First And Final Report Of Personal Representative {PR-165}

SDSC PR-165 (Rev. 6/16) FIRST AND FINAL REPORT OF PERSONAL REPRESENTATIVE & Prob. Code 247247 10831, 10951, 10954, Optional Form PETITION FOR FINAL DISTRIBUTION 11640 et seq. Page 1 of 10 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TELEPHONE NO.: FAX NO. (Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA 92101 CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101 ESTATE OF FIRST AND FINAL REPORT OF PERSONAL REPRESENTATIVE & PETITION FOR FINAL DISTRIBUTION ON: WAIVER OF ACCOUNT OR ACCOUNT; PAYMENT OF STATUTORY FEES TO PERSONAL REPRESENTATIVE OR WAIVER OF FEES; PAYMENT OF STATUTORY FEES TO ATTORNEY OR WAIVER OF FEES; PAYMENT OF COSTS / REIMBURSEMENTS; ATTORNEY FOR EXTRAORDINARY SERVICES; PERSONAL REPRESENTATIVE WITHHOLDING; REISSUANCE / EXTENSION OF LETTERS CASE NUMBER Petitioner(s) (name(s)) allege(s): 1. Decedent (name) died testate intestate on (date) being a resident of County of San Diego, State of California / County of State of at time of death. 2. Will dated and codicil dated was/were admitted to Probate Court by order of this court on (date) . 3. Petitioner qualified as executor administrator administrator with will annexed and Letters (JC Form #DE-150) the personal representative of the decedent222s estate. 4. On (date) , by order of this court, petitioner was authorized to administer the estate with full limited authority and without court supervision under the Independent Administration of Estate Act, or no authority. This authority has not been revoked. 5. Petitioner222s report covers the period of (date of death) through . Waiver of Accounting Schedule of assets on hand at end of reporting period are attached as Attachment 5. Schedules of receipts, gains, and/or losses are attached as Attachment 5 (Refer to Cal. Rules of Court, rule 7.550(b)(6)). Accounting A summary of accounting and accounting schedules are attached as Attachment 5. 6. Notice of Petition to Administer Estate (JC Form #DE-121) has been published for the period and in the manner as prescribed by law, and within thirty (30) days after completion of the publication, there was filed with the clerk of this court, an affidavit, showing the publication in the manner and form required by law.7. More than four (4) months have elapsed since the issuance of Letters (JC Form #DE-150). Reasonable efforts were made to identify creditors of the estate and a Notice of Administration (JC Form #DE-157) has has not been sent to all known creditors of the estate. The time for filing and presenting creditor222s claims has expired. American LegalNet, Inc. www.FormsWorkFlow.com ESTATE OF CASE NUMBER SDSC PR-165 (Rev. 6/16) FIRST AND FINAL REPORT OF PERSONAL REPRESENTATIVE & Prob. Code 247247 10831, 10951, 10954, Optional Form PETITION FOR FINAL DISTRIBUTION 11640 et seq. Page 2 of 10 8. Other than taxes or creditor claims addressed in this petition, petitioner has no reason to believe that any public entity listed in Prob. Code 247 9201 has any basis for making a claim against the estate. OR Notice was sent as follows: Date Mailed Date Mailed Sales and Use Tax Motor Vehicle Fuel License Tax Use Fuel Tax Franchise and Income Tax Cigarette Tax Alcohol Beverage Tax Unemployment Insurance State Hospital for Mentally Disordered 9. a. The notice required by Prob. Code 247 9202(a) was served on the California Department of Health Care Services on (date) , with a copy of the decedent222s death certificate and with a copy of the death certificate of the decedent222s pre-deceased spouse or registered domestic partner (name) . OR The decedent did did not receive and was was not the surviving spouse or registered domestic partner of a person who received Medi-Cal benefits. b. Petitioner knows of no heir that is confined in a prison or facility under the jurisdiction of the Department of Corrections or the Department of Youth Authority or confined in any county jail, road camp, industrial farm, or other local correctional facility to which notice is required under Prob. Code 247 9202(b); therefore, no notice is required to be given to the Director of the California Victim Compensation and Government Claims Board. OR Notice was given as required under Prob. Code 247 9202(b) on (date) . c. The notice given pursuant to Prob. Code 247 9202(c) was mailed to the Franchise Tax Board on (date) . 