File No.
STATE OF NORTH CAROLINA
                                                                         In The General Court Of Justice 
                                                                                 Superior Court Division
                                         County                                  Before the Clerk

     IN THE MATTER OF THE ESTATE OF:
Name Of Decedent/Trust
                                                                         RECEIPT
Name Of Personal Representative/Trustee                                 PARTIAL  FINAL

                                                          ACKNOWLEDGMENT
I, the undersigned beneficiary, agree that I did receive from the Personal Representative/Trustee of the estate/trust a 
distribution consisting of the following:

                                        DESCRIPTION                              VALUE
                                                                        $

Date                  Name Of Beneficiary (Type Or Print) Signature 

                      Name Of Witness (Type Or Print)     Signature 

AOC-E-521, New 2/01
2001 Administrative Office of the Courts