STATE OF SOUTH CAROLINA COUNTY OF: ____________________________ IN THE MATTER OF: ________________________________________ (Decedent) ) ) ) ) ) ) ) IN THE PROBATE COURT RELEASE/SATISFACTION OF CLAIM CASE NUMBER: ____________________________________ Creditor: Original Creditor: Account Number: Other Reference Number: Original Claim Amount: The undersigned hereby states the claim has been resolved as follows: Claim was satisfied in full Claim was compromised to our satisfaction Claim is withdrawn Claim is released Other ______________________________________ Executed this ______ day of _____________________, 20_______. Creditor: ______________________________________ Signature of Authorized Agent: ___________________________________________ Print Agent Name: ______________________________________ *Witness Signature: Print Name: *The Personal Representative is not allowed to serve as the witness. FORM #325ES (04/2017) 62-3-805, 62-3-813 American LegalNet, Inc. www.FormsWorkFlow.com