San Bernardino — 13-19620-360

Source: https://sanbernardino.courts.ca.gov/system/files/forms-filing/13-19620-360petitionforfinaldistributionaccountingreportofadministrator.pdf

ATTORNEY AND/OR PERSONAL REPRESENTATIVE STATE BAR NO.: For Court Use Only NAME: STREET NAME: CITY: STATE: ZIP CODE: TELEPHONE NO.: EMAIL ADDRESS: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: IN THE MATTER OF THE ESTATE OF:

☐ PETITION FOR FINAL DISTRIBUTION CASE NUMBER(S): ☐ AND ALLOWANCE OF FEES TO PERSONAL REPRESENTATIVE ☐ ______ AND FINAL ACCOUNT HEARING DATE: DEPT.: ☐ WAIVER OF ACCOUNT AND REPORT OF ☐ EXECUTOR ☐ ADMINISTRATOR ☐ ADMINISTRATOR- WITH-WILL-ANNEXED (Probate Code §§ 1060-1064 et seq.)

INFORMATION TO THE PERSONAL REPRESENTATIVE OF THE ESTATE: You must give notice of this petition to all interested persons using form DE-120, including those listed in Probate Code § 11000.

The petitioner (name of representative) __________________________________________________, as

☐ executor ☐ administrator ☐ administrator-with-will-annexed of the Estate of (name of decedent)

_____________________________________________, deceased alleges:

1. DATE OF DEATH AND DOMICILE

(name of decedent) _______________________________ died on (date) _______________ in the City

of_________________________________, County of __________________________, State of ___________________

and was a resident of (county) ____________________________, State of ________________________________ at the

time of decedent’s death.

2. APPOINTMENT OF PERSONAL REPRESENTATIVE

☐ The decedent’s ☐ Will dated ______________ ☐ and codicil dated _______________ was/were admitted to

probate by order of this Court on (date order was entered) __________________________.

OR

☐ Despite search and inquiry, no will of decedent has been found.

Petitioner qualified as ☐ executor ☐ administrator ☐ administrator-with-will-annexed of the estate and ☐ Letters

Testamentary ☐ Letters of Administration ☐ Letters of Administration-with-will-annexed were issued to petitioner on (date

issued) ________________. At all times since then, petitioner has been acting as the duly qualified ☐ executor

☐ administrator ☐ administrator-with-will-annexed of the decedent’s estate.

3. AUTHORITY GRANTED UNDER INDEPENDENT ADMINISTRATON OF ESTATES ACT

On (date Order for Probate was signed) _______________, petitioner was granted ☐ full ☐ limited authority by

order of this Court to administer the estate without court supervision under the Independent Administration of Estates Act

PETITION FOR FINAL DISTRIBUTION; ACCOUNTING; REPORT OF ADMINISTRATOR

Form Approved for Optional Use (Probate Code § § 1060-1064 et seq.) Form # 13-19620-360 Rev.07/01/2026

IN THE MATTER OF THE ESTATE OF: CASE NUMBER:

pursuant to Probate Code § 10402 (full authority) or Probate Code § 10403 (limited authority). This authority has not been

revoked.

4. BOND AND BLOCKED ACCOUNT

   Bond was ☐ waived ☐ ordered in the amount of __________________ and remains current.

   Funds in the amount of _________________ were deposited into a blocked account.

5. STATUS OF ESTATE

   Petitioner has performed all duties required of petitioner for the estate of the decedent with respect to the

administration of the estate. The estate is now ready for distribution and is in a condition to be closed.

6. NOTICE OF DEATH

   Notice of Petition to Administer Estate, which constitutes one form of notice to creditors, has been published for the

period and in the manner prescribed by law. Within thirty (30) days after the completion of publication, an Affidavit of

Publication showing due publication in the manner and form required by law was filed with the clerk of the court.

Reasonable efforts were made to identify creditors of the estate and Notice of Administration to Creditors was sent to all

known creditors of the estate on (date or dates when Notice was mailed) _____________________________________.

More than four months have elapsed since the first issuance of Letters, and the time for filing or presenting claims has

expired.

