IN THE CIRCUIT COURT FOR THE TWENTY-THIRD JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS IN THE MATTER OF THE ESTATE OF _________________________________________ Case No._________________________________ REFUNDING BOND AND RECEIPT The undersigned hereby acknowledges receipt of the sum of $__________________________ (or of assets of that value per attached list), the same being in partial/full distribution of the share of the undersigned in the above estate. [] If this distribution is made before the expiration of the period when claims are barred, the undersigned submits herewith a bond in double the amount of the above distribution; or If this distribution is made in an estate being administered in Summary Administration, the undersigned submits herewith a bond in the amount of the above distribution, [] The undersigned, distributee, binds himself, his heirs, successors and assigns to pay to the Representative of the Estate an amount equal to the above distribution or an amount equal to double to the above distribution, as applicable, upon order of this Court. Now therefore the condition of this obligation is such that if the distributee shall refund to the Representative of the Estate all or any part of said distribution as directed by this Court, together with the expenses of recovery including reasonable attorney's fees and additional expenses of administration then this obligation is void; otherwise it remains in full force. The distributee enters his Appearance in the above entitled proceeding and submits to the jurisdiction and the orders of this Court herein. Dated__________________________________ ___________________________________ Distributee Address_____________________________ ____________________________________ ____________________________________ Probate29\Refunding Bond & Receipt Rev. 11/16/2012 American LegalNet, Inc. www.FormsWorkFlow.com