IN THE CHANCERY COURT OF HAMILTON COUNTY, TENNESSEE PART 2 PROBATE DIVISION SWORN STATEMENT IN LIEU OF FINAL ACCOUNTING T.C.A § 30-2-601 FILE N0. PERSONAL REPRESENTATIVE(S) IN THE MATTER OF THE ESTATE OF DECEASED The final accounting is due not later than 15 months from the date of the qualification of the personal representative. This form may be used to close the estate provided accountings have been duly waived. If this form is used, the estate attorney must prepare the ORDER CLOSING THE ESTATE. You must present proof that each claim filed with the court has been paid. The undersigned personal representative(s) and residuary distributee(s) of this estate hereby swear: 1. This estate is solvent. 2. The value of the gross estate for estate tax purposes is $_______________. 3. The personal representative(s), by signing this statement, acknowledge they: 3.1 properly administered this estate; 3.2 paid or settled all claims lawfully presented; 3.3 paid all expenses of administration; 3.4 mailed or delivered notice of the requirements to file claims, as prescribed in T.C.A. § 302-306(e), to the creditors of the decedent who were known to or reasonably ascertainable by the personal representative(s); 3.5 filed or with this statement is filing (unless waived pursuant to T.C.A. § 67-8-409) the final receipt and release from the Tennessee Department of Revenue evidencing payment of all Tennessee Inheritance or Estate Taxes due; and 3.6 4. distributed this estate according to the will (or the laws of descent and distribution). The residuary distributee(s), by signing this statement, acknowledge: 4.1 this estate has been properly distributed to them; 4.2 they approve the fee of $_______________ and expenses of $_______________ paid to ____________________________________as attorneys for the personal representative(s); 4.3 acknowledge no fees or expenses were paid to the personal representative(s); OR they approve the fee of $_______________ and expenses of $_______________ paid to ______________________________________________ as personal representative(s); and Page 1 of 2 pages. SWORN STATEMENT IN LIEU OF FINAL ACCOUNTING Form 082P, Rev. 2011.03.16 American LegalNet, Inc. www.FormsWorkFlow.com 4.4 waive the requirement for the Court to send them notice of the filing of this Statement in Lieu of Final Accounting or a copy of the signed Final Order. Signed this ____ day of ________________, 20___ THIS FORM MAY BE SIGNED IN COUNTERPART. ____________________________________ Personal Representative ____________________________________ Residuary Distributee ____________________________________ Personal Representative ____________________________________ Residuary Distributee ____________________________________ Personal Representative ____________________________________ Residuary Distributee Sworn to and subscribed before me, on this ____ day of ____________, 20___. My Commission Expires: __________________ ____________________________________ NOTARY PUBLIC Page 2 of 2 pages. SWORN STATEMENT IN LIEU OF FINAL ACCOUNTING Form 082P, Rev. 2011.03.16 American LegalNet, Inc. www.FormsWorkFlow.com