7. CREDITORS' CLAIMS

☐ No claims have been filed with the court or presented to the personal representative.

☐ The following claims have been filed with the court or presented to the personal representative:

Name of Creditor Date Claim Filed Purpose Amount of Claim Allowed/Rejected

a. _________________ _____________ _________________ ______________ _____________

b. _________________ _____________ _________________ ______________ _____________

c. _________________ _____________ _________________ ______________ _____________

d. _________________ _____________ _________________ ______________ _____________

e. _________________ _____________ _________________ ______________ _____________

☐ All claims have been allowed and paid or satisfied in full.

☐ The following claims were allowed and have not yet been paid or satisfied:

Name of Creditor Approved amount Reason claim not paid or satisfied:

a. _________________ _____________ __________________________________________________

b. _________________ _____________ __________________________________________________

c. _________________ _____________ __________________________________________________

d. _________________ _____________ __________________________________________________

e. _________________ _____________ __________________________________________________

PETITION FOR FINAL DISTRIBUTION; ACCOUNTING; REPORT OF ADMINISTRATOR
(Probate Code § § 1060-1064 et seq.)

Form Approved for Optional Use Form # 13-19620-360 Rev. 07/01/2026

IN THE MATTER OF THE ESTATE OF: CASE NUMBER:

8. COMPLIANCE WITH PROBATE CODE §9202

   a. Notice to the Director of Health Services:

   ☐ is not required under Probate Code Section 9292 because the decedent did not receive and was not the

   surviving spouse of someone who received Medi-Cal benefits.

   OR

   ☐ has been given as required by law under Probate Code Section 9202. A notice was received from the

   Director of Health Services stating that no creditor’s claim will be filed against the estate because decedent has

   not received any Medi-Cal benefits.

   ☐ has not been given.

   b. Notice to the Director of the California Victim Compensation or to the Government Claims Board:

   ☐ was not sent under Probate Code Section 9202(b) because no heir is confined in a prison or facility under the

   jurisdiction of the Department of Corrections or the Department of the Juvenile Justice or confined in any county

   or city jail, road camp, industrial farm, or other local correctional facility.

   ☐ has been given under Probate Code section 9202(b). No creditor’s claim has been received, or the creditor’s

   claim of $__________ has been paid as set forth above.

   ☐ has not been given.

   c. Notice to the Franchise Tax Board:

   ☐ has been provided as required by Probate Code section 9202(c) as provided in section 1215. Notice was

   sent on _________, 20. (Attach copy of Notice)

   ☐ has not been given.

9. DEBTS OF DECEDENT

   All debts of decedent and of the estate and all expenses of administration, except closing expenses and statutory

commissions of the personal representative (and their attorneys) have been paid.

10. INVENTORY AND APPRAISAL

    An Inventory and Appraisal was returned and filed on (date inventory was filed) _______________ showing a value

of $ ____________________________. (check the box below and add information If additional inventories filed)

☐ One or more Supplemental Inventory and Appraisal was filed in the amount(s) of $_____________________ for

total assets belonging to the estate of $__________________.

Petitioner alleges that such inventory/inventories contain all the assets of decedent's estate that have come to

petitioner's knowledge or possession.

PETITION FOR FINAL DISTRIBUTION; ACCOUNTING; REPORT OF ADMINISTRATOR (Probate Code § § 1060-1064 et seq.)

Form Approved for Optional Use Form # 13-19620-360 Rev. 07/01/2026

IN THE MATTER OF THE ESTATE OF: CASE NUMBER:

11. ACTIONS TAKEN UNDER INDEPENDENT ADMINISTRATION OF ESTATES ACT

☐ Decedent's real property located at__________________________________________________ was sold for

$ ___________________________, on (date) ___________________ under the Independent Administration of Estates

Act. A Notice of Proposed Action was given as prescribed by law to the persons entitled to receive notice. Objections to

the sale ☐ were ☐ were not received. (Add, if applicable): ☐ The net proceeds of sale will be distributed as part of the

residue of the decedent's estate.

