____________
____________
Court
County,
Tennessee
STATEMENT IN LIEU OF FINAL
ACCOUNTING
Case Number
IN THE MATTER OF THE ESTATE OF ____________________________________, DECEASED
Pursuant to Section 30-2-601 of the Tennessee Code Annotated, the undersigned, being the personal
representative and the residuary beneficiaries (or heirs if there is no will) of this estate, swear to the following:
1. This estate is solvent.
2. The gross value of this estate for federal estate tax purposes is $___________________.
3. The personal representative has:
 properly administered this estate;
 mailed or delivered notice of the requirements to file claims, as prescribed in Section 30-2-306(e)
of the Tennessee Code Annotated, to the creditors of the decedent who were known to or
reasonably ascertainable by the personal representative;
 paid or settled all claims lawfully presented;
 paid all expenses of administration;
 filed the final receipt and release from the Tennessee Department of Revenue (unless it has been
waived pursuant to Section 67-8-409 of the Tennessee Code Annotated) evidencing payment of
all Tennessee Inheritance or Estate Taxes due; and
 distributed this estate according to the will or to the laws of descent and distribution, whichever is
applicable.
4. The residuary beneficiaries or heirs:

acknowledge that this estate has been properly distributed to them;

approve the fee of $_______________ and expenses of $_______________ paid to
________________________, as attorney for the personal representative;

approve the fee of $_______________ and expenses of $_______________ paid to the personal
representative; and

waive the requirement for the Court to send them notice of the filing of this Statement in Lieu of
Final Accounting or a copy of the signed Final Order.
Signed this ____ day of ________________, 20___.
____________________________________
Personal Representative
____________________________________
Heir or Residuary Beneficiary
____________________________________
Personal Representative
____________________________________
Heir or Residuary Beneficiary
____________________________________
Personal Representative
____________________________________
Heir or Residuary Beneficiary
____________________________________
Personal Representative
____________________________________
Heir or Residuary Beneficiary
STATE OF _______________________
________________________ COUNTY
Sworn to and subscribed before me this ____ day of ____________________, 20___ by the following
person(s): _________________________________________________________________________________.
My commission expires: _____________
STATEMENT IN LIEU OF FINAL ACCOUNTING
________________________________________
Notary Public
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