For Clerk's Use Only SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case Number: ________________________ In the Matter of the Estate of: LETTERS OF APPOINTMENT and ACCEPTANCE OF APPOINTMENT OF SPECIAL ADMINISTRATOR _____________________________________ (Name of Decedent) Deceased. ISSUANCE OF LETTERS _________________________________________ is hereby appointed as Special Administrator of this Estate. The Special Administrator shall only be permitted to exercise the following powers: · The Special Administrator is expressly authorized to make all funeral arrangements for the decedent at a local funeral home. The appointment shall terminate upon the earlier of the appointment of a general Personal Representative for the Estate or the completion of funeral arrangements. Dated this _________ day of ________________, 20_______. ____________________________________________ Judicial Officer ACCEPTANCE OF APPOINTMENT STATE OF ARIZONA County of Mohave ) ) ss. ) I accept the duties of Special Administrator of the Estate of the above-named person who has died and affirm or swear that I will perform the duties assigned. ________________________________________________________ Signature of Special Administrator Subscribed & sworn to before me this ___________day of By _____________________________________ ________________________ Date , 20_____. My Commission Expires:____________________ Page 1 of 1 _______________________________ Notary Public / Deputy Clerk 3/12/2012 American LegalNet, Inc. www.FormsWorkFlow.com