SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ NRT _________ Trust of ________________________________ Settlor VERIFICATION AND CERTIFICATE OF NOTICE OF EXISTENCE OF REVOCABLE TRUST I have mailed or caused to be mailed a copy of the Notice of Existence of Revocable Trust as permitted by D.C. Code, sec. 19-1305.05(d) and 19-1306.04(a)(3) on the ___________ day of __________________, 20___, to the following persons: List names and addresses of all qualified beneficiaries of the trust, heirs of the deceased settlor, and creditors. Name __________________________ __________________________ __________________________ __________________________ __________________________ Address _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ Statement of Non-Mailing No notice has been sent to the following qualified beneficiaries of the trust, heirs of the deceased settlor, or creditors whose identities or locations are not known or ascertainable by reasonably diligent effort: ___________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ I have previously filed or file herewith proofs of publication of the Notice of Existence of Revocable Trust as permitted by D.C. Code, sections 19-1305.05(d) and 19-1306.04(a)(3). I do 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. ______________________ Date _____________________________________ Signature ______________________________________ Trustee or Attorney for Trustee _____________________________________ Address _____________________________________ _____________________________________ Telephone number _____________________________________ E-mail (optional) Jan. 2010 _____________________________________ Bar Number (if filer is an attorney) American LegalNet, Inc. www.FormsWorkFlow.com