SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION Trust No._____ ______________________ Name of Deceased Settlor VERIFICATION AND CERTIFICATE OF NOTICE OF EXISTENCE OF REVOCABLE TRUST I do solemnly declare and affirm that I have mailed or caused to be mailed a copy of the Notice of Existence of Revocable Trust as permitted by D.C. Code §§ 19-1305.05(d) and 19-1306.04(a)(3) on the ____day of____________200_, to the following persons: Name Address Qualified Beneficiary of the Trust /Heir/Creditor (Attach list of names and addresses of all qualified beneficiaries of the trust, heirs of the decedent and creditors.) Statement of Non-mailing I do further solemnly declare and affirm that no Notice has been sent to the following qualified beneficiaries of the trust, heirs of the deceased settlor and to creditors whose identities or locations are not known or ascertainable by reasonably diligent effort: I do further solemnly declare and affirm that I have previously filed or file herewith proofs of publication of the Notice of Existence of Revocable Trust as permitted by D.C. Code §§ 19-1305.05(d) and 19-1306.04(a)(3). Date:_______________ ___________________________ Trustee or Attorney for Trustee American LegalNet, Inc. www.FormsWorkflow.com