PR-1828, 10/10 Statement of Transfer of Interest in Property (Informal Administration) 247865.202, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Name Amended Statement of Transfer of Interest in Property Informal Administration (247 865.202, Wisconsin Statutes) Case No. UNDER OATH, I VERIFY: 1. This estate was closed using a Personal Representative Statement to Close (PR-1816) form. 2. The decedent had an interest in property (other than an interest in joint tenancy, life estate, survivorship marital property, interest in real property with a designated transfer on death beneficiary or interest passing by nontestamentary disposition under a marital property agreement) and this interest was transferred pursuant to probate. 3. The decedent See attached Description of Property and Recording Data from creating document ( If any ) Person Receiving Property State of County of Subscribed and sworn to before me on Notary Public/ Court Official Name Printed or Typed My commission/term expires : 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 Name Printed or Typed Address Telephone Number Date Personal Represent ative Name Printed or Typed Address Telephone Number Date Form completed by: (Name) Address Telephone Number Bar Number (If any) American LegalNet, Inc. www.FormsWorkFlow.com