Fill and Sign the This Decedent Died on or Aboutat the Age of Form

Name:_________________________________________________ Address:_______________________________________________ City, State. Zip:_________________________________________ Telephone:_____________________________________________ State Bar Code:_________________________________________ Client:_________________________________________________ IN THE SUPERIOR COURT OF T HE STATE OF ARIZONA In and for the County of ___________________ ___________________________________________ IN THE MATTER OF THE ESTATE OF: CASE NO. APPLICATION FOR INFORMAL _____________________________________ APPOINTMENT OF SPECIAL Deceased. ADMINISTRATOR _________ ___________________________________________________________________________PB43 1. This decedent died on or about_______________________at the age of_________. At the time of death the decedent was domiciled in___________________County, State of _________ _____. 2. The surviving spouse, children, devisees and heirs of decedent are [ ] listed below; [ ] listed on an accompanying exhibit. (State names, addresses and relationships. State ages of minors.) 3. Venue for this proceeding is in this county because: [ ] Decedent was domiciled in this county at time of death. [ ] Decedent owned property in this county. 4. The details of any demand for notice Applicant has received or of any demand for notice of any probate or appointment proceeding concerning the decedent that has been filed in this state or elsewhere that Applicant is aware of are: 5. No general Personal Representative is presently qualified and acting for the estate. 6. It is nece ssary that a Special Administrator be appointed to protect this estate pending the appointment of a general personal representative because: 7. _____________________________, whose address is_________________________________, is qualified to act as Spe cial Administrator under ARS 14 -3614 because: 8. Applicant has the following interest in the estate: 9. Applicant's name and address is as follows: 10. The time limit for informal probate or appointment as provided in ARS 14 -3108 has not expire d because: [ ] Three years have not passed since decedent's death. [ ] More than three years have passed since decedent's death, but the following circumstances authorize informal probate or appointment proceedings: 11. [ ] Bond is not required of the Special Administrator because: [ ] Bond is required of the Special Administrator, and Applicant's best estimate of the value of property owned by decedent and subject to probate jurisdiction of the Court is as follows: Personal Property $________________________ Real Estate (less encumbrances) $________________________ Expected Annual Income from the Estate $________________________ TOTAL $________________________ WHEREFORE Applicant requests that this Court: A. Appoint_______________________________Special Administrator of decedent's estate. B. Fix any bond required of the Special Administr ator. I have read the foregoing application and swear that all statements made therein are accurate and complete to the best of my knowledge and belief. STATE OF ARIZONA ) )ss ________________________________________ County of________________) Signature of SUBSCRIBED AND SWORN before me this date: ______________________ Notary___________________________________________ Seal