_____________________________
COUNTY SURROGATE COURT

IN THE MATTER OF THE ESTATE OF

____________________________, DECEASED

KNOW ALL MEN BY THESE PRESENTS, THAT I,


of the Township of             County of                 State of 
hereinafter known as the Obligor, am held and firmly bound unto 


                                                                        hereinafter known as the Obligee, 
in the sum                                                             lawful money of the United
States of America, to be paid to the Obligee or to Obligee’s Attorney, Obligee’s successors in office or assigns; for which payment well and truly to be made I bind myself, my heirs, executors and administrators firmly by these presents. 
     THE CONDITION OF THE ABOVE OBLIGATION is such, that whereas, the Obligor has received from the Obligee




    AND IN CONSIDERATION THEREFOR, the Obligor has released and forever discharged, and by these presents, does release and forever discharge the Obligee from all claims and demands whatsoever on account of or in respect to the estate of the said deceased, and of Obligor’s interest therein;

If the Obligor is a legatee and any part of the whole of such legacy shall at any time hereafter appear to be wanting to discharge any debt or debts, legacy or legacies, which the said executor or administrator may not have other assets to pay, the Obligor will return said legacy or such part thereof as may be necessary for the payment of the said debts, or for the payment of a proportional part of the said legacies; or

If the Obligor is a distributee and any debt or debts, truly owing by the intestate, shall be afterwards sued for and recovered or otherwise duly made to appear, and which there shall be no other assets to pay, Obligor shall refund and pay back to the administrator his ratable part of such debt or debts, out of the part and share so allotted to him;

Then the above obligation to be void, or else to be and remain in full force and virtue.

If more than one person executes the within instruments, then words used in the singular shall be considered to include the plural, and wherever herein any particular gender is used it shall be inclusive of the masculine, feminine and neuter gender, where the text so requires.

SIGNED, SEALED AND DELIVERED 
IN THE PRESENCE OF



__________________________                                 ________________________
                Witness                                                             Beneficiary

before me, the subscriber, a                     of the State of                                 personally appeared                                             who, I am satisfied, is the person
in the foregoing instrument named, and thereupon acknowledged that he/she signed, sealed and delivered the same as his/her act and deed, for the uses and purposes therein expressed.

                                                 ________________________________________ 

                                                                    Notary Public (seal)