CIV-710 (8/17)(cs) Dist. Ct. Civ. R. 32(a) PRESUMPTIVE DEATH PETITION AS 09.55.020 IN THE DISTRICT COURT FOR THE STATE OF ALASKA AT In the Matter of the Presumption of the ) Death of ) ) ) CASE NO. Date of Birth: ) ) PRESUMPTIVE DEATH PETITION Petitioner asks the court to summon a jury to establish the presumption of death of the missing person named above. Petitioner states as follows: 1.I am interested in establishi(relationship to deceased or official capacity) 2.The event that likely led to death took place at or near the following city or location inAlaska: 4.The following circumstances lead me to believe said missing person is dead: Signature of Petitioner Print Name Address Line 2 Date Phone VERIFICATION , petitioner in this case, says on oath or affirms that he or she has read the above petition and believes all statements made in the document are true. Subscribed and sworn to or affirmed before me at , Alaska on . (SEAL) Signature and Title of Officer Taking Oath ACCEPTANCE It appears that the circumstances surrounding the disappearance described above provide reasonable grounds for believing that the missing person has suffered death from accidental or Date Judicial Officer American LegalNet, Inc. ww