Petition/Administration or Probate of Will PC-200 REV. 4/19 CONNECTICUT PROBATE COURTS Petition/Administration or Probate of Will PC-200 Page 1 of 4 RECEIVED: Instructions: 1) Any person may use this form to petition the court for administration or probate of a will and the appointment of an administrator or executor. Each proposed fiduciary must sign the acceptance of trust. 2)For Connecticut residents, the petition must be filed in the court for the probate district in which the decedent was domiciled on the date of death. If the decedent was not a Connecticut resident, thepetition may be filed in a probate district meeting the requirements of C.G.S. section 45a-287 or 45a- 3) Attach a certified copy of the decedent222s death certificate (with the social security number redacted) with the original will and codicils, if any. Also Confidential Sheet, PC-200CI, with the decedent222ssocial security number. If the proposed fiduciary is not a Connecticut resident, attach acompleted Appointment of Probate Judge as Agent for Service by Non-Resident Fiduciary, PC-482. 4)If the petitioner is seeking to probate a will, the petition must send a copy of this petition to each heirof the decedent and beneficiary under the will, along with a copy of the will and codicil, and certify tothe court that a copy has been sent. If a beneficiary is a charity, the petitioner must also send a copy ofthe petition and will and codicil to the Attorney General.5)For more information, see C.G.S. sections 45a-282 et seq. and 45a-303. 6) Type or print n ink. File in duplicate. Use an additional sheet, or Probate Court Name District Number Estate of (Include all names and initials under which any asset was held.) Hereinafter referred to as the decedent Date of Death Wrongful Death Claim Decedent222s Residence at Time of Death (Include full address.) Jurisdiction Based On:omicile in District Other (If domicile is different than residence or jurisdiction is based on ther, use Second Sheet, PC-180, for explanation.) Petitioner (Name and address) Surviving Spouse (If there is no surviving spouse, so state.) Heirs, Beneficiaries and Trustees, if any. Indicate any person who is under age 18 and include date of birth, any person in the military service or any person under conservatorship or legal disability. C.G.S. sections 45a-436, 45a-438 and 45a-439. Include the name, address and position of trust of the legal representative of any party. 1.Heirs (Names and addresses) Spouse American LegalNet, Inc. www.FormsWorkFlow.com Petition/Administration or Probate of Will PC-200 REV. 4/19 CONNECTICUT PROBATE COURTS Estate of Petition/Administration or Probate of Will PC-200 Page 2 of 4 Children Children of a deceased child If NO children or grandchildren, list surviving parents If NO spouse, children, grandchildren or parents, list brother(s) and sister(s) or children of any deceased brother or sister (Identify relationship to decedent.) If NONE of the above apply, please refer to C.G.S. section 45a-439(a)(3) and provide a family tree. 2.Beneficiaries under the will, including nominated testamentary trustees and inter vivos trustees. (List name andaddressand include paragraph in will where interest in the estate arises. It is not necessary to list the address if it isalreadylisted above.3.Beneficiaries of testamentary trust(s) established under the will. (List name and address of each current beneficiaryandpresumptive remainder beneficiary and include paragraph in will where the arises. It is not necessaryto list the address if it is already listed above. Probate Court Rules of Procedure sections1.1(9) and 1.1(27).)The petitioner states that the following efforts have been made to identify or locate any person whose name and/or address is unknown. Heirs, Beneficiaries and Trustees, if any. Indicate any person who is under age 18 and include date of birth, any person in the military service or any person under conservatorship or legal disability. C.G.S. sections 45a-436, 45a-438 and 45a-439. Include the name, address and position of trust of the legal representative of any party. American LegalNet, Inc. www.FormsWorkFlow.com Petition/Administration or Probate of Will PC - 200 REV. 4 /19 CONNECTICUT PROBATE COURTS Estate of Petition/Administration or Probate of Will PC-200 Page 3 of 4 The etitioner represents that: Decedent left a will and codicil(s) herewith presented for probate, dated . * Decedent, after making the will and codicil(s) had a child born, or adopted a minor child, or married or had his or her marriage dissolved by divorce or annulment. C.G.S. sections 45a-257a to 45a-257c. (Provide written explanation.) The proposed fiduciary named below is not the primary executor named in the will or codicil. (Provide copy of letter of declination or other written explanation.) Decedent left no will. One or more of the children listed are not also the children of the surviving spouse. Decedent had a conservator of the estate: (List name and probate district in which conservator was appointed.) Decedent owned an interest in real estate other than in survivorship in Connecticut at the time of death. The estimated value of solely owned assets, excluding real estate is $. Did the decedent or spouse or children of the decedent ever receive aid or care from the State of Connecticut? Yes No If yes, check appropriate box(es). State of Connecticut Department of Veterans222 Affairs. C.G.S. section 45a-355. (Rocky Hill facility) WHEREFORE the petitioner requests that the will and codicil(s), if any, be approved and admitted to probate and theither letters testamentary or letters of administration be granted to the below-named proposed fiduciary. The representations made in this petition are made under penalty of false statement. Signature of Petitioner Type or Print Name Date PROPOSED FIDUCIARY If appointed, I will accept the position of trust: Signature of Proposed Fiduciary Date: Type or Print Name Address hone Number Fiduciary is is not a resident of the State of Connecticut. Signature of Proposed Fiduciary Date: Type or Print Name Address hone Number Fiduciary is is not a resident of the State of Connecticut. American LegalNet, Inc. www.FormsWorkFlow.com Petition/Administration or Probate of Will PC - 200 REV. 4 /19 CONNECTICUT PROBATE COURTS Petition/Administration or Probate of Will PC-200 Page 4 of 4 Each of the undersigned represents that he or she has examined the petition and related documents and HEREBY WAIVES NOTICE OF HEARING upon the petition and has NO OBJECTION to the granting and approval thereof. (If space is insufficient, use General Waiver, PC-181. Please also type or print name.) Name: Name: Name: Name: Name: Name: CERTIFICATION *I certify that a copy of the will and codicil(s), if any, and this petition were sent to the following persons as provided in theProbate Court Rules of Procedure, sections 30.6(a) and 30.7: Name and Address Signature of Petitioner or Attorney Type or Print Name Date CERTIFICATE - EXISTENCE OF INTER VIVOS TRUST (Complete this section for trusts that are beneficiaries under the will.) This is to certify that the trust document for the (Name of Trust) dated between (Name(s) as grantor(s) and (Name(s) as trustee(s), is in my/our possession, has been duly executed, and the trust is in full force and effect. The representations contained in this certificate are made under penalty of false statement. Signature of Current Trustee Type or Print Name Date Signature of Current Trustee Type or Print Name Date Estate of American LegalNet, Inc. www.FormsWorkFlow.com