IN THE CIRCUIT COURT OF THE TWELFTH JUDICIAL CIRCUIT WILL COUNTY ­ IN PROBATE Estate of CASE NO: RECEIPT ON DISTRIBUTION I, (Name) , acknowledge receipt of 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 $ as set forth in the accounting. Distributee Address and the fees of the attorney in the amount of $ Atty. Name ARDC # Firm Name Attorney for Address City & Zip Telephone ANDREA LYNN CHASTEEN, CLERK OF THE CIRCUIT COURT Form 30 F American LegalNet, Inc. www.FormsWorkFlow.com (Revised 12-16)