Beneficiaries Named in Will in Custody of Court That Has Not Been Submitted for Probate PC-285 REV. 1/16 RECEIVED: CONNECTICUT PROBATE COURTS RECORDED Instructions: 1) A petitioner who has filed a PC-200, Petition/Administration or Probate of Will, must file this form if notified by the court that there is a will in the custody of the court that has not been submitted for probate. 2) If the petitioner has submitted another will for probate, the petitioner is required to send a copy of the petition, PC-200, and a copy of that will to each person listed on this form. 3) For more information, see sections 30.4 and 30.7 of the Probate Court Rules of Procedure. 4) Type or print the form in ink. Use an additional sheet or Second Sheet, PC-180, if more space is needed. District Number Date of Death Probate Court Name Estate of Petitioner (List name and address.) The petitioner has filed a petition requesting admission to probate of a purported will of the deceased dated __________. The petitioner has filed a petition for administration of the estate. The petitioner represents that the names and addresses of the beneficiaries under the will dated _______________in the custody of the court that has not been not submitted for probate are as follows: (Indicate any person who is a minor [list date of birth], in active military service or under conservatorship. Include the name and address and position of trust of the legal representative of any party who has been adjudicated incapable.) 1. Beneficiaries Under Will Not Submitted for Probate, including Trustees: 2. Beneficiaries of Testamentary Trust(s) Established Under Will Not Submitted for Probate, if any: 3. Executor Under Will Not Submitted for Probate: I hereby certify that I have sent a copy of the petition and the will that I have submitted for admission to probate to the above-named persons in accordance with Section 30.7 of the Probate Court Rules of Procedure. The representations made in this petition are made under the penalty of false statement. Signature of Petitioner Title Type or Print Name Date Beneficiaries Named in Will in Custody of Court That Has Not Been Submitted for Probate PC-285 American LegalNet, Inc. www.FormsWorkFlow.com