0010 PETITION FOR PROBATE OF WILL AND FOR LETTERS OF ADMINISTRATION WITH WILL ANNEXED In accordance with 2476-2 of the Probate Act of 1975 (223Probate Act224) [755 ILCS 5/6-2], states under the penalties of perjury: [printed name of the Petitioner]1. þ , whose place of residence at the time of death was [printed name of the decedent] [address] [city] [county] [state] died on , at leaving a Will [date] [city] [state] þ dated (and codicil dated ) þ þ þ þ þ þ þ þ þ þ þ þ þ þ which the Petitioner believes to be the valid last Will of the testator;2. The approximate value of the estate in this state is: Annual income Personal $ þ þ Real $ from Real Estate $ ; þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ and, if the heir or legatee is a minor (M) or a person with a disability (D), so state.]4. The testator nominated as Executor , who ;[reason for not acting] þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ or equally with (E) the Petitioner are also set forth on Exhibit A attached to this PETITION; [If none, so state.]6. þ The Petitioner is a þ þ þ þ þ þ þ þ þ þ þ þ þ a resident of the United States to act, as administrator; þ þ þ þ [printed name of the proposed administrator] ,[address of proposed administrator] þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ of unsound mind, is not an adjudged person with a disability, and has not been convicted of a felony. Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 1 of 3 þ þ Case No. Calendar Estate of DeceasedIN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT 226 PROBATE DIVISION þ þ þ Independent Administration. Supervised Administration. þ þ þ þ þ þ þ þ þ þ þ þ [printed name of the proposed executor] be appointed Administrator with the (Independent) (Supervised) þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ [signature of the Petitioner] [address] [city/state/zip] þ Case No. Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 2 of 3 þ þ þ þ þ þ þ þ þ Attorneys for þ Address þ City/State/Zip þ Telephone þ Email þ Exhibit Aattached to and made a part of Petition for for Probate of Will and for Letters of Administration with will AnnexedEstate of , Deceased # RelationshipCheck All ApplicableBoxes. þ þ Street þ City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney þ þ þ þ þ Street þ City/State/Zip Heir Legatee þ­ 226226226226226226226226226 Minor Person with a disability226226226226226226226226226 Preference Equal. þ þ Street þ City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney þ þ þ þ þ Street þ City/State/Zip Heir Legatee þ­ 226226226226226226226226226 Minor Person with a disability226226226226226226226226226 Preference Equal. þ þ Street þ City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney þ þ þ þ þ Street þ City/State/Zip Heir Legatee þ­ 226226226226226226226226226 Minor Person with a disability226226226226226226226226226 Preference Equal. þ þ Street þ City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney þ þ þ þ þ Street þ City/State/Zip Heir Legatee þ­ 226226226226226226226226226 Minor Person with a disability226226226226226226226226226 Preference EqualIf additional entries are required, please attach additional sheets. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ has been nominated, each of the following statements is true: þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ Case No. Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 3 of 3 þ þ