HomeMy WebLinkAbout05-19-10 (5)~a ~J~~..
This receipt, re
given this ~$_ day of
and indemnity agreement (hereinafter called the "RELEASE") is
a-~1~ o ~ 2009, by:
Guistwhite Family Practice
(hereinafter
GUARDIANSHIP Sl
ESTATE (hereinafter
For the purpo
herein, and intending
and agrees as follows:
1. Acknowledgment
the Fiduciary the
properly signed, w
the "CLAIMANT") to and in favor of KEYSTONE
ES, (ADMINISTRATOR) of the CYNTHIA N. STAGER
"ADMINISTRATOR").
inducing the ADMINISTRATOR to make the distribution described
legally bound, the Claimant hereby represents, warrants, convenants
pt -The Claimant acknowledges that he will receive of and from
~g securities upon returning this Receipt 8c Release document
and notarized to the department.
In the form of a check in the amount of $252.46
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 Agreerr
without the adjudi
Administrator and
Claimant from the
any and all liabili
which the Admini
connection with th
a) Refund or reti
distribwted by
at any. time to
such error or
Iaw or of fact.
- The Administrator has indicated a willingness to make a distribution
on by the Court. Accordingly, the Claimant agrees to indemnify the
d them harmless, to the extent of any funds or assets received by the
ninistrator hereunder, from and against the Claimant's pro rata share of
including attorney's fees and other costs or expenses of defense) to
or may be subjected by reason of its administration of the account. In
greement, the Claimant agrees to:
promptly upon the Administrator written demand, any funds or assets
Administrator to the Claimant, if the distribution thereof is determined
e been an erroneous or negligent distribution to the Claimant, whether
igence was or was claimed to have been premised upon a mistake of
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b) Modify and dis 1' ce any otherwise applicable period limiting the time within which the
Administrator tion to collect an enoneous or negligent distribution must be
commenced, so s to provide that the Administrator need not commence an action to
collect an erro us or negligent distribution to the Claimant until two (2) years after
such time as th Administrator shall have obtained actual knowledge of such error or
negligence.
Miscellaneous - The'construction, effect, validity and performance of this Release shall be
governed in all res c~ts by the laws of the Commonwealth of Pennsylvania.
The provisions of 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 pe ~st as if such invalid or unenforceable provision had never been a part
hereof.
This Release shall ind the Claimant his heirs, representatives, successors, and assigns
together with any c i dren with respect to whom the Claimant is a natural guardian.
IN WITNESS OF, the Claimant has executed and sealed this Release on the date
first above inscribe nd the presence of at least two (2) witnesses.
BY:
Guistwhite Family Practice
Authorized Representative of Claimant
WITNESSES:
~ ~~
(WITNESS ONE)
(WITNESS TWO)
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