IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT, LAKE COUNTY, ILLINOIS PROBATE DIVISION Estate of Deceased. ) ) ) ) No. FINAL REPORT OF INDEPENDENT REPRESENTATIVE __________________________________________________________, independent representative of this Estate, on oath states that the administration of the estate has been completed in accordance with Sec. 28-11 of the Probate Act and further states as follows: 1. Notice of probate has been given in compliance with Section 6-10 or Subsection 28-2 (c) of the Probate Act. 2. The notice to creditors required by Section 18-3 has been published, and the first publication occurred more than 6 months before the date of this report. 3. Each claim filed has been allowed, disallowed, compromised, dismissed or is barred. 4. All estate and inheritance taxes have been determined and paid. *5. (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. 6. All administrative 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 therefor have been obtained and are attached, and the independent representative has fully accounted to all interested persons for all acts of administration and distribution. 7. The fees paid or payable to the independent representative and his attorney ___________________________ approved by all interested persons. (have been) (have not been) 8. Approvals of this report, or receipts, have been obtained from all interested persons and are filed with this report except for those listed on the attachment to this report. Name Attorney for Representative Address City Telephone *Strike (a) or (b) if not applicable __________________________________________ Independent Representative Signed and sworn to before me __________________________, ______. _________________________________ Notary Public – Circuit Court Clerk 171-206 Rev. 09/00 2002 © American LegalNet, Inc.