DATE FILEDFORCOURT USE ONLY The undersigned, a party in interest, is aggrieved by an order or decree entered on:whereby said court (Enter all actions of the Court):and in consequence thereof and as a result claim an appeal from said order or decree to the Superior Court for said County and request Name of ClaimantDateSignature of Claimant CLAIM OF APPEALRIGL 33-23-1 et seqPC-9.3 (Rev. 07/17) State of Rhode Island and Providence PlantationsProbate CourtPage 1 of 1 STATE OF RHODE ISLANDCounty ofEstate ofAlias PROBATE COURT OF THECity or Town of American LegalNet, Inc. www.FormsWorkFlow.com