SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ ADM _________ Estate of ________________________________ Deceased VERIFICATION AND CERTIFICATE OF NOTICE BY PERSONAL REPRESENTATIVE PURSUANT TO SCR-PD 403(b)(4) (For estates of decedents dying on or after July 1, 1995) I do solemnly declare and affirm that I have mailed or caused to be mailed a copy of the notice of appointment and general information statement as required in D.C. Code, sec. 20-704 (a) and (b) on the ___________________________ day of _____________________ _______ , to the following persons: List names and addresses of all heirs, legatees, and creditors referred to in D.C. Code, sec. 20-704(b) (Attach additional sheets if necessary) I do further solemnly declare and affirm under penalty of law that the contents of the foregoing document are true and correct to the best of my knowledge, information, and belief, that I have previously filed or file herewith proofs of publication as required by SCR-PD 403(b)(4), and that to the best of my knowledge and belief the value of the probate estate (remains the same as) (increased/decreased in the following amount from) that set forth in the petition for probate previously filed with the Court ( $ ____________________); and that I have paid or tender herewith court costs pursuant to SCR-PD 425(a)(1) through (4) and in accordance with D.C. Code, sec. 15707(a). Dated: __________________________ January 2014 � 147.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com _______________________________________ Signature of attorney _______________________________________ Typed name of attorney _______________________________________ Address (actual address/not Post Office Box) _______________________________________ _______________________________________ _______________________________________ Telephone number _______________________________________ Email address _______________________________________ Unified Bar number _______________________________________ Signature _______________________________________ Typed name ____________________________________________ Address (actual address/not Post Office Box) ____________________________________________ ____________________________________________ ____________________________________________ Telephone number ____________________________________________ Email address ____________________________________________ Bar number (if filer is an attorney) January 2014 � 147.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com Instructions for Filing "Verification and Certificate of Notice by Personal Representative Pursuant to SCR-PD 403(b)(4)" (For estates of decedents dying on or after July 1, 1995 and whose estates are unsupervised.*) Overview: The purpose of this form is to certify to the Register of Wills for the record that all heirs, all legatees (persons who take under a will) and all creditors have received notice of the probate proceedings. When the Notice must be given: A copy of the General Information Sheet (covered below) and the Notice of Appointment, Notice to Creditors and Notice to Unknown Heirs (also covered below) must be mailed to all creditors, heirs and legatees within twenty (20) days of the date of the order appointing the personal representative. How the Notice must be mailed: The notices must be sent by registered or certified mail, postage prepaid, return receipt requested, to the last known address, with delivery restricted to the addressee. The filing of the green return receipts is optional. When the Verification and Certificate of Notice must be filed: The Verification and Certificate of Notice must be filed with the Court within ninety (90) days of the date of the order appointing the personal representative. Newspaper Notice: Immediately upon appointment of the personal representative, the Probate Division will transmit the Notice of Appointment, Notice to Creditors and Notice to Unknown Heirs to the newspapers selected by the petitioner and will return to the personal representative or attorney, if any, one copy of the Notice of Appointment, Notice to Creditors and Notice to Unknown Heirs with the initial publication date stamped on it. The personal representative must mail a copy of that notice to all creditors and to each heir and legatee. The two newspapers will bill the personal representative for the costs of publication. Upon receipt of payment, the newspapers will send the personal representative a Proof of Publication which will bear a raised seal. The personal representative must file these original Proofs of Publication along with the Verification and Certificate of Notice. The Verification and Certificate of Notice will not be accepted for filing without the Proofs of Publication. General Information for Heirs, Legatees, and Creditors (General Information Sheet): The personal representative is required to send a copy of this sheet along with the Notice of Appointment, Notice to Creditors, and Notice to Unknown Heirs to all creditors and to each heir and legatee. Creditors: In the space provided in the Verification and Certificate of Notice, the personal representative must list the names of each creditor of the decedent. The notice must be sent to any creditor whose identity is known or discoverable through reasonably diligent effort. * Supervised Estates: These instructions also apply to supervised estates with the exception that the Verification and Certificate of Notice form is not used. Instead, the Inventory form is used. In supervised cases the required information must be provided on the "Verification and Certificate" on the reverse side of the Inventory form. January 2014 � 147.10.v2 American LegalNet, Inc. www.FormsWorkFlow.com