Form PE17 SUPERIOR COURT Unit STATE OF VERMONT PROBATE DIVISION Docket No.___________________ In re ESTATE OF Decedent MOTION TO APPOINT SPECIAL ADMINISTRATOR Petitioner requests the Court appoint a special administrator to take charge of this estate for the following reasons: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Petitioner nominates the following named person: Proposed Special Administrator Telephone Number Email Mailing Address City, State, Zip PETITIONER SIGNATURE: __________________________________ Petitioner name � IF NOT NOMINATED SPECIAL ADMINISTRATOR Mailing Address City, State, Zip Telephone Number Email DATE:_______________ American LegalNet, Inc. www.FormsWorkFlow.com