STATE OF MICHIGAN

PROBATE COURT
COUNTY

ORDER ESTABLISHING DEATH OF 
ACCIDENT OR DISASTER VICTIM
(Part 1)

CASE NO. and JUDGE

Court address              

 

 

 

Court telephone no.

2. An accident or disaster occurred on 

 in which the following person was killed or may be 

1. Notice of hearing was given to or waived by all interested persons.

presumed to have died: 

Name

Date

                                         

XXX-XX-
Last four digits of social security no. 

 

 

Date of birth

Street address                                                      City                                          State                           Zip

 .

 .

In the matter of 

First, middle, and last name

THE COURT FINDS:

                     

 

 

 

 

   

3. The accident or disaster occurred at 

 

4. The above described person is dead.

5. The date of death is 

Date

6. The time of death

 is at or about 

Time

 m.

 is not possible to ascertain.

   

 

 

 

 

IT IS ORDERED the death of the presumed decedent is established in accordance with the above findings.

 

                     

Judge signature and date

JIS Code: OEDApproved, SCAOForm PC 550, Rev. 5/21MCL 700.1207, MCL 700.1208Page 1 of 1Distribute form to:Court, Part 2Petitioner, Part 1Interested persons, Part 2STATE OF MICHIGAN

PROBATE COURT
COUNTY

ORDER ESTABLISHING DEATH OF 
ACCIDENT OR DISASTER VICTIM
(Part 2)

CASE NO. and JUDGE

Court address              

 

 

 

Court telephone no.

1. Notice of hearing was given to or waived by all interested persons.

2. An accident or disaster occurred on 

 in which the following person was killed or may be 

Date

Last four digits of social security no. 

Date of birth

 

 

Street address                                                      City                                          State                           Zip

 .

 .

In the matter of 

First, middle, and last name

THE COURT FINDS:

presumed to have died: 

Name

                                         

                     

 

 

 

 

   

3. The accident or disaster occurred at 

 

4. The above described person is dead.

5. The date of death is 

Date

6. The time of death

 is at or about 

Time

 m.

 is not possible to ascertain.

   

 

 

 

 

IT IS ORDERED the death of the presumed decedent is established in accordance with the above findings.

 

                     

Judge signature and date

JIS Code: OEDApproved, SCAOForm PC 550, Rev. 5/21MCL 700.1207, MCL 700.1208Page 1 of 1Distribute form to:Court, Part 2Petitioner, Part 1Interested persons, Part 2