NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: ESTATE OF: CASE NUMBER: PETITION FOR TERMINATION OF PROCEEDINGS AND DISCHARGE OF PERSONAL REPRESENTATIVE HEARING DATE: DEPT.: TIME: Petitioner, (Name) , is the personal representative of the decedent and alleges the following: 1. 2. Decedent Information Decedent's date of death: Letters Letters were issued on: No letters were issued. . . 3. There is no property of any kind belonging to the estate and subject to administration (check all of the following that apply): All of the decedent's property is in a revocable living trust, held in joint tenancy, held as community property with right of survivorship, or is subject to a beneficiary or payable on death (POD) designation. All of the decedent's property has passed to the decedent's surviving spouse or registered domestic partner pursuant to an order under Probate Code §13650, and a copy of that order is attached hereto. The value of all of the decedent's property is less than $100,000 and (check one): said property has been distributed pursuant to an affidavit or declaration under Probate Code §13100 and a copy of said affidavit or declaration is attached hereto. an order was issued on pursuant to a petition filed herein under Probate Code §13151, and a copy of that order is attached hereto. Petition for Termination and Discharge PRO 054 02/12 Page 1 of 3 PC 12251 American LegalNet, Inc. www.FormsWorkFlow.com The value of all of the decedent's property is less than $20,000 and (check one): an order was issued on pursuant to a petition filed herein under Probate Code §6600 et seq., and a copy of that order is attached hereto. an affidavit under Probate Code §13200 was filed herein on . Other (explain) . NOTE: This form may NOT be used if decedent died owning a interest in real property that was subsequently lost to foreclosure. 4. 5. Costs. All costs of administration have been paid. Notice Petitioner will give notice of the hearing on this petition to all interested persons as provided in Probate Code § 1220. The Notice required by Probate Code § 9202 (c) was given to the California Franchise Tax Board and proof of service of this notice was filed herein on . (Date) Petitioner will give notice of the hearing on this petition to all persons who have requested special notice. 5. Prayer WHEREFORE, Petitioner requests that the court make an order terminating the administration of the estate and discharging the personal representative. Dated: (Signature) Petitioner (Name of Attorney or Law Firm) (Typed or Printed Name) By: (Signature) Attorney for Petitioner Petition for Termination and Discharge PRO 054 02/12 Page 2 of 3 (Typed or Printed Name) PC 12251 American LegalNet, Inc. www.FormsWorkFlow.com VERIFICATION I, (Petitioner) , declare as follows: I am the Petitioner in the above-entitled matter. I have read the foregoing petition and I certify that the same is true of my own knowledge, except as to those matters which are stated on information and belief, and as to those matters, I believe them to be true. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. day of , 2____, at (City and State) 1. 2. 3. Executed this . (Signature) Petition for Termination and Discharge PRO 054 02/12 Page 3 of 3 PC 12251 American LegalNet, Inc. www.FormsWorkFlow.com