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STATE OF WISCONSIN, CIRCUIT COURT, BURNETTFor Offidal Use <br /> COUNTY <br /> uTA[T.F.OF WISCONSIN <br /> IN THE MATTER OF THE ESTATE OF Domiciliary Letters <br /> (Informal Administration) <br /> FEB 13- 2010 <br /> ANNIE MARCYAN <br /> CCUNTV pF 13lIRNETr <br /> Case N0. 10 PR 04 FlECISTERCIRCUIT COLiRT INPRoa"fI-/JUVENILECLE-RI( <br /> To: Nichole Pettis & Michael Moser, Co-Personal Representatives <br /> PO Box 362 847 19"'Ave.N. <br /> Frederic, W154837 So. St. Paul,MN 55075 <br /> The decedent, whose date of birth was October 11. 1927 and date of death was January 27.2010 <br /> died domiciled in Burnett County, State of Wisconsin <br /> You are granted domiciliary letters with general powers and duties of a personal representative. <br /> state d Wlwonan <br /> County d Burnett <br /> This druummt u a mand ol,true ane wrm lies a at a1° LETTERS ISSUED BY <br /> original a. by me I tuddher arttly"t aid laden <br /> a6�Wfu andedee. <br /> —" Probate Registr <br /> ey n Jacnueline O Baasch <br /> Name Printed or Typed <br /> February JJD 2010 <br /> . Date <br /> Name of Attorney/Personal Representative <br /> Nichole Pettis & Michael Moser,Co-PRs <br /> Address <br /> PO Box 362 847 19th Ave.N. <br /> Frederic,W154837 So. St.Paul, MN 55075 <br /> Telephone Number <br /> 612-386-4995 <br /> PR-1810,10/00 Domiclllary Letters(Informal Administration) §§858.21 and 855.08,Wisconsin Statutes <br /> This form shall not be modified. It may be supplemented with additional material. - <br />