IN THE CHANCERY COURT OF HAMILTON COUNTY, TENNESSEE PART 2 PETITION FOR TESTATE ADMINISTRATION PROBATE DIVISION FILE N0. IN THE MATTER OF THE ESTATE OF DECEDENT ITEM 1. PETITIONER(S). Relationship of Petitioner(s) to Decedent: ITEM 2. PERSONAL REPRESENTATIVE(S). Petitioner(s) seek to have ________________________________________________________________________________ appointed as personal representative(s) for this estate and verily believe said person(s) stand ready, willing and qualified to undertake the office as required by law and will furnish bond as directed by the COURT. ITEM 3. DECEDENT. Decedent died on __________ at the age of ______ at ______________________________________________________ Date City & State Decedent's residence at time of death was: ______________________________________________, _______________________________, ______________________ Street and Number City State Zip Code ITEM 4. TENNCARE. At time of death, was Decedent enrolled in TennCare? Yes No Unknown ITEM 5. WILL. The document(s) offered for probate were executed on _______________________________________________and the names of all attesting witnesses are: _________________________________________________________________________________________ The ORIGINAL document(s) offered for probate are herewith presented to the COURT for probate. A true copy of the document(s) is tendered herewith as exhibit to this petition. ITEM 6. OTHER DOCUMENTS. Petitioner(s) is/are not aware of any instrument revoking the document(s) being offered for probate. Petitioner(s) aver that a search has been made for a subsequently dated will or codicil and none has been found and verily believe the document(s) being offered for probate constitute Decedent's last will and testament. ITEM 7. DEVISEES & LEGATEES. The following are the devisees and legatees under the will: Name Age Relation Mailing Address Zip Code ITEM 8. HEIRS. The following are those who are not devisees and legatees under the will who would otherwise be entitled to Decedent’s property as heirs at law if there were no will: Name Age Relation Mailing Address Zip Code Page 1 of 3 pages. PETITION FOR TESTATE ADMINISTRATION Form 078P, Rev. 2011.01.05 American LegalNet, Inc. www.FormsWorkFlow.com ITEM 9. DISABILITY. Those persons listed in Items 7 and 8, if any, who are under disability are: Personalty Real Estate in: Estimated fair market value Personalty ITEM 10. 2 assets to be administered of VALUE. Real Estate in: * 3Total estimated gross value of this estate for Tenn. inheritance tax purposes *Real estate is a non-probate asset unless specifically devised to the estate or required to be sold to pay debts. ITEM 11. BOND. NOT WAIVED WAIVED in Will at: ITEM 12. INVENTORY. NOT WAIVED WAIVED in Will at: PREMISES CONSIDERED, PETITIONER(S) PRAY 1. That the will be proved and established, probate of said will be granted, and the same ordered for record. 2. That the CLERK & MASTER qualify the personal representative and issue letters for testate administration. 3. That notice be given for creditors of Decedent's estate requiring them to file their claims. T.C.A. § 30-2-306(a). by publication not be given. T.C.A. § 30-2-306(e). 4. That if bond is required and if the inventory reveals the estate exceeds the amount as set out in this petition, the personal representative be required to increase the bond accordingly. 5. That inventory be waived or that 60 days be allowed for filing. T.C.A. § 30-2-301(a). 6. That affidavits to each devisee or legatee be waived or that 60 days be allowed for filing. T. C. A. § 30-2-301(b)(1)(A). 7. That, for a decedent who was 55 years or older at time of death, the affidavit of notice to TennCare be filed within 60 days. T. C. A. § 30-2-301(b)(5). 1 non-probate assets _____________________________________ _____________________________________ Petitioner Petitioner _____________________________________ _____________________________________ Address Address _____________________________________ _____________________________________ _____________________________________ _____________________________________ Petitioner Petitioner _____________________________________ _____________________________________ Address Address _____________________________________ _____________________________________ WE ARE SURETY FOR COSTS IN THIS CAUSE. ___________________________________________________________ Attorneys for Petitioner By_____________________________________________ BPR# ___________________________________________________________ Address ___________________________________________________________ ___________________________________________________________ Tel. N0. Fax N0. CHANCERY COURT OF HAMILTON COUNTY TENNESSEE } Sworn to and subscribed before me this ____ day of ______________, 20___. S. LEE AKERS, CLERK & MASTER By________________________________________ Deputy Probate Clerk Page 2 of 3 pages. PETITION FOR TESTATE ADMINISTRATION Form 078P, Rev. 2011.01.05 American LegalNet, Inc. www.FormsWorkFlow.com MASTER’S ORDER From an examination of Petitioner(s) and witnesses under oath it appears the facts stated in the petition are true, the will dated ___________________________________________________________________ is the true and entire last will of Decedent, executed and proved according to law, to the best knowledge of Petitioner(s) the estimated gross value of this estate for inheritance tax purposes is $______________, and that after proper qualification and pursuant to T. C. A. § 16-16-201 letters are to be issued to: _____________________________________________________________________________________________________ Bond: Waived Set at $ Inventory: Waived 60 days to file accurate inventory of the probate estate. T.C.A. § 30-2-301(a). Affidavit of Notice to each devisee or legatee: Waived 60 days to file affidavit. T. C. A. § 30-2-301(b). Affidavit of Notice to TennCare: N/A 60 days to file affidavit. T. C. A. § 30-2-301(b)(5). This ____ day of ____________________, 20___. ____________________________________________ S. LEE AKERS, CLERK & MASTER Page 3 of 3 pages. PETITION FOR TESTATE ADMINISTRATION Form 078P, Rev. 2011.01.05 American LegalNet, Inc. www.FormsWorkFlow.com