Fill and Sign the Mississippi Beneficiary Form

IN THE CHANCERY COURT OF _______________________ (Name) COUNTY, MISSISSIPPI IN THE MATTER OF THE ESTATE OF _________________________ Cause Number______________ (Name of Decedent) , DECEASED RECEIPT Comes now, ________________________ (Name of Beneficiary) , a beneficiary named in Item ____________ of the last will and testament of _________________________ (Name of Decedent) , deceased. The said _____________________ (Name of Beneficiary) , does hereby acknowledge receipt of the sum of $______________ from the Executor of the above captioned estate in full and complete satisfaction of the bequest specified in said Will. The undersigned further agrees, in consideration of the delivery of said sum, that if any claims, charges or expenses (including but not limited to taxes, court costs, attorneys’ fees and/or Executor’s compensation) became properly payable by the Executor out of the property hereby being delivered, the undersigned will, immediately upon demand of the Executor, pay over to the Executor or re-transfer and re-deliver to the Executor such part of sum as is necessary in order to satisfy such claims, charges or expenses. Witness my signature this _______________________ (date) . STATE OF MISSISSIPPI COUNTY OF _______________ Personally appeared before me, the undersigned authority in and for the said county and state, on this _____ day of ________________, 20____, within my jurisdiction, the within named, ________________________ (Name of Beneficiary) , who acknowledged that he executed the above and fore going instrument. __________________________ NOTARY PUBLIC My Commission expires: ______________________