CONNECTICUT PROBATE COURTS Affidavit of Closing PC-213 REV. /1 RECEIVED: Instructions: 1) The fiduciary of the estate shall file this form not later than 30 days after completing distribution of all assets on hand at the end of the accounting period of the fiduciary222s final financial report or account. 2)The fiduciary shall send a copy of this form to each party and attorney of record and certify to the courtthat it has been sent. 3)For more information, see the Probate Court Rules of Procedure, sections 30.12 and 36.12. 4) Type or print the form in ink. Use Second Sheet, PC-180, or an additional sheet if more space is needed. Probate Court Name District Number Estate of Date Fiduciary (List name of each fiduciary.) Position of Trust hereby make return under penalty of false statement that all monies and property of every description in the fiduciary's hands and control have been paid over and distributed to the persons entitled thereto according to the orders of the court, and that so far as the fiduciary has any knowledge, the estate is now fully administered and settled. The fiduciary further certifies that the following is a true and complete statement of any transactions since the end of the accounting period of the fiduciary222s final financial report or account on file, including, but not limited to, the disposition of (a) the reserve shown on the financial report or account; (b) any additional income and/or assets received subsequent thereto and not reflected therein, and (c) amounts disbursed from the reserve and additional income and assets: None See schedule below and on following page. Second Sheet, PC-180, or separate accounting is attached hereto. American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTS Affidavit of Closing PC-213 REV. 7/15 Probate Court Name District Number Estate of Date The representations made in this affidavit of closing are made under the penalty of false statement. Signature of Petitioner Title Type Name Date Certification I certify that a copy of this affidavit of closing was sent to the following persons: Name and Address Signature of Fiduciary or Attorney Type or Print Name Date Date Signature of Petitioner Title Type Name Date American LegalNet, Inc. www.FormsWorkFlow.com