DATE FILEDFORCOURT USE ONLY Respectfully represents thatName of AbsenteeResided in(City/Town) Date ofPersonal estate estimated at: $AbsenceAssets unknown whose whereabouts have been uknown for more than one year. Petitioner:NameRelationship to AbsenteeStreet AddressCity/TownStateZipCodePhoneNumberRespectfully requests that:Name of NomineeRelationship toAbsenteeStreet AddressCity/TownStateZip CodeE-mailName of Co-Nominee Relationship toAbsenteeStreet AddressCity/TownStateZip CodeE-mailor any other suitable person be appointed to administer.Attach Form PC-9.1, Waiver, if applicable.Absentee left the following spouse and heirs at law (Indicate any minors or adults with impediments):NameRelationshipAddressSpouseYou may provide additional attachments, if necessary.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 NotaryStateCountyOnday of, 20the petitioner, known to me or proved through satisfactory evidence, signed Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary Seal RECEIVERRIGL 33-20-1 et. seq.PC-2.13 (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. SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com DECREEUpon hearing, it is hereby ordered and decreed:Appointed RECEIVER(S):AppointedReceiverStreet AddressCity/TownStateZip CodeEmailPhone NumberAppointedReceiverStreet AddressCity/TownStateZip CodeEmailPhone NumberBond Fixed at: $RECEIVER of the property of the above name absentee whose whereabouts have been unknown for more than one year, he/she having disappered from his/her usual place of residence. With Surety Without Surety Appointed APPRAISER(S): Check box if Appraiser(s) is/are the same as above OR Complete Appraiser(s) information below. Appraiser NameStreet AddressCity/TownStateZip CodeEmailPhone NumberCo-Appraiser NameStreet AddressCity/TownStateZip CodeEmailPhone NumberAppointed RESIDENT AGENT:ResidentAgent NameStreetAddressCity/TownStateZip CodeEmailPhone NumberEntered as an order and decree of the court on:Probate JudgeDateSignature of Probate JudgePC-2.13 (Rev. 07/17) Page 2 of 2 SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com