wisconsin Chronic Disease Program. I lack information to complete this section. (Complete question 7 OR 8 below, whichever is applicable.) 7. The decedent died leaving a will, dated . codicil(s) (If any) , dated . I believe these documents were executed properly and are valid . I made diligent inquiry and am unaware of any revocation by decedent . The original will, including any codicil(s), is in the possession of the court. accompanies this application. was probated elsewhere and an authenticated copy accompanies this application. is en route to the court by mail or personal delivery (for eFilers only) . The personal representative(s) named by the decedent in the will and/or any codicil is : Name (s) I nominate to serve as personal representative (s). The trustee(s) named by the decedent in the will and/ or codicil is: Name (s) I nominate to serve as trustee (s) . Application for Informal Administration Page 2 of 2 Case No. PR-1801 , 02/18 Application for Informal Administration §§851.21, 856.09, 865.06 and 879.01, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 8. I made diligent inquiry and am unaware of any unrevoked will of the decedent and believe that the decedent died leaving no will. I nominate to serve as personal representative (s) . 9. The names and mailing addresses of all interested persons are: (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.) See attached Name Relationship [e.g. Heir, Beneficiary, Fiduciary] Mailing Address [Street, City, State, Zip] If Minor, Date of Birth 10. Other: I REQUEST : 1. A statement of informal administration be issued. 2. The will, including any codicil(s), be admitted to informal administration. 3. Domiciliary l etters be issued to 4. Lett ers of tru st be issued to for the following trust: Letters of t rust be issued to for the following trust: 5. Other: State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: ► Applicant Name Printed or Typed Address Telephone Number Date Form completed by: (Name) Address Telephone Bar Number (if any)