Free $$WRK1$$ - Illinois

2753 Report of Attorney-In-Fact or Consul IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION

(Rev. 7/5/00) CCP 0387

Estate of

____________________________________________
Deceased

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No. _______________________________________ Docket ___________________________________ Page ___________________________________

REPORT OF ATTORNEY-IN-FACT OR CONSUL

____________________________________________________________________ on oath states:
1. An order was entered on ____________________________, _________, directing the representative of the estate to pay to me as __________________________________________________________________
(Attorney-in-fact) or (official position and country) (Name of distributee)

the distributive share of ______________________________________________________________________. 2. On ______________________________________, ________, the share was paid to me. 3. I paid the distributee the total amount received by me after deducting the expenditures listed below. 4. Received by me: Property: Cash Deductions authorized by distributee $ ____________________ $ ____________________ $ ____________________ Net Cash Paid and distributed to distributee: Cash Property: 5. The receipt of the distributee is attached. $ ______________________ $ __________________ $ ______________________

_________________________________________
(Attorney-in-fact) (Consul) Atty. No.:__________________ Name: _____________________________________________ Signed and sworn to before me Atty. for Petitioner: __________________________________ _______________________________________, ________ Address: ___________________________________________ City/State/Zip: ______________________________________ Telephone: _________________________________________ DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS