Approved, SCAO
JIS CODE: OED
STATE OF MICHIGAN PROBATE COURT COUNTY OF In the matter of 1. Date of hearing: THE COURT FINDS:
ORDER ESTABLISHING DEATH OF ACCIDENT OR DISASTER VICTIM
FILE NO.
, presumed decedent Judge:
Bar no.
2. Notice of hearing was given to or waived by all interested persons. 3. An accident or disaster occurred on to have died:
Name Date
in which the following person was killed or may be presumed
XXX-XXLast four digits of social security no. Street address Date of birth City State Zip
4. The accident or disaster occurred at 5. The above described person is dead. 6. The date of death is 7. The time of death is at or about
Time Date
.
.
m.
is not possible to ascertain. IT IS ORDERED the death of the presumed decedent is established in accordance with the above findings.
Date
Judge
Do not write below this line - For court use only
PC 550 (9/05)
ORDER ESTABLISHING DEATH OF ACCIDENT OR DISASTER VICTIM
MCL 700.1207, MCL 700.1208