SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION In re Estate of ________________________________ Deceased _________ ADM _________ PETITION FOR APPOINTMENT OF SPECIAL ADMINISTRATOR TO OPEN SAFE DEPOSIT BOX Name of Decedent: Address of Decedent: Date of Death: Name of Petitioner: Address of Petitioner: ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ ______________________________________________ Relationship to Decedent: ______________________________________________ Does the Petitioner have a copy of the Will, the original of which is sought? ______ Is the Petitioner named in this copy of the Will? ____________________________ If so, in what capacity? _______________________________________________ Location of safe deposit box(es) in the District of Columbia sought to be opened: ______________________________________________ ______________________________________________ Does the Petitioner know of anyone holding a higher priority for appointment pursuant to D.C. Code 20-303? _________________________________________ If so, what actions has Petitioner taken to contact such person(s)? _____________ __________________________________________________________________ __________________________________________________________________ Has or have any such person or persons declined to seek entry into the safe deposit box(es)? ___________________________________________________________ Does the Petitioner seek to have a representative from the Probate Division accompany the Special Administrator to the opening of the safe deposit box(es)? __________________________________________________________________ Does the Petitioner seek to have anyone else accompany the Petitioner to the opening of the safe deposit box(es)? _____________________________________ October 2010 � 127.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com Name __________________ __________________ __________________ __________________ __________________ __________________ __________________ List of Interested Persons Address _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ Relationship ___________ ___________ ___________ ____________ ____________ ____________ ____________ WHEREFORE, Petitioner prays that the Court appoint ________________________ Special Administrator to open the safe deposit box(es). ______________________________ Petitioner's Signature ______________________________ Telephone Number I do solemnly declare and affirm under penalty of law that the contents of the foregoing document are true and correct to the best of my knowledge, information, and belief. ______________________________ Petitioner ______________________________ Signature of Petitioner's Attorney ______________________________ Type Name of Petitioner's Attorney ______________________________ Address of Petitioner's Attorney ______________________________ ______________________________ Telephone Number of Petitioner's Attorney ___________________________________ E-mail Address ______________________________ Bar No. (if filer is an attorney) October 2010 � 127.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION In re Estate of ________________________________ Deceased _________ ADM _________ ORDER Upon consideration of the Petition for Appointment of a Special Administrator To Open a Safe Deposit Box filed by _________________________ that seeks the appointment of ________________________ as Special Administrator, and it appearing to the Court that [ ] no one holds a higher priority for appointment than the Petitioner, or [ ] while other person(s) hold(s) a higher priority for appointment than Petitioner, such persons have not come forward to seek appointment and that good cause exists to vary the priority of appointment, it is by the Court this ___________ day of _____________________, 20___, ORDERED, that _________________________ be appointed Special Administrator To Open a Safe Deposit Box located at ________________________ __________________________________________________________________; and it is further ORDERED, that the Special Administrator: [] [] [] shall not to be accompanied by a representative from the Probate Division, or shall be accompanied by a representative from the Probate Division when opening the safe deposit box. shall be accompanied by _______________________________ when opening the safe deposit box; and it is further ORDERED, that the appointment of Special Administrator shall terminate thirty (30) days of the date of this Order; and it is further October 2010 � 127.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com ORDERED, that the Special Administrator shall have no other authority than that granted herein and shall have no authority to receive any assets of the decedent and hence shall not be required to post bond; and it is further [ ] ORDERED, that the Special Administrator shall forthwith deliver any testamentary document(s) found in the safe deposit box to the Probate Division, or [ ] ORDERED, that the Probate Division's representative shall deliver any testamentary document(s) found in the safe deposit box to the Probate Division. __________________________________ JUDGE CC: October 2010 � 127.10.v1 American LegalNet, Inc. www.FormsWorkFlow.com