FormP_153
STATEOFVERMONT
SUPERIORCOURT
Unit
DocketNo._____________________
I
nre
RECEIPT
IcertifythatIhavereceived
from
NameofFiduciary
,whois
theFiduci ryforthisproceeding,thefollowingpropertyand/orcash:a
Iacc :(checkappropriatebox)eptthisdistributionofcashand/orpropertyin
Fullsatisfactionofmyinterestintheestate.
Partialsatisfactionofmyinterestintheestate.
Fullsatisfactionforallassetsheldformeduringmyguardianship.
D
ate
Signature

PrintedName
Address
Address
TelephoneNumber
SML 11/12