1PETITION FOR DISCHARGE OF PERSONAL REPRESENTATIVE

INSTRUCTIONS

I. Specific Instructions

1. This form is to be used for a petition for discharge of a personal representative

pursuant to O.C.G.A. § 53-7-50 or discharge of a temporary administrator pursuant
to O.C.G.A. § 53-7-52. A personal representative may, pursuant to O.C.G.A.
§ 53-7-50 (e), petition the court solely for discharge from office but not from all
liability.

2. If the petition is filed by a personal representative, the notice to debtors and

creditors must have been published for four weeks, and three months must have
elapsed from the date of the last publication. O.C.G.A. §§ 53-7-41; 53-11-4.

3. Signatures of heirs who acknowledge service must be sworn to before a notary

public or the clerk of any probate court of this State. It is not necessary that all
acknowledgments appear on the same page. An attorney at law may acknowledge
service on behalf of an heir. However, such attorney must certify that he or she
currently represents that heir with regard to the pending matter and, in order to
comply with O.C.G.A. § 53-11-6, the attorney’s signature must be sworn to as
provided above. With regard to a power of attorney, the attorney-in-fact may
acknowledge service on behalf of the grantor of the power, provided that the
power of attorney grants such authority, the signature of the attorney-in-fact is
attested, a copy of the power of attorney is attached, and the attorney-in-fact
certifies that the copy is a true copy and is still in effect.

4. O.C.G.A. § 53-11-2 provides that a party to a probate proceeding who is not sui
juris, is unborn, or is unknown must be represented by a guardian provided that
the Court may appoint a guardian ad litem or determine that the natural guardian,
guardian, conservator, or testamentary guardian has no conflict and may serve.
Further, the Court may appoint a guardian ad litem for a deceased heir whose
estate has no personal representative. If a guardian ad litem is necessary, use
GPCSF Supplement 1.

5. Use GPCSF Supplement 2 if the Court determines it is appropriate to appoint a

special process server.

6. Use GPCSF Supplement 3 if an additional certificate of service is necessary.

GPCSF 33 [1] Eff. July 2021

 7. If the decedent died intestate, paragraph 3 requires that a definitive statement be
made to show to the court that the persons named in paragraph 2 constitute all of
the heirs of the decedent and that there are no heirs of the same or closer degree
according to O.C.G.A. § 53-2-1. Provide the date of death for any deceased heirs.
[If you are uncertain how to determine the heirs of a decedent, please refer to the
“Heirs Determination Sheet” available from the probate court or at
www.gaprobate.gov.] Examples of such statement would be: (a) “Decedent was
or was not married at the time of his death and had no children born, adopted,
living, or deceased, other than listed herein”; (b) “Decedent had no other siblings
half or whole other than those listed herein”; and (c) “Decedent’s brother who
died previously had no other children born, adopted, living, or deceased, other
than listed herein.”

8. According to Uniform Probate Court Rule 5.6 (A), unless the Court specifically
assumes the responsibility, it is the responsibility of the moving party to prepare
the proper citation and deliver it properly so it can be served according to law.
All pages after the notice regarding Uniform Probate Court Rule 5.6 (A) are to be
completed by the moving party, unless otherwise directed by the Court.

II. General Instructions

General instructions applicable to all Georgia Probate Court Standard Forms are
available in each probate court or at www.gaprobate.gov, labeled GPCSF 1.

GPCSF 33 [2] Eff. July 2021

 IN THE PROBATE COURT OF RICHMOND COUNTY
STATE OF GEORGIA

IN RE: ESTATE OF )
)
RAYMOND DIXON, ) ESTATE NO. 2024-RCGP-691
DECEASED )

PETITION FOR DISCHARGE OF PERSONAL REPRESENTATIVE

The petition of KENDRICK DIXON , as (executor(s))
(administrator(s))(temporary administrator(s)) of the above-referenced estate, shows:

1.
Petitioner(s)
[Initial one]:
______ (a) has/have fully administered the estate of the decedent.
______ (b) was/were allowed to resign without fully administering said estate.
______ (c) has/have completely discharged all duties as temporary administrator(s).

