PR-1928, 10/10 Petition for Summary Confirmation of Interest in Property 247247705.10(1), 705.15, 766.58, and 867.046, 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 Petition for Summary Confirmation of Interest in Property 247867.046(1m), Wisconsin Statutes Case No. UNDER OATH, I STATE: 1. I am a beneficiary of a marital property agreement a TOD beneficiary or a beneficiary of a transfer under 247705.10(1), Wis. Stats., and my mailing address is . 2. The decedent, with date of birth and date of death , was domiciled in County, State of , with a mailing address of . 3. At the time of death the decedent had survivorship marital property; an interest in property transferable under a marital property agreement; an interest in real property with a designated TOD beneficiary, OR an interest in property subject to disposition under a controlling instrument governed by 247705.10(1), Wis. Stats., (controlling instrument or copy of other documentation attached) which is located in County, Wisconsin: See attached Description of Property (include legal description of real estate, WI coun ty where the property is located and Recording Data from creating document) I REQUEST THE COURT: Issue acertificate termination or transfer of in the property and my interest in the property as stated in this Petition. 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 Telephone Number Date Form completed by: (Name) Address Telephone Number Bar Number American LegalNet, Inc. www.FormsWorkFlow.com