Approved, SCAO JIS CODE: CIS STATE OF MICHIGAN PROBATE COURT COUNTY OF SWORN CLOSING STATEMENT, SUMMARY PROCEEDING Small Estates FILE NO. Estate of 1. I am the personal representative and upon filing this sworn closing statement with the court, this estate will be closed without a hearing. 2. The interested persons, addresses, and their representatives are identical to those appearing on the initial application/petition except as follows: . 3. The estate is not under supervised administration and I have not been prohibited by court order from filing this statement. 4. To the best of my knowledge, the value of the entire estate, less liens and encumbrances, did not exceed administration costs and expenses, reasonable funeral and burial expenses, homestead allowance, family allowance, exempt property, and the reasonable and necessary medical and hospital expenses of the decedent's last illness. The value of the estate is shown on the inventory that I sent to all the interested persons. 5. I fully administered the estate by disbursing and distributing it to the persons entitled to it. 6. I delivered a copy of this sworn closing statement to the distributees of the estate and to all creditors or other claimants and demandants, of whom I am aware, whose claims are neither barred nor paid. I furnished a full written account of the estate administration to the distributees whose interests are affected. Personal representative signature Address Personal representative name (type or print) City, state, zip Sworn to before me on , Telephone no. County, Michigan. Date My commission expires: Signature: Date Notary public, State of Michigan, County of Address Attorney signature Attorney name (type or print) Bar no. City, state, zip Telephone no. NOTICE TO INTERESTED PERSON(S): You may object to this sworn closing statement by filing written objections with the probate court mentioned above along with a $20.00 filing fee. If an objection is not filed within 28 days after this sworn closing statement is filed with the court, the probate register will issue a certificate stating that it appears that I have fully administered this estate. The certificate does not preclude any action against me or the surety on a bond that I may have obtained. If an action or proceeding involving me is not pending in this court one year after this sworn closing statement is filed, my appointment ends. Do not write below this line - For court use only MCL 700. 3205, MCL 700.3988, MCR 5.311(A) PC 590 (9/07) SWORN CLOSING STATEMENT, SUMMARY PROCEEDING, Small Estates American LegalNet, Inc. www.FormsWorkflow.com