PETITION FOR ADMISSION OF WILL AND SUMMARY ADMINISTRATION - PROBATE STATE OF ILLINOIS UNITED STATES OF AMERICA IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT 3806 (Rev. 06/06) COUNTY OF DU PAGE IN RE THE ESTATE OF CASE NUMBER DECEASED File Stamp Here PETITION FOR ADMISSION OF WILL AND SUMMARY ADMINISTRATION The undersigned, on oath states: 1. The decedent , whose place of residence at the time of death was died on , leaving a Will dated be the last valid Will of the testator. , and codicil dated which petitioner believes to 2. The gross value of the decedent real and personal estate subject to administration in this State does not exceed $100,000.00 and is itemized on Exhibit A attached hereto and made a part of this petition. 3. There are no unpaid claims against the estate except the following: (List on Additional sheet and attach) If none, so state. Name Address Amount $ 4. No tax will be due to the United States or this state by reason of the death of the decedent. All taxes due the United States or this state by reason of the death of the decedent have been paid or provided for. All taxes due the United States or this state by reason of the death of the decedent are the responsibility of another fiduciary. 5. No person is entitled to a surviving spouse's or child award. The following persons are entitled to a surviving spouse's or child's award and the minimum awards allowable and amounts paid are as follows: Name Age Minimum Award Amount Paid (List on Additional Sheet and attach) 6. The names and addresses of the testator's heirs and legatees are: List Heirs First (List on Additional Sheet and attach) Name Relationship Heir (H) Legatee (L) Minor (M) Disabled Person (D) Address (If unknown, so state) 7. All heirs and legatees of the decedent have consented in writing to distribution of the estate on summary administration and their consents are attached to this petition. 8. Each distributee tenders a bond, with surety, in the value of his/her distributive share. Petitioner asks that the Will be admitted, and that the court determine the rights of claimants and other person interested in this cause. Direct payment of claims and distribution of the estate on summary administration, excuse the issuance of letters of office or revoke the letters issued and discharge the representative. Name: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: PRO SE Petitioner Signature Address , City, State, Zip Signed and sworn to before me Date Circuit Clerk or Notary Public CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60189-0707 American LegalNet, Inc. www.FormsWorkflow.com