Fill and Sign the Summary Assignment Affidavit Wisconsin Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF THE ESTATE OF             Amended Affidavit of Additional Property and/or Creditor for Summary Assignment (Formal Administration) for Summary Assignment Case No.       FILE ONLY TO REPORT ADDITIONAL information NOT INCLUDED IN THE PETITION. UNDER OATH, I STATE: 1. The property subject to administration, including any encumbrance, lien, or other charge against each item, and not previously included in the petition for summary assignment is as follows: See attached Description of Property (Include real estate, stocks or bonds, licensed motor vehicles and all other property) Value of Decedent’s Interest at Date of Death A. Total value of property subject to administration       $       B. Minus total value of encumbrances, liens or other charges against each item of property       ($       ) C. Net value of property subject to administration $      TOTAL (Value from Section A less total from Section B) 2. The name and mailing address of any additional creditor of the decedent or the decedent’s estate and the amount of the claim not previously included in the petition, is as follows: See attached Name of Creditor Mailing Address Claim Amount             $       State of       County of       Subscribed and sworn to before me on       Notary Public/Court Official       Name Printed or Typed My commission/term expires:        Petitioner       Name Printed or Typed       Address       PR-1841 , 10/10 Affidavit of Additional Property and/or Creditor for Summary Assignment (Formal Administration) §867.02, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Affidavit of Additional Property and/or Creditor for Summary Assignment Page 2 of 2 Case No. Form completed by: (Name)             Telephone Number Address             Date Telephone Number       Bar Number       PR-1841 , 10/10 Affidavit of Additional Property and/or Creditor for Summary Assignment §867.02, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2