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This receipt, r~l~ase, and indemnity agreement (hereinafter called the "RELEASE") is
given this ,~4 day o ~i S~,l•~~ 2009, by:
', Center for Kidney Diease & Hypertension
(hereinafter a~lled the "CLAIMANT") to and in favor of KEYSTONE
GUARDIANSHIP S I~VICES, (ADMINISTRATOR) of the CYNTHIA N. STAGER
ESTATE (hereinafter Iled "ADMINISTRATOR").
For the purpos~ cif inducing the ADMINISTRATOR to make the distribution described
herein, and intending t ~e legally bound, the Claimant hereby represents, warrants, convenants
and agrees as follows: I '',
1. Acknowledgment o eceipt -The Claimant acknowledges that he will receive of and from
the Fiduciary the Mowing securities upon returning this Receipt & Release document
properly signed, wi ssed and notarized to the department.
- In the form of a check in the amount of $99.05
2. Release - AND T BEFORE, the Claimant hereby does by these presents remise, release,
quit-claim, and fore r discharge the said Administrator, their heirs, successors and assigns of
and from the said yments to me and of and from all actions, suits, payments, accounts,
reckonings, claims d demands whatsoever, for or by reason thereof, or of any other act,
matter, cause or thi whatsoever.
3. Indemnity Agreeme The Administrator has indicated a willingness to make a distribution
without the adjudic 'on by the Court. Accordingly, the Claimant agrees to indemnify the
Administrator and Id them harmless, to the extent of any funds or assets received by the
Claimant from the mmistrator hereunder, from and against the Claimant's pro rata share of
any and all liabili (including attorney's fees and other costs or expenses of defense) to
which the Adminis a'tor may be subjected by reason of its administration of the account. In
connection with thi agreement, the Claimant agrees to:
a) Refund or retu ,promptly upon the Administrator written demand, any funds or assets
distributed by t e Administrator to the Claimant, if the distribution thereof is determined
at any time to h e been an erroneous or negligent distribution to the Claimant, whether
such error or n igence was or was claimed to have been premised upon a mistake of
law or of fact. H
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b) Modify and dis ace any otherwise applicable period limiting the time within which the
Administrator lion to collect an erroneous or negligent distribution must be
commenced, s to provide that the Administrator need not commence an action to
collect an erro a us or negligent distribution to the Claimant until two (2) years after
such time as el, Administrator shall have obtained actual knowledge of such error or
negligence.
4. Miscellaneous - Tl~e construction, effect, validity and performance of this Release shall be
gov0rned in all res is by the laws of the Commonwealth of Pennsylvania.
The provisions of h~s Release shall be deemed severable in the event that one or more
thereof shall be d ~med invalid or unenforceable, with the effect that the remaining
provisions shall per ~ t as if such invalid or unenforceable provision had never been a part
hereof. I
This Release shall ~ and the Claimant his heirs, representatives, successors, and assigns
together with any ch~l ren with respect to whom the Claimant is a natural guardian.
IN WITNESS I~EOF, the Claimant has executed and sealed this Release on the date
first above inscribed and the presence of at least two (2) witnesses.
BY:
', Center for Kidney Diease & Hypertension
Authorized epresentative of Claimant
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