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2648 Receipt of Distributee to Attorney-In-Fact or Consul IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT - PROBATE DIVISION Estate of

(Rev. 9/24/01) CCP 0388

_____________________________________________________ Deceased

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No. __________________________________ Docket _______________________________ Page ________________________________

RECEIPT OF DISTRIBUTEE TO ATTORNEY-IN-FACT OR CONSUL
I, ____________________________________________________________________, acknowledge receipt of my distribute share of this estate as follows:

Cash Deductions authorized by me: ____________________________________________ ____________________________________________ ____________________________________________ $ _____________________ _____________________ _____________________ Total deductions Amount paid to me Property distributed to me in kind:

$______________________

$______________________ $______________________

_______________________________________, 20_______

* _______________________________________________ Distributee Signature ________________________________________________ Distributee Name (Print or Type) Address ________________________________________ City/State/Province _______________________________ Country ________________________________________

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS