APPENDIX. Real Property Transfers From Guardianship and Decedent Estates In Cook County, Illinois

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1 APPENDIX Real Property Transfers From Guardianship and Decedent Estates In Cook County, Illinois October 19, 2016 Steve Raminiak, Esq. Law Offices of Steve Raminiak, P.C. 121 S. Wilke, Suite 406 Arlington Heights, Illinois (

2 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of: JANE SAMPLE, Court No. 16 P XXXX A Disabled Person PETITION FOR AUTHORIZATION TO LIST REAL PROPERTY FOR SALE NOW COMES JOHN SAMPLE ("JOHN", plenary Guardian of the Estate of JANE SAMPLE ("JANE", a disabled person, by and through his attorney, YOUR LAW FIRM, P.C., and respectfully presents his Petition for Authorization to List Real Property for Sale, and in support thereof, states as follows. 1. JOHN was appointed as Guardian of the Estate and Person on July 4, 2016 and continues to act in those capacities. 2. The Inventory, approved September 5, 2016, reported personal property with a total value of $200, and real property commonly known as 4321 E. Addison, Chicago, Illinois ("JANE's House". 3. On September 5, 2016, this Court also entered an Order that authorized JANE's placement at ACME NURSING HOME, 5432 E. Belmont, Chicago, Illinois. Due to the severity of her dementia, it seems very unlikely that she will ever return to her home. 4. Two Comparative Market Analyses for JANE's House have been attached to this Petition as Exhibits "A" and "B", and the Guardian believes that it is in JANE's best interest to list said property at $369, The Guardian also requests authorization to spend up to $1, from this Estate to clean such property and prepare it for sale. 1

3 WHEREFORE, JOHN SAMPLE, plenary Guardian of the Estate of JANE SAMPLE, a disabled person, respectfully requests that this Court enter an Order which: A. authorizes the Guardian to list the Disabled Person's real property commonly known as 4321 E. Addison, Chicago, Illinois, for $369,900.00, B. provides that all closing costs, attorneys' fees, realtors' fees (which shall not total more than 5% of the purchase price, title fees, pro rata taxes, utilities, and other costs associated with the sale of said real property be paid out of the proceeds of this sale, C. authorizes the Guardian to spend no more than $1, of the Disabled Person's funds to clean such property and prepare it for sale, and D. grants such other relief as the Court deems appropriate. Attorney No. XXXXX Respectfully submitted, You Attorney, Esq. JOHN SAMPLE Your Law Firm, P.C. Attorneys for Guardian (312 XXX-XXXX By: you@your address.com One of His Attorneys 2

4 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of: JANE SAMPLE, Court No. 16 P XXXX A Disabled Person PETITION FOR BUDGET, CARE PLAN AND AUTHORIZATION TO LIST REAL PROPERTY FOR SALE NOW COMES JOHN SAMPLE ("JOHN", plenary Guardian of the Estate of JANE SAMPLE ("JANE", a disabled person, by and through his attorney, YOUR LAW FIRM, P.C., and respectfully presents his Petition for Budget, Care Plan, and Authorization to List Real Property for Sale, and in support thereof, states as follows. 1. JOHN was appointed as Guardian of the Estate and Person on July 4, 2016 and continues to act in those capacities. 2. The Inventory, approved September 5, 2016, reported personal property with a total value of $200, and real property commonly known as 4321 E. Addison, Chicago, Illinois. I. Budget and Care Plan 3. The proposed monthly expenses of the Disabled Person are itemized on the attached Exhibit "A," and total $6, per month. $4, of such monthly expenses are associated with the Disabled Person's proposed placement at ACME NURSING HOME ("ANH", 5432 E. Belmont, Chicago, Illinois. 4. The Disabled Person receives $1, per month in social security benefits, and $ per month from a pension. The Guardian is placing the assets of the Estate into conservative 3

