REPORT OF REPRESENTATIVE FOR INTERESTED PARTY PC-170 REV. 3/03 RECORDED: STATE OF CONNECTICUT COURT OF PROBATE [Type or print in black ink.] TO: COURT OF PROBATE, DISTRICT OF DISTRICT NO. ESTATE OF /IN THE MATTER OF PERSON(S) REPRESENTED THE REPRESENTATIVE states that he or she has acquainted himself or herself with the rights of those he or she represents in the following matters, where checked; has examined the circumstances of the matter; has taken such action as necessary for the protection of such rights; and, with respect to such rights, has no legal objection to: The admission to probate of the will and/or codicils, if any, so offered by the petitioner and the issuance of letters testamentary to the proposed fiduciary OR the granting of letters of administration to the proposed fiduciary. The granting of authority to sell or mortgage the real property on the terms and conditions set forth in the application to sell or mortgage. The allowance of the administration account. The appointment of a conservator of the estate person. The allowance of the following interim accounts: [Specify dates covered by each such account.] Other [Specify.] COMMENTS BY REPRESENTATIVE [Use back of form or additional sheets if more space is required. BUT PLEASE NOTE: All comments by an appointed ATTORNEY representative are subject to the attorney/client requirements as set forth in Rule 1.6 of the Rules of Professional Conduct.] Dated at: ,Connecticut, on [Month, Day, Year] SIGNED .......................................................................... Representative for an interested party Type Name: REPORTOF REPRESENTATIVE FOR INTERESTED PARTY PC-170 American LegalNet, Inc. www.FormsWorkflow.com