2621 Receipt on Distribution (Rev. 7/5/00) CCP 0379 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of } _____________________________________________ Deceased No. _______________________________ Docket _____________________________ Page ______________________________ RECEIPT ON DISTRIBUTION I, _________________________________________________________________________, acknowledge receipt of (name) my share of this estate as follows: I appear, waive notice, and consent to the approval of the __________________________________________ (current) (final) account of ______________________________________________________________________________________ (name and office) ___________________________________________________________________________________________________, and I consent to the fees of the representative in the amount of $ _________________________________ and the fees of the attorney in the amount of $_____________________________ as set forth in the accounting. Atty. No.:__________________ Firm Name: ___________________________________________ Name: ________________________________________________ Atty. for Petitioner: __________________________________ Address: ____________________________________________ _______________________________________________ Distributee Address________________________________________ _______________________________________________ City/State/Zip: ________________________________________ Telephone: __________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS Print This Form For your protection and privacy, please press the Clear This Form button after you have printed the form. Clear This Form