IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF File No. COUNTY, PROBATE DIVISION Division Deceased. RECEIPT OF BENEFICIARY AND CONSENT TO DISCHARGE The undersigned, hereby acknowledges having received from the personal representative of this estate the following: , The undersigned further acknowledges receipt of complete distribution of the share of the estate to which the undersigned was entitled, releases the personal representative from all further liability in connection with this estate, and consents to the entry of an order discharging the personal representative without notice, hearing, or waiting period and without further accounting. Signed on this ________ day of _________________________, ________. Beneficiary [Print or Type Names Under All Signature Lines] Bar Form No. P-5.0530 � Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com