PR-1837, 09/16 Order on Petition for Summary Settlement (Formal Administration) 247247867.01 and 867.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Name Amended Order on Petition for Summary Settlement with Order Appointing Special Administrator (Formal Administration) Case No. A Petition for Summary Settlement was filed. THE COURT FINDS: 1. The decedent, with date of birth and date of death , was domiciled in County, State of , with a mailing address of . 2. The court has jurisdiction and is the proper venue. 3. Notice to interested persons was given as required by the court. waived. not required. 4. The petitioner is an interested person. 5. Notice, if required, was given to the Department of Health Services and more than 30 days have elapsed since notice was given. 6. The estate is one properly settled under summary settlement in that (Select either A or B below.) A. the estate, less the amount of the debts for which any property in the estate is security, does not exceed in value the costs, expenses, allowances, and claims under 247859.25(1)(a) to (g), Wis. Stats. B. the estate, less the amount of the debts for which any property in the estate is security, does not exceed $50,000 in value and the decedent is survived by a spouse or domestic partner, or one or more minor children. 7. A detailed statement of all property subject to administration including any encumbrance, lien, or other charge against each is as follows: See attached American LegalNet, Inc. www.FormsWorkFlow.com PR-1837, 09/16 Order on Petition for Summary Settlement (Formal Administration) 247247867.01 and 867.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 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 p roperty subject to a dministration $ B. Minus total value of e ncumbrances, liens or other charges against each item of property ($ ) C. Net value of prope rty subject to administration TOTAL $ (Value from Section A less total from Section B) 8. Complete section A or B below. A. The estate is appropriate to be settled under 247867.01(1)(a), Wis. Stats. The priority claims against the estate under 247859.25, Wis. Stats., and the persons entitled to payment are as follows: See attached Persons(s) Entitled to Payment Amount (1) Costs and expenses of administration $ (2) Funeral and burial expenses $ (3) Provisions for the family of the decedent under 247247861.31, 861.33 and 861.35, Wis. Stats. $ (4) All o ther claims in order of priority under 247859.25, Wis. Stats. $ B. The estate may be settled under 247867.01(1)(b), Wis. Stats. Any property not otherwise assigned shall be assigned as an allowance under 247861.31, Wis. Stats., to the surviving spouse or domestic partner. the minor children. both the surviving spouse or domestic partner and the minor children. 9. The decedent had a life estate or interest as a joint tenant or there is property which is security for a debt in which decedent had such interests for which a certificate has not been issued. Any real estate in which the decedent had this interest is described as follows: See attached American LegalNet, Inc. www.FormsWorkFlow.com PR-1837, 09/16 Order on Petition for Summary Settlement (Formal Administration) 247247867.01 and 867.04, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 Description of Property Includes real estate, stocks or bonds, licensed motor vehicles and all other property, including digital property as defined under 247 711.03(10), Wis. Stats. 10. It is necessary to appoint a special administrator with the following powers: 11. Other: THE COURT ORDERS: 1. The property is assigned to the persons entitled to it as follows: See attached Person(s) Entitled to Receive Description of Property Includes 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 $ 2. Any person indebted to or holding money or other property of the decedent pay the indebtedness or deliver the property to the persons found to be entitled to receive it. 3. The decedent immediately prior to death had an estate for life or an interest as a joint tenant in property for which a certificate of termination was not issued and the court certifies that such interests terminated at death. 4. The estate started under Chapter 856 is terminated; upon filing of any account or receipts required by the court, the personal representative is discharged and any bond is cancelled. 5. The petitioner must inform known unsatisfied creditors as to the final disposition of the estate. 6. Letters of special administration are issued to upon filing a bond of $ , with the following powers: 7. Other: THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL IF SIGNED BY A CIRCUIT COURT JUDGE. Form completed by: (Name) Address Telephone Number Bar Number American LegalNet, Inc. www.FormsWorkFlow.com