RECEIPT FOR FUNDS FROM TRUSTEE

I, ______________________, Distributee of the ____________________________Trust,

acknowledge receipt of payment in the sum of $______________________to which I am entitled,
from the ____________________________________Trust, which has been in the hands of
____________________________________, the TRUSTEE.
DATED this _________day of _________________, 2011.

______________________________
Your name

STATE OF _____________ §
§
COUNTY OF ___________ §

This instrument was acknowledged before me on the ______th day of ________, 2011, by
the said _______________________ to certify which, witness my hand and seal of office.

______________________________
Notary Public, State of ___________