THE ACCOUNT for the period from to

(number of account) (date) (date)

Schedule A (Received) $

Schedule B (Paid Out) $

Schedule C (Balance/Zero for Final Account) $

MUST BE ADVERTISED.Signatureof Fiduciary

Signature ofCo-Fiduciary

Name ofFiduciary

Name ofCo-Fiduciary

Title ofFiduciary

Title ofCo-Fiduciary

Notary:

Name of Notary

State County

On day of , 20 the petitioner, 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

Entered:Probate Judge

Signature of Probate Judge

Date

DATE FILEDFOR

COURT USE ONLYACCOUNT

RIGL 33-14-1 et. seq.

PC-7.1 (Rev. 07/17)

State of Rhode Island and Providence PlantationsProbate Court

Page 1 of 4

STATE OF RHODE ISLANDCounty of

Estate of

Alias

PROBATE COURT OF THECity or Town of

No.

NOTARY SIGN HERE

PROBATE JUDGE SIGN HERE

FIDUCIARY SIGN HERE CO-FIDUCIARY SIGN HERE

No. SCHEDULE A

Amount of personal estate according to inventory; or balance of next prior account: $

Amount received from gain on sale of personal estate over appraised value and from other property as follows: $

Number Date Description Amount$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Total $

PC-7.1 (Rev. 07/17) Page 2 of 4

No. SCHEDULE B

Here follows the settlement of all claims filed with the clerk and not previously accounted for; either by payment in full or in part or by abandonment by the creditor after disallowance: together will all other debts and expenses incurred in the administration of the accounting period.

Number Date Description of payments, charges, losses, and distributions Amount

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Total $

PC-7.1 (Rev. 07/17) Page 3 of 4

No. SCHEDULE C

This Schedule contains all items of personal property now in possession of the fiduciary, including cash and bank accounts.

Number Date Description of payments, charges, losses, and distributions Amount

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Total $

PC-7.1 (Rev. 07/17) Page 4 of 4