700 - 0015 2 (04/2018) Page 1 of 1 STATE OF VERMONT SUPERIOR COURT PROBATE DIVISION Unit Docket No.: In re: I hereby state under oath: 1. This report is filed within one year after the final decree in this proceeding. 2. I have paid and delivered the money and/or other property to the persons entitled to receive it. 3. I have filed a receipt for each payment and delivery or such other proof as required by the Court. I have attached an affidavit explaining the omission if I was unable to obtain the p roof required. I hereby swear or affirm that the information in this report is true to the best of my knowledge and belief. Date Signature Printed Name Signed and sworn to before me: ORDER OF APPROVAL AND DISCHARGE approved, and the proceeding closed. The Fiduciary is discharged. Dated Date Signature of Notary Public Expiration Date American LegalNet, Inc. www.FormsWorkFlow.com