IN THE CIRCUIT COURT FOR THE TWENTY-THIRD JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS IN THE MATTER OF THE ESTATE OF: Case No._____________________________ __________________________________ Deceased DECEDENT: Name: Address: City: State: Zip: _________________________________________________ INDEPENDENT REPRESENTATIVE: Name: Address: City: State: Zip: _________________________________________________ TYPE OF INDEPENDENT REPRESENTATIVE: [ ] Administrator [ ] Executor _________________________________________________ ATTORNEY: Name: Address: City: State: Zip: FINAL REPORT OF INDEPENDENT REPRESENTATIVE The Independent Representative of this estate, on oath states that the administration of this estate has been completed, and in accordance with Section 28-011 of the Probate Act of 1975 (IL Revised Statutes, Chapter 110 ½) further states as follows: 1. Notice of probate has been given in compliance with Section 6-10 or Section 9-5 of the Probate Act. 2. The Notice to Creditors has been published, and that reasonable care was used to determine the creditors of the decedent and all known creditors have been given notice as required under Section 18-3. 3. Each claim filed has been allowed, disallowed, compromised, dismissed or is barred and all claims allowed have been paid. 4. All estate taxes have been determined and paid. 5. That a Notice of Probate and Release of Estate's Interest in Real Estate, if applicable, has been filed as required by statute. 6. The fees of the Independent Representative and/or attorney for the estate have been paid and approved as provided herein. 7. All administration expenses and other liabilities of the estate have been paid, the remaining assets of the estate have been distributed to the persons entitled thereto, copies of the inventory and final account have been mailed to all interested persons and their receipts therefore have been obtained and are attached, and the Independent Representative has fully accounted to all interested persons for all acts of administration and distribution. WHEREFORE, the Independent Representative prays the Court to enter an Order declaring the estate closed, discharging the Independent Representative and canceling any Bond which may have been filed with the Court in his/her behalf. __________________________________________________ Independent Representative Sworn to before me this ____ day of________________, 20 ___. __________________________________________________ Clerk of Court/Notary Public Telephone: _________________________________________________ CLAIMS: All claims allowed have been [ ] paid in full [ ] paid according to their respective priorities, the estate being insufficient to pay all claims in full. __________________________________________________ FEES: Fees of Independent Representative and attorney [ ] have [ ] have not been approved by all interested persons. Name of Interested Persons Entitled to Notice Notice Post Office Address "Required" (If "Unknown" so state) or "Waived" Probate18\Final Report of Independent Representative 11/19/2012 American LegalNet, Inc. www.FormsWorkFlow.com Name of Interested Persons Entitled to Notice Notice Post Office Address "Required" (If "Unknown" so state) or "Waived" Probate18\Final Report of Independent Representative 11/19/2012 American LegalNet, Inc. www.FormsWorkFlow.com