PR-1927, 10/10 Certification of Termination of Joint Tenancy or Life Estate (247867.04, Wis. Stats.) 247867.04, 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 Certificate of Termination of Joint Tenancy or Life Estate (247867.04, Wisconsin Statutes) Case No. Based on the Petition for Termination of Joint Tenancy or Termination of Life Estate, THE COURT CERTIFIES: 1. The decedent date of death was . 2. oint tenant or as a tenant for life in the following property(ies) in Wisconsin terminated. See attached Description of Property (include legal description of real estate, WI county where the property is located and Recording Data from creating document) (Joint tenant or Life estate) 3. The names and interest of any surviving joint tenant or other person interested in the property is as follows: See attached Name of any Surviving Joint Tenant or Others Interested in Property (If more than one item of property described, specify i n which property person has an interest.) Form completed by: (Name) ( COURT SEAL) Address Telephone Number Bar Number American LegalNet, Inc. www.FormsWorkFlow.com