Petition To Establish Death Of Accident Or Disaster Victim {PC 549}

Approved, SCAO OSM CODE: PEDSTATE OF MICHIGAN FILE NO. PROBATE COURT PETITION TO ESTABLISH DEATH OF COUNTY OF ACCIDENT OR DISASTER VICTIM In the matter of , presumed decedent1. I am interested in this matter as . 2. Presumed decedent information: Date of birth Social Security Number Name of foreign country if citizen of foreign country Domicile: City/Township/Village County State3. The presumed decedent apparently died as result of an accident or a disaster which occurred on or about (not less than 63 days nor more than 7 years after the accident/disaster) and , if known, Date Time a. at , within this county. Location b. upon or within the Great Lakes or their connecting waters, at a location adjacent to this county. c. at a location outside of Michigan or its adjoining waters but the presumed decedent was domiciled in this county at the time of death. 4. The facts and circumstances concerning the accident or disaster are as follows: 5. The reasons I believe the presumed decedent died in the accident or disaster are as follows: (PLEASE SEE OTHER SIDE) Do not write below this line - For court use only PC 549 (9/02) PETITION TO ESTABLISH DEATH OF ACCIDENT OR DISASTER VICTIM MCL 700.1207(e), (f), MCL 700.1208<<<<<<<<<********>>>>>>>>>>>>> 2 is unidentifiable. 6. The body of the presumed decedent has disappeared. 7. The name, age, and relationship to the presumed decedent and the address of each person known or believed to be an heir of the presumed decedent are as follows: NAME AGE RELATIONSHIP RESIDENCE 8. Of the above heirs, the following are under legal disability: REPRESENTED BY: NAME DISABILITY (name, address, capacity) I REQUEST that the court establish the location of the accident or disaster, the cause, and date of the presumed decedents death,and, if possible, the time of death. I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best of myinformation, knowledge, and belief. Date Petitioner signature Attorney signature Attorney name (type or print) Bar no. Petitioner name (type or print) Address Address City, state, zip Telephone no. City, state, zip Telephone no.