COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : Index No. IN THE CHANCERY COURT FOR WILLIAMSON COUNTY, TENNESSEE : ESTATE OF: _______________________________ :) Plaintiff(s) -against- Calendar No. NO.________________ JUDICIAL SUBPOENA : STATEMENT IN LIEU OF ACCOUNTING : The undersigned, being the Personal Representative of the Estate herein, pursuant to T.C.A. : § 30-2-601, states that the Personal Defendant(s) Representative has: : ...................................................... 1. Properly administered the Estate of __________________________________; 2. THE PEOPLE OFHas paid or settled all claims lawfully presented; THE STATE OF NEW YORK 3. Has paid all expenses of administration; 4. TO Has mailed or delivered notice of the requirement to file claims, as prescribed in GREETINGS: § 30-2-306(e), to the creditors of the decedent who were known to me or WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before reasonably ascertainable. at the , the Honorable Court located at County of Has the with the Clerk the final receipt and o'clock in from the Tennessee recessed release the in room 5. , on filed day of , 20 , at noon, and at any or adjourned date, to testify and give evidence as a witness in this action on the part of the Department of Revenue evidencing payment of all Tennessee inheritance and/or estate tax or waiver thereof; Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a 6. Has distributed the estate according to the will and obtained and filed receipts result of your failure to comply. for specific bequests. Witness, Honorable Court in County, day of STATE OF _____________________________ COUNTY OF ___________________________ , one of the Justices of the , 20 ___________________________________ PERSONAL REPRESENTATIVE (Attorney must sign above and type name below) Personally appeared before me, the undersigned, a Notary Public/Clerk & Master in and for said county and state, _____________________________________, withAttorney(s) for whom I am personally acquainted or proved to me on the basis of satisfactory evidence, and who acknowledged that the foregoing was executed for the purpose contained therein. This _____ day of ___________________, 20_____. My Commission Expires: _________ (Form #10 11/01/02) Office and P.O. Address ____________________________________ NOTARY PUBLIC/CLERK & MASTER Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com