Form PC-3.4 "Acceptance/Declination" - Rhode Island

Form PC-3.4 is a Rhode Island Secretary of State form also known as the "Acceptance/declination". The latest edition of the form was released in July 1, 2017 and is available for digital filing.

Download an up-to-date Form PC-3.4 in PDF-format down below or look it up on the Rhode Island Secretary of State Forms website.

ADVERTISEMENT

Download Form PC-3.4 "Acceptance/Declination" - Rhode Island

826 times
Rate
4.8(4.8 / 5) 50 votes
State of Rhode Island and Providence Plantations
DATE FILED
Probate Court
FOR
ACCEPTANCE/DECLINATION
COURT USE ONLY
RIGL 33-8-4
STATE OF RHODE ISLAND
Select County
County of
PROBATE COURT OF THE
Select City or Town
Estate of
City or Town of
Alias
No.
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
PERSON DECLINING SIGN HERE
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
NOTARY SIGN HERE
Commission ID#
Commission Expiration Date
Notary Seal
PC-3.4 ( Rev. 07/17)
Page 1 of 2
State of Rhode Island and Providence Plantations
DATE FILED
Probate Court
FOR
ACCEPTANCE/DECLINATION
COURT USE ONLY
RIGL 33-8-4
STATE OF RHODE ISLAND
Select County
County of
PROBATE COURT OF THE
Select City or Town
Estate of
City or Town of
Alias
No.
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
PERSON DECLINING SIGN HERE
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
NOTARY SIGN HERE
Commission ID#
Commission Expiration Date
Notary Seal
PC-3.4 ( Rev. 07/17)
Page 1 of 2
Decline(s) said trust:
Signature of Person Declining
PERSON DECLINING SIGN HERE
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
NOTARY SIGN HERE
Commission ID#
Commission Expiration Date
Notary Seal
Accepts said trust:
Signature of Executor/Executrix or Adminstrator/Administratrix
Date
EXECUTOR/EXECUTRIX OR ADMINISTRATOR/ADMINISTRATRIX SIGN HERE
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
NOTARY SIGN HERE
Commission ID#
Commission Expiration Date
Notary Seal
Accepts said trust:
Signature of Executor/Executrix or Adminstrator/Administratrix
Date
EXECUTOR/EXECUTRIX OR ADMINISTRATOR/ADMINISTRATRIX SIGN HERE
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
NOTARY SIGN HERE
Commission ID#
Commission Expiration Date
Notary Seal
PC-3.4 ( Rev. 07/17)
Page 2 of 2
ADVERTISEMENT
Fill PDF online
Page of 2