RI Deed-Executor, Administrator, Trustee, Guardian, Conservator, Receiver, or Commissioner 1

__________________, executor of the will of ________________ administrator of the estate of ____________________ trustee under __________________ guardian of _________________________ conservator of __________________ receiver of the estate of __________________ commissioner by the power conferred by __________________________ and by every other power me thereunto enabling, for dollars paid, grant to _______________________________________________

(description, and encumbrances, if any)

Witness _________ hand this ________ day of ___________, 20______.

STATE OF RHODE ISLAND

COUNTY OF ____________

In [city/town] on this _______ day of __________, 20_______, before me personally appeared [name(s) of person(s) signing], [title(s)] of [in what capacity signing], to me known and known by me to be the party executing the foregoing instrument on behalf of said ______________________________, and acknowledged said instrument and the execution thereof, to be his/her/their free act and deed in said capacity and the free act and deed of said ____________________________.

_________________________________

Notary Public

Printed Name: _____________________

My commission expires: _____________