FORM #559GC (01/2019) 62-5-416, 62-5-422(12), 62-5-423(B), 62-5-426 STATE OF SOUTH CAROLINA ) ) COUNTY OF ) ) ) IN THE MATTER OF: ) PROBATE COURT USE ONLY , ) ) IN THE PROBATE COURT a protected person. ) ) CASE NUMBER - GC - - ) ) RELEASE/SATISFACTION OF CLAIM 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 c ompromised and any deficiency waived. Claim is withdrawn . Claim is released . Other . Executed this day of , 20. Creditor: Signature of Authorized Agent: Print Agent Name and Title: *Witness Signature: Print Name: *The Conservator shall not serve as the witness. American LegalNet, Inc. www.FormsWorkFlow.com