Haw. Prob. R. Flag Sheet 1-F

Probate No.

(Attorney for Petitioner or Pro Se Petitioner)

Tel. No. Estate of

For estates of decedents dying on or before January 1, 1997, skip to Item VI, Objection or

Opposition.

I. Timeliness of Election (HRS §560:2-211(a), (b))

1. Date of Death:

2. Date of Probate of Will:

3. Date of Extension Granted by the Court, if any:

II. Persons Entitled to Notice

1. List the names of all interested persons (HRS §560:1-401) and state whether they

have been notified of this proceeding.

Notified?

Name Yes No

2. List all persons interested in the decedent’s nonprobate transfers to others (HRS

§560:2-211(b)) and state whether they have been notified of this proceeding.

Notified?

Name Yes No

III. Elective Share Percentage

1.a. For how many years were the surviving spouse and

the decedent married to each other? years

or

b. For how many years were the surviving reciprocal beneficiary

and the decedent in a reciprocal beneficiary relationship? years

2. State the elective share percentage that corresponds

to the years stated in item 1. (HRS §560:2-202(a)). percent

IV. Augmented Estate

Summarize, by stating the value of the following:

1. . Decedent’s net probate estate (HRS §560:2-204) $

2. Decedent’s nonprobate transfers to others

(HRS §560:2-205) $

3. Decedent’s nonprobate transfers to the

surviving spouse (HRS §560:2-206) $

4. The surviving spouse’s property and nonprobate

transfers to others (HRS §560:2-207) $

5. The amount of any exclusions pursuant to

HRS §560:2-208(a) $

6. Any property excluded to avoid overlapping

application pursuant to HRS §560:2-208 $

State the value of the augmented estate $

V. Determination of Elective Share Amount

State the value of the elective share amount (the

elective share percentage of the augmented estate,

HRS §560:2-202). $

VI. 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