Affi d av it in Lieu of Administration CONNECTICUT PROBATE COURTS to Settle Full Estate PC - 2 1 07 NEW 10/17 Affidavit In Lieu of Administration to Settle Full Estate PC-2107 Page 1 of 3 RECEIVED Instructions: 1)An executor or administrator appointed by the Probate Court may use this form to settle a decedent222s estate that was opened as a full estate but has subsequently been determined to beeligible for settlement as a small estate under C.G.S. section 45a2)The fiduciary may submit this affidavit as a substitute for the inventory, return of claims and finalaccount to complete the administration of the estate. If assets exceed debts, the fiduciary mustsubmit a schedule of distribution or proposed distribution listing theEstate of Hereinaf ter referred to as the decedent . Fiduciary (List each fiduciary of the estate.) Position of Trust THE FIDUCIARY represents that: 1.The court granted:A petition to probate the last will and testament of the decedent dated Total $ American LegalNet, Inc. www.FormsWorkFlow.com Affi d av it in Lieu of Administration CONNECTICUT PROBATE COURTS to Settle Full Estate PC - 2 1 07 NEW 10/17 Affidavit In Lieu of Administration to Settle Full Estate PC-2107 Page 2 of 3 4.The expenses and claims are as follows: Expenses and Claims Creditor Amount (If already paid, state name of person who paid . ) Funeral Expenses Administration Expenses (For example, probate and attorneys222 fees) Claims Due for Last Sickness Taxes Due the State of Connecticut or the United States Other Claims This affidavit is submitted in lieu of the inventory return of claims final financial report or account required to complete the administration of a full estate. WHEREFORE, the fiduciary requests the court to excuse the requirement of the above documents required to settle the estate and approve the affidavit in lieu of administration and the schedule of distribution or the proposed distribution to the beneficiaries of the estate, a copy of which is attached. The representations made in this affidavit are made under the penalty of false statement. Signature of Fiduciary Date Signature of Fiduciary Date American LegalNet, Inc. www.FormsWorkFlow.com Affi d av it in Lieu of Administration CONNECTICUT PROBATE COURTS to Settle Full Estate PC - 2 1 07 NEW 10/17 Affidavit In Lieu of Administration to Settle Full Estate PC-2107 Page 3 of 3 CERTIFICATION I ertify that a copy of this affidavit and schedule of distribution or proposed distribution, if any, was sent to the following persons as required by Probate Court Rules of Procedure, section 30.12: Name and Address Signature of Fiduciary Date: Type or Print Name Date: Type or Print Name Signature of Fiduciary American LegalNet, Inc. www.FormsWorkFlow.com