DATE FILEDFORCOURT USE ONLY Respectfully represents:Name of DeceasedDate of Death(Died Intestate)Address: Petitioner:NameRelationship to DeceasedStreet AddressCity/TownStateZipCodePhoneNumber1. He/She is of full age and legal capacity, and a resident of the State of Rhode Island.town in which the Deceased resided. 3. The following persons would inherit under the provisions of RIGL 33-1-1 in case of intestacy.NameRelationshipAddressthe value as of date of death listed, and that said assets consist of personal property only and does not exceed $15,000.00 in value, exclusive of all tangible personal property. 5. The Deceased owned no real estate at the time of their death. 6. That the undersigned will act as Voluntary Informal Administrator(s) for the Deceased and will administer the Estate according to law and apply the proceeds of the Estate in conformity with the provisions of RIGL 33-24-1(e), including the payment of the funeral bill.In Witness Whereof I/we sign this petition on the day of , . (day) (month) (year) PETITION FOR VOLUNTARY INFORMAL ADMINISTRATORRIGL 33-24-1PC-1.10 (Rev. 09/17) State of Rhode Island and Providence PlantationsProbate CourtPage 1 of 3 STATE OF RHODE ISLANDCounty ofEstate ofAlias PROBATE COURT OF THECity or Town ofNo. American LegalNet, Inc. www.FormsWorkFlow.com Name of Signature Street AddressCity/TownStateZipCodePhoneNumberName ofSignatureStreet AddressCity/TownStateZipCodePhoneNumberNotary:Name of NotaryStateCountyOn day of , 20the petitioner, known to me or proved through satisfactory evidence, signed the Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary SealReviewed and approved:Probate JudgeDateSignature of Probate JudgeProbate ClerkDateSignature of Probate ClerkPC-1.10 (Rev. 09/17) Page 2 of 3 AFFIANT SIGN HERE SIGN HERE SIGN HERE SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com PC-1.10 (Rev. 09/17) Page 3 of 3 SCHEDULE OF PERSONAL PROPERTY TITLED SOLELY IN DECEASED222S NAME(Not to exceed $15,000.00. No real estate or tangible personal property.)ValueTotal (Not to exceed $15,000.00) American LegalNet, Inc. www.FormsWorkFlow.com