PR-1814, 05/19 Estate Account (Informal Administration and Formal Administration) 247247862.01, 862.05, 862.07, 862.11 and 865.16(1)(c), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Name Amended Interim Final Supplemental Estate Account Informal Administration Formal Administration Case No. UNDER OATH I VERIFY: I am the personal representative special administrator of this estate and this estate account is true and correct. The following is my account of the administration of this estate from [Date of Death or Date of prior estate account] to [Date] . List interested persons on page 2. RECEIPTS TOTAL DISBURSEMENTS TOTAL Net Value of property, subject to administration from Inventory (or assets on hand as of last estate account) Funeral Expenses Schedule (F) Added Property to which the decedent was entitled to on Date of Deat h not included in Inventory or p rior Estate Account , including refunds. Schedule (A) Debts of Decedent (G) Dividends (B) Claims (including those by judgment) (H) Interest (C) Taxes Paid (I) Capital Gains (Losses) (D) Interest Paid (J) Other Receipts (E) Administration Expenses (K) Other Payments (L) Distributions Paid to Date (M) TOTAL DISBURSEMENTS Assets on Hand (N) TOTAL TOTAL Totals in each column must be the same. P roposed distribution of Assets on Hand (Schedule O ) Total Fees paid during a dministration : Personal Representative : Guardian Ad Litem : Special Administrator : Attorney : State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Personal Representative /Special Administrator Name Printed or Typed Address Telephone Number Date American LegalNet, Inc. www.FormsWorkFlow.com PR-1814, 05/19 Estate Account (Informal Administration and Formal Administration) 247247862.01, 862.05, 862.07, 862.11 and 865.16(1)(c), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Personal Representative /Special Administrator Name Printed or Typed Address Telephone Number Date Form c ompleted by: (Name) Telephone Number Bar Number (If any) Address ESTATE ACCOUNT SUPPORTING S CHEDULE List of Interested Persons The names and mailing addresses of all interested persons are as follows : (For any person with disabilities, also list any guardian of estate; for any person in the military, also list attorney or attorney in fact; and for any minor, list date of birth.) Name Mailing Address If Minor, Date of Birth American LegalNet, Inc. www.FormsWorkFlow.com PR-1814, 05/19 Estate Account (Informal Administration and Formal Administration) 247247862.01, 862.05, 862.07, 862.11 and 865.16(1)(c), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 Schedule (A - O ) Estate Account Supporting Schedules (List details of each schedule) Amount American LegalNet, Inc. www.FormsWorkFlow.com