OR

☐ (Describe actions taken): _______________________________________________________________________

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A Notice of Proposed Action was given as prescribed by law to the persons entitled to receive notice. Objections to the

actions stated ☐ were ☐ were not received.

12. PERSONAL PROPERTY TAXES

    All personal property taxes due and payable by this estate ☐ have been paid

OR

☐ No personal property taxes are due and payable by this estate.

13. CALIFORNIA AND FEDERAL ESTATE TAXES

A federal estate tax return, Form 706, has not been filed because the estate is not sufficient to require such a

return. No California estate taxes are due and payable by this estate.

14. INCOME TAXES

☐ All California and federal income taxes due and payable by the estate will be paid by the personal representative

from decedent's estate prior to distribution.

OR

☐ No California or federal income taxes are due and payable by the estate.

15. INVESTMENT OF CASH ON HAND

    Petitioner has invested and maintained all cash in interest bearing accounts or in investments authorized by law or

    the governing instrument, except for an amount of cash that is reasonably necessary for the orderly administration

    of the estate as required by Probate Code §1064(a)(5).

    PETITION FOR FINAL DISTRIBUTION; ACCOUNTING; REPORT OF ADMINISTRATOR (Probate Code § § 1060-1064 et seq.)

Form Approved for Optional Use Form # 13-19620-360 Rev. 07/01/2026

IN THE MATTER OF THE ESTATE OF: CASE NUMBER:

16. WAIVER OF ACCOUNT (if applicable)

☐ (Name(s)) _________________________________________________________________________________

________________________________________________________________________________________________,

the person(s) entitled to distribution of all of the estate, waive(s) an account by petitioner. Such waiver(s) ☐ are on file

OR ☐ will be filed in this proceeding OR ☐ are attached hereto.

17. SUMMARY OF ACCOUNT (if account not waived)

    Petitioner is chargeable with and is entitled to the credits set forth in the Summary of Account below. The account

covers the period from (date of death or ending period of last account filed) __________________ to (end of period

covered by this account) _________________. Schedules A through _______________ in support of the Summary of

Account are attached hereto and incorporated herein by this reference:

CHARGES

a. Inventory and Appraisal $ ____________________

b. Supplemental Inventory and Appraisal (if any) $ ____________________

c. Additional Property Received (if any) $ ____________________

d. Income Receipts During Account Period (Schedule A) $ ____________________

e. Gains on Sales or Other Disposition of Assets (Schedule B) $ ____________________

f. Net Income from Trade or Business (if any) (Schedule C) $ ____________________

Total Charges $ ____________________

CREDITS

a. Disbursements During Accounting Period (Schedule D) $ ____________________

b. Losses on Sales or Other Disposition of Assets (Schedule E) $ ____________________

c. Net Loss from Trade or Business (if any) (Schedule F) $ ____________________

d. Distributions to Beneficiaries (if any) (Schedule G) $ ____________________

e. Property on Hand at End of Accounting Period (Schedule G) $ ____________________

Total Credits $ ____________________

18. CHARACTER OF PROPERTY

    The whole of the estate is decedent’s

☐ separate ☐ one-half interest in the community property of decedent and his/her surviving spouse ☐ quasi-

community property OR

☐ (Describe interest if mixed): ____________________________________________________________________

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19. SCHEDULE OF PURCHASES OR OTHER CHANGES IN FORM OFASSETS

    Certain assets were disposed of or changed in form during the administration of the estate. All changes in

investments are shown on Attachment 19, attached hereto and made a part hereof by reference.

PETITION FOR FINAL DISTRIBUTION; ACCOUNTING; REPORT OF ADMINISTRATOR (Probate Code § § 1060-1064 et seq.)

