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Wisconsin Real Estate Forms

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					                                                AP P L I C AT IO N FO R T HE
                                      T ERM IN AT IO N O F D E CE D ENT ’ S I NT ER E ST
                                  AN D CO NF IRM AT I O N O F AP P L IC ANT ’ S I NT ER E ST
                                                      IN P RO P ERT Y
     Use black ink

              Use black ink
       iii
         DECEDENT’S NAME                                                   DATE OF DEATH


         ADDRESS OF DECEDENT AT DATE OF DEATH                                    CITY                  ST          ZIP




      PRESENTATION OF DEATH CERTIFICATE
      I c e r t i f y t h a t I h a ve vi e w e d a c e r t i f i e d c o p y o f t h e d e c e d e n t ’ s d e a t h
      certificate.

      __ _ __ _ __ _ _ __ _ __ _ __ __ _ __ _ __ _ _ __ _ __ _ __                        __ _ __ _ __ _ __ _ _ __
      REGISTER OF DEEDS SIGNATURE                                                         DATE                                              Recording area

  THE INTEREST OF THE DECEDENT IN THE PROPERTY NOTED HEREIN                                                                            Name and return address:
  IS HEREBY TERMINATE D/CONFIRMED UNDER THE FOLLOWING STATUTE :
   (please check appropriate statute )

     s. 867.045 which pertains to real property in which the decedent was a joint
  tenant, had a vendor’s or mortgagee’s interest, or had a life estate. (You must
  provide a copy of the document establishing interest in the real property.)

     s . 8 6 7 . 0 4 6 wh i c h p e r t a i n s t o p r o p e r t y o f a d e c e d e n t s p e c i f i e d i n a m a r i t a l
  property agreement; survivorship marital property ; or a third party confirmation; or
  a nonprobate transfer on death as described in s.705. 10(1).
  (You must provide a copy of the document establishing interest in property.)
                                                                                                                                      Parcel Identification Number
  Presentation of recorded document establishing interest in real estate.                                                             S E N D T AX S T AT E M E N T T O :

DOCUM DOCUMENT #                     VOLUME/REEL                 PAGE/IMAGE             RECORDS/DEEDS




  Description of the real estate.                                                          See Attached




        Description of personal property (if any) being transferred.
        You may list savings accounts, checking accounts an d securities on attached pages. Indicate person(s) receiving property .
        D E C L AR AT I O N : I (W e ) d e c l a r e t h a t t h i s d o c u m e n t i s , t o t h e b e s t o f m y ( o u r ) k n o w l e d g e a n d b e l i e f , t r u e , c o r r e c t a n d
        c o m p l e t e a n d i s i n c o n f o r m i t y wi t h t h e p r o v i s i o n s a n d l i m i t a t i o n s o f t h e W i s c o n s i n S t a t u t e s .
                       N a m e a n d Ad d r e s s                                   Ap p l i c a n t ’ s                           Ap p l i c a n t S i g n a t u r e
                (List all remaindermen/                                 Interest in Property                                                (Notarized)                                  Date
                  beneficiaries. If more space is                   (ie: spouse, remainderman,              (P ri nt or type nam e bel ow si gnature)
                  needed, attach pages. )                           beneficiary)




        T h i s d o c u m e n t wa s d r a f t e d         S T AT E O F W I S C O N S I N , C o u n t y o f
        by:(print or type name below)                      S u b s c r i b e d a n d s wo r n t o b e f o r e m e o n :

                                                           by the above named person(s):


             NOTE: SEE DIRECTIONS.
                                                           Signature of Notary or other person
               Wisconsin Register of Deeds                 authorized to administer an oath (as per
                Association Form HT-110                    s 706.06, 706.07)
                Website Version 05/2010
                                                           Print or type name:
                                                           Title:                                                            Date Commission Expires:

                     T H I S I S A S T AN D AR D F O R M . AN Y M O D I F I C AT I O N S T O T H I S F O R M S H O U L D B E C L E AR L Y I D E N T I F I E D .

				
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