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Here is the text we could read:

STATE OF MICHIGAN

PROBATE COURT
COUNTY

TESTIMONY TO IDENTIFY HEIRS

CASE NO. and JUDGE

Court address

Court telephone no.

First, middle, and last name of decedent

In the matter of

1. My name is

. My address is

2. I am related to the decedent (or know his/her family) as follows:

3. The date and time of the death of the decedent is

and at that time the

Date

Time

decedent’s domicile (residence) was

Address

NOTE: IN THE FOLLOWING QUESTIONS, TREAT ALL PERSONS WHO DIED WITHIN 120 HOURS AFTER THE DECEDENT AS IF
THEY DID NOT SURVIVE THE DECEDENT. List persons who died within 120 hours after the decedent in item 14 below.

did not leave a surviving spouse.
left a surviving spouse named

a. The decedent had the following children, both natural (born in or out of wedlock) and adopted:

b. Of the children listed in 5a, the following are no longer heirs due to their adoption by someone other than a

c. Of the children listed in 5a, the following were not children of the surviving spouse:

Answer question 6 only if question 5a was checked.
6.

a. The following children listed in 5a died before the decedent:

b. Children listed in 6a left their own children (either natural or adopted) or left grandchildren from one or more of
their own predeceased children who survived the decedent. The names of these descendants and the name of
the child in 6a to whom they are related are as follows:

4. The decedent

stepparent:

c. Of the persons listed in 6b, the following are no longer heirs due to their adoption by someone other than a

stepparent:

Approved, SCAO
Form PC 565, Rev. 12/22
MCL 700.2103, MCL 700.2104, MCR 5.104(C), MCR 5.302(B),
MCR 5.308(B)(2)(a)
Page 1 of 3

PCS Code: TESTCS Code: TESTTestimony to Identify Heirs
Page 2 of 3

(12/22)

Case No.

If decedent left no surviving descendant, complete 7.
7. The decedent

did not leave a surviving parent.

left a surviving parent named

If decedent is not survived by spouse, descendants, or parents, complete 8 (and 9, if applicable).
8. The decedent
natural or adopted, whole blood or half blood, who were not adopted by others and who survived the decedent:

did not leave surviving brothers or sisters.

left the following brothers or sisters, either

9. One or more of the brothers and sisters of the decedent died before him/her leaving descendants, either natural or
adopted, who were not adopted by others and who survived the decedent. The names of these descendants, and

the name(s) of their deceased ancestor are

If decedent was not survived by spouse, descendants, parent, brother, or sister or children of deceased brother or sister,
complete10 (and 11, if applicable).
10. The decedent

left surviving grandparents (both maternal and paternal)

did not leave surviving grandparents.

11. Both maternal grandparents and/or both paternal grandparents died before decedent. Their surviving descendants
and their relationships to the grandparents are

named

Maternal grandparents:

Paternal grandparents:

12. The following heirs listed above are under legal disability and are currently living. Their name(s), legal disability, and

name(s) of their representative(s) are

13. The following deceased heirs survived the decedent by more than 120 hours. Their name(s) and the name(s) of
those who represent decedent’s interests are

14. The following persons identified above did not survive the decedent by 120 hours. Their names, relationships to
decedent, and the date and time of their deaths are:

NAME

RELATION

DATE OF DEATH

TIME OF DEATH

Testimony to Identify Heirs
Page 3 of 3

(12/22)

Case No.

15. The decedent left a will.

All devisees are heirs.
Some of the devisees named in the will or codicil are not heirs of the testator.

(A supplemental testimony form is completed and attached.)

I declare under the penalties of perjury that this testimony has been examined by me and that its contents are true to the
best of my information, knowledge, and belief.

Date

Signature

Attorney signature

Address

Name (type or print) Bar no.

City, state, zip Telephone no.

PC 565, Testimony to Identify Heirs

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/Estates-Trusts (2023-03)
Page(s): 3
Fields(s): 72
Average fields per page: 24
Reading Level: Grade 9
LIST Grouping(s): ES-02-00-00-00, ES-00-00-00-00, ES-03-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

court_address was Court address (0.63 conf)
first_middle_last_name was First middle and last name of decedent (0.43 conf)
address was My address is (0.46 conf)
undefined__1 was undefined (0.38 conf)
name was 1 My name is (0.36 conf)
undefined__2 was undefined_2 (0.39 conf)
signature_date__1 was Date (1.00 conf)
leave_surviving_spouse was did not leave a surviving spouse (0.45 conf)
left_surviving_spouse_named was left a surviving spouse named (0.48 conf)
undefined__3 was undefined_3 (0.39 conf)
decedent_following_children_natural_born_wedlock_adopted was a The decedent had the following children both natural born in or out of wedlock and adopted (0.48 conf)
children_longer_due_someone was b Of the children listed in 5a the following are no longer heirs due to their adoption by someone other than a (0.35 conf)
children_following_surviving was c Of the children listed in 5a the following were not children of the surviving spouse (0.41 conf)
undefined__4 was undefined_4 (0.39 conf)
stepparent__1 was stepparent (0.28 conf)
undefined__5 was undefined_5 (0.39 conf)
undefined__6 was undefined_6 (0.39 conf)
undefined__7 was undefined_7 (0.39 conf)
following_children_died was a The following children listed in 5a died before the decedent (0.33 conf)
children_left_either_one was b Children listed in 6a left their own children either natural or adopted or left grandchildren from one or more of (0.36 conf)
c_longer_due_someone was c Of the persons listed in 6b the following are no longer heirs due to their adoption by someone other than a (0.36 conf)
undefined__8 was undefined_8 (0.39 conf)
child_related_follows__1 was the child in 6a to whom they are related are as follows 1 (0.40 conf)
child_related_follows__2 was the child in 6a to whom they are related are as follows 2 (0.40 conf)
stepparent__2 was stepparent_2 (0.31 conf)
county was County (0.39 conf)
judge was Judge (0.39 conf)
court_telephone was Court telephone no (0.51 conf)
related_know_follows was 2 I am related to the decedent or know hisher family as follows (0.46 conf)
time was time (0.45 conf)
leave_surviving_parent was did not leave a surviving parent (0.45 conf)
left_surviving_parent_named was left a surviving parent named (0.48 conf)
decedent__1 was 7 The decedent (0.38 conf)
leave_brothers_sisters was did not leave surviving brothers or sisters (0.37 conf)
left_sisters_either was left the following brothers or sisters either (0.38 conf)
blood_others_survived__1 was natural or adopted whole blood or half blood who were not adopted by others and who survived the decedent 1 (0.41 conf)
blood_others_survived__2 was natural or adopted whole blood or half blood who were not adopted by others and who survived the decedent 2 (0.41 conf)
one_leaving_either was 9 One or more of the brothers and sisters of the decedent died before himher leaving descendants either natural or (0.34 conf)
names_deceased_ancestor was the names of their deceased ancestor are (0.38 conf)
undefined__9 was undefined_9 (0.39 conf)
leave_surviving_grandparents was did not leave surviving grandparents (0.34 conf)
left_surviving_maternal was left surviving grandparents both maternal and paternal (0.41 conf)
decedent__2 was 10 The decedent (0.38 conf)
maternal_paternal_surviving was 11 Both maternal grandparents andor both paternal grandparents died before decedent Their surviving descendants (0.46 conf)
relationships_grandparents was and their relationships to the grandparents are (0.38 conf)
undefined__10 was undefined_10 (0.39 conf)
following_legal_living was 12 The following heirs listed above are under legal disability and are currently living Their names legal disability and (0.33 conf)
following_deceased_heirs_survived_decedent_hours_names was 13 The following deceased heirs survived the decedent by more than 120 hours Their names and the names of (0.40 conf)
following_persons_identified_survive_decedent_hours_names_relationships was 14 The following persons identified above did not survive the decedent by 120 hours Their names relationships to (0.41 conf)
undefined__11 was undefined_11 (0.39 conf)
names_representatives was names of their representatives are (0.37 conf)
undefined__12 was undefined_12 (0.39 conf)
represent_decedents_interests was those who represent decedents interests are (0.43 conf)
undefined__13 was undefined_13 (0.39 conf)
name_row__1 was NAMERow1 (0.43 conf)
relation_row__1 was RELATIONRow1 (0.31 conf)
dat_e_f_death_row__1 was DATE OF DEATHRow1 (0.41 conf)
tim_e_f_death_row__1 was TIME OF DEATHRow1 (0.41 conf)
name_row__2 was NAMERow2 (0.43 conf)
relation_row__2 was RELATIONRow2 (0.31 conf)
dat_e_f_death_row__2 was DATE OF DEATHRow2 (0.41 conf)
tim_e_f_death_row__2 was TIME OF DEATHRow2 (0.41 conf)
decedent_left was 15 The decedent left a will (0.36 conf)
devisees_heirs was All devisees are heirs (0.44 conf)
devisees_named_codicil_heirs_testator was Some of the devisees named in the will or codicil are not heirs of the testator (0.41 conf)
signature_date__2 was Date_2 (1.00 conf)
name_type_print was Name type or print (0.45 conf)
bar was Bar no (0.41 conf)
users1_address_line_one was Address (1.00 conf)
users1_address_line_two was City state zip (1.00 conf)
telephone was Telephone no (0.44 conf)
text__1 was Text3 (0.35 conf)
text__2 was Text4 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

PC 565, Testimony to Identify Heirs

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02