Acceptance Declination {PC-3.4}

The undersigned named (check one): Executor(s)/Executrix(trices) Administrator(s)/Administratrix(trices) OtherFiduciaryNameStreet AddressCity/TownStateZip CodeEmailPhoneNumberCo-FiduciaryNameStreet AddressCity/TownStateZip CodeEmailPhoneNumber Decline(s) said trust:Signature of Person DecliningNotary:Name of NotaryStateCountyOn day of , 20the person declining, known to me or proved through satisfactory evidence, Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary Seal DATE FILEDFORCOURT USE ONLY ACCEPTANCE/DECLINATIONRIGL 33-8-4PC-3.4 ( 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 of SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com Decline(s) said trust:Signature of Person DecliningNotary:Name of NotaryStateCountyOn day of , 20the person declining, known to me or proved through satisfactory evidence, Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary Seal Accepts said trust:Signature of Executor/Executrix or Adminstrator/AdministratrixDateNotary:Name of NotaryStateCountyOn day of , 20the executor/executrix or administrator/administratrix, known to me or proved Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary Seal Accepts said trust:Signature of Executor/Executrix or Adminstrator/AdministratrixDateNotary:Name of NotaryStateCountyOn day of , 20the executor/executrix or administrator/administratrix, known to me or proved Signature of Notary PublicDateCommission ID#Commission Expiration DateNotary Seal PC-3.4 ( Rev. 07/17) Page 2 of 2 PERSON DECLINING SIGN HERESIGN HERESIGN HERESIGN HERE SIGN HERESIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com