Sworn Closing Statement Summary Proceeding Small Estates {PC 590}

Approved, SCAO OSM CODE: CISSTATE OF MICHIGAN FILE NO. PROBATE COURT SWORN CLOSING STATEMENT, COUNTY OF SUMMARY PROCEEDING Small Estates Estate of 1. I am the personal representative and upon filing this sworn closing statement with the court, this estate will be closed with out a hearing. 2. The interested persons, addresses, and their representatives are identical to those appearing on the initial application/peti tion except as follows: 3. The estate is not under supervised administration and I have not been prohibited by court order from filing this statement. 4. To the best of my knowledge the value of the entire estate less liens and encumbrances did not exceed homestead allowances, family allowances, exempt property, costs and expenses of administration, reasonable funeral expenses, and reasonable, necessary medical and hospital expenses of the last illness of the decedent. The value of the estate is shown on the inventory that I sent to all of the interested persons. 5. I fully administered the estate by disbursing and distributing it to the persons entitled to it. 6. I delivered a copy of this sworn closing statement to the distributees of the estate and to all claimants and demandants, of whom I am aware, whose claims are not barred and have not been paid. I furnished a written full account of the administration to t he distributees whose interests are affected. Personal representative signature Sworn to before me on , County, Michigan. Date My commission expires: Signature: Date NOTICE TO INTERESTED PERSON(S): You may object to this sworn closing statement by filing written objections with the above mentioned probate court along with a $15.00 filing fee. If an objection is not filed within 28 days after this sworn closing s tatementis filed with the court, the probate register will issue a certificate stating that it appears I have fully administered this e state. Thecertificate does not preclude any action against me or the surety on a bond I may have obtained. If an action or proceeding in volvingme is not pending in this court one year after this sworn closing statement is filed, my appointment ends. Attorney signature Attorney name (type or print) Bar no. Personal representative name (type or print) Address Address City, state, zip Telephone no. City, state, zip Telephone no. Do not write below this line - For court use only MCL 700.3988; MSA 27.13988,PC 590 (3/00) SWORN CLOSING STATEMENT, SUMMARY PROCEEDING, Small Estates MCR 5.311(A)