Affidavit in Lieu of Probate of Will/Administration (Rev. 1/14) - Free Download
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Affidavit in Lieu of Probate
CONNECTICUT PROBATE COURTS
of Will/ Administration
PC-212 Rev. 1/14
Instructions: 1) This form may be used to settle a decedent’s estate using the small estates procedure under C.G.S.
section 45a-273. The small estates procedure may be used only if both of the following conditions
are met: (a) the decedent had no solely owned real estate and (b) the total value of all of the
decedent’s personal property does not exceed $40,000.
2) The small estates procedure is a simplified method of settling an estate that avoids formal probate
proceedings. Under the procedure, the decedent’s assets may be used to: (a) pay the decedent’s
funeral expenses and the expenses of administering the estate (these are referred to as expenses),
pay claims associated with the decedent’s last illness or other claims that the decedent owed at the
time of death (these are referred to as claims) or (b) reimburse a person who paid expenses o
laims from nonprobate assets. Any assets remaining after payment of expenses and claims are
then distributed to the decedent’s heirs or beneficiaries.
3) Attach PC-212A, Request for Order of Distribution, if (a) assets exceed expenses and claims or (b)
erson who paid expenses or claims with nonprobate assets waives reimbursement.
4) For further information, see C.G.S. section 45a-273 and Probate Court Rules of Procedure, sections
30.12, 30.13 and 30.23.
5) Type or print the form in ink. Use an additional sheet if needed. File two copies of the form with
the Probate Court where the decedent resided.
Probate Court Name District Number
Estate of (Include all names and initials under which assets were held by the decedent.)
Decedent's Residence at Time of Death (Include full address.)
Date of Death
Petitioner (List the name, address, and telephone number.)
Relationship to Decedent, if any
HE PETITIONER represents that:
The petitioner is the surviving spouse of the decedent.
There is no surviving spouse, and the petitioner is a next of kin of the
There is no surviving spouse or next of kin, or such surviving spouse or next of kin has refused to file such
affidavit, and the petitioner has the following interest in the estate:
No petition for settlement of the estate is pending in any Probate Court.
The decedent died owning no real estate, other than survivorship real estate, if any, in the State of
Connecticut. The market value of the solely-owned assets listed below does not exceed $40,000.
The decedent did did not ever receive aid or care from the State of Connecticut. (If affirmative, check
State of Connecticut Department of Veterans' Affairs. C.G.S. section 45a-273(c).
(Rocky Hill facility)
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