Fill and Sign the Receipt Form

IN THE ___________COURT OF _____________ (County), ___________ (State) IN THE MATTER OF THE WILL AND ESTATE OF __________________ (Name of Decedent), NO. _______, ________ DECEASED RECEIPT Comes now, _______________________ (Name of Beneficiary), a residuary beneficiary named in Article III of the last will and testament of _____________________ (Name of Decedent) , and deceased. The said _________________ (Name of Beneficiary) does hereby acknowledge receipt of the sum of $____________ from the Executor of the above captioned estate in partial satisfaction of the residual 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 Executor’s compensation) became properly payable by the Executor out of the property hereby delivered, the undersigned will, immediately upon demand, pay over the amount thereof to the Executor or re-transfer and re-deliver to the Executor in order to satisfy such claims, charges or expenses, such part of the assets delivered herewith as said Executor may demand. This the _____ day of ______________, 20_____ (Printed Name of Beneficiary) (Signature of Beneficiary) SWORN to and subscribed before me, this the _____ day of ______________, 20_____. _____________________________ Notary Public My Commission Expires: ___________________