Receipt On Distribution {CCP 0379}

RECEIPT ON DISTRIBUTION þ I, , acknowledge receipt of my share of the estate as follows: [printed name of the distributee] I appear, waive notice and consent to the approval of the ACCOUNT of (CURRENT) (FINAL) [printed name of the representative]as and consent to the fees of the representative in the amount of $ and the fees of the attorneys in theamount of $ as set forth in the ACCOUNT.Dated: þ , 20 [signature of the distributee]*Strike if this RECEIPT is not for a share of the residue. Attorney Number Name þ Firm Name þ Attorneys for þ Address þ City/State/Zip þ Telephone þ Email þ Dorothy Brown, Clerk of the Circuit Court of Cook CountyPage 1 of 1CCP-0379 (Rev. 10/1/2018) Case No. Calendar Estate of DeceasedIN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT 226 PROBATE DIVISION*2621