STATE OF MICHIGAN
PROBATE COURT
COUNTY
SUPPLEMENTAL TESTIMONY
TO IDENTIFY NONHEIR DEVISEES
Testate Estate
CASE NO. and JUDGE
Court address Court telephone no.
In the matter of
First, middle, and last name of decedent
JIS Code: TSS
Approved, SCAO
Form PC 566, Rev. 6/23
MCL 700.2702, MCL 700.2707-700.2710, MCR 5.302
Page 1 of 2
***USE THIS FORM ONLY IF A DEVISEE NAMED IN THE WILL OR CODICIL IS NOT AN HEIR OF THE TESTATOR***
NOTE: TREAT ALL PERSONS WHO DIED WITHIN 120 HOURS AFTER THE DECEDENT AS IF THEY DID NOT SURVIVE THE
DECEDENT. List persons who died within 120 hours after the decedent in item 18 below.
16. The names of all devisees named in the will and codicils who are not heirs of the decedent (include testamentary
trustees and beneficiaries of testamentary trusts) are
.
17. Of the devisees listed in 16, the following died before the decedent. Their names and relationships to the
decedent are
.
18. The following devisees died within 120 hours after the decedent. Their names, relationships to decedent, and the
date and time of their deaths are:
NAME RELATIONSHIP DATE OF DEATH TIME OF DEATH
19. The following are descendants of the predeceased devisees named above, who survived the decedent:
.
20. Class gifts in the will or codicils, where the members are not specifically identified by name, are as follows:
.
Supplemental Testimony to Identify Nonheir Devisees, Testate Estate (6/23)
Page 2 of 2
Case No.
I declare under the penalties of perjury that this supplemental testimony has been examined by me and that its contents are
true to the best of my information, knowledge, and belief.
Signature
Date
Attorney signature
Name (type or print) Bar no.
Address
City, state, zip Telephone no.
21. The following devisees named above are under legal disability. Their names, legal disabilities, and names of their
representative(s) are
.
22. The following deceased devisees survived the decedent by more than 120 hours. Their names and the names of
those who represent their interests are
.
23. The guardian ad litem for each devisee under the will and codicils who is unborn, unknown, or unascertainable is
.
