SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ SEB _________ (Linked to _______WIL_______) Estate of ________________________________ Deceased PETITION FOR ADMINISTRATION OF SMALL ESTATE ____________________________ Name ____________________________ Name _______ Age _______ Age _________________________________________ Address _________________________________________ Address hereinafter, "petitioner," being a citizen of the United States or a lawfully admitted permanent resident thereof, of legal age and not otherwise excluded from acting as personal representative pursuant to D.C. Code, sec. 20-303(b), shows: 1. ____________________________, the decedent, a domiciliary of _________________________________, residing at ______________________________________________________________________________, died at ____________________________________________________________ on ______________________________ (with)(without) a will. 2. Place Date Petitioner is entitled to be appointed personal representative of the decedent's estate under, D.C. Code sec. 20-303 for the following reasons: __________________________________________________________________ _____________________________________________________________________________________________ 3. The court has jurisdiction in this matter, because: Decedent died domiciled in the District of Columbia Other (please state basis for jurisdiction): ________________________________________________ _____________________________________________________________________________________________ 4. There are no other proceedings regarding the administration of the estate except ______________________ _____________________________________________________________________________________________ 5. 6. Petitioner has made a diligent search to discover all property and debts of the decedent. All assets subject Petitioner has made a diligent search for wills and codicils of the decedent and to the best knowledge of the to administration in the District of Columbia do not exceed $40,000.00, effective April 27, 2001. petitioner, the will dated ___________________________________________________ and codicil(s) dated __________________________________________________ accompanying this petition (is)(are) the decedent's last will and petitioner knows of no later will or codicil(s), and said will and codicil(s), if any, came into petitioner's hands in the following manner _____________________________________________________________________ _____________________________________________________________________________________________. 7. All information required pursuant to D.C. Code, sec. 20-304(a) has been furnished except ________________ _____________________________________________________________________________________________. November 2010 ­ 204.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com The decedent was survived by - (please check appropriate boxes) a. b. c. d. e. f. g. h. i. j. k. Spouse/Domestic Partner. Children. Grandchildren. Brothers and/or Sisters. Nieces and/or Nephews. No Spouse/Domestic Partner. Check appropriate box and go to b. Descendants of predeceased children. If so, stop here; if not, go to c. Descendants of predeceased grandchildren. If so, stop here; if not, go to d. Descendants of predeceased brothers and/or sisters. If so, stop here; if not, go to f. Descendants of predeceased nieces and/or nephews. If so, stop here; if not, go to g. Parents. If so, stop here; if not go to e. Uncles and/or Aunts. If so, stop here; if not, go to h. First cousins. If so, stop here; if not, go to i. Grandparents. If so, stop here; if not, go to j. Other heirs. If none, go to k. Notify Office of the Attorney General, Chief of the Civil Enforcement Section, 441 4th Street, N.W., Washington, D.C. 20001. LIST OF INTERESTED PERSONS must include names of heirs if decedent died intestate; heirs and legatees, including trustees and all named Personal Representatives if the decedent died testate. Refer to D.C. Code, secs. 19-301 through 312 and sec. 20-101(d)(1). If under age of 18 or an adult who is legally disabled, also list as an interested person the judicially appointed guardian, conservator or committee for such person. If no judicially appointed representative exists, then list the parent or custodian or an attorney-in-fact, if any, for such person (subject to the terms of the power of attorney), or any other person with legal authority to act for such disabled person. Note: If each trustee is also a petitioning party or acting personal representative, list all beneficiaries under trust. Refer to D.C. Code, sec. 20-101(g). Any creditor of the decedent, including those persons whose rights accrue at the time of death, who has timely presented a claim in excess of $500 that has not been barred or discharged is also an interested person. Petitioner(s) should update list of interested persons or creditors with claims in excess of $500 as they become known. Indicate, when applicable, grandchildren and nieces and nephews by family groups, by showing the name of their deceased parent who was related to the decedent Sample: Joe Petitioner 1234 Hexagon Street, N.W. Washington, D.C. 20000 Son/heir/legatee/petitioner Interested persons ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Address Relationship (Age, if under 18) ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ (Use continuation sheet, if necessary) WITNESS TO WILLS/CODICILS (Names) _____________________________________________________________________________________________ _____________________________________________________________________________________________ November 2010 ­ 204.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com Character, Location and Estimated Value of Property Titled in Decedent's Name Estimated Value Real P