CONNECTICUT PROBATE COURTS Affidavit in Proof of Will and/or Codicil PC - 210 REV. 1/1 9 Affidavit in Proof of Will and/or Codicil PC - 210 RECEIVED: Instructions: 1) A witness having attested to a will or codicil being offered for probate may use this form to state facts relating to the making and execution of the will. This form must be signed and acknowledged before an officer authorized to administer an oath. 2)For more information, see C.G.S. sections 45a-251 and 45a-285.3)Type or print the form in ink. Use a separate sheet, or PC-180, Second Sheet, if more space is needed. Probate Court Name District Number Estate of Town and State Where Instrument was Executed , deceased Hereinafter referred to as the testator In the matter of proving the following instrumen ts of the testator: Last Will and Testament dated and/or First Codicil to the Last Will and Testament, dated and/or Second Codicil to the Last Will and Testament, dated Having been duly sworn, the undersigned subscribing witness makes affidavit and says that: On the date and at the place written above and in the presence of the undersigned and each other subscribing witness to the instrument, the testator executed the instrument attached to this affidavit (or the certified copy of the instrument attached to this affidavit) and declared the same to be the last will and testament and/or codicil of the testator. The undersigned thereupon subscribed the instrument as a witness at the request of the testator in the presence of the testator and in the presence of each other subscribing witness. At the time of execution of the instrument, the testator was at least 18 years of age and of sound mind and memory and competent in every respect to make a will and was not under any restraint. The undersigned makes this affidavit after the death of the testator and at the request of the executor or a person interested under the will and/or codicil. Signature Type or Print Name SUBSCRIBED AND SWORN TO BEFORE ME DATE Judge, Clerk, Notary Public, Comm. of Superior Court American LegalNet, Inc. www.FormsWorkFlow.com