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                                                                                       Schedule                      Request for a Closing Certificate
                                                                                                      CC                                             for Fiduciaries
                                                                                       Use BLACK INK                               Wisconsin Department of Revenue    
                                                                                        ESTATES ONLY – Decedent’s last name                                  Decedent’s first name     M.I.              Decedent’s social security number

                                                                                        TRUSTS ONLY – Legal name                                                                                         Estate’s/Trust’s federal EIN

                                                                                        Individual or firm to whom the closing certificate should be mailed  Attention or c/o                            County of jurisdiction (Name Only)

                                                                                        Address                                                                                                          Probate case number
                                                                          DO NOT STAPLE
                                                                                        City                                                                 State Zip code                              Date of decedent’s death (MM DD YYYY)

                                                                                        PART I        Information Required When Requesting a Closing Certificate for Estates
                                                                                       Complete lines 1 through 11 and sign.
                                                                                        1  Is a certificate required by the court?  ................         Yes              No     (See instructions)
                                                                                          If no, DO NOT submit Schedule CC. The department only issues a Closing Certificate if a court requires it to close a proceeding.
                                                                                        2  Does the decedent have a will?  .........................         Yes              No     (If yes, include a copy)
                                                                                        3  Type of probate        Formal            Informal                 Other 
                                                                                        4  If the decedent did not file tax returns for the 4 years prior to death, enter the year and the decedent’s approximate income:
                                                                                          20          $           ,         20        $                            ,          20   $                   ,     20   $                         .
                                                                                        5  Was the decedent contacted by the IRS and/or Wis. Dept. of Revenue in the last 3 years?                            Yes      No
                                                                                           If yes, explain:
                                                                                        6  Is the gross income of the estate
                                                                                          less than $600?  ................................................  Yes              No
                                                                                        7  Will a final Form 2 be filed at a later date?  .........          Yes              No
                                                                                        8  Was the decedent a resident of Wisconsin
                                                                                           at the time of death?  .......................................... Yes              No
                                                                                        9  Did the decedent own an interest in any
(see instructions)                                                                         partnership, S corporation, LLC, or LLP?  ..........              Yes              No
                                                                                        10  Enter the totals of each of the assets listed below.
                                                                                          Probate Assets  (Required:        Include a copy of the inventory)                         NO COMMAS; NO CENTS
                                                                                              aReal Estate   .......................................                             10a                         .00
                                                                                              bStocks and Bonds  ..................................                              10b                         .00
                                                                                             c  Mortgages, Notes, and Cash  .......................... 10c                                                   .00
                                                                                                                                                                                                                  NOTE
                                                                                              dLand Contracts and Installment Sales  ...................                         10d                         .00  Where  any  line 
                                                                                             e  Insurance Payable to Estate    .......................... 10e                                                .00  from  10a  through 
                                                                                                                                                                                                                  10L  is  left  blank, 
                                                                                             f  Annuities and Employee Death Benefits Payable to Estate  ... 10f                                             .00  it  will  be  deemed 
                                                                                                                                                                                                                  that NONE            is  the 
                                                                                             g  Other Miscellaneous Property  ......................... 10g                                                  .00  DECL A R ATI O N 
                                                                                          Nonprobate Assets                                                                                                       for that line by the 
                                                                                                                                                                                                                  person(s)  signing 
                                                                                             h  Jointly Owned Survivorship – Decedent’s share of property  .. 10h                                            .00  Schedule CC.
                                                                                             i  Decedent’s Share of Survivorship Marital Property  ......... 10i                                             .00
                                     DO NOT ATTACH SCHEDULE CC TO FORM 2                     j  Insurance Payable to Named Beneficiaries              ............... 10j                                    .00
                                                                                              kTransfers During Decedent’s Life     (gifts, etc.)       ..............10k                                    .00
                                                                                             L  Other Assets   ...................................... 10L                                                    .00
                                                                                             m  Wisconsin GROSS Estate (add lines 10a through 10L)                    ......................  10m                                          .00
                                                                                        11  Fiduciary fees paid or payable to the personal representative or trustee  ..............  11                                                   .00
                                                                                       I-030 (R. 7-24)

Schedule CC                                                                                                                                  Page 2
 PART II     Information Required When Requesting a Closing Certificate for Trusts
Complete lines 1 through 10 and sign.
 1  Is a certificate required by the court? ................................................  1                              Yes             No
    If yes, include a statement from the court verifying that a Closing Certificate is required to close a proceeding.
    If no, DO NOT submit Schedule CC. The department only issues a Closing Certificate if a court requires it to close a proceeding.
  2  Include a copy of the trust instrument with amendments (will/codicils).
    3a  Grantor(s) name(s)
        Grantor(s) Social Security number(s) (SSN) 
    b  Grantee(s) name(s) 
        Grantee(s) Social Security number(s) (SSN)
 4  On what date was the trust funded? .................................................   4
                                                                                                                           M  M D  D    Y  Y  Y  Y
 5  Was the trust contacted by the IRS and/or Wis. Dept. of Revenue in the last 3 years? ..........  5                       Yes             No
    If yes, explain:

 6  State reason for closing the trust. If death of beneficiary, provide name of beneficiary, social security number, last address, 
     and date of death.

 7  Have you petitioned the court to close the trust? .......................................  7                             Yes             No
    If yes, include a copy of the petition. If no, explain why no petition has been filed:
 
 8  Has the trust filed fiduciary income tax returns with Wisconsin in any of the last four years? .....  8                  Yes             No
    If no, provide either a) copies of informal or formal annual accountings for the past four years, or showing the trust’s income 
     and expenses for each of the past four years.
 9  Enter the total fair market value of each of the assets listed below that are held by the trust at the end of the year preceding the 
     final year of the trust.   (NOTE  Where any line from 9a through 9f is left blank, it will be deemed that NONE is the DECLARATION             
     for that line by the person(s) signing Schedule CC.)
     a  Real Estate ...................................  9a                                                  .00           NO COMMAS; NO CENTS
     b  Stocks and Bonds ..............................  9b                                                  .00
     c  Mortgages, Notes, and Cash  .....................  9c                                                .00
     d  Annuities and Life Insurance ......................  9d                                              .00
     e  Interest in Partnerships, LLCs, and S Corporations ....  9e                                          .00
     f    Other Miscellaneous Property  ....................  9f                                             .00
     g Total Assets  (add lines 9a through 9f)  ......................................  9g                                                     .00
 10  Fiduciary fees paid or payable to the personal representative or trustee ...............                   10                             .00

Third   Do you want to allow another person to discuss this schedule with the department (see instructions)?     Yes Complete the following.   No
Party                                                                                                        Personal
               Designee’s                                 Phone                                              identification
Designee       name                                       no.         (        )                             number (PIN)
I,  as  fiduciary,  declare  under  penalties  of  law  that  I  have  examined  this  schedule  (including  accompanying  documents  and 
statements) and to the best of my knowledge and belief it is true, correct, and complete.
Your signature                                                                            Date                             Daytime phone
                                                                                                                           (    )
Fiduciary’s address                                       City                                                   State     Zip code

PERSON PREPARING FORM if other than the preceding signer Signature of preparer            Date                             Daytime phone
                                                                                                                           (    )

Mail completed form to:
Wisconsin Department of Revenue 
PO Box 8918 • Madison WI 53708-8918