2.
Listed below are all of the heirs of the intestate decedent or beneficiaries of the testate
decedent, or persons who succeeded to the interest of any heir or beneficiary who died after the
decedent died:

Name Age (or over 18) Address Relationship

Name Age (or over 18) Address Relationship
Kendrick Dixon Over 18 238 Griffin Mountain Son
Trail NE, Conyers,
Georgia 30013
Britt D. Dixon Over 18 193 Piedmont Road, Son
Madison Hull,
Georgia 30646

GPCSF 33 [1] Eff. July 2021

[If discharge is sought solely from office and not from office and all liability, STRIKE paragraphs 3 and 4 below.]

3.
Required: [If the decedent died intestate (without a will), make a definitive statement
with sufficient factual information to enable the Court to conclude that all of the heirs of the
decedent are included and that there are no heirs of similar or closer degree according to
O.C.G.A.
§ 53-2-1. Provide the names of any deceased heirs and include the date of death for each (see
instructions for further clarification). Also, state here all pertinent facts that may govern the
method of giving notice to any party and that may determine whether or not a guardian ad litem
should be appointed for any party. If any heirs listed above are cousins, grandchildren,
nephews, or nieces of the decedent, please indicate the deceased ancestor through whom they
are related to the decedent.]
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

4.
Of those named in paragraph 2 above, it is not necessary to notify the following heirs or
beneficiaries (a) who have relieved the personal representative of all liability and as to each of
whom a copy of the writing(s) granting such relief is/are attached hereto; or (b) with respect to
whom the personal representative has been relieved of all further liability in (a settlement of
accounts)(an intermediate report)(other binding proceeding) pursuant to an order of this Court
dated _____________________________________ and hereby incorporated herein as follows:
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

5.
The following heirs or beneficiaries are represented or should be represented by a
guardian [State names of heir/beneficiary and guardian, if one has already been appointed, and
reason guardian needed/appointed]:
___________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

6.
All claims against the estate have been paid (except for the following that have not been
paid for the reasons set forth below) [Provide names and addresses for service]:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

GPCSF 33 [2] Eff. July 2021

_____________________________________________________________________________________

GPCSF 33 [3] Eff. July 2021

 7.
[Initial one]:
____ All necessary (inventories)(and)(returns) have been filed.
____ Petitioner was relieved of filing (inventories)(and)(returns).

8.
Additional Data: [Where full particulars are lacking, state here the reasons for any such
omission.]

_____________________________________________________________________________________
_____________________________________________________________________________________

WHEREFORE, petitioner(s) pray(s):

[Initial one]
______ (a) to be discharged solely from office and, therefore, pray(s) that notice issue
and be published one time in the official county newspaper with copies thereof being mailed by
First-Class Mail to the creditors named in paragraph 6 above and that an order issue discharging
the petitioner(s) from office.
OR
______ (b) to be discharged from office and all liability and, therefore, pray(s) that
notice issue and be served and published as required by law and that an order issue releasing and
discharging the petitioner(s) from office and from all liability.

Signature of Petitioner

Kendrick Dixon
Printed Name
238 Griffin Moutain Trail NE
Conyers, Georgia 30013
Mailing Address
678-779-3983
Telephone Number

Signature of Attorney: ______________________________________________________

Printed Name of Attorney: Sharline S. Green

Address: 1775 Parker Road SE, Suite C-210__________________________

Conyers, Georgia 30094__________________________________

GPCSF 33 [4] Eff. July 2021

 Telephone Number: 678-468-2602 _______ State Bar #__627372_______________

GPCSF 33 [5] Eff. July 2021

 VERIFICATION

GEORGIA, RICHMOND COUNTY

Personally appeared before me the undersigned petitioner(s) who after being duly sworn,
state(s) that the facts set forth in the foregoing petition for discharge of personal representative
(and the attached exhibit(s)) are true and correct.

