Sample: Inventory and Appraisement / Closing Statement (NDPC Form 10/14/15) for the Estate of Eleanor M. Doe

Everything about this estate is made up except the format. Every figure below is produced by the ledger from ordinary entries (a house sold at a gain, dividends, the funeral bill, two distributions), and it balances to the penny. Yours would look like this, with your numbers.

Estate of Eleanor M. Doe
In the District Court of County, State of North Dakota
In the Matter of the Estate of Eleanor M. Doe, DeceasedProbate No.

Personal Representative’s Verified Statement to Close the Estate

N.D.C.C. 30.1-21-03 · NDPC Form 15, Rev Sep 2026
This document also carries NDPC Form 14, Records of Receipts and Disbursements, Rev Sep 2026, as the full account in writing paragraph 5 below requires.

Statement

1. I am the duly appointed, qualified and acting personal representative of the above estate.

2. I have published notice to creditors as provided in N.D.C.C. 30.1-19-01 and have filed proof of publication of such notice. The first publication occurred more than three months prior to the date of this statement.

Publication is permissive under N.D.C.C. 30.1-19-01, and this paragraph, and 30.1-21-03’s three-month bar, apply only where notice was published and mailed. This statement, Form 15, is the closing route for an estate that published notice. A small estate under N.D.C.C. 30.1-23-03 that did not publish closes instead on the Sworn Statement of Personal Representative Closing a Small Estate, Form 16, a different document not built here. An estate that did not publish notice and is not a small estate cannot truthfully sign paragraph 2 as printed above.

3. I have fully administered the estate of the decedent by making payment, settlement or other disposition of all claims which were presented, expenses of administration and estate, inheritance and other death taxes except as follows (list the exceptions, if none, write “none”):

4. I have distributed the assets of the estate to the persons entitled to the assets in the amount and manner to which they are entitled.

N.D.C.C. 30.1-21-03(1)(a) allows either of two arrangements for a claim not fully discharged, and the form pre-prints only the first, in parentheses. Both print below, each with its own box.

By agreement with the distributees the assets were distributed subject to outstanding liabilities of the estate.

Other arrangements were made to accommodate an undischarged claim, detailed here:

5. I have sent a copy of this statement to all distributees of the estate (and to all creditors or claimants of the estate whom I am aware whose claims are neither paid nor barred), and I have furnished a full account in writing of my administration to the distributees whose interests are affected thereby.

The full account in writing is the Form 14 register below. The form’s own text reads “whom I am aware,” where it means “of whom I am aware”; it is reproduced verbatim above and not silently tidied.

6. This statement is filed for the purpose of closing this estate and terminating the appointment of the undersigned pursuant to N.D.C.C. 30.1-21-03.

Distributees Sent This Statement

N.D.C.C. 30.1-21-03(1)(b). Every distributee the estate’s own record shows, in the order each first appears. The preparer adds any creditor or claimant whose claim is neither paid nor barred, which the record does not carry.

  • Sarah Doe
  • Michael Doe

Records of Receipts and Disbursements

NDPC Form 14, Rev Sep 2026

One combined register, receipts and disbursements together, date-ordered. Paid By/To holds the payer on a receipt and the payee on a disbursement; For is the purpose, and it is never the payee repeated.

