Petition for Formal Adjudication of Intestacy, Determination of Heirs, and Formal Appointment of Personal Representative (DHS-8350C)

Follow the instructions for (DHS-8350C) (PDF) to ask the court to initiate probate for an estate with a will.

1. Fill in the header.

· Select your county name from the top left dropdown.

· Enter decedent’s (deceased person’s) name on the left.

· Enter the court district number in the top right. If you are unsure of your district, look up the court district.

· Since you are opening a new court file, you do not need to enter a file number.

2. Fill in the body. Any statements that do not have a blank are true for all Medical Assistance (MA) claims, except where otherwise noted.

· Enter your name and the name of the county you work for.

· Enter your office address and the county you work for at number 1.

· Enter the date of the MA claim and the amount of the MA claim.

· Enter the date range of when decedent received MA.

· Enter decedent’s date of birth, and the city and state where decedent was born at number 2.

· Enter decedent’s date of death, and the city and state where decedent died.

· Enter the county, state, and address where decedent was domiciled at time of death. “Domicile” has a legal meaning: the bodily presence of an individual person in a place with an intent to make such a place one's home.

· Check the applicable box at number 3. If it has been more than three years since decedent’s death, do not use this form. Use the Determination of Descent forms if it has been more than three years since decedent died. The possible exceptions to this rule are:

a. if a previous proceeding was dismissed because of doubt about the fact of the decedent's death, and decedent's death occurred prior to the initiation of the previous proceeding;

b. for the estate of an absentee, or disappeared or missing person, within three years after the death of the absentee or disappeared or missing person is established; or

c. if a proceeding to contest an informally probated will and to appoint a person with legal priority is granted, probate may be commenced within the later of 12 months from the informal probate order or three years from the decedent's death.

· Check the applicable box at number 4.

· Check the applicable box at number 8.

· Check the box at number 9, if applicable. Enter information on any predeceased issue (if any). “Issue” has a legal meaning: lineal descendants.

· Enter the name of the person you propose as personal representative (the county worker) at number 12.

· Check the appropriate box at number 13. A party can file a demand for notice in court without opening probate. If a party has filed a Demand for Notice, always give them proper notice. You give proper notice by sending the court filings to the party.

3. Fill in what you are asking the court to do.

· Enter the name of the person you are nominating to be personal representative at number 7.

· Enter the name of the person you are nominating to be personal representative at number 8.

4. Fill in the information for the attorney representing the county in this matter in the bottom left.

5. Fill in Exhibit A, if needed.

· Enter the name, address, relationship and interest for every known interested person in the first two columns.

· Enter whether the interested person is an adult or deceased. If the interested person is a minor, enter the minor’s date of birth in the last column.

6. Fill in Exhibit B, if known.

· Enter the known assets in the columns.

· Add each column and enter the total in the “TOTAL” blank in the table.

· Enter the approximate indebtedness (how much is owed) of the estate.

7. Date and sign the document.