Sworn to and subscribed before me this

______day of________________, 20____. ____________________________________
Signature of Petitioner

_____________________________________ Kendrick Dixon _______

NOTARY/CLERK OF PROBATE COURT Printed Name of Petitioner
My Commission Expires: _________________

GPCSF 33 [6] Eff. July 2021

 IN THE PROBATE COURT OF RICHMOND COUNTY
STATE OF GEORGIA

IN RE: ESTATE OF )
)
RAYMOND DIXON, ) ESTATE NO. 2024-RCGP-691
DECEASED )

ACKNOWLEDGMENT OF SERVICE AND CONSENT TO PETITION

The undersigned, being 18 years of age or older, laboring under no legal disability and
being heirs or beneficiaries or unpaid purported creditors of the above-named decedent, hereby
acknowledge service of a copy of the petition for discharge of personal representative, and
notice, waive copies of same, waive further service and notice, and hereby consent to the
petition.

Sworn to and subscribed before me this

_____day of_______________, 20____. ______________________________________
Signature of Interested Party
______________________________________ Kendrick Dixon ________________________
NOTARY/CLERK OF PROBATE COURT Printed Name of Interested Party
My Commission Expires:_______________
------------------------------------------------------------------------------------------------------------------------------
Sworn to and subscribed before me this
_____day of_______________________, 20____. ______________________________________
Signature of Interested Party
______________________________________ ______________________________________
NOTARY/CLERK OF PROBATE COURT Printed Name of Interested Party
My Commission Expires: ______________
------------------------------------------------------------------------------------------------------------------------------
Sworn to and subscribed before me this
_____day of_______________________, 20____. ______________________________________
Signature of Interested Party
______________________________________ ______________________________________
NOTARY/CLERK OF PROBATE COURT Printed Name of Interested Party
My Commission Expires: _______________
------------------------------------------------------------------------------------------------------------------------------
Sworn to and subscribed before me this
_____day of_______________________, 20____. ______________________________________
Signature of Interested Party
______________________________________ ______________________________________
NOTARY/CLERK OF PROBATE COURT Printed Name of Interested Party
My Commission Expires: _______________
------------------------------------------------------------------------------------------------------------------------------
Sworn to and subscribed before me this
_____day of_______________________, 20____. ______________________________________
Signature of Interested Party
______________________________________ ______________________________________

GPCSF 33 [7] Eff. July 2021

NOTARY/CLERK OF PROBATE COURT Printed Name of Interested Party
My Commission Expires:_______________

GPCSF 33 [8] Eff. July 2021

 IN THE PROBATE COURT OF RICHMOND COUNTY
STATE OF GEORGIA

IN RE: ESTATE OF )
)
RAYMOND DIXON, ) ESTATE NO. 2024-RCGP-691
DECEASED )

ACKNOWLEDGMENT OF SERVICE AND CONSENT TO PETITION

The undersigned, being 18 years of age or older, laboring under no legal disability and
being heirs or beneficiaries or unpaid purported creditors of the above-named decedent, hereby
acknowledge service of a copy of the petition for discharge of personal representative, and
notice, waive copies of same, waive further service and notice, and hereby consent to the
petition.

Sworn to and subscribed before me this

_____day of_______________________, 20____. ______________________________________
Signature of Interested Party
______________________________________ Britt D. Dixon
_________________________
NOTARY/CLERK OF PROBATE COURT Printed Name of Interested Party
My Commission Expires: ______________
------------------------------------------------------------------------------------------------------------------------------
Sworn to and subscribed before me this
_____day of_______________________, 20____. ______________________________________
Signature of Interested Party
______________________________________ ______________________________________
NOTARY/CLERK OF PROBATE COURT Printed Name of Interested Party
My Commission Expires: _______________
------------------------------------------------------------------------------------------------------------------------------
Sworn to and subscribed before me this
_____day of_______________________, 20____. ______________________________________
Signature of Interested Party
______________________________________ ______________________________________
NOTARY/CLERK OF PROBATE COURT Printed Name of Interested Party
My Commission Expires: _______________
------------------------------------------------------------------------------------------------------------------------------
Sworn to and subscribed before me this
_____day of_______________________, 20____. ______________________________________
Signature of Interested Party
______________________________________ ______________________________________
NOTARY/CLERK OF PROBATE COURT Printed Name of Interested Party
My Commission Expires:_______________

GPCSF 33 [9] Eff. July 2021

 NOTICE
THE FOLLOWING PAGES ARE TO BE
COMPLETED BY THE PETITIONER (MOVING
PARTY) UNLESS OTHERWISE DIRECTED BY THE
COURT.

SEE UNIFORM PROBATE COURT RULE 5.6 (A).

