Fill and Sign the Payment Release Form

Receipt for Payment of Trust Fund and Release I, ________________________________________________________ (Name of Beneficiary) , do hereby acknowledge receipt of the sum of $___________________from __________________________________________________ (Name of Trustee) , under the [e.g., Declaration of Trust of (name of Trustor) dated (date) for the benefit of (Name of Beneficiary) ]_________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ __ . I do further acknowledge that receipt of said funds constitutes full and complete payment and settlement of my share of the said Trust, and I do hereby release the said Trustee from all liability under said Trust. Witness my signature on this __________________________________________ (date). __________________________________________ __________________________________________ (Printed Name and Signature of Beneficiary) STATE OF ________________________________________________ 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: ______________________ (Form of acknowledgement may vary by state)