DATE FILEDFORCOURT USE ONLY Petitioner:NameRelationship to DeceasedStreet AddressCity/TownStateZipCodePhoneNumberI, being duly sworn, upon my oath depose and say: That I am: a relative a friendother:of the late:who died a resident ofon.(name of Deceased) (town of residence)(date of death)1.That upon his/her death, the deceased left a Last Will and Testament dated, attached hereto. That under Paragraph, of said Last Will and Testament, I am named Executor/Executrix of the estate: that there are no assets which require Probate Administration under the terms of the late222s Last Will and Testament. 2.The funeral bill for the deceased, attached hereto, was paid in full on:3.The decedent left the following heirs at law:Name of Heir At LawRelationship toDeceasedStreet AddressCity/TownStateZipCodePhoneNumber 4.Said Will is presented to the Probate Court of the city/town of:RIGL 33-7-5issuance of letters testamentary or letters of administration regarding the estate of the decedent.Petitioner: To the best of my knowledge or belief, the statement(s) contained within this document are truthful and accurate.Signature of PetitionerDateNotary:Name of NotaryStateCountySignature of Notary PublicDateCommission ID#Commission Expiration DateNotary SealFiled and recorded on(MM/DD/YYYY) only: NO ACTION TAKENProbate ClerkNameDateProbate ClerkSignatureProbate Seal PETITION TO FILE WILL WITH NO ASSETS RIGL 33-7-5PC-1.4 (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 ofNo. SIGN HERE SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com Deceased left the following surviving spouse and heirs at law:NAMERELATIONSHIPADDRESS(Indicate any minors or incompetents.)PC-1.4 (Rev. 07/17) Page 1A of 1 American LegalNet, Inc. www.FormsWorkFlow.com