5 investments which shall realize approximately 2% growth per year, totaling approximately $ per month. 5. Applying the amount of all proposed allowable monthly expenses to the entirety of the Disabled Person's anticipated monthly income results in a deficit of approximately $4, per month. 6. While this deficit is substantial, the Guardian believes that it is in the Disabled Person's best interests to be placed at ANH. 7. JANE is 88 years old and is almost ready for discharge from ACME REHABILITATION CENTER ("ACR", a rehabilitation center, in Chicago, Illinois. A Report of Physician, filed on July 4, 2016, states, in relevant part, that JANE suffers from "Vascular Dementia with psychotic features" and is "not able to function independently." 8. ANH has a "reminiscence" unit that is specifically designed to support people with memory loss and maximize their quality of life. It is in JANE s best interest to enjoy such benefits while she has the ability to do so. ANH's fee schedule, which references these services, is attached as Exhibit "B." Also, ANH accepts Medicaid for patients who have spent down their assets. 9. The Guardian shall also make every effort to move JANE into a less costly housing option, as availability and circumstances permit. Presently, only one bedroom units are available at $4,800.00/month. Studio units cost $3,900.00/month and companion units cost $3,286.00/month. However, the Guardian will not move JANE into a companion unit if he believes that JANE's further decline into dementia will make such an arrangement unreasonable for JANE or her roommate. 4

6 10. The Guardian also believes that it is in JANE s best interests to approve a budget in order to prevent the need to ask the Court's approval for routine and expected expenses as they occur. II. Listing of Real Estate 11. This Estate owns real property commonly known as 4321 E. Addison, Chicago, Illinois ( JANE s House. Prior to JANE s admission to ACR in April 2015, she resided at such property for many years. 12. A Report of Physician, filed on July 4, 2016, states, in relevant part, that JANE is "not able to function independently" due to her dementia and "require(s a 24 (hour supervised setting for appropriate activities of daily living." 13. Unfortunately, due to JANE s continued, irreversible decline, and the cost that the Estate would suffer to care for her at her home, she will very likely never return to her residence in Chicago. 14. The Guardian has obtained two Comparative Market Analyses ("CMAs" regarding the value of JANE s House. See Exhibits "C" & "D." The Guardian prays for the authority to list such property at the value listed on the higher CMA, $369,900.00, and to lower the price of such listing by no more than ten percent (10% of such price in order to attract offers for the Disabled Person's real property. 15. The Guardian also prays for the allocation of $1, of the Disabled Person's funds to clean such property and prepare it for sale. WHEREFORE, JOHN SAMPLE, Plenary Guardian of the Estate and Person of JANE SAMPLE, a disabled person, respectfully requests that this Court enter an Order which: A. approves the budget as set forth in Exhibit "A" to this Petition, 5

7 B. authorizes the permanent placement of JANE SAMPLE at ACME NURSING HOME, 5432 E. Belmont, Chicago, Illinois, C. authorizes the Guardian to list the Disabled Person's real property 4321 E. Addison, Chicago, Illinois for $369,900.00, and to lower the price of such listing by no more than ten percent (10% of such price without further Order of Court, D. provides that all closing costs, attorneys' fees, realtors' fees (which shall not total more than 5% of the purchase price, title fees, pro rata taxes, utilities, and other costs associated with the sale of said real property be paid out of the proceeds of this sale, E. authorizes the Guardian to spend no more than $1, of the Disabled Person's funds to clean such property and prepare it for sale, and F. grants such other relief as the Court deems appropriate. Attorney No. XXXXX Respectfully submitted, You Attorney, Esq. JOHN SAMPLE Your Law Firm, P.C. Attorneys for Guardian (312 XXX-XXXX By: One of His Attorneys 6

8 Expense Estate of JANE SAMPLE Case No. 16 P XXXX Exhibit "A" - Annual Budget Monthly Allowance Acme Nursing Home (1 bedroom $4, Administration of Medications (11 medications per day $41.00 Medications $ Blue Cross Blue Shield Supplemental Insurance $ Beautician $50.00 Discretionary Fund for Groceries and other Personal Items for the Disabled Person $ Regular maintenance associated with the Disabled Person s real estate (including lawn care, snow removal, leaf removal $ Utilities for the Disabled Person s real estate $ Insurance on the Disabled Person s real estate $63.00 Total: $6,

