PR-1945, 10/10 Petition for Certificate of Descent/Judgment Determining Descent 247867.05, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Name Amended Petition for Certificate of Descent Judgment Determining Descent Case No. UNDER OATH, I STATE: 1. The decedent, with date of birth and date of death , was domiciled in County, State of , with a mailing address of or had no domicile in Wisconsin. Property of decedent is located in this county. 2. The tor as can be ascertained with due diligence is as follows: 3. I am interested as . 4. The decedent died intestate. 5. The estate was not 6. The names and mailing addresses of all heirs of decedent or their grantees entitled to an interest in the property are as follows: (For any person with disabilities, also list any guardian of estate; for any person in the military, also list attorney or attorney in fact; and for any minor, list date of birth.) See attached Name Relationship Mailing Address If Minor, Date of Birth American LegalNet, Inc. www.FormsWorkFlow.com PR-1945, 10/10 Petition for Certificate of Descent/Judgment Determining Descent 247867.05, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 7. This estate is not subject to an inheritance tax, OR This estate may be subject to an inheritance tax. A petition was filed for Appointment of a Special Administrator with powers to determine the tax. 8. Decedent left the following described property for which a determination of descent is sought. See attached Legal Description 9. The heirs or their grantees respective rights and interests in the property are as follows: See attached Name of Heir or Grantee Interest in Property 10. Other: I REQUEST THE COURT: 1. Determine the heirs of decedent and descent of the property and issue a certificate of descent. a judgment determining descent. 2. Other: 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 (If any) American LegalNet, Inc. www.FormsWorkFlow.com