Haw. Prob. R. Flag Sheet 1-B

Probate No.

(Attorney for Petitioner or Pro Se Petitioner)

Tel. No. Estate of

I. Death Certificate

The death certificate actually shows the following information:

1. Name of decedent in full:

2. Date of death:

3. Marital status:

II. Publication Notice

1. Name of decedent as actually published

2. Dates of actual publication (in 3 consecutive weeks):

; ; .

III. Proof of Service

1. List or attach a list of all interested persons who are entitled to notice of hearing,

and their relationship to the decedent.

Name Relationship

2. Was notice served on all interested persons?

(HRS §560:1-401) Yes No

3. If “No,” were waivers of notice obtained and filed for all

interested persons other than those served under 2 above? Yes No

4. If “No,” list the names of all interested persons who have not been served and

have not waived notice.

IV. Consent, Renunciation & Waiver (CRW)

1. Does the petition name the person with the highest priority

to be appointed? Yes No

2. If “No,” list or attach a list of the names of those persons who have higher or

equal priority with the proposed PR, and whether their consent, renunciation and

waiver (CRW) have been obtained and filed.

CRW Filed?

Name Yes No

V. Bond (Personal Representative (PR))

1. Does the petition request the appointment of the

proposed PR without bond? Yes No

State the reason for this request and include the relationship of the proposed PR to

the decedent or heirs.

VI. Prayer for Special Matters

(Note: Anything beyond the normal and ordinary probate matters shall be specified in this classification as special or unusual matters.)

1.Special matters requested?Yes No

2. If “Yes,” enumerate such special matters.

VII. Existence of a Will That is Not Being Probated

1. Are you aware of any will that for any reason is not being

offered for probate? Yes No

2. If “Yes,” state briefly the reason why the will is not being offered for probate, and list any persons entitled to notice under said will who are not entitled to notice under this Petition for Adjudication of Intestacy.

VIII. Objection or Opposition

1. Are you aware of any opposition or objection to this petition? Yes No

2. If “Yes,” state by whom (include the relationship of the objector to the decedent or beneficiaries) and the grounds for the objection, if known.

THE UNDERSIGNED HEREBY CERTIFIES THAT TO THE BEST OF SAID INDIVIDUAL’S KNOWLEDGE AND BELIEF ALL OF THE FOREGOING FACTS

AND FIGURES ARE TRUE AND CORRECT.

Attorney for Petitioner or Pro Se Petitioner

Hearing Date: