\ CERTIFICATE OF DEVISE, DESCENT OR DISTRIBUTION PC- 250 RETURN TO: CERTIFICATE OF DEVISE, DESCENT OR DISTRIBUTION PC-250 REV. 4/18 STATE OF CONNECTICUT COURT OF PROBATE COURT OF PROBATE, DISTRICT NO. ESTATE OF ,deceased DA TE OF DEATH Pursuant to C.G.S. section 45a-450, this certifies that as appears in the records of this court, the deceased died on the date stated above, and the following real property of the decedent is devised, distributed, set out, divided or descends to: [Name, place of residence and share of distributee and the street, lot number of the real property, or, if none, a brief description of the location.] For a more particular description, reference should be made to the records of the Probate Court. Dated at , Connecticut, on [Month, Day, Year] Judge/Clerk COURT SEAL Certified True Copy FOR COURT USE ONLY Sent to: Date sent: Note to fiduciary: File certificate with town clerk where real property is situated. FF Judge/Clerk American LegalNet, Inc. www.FormsWorkFlow.com