Assets And Liabilities Of Estate To Be Relieved From Administration Page 2
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1
2(Reverse of Form 5.1)
Following is a list of decedent's known debts. [Use extra sheets if necessary]
Name of Creditor
Nature of Debt
Amount
$
Total Debts
$
CERTIFICATION
The undersigned appraiser agreed to act as appraiser of decedent's estate, and to appraise the property exhibited truly,
honestly, impartially, and to the best of the appraiser's knowledge and ability. The appraiser further says that those assets
whose values were not readily ascertainable are indicated above by a check in the "Appraised" column opposite each such
item, and that such values are correct.
The undersigned applicant determined the value of those assets whose values were readily ascertainable and were not
appraised by the appraiser, and that such values are correct, and to applicant's knowledge the above list of decedent's debts is
correct.
___________________________________
Date
___________________________________
________________________________________
Appraiser
Applicant
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