STATE OF NEW YORKSURROGATE222S COURT : COUNTY OF BROOMEProceeding for ADMISSION ESTATE OF OF SERVICE DeceasedThe undersigned hereby admits due, personal and timely service of the process issued in theabove entitled proceeding and acknowledges the receipt of a copy of the following:(delete lines not applicable)PROBATE: A copy of the will being offered for probateACCOUNTING: A copy of the summary statement of the accountOTHER PROCEEDINGS: (Specify documents if any) STATE OF NEW YORKCOUNTY OF BROOME ss:On , before me personally cameto me personally known to be the same person described in and who executed the foregoinginstrument and to me such person duly acknowledged that he or she executed the same. (Notary Public) American LegalNet, Inc. www.FormsWorkFlow.com