(Reverse of Form 16.0)
The whole estate of said minor is estimated as follows:
Personal Property..................................................................................
$ _________________
Real Estate ..........................................................................................
$ _________________
Annual Rents.........................................................................................
$ _________________
Other annual income .............................................................................
$ _________________
Total
$ _________________
Applicant offers the attached bond in the amount of $ ___________________________
I hereby certify that all the information and statements contained in this application and attached
exhibits are correct to the best of my knowledge and belief.
____________________________________
_____________________________________
Attorney for Applicant
Applicant
____________________________________
_____________________________________
Typed or Printed Name
Typed or Printed Name
____________________________________
_____________________________________
Address
Address
____________________________________
_____________________________________
City
State
Zip
City
State
Zip
____________________________________
_____________________________________
Phone Number (include area code)
Phone Number (include area code)
_______________________________
Supreme Court Registration Number
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