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AOC-830 Rev. 7-12 Page 1 of 2

Doc. Code: PDA & ODA

Case No._____________________

Commonwealth of Kentucky Court of Justice KRS 391.030; 394.145; 395.455; 396.095

Petition/order to disPense With AdministrAtion

(Surviving Spouse/ Children/Preferred Creditor)

(Name of Decedent)

District/Probate Court________________________ County_______________________

IN RE: Estate of _______________________________________________________________________ Address: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Date of Death: _____________________________ Date of Birth: _____________________________ Social Security Number: ____________________________


1. 2. ComesthePetitioner,beingfirstdulysworn,andstatesasfollows: Decedent died [ ] testate [ ] intestate with residence at the above listed address and on the above date. At the time of death, decedent left no estate to be administered with the exception of the following assets (include value for each asset listed): _____________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 3. In relation to the above named decedent, I am the (check all that apply) [ ] surviving spouse [ ] only surviving child [ ] surviving child whose surviving siblings have signed a waiver herein or attached a waiver [ ] preferred creditor [ ] preferred creditor of the decedent whose surviving spouse has signed a waiver herein or attached a waiver [ ] assignee of the preferred creditor. 4. [ ] (check if applicable) PetitionerappliesforProbateofDecedent'sWill,filedherewith,whichishis/herLastWilland Testament.

5. Asapreferredcreditor/assigneeofdecedent,Ihavepaidthefollowingclaim(s)againsttheestateinthefollowingorder (attach receipts): Claim a. b. c. d. Cost and Expenses of Administration Funeral expenses Debts and taxes with preference underfederalandKentuckyLaw Other Payee __________________________________ __________________________________ __________________________________ __________________________________ Amount ____________ ____________ ____________ ____________

6. I certify that there has been no previous administration of decedent's estate within Kentucky or elsewhere.

AOC-830 Rev. 7-12 Page 2 of 2

Doc. Code: PDA & ODA

Case Number _______________________

Because the exemption given to the above survivingspouse/child(ren)and/orclaim(s)oftheabovepreferredcreditor/assignee equals or exceeds the value of the above estate asset(s), I ask this Court to dispense with the administration of the above estate and to transfer the above personal property to me or my designee, __________________________________________. ____________________________________ Name of Surviving Spouse Waiving Preference

(Please Print)

_______ Age


Signature of Surviving Spouse Waiving Preference

(If Petitioner is not Decedent's Spouse)

Address/P.O.BoxAddress:__________________________________________________________________________ ________________________________________________________________________________________________ _____________________________________________ Signature of Surviving Child Waiving Preference _____________________________________________ Signature of Surviving Child Waiving Preference

__________________________________________ Petitioner's Signature Address: ________________________________________________________________________________________ ________________________________________________________________________________________________ Phone Number: ______________________________________________ Subscribed and sworn before me by petitioner on _________________________________, 2_______. My commission expires _____________________. _____________________________________________________ Name/Title


[ ] Upon hearing, the Will offerred was proven by _______________________________ and ORDERED PROBATED astheLastWillandTestament of Decedent this _________ day of __________________________________, 2________. The Will shall be probated only and no letters of administration shall be issued. Upon verifiedpetitionoftheabovepetitioner,ITISHEREBYORDEREDthatthepetitionbegrantedtodispense with the administration of the estate of the above decedent, and the above personal property is transferred to petitioner or his/herdesignee,_________________________________________________________________________________.

________________________________, 2_______ Date

_____________________________________________ Judge's Signature


I certify that this petition and order were prepared in accordance with CR 11. ___________________________________________ Attorney for Petitioner Distribution: Court File Petitioner _____________________________________________ Address and Phone Number


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