Affidavit for Filing Will Not Submitted for Probate PC-211 REV. 1/17 RECEIVED: CONNECTICUT PROBATE COURTS Instructions: Any person may use this form to file an original will(s), and codicil(s), if any, when the will is not being submitted for probate. The reason for filing a will that is not submitted for probate may be that (a) the decedent left no solely-owned assets to be administered through the Probate Court; or (b) an Affidavit in Lieu of Probate of Will/Administration, PC-212, has been or is being filed for settlement of the estate; or (c) a person is in possession of a will executed by the decedent in accordance with C.G.S. section 45a-282(a). 2) This form should be filed in the probate district in which the decedent was domiciled as of the date of death. If the decedent was not domiciled in Connecticut, file this form in the probate district in which the decedent resided as of the date of death. 3) For more information, see C.G.S. sections 45a-273 and 45a-282. District Number 1) Probate Court Name Estate of Date of Death Name, Address and Relationship of Subscriber to Decedent Date(s) of Will and Codicil(s) The undersigned hereby presents the purported will and codicil(s), if any, referenced above and certifies to his or her best knowledge and belief that: the decedent left no assets to be administered in accordance with the law and, therefore, the will and codicil(s), if any, is presented to the court for filing only, or a petition has been made for settlement of the estate by affidavit in lieu of administration (C.G.S. section 45a-273) and, therefore, the will and codicil(s), if any, is presented to the court for filing only, or the will and codicil(s), if any was in the possession of the undersigned and that the undersigned is delivering the document(s) to the court as required by C.G.S. section 45a-282(a). The representations made in this petition are made under the penalty of false statement. Signature of Subscriber Type or Print Name Date Receipt of the above-referenced purported will, and codicil(s), if any, is hereby acknowledged. Dated at , Connecticut on [Month, Day, Year] ____________________________________ Judge/Clerk Affidavit for Filing Will Not Submitted for Probate American LegalNet, Inc. www.FormsWorkFlow.com PC-211