DEBTOR'S RECEIPT FOR FUNDS DEPOSITED BY DEBTOR CAUSE NO.___________ FOR THE USE AND BENEFIT OF: _______________________________ } { IN THE COUNTY COURT AT LAW } } { { NUMBER _______OF FORT BEND COUNTY, TEXAS GREETINGS: I, Laura Richard, County Clerk of Fort Bend County, Texas in accordance with Section 1355.001 Texas Estates Code received $__________ from _____________________________________________, whose address is ____________________________________________, and who is hereinafter referred to as DEBTOR. The funds are being deposited in the Trust Fund for the use and benefit of the named CREDITOR and as being deposited by said DEBTOR, in accordance with said Section 1355.001 Texas Estates Code. Dated: ________________________, __________. LAURA RICHARD, COUNTY CLERK FORT BEND COUNTY, TEXAS By______________________________ Deputy American LegalNet, Inc. www.FormsWorkFlow.com