Cover Sheet/Administration Account/Decedent222s Estate PC - 241 REV. 7 /19 CONNECTICUT PROBATE COURTS Cover Sheet /Administration Account/Decedent222s Estate PC - 241 Page 1 of 2 RECEIVED: Instructions: 1) A fiduciary may use this form as a cover sheet to the fiduciary222s account for a decedent222s estate. The fiduciary must attach supporting schedules containing the detail required under Probate Court Rules of Procedure, rule 38. Report all assets at fair market value on the date of death. 2) For simple estates, the fiduciary may use a Financial Report, PC-246, or a Decedent222s Administration Account (Short Form), PC-242. 3)The fiduciary must send a copy of the account, including the cover sheet and supporting schedules, toeach party and attorney and certify to the court that a copy has been sent. 4)For further information, see Probate Court Rules of Procedure, rules 36 through 38.5)Type or print in ink. Use an additional sheet, or PC-180, if more space is needed. Probate Court Name District Number Estate of Hereinafter referred to as the decedent Fiduciary (Name, address and telephone number of each fiduciary) Position of Trust The fiduciary represents that: 1)The accounting attached to this cover sheet is a true and complete account of all assets of the decedent222s estateand the fiduciary222s receipts, payments and distributions. 2)All funeral expenses, taxes, administration expenses and all claims against the estate allowed by the fiduciary havebeen fully paid, and there are no claims now outstanding against the estate. 3)There are no heirs or distributees other than those listed in the Petition/Administration or Probate of Will, PC-200, orin the schedule of proposed distribution. 4)All supporting records for this account have been retained as required by Probate Court Rules of Procedure,section 36.13, and the records are available for review upon request. The account consists of pages. WHEREFORE each fiduciary requests that the court approve this account, approve and order distribution in accordance with the schedule of proposed distribution attached hereto, and release each fiduciary from liability with respect to all items shown in this account pursuant to C.G.S section 45a-176. The representations made in this account are made under penalty of false statement. Signature of Fiduciary Signature of Fiduciary Type or Print Name Type or Print Name Date Date American LegalNet, Inc. www.FormsWorkFlow.com Cover Sheet/Administration Account/Decedent222s Estate PC - 241 REV. 7 /19 CONNECTICUT PROBATE COURTS Estate of Cover Sheet /Administration Account/Decedent222s Estate PC - 241 Page 2 of 2 CERTIFICATION I certify that a copy of this account was sent to the following persons as provided in the Probate Court Rules of Procedure, section 30.12: Name and Address Signature of Petitioner or Attorney Date American LegalNet, Inc. www.FormsWorkFlow.com