ND PROBATE CODE FORM 17 Page 1 10/01/03 APPLICATION FOR INFORMAL APPOINTMENT OF A PERSONAL REPRESENTATIVE IN INTESTACY. (N.D.C.C. 30.1-14-01). Name, Address, and Telephone No. of Attorney Space below for use of District Court only Probate No. _____________ Attorney ___________________ for: IN THE DISTRICT COURT OF __________________________________ COUNTY, STATE OF NORTH DAKOTA In the Matter of the Estate of ________________________________________________________________, Deceased. APPLICATION FOR INFORMAL APPOINTMENT OF PERSONAL REPRESENTATIVE IN INTESTACY I, as the applicant, provide the following information: A. (1) I am _________________________________________________________________________________________. (state interest of applicant) (2) Decedent died on ___________________________,__________, at the age of ________________________ years. At the time of death, the decedent was domiciled in ____________________________________________ County, _________________________________________ (state), and is survived by the following persons who are the surviving spouse, children, heirs or devisees of decedent. Name Age Relationship Address (3) Venue for this case is in this County because ________________________________________________________ _____________________________________________________________________________________________. (4) No personal representative has been appointed whose letters have not been terminated, except _________________ ____________________________, whose address is __________________________________________________, was appointed personal representative on ________________________________________, _________, in _____________________________ County, ____________________________________________________(state). Page 1 of NDPC FORM 17 American LegalNet, Inc. www.FormsWorkflow.com ND PROBATE CODE FORM 17 Page 2 10/01/03 (5) I have not received any demand for notice and am unaware of a demand for notice of any probate or appointment proceeding concerning the decedent that may have been filed in this state or elsewhere, except as follows:________ _____________________________________________________________________________________________. (6) The time limit for informal appointment has not expired. B. I further state pursuant to Section N.D.C.C. 30.1-14-01(d): (1) That after the exercise of reasonable diligence, I am unaware of any unrevoked testamentary instrument relating to the property having a situs in this state under Section 30.1-02-01, except such instrument as attached hereto, or described herein, is not being probated, because ______________________________________________________________ _____________________________________________________________________________________________. (2) The priority of the person whose appointment is sought is ______________________________________________, and the names of any other persons having a prior or equal right to the appointment under Section 30.1-13-03 are as follows:______________________________________________________________________________________ _____________________________________________________________________________________________. WHEREFORE, I request that _________________________________________________________________ be appointed personal representative of decedent's estate and that letters of administration be issued to the appointee upon qualification and acceptance. STATE OF NORTH DAKOTA } } County of ____________________ } ss. ____________________________________________ ___________________________________________________, the applicant above, being duly sworn, states as follows: I have read the application and believe the statements therein to be true to the best of my knowledge. ____________________________________________ Subscribed and sworn to before me this ______________________ day of ________________________, ___________. ____________________________________________ Notary Public My Commission expires:_____________________________ _________________________, County, North Dakota Page 2 of NDPC FORM 17 American LegalNet, Inc. www.FormsWorkflow.com