File No.
STATE OF NORTH CAROLINA
                                                                                               In The General Court Of Justice
                                                County                                                    Superior Court Division
                                                                                                          Before The Clerk
   IN THE MATTER OF THE ESTATE OF:
Name, Street Address, City, State, And Zip Code Of Decedent
                                                                                               APPLICATION
                                                                           FOR LETTERS OF ADMINISTRATION

                                                                                                                          G.S. 28A-6-1, 28A-12-4
Social Security No. (last four digits) County Of Domicile At Time Of Death Date Of Death       Place Of Death (if different from County Of Domicile)

Name, Street Address, P.O. Box, City, State, And Zip Code Of Applicant     Name, Street Address, P.O. Box, City, State, And Zip Code Of Co-Applicant

Telephone No.                                                              Telephone No.

Legal Residence (County, State)                                            Legal Residence (County, State)

Name, Street Address, P.O. Box, City, State, And Zip Code Of Attorney      Attorney Bar No.

                                                                           Telephone No.

I, the undersigned, applying for letters of administration in the above estate, being first duly sworn, say that:
1.   The decedent was domiciled in this county at the time of the decedent’s death, or left property or assets in this county, or was 
   a nonresident motorist who died in North Carolina;                   no other proceeding for probate or for administration is pending in any 
   jurisdiction.
2.   a.  I am the person entitled to apply for letters or am applying after all persons having prior right to apply have renounced.
     b.  I am applying subject to G.S. 28A-6-2(1) and move that all necessary notices be issued.
     c.  I am the public administrator appointed by the Court.
3.   I am not disqualified pursuant to G.S. 28A-4-2 to administer the estate and have not renounced my right to do so.
4.   After diligent inquiry, I have determined that the persons listed below are all the persons entitled to share in the decedent’s estate.  
   (If there is a court-appointed guardian for any such person(s), list the guardian’s name and address on an attachment.)
                     NAME                                  AGE             RELATIONSHIP                   MAILING ADDRESS

                                                           Original - File     Copy - Applicant
                                                           (Preliminary Inventory On Reverse)
 AOC-E-202, Rev. 3/16
 © 2016 Administrative Office of the Courts

                                                   PRELIMINARY INVENTORY
(Give values as of date of decedent’s death. Continue on separate attachment if necessary.)
                                                PART  I.PROPERTY OF THE ESTATE
  1. Accounts in sole name of decedent (List bank, etc., each account no., and balance.)                             Est. Market Value
                                                                                                                   $

  2. Joint accounts without right of survivorship (List bank, etc., each account no., balance, and joint owners.)
                                                                                           % Owned By Decedent
                                                                                           % Owned By Decedent
                                                                                           % Owned By Decedent
                                                                                           % Owned By Decedent
  3.    Stocks/bonds/securities in sole name of decedent or jointly owned 
 without right of survivorship                                                             % Owned By Decedent
  4. Cash and undeposited checks on hand
  5. Household furnishings
  6. Farm products, livestock, equipment, and tools
  7. Vehicles
  8. Interests in partnership or sole proprietor businesses
  9. Insurance, Retirement Plans, IRAs, annuities, etc., payable to Estate
 10. Notes, judgments, and other debts due decedent
 11. Miscellaneous personal property
 12. Estimated annual income of Estate
                                                   (Base bond on this amount, if applicable.)     TOTAL PART I.    $
                PART II. PROPERTY WHICH CAN BE ADDED TO ESTATE IF NEEDED TO PAY CLAIMS
  1. Joint accounts with right of survivorship (List bank, etc., each account no., balance, and joint owners.)
                                                                                                                   $

  2.  Stocks/bonds/securities registered in beneficiary form and immediately transferred on death or jointly 
 owned with right of survivorship
  3. Other personal property recoverable (G.S. 28A-15-10)
  4. Real estate owned by decedent and not listed elsewhere
                                                                                                 TOTAL PART II.    $
                                                   PART III. OTHER PROPERTY
  1. There       is       is not     entireties real estate owned by decedent and spouse.
  2.  There      are      are not     Insurance, Retirement Plans, IRAs, annuities, etc., payable to named 
 beneficiaries.
  3.  There      is       is not     a potential claim for wrongful death arising under G.S. 28A-18.2.
Signature Of Applicant                                                     Signature Of Co-Applicant

SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME                                 SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME
Date                    Signature Of Person Authorized To Administer Oaths Date                     Signature Of Person Authorized To Administer Oaths

      Deputy CSC          Assistant CSC         Clerk Of Superior Court          Deputy CSC          Assistant CSC   Clerk Of Superior Court
        Date Commission Expires                                            Date Commission Expires
 Notary                                                                                                                                               Notary
        County Where Notarized                                             County Where Notarized
SEAL                                                                                                                 SEAL
AOC-E-202, Side Two, Rev. 3/16
© 2016 Administrative Office of the Courts