Petition To Establish Death Of Accident Or Disaster Victim
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Petition To Establish Death Of Accident Or Disaster Victim Form. This is a Michigan form and can be use in Probate Statewide.
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Tags: Petition To Establish Death Of Accident Or Disaster Victim, PC 549, Michigan Statewide, Probate
Approved, SCAO
JIS CODE: PED
STATE OF MICHIGAN
PROBATE COURT
COUNTY OF
PETITION TO ESTABLISH DEATH
OF
ACCIDENT OR DISASTER VICTIM
FILE NO.
In the matter of
, presumed decedent
1. I am interested in this matter as
2. Presumed decedent information:
Domicile:
.
XXX-XXDate of birth
Last four digits of SSN Name of foreign country if citizen of foreign country
City/Township/Village
State
County
3. This petition is being filed not less than 63 days nor more than 7 years after the accident/disaster.
4. The presumed decedent apparently died as result of an accident or a disaster which occurred on or about
and
Date
a. at
Time
, if known,
, within this county.
Location
b. upon or within the Great Lakes or their connecting waters, at a location adjacent to this county.
c. at a location outside of Michigan or its adjoining waters but the presumed decedent was domiciled in this county at the time
of death.
5. The facts and circumstances concerning the accident or disaster are as follows:
6. The reasons I believe the presumed decedent died in the accident or disaster are as follows:
(PLEASE SEE OTHER SIDE)
Do not write below this line - For court use only
PC 549 (9/05)
PETITION TO ESTABLISH DEATH OF ACCIDENT OR DISASTER VICTIM
MCL 700.1207(e), (f), MCL 700.1208
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is unidentifiable.
has disappeared.
7. The body of the presumed decedent
8. The name, age, and relationship to the presumed decedent and the address of each person known or believed to be an heir
of the presumed decedent are as follows:
NAME
AGE
RELATIONSHIP
RESIDENCE
9. Of the above heirs, the following are under legal disability:
NAME
REPRESENTED BY:
DISABILITY
(name, address, capacity)
I REQUEST that the court establish the location of the accident or disaster, the cause, and date of the presumed decedent's death,
and, if possible, the time of death.
I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of my
information, knowledge, and belief.
Date
Petitioner signature
Attorney signature
Attorney name (type or print)
Bar no.
Address
City, state, zip
Petitioner name (type or print)
Address
Telephone no.
City, state, zip
Telephone no.
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