Approved, SCAO JIS CODE: TSS STATE OF MICHIGAN PROBATE COURT COUNTY OF FILE NO. SUPPLEMENTAL TESTIMONY INTERESTED PERSONS Testate Estate Estate of ***USE THIS FORM ONLY IF A DEVISEE NAMED IN THE WILL OR CODICIL IS NOT AN HEIR OF THE TESTATOR*** NOTE: TREAT ALL PERSONS WHO DIED WITHIN 120 HOURS AFTER THE DECEDENT AS IF THEY DID NOT SURVIVE THE DECEDENT. List persons who died within 120 hours after the decedent in item 17 below. 15. The names of all devisees named in the will and codicils who are not heirs of the decedent (include testamentary trustees and beneficiaries of testamentary trusts) are: 16. Of the devisees listed in 15, the following died before the decedent. Their name(s) and relationship(s) to the decedent are: 17. The following devisees died within 120 hours after the decedent. Their name(s), relationships to the decedent, and date and time of death are: NAME RELATIONSHIP DATE OF DEATH TIME OF DEATH 18. The following are descendants of the predeceased devisees named above, who survived the decedent: 19. Class gifts in the will or codicils, where the members are not specifically identified by name, are as follows: SEE SECOND PAGE Do not write below this line - For court use only PC 566 (9/07) SUPPLEMENTAL TESTIMONY, INTERESTED PERSONS, Testate Estate MCL 700.2702, MCL 700.2707-700.2710 American LegalNet, Inc. www.FormsWorkflow.com 20. The following devisees named above are under legal disability. Their names, legal disabilities, and names of their representative(s) are: 21. The following deceased devisees survived the decedent by more than 120 hours. Their names and the names of those who represent their interests are: 22. The guardian ad litem for each devisee under the will and codicils who is unborn, unknown, or unascertainable is: Witness signature Subscribed and sworn to before me on , County, Michigan. Date My commission expires: Signature: Date Judge/Deputy register/Notary public Notary public, State of Michigan, County of Attorney signature Name (type or print) Bar no. Address City, state, zip Telephone no. American LegalNet, Inc. www.FormsWorkflow.com