HomeMy WebLinkAbout11-03-06 (3)
ESTATE OF
DOROTHY A. WERTZ,
Deceased
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
) ORPHANS' COURT DIVISION
)
) NO. 21-06-0290
INRE:
RECEIPT AND RELEASE
I, JOHN T. WERTZ, the undersigned, being a beneficiary under the Estate of Dorothy
A. Wertz, deceased, do hereby:
1. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received all sums and property to which I am entitled as a
beneficiary of the Estate of Dorothy A. Wertz;
4. To the extent of said distribution, release John T. Wertz, Executor, ofthe Estate of
Dorothy A. Wertz, and his heirs and personal representatives, from all liabilities, whether due to
his negligence or otherwise, which he may have by reason of his administration of the Estate;
5. Agree to refund to the Estate and to the said John T. Wertz, Executor, any portion of
the distribution to which I am not properly entitled, and, to the extent of said distribution, to
indemnify him and the Estate for claims made against him and to reimburse him and the Estate
all expenses and costs incurred in connection with any such claim; and
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6. Declare that this instrument shall be legally binding upon me~ ip.Jl1f?~~,~,~iij~'8C/,J
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representatives, and assigns.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this 217 day of
OC.-C
,2006.
JOI~4~-
(SEAL)
COMMONWEtL TH OF PE.NN..S..YL..V A.. NI~ )
L' \y~ I \ (; ",I /1, j ( SS:
COUNTY OF L IWul VLLt"-- )
On this, the c::;, 0+ttctay of,thi'fr , 2006, before me, the
undersigned officer, personally appeared JOHN T. WERTZ, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument and acknowledged
that he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
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NOT '~ SStJ.
WENOY S. CHESBRO, ~ Pltfk
lower Ahn Twp., C~ ~
My CommIaeion ~ May 10, 2001