RECEIPT OF DISTRIBUTION - PROBATE STATE OF ILLINOIS 3832 (Rev. 4/17) UNITED STATES OF AMERICA COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT IN RE THE ESTATE OF CASE NUMBER DECEASED File Stamp Here RECEIPT OF DISTRIBUTION I, , acknowledge receipt of my share of this estate as follows: I appear, waive notice and consent to the approval of the Administrator Independent Representative current account final account of the Executor and consent to the allowances of fees to the representative and attorney as set forth in the account. Distributee Signature Address City, State, Zip Name: DuPage Attorney Number: Attorney for: Address: City/State/Zip: Telephone Number: Email: Judge CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60187-0707 Pro Se Date American LegalNet, Inc. www.FormsWorkFlow.com