Fill and Sign the Above This Line Reserved for Official Use Only Certificate of Trust Form

IN THE _____________ (Name of Court) OF ______________ (County) OF _____________ (State) IN THE MATTER OF THE ESTATE OF ____________________ (Name of Decedent), Cause NO. _____________ DECEASED Release and Waiver I, __________________ (Name of Beneficiary), acknowledge that _____________________ (Name of Executor) as the Executor of the Estate of _____________________ (Name of Decedent), Decedent, late of ________________ _____________________________________ (street address, city, state, zip code), has fully and satisfactorily accounted to me as beneficiary under the Last Will and Testament of ____________________ (Name of Decedent), for all moneys and property held by said Executor. Now, therefore, in consideration of the sum of $__________ (dollar amount) paid to me, the receipt of which is acknowledged, I release, exonerate, and discharge ___________________ (Name of Executor), as Executor and his/her sureties from any and all liability and accountability to me, and I consent that Executor may have a decree entered discharging him from any and all claims, demands, liability, and accountability to me without further accounting. I waive the issue and service on me of a citation to attend the judicial settlement of the accounts of Executor or any other proceedings taken by him/her in ______________ (Name of Court) of ___________________ (Name of County), pertaining or relating to the Estate of Decedent. Witness my signature this the _______ day of ________________, 20_____. ______________________________(Printed Name of Beneficiary)______________________________(Signature of Beneficiary) STATE OF ______________________ CITY OF ______________________ Personally appeared before me, the undersigned authority-at-law in and for the jurisdiction aforesaid, the within-named _________________ (Name of Beneficiary), who, being by me first duly sworn, stated under oath that he/she signed, executed, and delivered the above and foregoing instrument on the day and year therein stated for the
(year) of (date, time, and place of signing) the purpose of receiving payment of the said sum of (dollar amount) which i hereby give and receive payment in full or partial and in such manner and form as may be prescribed by law. (signatures of a witness and of both the signatures, if any.) [signatures of witness.](j) deeds (seal) . By the order of (name of court) as trustee of (name of decedent's estate) to (name of beneficiary), the following documents