Form 5.10 - Application For Summary Release From Administration Page 2
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2CASE NO.__________________
Accounts maintained by a Financial Institution (include financial institution name and the
account’s complete identifying number):
$___________
____________________________________________________________$___________
Stocks and Bonds (include for each stock or bond its serial number, the name of its
issuer, the name and address of its transfer agent, and the total number of shares of stocks
or bonds):
$___________
____________________________________________________________$___________
Real estate described in accompanying Form 12.0 Application for Certificate of Transfer
and Form 12.1 Certificate of Transfer and date of death value. [Attach verification of
value.]
$____________
Other assets and date of death values
$____________
Total Assets
$____________
Applicant requests an order granting summary release.
____________________________________
___________________________________________
Attorney for Applicant
Applicant’s Signature
______________________________________
___________________________________________
Typed or Printed Name
Applicant’s Typed or Printed Name
______________________________________
___________________________________________
Street Address
Street Address
______________________________________
___________________________________________
City
State
Zip Code
City
State
Zip Code
______________________________________
___________________________________________
Phone Number (include area code)
Phone Number (include area code)
Attorney Registration No. ________________
Signed and acknowledged by the applicant in my presence this _________ day of
_____________________, _________.
________________________________
NotaryPublic/DeputyClerk
FORM 5.10 - APPLICATION FOR SUMMARY RELEASE FROM ADMINISTRATION
Eff. Date March 1, 2008
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Parent category: Legal