CONNECTICUT PROBATE COURTS Petition/Access Jointly Owned Assets In a Safe Deposit Box PC - 203A Rev. 4/19 Petition/Access Jointly Owned Assets In a Safe Deposit Box PC-203A RECEIVED: Instructions: 1) Any person having sufficient interest in the presence of jointly owned assets located in a safe deposit box owned by the decedent may use this form to request access to the safe deposit box. 2)This form can be used only if the decedent was the sole owner of the safe deposit box, and no otherprobate proceedings have been instituted for the estate of the deceased owner. 3)This petition must be filed in the probate district in which the decedent resided at the time of death.4)For more information, see C.G.S. section 45a-277.5)Type or print the form 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. Date of Death Decedent222s residence at time of death (Include full address.) Petitioner (Name, address and telephone number) Bank or financial institution holding safe deposit box (Name and/or branch and address) Heirs and beneficiaries (Names and addresses) The heirs of the decedent are as follows: The decedent left a will dated under which the beneficiaries are as follows: American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTS Petition/Access Jointly Owned Assets In a Safe Deposit Box PC - 203A Rev. 4/19 Petition/Access Jointly Owned Assets In a Safe Deposit Box Estat e of The petitioner represents that to the best of my knowledge and belief : N o probate proceedings have been initiated for the decedent222s estate. I have an interest in jointly owned assets located in the safe deposit box that is in the sole name of the decedent. The following assets, stocks, bonds, annuities or certificates of deposit are located in the safe deposit box solely owned by the decedent. (List assets and explain the basis for claim of ownership .) Wherefore the petitioner requests that the court: 1) issue an order to open the decedent's safe deposit box to obtain an inventory of its contents by a bank officer, and 2) after review of the inventory, issue an order authorizing the removal of the above-referenced items from thedecedent222s safe deposit box. The representations made in this petition are made under penalty of false statement. Signature of Petitioner Type or Print Name Date PC-203A American LegalNet, Inc. www.FormsWorkFlow.com