PETITION FOR PROBATE OF WILL AND FOR LETTERS TESTAMENTARY In accordance with 2476-2 of the Probate Act of 1975 [755 ILCS 5/6-2], 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 leaving a Will [date] � [city] [state] � dated � , � (and Codicil dated ) � � � � � � � � � � � � � � which the Petitioner believes to be the valid last Will of the testator;2. The approximate value of the estate in this state is: Annual income Personal $ Real $ from Real Estate $ ; � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � and, if the heir or legatee is a minor (M) or a person with a disability (D), so state.] � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � of unsound mind, is not an adjudged person with a disability, 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 DIVISION � � � Independent Administration. � Supervised Administration. � � � � � � � � � � � � [printed name of the proposed executor] be appointed � � � � � � � � (independent) (supervised) � � � � � � � � � � � � [signature of the Petitioner] [address] [city/state/zip] � Case No. Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 2 of 3 � � � � � � � � � Attorneys for � Address � City/State/Zip � Telephone � Email � Exhibit Aattached to and made a part of a Petition for Probate of Will and for Letters TestamentaryEstate of , Deceased � � � � � � � � � Relationship � � ApplicableBoxes. � � Street � City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney � � � � � Street � City/State/Zip Heir Legatee �� 226226226226226226226226226 Minor Person with a Disability226226226226226226226226226 Preference Equal. � � Street � City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney � � � � � Street � City/State/Zip Heir Legatee �� 226226226226226226226226226 Minor Person with a Disability226226226226226226226226226 Preference Equal. � � Street � City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney � � � � � Street � City/State/Zip Heir Legatee �� 226226226226226226226226226 Minor Person with a Disability226226226226226226226226226 Preference Equal. � � Street � City/State/Zip Notice for this heir or legatee shall also be sent to: Guardian of the Estate Agent under Power of Attorney � � � � � Street � City/State/Zip Heir Legatee �� 226226226226226226226226226 Minor Person with a Disability226226226226226226226226226 Preference EqualIf 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 � �