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HomeMy WebLinkAbout05-19-10 (6)©$- ~ This receipt, rel given this~_ day of (hereinafter c GUARDIANSHIP SE ESTATE (hereinafter i e se, and indemnity agreement (hereinafter called the "RELEASE") is 2009, by: III Health Network t led the "CLAIMANT") to and in favor of KEYSTONE CES, (ADMINISTRATOR) of the CYNTHIA N. STAGER Iled `ADMINISTRATOR"). For the purpose f inducing the ADMINISTRATOR to make the distribution described herein, and intending to legally bound, the Claimant hereby represents, warrants, convenants and agrees as follows: 1. Acknowledgment o~eceipt -The Claimant acknowledges that he will receive of and from the Fiduciary the lowing 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 $20.3 2. Release - AND T FORE, the Claimant hereby does by these presents remise, release, quit-claim, and fore discharge the said Administrator, their heirs, successors and assigns of and from the said a ments 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 thin whatsoever. 3. Indemnity Agreeme t -The Administrator has indicated a willingness to make a,distribution without the adjudic t on by the Court. Accordingly, the Claimant agrees to indemnify the Administrator and d them harmless, to the extent of any funds or assets received by the Claimant from the d inistrator hereunder, from and against the Claimant's pro rata share of any and all liability including attorney's fees and other costs or expenses of defense) to i which the Administ a or may be subjected by reason of its administration of the account. In connection with this greement, the Claimant agrees to: a) Refund or retu ,promptly upon the Administrator written demand, any funds or assets I distributed by 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 ne igence was or was claimed to have been premised upon a mistake of law or of fact. ~ No I ~ b Page 1 oft Pages W~ ~ i ~ II ~?`-~ ~ ~ ' ~ ~D -- ='rt a~ ~~ ~ ,~~ W U b) Modify and dis 1 ce any otherwise applicable period limiting the time within which the Administrator tion to collect an en•oneous or negligent distribution must be commenced, so 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) yeazs after such time as t Administrator shall have obtained actual knowledge of such error or negligence. 4. Miscellaneous - Tt~e~construction, effect, validity and performance of this Release shall be governed in all res is by the laws of the Commonwealth of Pennsylvania. The provisions of is Release shall be deemed severable in the event that one or more thereof .$hall 1z~_ d med. invalid or unenforceable, with the effect that the remaining provisions shall pe s 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: Health Network Autho ' epresentative of Claimant WITNESSES: Page 2 of 2 Pages T FCC (1NF.1 '.