Fill and Sign the Short Form Settlement

Office of the ducicuy S pire suro County Co mmissi o n P.O. Box , West Virginia - - D a te: Dear Personal Repres e nt a tive: RE: Estate of : The deadline for claims to be fled a gain s t the E state has e x pired and no claims h a ve been received in this ofce. As Fiducia r y of this Es t ate y ou m a y now pro c eed to w ard closing t h e Estate by c o mpl e ti n g the e n c los e d SHO R T F O R M SETTLEMENT report. Either TYPE or PRINT LEGIBLY IN INK the in f ormation r e que s ted. Please read the fol l owing inst r uct i ons careful l y in order to under s tand how to c o mpl e te t he f orms. Lines 1-5 ar e self-expl a natory. #2 – You will only receive a release if your e s t a te value is over $1,000, 0 00. (6) Line 6 – If distribution is being m a de by a Will, write only these w or d s; “According to the p r ovisions of the Will of Re c ord” If the dece d ent died without a W ill, pro p erty must be distributed as follows: Surviving s p ouse, no c hildren OR Surviving Spouse and c hildren OR 100% to surviving spouse Spouse and decedent only Surviving spouse with children outside 60% to s ur v iving spou s e marriage and children with d ece d ent 40% to d escendents of decedent Surviving s p ouse and c hildren of d ecedent 50% to s ur v iving spou s e not with surviving spouse 50% to d escendents of decedent (7) Line 7a – self-explanatory Line 7b – if you w ill no t be distri b uting according to line 6, explain how distribution is to be m a de. If a benefciary is t a king personal property because they have paid debts or cl a ims from personal fun d s, then st a te such under 7b as “distribution being made in lieu of cash for advancements to the estate b y (n a m e of person).” (8) The P e rso n al Re p res e ntative (al s o called Fi d uciary, Exe c utor, Administr a tor, etc.) must sign the settlement report and have their signature acknowledged before a Notary Pu b lic. THE NOTARY MUST USE THEIR SE A L FOR EV E RY SIGNAT U R E . (9) WAIVER A ND A PPLICATI O N F OR SHORT FO R M SETTLEM E NT must be signed by each beneficiary (includ i ng t h e person a l r epresentative if that person is a benefciary) and each signature must be acknowledged before a N ot a r y . If there is only one b e nefci a ry, ( s )he must sign the w a iver. If another person is signing as power of attorney for a benefciary, a certifed copy of the power of attorney mu s t be included w i th the Sh o rt Fo r m a nd Waiver. Ma ke sure the Not a ry us e s their seal for each and every signat u re. After c o mp l eti n g ea c h o f the s teps o utlined a b ove, please do the follo w ing: 1. Retu r n t he Sh o rt F o r m and Waiv e r to this o f c e – one original plus two copies 2. Enclose a c heck made payable to the County Fiduciary F u nd in the amount of $ 21.00 for the frst f our pages of the original. For any additional p a ges you must conta c t our ofce for the corre c t fee. Any forms received w i th the incorre c t filing fee are subject to b e returned for the c orr e ct amount - or if notari z ed i ncorrec t ly. (Make sure the notary uses th e ir s eal/st a mp f or eve r y sign a tur e . If you are u nable to obtain all the beneficiaries’ signature s , or there are any outstanding debts or claims, you must use our LONG F O RM SETT L EMENT , w hich r equi r es a full accou n ti n g of t he est a te and pr o of of pa y m e n t of debts/claims. If a L ong Form is needed, please notify our ofce and we w i ll send t h e f o rm to you. Th a nk Y ou, Ofce of the Fiduciary Supervisor Enclosure P.S. All as s ets EXCE P T REAL E S TATE mu s t be tr a nsferred from the n a me of the deced e nt to the benefciariess prior to the Estate closing. In the C o un ty C o mmis s ion of County, West Virginia In the M a