Affidavit Complete Distribution 5000 Or Less {PC-1.13}

STATE OF RHODE ISLANDCounty ofEstate ofAlias DATE FILEDFORCOURT USE ONLY PROBATE COURT OF THECity or Town ofNo. The undersigned:FiduciaryTitleStreet AddressCity/TownState Zip CodeEmailPhone NumberCo-FiduciaryTitleStreet AddressCity/TownState Zip CodeEmailPhone Numberof the above estate on oath depose(s) and swear(s) that:1.The asset(s) that were discovered after the original probate was closed in the amount of $were distributed to the NameAddressAmount.Fiduciary: To the best of my knowledge or belief, the statement(s) contained within this document are truthful and accurate.Signature of FiduciaryDateSignature of FiduciaryDateNotary:Name of NotaryStateCountyOn day of , 20 the petitioner, known to me or proved through satisfactory evidence, signed the Signature of Notary PublicDateCommission ID #Commission Expiration DateNotary Seal AFFIDAVIT OF COMPLETE DISTRIBUTION OF ASSETS $5,000.00 OR LESS RIGL 33-14-13(4C)PC-1.13 (Rev. 07/17) State of Rhode Island and Providence PlantationsProbate CourtPage 1 of 1 FIDUCIARY SIGN HERE ARY SIGN HERE American LegalNet, Inc. www.FormsWorkFlow.com