Approved, SCAO

STATE OF MICHIGAN
PROBATE COURT
COUNTY OF

Estate of

a hearing.

except as follows:

SWORN CLOSING STATEMENT,
SUMMARY PROCEEDING
Small Estates

JIS CODE: CIS

FILE NO.

1. I am the personal representative and upon filing this sworn closing statement with the court, this estate will be closed without

2. The interested persons, addresses, and their representatives are identical to those appearing on the initial application/petition

.

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 administration costs
and expenses, reasonable funeral and burial expenses, homestead allowance, family allowance, exempt property, and the
reasonable and necessary medical and hospital expenses of the decedent's last illness.  The value of the estate is shown on the
inventory that I sent to all 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 creditors or other claimants and
demandants, of whom I am aware, whose claims are neither barred nor paid.  I furnished a full written account of the estate
administration to the distributees whose interests are affected.

Personal representative signature

Personal representative name (type or print)

Sworn to before me on

My commission expires:

Date

Date

Notary public, State of Michigan, County of

Address

City, state, zip

,

Signature:

Telephone no.

  County, Michigan.

Attorney signature

Address

Attorney name (type or print)

Bar no.

City, state, zip

Telephone no.

NOTICE TO INTERESTED PERSON(S):  You may object to this sworn closing statement by filing written objections with the probate
court mentioned above along with a $20.00 filing fee.  If an objection is not filed within 28 days after this sworn closing statement
is filed with the court, the probate register will issue a certificate stating that it appears that I have fully administered this estate.  The
certificate does not preclude any action against me or the surety on a bond that I may have obtained.  If an action or proceeding involving
me is not pending in this court one year after this sworn closing statement is filed, my appointment ends.

Do not write below this line - For court use only

PC 590   (9/07)   SWORN CLOSING STATEMENT, SUMMARY PROCEEDING, Small Estates

MCL 700. 3205, MCL 700.3988,
MCR 5.311(A)