IN THE ORPHANS' COURT FOR (OR) BEFORE THE REGISTER OF WILLS FOR IN THE ESTATE OF: ESTATE NO. DATE OF DEATH , MARYLAND ¨ WITH ¨ WITHOUT WILL INFORMATION REPORT 1.a. At the time of death did the decedent have any interest as a joint owner (other than with a person exempted from inheritance tax by Code, Tax General Article, §7-203) in any real or leasehold property located in Maryland or any personal property, including accounts in a credit union, bank, or other financial institution? ¨ No ¨ Yes If yes, give the following information as to all such jointly owned property: Nature of Property Total Value of Property Name, Address, and Relationship of Joint Owner 1.b. At the time of death did the decedent have any interest in any real or leasehold property located outside of Maryland either in the decedent's own name or as a tenant in common? ¨ No ¨ Yes If yes, give the following information as to such property: Case Number, Names, and Location of Court Where Any Court Proceeding Has Been Initiated With Reference to the Property Address, and Nature of Property RW1124 Page 1 of 2 ROWNET 1/1/2016 American LegalNet, Inc. www.FormsWorkFlow.com ESTATE OF: ESTATE NO. 2. Except for a bona fide sale or a transfer to a person exempted from inheritance tax pursuant to Code, Tax General Article, §7-203, within two years before death did the decedent make any transfer of any material part of the decedent's property in the nature of a final disposition or distribution, including any transfer that resulted in joint ownership of property? ¨ Date of Transfer No ¨ Yes If yes, give the following information as to each transfer: Nature of Property Transferred Total Value of Property Name, Address, and Relationship of Transferee 3. Except for interests passing to a person exempted by Code, Tax General Article, §7-203, at the time of death did the decedent have (a) any interest less than absolute in real or personal property over which the decedent retained dominion while alive, including P. O. D. account, (b) any interest in any annuity or other public or private employee pension or benefit plan, (c) any interest in real or personal property for life or for a term of years, or (d) any other interest in real or personal property less than absolute, in trust or otherwise? ¨ No ¨ Yes If yes, give the following information as to each interest: Name, Address, and Relationship of Successor, Owner, or Beneficiary Description of Interest and Amount or Value Date and Type of Instrument Establishing Interest I solemnly affirm under the penalties of perjury that the contents of this document are true to the best of my knowledge, information, and belief. Attorney Address Personal Representative Date Personal Representative Personal Representative Date Date Telephone Number Facsimile Number Email Address RW1124 Page 2 of 2 ROWNET American LegalNet, Inc. www.FormsWorkFlow.com 1/1/2016