Form Approved for Optional Use Form # 13-19620-360 Rev. 07/01/2026

IN THE MATTER OF THE ESTATE OF: CASE NUMBER:

20. INTESTATE HEIRS/DEVISEES UNDER WILL

    The following are the ☐ decedent’s heirs under the laws of intestate succession ☐ devisees named in the

decedent’s Will:___________________________________________________________________________________

Name Age Relationship to Decedent Address

a. _______________________ ______ ____________________ __________________________________

b. _______________________ ______ ____________________ __________________________________

c. _______________________ ______ ____________________ __________________________________

d. _______________________ ______ ____________________ __________________________________

e. _______________________ ______ ____________________ __________________________________

f. _______________________ ______ ____________________ __________________________________

g. _______________________ ______ ____________________ __________________________________

h. _______________________ ______ ____________________ __________________________________

i. _______________________ ______ ____________________ __________________________________

j. _______________________ ______ ____________________ __________________________________

☐ Additional heirs/devisees are listed in Attachment _______.

21. PROPOSED DISTRIBUTION OF ESTATE

☐ By the terms of decedent’s Will ☐ Pursuant to the laws of intestate succession, the estate should be distributed

☐ as shown on Attachment 21 OR ☐ as follows:

Name Description of Share of Estate

a. _______________________ ______________________________________________________________

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b. _______________________ ______________________________________________________________

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c. _______________________ ______________________________________________________________

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d. _______________________ ______________________________________________________________

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e. _______________________ ______________________________________________________________

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22. COMPUTATION OF STATUTORY COMPENSATION

    The statutory compensation payable to the ☐ executor’s ☐ administrator’s ☐ administrator-with-will-annexed for

services is $ __________________, computed on a fee base of $ ____________________. The statutory attorneys’

compensation payable for services is $ ____________________. The fee base and statutory attorneys’ fees are arrived

at as follows:

PETITION FOR FINAL DISTRIBUTION; ACCOUNTING; REPORT OF ADMINISTRATOR (Probate Code § § 1060-1064 et seq.)

Form Approved for Optional Use Form # 13-19620-360 Rev. 07/01/2026

IN THE MATTER OF THE ESTATE OF: CASE NUMBER:

FEE BASE

a. Inventory and Appraisal $ ____________________

b. Supplemental Inventory (if any) $ ____________________

c. Income Receipts During Account Period $ ____________________

d. Gains on Sales $ ____________________

e. Less: Losses on Sale $ ____________________

TOTAL FEE BASE $ ____________________

STATUTORY FEE COMPUTATION

a. 4% of first $100,000 $ ____________________

b. 3% of next $100,000 $ ____________________

c. 2% of next $800,000 $ ____________________

d. 1% of next $1,000,000 to $10,000,000 $ ____________________

TOTAL FEE $ ____________________

23. STATUTORY EXECUTOR/ADMINISTRATOR COMPENSATION

☐ Petitioner should be authorized to pay themselves the sum of $ ____________________ for ordinary services

rendered to the estate in discharge of this obligation.

OR

☐ By signing this petition, Petitioner waives the right to statutory commissions as ☐ executor ☐ administrator ☐

administrator-with-will-annexed.

24. STATUTORY ATTORNEY COMPENSATION

☐ Petitioner should be authorized to pay Attorney the sum of $ ____________________ for ordinary services

rendered to the estate in discharge of this obligation.

OR

☐ Statutory attorney compensation is not requested.

25. EXTRAORDINARY FEES NOT REQUESTED

No extraordinary fees are requested by Petitioner or Attorney. If extraordinary fees are requested, this form should

not be used.

26. REIMBURSEMENT EXECUTOR/ADMINISTRATOR

☐ Petitioner should be authorized to reimburse themselves the sum of $ ____________________ for costs incurred

in administration.

27. REIMBURSEMENT ATTORNEY

☐ Petitioner should be authorized to pay Attorney the sum of $ ____________________ for costs incurred in

administration.

PETITION FOR FINAL DISTRIBUTION; ACCOUNTING; REPORT OF ADMINISTRATOR (Probate Code § § 1060-1064 et seq.)

Form Approved for Optional Use Form # 13-19620-360 Rev. 07/01/2026

IN THE MATTER OF THE ESTATE OF: CASE NUMBER:

28. DISCLOSURE OF RELATIONSHIPS BETWEEN FIDUCIARY, ATTORNEYS, AND OTHER AGENTS HIRED BY

    FIDUCIARY ☐ Petitioner has no personal, financial or other relationship with attorneys or other agents hired by the petitioner.

