STATE OF SOUTH CAROLINA COUNTY OF: IN THE MATTER OF: Personal Representative(s):
) ) ) ) ) )
IN THE PROBATE COURT PROPOSAL FOR DISTRIBUTION CASE NUMBER:
Name and Address of Distributee
Amount or Item
Executed this Signature: Name: Address: Telephone (O): (H):
day of Signature: Name: Address: Telephone (O): (H):
, 20
.
FORM #410PC (1/91) 62-3-1001, 62-3-1002, 62-3-1003