9 Guardian s Rider to Listing Agreement The parties further agree to the following additional provisions. 1 The real and personal property will be sold as-is without any representations or warranties by the Seller, whatsoever. Buyer shall take the property subject to any and all building and zoning violations. 2 This agreement, and any sales contracts resulting therefrom, are contingent on approval by the Circuit Court of Cook County, Probate Division, and such Court s authorization allowing, Guardian of the Estate of, to enter into such contract and to bind the estate thereto. If such approval is not granted, this agreement shall be void and have no legal effect. 3 The Realtor/Broker agrees and acknowledges that said Guardian has no personal liability under the terms of this contract or any sales contract and agrees to look exclusively to the Estate of for the performance of such contracts. 4 If the Buyer under any contract of sale defaults for any reason, all earnest money shall be forfeited to the Seller without prior approval from the Buyer and no broker s commission or cost will be paid. 5 Seller shall execute a Guardian s deed or other appropriate deed to transfer title under any sales contract. 6 The broker s commission shall be 5% of the sale price and shall only be paid out of the proceeds of the sale, subsequent to the closing of the sale. 7 Any party submitting an offer to purchase the property must also submit a letter from a financial institution/lender confirming pre-qualification of the purchaser. In addition, any potential Buyer must tender the earnest money, in the form of a cashier s check, to the listing Realtor/Broker a minimum of 24 hours prior to said Guardian s presentation to the Court of the Petition for Authorization to Sell Real Property in order for said Buyer s offer to be considered for acceptance. 8 The Seller does not agree to dual agency and the Realtor/Broker shall not act as dual agent for both the Buyer and the Seller. 9 Any and all provisions providing for the Seller to indemnify or hold Realtor/Broker, or any other party harmless or to pay any costs or attorney s fees are hereby deleted from the agreement. 10 Any arbitration provisions are hereby deleted. 11 The parties agree that for purposes of this rider, facsimile signatures and initials shall be effective as originals. 12 Any Contract for Sale is subject to the ability of the Seller to provide insurable title or title as otherwise required in the Contract for Sale. 13 If the said sale is a cash transaction (no mortgage is secured by Buyer, Buyer shall wire cash funds to Seller s title company at least 24 hours prior to the scheduled closing date and time with proof of said wire transfer to be provided to the Seller s attorney at least 24 hours prior to the scheduled closing date and time. 14 If there are any inconsistencies between the terms of the Real Estate Contract and the Rider, the terms of the Rider shall prevail. Seller,, Guardian of the DATE Broker (signature DATE Estate and Person of, a disabled person Broker (printed 8

10 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of: JANE SAMPLE, Court No. 16 P XXXX A Disabled Person EMERGENCY PETITION FOR AUTHORIZATION TO SELL REAL PROPERTY NOW COMES JOHN SAMPLE ("JOHN", plenary Guardian of the Estate of JANE SAMPLE ("JANE", a disabled person, by and through his attorney, YOUR LAW FIRM, P.C., and respectfully presents his Emergency Petition for Authorization to Sell Real Property, and in support thereof, states as follows. 1. JOHN was appointed as Guardian of the Estate and Person on July 4, 2016 and continues to act in those capacities. 2. The Inventory, approved September 5, 2016, reported personal property with a total value of $200, and real property commonly known as 4321 E. Addison, Chicago, Illinois. 3. This Court authorized the Guardian to list said real property for sale for $369, per Court Order entered on September 25, See Exhibit A. 4. The Guardian has recently negotiated an offer to sell such real property for $348, See Exhibit B. The closing date of the contemplated contract is November 24, The Guardian puts this Petition forward as an emergency due to the necessity of reaching a speedy agreement on sales of real property under optimal circumstances. 9

11 WHEREFORE, JOHN SAMPLE, Plenary Guardian of the Estate and Person of JANE SAMPLE, a disabled person, respectfully requests that this Court enter an Order which: A. authorizes the Guardian to sell that parcel of JANE SAMPLE s real property, commonly known as 4321 E. Addison, Chicago, Illinois, for the price of $348,000.00, pursuant to the contract attached as Exhibit B, B. provides that all closing costs, attorneys fees, realtors fees (which shall not total more than 5% of the purchase price, title fees, pro rata taxes, utilities, and other costs associated with the sale of said real property be paid out of the proceeds of this sale, and C. grants such other relief as the Court deems appropriate. Attorney No. XXXXX Respectfully submitted, You Attorney, Esq. JOHN SAMPLE Your Law Firm, P.C. Attorneys for Guardian (312 XXX-XXXX By: you@your address.com One of His Attorneys 10

12 Guardian s Rider to Contract to Sell The undersigned, Sellers and Buyers agree to the following. 1 This contract is subject to the approval by the Circuit Court of Cook County, Probate Division. If such approval is not granted, Buyers shall receive prompt return of all earnest money, and this contract shall then be void and have no legal effect. 2, Guardian of the Estate of, a disabled person, has no personal liability under the terms of this contract. The parties shall look only to the Estate of for performance under this contract. 3 Any and all provisions in the contract regarding arbitration are deleted. 4 If there are any inconsistencies between the terms of this Rider and the terms of the contract, the terms of this Rider shall prevail. 5 Sellers shall execute a deed or cause to have an appropriate deed executed to transfer title to, as Guardian of the Estate of the Estate of. Seller,, Guardian of the DATE Buyer (signature DATE Estate and Person of, a disabled person Buyer (printed 11

