Schedule A Proposed Distribution Final Financial Report Trust {PC-443A}

Schedule A: Proposed Distribution/Final Financial Report Trust PC-443A Rev. 7/13 R E C E IVE D : CONNECTI CUT PROBATE COURTS R E C O R DE D : Instructions: 1) This form is attached to and made a part of the final financial report for the above-referenced 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 distribution. Attach second sheet if necessary. 2) Type or print the form in ink. District Number Probate Court Name Estate of of Will for the Benefit of Trust Under Article Trustee (List name, address and telephone number of each trustee.) 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 trust is as follows: Itemized List of Proposed Distributions Section of Will Providing for Distribution Name of Distributee Assets to be distributed Fair Market Value $ $ $ $ $ $ Subtotal $ $ $ $ $ $ $ Subtotal $ Schedule A: Proposed Distribution/Final Financial Report Trust PC-443A New 7/13 PAGE American LegalNet, Inc. www.FormsWorkFlow.com 1/2 Schedule A: Proposed Distribution/Final Financial Report Trust PC-443A New 7/13 CONNECTI CUT PROBATE COURTS R E C O R DE D : Name of Distributee Section of Will Providing for Distribution Assets to be distributed Fair Market Value $ $ $ $ $ $ Subtotal $ $ $ $ $ $ $ Subtotal $ $ $ $ $ $ $ Subtotal $ Total $ 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 Trustee Type or Print Name Date Signature of Trustee Type or Print Name Date Schedule A: Proposed Distribution/Final Financial Report Trust PC-443A NEW 7/13 PAGE 2/2 American LegalNet, Inc. www.FormsWorkFlow.com