Fillable VERIFIED PETITION FOR ISSUANCE OF CERTIFICATE OF PRESUMED (Vermont Judiciary)

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VERIFIED PETITION FOR ISSUANCE OF CERTIFICATE OF PRESUMED (Vermont Judiciary)

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Form PE58A
STATE OF VERMONT
SUPERIOR COURT
PROBATE DIVISION
Unit
Docket No._____________________
In re ESTATE OF
VERIFIED PETITION FOR
ISSUANCE OF CERTIFICATE OF PRESUMED DEATH
I,
state that
Name of Person
:
1. Was a resident of this probate unit;
2. Has been absent for a continuous period of five years;
3. Has not been heard from or, after diligent search, been seen, during this period; and
4. There is no satisfactory explanation for this person’s absence.
5. This person was last seen alive on
Date
I am related to
Name of Decedent
in that I am his/her
Spouse, child, other near relative
To the best of my knowledge, and belief, the following statements are true about this person:
Date of Birth
/ /
Birthplace (Town and State)
Marital Status
Mother/Parent’s Birth Name
Father/Parent’s Birth Name
Spouse/Civil Union Partner
Last Residence
Ever in U.S. Armed Forces
Veteran of Any War
Occupation
Business/Industry
Education
Hispanic Origin
Race
Sex
Therefore, I request the Court to direct the Chief Medical Examiner to complete and sign a certificate of
presumed death of this person.
Attached are:
(1) Entry fee of payable to “Vermont Superior Court” [see instructions]
(2) One or more affidavits of diligent search for the person.
(3) List of Interested Persons
[Probate Form 2]
PETITIONER SIGNATURE:
Petitioner Signature
Date
Petitioner name
Mailing Address
City, State, Zip
Telephone Number
Email
$____________
Decedent
SML 11/12
Consent of Interested Persons
By our signatures below, we, the interested persons in any estate of the absent
person who is the subject of this petition, consent to this petition. We understand
that, if all the interested persons do not sign below, a hearing may be scheduled by
the Court and notice of that hearing will be given to all interested persons by the
petitioner or the Court.
Signature
Printed Name
Date
Oath
At
Town, State
on
Date
/ /
Name of Petitioner
appeared and made oath that the foregoing statements are true to the best of the petitioner’s
knowledge, information and belief and that, insofar as based on information, the petitioner
believes this information to be true.
Date
Signature of Register, Judge or Notary Public
Expiration Date
/ /
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VERIFIED PETITION FOR ISSUANCE OF CERTIFICATE OF PRESUMED (Vermont Judiciary)

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Completed 30 July 2020

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