PR-1963, 10/10 Petition for Transfer of Residue (Ancillary Administration) 247868.03, 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 Transfer of Residue (Ancillary Administration) Case No. UNDER OATH, I STATE: 1. I was issued ancillary letters. 2. in Wisconsin from [Date] to [Date of death or Date of prior account] . See attached Inventory Value at Date of D eath $ See attached Additional Items Received Amount $ See attached Items Disbursed Amount $ 3. All claims allowed in Wisconsin were paid. 4. All taxes and charges levied or incurred in Wisconsin were paid. 5. The following assets remain for transfer to the representative in the domiciliary jurisdiction: See attached Assets Remaining to be Transferred Amount $ 6. Other: American LegalNet, Inc. www.FormsWorkFlow.com PR - 1963, 10/10 Petition for Transfer of Residue (Ancillary Administration) � 868.03, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 I REQUEST THE COURT : 1. A llow t he account. 2. A uthorize the transfe r of any movable assets on hand to the representative in the domiciliary jurisdiction. as follows: 3. T erminate a ncillary l etters and cancel any bond in Wisconsin . 4. Other: State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Local Representative Name Printed or Typed Address Telephone Number Date Form completed by: (Name) Address Telephone Number Bar Number