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 of Death: File Stamp FINAL REPORT OF INDEPENDENT REPRESENTATIVE Executor Administrator The Independent Representative of this estate certifies that the administration of this estate has been completed, and in accordance with 755 ILCS 5/28-11 further states: 1. Notice of probate has been given in compliance with 755 ILCS 5/6-10 or 755 ILCS 5/9-5. 2. The Notice to Creditors has been published, that reasonable care was used to determine the creditors of the decedent, and all known creditors have been given notice as required under 755 ILCS 5/18-3. 3. Copies of an inventory and accounting have been mailed or delivered as required under 755 ILCS 5/28-3. 4. Each claim filed has been allowed, disallowed, compromised, dismissed or is barred and that all claims allowed have been paid in full or paid according to their respective priorities. 5. All death taxes have been determined and paid or provided for or that the estate is not subject to death taxes. 6. All administration expenses and other liabilities of the estate have been paid and that administration has been completed or, to the extent not completed, has been provided for as specified in the report. 7. The remaining assets of the estate have been distributed to the persons entitled thereto. 8. The fees paid, or payable to, the independent representative and attorney have been approved by all interested persons. 9. The name(s) and address(es) of each of the person(s) entitled to receive notice of the filing of this report are attached and incorporated fully herein. WHEREFORE, the Independent Representative prays the Court enters an Order approving this account, declaring the estate closed, discharging the Independent Representative, and cancelling any bond which may have been filed with the Court. 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. Independent Representative's Signature Print Name Address City, State, Zip Attorney/Pro Se: Address: City, State, Zip: Telephone No.: Atty. Registration No.: Attorney E-mail: P1-PR-023 (11/12) American LegalNet, Inc. www.FormsWorkFlow.com