Form Sc4421 - Declaration

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STATE OF SOUTH CAROLINA
SC4421
DEPARTMENT OF REVENUE
DECLARATION
(Rev. 4/7/03)
3102
Personal Representative Commissions
Estate of:
Date of Death:
(We)
declare that
(our) total commissions of $
to administer this estate has been agreed upon and
has been or will be paid as follows:
Name and Address
Social Security
Total Amount
Date Paid
of Payee
Number of Payee
Paid or to be Paid
or to be Paid
(Signature of Personal Representative)
(Date)
(Signature of Personal Representative)
(Date)

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