PETITION BY REPRESENTATIVE OF FOREIGN COUNTRY TO RECEIVE DISTRIBUTION � In accordance with Rule 12.19 of the Circuit Court of Cook County, [printed name of the Petitioner]states under the penalties of perjury:1. I am for � � at , Illinois;2. � Pursuant to treaty or convention between my country and the United States, I am entitled to receive the share of anestate distributable to a citizen and resident of � ; [country]3. � , of [printed name of the distributee] � [address] , is a citizen and resident of [address (continued)] and a distributee of this estate, and has authorized me to receive and receipt for [country] � the distributive share of the distributee; a copy of the authorization (and an English translation thereof if applicable) is attached. I ask leave to receive and to receipt for the distributee222s share. � I will pay and deliver the share to the distributee or, if unable to do so, will deposit the share with the Cook County Treasurer. [signature of the Petitioner] [address] [city/state/zip] [telephone number] � Attorney Number Name � Firm Name � Attorneys for � Address � City/State/Zip � Telephone � Email � Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 1 of 1CCP-0385 (Rev. 10/1/2018) Case No. Calendar Estate of DeceasedIN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT 226 PROBATE DIVISION2400