tter of , Social Security # , deceased SHO R T FO RM S E TT L EMENT STATE OF WEST VI R GINIA COUNTY OF , to- w it _, being frst duly sworn, deposes and says that: (1) I am the duly appointed and acting per s onal representative of the estate of , deceased. (2) A “Releas e ” for the W est Virginia Inheritance and Transfer ta x es has been fled with the C lerk of the C ounty Comm i ssion of County, WV. (3) More than ninety (90) days have elapsed sin c e the fl i ng of n o tice r e qu i red by WVC 44-3A-4, (newspaper publication for claims in an est a te). (4) The t i me fo r fl i ng cl ai ms ag a inst t his est a te h as expired. (5) No known and unpaid claims exi s t ag a inst this estate. (6) The a lloc a t i on to which each distribute and benefciary is entitled in the distribution of this est a te is as follows: Cross out Section that d oes not apply and initial (7a) All property to which each distribute is entitled has been or, upon approval of this settlement, will be delivered to said distribute and benefciary in conformity with the above allocation. (7b) although, each dis t ributee and benefciary is entitled to the above distribution, each distribute and be n efciary has agreed to a diferent allocation, as follows: Signature of the Fiduciary Taken, subscribed and s worn to before the und e rsigned authority by , in the county aforesaid t h is d a y of , 2 0 . My commission e x pires, _. Nota r y Public In the C ounty Commis s ion of C o unty, West Virginia In the Matter of , Social Security # deceased WAIVER A N D A PPLICATI O N F OR SHORT FO R M SETTLEM E N T Pursu a nt to the requirements set forth in Section 4, Artic l e 3A, Chapter 44, of the West Virginia Code as amended, we, the distri b ut e s and benefciaries of the above- referenced estate, hereby m a ke a p plication fo r t h e accep t ance of t h e atta c hed s h ort f o r m se t tl e me n t of this estate, there b y waiving a ny an d all rights we m a y h a ve to inspect, approve, afrm, or obcect to a c ompl e te an d compr e h e nsive stat e m ent of settlem e nt of t h is estate as ot h erwise set forth in Article 3A, Chapter 44 of the We s t Virginia Code as amended. Signature o f Benef c ia r y Signature o f Benef c ia r y Signature o f Benef c ia r y Signature o f Benef c ia r y Signature o f Benef c ia r y Signature o f Benef c ia r y St a te of County of , to-wit: The f or e go i ng W a iver and Appli c ati o n f o r Sh ort Fo r m S e ttl e m e nt w a s ackno w l e dged bef o re me this day of , 20 , b y (Name of Benefciary). My Co mmission expires, . (Notary Public) St a te of County of , to-wit: The f or e go i ng W a iver and Appli c ati o n f o r Sh ort Fo r m S e ttl e m e nt w a s ackno w l e dged bef o re me this day of , 20 , b y (N a m e of B enefciary). My Co mmission expires, . (Notary Public) St a te of County of , to-wit: The f or e go i ng W a iver and Appli c ati o n f o r Sh ort Fo r m S e ttl e m e nt w a s ackno w l e dged bef o re me this day of _, 20 , b y (N a m e of Benefci a ry). My Co mmission expires, . (Notary Pu b lic) St a te of County of , to-wit: The f or e go i ng W a iver and Appli c ati o n f o r Sh ort Fo r m S e ttl e m e nt w a s ackno w l e dged bef o re me this day of , 20 , b y (N a m e of B enefciary). My Co mmission expires, _. (Notary Pu b lic) St a te of County of , to-wit: The f or e go i ng W a iver and Appli c ati o n f o r Sh ort Fo r m S e ttl e m e nt w a s ackno w l e dged bef o re me this day of , 20 , b y (N a m e of B enefciary). My Co mmission expires, . (Notary Public) St a te of County of , to-wit: The f or e go i ng W a iver and Appli c ati o n f o r Sh ort Fo r m S e ttl e m e nt w a s ackno w l e dged bef o re me this day of , 20 , b y (N a m e of B enefciary). My Co mmission expires, (Notary Pu b lic)