File No. STATE OF NORTH CAROLINA In The General Court Of Justice Superior Court Division Before The Clerk NOTE TO APPLICANTS: The decision to apply for summary administration rather than regular administration County may have significant legal ramifications. Applicants are advised to seek legal counsel. IN THE MATTER OF THE ESTATE OF: Name And Address Of Decedent Social Security No. APPLICATION AND PETITION FOR SUMMARY ADMINISTRATION OF ESTATE WITHOUT A WILL County Of Domicile At Time Of Death G.S. 28A-28-1 et. seq. Date Of Death Place Of Death (If Different From County Of Domicile) Date Of Marriage Place Of Marriage (If Different From County Of Domicile) Name And Mailing Address Of Petitioner Name And Address Of Attorney Telephone No. Telephone No. Legal Residence (County, State) I, the undersigned, petition the Court for an Order of Summary Administration of the above estate, and being first duly sworn or affirmed, say that: 1. The decedent was domiciled in this county at the time of the decedent's death. 2. I am the surviving spouse of the decedent, and I am the sole heir of the decedent. There is no other heir under the North Carolina Intestate Succession Act. 3. The decedent did not leave a paper writing purporting to be the decedent's Last Will and Testament. 4. No application or petition for appointment of a personal representative is pending or has been granted in this State. 5. The decedent did did not own an interest in real estate, wholly or partially, at the time of the decedent's death. A complete legal description, sufficient to specifically identify each tract of such real property is attached. 6. The decedent did did not own an interest in personal property at the time of the decedent's death. A complete description of the nature of decedent's personal property, the location and probable value of said property, to the extent that these facts are known or can with reasonable diligence be ascertained, is on the reverse. (NOTE: See the Instructions for Inventory on side two of AOC-E-202.) 7. To the extent of the property received by me under intestate succession, I assume all liabilities of the decedent that were not discharged by reason of death, and I assume liability for all taxes and valid claims against the decedent or the estate, as provided in G.S. 28A-28-6. AOC-E-906M, Rev. 3/07 © 2007 Administrative Office of the Courts (Over) American LegalNet, Inc. www.FormsWorkflow.com INVENTORY (Give values and descriptions as of date of decedent's death. Continue on separate attachment if necessary.) PART I. Market Value 1. Accounts in sole name of decedent (List bank, etc., each account no. and balance.) $ 2. Joint accounts without right of survivorship (List bank, etc., each account no., balance and joint owners.) % Owned By Dec. % Owned By Dec. % Owned By Dec. % Owned By Dec. 3. Stocks and bonds in sole name of decedent or jointly owned without right of survivorship................................................................. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. % Owned By Dec. Cash and undeposited checks on hand....................................................................................... Household furnishings.................................................................................................................. Farm products, livestock, equipment and tools........................................................................... Vehicles........................................................................................................................................ Interest in partnership or sole proprietor businesses.................................................................. Insurance, Retirement Plan, I.R.A., etc., payable to Estate........................................................ Notes, judgments, and other debts due decedent....................................................................... Miscellaneous personal property................................................................................................. Real estate willed to the Estate............................................................. $ Estimated annual income of Estate............................................................................................. TOTAL PART I. $ PART II. PROPERTY WHICH CAN BE ADDED TO ESTATE IF NEEDED TO PAY CLAIMS 1. Joint accounts with right of survivorship (List bank, etc., each account no., balance & joint owners.) $ 2. Stocks and bonds jointly owned with right of survivorship......................................................... 3. Other personal property recoverable (G.S. 28A-15-10)............................................................. 4. Real estate owned by decedent and not listed elsewhere......................................................... 1. 2. 3. 4. $ TOTAL PART II. PART III. Entireties Real Estate owned by decedent and spouse (List 1/2 value).......................................... $ Insurance, Retirement Plan, I.R.A., accounts, etc., payable to named beneficiaries................. There are are not transfers over which decedent retained any interest as described in N.C. Inheritance Tax Laws, G.S. 105-2(3) through 105-2(6)..................................................... There were were not gifts made 3 years or less before dedecent's death..................... $ TOTAL PART III. Date SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Signature Of Applicant Signature Deputy CSC Assistant CSC Clerk Of Superior Court Name Of Applicant (Type Or Print) Date My Commission Expires Notary County Where Notarized SEAL AOC-E-906M, Side Two, Rev. 3/07, © 2007 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkflow.com