DATE FILEDFORCOURT USE ONLY Name of DecedentResident Decedent Died: Street AddressCity/TownStateZip CodePersonal estate estimated at: $ Assets unknownPetitioner:NameRelationship to DecedentStreet AddressCity/TownStateZipCodePhoneNumberRespectfully requests that:Name of NomineeRelationship toDecedentStreet AddressCity/TownStateZip CodeE-mailName of Co-Nominee Relationship toDecedentStreet AddressCity/TownStateZip CodeEmailmay be appointed CUSTODIAN/CO-CUSTODIAN.Attach Form PC-9.1, Waiver, if applicable.Petitioner: To the best of my knowledge or belief, the statement(s) contained within this document are truthful and accurate.Signature of PetitionerDateNotary:Name of NotaryStateCountyOn day of , 20the petitioner, known to me or proved through satisfactory evidence, signed the document in Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary Seal CUSTODIANSHIPRIGL 8-9-9PC-2.11 (Rev. 10/17) State of Rhode Island and Providence PlantationsProbate CourtPage 1 of 2 STATE OF RHODE ISLANDCounty ofEstate ofAlias PROBATE COURT OF THECity or Town ofNo. SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com DECREEUpon hearing, it is hereby ordered and decreed:Is/are Appointed CUSTODIAN(S):AppointedCustodianRelationship toDecedentStreet AddressCity/TownStateZip CodeEmailPhone NumberAppointed Co/CustodianRelationship toDecedentStreet AddressCity/TownStateZip CodeEmailPhone NumberBond Fixed at: $ With Surety Without Surety Appointed APPRAISER(S): Check box if Appraiser(s) is/are the same as above OR Complete Appraiser(s) information below.Appraiser NameStreet AddressCity/TownStateZip CodeEmailPhone NumberCo-Appraiser NameStreet AddressCity/TownStateZip CodeEmailPhone NumberAppointed RESIDENT AGENT:Resident Agent NameStreet AddressCity/TownStateZip CodeEmailPhoneNumberEntered as an order and decree of the court on:Probate JudgeDateSignature of Probate JudgePC-2.11 (Rev. 10/17) Page 2 of 2 SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com