Schedule A: Proposed Distribution/Final Financial Report Conservator/Guardian PC-442A New 7/13 R E C E IV E D : CONNECTI CUT PROBATE COURTS R E C OR D ED : Instructions: 1) This form is attached to and made a part of the final financial report for the referenced estate. Except as provided in section 37.4 of the Probate Court Rules of Procedure, distributions must be itemized and listed at fair market value on the date of distribution. Attach second sheet if necessary. 2) Type or print the form in ink. District Number Probate Court Name Estate of Fiduciary (List name, address and telephone number of each fiduciary.) EACH FIDUCIARY WHO SIGNS THIS PROPOSED DISTRIBUTION REPRESENTS UNDER PENALTIES OF FALSE STATEMENT THAT: The proposed distribution of all the assets on hand for distribution as of the termination of the estate is as follows: Itemized List of Proposed Distributions Name of Distributee Assets to be distributed Fair Market Value $ $ $ $ $ $ Subtotal $ $ $ $ $ $ $ Subtotal $ $ $ $ $ $ $ Subtotal $ Schedule A: Proposed Distribution/Final Financial Report Conservator/Guardian PC-442A REV. 7/13 PAGE 1/2 American LegalNet, Inc. www.FormsWorkFlow.com Schedule A: Proposed Distribution/Final Financial Report Conservator/Guardian PC-442A New 7/13 CONNECTI CUT PROBATE COURTS R E C OR D ED : Name of Distributee Assets to be distributed Fair Market Value $ $ $ $ $ $ Subtotal $ $ $ $ $ $ $ Subtotal $ Total $ Complete this section if there is a reserve for final expenses. Reserve (if any) Assets $ $ Total $ Fair Market Value The representations contained in this proposed distribution are made under the penalties of false statement. Signature of Fiduciary Type or Print Name Date Signature of Fiduciary Type or Print Name Date Schedule A: Proposed Distribution/Final Financial Report Conservator/Guardian PC-442A NEW 7/13 PAGE 2/2 American LegalNet, Inc. www.FormsWorkFlow.com