FINAL REPORT OF INDEPENDENT REPRESENTATIVE - PROBATE STATE OF ILLINOIS 3815 (Rev. 4/17) UNITED STATES OF AMERICA COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT IN RE THE ESTATE OF CASE NUMBER DECEASED FINAL REPORT OF INDEPENDENT REPRESENTATIVE File Stamp Here The undersigned, on oath states: That the administration of the estate has been completed and in accordance with Section. 28-11 of the Probate Act of 1975 (755 ILCS 5/28-11) further states as follows: Notice of probate has been given in compliance with Section. 6-10 or Subsection 28-(C) of the Probate Act, The notice to creditors required by Section 18-3 has been published, and the first publication occurred more than six (6) months before the date of this report. Each claim filed has been allowed, disallowed, compromised, dismissed or is barred. All estate and inheritance taxes have been determined and paid. (*strike (a) or (b) if not applicable) (a) All claims allowed have been paid in full. (b) The estate was not sufficient to pay all of the claims in full, and all claims allowed have been paid according to their respective priorities. All administration expenses and other liabilities of the estate have been paid, the remaining assets of the estates 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. The fees paid or payable to the independent representative and the representative's attorney, have not been has been approved by all interested persons. Approvals of this report, or receipts, have been obtained from all interested persons and are filed with this report except for the following Name Address City, State, Zip (additional names, see attached) Name: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: Email: Pro Se Independent Representative Subscribed and sworn to before me Date Circuit Clerk or Notary Public CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60187-0707 American LegalNet, Inc. www.FormsWorkFlow.com