10. No Requests for Special Notice (JC Form #DE-154) have been filed in this proceeding. OR The following requests for special notice have been filed in this proceeding: Continued on Attachment 10. Name Date Filed Relationship 11. Petitioner has given notice to all persons entitled to notice, including those listed above who have requested special notice (SDSC Local Rule 4.5.1). Continued on Attachment 11. Name Address Where Notice was Sent 12. Petitioner has performed all required duties as personal representative of the estate. All costs of administration incurred to date, including costs of publication and the probate referee222s fees have been paid, and the estate is now in a condition to be closed. American LegalNet, Inc. www.FormsWorkFlow.com ESTATE OF CASE NUMBER SDSC PR-165 (Rev. 6/16) FIRST AND FINAL REPORT OF PERSONAL REPRESENTATIVE & Prob. Code 247247 10831, 10951, 10954, Optional Form PETITION FOR FINAL DISTRIBUTION 11640 et seq. Page 3 of 10 13. The following Inventory and Appraisal(s) (JC Form #DE-160) have been filed with the court: Continued on Attachment 13. Date Filed Type Amount Partial No.: Final Supplemental Corrected/Amended Partial No.: Final Supplemental Corrected/Amended Partial No.: Final Supplemental Corrected/Amended Total Inventory and Appraisal Value: 14. The estate consists of entirely a combination of decedent222s separate community quasi-community property. 15. Petitioner alleges that no family or affiliate relationships exist between petitioner and any agent hired by petitioner during the period of administration. OR The following family or affiliates were hired: Continued on Attachment 15. Name Capacity Retained Relationship 16. There was no cash to invest in interest-bearing accounts. OR At all times during the period of administration, petitioner has kept all surplus cash in interest-bearing accounts. 17. Petitioner did not take any action without prior court approval under the Independent Administration of Estates Act for which notice of proposed action was required. OR Petitioner took the following action without prior court approval under the Independent Administration of Estate Act for which notice of proposed action was required. Continued on Attachment 17. Nature of Action Date Action was Taken When & to Whom Notice was Given (Name & Date) Notice Waived (Name & Date) Objections Received (Name & Date) American LegalNet, Inc. www.FormsWorkFlow.com ESTATE OF CASE NUMBER SDSC PR-165 (Rev. 6/16) FIRST AND FINAL REPORT OF PERSONAL REPRESENTATIVE & Prob. Code 247247 10831, 10951, 10954, Optional Form PETITION FOR FINAL DISTRIBUTION 11640 et seq. Page 4 of 10 18. No Creditor222s Claim(s) (JC Form #DE-172) has/have been filed with the court. OR The following Creditor222s Claim(s) (JC Form #DE-172) was/were filed with the court: Continued on Attachment 18. Date Claim Filed Claimant Amount of Claim Amount Allowed Amount Denied Date Allowed / Denied 19. The following written demands for payment were received within four months after Letters (JC Form #DE-150) were first issued, and were treated as filed claims and paid before the expiration of 30 days after the four month period, and (1) the debts were justly due; (2) the debts were paid in good faith; (3) the amounts paid were the true amounts of the indebtedness over and above all payments and offsets; and (4) the estate is solvent. Continued on Attachment 19. Date Paid Payee Description Amount 20. The estate is solvent insolvent and petitioner has paid not paid all debts of the decedent and the estate and all expenses of administration except closing expenses and statutory fees. 21. No federal or state estate tax return has been filed, taxes