GPCSF 33 [10] Eff. July 2021

 IN THE PROBATE COURT OF RICHMOND COUNTY
STATE OF GEORGIA

IN RE: ESTATE OF )
)
RAYMOND DIXON, ) ESTATE NO. 2024-RCGP-691
DECEASED )

ORDER FOR SERVICE OF NOTICE

[Initial A. (discharge solely from office) or B. (discharge from office and all liability)]

______ A. The petition for discharge of personal representative having been filed,
seeking discharge solely from office, it is ordered that notice be published one time in the
newspaper in which sheriff’s advertisements are published in this county at least ten days before
__________________________, 20 ___ and that a copy of the petition and notice be mailed by
First-Class Mail to the creditors whose claims have not been paid as set forth in paragraph 6 of
the petition.

______ B. The petition for discharge of personal representative having been filed,
seeking discharge from office and all liability, it is ordered that all heirs or beneficiaries or
unpaid creditors who did not acknowledge service and consent to the petition be served as
follows:

[Initial all that apply]

______ Notice, together with a copy of the petition, shall be served personally, or by
registered or certified mail or statutory overnight delivery, as requested by the petitioner(s)
pursuant to O.C.G.A. § 53-11-3, at least 30 days before the deadline for filing objections on the
following interested parties who reside in Georgia:
_____________________________________
______________________________________________________________________________
______________________________________________________________________________

______ Notice, together with a copy of the petition, shall be served by registered or
certified mail, return receipt requested, pursuant to O.C.G.A. § 53-11-4, upon the following
nonresident interested parties whose current residence addresses are known: ________________
______________________________________________________________________________
______________________________________________________________________________

______ Notice shall be published once a week for four weeks in the legal organ of this
county, before____________________, 20_______ in order to serve by publication the
following interested parties whose current residence addresses are unknown:
_________________________
______________________________________________________________________________
______________________________________________________________________________

GPCSF 33 [11] Eff. July 2021

 _______ [Applies in all cases unless notice is published for four weeks] Notice shall be
published one time in the legal organ of this county at least ten days before
_______________________, 20______ which is the date on or before which any objection is
required to be filed.

SO ORDERED this ________ day of _____________________, 20_____.

______________________________________
Judge of the Probate Court

GPCSF 33 [12] Eff. July 2021

 IN THE PROBATE COURT OF RICHMOND COUNTY
STATE OF GEORGIA

IN RE: ESTATE OF )
)
RAYMOND DIXON, ) ESTATE NO. 2024-RCGP-691
DECEASED )

NOTICE
[For discharge solely from office]

IN RE: 1Petition for Discharge of Personal Representative

TO: ____________________________________________________________________________
____________________________________________________________________________
[List all creditors who did not acknowledge service whose claims have not been paid. ]
and to whom it may concern:

This is to notify you to file an objection, if there is any, to the petition for discharge of
personal representative, in this Court on or before ___________________________, 20______.

BE NOTIFIED FURTHER: All objections to the Petition must be in writing, setting

forth the grounds of any such objections. All objections should be sworn to before a notary
public or before a probate court clerk, and filing fees must be tendered with your objections,
unless you qualify to file as an indigent party. Contact probate court personnel for the required
amount of filing fees. If any objections are filed, a hearing will be (held on
__________________________) (scheduled at a later date). If no objections are filed, the
petition may be granted without a hearing.

_____________________________________
Judge of the Probate Court
By: _________________________________
Clerk of the Probate Court
______________________________________
______________________________________
Address
______________________________________
Telephone Number

GPCSF 33 [13] Eff. July 2021

 IN THE PROBATE COURT OF RICHMOND COUNTY
STATE OF GEORGIA

IN RE: ESTATE OF )
)
RAYMOND DIXON, ) ESTATE NO. 2024-RCGP-691
DECEASED )

NOTICE
[For discharge from office and all liability]

