STATE OF SOUTH CAROLINA	)	IN THE PROBATE COURT
)
COUNTY OF GREENVILLE	)	CONSERVATOR
)	RECEIPT AND RELEASE WITH WAIVER
IN THE MATTER OF:	)	FOR ASSETS RECEIVED FROM AN ESTATE
)
(Decedent)	)	CASE NUMBER: _______________________

The undersigned hereby acknowledges receipt from the Personal Representative in this matter of the following property:

Option One:

I am the appointed Conservator for _____________________________ (name of protected person), under File No. ____________________________ - copy of certificate of appointment is attached.

All assets to which the Conservatorship is entitled have been received and deposited into the Conservatorship account – copy of deposit slip is attached.

OR

Option Two:

I am the appointed Conservator for _______________________________ (name of protected person), under File No. ______________________ - copy of certificate of appointment is attached.

All assets to which the Conservatorship is entitled will be handled by Broker: ____________________

________________________ - copy of restricted account agreement is attached.

All assets to which the Conservatorship is entitled are deposited with said agency – copy of deposit slip (or agency confirmation) is attached.

In consideration of the above listed distribution, the undersigned hereby releases and forever discharges the Personal Representative and the Estate from any and all rights and claims, which the undersigned may have against the Personal Representative and the Estate, and waives right to demand a hearing on all Accountings (if applicable), Proposals for Distribution (if applicable), and the Application for Settlement.

Executed this _____ day of __________________________, 20_____.

Signature:
Print Name:

*Witness Signature:
Print Name:

*The Personal Representative is not allowed to serve as the witness. The witness must be a disinterested party--not related to decedent, beneficiary or personal representative.