13 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of: JANE SAMPLE, Court No. 16 P XXXX A Disabled Person REPORT ON SALE OF REAL PROPERTY NOW COMES JOHN SAMPLE ("JOHN", plenary Guardian of the Estate of JANE SAMPLE, a disabled person, by and through his attorney, YOUR LAW FIRM, P.C., and respectfully presents his Report on Sale of Real Property, and in support thereof, states as follows. 1. JOHN was appointed as Guardian of the Estate and Person on July 4, 2016 and continues to act in those capacities. 2. On September 25, 2016, this Court entered an Order which authorized the Guardian to list this Estate s real property, commonly known as 4321 E. Addison, Chicago, Illinois for sale at a price of $369, See Exhibit A. On October 31, 2016, this Court authorized the Guardian to sell such property for $348, See Exhibit B. 3. Closing was on November 24, The Estate received net proceeds of $218, which were deposited into the Estate. See the Settlement Statement attached as Exhibit C. WHEREFORE, JOHN SAMPLE, Plenary Guardian of the Estate and Person of JANE SAMPLE, prays that this Report on Sale be approved. Attorney No. XXXXX Respectfully submitted, You Attorney, Esq. JOHN SAMPLE Your Law Firm, P.C. Attorneys for Guardian (312 XXX-XXXX By: you@your address.com One of His Attorneys 12

14 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of: JANE SAMPLE, Court No. 16 P XXXX Deceased DIRECTION I am an heir of Jane Sample, and have reviewed documents provided by the Executor in regards to that real property commonly referred to as 4321 E. Addison, Chicago, Illinois, Chicago, Illinois ("Jane s House". I agree that Jane s House should be initially listed for sale at the price of $369,900.00, and that it ultimately be sold for no less than $296, DATE: SIGN HERE: PRINT NAME HERE: Attorney No. XXXXX You Attorney, Esq. Your Law Firm, P.C. Attorneys for Executor (312 XXX-XXXX you@your address.com 13

15 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of: JANE SAMPLE, Court No. 16 P XXXX Deceased VERIFIED PETITION FOR AUTHORIZATION TO SELL REAL PROPERTY AND TO PAY CLAIMANTS AND BENEFICIARIES OF THE ESTATE NOW COMES JOHN SAMPLE ("JOHN", Executor of the Estate of JANE SAMPLE (the Decedent, deceased, by and through his attorney, the YOUR LAW FIRM, P.C., and respectfully presents his Verified Petition for Authorization to Sell Real Property and to Pay Claimants and Beneficiaries of the Estate, and in support thereof states as follows. 1. Decedent died on Jan. 1, JOHN was appointed as Executor on March 13, At Section 3.1.a., the Decedent s Will states, in relevant part, My real property located at 4321 E. Addison, Chicago, Illinois, shall be sold to, my son, JOHN SAMPLE, for $50, or appraised value if less The sale proceeds shall be equally shared amongst my five children, with JOHN SAMPLE deducting his share from the sale price. 3. An appraisal of real property commonly known as 4321 E. Addison, Chicago, Illinois, which values said property at $20, as of Jan. 1, 2016, is attached as Exhibit A. 4. The Inventory, filed contemporaneously with this Petition, shows that there is only $5, in personal property, all in cash, in this Estate. 5. JOHN personally paid administrative expenses associated with this Estate, which totaled $6,000.00, and which were allowed by a Claim Order entered July 4, See Exhibit "B." 6. Also, on July 4, 2016, this Court entered an Order which allowed a claim of $10, in favor of Illinois Department of Healthcare and Family Services ( IDHFS. See Exhibit "C." 14

