ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address and telephone #): FOR COURT USE ONLY STATE BAR NO: ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF MARIN 3501 Civic Center Drive P.O. Box 4988 San Rafael, CA 94913-4988 IN THE MATTER OF THE ESTATE OF Deceased CASE NUMBER DECLARATION OF FINAL DISCHARGE AND ORDER I, ______________________________________________________, say: I am the _______________________________________ of the above entitled estate; that I have under approval, (Executor / Administrator / Guardian, etc.) authorization and order of the Court, paid all sums of money due from me as _________________________________ (Executor / Administrator / Guardian, etc.) and all required receipts and vouchers for same are on file in said estate; that distribution and delivery has been made of all the property and assets of said estate in accordance with the decree therefore made and that receipts from all the respective distributees are on file in said estate and that I have performed all acts lawfully required of me as _______________________________________. (Executor / Administrator / Guardian, etc.) I declare under penalty of perjury under the laws of California that the foregoing is true and correct and that this declaration was executed on Dated: __________________________, at California DECLARANT SIGNATURE PRINTED NAME ORDER OF FINAL DISCHARGE It appears from the aforesaid declaration that the above-entitled estate has been fully administered and that a final decree of discharge is in order. It is therefore ORDERED, ADJUDGED AND DECREED THAT (Name) as ___________________________________ of the above-entitled estate is hereby released and discharged and (Executor / Administrator / Guardian, etc.) that ___________ and ___________ sureties are discharged and released from all liability to be incurred hereafter. (He/She) (His/Her) ______________________________________ DATED PR001 JUDGE OF THE SUPERIOR COURT DECLARATION OF FINAL DISCHARGE AND ORDER Rev. 3/07 American LegalNet, Inc. www.FormsWorkflow.com