Free PC-201 - Connecticut

APPLICATION/ANCILLARY PROBATE OF WILL PC-201 REV. 7/95

STATE OF CONNECTICUT COURT OF PROBATE [Type or print in black ink. File in duplicate.] [Use Second Sheet, PC-180, for additional data.] DISTRICT NO.

RECORDED:

TO: COURT OF PROBATE, DISTRICT OF ESTATE OF [Include all names and initials under which any asset was held.]

SOCIAL SECURITY NO. DATE OF DEATH

DECEDENT'S RESIDENCE AT TIME OF DEATH [Include full address.]

PETITIONER [Name, address, and zip code.]

SURVIVING SPOUSE [Name, address, and zip code. If no surviving spouse, so state.]

JURISDICTION APPERTAINS TO THIS COURT BASED ON THE FOLLOWING: [C.G.S. §45a-287] The decedent last resided in this district. The decedent has real or tangible personal property located in this district. The decedent has maintained bank accounts or evidence of other tangible property in this district. An executor or trustee named in the will resides in this district or, in the case of a bank or trust company, has an office in this district. A cause of action in favor of the decedent arose in this district, or a debtor of the decedent resides or has an office in this district.
HEIRS, NEXT OF KIN, BENEFICIARIES, and TRUSTEES, if any. [Give names, addresses, zip codes, and relationships.] If heir, indicate ancestor through whom heir takes. If beneficiary, indicate paragraph of will where interest is stated or may arise. For all minors listed, give date of birth. Indicate any person who is under legal disability or in the military service. C.G.S. §§45a-436, 438, 439.

THE PETITIONER REPRESENTS that: No other application for ancillary probate has been filed in the State of Connecticut. Decedent, or spouse or children of the decedent, did did not ever receive aid or care from the State of Connecticut. [If affirmative, check appropriate box(es).] State of Connecticut (D.A.S) Department of Veterans' Affairs C.G.S. §45a-355. THE PETITIONER HEREWITH PRESENTS to the Court the duly authenticated and exemplified copy of the Last Will and Testament and codicils, if any, of the decedent dated and the record of the proceedings proving and establishing the same by a court of competent jurisdiction and REPRESENTS that the time for taking an appeal therefrom has has not expired, and no appeals are presently pending. Attached hereto is a complete statement of the property and estate of the decedent in Connecticut. C.G.S. §45a-288. WHEREFORE, THE PETITIONER REQUESTS this Court to order that said copies be filed and recorded and that letters ancillary testamentary be issued to the fiduciary named below. The representations contained herein are made under the penalties of false statement. Date: ........................................................................... Petitioner:
PROPOSED FIDUCIARY IF APPOINTED, I WILL ACCEPT SAID POSITION OF TRUST
Signature ................................................................................
[Type or print name under signature.]

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Address and zip code: Fiduciary is is not a resident of the State of Connecticut. Fiduciary is is not a resident of the State of Connecticut.

Telephone number:

Telephone number:

ATTORNEY FOR PROPOSED FIDUCIARY [Name, address, zip code, telephone number, Conn. Bar Juris No.]

Each of the undersigned represents that he or she has examined the application and related documents and hereby WAIVES NOTICE OF HEARING upon said application and has NO OBJECTION to the granting and approval thereof. [If space is insufficient, use General Waiver, PC-181. Please also type or print name.]

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APPLICATION/ANCILLARY PROBATE OF WILL PC-201

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