DatePaid By/ToForAmount
Beginning Balance
Cash and bank assets from the inventory$60,740.17
Nov 22, 2025Riverside Funeral HomeFuneral costs($8,940.00)
Nov 23, 2025The Local GazetteObituary notice($312.00)
Dec 1, 2025Overlook Medical CenterFinal medical bill($1,208.40)
Dec 5, 2025PSE&GUtilities($210.00)
Dec 9, 2025Surrogate's CourtFiling fee for letters testamentary($128.57)
Dec 15, 2025Doe & Associates, Esq.Attorney fee for estate administration($2,400.00)
Dec 20, 2025Cornerstone AppraisalsReal property appraisal($450.00)
Jan 5, 2026State FarmHomeowner's insurance($1,140.00)
Jan 5, 2026PSE&GUtilities($235.00)
Jan 10, 2026Chase Card ServicesCredit card payoff($2,214.90)
Jan 15, 2026Guardian LifeProceeds of sale: Life insurance policy payable to the estate$50,000.00
Jan 15, 2026Surrogate's CourtFiling fee for the inventory($95.00)
Jan 20, 2026Green Acres LandscapingLawn care and snow removal($620.00)
Jan 31, 2026Vanguard BrokerageQuarterly dividend$412.55
Feb 1, 2026County Tax CollectorProperty tax($3,860.00)
Feb 5, 2026PSE&GUtilities($248.00)
Feb 20, 2026State FarmRefund of unused homeowner's insurance premium$340.00
Mar 5, 2026PSE&GUtilities($260.00)
Mar 31, 2026First National BankSavings interest$63.12
Apr 15, 2026U.S. TreasuryFederal fiduciary income tax (Form 1041)($1,080.00)
Apr 22, 2026Meridian Title Co. (closing)Proceeds of sale: 214 Maple Street, house and lot$427,500.00
Apr 30, 2026Vanguard BrokerageQuarterly dividend$398.20
Jun 15, 2026Sarah DoeDistribution($60,000.00)
Jun 15, 2026Michael DoeDistribution($60,000.00)
Jun 30, 2026First National BankSavings interest$61.80
Jul 15, 2026Daniel R. Doe, executorExecutor commission($9,400.00)
Jul 31, 2026Vanguard BrokerageQuarterly dividend$421.90
Total Receipts$479,197.57
Total Disbursements$152,801.87
Ending Balance$387,135.87

Distributions in kind

BeneficiaryItemCarrying value
Michael Doe2021 Subaru Outback$17,800.00

An in-kind distribution moves no money, so it has no row in the register above. It is listed here instead, with the value it was carried at, so folding it into the register would misstate the Ending Balance.

Property Received Since the Inventory

N.D.C.C. 30.1-18-08’s supplementary-inventory cross-reference: property not in the original inventory, or a value or description that was erroneous or misleading. Its own total, never added to the register above.

DescriptionValue
Coin collection found in decedent's safe deposit box$2,150.00
Total property received since the inventory$2,150.00

Estate Tax

N.D.C.C. ch. 57-37.1, North Dakota’s estate tax chapter, is on the books and has not been repealed. Under 57-37.1-04(1), the tax is measured entirely by the maximum tax credit allowable for state death taxes against the federal estate tax. A North Dakota Estate Tax Return is due within fifteen months after the decedent’s death, if one is required. Whether a return is required is a question for the estate’s attorney or the North Dakota Tax Commissioner. This statement computes no tax and does not say one is or is not owed.

Termination of Appointment

If no proceeding involving the personal representative is pending in the court one year after this statement is filed, the appointment of the personal representative terminates (N.D.C.C. 30.1-21-03(2)).

N.D.C.C. 30.1-21-03.1, a section unique to North Dakota, lets any devisee, heir, distributee or claimant petition, or the court act on its own motion, if no closing statement has been filed within three years of the date of death, requiring both the personal representative and any attorney employed by the personal representative to show cause why the estate has not been closed.

Compensation

Recorded in the ledger as executor compensation$9,400.00
Remaining compensation claimed, if any$ ________

Compensation is reasonable compensation, with no schedule and no percentage (N.D.C.C. 30.1-18-19). The court may review a fee on an interested person’s petition (30.1-18-21). This product does not compute a fee and does not claim a court has allowed or will allow any amount.

Verification

Daniel R. Doe, being first duly sworn, says that they are the personal representative of the above estate and that they have read the foregoing statements and knows the contents thereof, and verily believes the statements made therein to be true.

The form’s own jurat reads “says that they are ... and knows the contents thereof.” It is reproduced verbatim above and not silently tidied.

Subscribed and sworn to before me this day of .

Daniel R. Doe, Personal Representative
Signature
Notary Public

Address:

City/State/Zip:

Phone:    Email:

Prepared with ExecutorLedger. This document follows the general style of the named format; it is not a court form and ExecutorLedger does not provide legal advice. Review with your attorney before signing, circulating, or filing. Estate of Eleanor M. Doe: Personal Representative’s Verified Statement to Close the Estate, N.D.C.C. 30.1-21-03, with NDPC Form 14. Page ________ of ________.

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