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									                         IN THE COURT OF QUEEN’S BENCH

                            JUDICIAL CENTRE OF REGINA

                                     IN THE ESTATE OF

                                 JANE DOE, DECEASED


        The application of JOHN DAVID DOE, of Regina, Saskatchewan, STATES


1.      JANE DOE, late of Regina, Saskatchewan, deceased, died at Swift Current,

        Saskatchewan on or about the 29th day of September, 2006 and at the time of death

        resided in Saskatchewan (or resided outside of Saskatchewan but had property in


2.      The deceased made a Last Will and Testament dated the 27th day of November,

        1992, (and codicil or codicils dated the ___ day of _____, ___) and was at the time

        of making the Will (and codicils) the full age of 18 years.1

3.      The following beneficiaries (beneficiary), and no other persons, are entitled to share

        in the estate of the Deceased:

        NAME AND ADDRESS                                     RELATIONSHIP

        John David Doe
        658 Pine St.                                         Adult Son
        Regina, Saskatchewan
        S4H 3T8

        Sally Lynn Brown
        (named in the will as Sally Lynn Doe)                Adult Daughter
        1783 Smith St
        Calgary, Alberta
        T5H 7Y8

(If applicable, add 3(a) as below)
3. (a) The deceased died intestate as to a portion of his/her estate leaving surviving the

       following persons, and no others, who are entitled by law to share in the estate:

       (Show here the name and address of each beneficiary and the relationship to the


4.     Every Person named as a beneficiary survived the deceased.2

5.     No beneficiary is now under the age of eighteen (18) years, and no child under the
       age of eighteen (18) years survived the deceased, and no posthumous child has been
       or will be born to the deceased. 3

6.     The Deceased was not survived by any dependent adult who is a beneficiary of the

       estate or may have a claim against it under the Dependant’s Relief Act or The

       Family Property Act. 4

7.     The Deceased was 65 years of age at death.

8.     The Deceased was married (state marital status) at death.

9.     The Deceased did not, after execution of the will, marry or cohabitate in a spousal

       relationship continuously for two years.5

10.    After making the will and before his/her death, the marriage of the testor was not

       terminated by a final judgment of divorce nor was it found to be void or declared a

       nullity by a court in a proceeding to which the testator was a party, nor did the

       testator and his/her spouse, who were not legally married, cease to cohabit in a

       spousal relationship for at least 24 months.6

11.    The Applicant is the alternate Executor named in the Will and is 18 years of age or

       more. The first-named Executor, namely Sally Lynn Brown, has renounced her right

       to probate and her renunciation is filed herewith.7

12.    Neither witness to the Will is a beneficiary or the spouse of a beneficiary named in

       the Will.8
13.    The value of the estate for the purpose of Local Registrar’s fees is $326,983.32.

14.    No other application for grant has been made to this Honourable Court to prove the

       Will or for letters of administration with the will annexed, to the best of the

       Applicant’s information and belief.

       Therefore the Applicant requests that probate of the Will of the Deceased may be

       granted by this Honourable Court.

       Dated this ____ day of _____, 200_.


                                                                          JOHN DAVID DOE

This document was delivered by:

(name and Saskatchewan address required here)

                                                      This is Exhibit “A” to the Affidavit of
                                                      JOHN DAVID DOE, sworn before me at
                                                      the City of Regina, in the Province of
                                                      Saskatchewan, this __ day of _______, 200_.

                                                      A Commissioner for Oath in and for
                                                      the Province of Saskatchewan.

 If otherwise, see rule 706(1)(a) of the Queen’s Bench Rules (located online at: and The Wills Act, sections 5 & 6 (located
online at: and set out in the
applicable exception. For the applicable age see the provisions of The Age of Majority Act.

  If otherwise, state whether the deceased beneficiary was a brother, sister, child or other relative of the
testator/testatrix, and if so, if he or she is survived by a child now under 18. See section 32 of The Wills Act. If
so, file form 101.

    If otherwise, so state and file form 101.

    If otherwise, so state and file form 101.

    If otherwise, set out the applicable exemption: see Rule 706(1)(b).

    If otherwise, comply with Rule 706(1).

    The applicant(s) is/are the executor(s) named in the will and (each) is 18 years of age (or a trust company).

    If otherwise, set out the applicable exception: see Rule 706(1)(c).

NOTE: all red text must be either deleted or replaced with the specific
information to your situation and changed into black print. The red text is only
to highlight where information may be changed.

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