CERTIFICATE OF SERVICE OF FINAL REPORT UNDER MODIFIED ADMINISTRATION IN THE ESTATE OF: ESTATE NO. I hereby certify that on this day of , , I delivered or mailed, postage prepaid, a copy of the foregoing Final Report Under Modified Administration and attached Schedules to the following persons: Names Addresses Attorney Address Address Telephone Number Facsimile Number Email Address Personal Representative Personal Representative Personal Representative FOR REGISTER OF WILLS USE Distributions subject to tax at Exempt distributions to Identity of the Recipient Tax Thereon % Exempt distributions to Identity of the Recipient Exempt distributions to Identity of the Recipient Total Inheritance Tax due Total Inheritance Tax paid Gross estate Probate Fee & Costs Collected RW1144 (must be filed with RW1143) Rev. 01/01/2016 American LegalNet, Inc. www.FormsWorkFlow.com ROWNET PDF