2753 Report of Attorney-In-Fact or Consul (Rev. 7/5/00) CCP 0387 IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of ____________________________________________ Deceased } No. _______________________________________ Docket ___________________________________ Page ___________________________________ REPORT OF ATTORNEY-IN-FACT OR CONSUL ____________________________________________________________________ on oath states: 1. An order was entered on ____________________________, _________, directing the representative of the estate to pay to me as __________________________________________________________________ (Attorney-in-fact) or (official position and country) the distributive share of ______________________________________________________________________. (Name of distributee) 2. On ______________________________________, ________, the share was paid to me. 3. I paid the distributee the total amount received by me after deducting the expenditures listed below. 4. Received by me: Property: Cash $ ______________________ Deductions authorized by distributee $ ____________________ $ ____________________ $ ____________________ $ __________________ Net Cash Paid and distributed to distributee: Cash $ ______________________ Property: 5. The receipt of the distributee is attached. _________________________________________ (Attorney-in-fact) (Consul) Atty. No.:__________________ Name: _____________________________________________ Signed and sworn to before me Atty. for Petitioner: __________________________________ _______________________________________, ________ 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