DATE FILEDFORCOURT USE ONLY AFFIDAVIT OF NEWLY DISCOVERED ASSETS $5,000.00 OR LESSAND STATEMENT OF PROPOSED DISTRIBUTION RIGL 33-14-13PC-1.11 (Rev. 07/17) State of Rhode Island and Providence PlantationsProbate CourtPage 1 of 2 STATE OF RHODE ISLANDCounty ofEstate ofAlias PROBATE COURT OF THECity or Town ofNo. American LegalNet, Inc. www.FormsWorkFlow.com administration proceeding, to the heirs at law as follows:Heir at LawRelationshipAmount$AddressHeir at LawRelationshipAmount$AddressHeir at LawRelationshipAmount$AddressHeir at LawRelationshipAmount$Address 4. Notice has been given pursuant to RIGL 33-14-13(a)(2) and (a)(3) to the following persons:Heir at LawRelationshipAmount$AddressHeir at LawRelationshipAmount$AddressHeir at LawRelationshipAmount$AddressHeir at LawRelationshipAmount$AddressFiduciaries: To the best of my knowledge or belief, the statement(s) contained within this document are truthful and accurate.Signature of FiduciaryDateSignature of FiduciaryDateNotary:Name of NotaryStateCountyOn day of , 20 the petitioner, known to me or proved through satisfactory evidence, signed the Signature of NotaryDateCommission ID#Commission Expiration DateNotary Seal PC-1.11 (Rev. 07/17) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com