Approved, SCAO JIS CODE: DBC, DBR STATE OF MICHIGAN PROBATE COURT COUNTY OF SAFE DEPOSIT BOX CERTIFICATE AND RECEIPT FILE NO. Estate of CERTIFICATE 1. The undersigned certify that they were present on this date at the opening of the safe deposit box number located in , Name of bank, trust or safe deposit company a. they did did not find a will of the decedent; b. they did did not find a deed to a burial plot in which decedent is to be buried; c. no item or items, other than such deed or will, were removed from the safe deposit box. Signatures of others present, if any: Date Signature of person named in order to examine contents of box Signature Signature of bank officer or authorized employee Signature REGISTER'S RECEIPT 2. I acknowledge receipt from Name of person given authority by court order to examine contents of box of the following items: a. Will of the decedent b. Burial plot deed Date Deputy Probate Register Do not write below this line - For court use only PC 552 (9/06) SAFE DEPOSIT BOX CERTIFICATE AND RECEIPT MCL 700.2517 American LegalNet, Inc. www.FormsWorkflow.com