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PETITION FOR LETTERS OF ADMINISTRATION In accordance with 2479-4 of the Probate Act of 1975 [755 ILCS 5/9-4], states under the penalties of perjury: [printed name of the Petitioner]1. � , whose place of residence at the time of death was [printed name of the decedent] , [address] [city] [county] [state] died on , at [date] [city] [state] ;[if the decedent was not a resident of Illinois, add: 223owning real or personal estate in this county and state224]2. The approximate value of the estate in this state is: Annual income Personal $ � � Real $ from Real Estate $ ; � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � set forth on Exhibit A attached to this PETITION; [Indicate the relationship of each heir and, if the heir is a minor � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Exhibit A; [If none, so state: .]5. � The Petitioner is a � � � � � � � � � � or to nominate a resident of the United States to act, as administrator;6. � The Petitioner nominates , [printed name of the proposed administrator] ,[address of proposed administrator] � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � and has not been convicted of a felony. Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 1 of 3 Case No. Calendar Estate of DeceasedIN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT 226 PROBATE DIVISIONCross Amended 0005 . The Petitioner seeks: � Independent Administration. � Supervised Administration. The Petitioner asks that � ,[printed name of the proposed administrator]be appointed � � � � � � � � � � � � � � � � � � � � � � [signature of the Petitioner] [address] [city/state/zip] � Case No. Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 2 of 3 Attorney Number Name � Firm Name � Attorneys for � Address � City/State/Zip � Telephone � Email � Exhibit Aattached to and made a part of a Petition for Letters of AdministrationEstate of , Deceased � � � � � � � � � RelationshipCheck All ApplicableBoxes. Name � Street � City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney Nominated Personal FiduciaryName � Street � City/State/Zip Heir Legatee �� 226226226226226226226226226 � Person with � � 226226226226226226226226226 Preference � . Name � Street � City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney Nominated Personal FiduciaryName � Street � City/State/Zip Heir Legatee �� 226226226226226226226226226 � Person with � � 226226226226226226226226226 Preference � . Name � Street � City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney Nominated Personal FiduciaryName � Street � City/State/Zip Heir Legatee �� 226226226226226226226226226 � Person with � � 226226226226226226226226226 Preference � . Name � Street � City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney Nominated Personal FiduciaryName � Street � City/State/Zip Heir Legatee �� 226226226226226226226226226 � Person with � � 226226226226226226226226226 Preference � If additional entries are required, please attach additional sheets. � � � � � � � � � � � � � � � � � � � � � � has been nominated, each of the following statements is true: � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Case No. Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 3 of 3