1. Gave notice to interested persons and to creditors as required by law and that the time for filing claims expired prior to the date of this statement




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STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY

For Official Use



IN THE MATTER OF THE ESTATE OF


     



 Amended


Personal Representative’s Statement to Close Estate

(Informal Administration)


     

Case No.      


I VERIFY that I, or a prior personal representative whom I have succeeded:

1. Gave notice to interested persons and to creditors as required by law and that the time for filing claims expired prior to the date of this statement.


2. Fully administered the estate by making payment, settlement, or other disposition of all claims presented, expenses of administration, reasonable funeral and burial expenses, death and other taxes, except as otherwise specified below.


  1. Inventoried the assets of the estate, furnished a copy of the inventory to interested persons and distributed the assets to the persons entitled to them.

4.  No unpaid claims, expenses or taxes are outstanding.

 Made the following detailed arrangements to accommodate any unpaid claims:

       See attached

5. Sent a copy of this statement to all distributees of this estate and to all creditors or other claimants of whom I am aware whose claims are neither paid nor barred.


6. Furnished a full account of the administration, in writing, to all persons whose interests are affected.



  1. Paid attorney fees of $      .



  1. Understand that if no proceedings challenging this statement or otherwise involving me as personal representative are pending in the court 6 months after this statement is filed, my appointment as the personal representative terminates.



State of      

County of      

Subscribed and sworn to before me on      


Notary Public/Court Official

     

Name Printed or Typed
My commission/term expires:      





Personal Representative

     

Name Printed or Typed

     

Address

     
     

Telephone Number

     

Date

State of      

County of      

Subscribed and sworn to before me on      




Notary Public/Court Official

     

Name Printed or Typed
My commission/term expires:      




Personal Representative

     

Name Printed or Typed

     

Address

     
     

Telephone Number

     

Date




PR-1816, 03/12 Personal Representative’s Statement to Close Estate (Informal Administration) §865.16, Wisconsin Statutes

This form shall not be modified. It may be supplemented with additional material.




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