Original File Number_______________________________ Sub #____________ KING COUNTY WILL REPOSITORY COVER SHEET (We are only authorized to accept Wills and Codicils) FOR IDENTIFICATION PURPOSES ONLY, COMPLETE THE TESTATOR'S INFORMATION BELOW: (PLEASE PRINT) Printed Name: _____________________________________________________________________________ ****EXACTLY AS ON WILL (List AKA's if applicable)**** Deposit Type: Will Only ______ (Clerks Initials) Deposit of Codicil(s) _______(Clerks Initials) Will and Codicil(s) ______(Clerks Initials) Subsequent Birth Place: ____________________________________________ Social Security Number:______________ (city, state or foreign country) (last four digits only) Date of Birth: _________________ Driver's License Number: ______________________________________ Father's Name: _____________________________________Mother's Maiden Name: __________________ (first, middle, last) Depositors Contact Number: ________________________Printed Name______________________________ Signature: _______________________________________________ Address: __________________________________________________________________________________________ (Street For Clerks' Use Only Date of Withdrawal ______________________ Type of Withdrawal Withdrawn by Testator Converted to Will Only Filing Withdrawn by Court Order Converted to Probate City State ZIP) Converting Case Number: __________________________________________________ Clerks Name: __________________ Print ___________________________________ Sign Date Signature of Testator I, _______________________________________________, have withdrawn my original will or will and codicil(s) and understand this completes this record and any future deposits will be handled as a new and separate transaction __________________________________________________________________________ American LegalNet, Inc. Date www.FormsWorkFlow.com