PR-1815, 03/12 Estate Receipt (Informal Administration or Formal Administration) 247247863.41, 865.21, and 867.21, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF THE ESTATE OF Name Amended Estate Receipt Informal Administration Formal Administration Case No. 1. I received from the personal representative special administrator of this estate the following: Describe items of property or mon ies received 2. This is a partial full distribution of my share of the estate. 3. This is a full satisfaction of the claim filed by in the amount of $ . 4. This is a distribution of funds to trust. [Identify Trust] . 5. Other: . Signature Name Printed or Typed Address Date Form completed by: (Name) Address Telephone Number Bar Number (If any) American LegalNet, Inc. www.FormsWorkFlow.com