FORM SUMMARY Name of Form: Summary Assignment - Findings and Order Form Number: PR-1844 Statutory Reference: §867.02, Wisconsin Statutes Benchbook Reference: PR-8 Purpose of Form: To assign the property to those entitled to it. May include order appointing special administrator. Who Completes It: Petitioner or attorney. Distribution of Form: Original to court. Accompanying Forms: New Form/Modification: Modification; last update 01/06. Modifications: Changed Department of Health and Family Services to Department of Health Services. 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: 04/24/2008 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use COUNTY STATE OF WISCONSIN, CIRCUIT COURT, Summary Assignment Findings and Order IN THE MATTER OF with Order Appointing Special Administrator Case No. A petition for summary assignment having been filed, THE COURT FINDS THAT: , and date of death was 1. The decedent, whose date of birth was , County, State of , died domiciled in . with a post office address of: . 2. Petitioner is interested as was not has been waived has been given as required by the court 3. Notice to interested persons: required. and more than 30 days have 4. The first publication of notice to creditors was made on (date) elapsed since that date. 5. Notice has been given to the Department of Health Services and more than 30 days have elapsed since that notice was given. 6. The estate is one properly settled under summary assignment in that: (Select either A or B below.) A. the estate was started under formal administration or summary settlement and meets the requirements of summary assignment. 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 cannot be summarily settled under §867.01, Wisconsin Statutes. 7. The decedent: A. left a will which has been filed and proof of the will has been given. B. died leaving no will. 8. A detailed statement of all property subject to administration including any encumbrance, lien, or other charge upon See attached. each is as follows: Description of Property Value of Decedent’s Interest at Date of Death A. Property Subject to Administration $ B. Encumbrances, liens or other charges upon each item: ($ C. Net value of Property Subject to Administration (Total value from Section A above less total from Section B above) PR-1844, 04/08 Summary Assignment - Findings and Order ) $ §867.02, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com Summary Assignment - Findings and Order Page 2 of 3 Case No. 9. The estate is appropriate to be settled under summary assignment. A. The priority claims against the estate under §859.25, Wisconsin Statutes are: Creditors Entitled to Payment Amount (1) Costs and expenses of administration: (2) Funeral and burial expenses: (3) Provisions for the family of the decedent under §§861.31, 861.33 and 861.35, Wis. Stats.: (4) Other priority claims under §859.25, Wis. Stats.: B. Persons entitled to be assigned property are: Person(s) Entitled to Assignment Interest to be Assigned 10. Any interest of the decedent as joint tenant terminated at death. 11. Any life estate of the decedent terminated at death. 12. Any interest of the decedent in survivorship marital property vested in the surviving spouse at death. 13. It is necessary to appoint a special administrator with the following powers: PR-1844, 04/08 Summary Assignment - Findings and Order §867.02, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com Summary Assignment - Findings and Order Page 3 of 3 Case No. THE COURT ORDERS THAT: 1. The property is assigned to the persons entitled to it as stated below. 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 as stated below. 3. Interests in real estate, stocks or bonds registered in the name of the decedent, the title of licensed motor vehicle, or any other form of property are transferred to: Person(s) Entitled to Receive Description of Property Value 4. If the decedent immediately prior to death had an estate for life or an interest as a joint tenant or in survivorship marital property, in any property for which a certificate of termination has not been issued, the court certifies that such interests terminated or vested at death. 5. The estate commenced under Chapter 856 is terminated; the personal representative is discharged and any bond is cancelled. 6. The petitioner shall mail or deliver a copy of this order to all persons interested in the estate whose post office address is known to the petitioner or can be ascertained with reasonable diligence. 7. Letters of Special Administration are issued to bond of $ upon filing a , with the following powers: THIS IS FINAL JUDGMENT/ORDER FOR PURPOSES OF APPEAL. BY THE COURT: Name of Attorney Circuit Court Judge/Court Commissioner Address Name Printed or Typed Date Telephone Number PR-1844, 04/08 Summary Assignment - Findings and Order §867.02, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com