, NO. INVENTORY & APPRAISEMENT (RCW 11.44.015) In accordance with RCW 9A.72.085, I declare under penalty of perjury under the laws of the State of Washington that the following is true and correct to the best of my knowledge: 1. The assets and liabilities shown on the Attachment to this Inventory & Appraisement comprise the true inventory and appraisement of all the property of the estate of Decedent at the time of his or her death that is subject to the jurisdiction of the above Court and that has come into my possession and knowledge. 2. Each item is appraised at its fair net value as of the date of Decedent's death and includes a statement of any encumbrance, lien, or other secured charge against that item. SIGNED Date: On Place: At Signature:, Personal Representative Inventory & Appraisement RCW 11.44.015 Page 1 of 2
Attachment to Inventory & Appraisement (a) Real property, by legal description: (b) Stocks and bonds: (c) Mortgages, notes, and other written evidences of debt: (d) Bank accounts and money: (e) Furniture and household goods: (f) All other personal property accurately identified, including the decedent's proportionate share in any partnership, but no inventory of the partnership property shall be required of the personal representative. Inventory & Appraisement RCW 11.44.015 Page 2 of 2
, NO. PROBATE NOTICE TO CREDITORS (RCW 11.40.030) PLEASE TAKE NOTICE The above Court has appointed me as Personal Representative of Decedent's estate. Any person having a claim against the Decedent must present the claim: (a) Before the time when the claim would be barred by any applicable statute of limitations, and (b) In the manner provided in RCW 11.40.070: (i) By filing the original of the claim with the foregoing Court, and (ii) By serving on or mailing to me at the address below a copy of the claim. The claim must be presented by the later of: (a) Thirty (30) days after I served or mailed this Notice as provided in RCW 11.40.020(1)(c), or (b) Four (4) months after the date of first publication of this Notice. If the claim is not presented within this time period, the claim will be forever barred except as provided in RCW 11.40.051 and 11.40.060. This bar is effective for claims against both the Decedent's probate and nonprobate assets. Date of First Publication of this Notice: Decedent s SSN (for WDSHS only):, Personal Representative Probate Notice to Creditors RCW 11.40.030 Page 1 of 1
, NO. CREDITOR'S CLAIM (RCW 11.40.070) Claimant's and If Claim made by Claimant's Agent: Agent's and Nature of Agent's Authority: Facts and circumstances surrounding the Claim: Amount of Claim: $ Creditor's Claim RCW 11.40.070 Page 1 of 2
If Claim is secured, the nature of the security; if not yet due, the date when it will become due; and if contingent, the nature of the uncertainty: Claimant's Signature: I acknowledge receipt of this Creditor's Claim on Date: Personal Representative I allow this Creditor's Claim in the amount of $ I reject this Creditor's Claim. Dated: Signed: Printed Creditor's Claim RCW 11.40.070 Page 2 of 2
, NO. DECLARATION OF MAILING OF PROBATE NOTICE TO CREDITORS TO WDSHS (RCW 11.40.020(1)(d)) I declare under penalty of perjury under the laws of the State of Washington that on the date written below, I added Decedent s Social Security Number to a true and correct copy of the Probate Notice to Creditors filed in these proceedings and mailed by firstclass mail of the US Postal Service, postage prepaid, that copy to: Office of Financial Recovery WA Dept. of Social & Health Services PO Box 9501 Olympia, WA 98507-9501 SIGNED On At, Personal Representative Declaration of Mailing of Probate Notice to Creditors to WDSHS RCW 11.40.020(1)(d) Page 1 of 1