In the Matter of the Estate Of

APPLICATION FOR APPOINTMENT OF ______Court Case Number ADMINISTRATOR FOR LEGAL ACTION ______County, Tennessee ONLY

IN THE MATTER OF THE ESTATE OF ______, DECEASED

1. Applicant. The Applicant is ______, who requests the Court to appoint Applicant as Administrator ad Litem of this estate for the limited purpose of pursuing a legal cause of action.

2. Residence. Applicant’s residence address is:

______.

3. The Decedent. Applicant would show that the Decedent died on ______[date]. Decedent’s address at time of death was ______[street address, city, county and state].

4. Relationship. Applicant’s relationship to Decedent was ______.

5. Heirs. The Decedent was survived by the following heirs whose names, relationships to the Decedent, ages and mailing addresses appear below:

______[Name] [Age] [Relationship] [Mailing Address] [Zip Code]

______[Name] [Age] [Relationship] [Mailing Address] [Zip Code] [Use an additional sheet for other persons.]

6. Litigation. Applicant would further show there is need for the appointment of an Administrator to proceed with litigation against ______[name] because: ______.

7. Other Matters. Applicant avers that these facts are true to the best knowledge, information, and belief of Applicant; that no person is currently serving as Administrator or executor for this estate; that Applicant is aware of no person interested in the estate or willing to serve as Administrator; that Applicant is ready, willing, and qualified to serve as Administrator ad litem according to law; that the Administrator ad Litem’s sole duty and function will be to provide a nominal party for a legal cause of action; and that where it becomes necessary for Applicant to take control and custody of property or assets of this estate, Applicant will execute a bond with good security before taking control and custody of such property or assets.

REQUESTS FOR RELIEF

Applicant prays that:

1. Applicant be appointed Administrator ad Litem of this estate pursuant to Section 30-1-109 of the Tennessee Code Annotated.

2. Applicant be issued Letters of Administration for Cause of Action Only.

3. Applicant be granted such additional relief as the Court may deem proper under the circumstances.

______Applicant

STATE OF TENNESSEE ______COURT OF ______COUNTY:

On ______, 20____, the Petitioner personally appeared before me and, after being duly sworn by me, deposed and said that the statements in the foregoing Petition are true to Petitioner’s knowledge except as to matters therein stated to be on information and belief, and these matters Petitioner believes to be true.

______Applicant

Sworn to and subscribed before me this ____ day of ______, 20___.

______Deputy Clerk

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