700-00055 - Report of Fiduciary for Small Estate (05/2018) Page 1 of 1
Decedent
REPORT OF FIDUCIARY FOR SMALL ESTATE
I, ____________________________________, state under oath:
☐ I have paid the funeral expenses of the deceased.
☐ I have paid all known debts of the deceased and have attached a list of debts paid showing the person
paid, the amount paid and the nature of the debts.
☐ I have paid the expenses of administration.
☐ I have paid over the balance of the estate in accordance with the terms of the Will or in accordance with
law if there is no Will.
☐ I have attached such receipts as are required by the Court.
I request that this report be accepted, that I be discharged as administrator, and that the estate be closed.
_______________________________ ______________________________________________________________
Date Signature of Fiduciary
______________________________________________
Fiduciary’s Printed
______________________________________________
Fiduciary’s Address
______________________________________________
______________________________________________
Fiduciary’s Phone Number
Signed and sworn to before me:
ORDER DISCHARGING FIDUCIARY AND CLOSING ESTATE
Based on the sworn statement of the Fiduciary of the Estate, the report is accepted, the Fiduciary is
discharged, and the estate is closed.
_______________________________ ______________________________________________________________
Date Signature of Judge
______________________________________________
Judge’s Printed Name
Date Signature of Register, Judge or Notary Republic Expiration Date
