DATE FILEDFOR

COURT USE ONLY

LAST WILL AND TESTAMENT

PC-10.11 (Rev. 07/17)

State of Rhode Island and Providence PlantationsProbate Court

Page 1 of 1

STATE OF RHODE ISLANDCounty of

Estate of

Alias

PROBATE COURT OF THECity or Town of

No.

Last Will and Testament of:

Date of Filing with Court:

Date for Hearing:

Notice in following Newspaper:

WILL PROVEDName ofProbate Clerk

Signature ofProbate Clerk

Date

Recorded Book No. Page Number

Recorded Will Fee $

PROBATE CLERK SIGN HERE