16 7. The following people advanced the following sums for the Decedent s funeral expenses: i. $2, by the Decedent's grandson, MICHAEL SAMPLE, ii. $ by the Decedent's grandson, FLYNN SAMPLE, and iii. $ by the Decedent's granddaughter, TILLIE SAMPLE, 8. Upon calculation of these sums (i.e., $20, $5, $6, $10, $2, $ $500.00, only $6, remains. The Decedent left five (5 lines of descendants which are all contemplated by her Will. See Affidavit of Heirship, filed March 13, The remainder would entitle each family line to $1, After the Decedent's death, JOHN s son MATHEW SAMPLE ( MATHEW died, leaving no spouse and three children. An Affidavit of Heirship for MATHEW is attached as Exhibit "D." JOHN anticipates that an appropriate family member will sign a Small Estate Affidavit upon the approval of this Petition so that MATHEW s share can be divided evenly among his three children. 10. After diligent efforts, JOHN cannot find anyone who can attest to the heirship of JOHN s daughter, MARY SAMPLE. JOHN intends to deposit all funds associated with MARY SAMPLE with the COOK COUNTY TREASURER. 11. MICHAEL SAMPLE has tendered a Waiver of Notice, Approval and Consent, which has been filed contemporaneously with this Petition, in which he states that he shall execute an Assignment which transfers his share of the Estate and repayment he is owed for funeral expenses to JOHN SAMPLE upon approval of this Petition. 12. RITA SAMPLE is living, over the age of 18 and does not suffer from any disability. 13. JOHN wishes to provide liquidity to the Estate so that he may receive sole ownership of real property commonly known as 4321 E. Addison, Chicago, Illinois. 15

17 WHEREFORE, JOHN SAMPLE, Executor of the Estate JANE SAMPLE, deceased, prays that this Honorable Court: A. authorize JOHN to apply the entirety of the $5, in the Estate s funds to the claim to IDHFS, B. authorize JOHN to pay the following $9, from JOHN s own personal funds, and not the funds of this Estate: i. the remaining $5, owed to IDHFS regarding their Claim Order, ii. $ to FLYNN SAMPLE, iii. $ to TILLIE SAMPLE, iv. $1, to be divided in equal shares to the children of MATHEW SAMPLE, and v. $1, to the COOK COUNTY TREASURER to represent the distribution of the Estate to MARY SAMPLE by the Decedent's granddaughter, TILLIE SAMPLE, and vi. $1, to RITA SAMPLE, C. authorize JOHN to transfer real property commonly known as 4321 E. Addison, Chicago, Illinois to himself, JOHN SAMPLE, personally, upon the subsequent execution of an Assignment by MICHAEL SAMPLE which is thereafter approved by this Court, and D. provide other and further relief as this Court deems appropriate. Attorney No. XXXXX Respectfully submitted, You Attorney, Esq. JOHN SAMPLE Your Law Firm, P.C. Attorneys for Guardian (312 XXX-XXXX By: you@your address.com One of His Attorneys 16

18 VERIFICATION Under penalties as provided by law pursuant to Section of the Illinois Code of Civil Procedure, the undersigned states that he has read the foregoing Verified Petition for Authorization to Sell Real Property and to Pay Claimants and Beneficiaries of the Estate and certifies that the statements set forth in the foregoing Verified Petition for Authorization to Sell Real Property and to Pay Claimants and Beneficiaries of the Estate are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he verily believes the same to be true. JOHN SAMPLE 17

19 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of: JANE SAMPLE, Court No. 16 P XXXX Deceased WAIVER OF NOTICE, APPROVAL AND CONSENT I am a legatee of this Estate, and I have reviewed that Petition for Authorization to Sell Real Property and to Pay Claimants and Beneficiaries of the Estate, which: asks that JOHN SAMPLE be allowed to make payments to certain persons from his personal funds totaling $9,600.00, asks that JOHN SAMPLE, as Executor, be authorized to transfer real property commonly known as 4321 E. Addison, Chicago, Illinois to himself, JOHN SAMPLE, personally, and acknowledges how I intend to assign my all of my interest as a beneficiary and as a claimant in this Estate to JOHN SAMPLE upon approval of said Petition. I hereby waive notice of the hearing on said Petition, and approve of and consent to the relief requested in said Petition. DATE STATE OF ILLINOIS COUNTY OF SS. PRINT NAME HERE SIGN NAME HERE The undersigned, a Notary Public, hereby certifies that, personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person and acknowledged that s/he signed the foregoing instrument as a free and voluntary act for the uses and purposes therein set forth. Given under my hand and official seal this day of, 20. Notary Public Attorney No. XXXXX You Attorney, Esq., Your Law Firm, P.C. Attorneys for Guardian, (312 XXX-XXXX, you@your address.com 18