OR

☐ Petitioner has the following personal, financial or other relationship with attorneys or other agents hired by the

petitioner:

29. CLOSING EXPENSES

    Petitioner asks for authorization to withhold the sum of $ ___________________ to offset closing costs and

expenses, and as a reserve for any liability that may hereafter be determined to be due from this estate.

30. SPECIAL NOTICE

☐ No one has filed a Request for Special Notice.

OR

☐ (Name(s)) _______________________________ has filed a Request for Special Notice.

WHEREFORE, petitioner prays for an order of this court that:

a. The administration of this estate be brought to a close ☐ without the requirement of an accounting by the

petitioner (only check if accounting has been waived). b. The ☐ PETITION FOR FINAL DISTRIBUTION ☐ AND ALLOWANCE OF STATUTORY FEES TO PERSONAL

REPRESENTATIVE ☐ AND STATUTORY ATTORNEY FEES AND SETTLEMENT OF (number of accounting) _______

☐ AND FINAL ACCOUNT ☐ ACCOUNT CURRENT ☐ WAIVER OF ACCOUNT AND REPORT OF ☐ EXECUTOR ☐

ADMINISTRATOR ☐ ADMINISTRATOR-WITH-WILL-ANNEXED (match caption on first page) be settled, allowed, and

approved as filed;

c. All the acts and proceedings of Petitioner as ☐ executor ☐ administrator ☐ administrator-with-will-annexed be

confirmed and approved;

d. Petitioner shall be authorized to withhold $ ________________ to defray closing expenses and to pay any

additional liabilities;

e. (If applicable) Petitioner shall be authorized and directed to pay themselves the sum of $ ________________,

representing statutory compensation for ordinary services rendered in the administration of this estate.

f. (If applicable) Petitioner shall be authorized and directed to pay Attorney the sum of $ ________________,

representing statutory compensation for ordinary services rendered in the administration of this estate.

g. Distribution of the estate of decedent in petitioner's hands and any other property of decedent or the estate not

now known or discovered be made to the persons entitled to it, as set forth in the petition; and that

h. Such further order be made as the court considers proper.

PETITION FOR FINAL DISTRIBUTION; ACCOUNTING; REPORT OF ADMINISTRATOR (Probate Code § § 1060-1064 et seq.)

Form Approved for Optional Use Form # 13-19620-360 Rev. 07/01/2026

IN THE MATTER OF THE ESTATE OF: CASE NUMBER:

Dated: _______________ _______________________________________________ (SIGNATURE OF PETITIONER/ATTORNEY FOR PETITIONER)

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(TYPE OR PRINT NAME OF PETITIONER/ATTORNEY FOR PETITIONER)

VERIFICATION

CCP 446, 20l5.5

I declare that: I am the ☐ executor ☐ administrator ☐ administrator-with-will-annexed of the above-entitled estate. I have read the

foregoing ☐ PETITION FOR FINAL DISTRIBUTION ☐ AND ALLOWANCE OF FEES TO PERSONAL

REPRESENTATIVE ☐ FIRST AND FINAL ACCOUNT ☐ WAIVER OF ACCOUNT AND REPORT OF ☐ EXECUTOR ☐

ADMINISTRATOR ☐ ADMINISTRATOR-WITH-WILL-ANNEXED (match caption on first page), and know the contents

thereof; the same is true of my own knowledge, except as to those matters which are therein stated upon my information

or belief, and as to those matters I believe them to be true.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and

that this verification was executed on (date) ____________at (city) ____________________________ (state) _________.

Dated: _______________ _______________________________________________ (SIGNATURE OF PETITIONER/ATTORNEY FOR PETITIONER)

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(TYPE OR PRINT NAME OF PETITIONER/ATTORNEY FOR PETITIONER)

PETITION FOR FINAL DISTRIBUTION; ACCOUNTING; REPORT OF ADMINISTRATOR (Probate Code § § 1060-1064 et seq.)

Form Approved for Optional Use Form # 13-19620-360 Rev. 07/01/2026