Sworn Statement of Personal Representative to Close

Sworn Closing Statement of Personal Representative

IN THE MATTER OF THE ESTATE OF :

CASE NO.

SWORN CLOSING STATEMENT OF PERSONAL REPRESENTATIVE

COMES NOW, , as the personal representative of the decedent,

and files this Sworn Statement for the purpose of closing this estate, and would attest to the following:

1. To the best of my knowledge, the value of the entire estate, less liens and encumbrances, did not exceed homestead allowance, exempt property, family allowance, costs and expenses of administration, reasonable funeral expenses, and reasonable, necessary medical and hospital expenses of the last illness of the decedent;

2. I have fully administered this estate by disbursing and distributing it to the persons entitled thereto.

3. I have sent a copy of this Closing Statement to all the distributees of this estate and to all creditors or other claimants of whom I am aware whose claims are neither paid nor barred and have furnished a full account in writing of the administration to the distributees whose interests are affected.

I have read the foregoing Statement and know of my own knowledge that the facts stated therein are true and correct.

Acknowledgment of Individual

STATE OF MAINE

COUNTY OF

The foregoing instrument was acknowledged before me this (date) by (name of person acknowledged).

My Commission Expires: