Fill and Sign the Wisconsin Summary Settlement 497431345 Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF THE ESTATE OF             Amended Order on Petition for Summary Settlement with Order Appointing Special Administrator (Formal Administration) Case No.       A petition for summary settlement 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. Notice, if required, was given to the Department of Health Services and more than 30 days have elapsed since notice was given. 6. The estate is one properly settled under summary settlement in that (Select either A or B below.) A. the estate, less the amount of the debts for which any property in the estate is security, does not exceed in value the costs, expenses, allowances, and claims under §859.25(1)(a) to (g), Wis. Stats. 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 the decedent is survived by a spouse or domestic partner, or one or more minor children. 7. 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-1837 , 10/10 Order on Petition for Summary Settlement (Formal Administration) §867.01 and 867.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 Order on Petition for Summary Settlement (Formal Administration) Page 2 of 3 Case No. 8. Complete section A or B below. A. The estate is appropriate to be settled under §867.01(1)(a), Wis. Stats. The priority claims against the estate under §859.25, Wis. Stats., and the persons entitled to payment are as follows: See attached Persons(s) Entitled to Payment Amount (1) Costs and expenses of administration       $       (2) Funeral and burial expenses       $       (3) Provisions for the family of the decedent under §§861.31, 861.33 and 861.35, Wis. Stats.       $       (4) All other claims in order of priority under §859.25, Wis. Stats.       $       B. The estate may be settled under §867.01(1)(b), Wisconsin Statutes. Any property not otherwise assigned shall be assigned as an allowance under §861.31, Wisconsin Statutes to the surviving spouse or domestic partner. the minor children. both the surviving spouse or domestic partner and the minor children. 9. 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             10. It is necessary to appoint a special administrator with the following powers:       11. Other:       PR-1837 , 10/10 Order on Petition for Summary Settlement (Formal Administration) §867.01 and 867.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 Order on Petition for Summary Settlement (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. The decedent immediately prior to death had an estate for life or an interest as a joint tenant in property for which a certificate of termination was not issued and the court certifies that such interests terminated at death. 4. The estate started 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 must inform known unsatisfied creditors as to the final disposition of the estate. 6. Letters of special administration are issued to       upon filing a       bond of $       , with the following powers:       7. Other:       THIS IS A FINAL ORDER FOR PURPOSES OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. BY THE COURT: Circuit Court Judge Circuit Court Commissioner       Name Printed or Typed       DateForm completed by: (Name)       Address       Telephone Number       Bar Number       PR-1837 , 10/10 Order on Petition for Summary Settlement (Formal Administration) §867.01 and 867.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3