IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Estate of: ) ) ) ) ) ) ) ) ) Person Who Died (Decedent) Date of Birth: CASE NO. SWORN STATEMENT OF PERSONAL REPRESENTATIVE TO CLOSE INFORMAL ESTATE 1. 2. 3. Personal Representative. I am the personal representative of this estate. Notice. I published notice to creditors with the first publication occurring more than six months ago. Duties. Except as specified in paragraph 4, I performed the following duties [you must do all of the following]: waived their right to receive an accounting, you must file the waivers with this document.] Paid, settled, or disposed of all claims presented; paid expenses of administration and estate; and paid inheritance and other death taxes. Distributed the assets of the estate to the persons entitled. Sent a copy of this document to all persons or creditors who received estate property, and to all interested persons whose claims were unpaid. Sent an accounting to all persons whose interests are affected. [If individuals 4. Remaining claims. No claims remain undischarged. Claims remain undischarged as described below: [All claims must be paid within one year of filing this document. Explain whether the personal representative distributed the estate subject to possible liability with the agreement of those receiving property, or explain in detail other arrangements which have been made to accommodate outstanding liabilities. Attach any signed agreements.] 5. Closing Statement. I am filing this statement to close this estate. I understand that my appointment as personal representative will end in one year as long as no action or proceeding involving me as personal representative is pending in the court. I will remain the personal representative until that time. AS 13.16.630 Page 1 of 2 P-355 (7/14)(cs) SWORN STATEMENT OF PERSONAL REPRESENTATIVE TO CLOSE INFORMAL ESTATE American LegalNet, Inc. www.FormsWorkFlow.com Date Signature of Personal Representative Printed Name Address Line 1 Address Line 2 Phone Number E-mail Address Verification I swear or affirm that I read this entire document and believe that all of the statements made in the document are true. Personal Representative's Signature Subscribed and sworn to or affirmed before me at on . (date) (SEAL) , Alaska Clerk of Court, Notary Public, or other person authorized to administer oaths. My commission expires: Certificate of Service [A copy of this Statement and a copy of the accounting must be given to all persons who received something in the estate or had claims against the estate.] I certify that on a copy of this Statement was [list everyone served and attach extra pages if necessary]: mailed hand delivered to Your signature: Page 2 of 2 P-355 (7/14)(cs) SWORN STATEMENT OF PERSONAL REPRESENTATIVE TO CLOSE INFORMAL ESTATE AS 13.16.630 American LegalNet, Inc. www.FormsWorkFlow.com