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e. Appointment ot personal rep; :~tative (2) Appointme• ~dministrator -
(1) Appointment of executo~,~-1s ;adminisfrator with ~ Petitioncti a nominee (See attachment 3~2)). ~
will annexed Petitioner is related to the decedent as:
i. Petitioner is named as executor in the will. '
ii. Q No executor is named in the will.
iii. Q Petitioner is a nominee (See attachment (3) ~ Appointment ot special administrator request- ;
3e) ed (See attachment 3e(3) for grounds and re- ,
iv. ~ Other named executors wilt not act be- quested powers).
cause of ~l death dechnaUon f. Pet~tioner is a[~ resident of Cat~forrna. •
Q other ~easons as set forth ~n attach- Q nonresident of California.
ment 3e ( iv
FACTS CONCERNING HEIRS
(Complete in a!! cases.) (Compfete only ~l no spouse or ~ssue su~v:ved the dece-
4. a. The decedent is survived by dent.) (Prob C 228, 229)
(1) spouse. j~ no spouse_ c. The decedent ~
.(2) ~ child. Q no child. (1) ~ had no predeceased spouse. ;
(3) ~ issue of pre- ~ no issue ot pre- (2) C had a predeceased spouse whose he~rs are ~
deceased chitd. deceased child. named in the list of he~rs.
(4) ~ parent. ~ no parent (Complete only no parent or issue surv~ved the dece-
. b. No surviving ch~fd or issue of a predeceased child dent.)
has bean omitted trom the list ot heirs d. The decedent ~s survrved by
(1) ~ a brother or sister or issue of a predeceased
brother or sister and none has been omitted
lrom the list ot he~rs.
(2) ~ no brother or sister or issue of a predeceased
i •
brother or sister.
; 5. The names, addresses, relationships and ages of heirs, devisees and tegatees so tar as known to pet~Uoner are:
~ (List add~tional names, addresses, relat~onsh~ps, and ages of heirs, devisees, and legatees in attachment 5.)
; Name and Address , Retat~onship Age
~ ELYSE N. WALTER ~
; 3499 Oaktrail Rd., Santa Ynez, CA 93460 Daughter Adult
~ LISANNE NIELSEN
3499 Oaktrail Rd, Santa Ynez, CA 93460 Granddaughter Adult
~ CHRISTINA ROLLINS
~ 2509 San Jacinto, Pasadena Texas 77502 Granddaughter Adult
~ STEPHEN L. NIELSEN -
2702 California, Arcata, CA 95521 Grandson Adult
PAUL S. NIELSEN
913 High Street, Houma, Louisiana 70360 Grandson Ad~slt
` ADDITIONAL FACTS CONCERNING THE INDEPENGENT ADMINISTRATION OF ESTATE -
~ 6. a. ~x Oecedent's will does not preclude ~ndependent adm~n~stration oi th~s estate under Prob C 591 et seq. ~
~ b. C Oecedent d~ed intestate.
? Dated: Apx'il 5, 1977 l~
' ELYSE N . WALTER ~Q ~ " " -
~ (Srgnature ol Uta~er)
~ (jyQe pr p~mt name)
S
~ I ce~t~fy (or declare) under penalty of per~u~y that the foreoo~ng ~s true and correct and that this decfarat~on is executed
~ on (Oate): . Ap~r'il S, 1977 . at (Piace~ . Santa Barbara ~ Cai~torn~a.
~ ~
~ ELYSE N. WALTER ~
~ (Type o+ Dnnt rame) (Sgnatu~e o at•oner)
~ . .,~~11'~SSIt~`
~ ' r~j~1 .,t r~~t~[ lfl~1~tV;~
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