For Official Use SAMPLE WILLIAM ELLIOTT, deceased Amended Informal Administration Formal Administration Case No. 1. I consent to serve as personal representative special administrator of this estate. I accept the duties, submit personally to the jurisdiction of the court in any proceeding relating to the estate that may be instituted by any interested person and agree to be bound by the laws of Wisconsin. 2. I will file any required bond. 3. I am a nonresident of Wisconsin. I appoint (Name) as resident agent to accept service of process. Mary Smith Signature Mary Smith Name Printed or Typed 555 Blank Street Address Someplace, WI (715) 999-9999 Telephone Number July 30, 2011 Date Acceptance by Resident Agent I accept appointment as resident agent for this estate to accept service of process. Resident Agent Name Printed or Typed Form completed by: (Name) Mary Smith Address Address 555 Street Someplace, WI 51111 Telephone Number Telephone Number (715) 999-9999 Bar Number (If any) N/A Date
555 Blank Street Address Someplace, WI Form completed by: (Name) Mary Smith Address 555 Blank Street Someplace, WI 51111 December 28, 2011 Date Telephone Number (715) 999-9999 Bar Number (If any) N/A , 03/12 (Informal Administration or Formal 865.21, and 867.21, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, (DECEDENT'S COUNTY) COUNTY For Official Use SAMPLE WILLIAM ELLIOTT, Amended Informal Administration Formal Administration deceased Case No. 11PR111 1. I received from the personal representative special administrator of this estate the following: Describe of property or monies received 2009 ACME GTS automobile - VIN 2010GB543W789 $26,500.00 Antique Shaker corner cabinet, silver dollar collection, sterling silver tea set, appliances 19,100.00 ¼ residual share 38,709.82 2. This is a partial full distribution of my share of the estate. 3. This is a full satisfaction of the claim filed by _________________________ in the amount of $___________. 4. This is a distribution of funds to trust. (Identify Trust) . 5. Other: . Signature Brown Name Printed or Typed 100 Second Street Address Someplace, WI 51111 Form completed by: (Name) Mary
For Official Use SAMPLE THE ESTATE OF WILLIM ELLIOTT, deceased For the following trust: For the benefit of John Miller Amended in Estate or Proceedings June 1, 2009 Date of Birth Case No. I/we (Names) Mary Smith , principal(s) and (Names) Larry Smith , surety(ies) are liable to the Circuit Court in the sum of $100,000.00 for which payment I/we bind my/ourselves and my/our estate(s), jointly and severally. If the principal faithfully performs duties as personal representative; special administrator; testamentary trustee; petitioner in summary settlement/assignment; assignee in summary assignment, to satisfy liability to creditors or other persons interested in the estate; Other: then this bond obligation shall be void; otherwise it shall remain in full force and effect. Witnessed By: Signature Signature (Seal) Signature of Principal (Seal) Signature of Principal I, being sworn as a surety, state that I am an adult resident of Wisconsin, residing in County. I am financially responsible for the actions of the principal(s) in the amount of this bond. I shall provide satisfactory evidence to the designated court officer. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: Signature of Surety Address Signature of Surety Address Satisfactory evidence as to financial responsibility of surety has been reviewed by the designated court officer. Designated Court Official APPROVED BY: Court Official Name Printed or Date Bond Approved Form completed by: (Name) Address Telephone Number Bar Number (If any) PR-1809, 10/10 Signature Bond in Estate or Trust Proceedings Chapters 701, 851 – 879, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material.