STATE OF CONNECTICUT APPLICATION FOR CERTIFICATE RELEASING CONNECTICUT COURT OF PROBATE SUCCESSION AND ESTATE TAX LIENS PC-205S NEW 7/2000 [Type or print in black ink. Complete this form and file in the probate court with PC-256S for each property location for which a release of lien is requested.] TO: COURT OF PROBATE, DISTRICT OF RECORDED: DISTRICT NO. ESTATE OF DATE OF DEATH PROPERTY ADDRESS [Enter the address of the property being sold, transferred, or mortgaged for which a release of lien is requested.] Street City State Zip Code MORE PARTICULARLY DESCRIBED AT: VOLUME PAGE OF THE ] [Attach Schedule A with description of property, if necessary. LAND RECORDS Was this property reported on the decedent's Connecticut Form S-1 or Is the estate required to file a federal Form 706, United States Estate (and Generation-Skipping Transfer Tax) Return? Form S-2, Succession Tax Return ? YES NO YES NO ESTIMATED CONNECTICUT SUCCESSION AND ESTATE TAXES 1A. $ 1A Estimated gross estate for succession tax purposes . 1 B. Estimated amount passing to each beneficiary class: AA $ A$ B.$ C$ Exempt Classes $ 2 2. Estimated gross estate for estate tax purposes $ AFFIRMATION [This form shall be executed by either the fiduciary/survivor OR the attorney/authorized representative.] The undersigned affirms that no succession or estate tax will be imposed on this estate. The representations contained herein are made under the penalties of false statement. Fiduciary's/Survivor's Name [If there is more than one fiduciary, complete information for all.] Date Signature of fiduciary/survivor Signature of attorney or authorized representative Date Firm name and street address Street Address City Attorney or authorized representative's name State Zip Code City Telephone Number State Zip Code Telephone Number APPLICATION FOR CERTIFICATE RELEASING CONNECTICUT SUCCESSION AND ESTATE TAX LIENS PC-205S American LegalNet, Inc. www.USCourtForms.com