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(Copy Receipt) (Clerk's Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In the Guardianship of: _______________________________________ CASE NO. _____________________ CREDITOR'S RECEIPT (RCP) I acknowledge receipt of the amount of $_______________ from the Guardianship Estate. This amount is accepted in full payment and satisfaction of a claim that the Guardian or Court has previously approved, and which was submitted on behalf of ____________________. SIGNED AT ______________, WASHINGTON THIS ____ DAY OF______________, 20___ Authorized Signature Company Printed Name of Person Signing Address Telephone/Fax Number CREDITOR'S RECEIPT - PAGE 1 OF 1 SPO GDN 02.0360 (03/2007) City, State, Zip Code Email Address American LegalNet, Inc. www.FormsWorkFlow.com