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The undersigned named (check one): Executor(s)/Executrix(trices) Administrator(s)/Administratrix(trices) Other Fiduciary Name Street Address City/Town State Zip Code Email Phone Number Co-Fiduciary Name Street Address City/Town State Zip Code Email Phone Number Decline(s) said trust: Signature of Person Declining Notary: Name of Notary State County On day of , 20 the person declining, known to me or proved through satisfactory evidence, signed the document in my presence and swore or affirmed the statement(s) in the documents is/are truthful and accurate. Signature of Notary Public Date Commission ID# Commission Expiration Date Notary Seal DATE FILED FOR COURT USE ONLY ACCEPTANCE/DECLINATION RIGL 33-8-4 PC-3.4 ( Rev. 07/17) State of Rhode Island and Providence Plantations Probate Court Page 1 of 2 STATE OF RHODE ISLAND County of Estate of Alias PROBATE COURT OF THE City or Town of No. PERSON DECLINING SIGN HERE NOTARY SIGN HERE

State of Rhode Island and Providence Plantations Probate ... · ACCEPTANCE/DECLINATION COURT USE ONLY RIGL 33-8-4 PC-3.4 ( Rev. 07/17) State of Rhode Island and Providence Plantations

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Text of State of Rhode Island and Providence Plantations Probate ... · ACCEPTANCE/DECLINATION COURT USE...

  • The undersigned named (check one): Executor(s)/Executrix(trices) Administrator(s)/Administratrix(trices)

    Other

    FiduciaryNameStreet AddressCity/Town State Zip

    CodeEmail Phone

    NumberCo-FiduciaryNameStreet AddressCity/Town State Zip

    CodeEmail Phone

    Number Decline(s) said trust:

    Signature of Person Declining

    Notary:Name of Notary State County

    On day of , 20 the person declining, known to me or proved through satisfactory evidence, signed the document in my presence and swore or affirmed the statement(s) in the documents is/are truthful and accurate. Signature of Notary Public Date

    Commission ID# Commission Expiration Date Notary Seal

    DATE FILEDFOR

    COURT USE ONLYACCEPTANCE/DECLINATIONRIGL 33-8-4

    PC-3.4 ( Rev. 07/17)

    State of Rhode Island and Providence PlantationsProbate Court

    Page 1 of 2

    STATE OF RHODE ISLANDCounty of

    Estate of

    Alias

    PROBATE COURT OF THECity or Town of

    No.

    PERSON DECLINING SIGN HERE

    NOTARY SIGN HERE

    http://webserver.rilin.state.ri.us/Statutes/TITLE33/33-8/33-8-4.HTM

  • Decline(s) said trust:

    Signature of Person Declining

    Notary:Name of Notary State County

    On day of , 20 the person declining, known to me or proved through satisfactory evidence, signed the document in my presence and swore or affirmed the statement(s) in the documents is/are truthful and accurate. Signature of Notary Public Date

    Commission ID# Commission Expiration Date Notary Seal

    Accepts said trust:Signature of Executor/Executrix or Adminstrator/Administratrix Date

    Notary:Name of Notary State County

    On day of , 20 the executor/executrix or administrator/administratrix, known to me or proved through satisfactory evidence, signed the document in my presence and swore or affirmed the statement(s) in the documents is/are truthful and accurate. Signature of Notary Public Date

    Commission ID# Commission Expiration Date Notary Seal

    Accepts said trust:Signature of Executor/Executrix or Adminstrator/Administratrix Date

    Notary:Name of Notary State County

    On day of , 20 the executor/executrix or administrator/administratrix, known to me or proved through satisfactory evidence, signed the document in my presence and swore or affirmed the statement(s) in the documents is/are truthful and accurate. Signature of Notary Public Date

    Commission ID# Commission Expiration Date Notary Seal

    PC-3.4 ( Rev. 07/17) Page 2 of 2

    PERSON DECLINING SIGN HERE

    NOTARY SIGN HERE

    NOTARY SIGN HERE

    NOTARY SIGN HERE

    EXECUTOR/EXECUTRIX OR ADMINISTRATOR/ADMINISTRATRIX SIGN HERE

    EXECUTOR/EXECUTRIX OR ADMINISTRATOR/ADMINISTRATRIX SIGN HERE

    Combo Box 1: [Select County]2: 3: Combo Box 4: [Select City or Town]5: 14: 15: 16: 17: 18: 19: 20: 7: 8: 10: 11: 12: 13: 9: 6: 21: 28: 23: 24: 29: 30: 22: 25: 26: 27: 48: 43: 44: 49: 50: 42: 45: 46: 47: 41: 58: 53: 54: 59: 60: 52: 55: 56: 57: 51: 31: 38: 33: 34: 39: 40: 32: 35: 36: 37: Check Box1: Check Box2: Check Box3: Check Box4: Check Box5: Check Box6: Check Box7: