IN THE COURT OF THE

DOMICILE

IN THE ESTATE of DECEASED late of

ADDRESS2,

MARITAL

deceased (“the Deceased”)

I, NAME, POSITION, of ADDRESS, do hereby make oath and say as follows:

1. The Deceased died at PLACE on DATE at the age of AGE years, having made and executed his/her last Will dated WILL.  The Deceased appointed EXECUTOR, now aged ..................... years, as the sole executor/executrix in the Will.

2. The Deceased died domiciled in DOMICILE

3. The Deceased named the following persons the beneficiaries in the estate:

 

Name                                  Now Aged/Date of death if applicable

EXECUTOR

4. By a Power of Attorney dated POA, EXECUTOR nominated and appointed me as his/her lawful attorney to apply for and obtain from the Courts of JURISDICTION_STATE a grant of letters of administration (with the Will annexed) of the estate of the Deceased limited for *his/her use and benefit until further representation be granted.  EXECUTOR  is now residing outside of DOMICILE.

8. I believe the paper writing shown to me and marked “A” by me to contain the true and original last Will of the Deceased, and I will administer according to the law all the estate which by law devolves to and vests in the personal representatives of the Deceased and I will exhibit a true and perfect inventory of all and singular the estate and effects and render a just and true account thereof whenever required by law so to do.

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