Form 12.1 - Certificate Of Transfer Page 2

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(Reverse of Form 12.1)
CASE NO.______________
The legal description of decedent's interest in the real property subject to this certificate is: [use extra sheets, if
necessary].
Prior Instrument Reference:
Parcel No:
This instrument was prepared by ______________________________________________________________________
ISSUANCE
This Certificate of Transfer is issued this _______ day of _______________________________________, 20_________.
_________________________________________________________
DIXIE PARK, Probate Judge
AUTHENTICATION
I certify that this document is a true copy of the original Certificate of Transfer No. _____________ issued on
_____________________________ and kept by me as custodian of the official records of this Court.
________________________________
___________________________________________________
DIXIE PARK, Probate Judge
Date
By ________________________________________________
Deputy Clerk
Print Form
12.1 - CERTIFICATE OF TRANSFER
PAGE 2
Amended: March 1, 2014
Discard all previous versions of this form

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