IN THE CIRCUIT COURT FOR FLORIDA IN RE: ESTATE OF COUNTY, PROBATE DIVISION File No. Division Deceased. REPORT OF DISTRIBUTION (Single Personal Representative) Petitioner, 1. , alleges: Petitioner, as the personal representative of the above estate, files herewith all remaining receipts necessary to show that the estate has been distributed in accordance with the proposed plan of distribution set forth in the Petition for Discharge. 2. The claims of all creditors have been paid or otherwise disposed of. Petitioner requests that an order be entered discharging petitioner as personal representative of this estate, and releasing the surety on petitioner's bond, if any, from further liability thereon. Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Signed on this ________ day of _________________________, ________. Personal Representative Attorney for Personal Representative Email Addresses: Florida Bar No. (address) Telephone: [Print or Type Names Under All Signature Lines] Bar Form No. P-5.0700 - 1 of 2 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com I CERTIFY that a copy hereof has been furnished to by , on , . Attorney [Print or Type Names Under All Signature Lines] Bar Form No. P-5.0700 - 2 of 2 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com