Fill and Sign the State of Michigan Probate Court County of Pc Form

1. I,, make this petition as . 2. Decedent died intestate on , a resident of in this county. 3. The property of the decedent at the date of his/her death had an estimated total value of $ . 4. The names, relationships, and addresses of the heirs of the decedent are set forth below: (Attach a separate sheet if necessary.) 5. Of the above heirs, none is under legal disability or otherwise represented, except as follows: 6. No other proceedings have been instituted in this or any other court to administer the estate of the decedent, and it is not necessary that a personal representative be appointed. I REQUEST that the court determine and adjudge: 7. a) the date of death of the decedent; b) the domicile of the decedent at the time of death; c) that the decedent died intest ate; d) the heirs of the decedent; e) the inheritance tax due, if any. I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief. STATE OF MICHIGAN PROBATE COURTCOUNTY OF PC 553 (9/14) PETITION TO DETERMINE HEIRS, Separate Proceedings Estate of Do not write below this line - For court use only FILE NO. JIS CODE: DTO Approved, SCAO PETITION TO DETERMINE HEIRSSeparate Proceedings Name State your interest/relationship Telephone no. Attorney signature Bar no. Address City, state, zip Name (type or print) Date Petitioner signature Address City, state, zip Telephone no. MCL 700.1302(a)(v), MCL 700.3106, MCR 5.308(B)(2) Date City, township, or village NAMEADDRESS RELATIONSHIP (if minor) AGE/DOB State Street address City Zip State Street address City Zip State Street address City Zip