IN RE: 1Petition for Discharge of Personal Representative

[Strike any paragraph if not applicable]
TO: _____________________________________________________________________________
__________________________________________________________________________________
[List here all interested parties having unknown addresses to be served by publication]
and (all and singular the heirs of said decedent,)(the beneficiaries under the will,) and to
whom it may concern:
This is to notify you to file an objection, if there is any, to the above-referenced petition,
in this Court on or before_________________, 20_____.
TO: Britt D. Dixon ______________________________________________________
Kendrick Dixon _____________________________________________________________
[List here all heirs having known addresses in the continental U.S. to be served by registered or certified
or statutory overnight delivery with restricted delivery to the addressee, if specifically requested by the
petitioner(s)]
This is to notify you to file an objection, if there is any, to the above-referenced petition,
in this Court on or before the 30th day after_____________________, 20 ______ (the date of the
mailing of this notice to you by certified or registered mail, return receipt requested); provided,
however, that if a return receipt for such notice is actually received by the Court within such 30
days, the deadline for the filing of any objection shall be 30 days from the date of receipt shown
on such return receipt.
TO: ________________________________________________________________________
________________________________________________________________________
[List here all heirs having known addresses outside the continental U.S. to be served by registered or
certified mail or statutory overnight delivery with restricted delivery to the addressee, if specifically
requested by the petitioner(s)]
This is to notify you to file an objection, if there is any, to the above-referenced petition,
in this Court on or before the 30th day after __________________, 20____ (the date of the
mailing of this notice to you by certified or registered mail, return receipt requested); provided,
however, that if a return receipt for such notice is actually received by the Court within such 30
days, the deadline for the filing of any objection shall be 30 days from the date of receipt shown
on such return receipt.

GPCSF 33 [14] Eff. July 2021

TO: ______________________________________________________________________________
______________________________________________________________________________
[List here all interested parties who reside in Georgia to be served personally or by registered or certified
mail or statutory overnight delivery with restricted delivery to the addressee, if specifically requested by
the petitioner(s)]

This is to notify you who are required to be served personally, to file an objection, if
there is any, to the above-referenced petition, in this Court on or before the 30th day after the
date you are personally served or sign the return receipt.

BE NOTIFIED FURTHER: All objections to the petition must be in writing, setting

forth the grounds of any such objections. All objections should be sworn to before a notary
public or before a probate court clerk, and filing fees must be tendered with your objections,
unless you qualify to file as an indigent party. Contact probate court personnel for the required
amount of filing fees. If any objections are filed, a hearing will be (held on
______________________, 20___)(scheduled at a later date). If no objections are filed, the
petition may be granted without a hearing.

_____________________________________
Judge of the Probate Court
By: _________________________________
Clerk of the Probate Court
_____________________________________
_____________________________________
Address
_____________________________________
Telephone Number

GPCSF 33 [15] Eff. July 2021

 IN THE PROBATE COURT OF RICHMOND COUNTY
STATE OF GEORGIA

IN RE: ESTATE OF )
)
RAYMOND DIXON, ) ESTATE NO. 2024-RCGP-691
DECEASED )

CERTIFICATE OF SERVICE

This is to certify that I have this date mailed (unless otherwise noted) in an envelope with
the proper postage affixed thereto for First-Class Mmail delivery copies of the Petition for
Discharge Personal Representative to the following parties at the addresses below:

Name Address
Kendrick Dixon 238 Griffin Mountain Trail NE, Conyers,
Georgia 30013

Britt D. Dixon 193 Piedmont Road, Madison Hull, Georgia

30646

This _______ day of ________________, 20____.

_____________________________________
Clerk of the Probate Court
_____________________________________
_____________________________________
Address
_____________________________________
Telephone Number

GPCSF 33 [16] Eff. July 2021

 IN THE PROBATE COURT OF RICHMOND COUNTY
STATE OF GEORGIA

IN RE: ESTATE OF )
)
RAYMOND DIXON, ) ESTATE NO. 2024-RCGP-691
DECEASED )

FINAL ORDER

The foregoing petition for discharge of Kendrick Dixon as Personal Representative was
filed. The Court finds that no objection has been filed and all requirements of law have been
fulfilled.

ACCORDINGLY, IT IS ORDERED that petitioner(s) be, and is/are hereby, discharged

[Initial one]

_____ (a) solely from office; or

_____ (b) from office and all liability.

SO ORDERED this _______________ day of _________________, 20____.

___________________________________________
Judge of the Probate Court

GPCSF 33 [17] Eff. July 2021