SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION CERTIFICATION OF FILING WILL I, ___________________________________________________, on this___________day of____________________, 20______, hereby submit for filing the following paper-writing(s) purporting to be the Last Will and Testament and/or Codicil(s) of ___________________________________________________________ ____________________________________________________________________________________ [ (insert all name(s) of decedent as reflected in the will(s) and/or codicil(s)] who died on or about the _______day of ___________________,20_____, domiciled in the District of Columbia: [state the date of the document and describe any unusual attributes of the document relating to whether or not it is a copy] and the same (was) (were) received from____________________________________ ______________________________________________________________________. Name __________________________________ (signature) Address_________________________________ _________________________________ Telephone Number_________________ FOR OFFICE USE ONLY Reviewed by_________________________ (signature) Comments: _________________________ ____________________________________ ____________________________________ ___________________________________________ ___________________________________________ American LegalNet, Inc. www.USCourtForms.com