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First And Final Report Of Personal Representative PR-165 - California

First And Final Report Of Personal Representative Form. This is a California form and can be used in Probate San Diego Local County .
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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO 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; CASE NUMBER 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 FOR EXTRAORDINARY SERVICES; WITHHOLDING; REISSUANCE / EXTENSION OF LETTERS Petitioner(s) (name(s)) 1. Decedent (name) being a resident of the State of 2. Will dated this court on (date) 3. Petitioner qualified as executor County of San Diego, State of California / at time of death. and codicil dated . administrator died testate intestate on (date) allege(s): County of was/were admitted to Probate Court by order of administrator with will annexed and Letters (JC Form #DE-150) were issued to petitioner on (date) . At all times since then, petitioner has been and now is duly qualified as the personal representative of the decedent's estate. 4. On (date) , by order of this court, petitioner was authorized to administer the estate with no authority. full limited authority and without court supervision under the Independent Administration of Estate Act, or This authority has not been revoked. 5. Petitioner's report covers the period of (date of death) Waiver of Accounting through . All beneficiaries or heirs waive an accounting and the required Waivers of Accounting are filed in this proceeding. 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 creditor's claims has expired. SDSC PR-165 (Rev. 04/15) Optional Form FIRST AND FINAL REPORT OF PERSONAL REPRESENTATIVE & PETITION FOR FINAL DISTRIBUTION Prob. Code §§ 10831, 10951, 10954, 11640 et seq. Page 1 of 10 American LegalNet, Inc. www.FormsWorkFlow.com ESTATE OF CASE NUMBER 8. OR Other than taxes or creditor claims addressed in this petition, petitioner has no reason to believe that any public entity listed in Prob. Code § 9201 has any basis for making a claim against the estate. Notice was sent as follows: Date Mailed Sales and Use Tax Use Fuel Tax Cigarette Tax Unemployment Insurance Motor Vehicle Fuel License Tax Franchise and Income Tax Alcohol Beverage Tax State Hospital for Mentally Disordered Date Mailed 9. a. The notice required by Prob. Code § 9202(a) was served on the California Department of Health Care Services on (date) 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. , with a copy of the decedent's death certificate and with a copy of the death certificate of the . decedent's pre-deceased spouse or registered domestic partner (name) 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 § 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 § 9202(b) on (date) . . c. The notice given pursuant to Prob. Code § 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: Name Date Filed Continued on Attachment 10. 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). Name Continued on Attachment 11. 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 referee's fees have been paid, and the estate is now in a condition to be closed. SDSC PR-165 (Rev. 4/15) Optional Form FIRST AND FINAL REPORT OF PERSONAL REPRESENTATIVE & PETITION FOR FINAL DISTRIBUTION Prob. Code §§ 10831, 10951, 10954, 11640 et seq. Page 2 of 10 American LegalNet, Inc. www.FormsWorkFlow.com ESTATE OF CASE NUMBER 13. The following Inventory and Appraisal(s) (JC Form #DE-160) have been filed with the court: Date Filed Partial No.: ________ Partial No.: ________ Partial No.: ________ Final Final Final Type Supplemental Supplemental Supplemental Continued on Attachment 13. Amount Corrected/Amended Corrected/Amended Corrected/Amended Total Inventory and Appraisal Value: 14. The estate consists of 15. entirely a combination of decedent's separate community quasi-community property. 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: Name Continued on Attachment 15. 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 no
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