Fill and Sign the Connecticut Schedule a Proposed Distribution Final Financial Report of Guardian or Conservator Form

Schedule A: Proposed Distribution/Final Financial Report Conservator/Guardian PC- 442 A R EV . 7/13  PAGE 1/2 Schedule A: Proposed Distribution/Final CONNECTICUT!PROBATE,COURTS Financial Report Conservator/Guardian PC-442A New 7/13 RECORDED: RECEIVED: Instructions: 1),This ,form,is,attached,to,and,made,a,part,of,the,final,financial,report,for,the,above Areferenced,estate., Except,as,provided,in,section,37.4,of,the,Probate,Court,Rules,of,Procedure,,distributions,must,be, itemized,and,listed,at,fair,market,value,on,the,date,of,di stribution.,Attach,second,sheet,if,necessary., 2) Type,or,print, the,form,in,ink. Probate Court Name District Number Estate of Fiduciary ( List name, address and tele phone number of each fiduciary.) EACH FIDUCIARY WHO SIGNS THIS PROPOSED DISTRIBUTION REPRESENTS UNDER PENALTIES OF FALSE STATEMENT THAT: The proposed distribution of all the assets on hand for distribution as of the termination of the estate is as follows: Itemized List of Proposed Distributions Name of Distributee Assets to be distributed Fair Market Value $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Total $$ $ $ Schedule A: Proposed Distribution/Final CONNECTICUT!PROBATE,COURTS Financial Report Conservator/Guardian PC-442A New 7/13 RECORDED: Schedule A: Proposed Distribution/Final Financial Report Conservator/Guardian PC- 442 A NEW 7/13  PAGE 2/2 Complete this section if there is a reserve for final expenses. Reserve (if,any) Assets Fair Market Value $ $ Total $ The representations contained in this proposed distribution are made under the penalties of false statement. Signature of Fiduciary Signature of Fiduciary Type or Print Name Type or Print Name Date Date