Release and Waiver of Claims Against Executor

Release and Waiver

IN THE OF

OF

IN THE MATTER OF THE ESTATE OF

DECEASED ,

Cause NO.

Release and Waiver

I, , acknowledge that

as the Executor of the Estate of

, Decedent, late of

,

has fully and satisfactorily accounted to me as beneficiary under the Last Will and

Testament of , for all moneys and

property held by said Executor.

Now, therefore, in consideration of the sum of $

paid to me, the receipt of which is acknowledged, I release, exonerate, and discharge

, 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

of

,

pertaining or relating to the Estate of Decedent.

Witness my signature this the day of 20

STATE OF

CITY OF

Personally appeared before me, the undersigned authority-at-law in and for the

jurisdiction aforesaid, the within-named

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

purposes therein mentioned as his/her own act and deed and that the things contained

therein are true and correct as stated therein.

SWORN to and subscribed before me, this the day of 20

NOTARY PUBLIC

My Commission Expires: