FORM SUMMARY Name of Form: Petition and Certificate of Joint Tenancy Termination/Life Estate Termination/Survivorship Marital Property Vesting/ Transfer on Death to Beneficiary Form Number: PR-1929 Statutory Reference: §§705.10(4), 705.15, 867.04 and 867.046, Wisconsin Statutes Benchbook Reference: Purpose of Form: To provide evidence of termination of the decedent’s interest(s) in property or vesting interest in survivorship marital property in surviving spouse. Who Completes It: Petitioner or attorney. Distribution of Form: Original to court. Accompanying Forms: None. New Form/Modification: Modification; last update 04/06. Modifications: Corrected to comply with 2005 Wisconsin Act 216. Comments: About this form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 10/11/2007 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use COUNTY STATE OF WISCONSIN, CIRCUIT COURT, Amended IN THE MATTER OF THE ESTATE OF Petition and Certificate of Joint Tenancy Termination Life Estate Termination Survivorship Marital Property Vesting Transfer on Death to Beneficiary Case No. UNDER OATH, I STATE THAT: , and my address is . 1. I am a person interested in the property as 2. The decedent whose date of birth was died domiciled in address of: , and date of death was , with a post office County, State of . County, 3. At the time of death the decedent had the following interests(s) in property in survivorship marital property. life estate. joint tenancy. Wisconsin: interest in real property with a designated transfer on death beneficiary. money or other benefits due or property subject to disposition in a controlling instrument (controlling instrument attached). The legal description of the property, the decedent’s interest and recording data are as follows: See attached I REQUEST THAT THE COURT ISSUE A: certificate of termination of joint tenancy. certificate of termination of life estate. certificate that survivorship marital property vested at death in the surviving spouse. certificate of transfer of the decedent’s interest in real property to the designated beneficiary. certificate of transfer of money controlled by or owned by decedent to the person designated in the controlling instrument. Subscribed and sworn to before me on Signature of Petitioner Notary Public/Court Official Name Printed or Typed My commission expires: Date PR-1929, 10/07 Petition and Certificate of Joint Tenancy Termination/Life Estate Termination/ Survivorship Marital Property Vesting/Transfer on Death to Beneficiary §§705.10(4), 705.15, 867.04 and 867.046, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Petition and Certificate of Petition and Certificate of Joint Tenancy Termination/Life Estate Termination/ Survivorship Marital Property Vesting/Transfer on Death to Beneficiary Page 2 of 2 Case No. _______________ CERTIFICATE Based on the above petition, the court certifies the date of death and: termination of joint tenancy. termination of life estate. survivorship marital property vested at death in surviving spouse. transfer of the decedent’s interest in real property to the designated beneficiary. transfer to person designated in a controlling instrument. BY THE COURT: Name of Attorney Circuit Court Judge/Court Commissioner Address Name Printed or Typed Telephone Number Bar Number Date PR-1929, 10/07 Petition and Certificate of Joint Tenancy Termination/Life Estate Termination/ Survivorship Marital Property Vesting/Transfer on Death to Beneficiary §§705.10(4), 705.15, 867.04 and 867.046, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com