Receipt And Release {JA-2}

SURROGATES COURT OF THE STATE OF NEW YORK COUNTY OF x ACCOUNTING BY as the RECEIPT AND RELEASE of the ESTATE OF a/k/a File No. Deceased. x The undersigned, being of full age, sound mind and under no disability, and entitled to share in the estate of the above named decedent as a [check one] [ ] legatee under a will, I] distributee of an intestate share, [ ] trust beneficiary, [ I creditor of the estat e, [ ] other [specify] (a) Acknowledges that each fiduciary named above has fully and satisfa ctorily accounted for all assets of the estate; (b) Approves the written account verified on 20, as, submitted to the undersigned; [Delete paragraphs (a) and (b) if the undersigned is not interested in or affected by the amount of the residuary estate or trust, or if payment is being made pursuant to a decree of the court.] (c) Acknowledges receipt of money paid or property transferred or deli vered as follows: money (cash or check) $ the following property: valued at $ The foregoing payment and/or transfer is in full payment or distribution of: [ ] a legacy under Paragraph/Article of the will or trust; [ ] a claim against the estate; [ ] the amount directed to be paid by a decree of this court dated: [ ] other [specify] (d) Releases and discharges each fiduciary named above from all liability to the undersigned for any and all matters relating to or derived from the administration o f the estate; waives the issuance and service of a citation to attend any and all proc eedings for the ]udicial settlement of the account; and authorizes the Surrogate to make and ent er a decree settling the account and fully releasing and discharging each fid uciary named above as to all matters embraced therein. Dated: (Signature) (Corporate Name) (Print Name) (Signature of Officer) jA-2 (12/96) -1- <<<<<<<<<********>>>>>>>>>>>>> 2STATE OF NEW YORK ) COUNTY OF ) ss. On 20, . before me personally appeared [INDIVIDUAL] [ to me known and known to me to be the person described in and who executed the foregoing receipt and release and duly acknowledged the execution thereof. [CORPORATION] ] [ to me known, who duly swore to the foregoing instrument and who did say that he/she resides at and that he/she is a of thecorporation/national banking association described in and which executed such instrument; and that he/she signed his/her name thereto by order of the Board of Directo rs of the corporation. Notary Public Commission Expires: (Affix Notary Stamp of Seal) Name of Attorney: Tel. No. Address of Attorney: -2-