Fill and Sign the Wisconsin Summary Assignment 497431351 Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF THE ESTATE OF             Amended Order on Petition for Summary Assignment with Order Appointing Special Administrator (Formal Administration) Case No.       A petition for summary assignment was filed. THE COURT FINDS: 1. The decedent, with date of birth       and date of death       , was domiciled in       County, State of       , with a mailing address of       . 2. The court has jurisdiction and is the proper venue. 3. Notice to interested persons was given as required by the court. waived. not required. 4. The petitioner is an interested person. 5. The first publication of notice to creditors was made on (Date)       and more than 30 days has elapsed since that date. 6. Notice was given to the Department of Health Services and more than 30 days has elapsed since that notice was given. 7. The estate is properly settled under summary assignment in that (Select either A or B below.) A. the estate was started under formal administration or summary settlement and meets the requirements of summary assignment. B. the estate, less the amount of the debts for which any property in the estate is security, does not exceed $50,000 in value and cannot be summarily settled under §867.01, Wisconsin Statutes. 8. The decedent A. left a will which was filed and proof of the will was given. B. died leaving no will. 9. A detailed statement of all property subject to administration including any encumbrance, lien, or other charge against each 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) PR-1844 , 10/10 Order on Petition for Summary Assignment (Formal Administration) §867.02, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 Order on Petition for Summary Assignment (Formal Administration) Page 2 of 3 Case No. 10. The estate is appropriate to be settled under summary assignment. The priority claims against the estate under §859.25, Wisconsin Statutes are as follows: See attached Creditors Entitled to Payment Amount (A) Costs and expenses of administration       $       (B) Funeral and burial expenses       $       (C) Provisions for the family of the decedent under §§861.31, 861.33 and 861.35, Wis. Stats.       $       (D) Other claims in order of priority under §859.25, Wis. Stats.       $       11. The decedent had a life estate or interest as a joint tenant or there is property which is security for a debt in which decedent had such interests for which a certificate has not been issued. Any real estate in which the decedent had this interest is described as follows: See attached Description of Property (Include real estate, stocks or bonds, licensed motor vehicles and all other property) Decedent’s Interest             12. It is necessary to appoint a special administrator with the following powers:       13. Other:       PR-1844 , 10/10 Order on Petition for Summary Assignment (Formal Administration) §867.02, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 Order on Petition for Summary Assignment (Formal Administration) Page 3 of 3 Case No. THE COURT ORDERS: 1. The property is assigned to the persons entitled to it as follows: See attached Person(s) Entitled to Receive Description of Property (Include real estate, stocks or bonds, licensed motor vehicles and all other property) Value             $       2. Any person indebted to or holding money or other property of the decedent pay the indebtedness or deliver the property to the persons found to be entitled to receive it. 3. Certification that any interest of the decedent immediately prior to death in an estate for life or as a joint tenant in any property for which a certificate of termination was not issued terminated at death. 4. The estate commenced under Chapter 856 is terminated; upon filing of any account or receipts, required by the court, the personal representative is discharged and any bond is cancelled. 5. The petitioner mail or deliver a copy of this order to all interested persons in the estate whose mailing address is known to the petitioner or can be ascertained with reasonable diligence. 6. Letters of special administration are issued to       upon filing a       bond of $       , with the following powers:       7. Other:       THIS IS FINAL ORDER FOR PURPOSES OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. BY THE COURT: Form completed by: (Name)       Circuit Court Judge Circuit Court Commissioner       Name Printed or Typed       DateAddress       Telephone Number       Bar Number       PR-1844 , 10/10 Order on Petition for Summary Assignment (Formal Administration) §867.02, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3