AOC-830 Rev. 12-16 Page 1 of 2 Doc. Code: PDA & ODA COM M O NW E A LT H O F K E lex et justitia Case No. ____________________ Court County Division ____________________ District/Probate ____________________ ____________________ NT U C KY CO Commonwealth of Kentucky Court of Justice www.courts.ky.gov KRS 391.030; 394.145; 395.455; 396.095 U RT OF JUS TI (Surviving Spouse/Children/Preferred Creditor) Petition/order to disPense With AdministrAtion IN RE: Estate of _______________________________________________________________________ (Name of Decedent) Address: ________________________________________ ________________________________________ ________________________________________ Date of Birth: _____________________________ C E Date of Death: _____________________________ Social Security Number: ____________________________ PETITION 1. 2. ComesthePetitioner,beingfirstdulysworn,andstatesasfollows: Decedent died [ ] testate [ ] intestate with residence at the above listed address and on the above date. At the time of death, decedent left no estate to be administered with the exception of the following assets (include value for each asset listed): _____________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ 3. In relation to the above named decedent, I am the (check all that apply) [ ] surviving spouse [ ] only surviving child [ ] surviving child whose surviving siblings have signed a waiver herein or attached a waiver [ ] preferred creditor [ ] preferred creditor of the decedent whose surviving spouse has signed a waiver herein or attached a waiver [ ] assignee of the preferred creditor. 4. [ ] (check if applicable) Petitioner applies for Probate of Decedent's Will,filedherewith,whichishis/herLastWilland Testament. (attach receipts): 5. As a preferred creditor/assignee of decedent, I have paid the following claim(s) against the estate in the following order Claim a. b. Cost and Expenses of Administration Funeral expenses Debts and taxes with preference underfederalandKentuckyLaw Other Payee __________________________________ __________________________________ __________________________________ __________________________________ Amount ____________ ____________ ____________ ____________ c. d. 6. I certify that there has been no previous administration of decedent's estate within Kentucky or elsewhere. American LegalNet, Inc. www.FormsWorkFlow.com AOC-830 Rev. 12-16 Page 2 of 2 Because the exemption given to the above surviving spouse/child(ren) and/or claim(s) of the above preferred creditor/ assignee equals or exceeds the value of the above estate asset(s), I ask this Court to dispense with the administration of the above estate and to transfer the above personal property to me or my designee, ________________________________. ____________________________________ Name of Surviving Spouse Waiving Preference (Please Print) _______ Age _____________________________________________ Signature of Surviving Spouse Waiving Preference (If Petitioner is not Decedent's Spouse) Address/P.O. Box Address: _________________________________________________________________________ _______________________________________________________________________________________________ _____________________________________________ Signature of Surviving Child Waiving Preference ____________________________________________ Signature of Surviving Child Waiving Preference __________________________________________ Petitioner's Signature Address: _______________________________________________________________________________________ _______________________________________________________________________________________________ Phone Number: __________________________________ Subscribed and sworn before me by petitioner on _________________________________, 2_______. My commission expires _____________________. _____________________________________________________ Name/Title ORDER [ ] Upon hearing, the Will offered was proven by ______________________________ and ORDERED PROBATED astheLastWillandTestamentofDecedentthis_________dayof__________________________________,2________. The Will shall be probated only and no letters of administration shall be issued. Uponverifiedpetitionoftheabovepetitioner, IT IS HEREBY ORDERED that the petition be granted to dispense with the administration of the estate of the above decedent, and the above personal property is transferred to petitioner or his/her designee, _____________________________________________________________________________. ________________________________, 2_______ Date ____________________________________________ Judge's Signature CERTIFICATE I certify that this petition and order were prepared in accordance with CR 11. ___________________________________________ Attorney for Petitioner Distribution: Court File Petitioner _____________________________________________ Address and Phone Number American LegalNet, Inc. www.FormsWorkFlow.com