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Here is the text we could read:

STATE OF MICHIGAN

CASE NO. and JUDGE

PROBATE COURT
COUNTY

PETITION TO ESTABLISH DEATH OF
ACCIDENT OR DISASTER VICTIM

Court address

Court telephone no.

In the matter of

First, middle, and last name

, presumed decedent

Petitioner’s name, address, and telephone no.

Petitioner’s attorney, bar no., address, and telephone no.

1. I am interested in this matter as

2. Presumed decedent information:

Put DOB in Ref. No.
row 1 on MC 97.
Date of birth

XXX-XX-
Last four digits of SSN

Put last 4 digits of SSN in
Ref. No. row 2 on MC 97.

Domicile:

City/Township/Village

County

State

Name of foreign country if citizen of foreign country

3. This petition is being filed not less than 63 days nor more than 7 years after the accident/disaster.

4. The presumed decedent apparently died as a result of an accident or a disaster which occurred on or about

Date

a. at

Location

and

Time

, if known,

, within this county.

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.

5. The facts and circumstances concerning the accident or disaster are as follows:

Approved, SCAO
Form PC 549, Rev. 5/21
MCL 700.1207(e), (f), MCL 700.1208
Page 1 of 2

JIS Code: PEDPetition to Establish Death of Accident or Disaster Victim
Page 2 of 2

(5/21)

6. The reasons I believe the presumed decedent died in the accident or disaster are as follows:

Case No.

7. The body of the presumed decedent

is unidentifiable.
has disappeared.

8. 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

9. Of the above heirs, the following are under legal disability:

NAME

DISABILITY

REPRESENTED BY:
(name, address, capacity)

I REQUEST that the court establish the location of the accident or disaster, the cause, and date of the presumed decedent’s
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 my information, knowledge, and belief.

Date

Petitioner signature

Attorney signature

PC 549, Petition to Establish Death of Accident or Disaster Victim

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): 2
Fields(s): 79
Average fields per page: 39
Reading Level: Grade 8
LIST Grouping(s): ES-00-00-00-00, ES-02-00-00-00.

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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.

stat_e_f_michiga_n_probat_cour_county was STATE OF MICHIGAN PROBATE COURT COUNTY (0.62 conf)
first_last_name_presumed was First middle and last name of presumed decedent (0.40 conf)
petitioners_name_address was Petitioners name address and telephone no (0.40 conf)
petitioners_attorney_address was Petitioners attorney bar no address and telephone no (0.52 conf)
undefined was undefined (0.38 conf)
name_foreign_country_citizen was Name of foreign country if citizen of foreign country (0.44 conf)
city_township_village was CityTownshipVillage (0.32 conf)
county was County (0.39 conf)
users1_address_state was State (1.00 conf)
signature_date__1 was Date (1.00 conf)
time was Time (0.45 conf)
location was Location (0.40 conf)
a_at was a at (0.31 conf)
within_great_connecting_adjacent was b upon or within the Great Lakes or their connecting waters at a location adjacent to this county (0.37 conf)
outside_adjoining_county was c at a location outside of Michigan or its adjoining waters but the presumed decedent was domiciled in this county at (0.39 conf)
unknown__1 was 1 (0.38 conf)
unknown__2 was 2 (0.38 conf)
unknown__3 was 3 (0.38 conf)
unknown__4 was 4 (0.38 conf)
unknown__5 was 5 (0.38 conf)
judge was Judge (0.39 conf)
text__1 was Text2 (0.35 conf)
text__2 was Text3 (0.35 conf)
facts_concerning_follows was 5 The facts and circumstances concerning the accident or disaster are as follows (0.39 conf)
presumed_accident_disaster was 6 The reasons I believe the presumed decedent died in the accident or disaster are as follows (0.42 conf)
1_2 was 1_2 (0.38 conf)
2_2 was 2_2 (0.38 conf)
3_2 was 3_2 (0.38 conf)
unidentifiable was is unidentifiable (0.33 conf)
disappeared was has disappeared (0.36 conf)
name_row__1 was NAMERow1 (0.43 conf)
age_row__1 was AGERow1 (0.36 conf)
relationship_row__1 was RELATIONSHIPRow1 (0.39 conf)
residence_row__1 was RESIDENCERow1 (0.37 conf)
name_row__2 was NAMERow2 (0.43 conf)
age_row__2 was AGERow2 (0.36 conf)
relationship_row__2 was RELATIONSHIPRow2 (0.39 conf)
residence_row__2 was RESIDENCERow2 (0.37 conf)
name_row__3 was NAMERow3 (0.43 conf)
age_row__3 was AGERow3 (0.36 conf)
relationship_row__3 was RELATIONSHIPRow3 (0.39 conf)
residence_row__3 was RESIDENCERow3 (0.37 conf)
name_row__4 was NAMERow4 (0.43 conf)
age_row__4 was AGERow4 (0.36 conf)
relationship_row__4 was RELATIONSHIPRow4 (0.39 conf)
residence_row__4 was RESIDENCERow4 (0.37 conf)
name_row__5 was NAMERow5 (0.43 conf)
age_row__5 was AGERow5 (0.36 conf)
relationship_row__5 was RELATIONSHIPRow5 (0.39 conf)
residence_row__5 was RESIDENCERow5 (0.37 conf)
name_row__6 was NAMERow6 (0.43 conf)
age_row__6 was AGERow6 (0.36 conf)
relationship_row__6 was RELATIONSHIPRow6 (0.39 conf)
residence_row__6 was RESIDENCERow6 (0.37 conf)
name_row__7 was NAMERow7 (0.43 conf)
age_row__7 was AGERow7 (0.36 conf)
relationship_row__7 was RELATIONSHIPRow7 (0.39 conf)
residence_row__7 was RESIDENCERow7 (0.37 conf)
name_row__8 was NAMERow8 (0.43 conf)
age_row__8 was AGERow8 (0.36 conf)
relationship_row__8 was RELATIONSHIPRow8 (0.39 conf)
residence_row__8 was RESIDENCERow8 (0.37 conf)
name_row__9 was NAMERow9 (0.43 conf)
age_row__9 was AGERow9 (0.36 conf)
relationship_row__9 was RELATIONSHIPRow9 (0.39 conf)
residence_row__9 was RESIDENCERow9 (0.37 conf)
name_row__10 was NAMERow1_2 (0.30 conf)
disability_row__1 was DISABILITYRow1 (0.41 conf)
name_address_capacity_row__1 was REPRESENTED BY name address capacityRow1 (0.33 conf)
name_row__11 was NAMERow2_2 (0.30 conf)
disability_row__2 was DISABILITYRow2 (0.41 conf)
name_address_capacity_row__2 was REPRESENTED BY name address capacityRow2 (0.33 conf)
name_row__12 was NAMERow3_2 (0.30 conf)
disability_row__3 was DISABILITYRow3 (0.41 conf)
name_address_capacity_row__3 was REPRESENTED BY name address capacityRow3 (0.33 conf)
signature_date__2 was Date_2 (1.00 conf)
text__3 was Text4 (0.35 conf)
signature_date__3 was Date_200 (1.00 conf)
text__4 was Text400 (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 549, Petition to Establish Death of Accident or Disaster Victim

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Identified Data Fields:

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