PR-1841, 05/16 Affidavit of Additional Property and/or Creditor for Summary Assignment (Formal Administration) 247247711.03(10) and 867.02, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Name Amended Affidavit of Additional Prope rty and/or Creditor for Summary Assignment (Formal Administration) Case No. FILE ONLY TO REPORT ADDITIONAL information NOT INCLUDED IN THE PETITION . UNDER OATH, I STATE: 1. The property subject to administration, including any encumbrance, lien, or other charge against each item, and not previously included in the petition for summary assignment is as follows: See attached Description of Property Include s real estate, stocks or bonds, licensed motor vehicles and all other property , including digital property as defined under 247 711.03(10), Wis. Stats. Value of Interest at Date of Death A. Total value of property subject to a dministration $ B. Minus total value of e ncumbrances, liens or other charges against each i tem of property ($ ) C. Net value of property subject to a dministration $ TOTAL (Value from Section A less total from Section B) 2. The name and mailing address of any additional creditor and the amount of the claim not previously included in the petition, is as follows: See attached Name of Creditor Mailing Address Claim Amount $ State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Petitioner Name Printed or Typed Address Telephone Number Date Form completed by: (Name) Address Telephone Number Bar Number American LegalNet, Inc. www.FormsWorkFlow.com