20 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of: JANE SAMPLE, Court No. 16 P XXXX Deceased VERIFED PETITION TO APPROVE DISTRIBUTION PURSUANT TO ASSIGNMENT NOW COMES JOHN SAMPLE ("JOHN", Executor of the Estate of JANE SAMPLE (the Decedent, deceased, by and through his attorney, YOUR LAW FIRM, P.C., and respectfully presents his Verified Petition to Approve Distribution Pursuant to Assignment, and in support thereof, states as follows. 1. Decedent died on Jan. 1, JOHN was appointed as Executor on March 13, At Section 3.1.a., the Decedent s Will states, in relevant part, My real property located at 4321 E. Addison, Chicago, Illinois, shall be sold to, my son, JOHN SAMPLE, for $50, or appraised value if less The sale proceeds shall be equally shared amongst my five children, with JOHN SAMPLE deducting his share from the sale price. 3. An appraisal of real property commonly known as 4321 E. Addison, Chicago, Illinois, which values said property at $20, as of Jan. 1, 2016, is attached as Exhibit A to JOHN's Petition for Authorization to Sell Real Property and to Pay Claimants and Beneficiaries of the Estate ("JOHN's Petition to Sell", filed September 5, The Inventory, filed contemporaneously with this Petition, shows that there is only $5, in personal property, all in cash, in this Estate. 5. JOHN personally paid administrative expenses associated with this Estate, which totaled $6,000.00, and which were allowed by a Claim Order entered July 4, See Exhibit "A." 19

21 6. Also, on July 4, 2016, this Court entered an Order which allowed a claim of $10, in favor of Illinois Department of Healthcare and Family Services ( IDHFS. See Exhibit "B." 7. The following people advanced the following sums for the Decedent s funeral expenses: a. $2, by the Decedent's grandson, MICHAEL SAMPLE, b. $ by the Decedent's grandson, FLYNN SAMPLE, and c. $ by the Decedent's granddaughter, TILLIE SAMPLE, 8. Upon calculation of these sums (i.e., $20, $5, $6, $10, $2, $ $500.00, only $6, remains. The Decedent left five (5 lines of descendants which are all contemplated by her Will. See Affidavit of Heirship, filed March 13, The remainder would entitle each family line to $1, On September 5, 2016, this Court entered an Order which approved of JOHN's Petition to Sell in which MICHAEL SAMPLE indicated that he shall execute an Assignment which transfers his share of the Estate and repayment he is owed for funeral expenses to JOHN SAMPLE upon approval of that Petition. This Assignment is attached as Exhibit "C." 10. MICHAEL SAMPLE resides at 6543 E. Irving Park Road, Chicago, Illinois JOHN SAMPLE resides at 4321 E. Addison, Chicago, Illinois. 11. No consideration is to be paid to MICHAEL SAMPLE nor are any expenses to be charged to him in regards to the Assignment attached as Exhibit "C," and said Assignment is irrevocable and has not otherwise been revoked. WHEREFORE, JOHN SAMPLE, Executor of the Estate JANE SAMPLE, deceased, prays that this Honorable Court: 20

22 A. authorizes the Executor to distribute assets pursuant to the Assignment attached as Exhibit "C" to this Petition, and B. grants such other relief as the Court deems appropriate. Attorney No. XXXXX Respectfully submitted, You Attorney, Esq. JOHN SAMPLE Your Law Firm, P.C. Attorneys for Executor (312 XXX-XXXX By: One of His Attorneys VERIFICATION Under penalties as provided by law pursuant to Section of the Illinois Code of Civil Procedure, the undersigned states that he has read the foregoing Verified Petition to Approve Distribution Pursuant to Assignment and certifies that the statements set forth in the foregoing Verified Petition to Approve Distribution Pursuant to Assignment are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that he verily believes the same to be true. JOHN SAMPLE 21

23 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of: JANE SAMPLE, Court No. 16 P XXXX Deceased ASSIGNMENT I hereby irrevocably convey, assign, and otherwise transfer my interest in this Estate that comprises my share of real property commonly known as 4321 E. Addison, Chicago, Illinois, including but not limited to all associated liabilities, which has a net value of about $1,200.00, and my interest in repayment for funeral expenses of JANE SAMPLE, which has a value of $2,000.00, to JOHN SAMPLE, personally, so that the total amount which he must pay to acquire said real property shall be reduced. DATE STATE OF ILLINOIS COUNTY OF SS. PRINT NAME HERE SIGN NAME HERE The undersigned, a Notary Public, hereby certifies that, personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person and acknowledged that s/he signed the foregoing instrument as a free and voluntary act for the uses and purposes therein set forth. Given under my hand and official seal this day of, 20. Notary Public Attorney No. XXXXX You Attorney, Esq., Your Law Firm, P.C. Attorneys for Guardian, (312 XXX-XXXX, you@your address.com 22