STATE OF MICHIGAN
PROBATE COURT
COUNTY
TESTIMONY TO IDENTIFY HEIRS
CASE NO. and JUDGE
Court address Court telephone no.
In the matter of
First, middle, and last name of decedent
PCS Code: TES
TCS Code: TEST
Approved, SCAO
Form PC 565, Rev. 12/22
MCL 700.2103, MCL 700.2104, MCR 5.104(C), MCR 5.302(B),
MCR 5.308(B)(2)(a)
Page 1 of 3
1. My name is
. My address is
.
2. I am related to the decedent (or know his/her family) as follows:
3. The date and time of the death of the decedent is
Date Time
and at that time the
decedent’s domicile (residence) was
Address
.
NOTE: IN THE FOLLOWING QUESTIONS, 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 14 below.
4. The decedent did not leave a surviving spouse.
left a surviving spouse named
.
5. a. The decedent had the following children, both natural (born in or out of wedlock) and adopted:
b. Of the children listed in 5a, the following are no longer heirs due to their adoption by someone other than a
stepparent:
c. Of the children listed in 5a, the following were not children of the surviving spouse:
Answer question 6 only if question 5a was checked.
6. a. The following children listed in 5a died before the decedent:
b. Children listed in 6a left their own children (either natural or adopted) or left grandchildren from one or more of
their own predeceased children who survived the decedent. The names of these descendants and the name of
the child in 6a to whom they are related are as follows:
c. Of the persons listed in 6b, the following are no longer heirs due to their adoption by someone other than a
stepparent:
Testimony to Identify Heirs (12/22)
Page 2 of 3
Case No.
If decedent left no surviving descendant, complete 7.
7. The decedent did not leave a surviving parent. left a surviving parent named
.
If decedent is not survived by spouse, descendants, or parents, complete 8 (and 9, if applicable).
8. The decedent did not leave surviving brothers or sisters. left the following brothers or sisters, either
natural or adopted, whole blood or half blood, who were not adopted by others and who survived the decedent:
9. One or more of the brothers and sisters of the decedent died before him/her leaving descendants, either natural or
adopted, who were not adopted by others and who survived the decedent. The names of these descendants, and
the name(s) of their deceased ancestor are
.
If decedent was not survived by spouse, descendants, parent, brother, or sister or children of deceased brother or sister,
complete10 (and 11, if applicable).
10. The decedent did not leave surviving grandparents. left surviving grandparents (both maternal and paternal)
named
.
11. Both maternal grandparents and/or both paternal grandparents died before decedent. Their surviving descendants
and their relationships to the grandparents are
Maternal grandparents:
.
Paternal grandparents:
.
12. The following heirs listed above are under legal disability and are currently living. Their name(s), legal disability, and
name(s) of their representative(s) are
.
13. The following deceased heirs survived the decedent by more than 120 hours. Their name(s) and the name(s) of
those who represent decedent’s interests are
.
14. The following persons identified above did not survive the decedent by 120 hours. Their names, relationships to
decedent, and the date and time of their deaths are:
NAME RELATION DATE OF DEATH TIME OF DEATH
Testimony to Identify Heirs (12/22)
Page 3 of 3
Case No.
15. The decedent left a will. All devisees are heirs.
Some of the devisees named in the will or codicil are not heirs of the testator.
(A supplemental testimony form is completed and attached.)
I declare under the penalties of perjury that this testimony has been examined by me and that its contents are true to the
best of my information, knowledge, and belief.
Date
Signature
Attorney signature
Name (type or print) Bar no.
Address
City, state, zip Telephone no.
