IN THE CIRCUIT COURT OF THE SIXTEENTH JUDICIAL CIRCUIT KANE COUNTY, ILLINOIS Case No. IN THE MATTER OF THE ESTATE OF (DECEDENT): Name: Address: City, State, Zip: Date and Place of Death: File Stamp CERTIFICATE OF MAILING AND/OR PUBLICATION Testate Intestate I, the undersigned, hereby certify that I have: Published the notice attached hereto once each week for three successive weeks in (name and address of newspaper) the same being a newspaper of general circulation published in Kane County, Illinois, and the first publication of said notice was on , within 14 days of the entry of the Order Admitting Will to Probate and/or issuance of Letters of Administration. Mailed this date to the persons listed below, by depositing the same in the U.S. Mail, postage prepaid, at , Illinois, the following: Notice of Claim and Admission of Will or Appointment of Representative Petition to Admit Will and to Appoint Representative Order Admitting Will to Probate and to Issue Letters Notice of Rights in Independent Administration Notice of Filing Representative's Final Report ( Independent Administration Only) Other: NAME 1. 2. 3. 4. 5. Dated: Representative Signed pursuant to Supreme Court Rule 137: Attorney/Pro Se: Address: City, State, Zip: Telephone No.: Atty. Registration No.: Attorney E-mail: P1-PR-017 (11/12) American LegalNet, Inc. www.FormsWorkFlow.com ADDRESS CITY, STATE, ZIP Under penalties as provided by law pursuant to 735 ILCS 5/1-109, the undersigned certifies that the statements set forth in this petition are true and correct, except as to matters stated to be on information and belief and as to such matters the undersigned certifies that he/she verily believes the same to be true.