HomeMy WebLinkAbout04-07-09 (2)IN THE COURT OF COIM~MON PLEAS OF CUAf1BERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF
MADELINE S. GOTTSHALL, Deceased I No. 21-08-00589
RECEIPT AND RELEASE
KNOW ALL MEN BY THESE PRESENTS, that the COMMONWEALTH OF
PENNSYLVANIA through its DEPARTMENT OF PUBLIC WELFARE, hereby acknowledges
receipt from Linda G. Mulder, Administratrix c.t.a. of the Estate of MADELINE S. GOTTSHALL;
the sum of FORTY-FOUR THOUSAND NINE HUNDRED TWENTY-FIVE AND 25/100
($44,925.25) DOLLARS in full satisfaction of all claims that the Department of Public Welfare
and the Commonwealth of Pennsylvanla have or may have against the above-captioned estate
pursuant to 62 Pa,C.S.A. Section 1412 with respect to assets received by the Estate during the
period as to which the attached accounts are stated,
The undersigned hereby fully releases and discharges the Estate of Madeline S. Gottshall,
deceased (the Estate) and the said Linda G. Mulder (the Administratrix) from any and all
claims that the Pennsylvania Department of Public Welfare (the "Department") and the
Commonwealth of Pennsylvania may have against the Estate, or against the Administratrix with
respect to assets received by the Estate during the period as to which the attached account is
stated.
This Receipt and Release constitutes a release of the Pennsylvania Department of Public
Welfare only to the extent of those assets of the decedent as set forth in the accounting
attached hereto, and shall not constitute a release of any claim of said Department in and to
any other assets presently in the hands of the Administratrix, in the hands of any other person,
or which may be hereafter discovered.
This instrument is executed in connection with an informal account presented to the
undersigned by the Administratrix for the periods beginning February 15, 2008 and ending
October 15, 2008.
IN WITNESS WHEREOF, and intending to be le ally bound here y, the undersigned has
caused this instrument to be executed this ay of ~ u~~-,,,_ , 2009.
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Commonwealth of Pennsylvania
Department of Public Welfare
BY
Print Name ~ S,~O~'~~G°%7
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