Form 74BB – Page 1 File No: ______

⃰ I DO CERTIFY that no other Request or Notice of Application in respect to the property of the said deceased has been received by me; and that no caveat against a Grant of Probate or Administration of the property of the deceased has been received by me; and that no will of the deceased has been deposited in any Court of Queen's Bench of this Province.

Dated this ___ day of ______, ______

No. ______

______

Deputy Registrar

(*If caveat filed, certify that a notice to caveator has been filed and served and that no probate action has been commenced within 30 days after service.)

THE QUEEN'S BENCH

______Centre

In Re

Deceased

REQUEST FOR ORDER

pursuant to Section 47 of

THE COURT OF QUEEN'S BENCH SURROGATE PRACTICE ACT

Filed by: ______

Address: ______

______

Telephone: ______

Form 74BB – Page 1 File No: ______

THE QUEEN'S BENCH

______Centre

REQUEST FOR ORDER

pursuant to Section 47 of

THE COURT OF QUEEN'S BENCH SURROGATE PRACTICE ACT

IN THE ESTATE OF ______, late of ______in

the Province of Manitoba, ______, deceased.

(occupation)

I, ______of ______, in

the Province of Manitoba ______, make oath and say:

(occupation)

1.  That I am of the full age of 18 years and that my place of residence and occupation are above correctly stated.

2.  That ______, late of the ______of ______, in the

Province of Manitoba, ______, died on or about the ____ day of ______, ______,

(occupation)

at the ______of ______, in the Province of Manitoba.

3.  That now produced to me, and marked as exhibit "A" to this my affidavit, is the last will of the deceased, ______(or that I have made or caused to be made a careful search in all places where the deceased might have been expected to keep papers, but I have been unable to discover any testamentary paper and I verily believe that the deceased died without having left any will).

4.  That I am the______and the deceased left

(state your relationship to the deceased or if you are the executor named in the will)

surviving (him or her) the following next-of-kin:

______

Name Address Kinship Age

5.  That the total value of all property of the said deceased which (he or she) in any way died possessed of or entitled to, does not exceed $10,000.00 consisting of $ ______personalty, and $ ______realty (which includes any interest of the deceased in a real property mortgage). The realty is situated in the Province of Manitoba and is more particularly described as follows:

6.  That the interest of the deceased in the above real property devolves (has been devised or sold) to

______of the ______of ______,

______and I hereby request that the court order that the deceased's interest in the

(occupation)

real property be vested in the said ______.

7.  That I do solemnly swear that I will faithfully administer the property of the deceased , pay the just debts and funeral expenses of the deceased, distribute the residue (if any) according to law and render a full and true account of my administration when required.

8.  I make this affidavit in support of a request for an order that the personal property of the said deceased be paid or delivered to me and that the deceased's interest in any real property be dealt with as above requested or delivered to me to be disposed of by me as the court directs.

SWORN (OR AFFIRMED) before me at the

______of______

in the Province of Manitoba,

this ____day of ______, _____. ______

Signature of Deponent

______

Deputy Registrar for the Queen’s Bench, or

Commissioner for Oaths in and for the

Province of Manitoba,

My Commission Expires: ______