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SAMPLE DOCUMENT FOR INFORMATION ONLY

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 SAMPLE DOCUMENT FOR INFORMATION only 1 First and Final Account/Waiver of Account) and Report of (Executor/Administrator/ Administrator- with-will-annexed), Petition for (Allowance of Statutory Fees to Personal Representative and for) Final Distribution Name, Address and Telephone Number of Person Without Attorney: In Pro Per SUPERIOR COURT OF THE STATE OF CALIFORNIA COUNTY OF SANTA CLARA In the Matter of the Estate of Decedent. ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Case No.: (FIRST AND FINAL ACCOUNT/WAIVER OF ACCOUNT) AND REPORT OF (EXECUTOR/ADMINISTRATOR/ ADMINISTRATOR- WITH-WILL ANNEXED), PETITION FOR (ALLOWANCE OF STATUTORY FEES TO PERSONAL REPRESENTATIVE AND FOR) FINAL DISTRIBUTION Date: Time: 9:00 Dept.

1 2 3 4 5 6 7 under the Independent Administration of Estates Act. A Notice of Proposed 8 9 10 11 11. 12 All personal property taxes due and payable by this esta

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