HomeMy WebLinkAbout05-19-10 (7)~3~
This receipt, r l ashy and indemnity agreement (hereinafter called the "RELEASE") is
given this `~ day o ,...3 r 2009, by:
Healthsouth of Mechanicsburg
(hereinafter
GUARDIANSHIP Sl
ESTATE (hereinafter
For the purpos
herein, and intending t~
and agrees as follows:
led the "CLAIMANT") to and in favor of KEYSTONE
VICES, (ADMINISTRATOR) of the CYNTHIA N. STAGER
Iled "ADMINISTRATOR").
f inducing the ADMINISTRATOR to make the distribution described
e legally bound, the Claimant hereby represents, warrants, convenants
1. Acknowledgment o eceipt -The Claimant acknowledges that he will receive of and from
the Fiduciary the llowing 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 $859.3
2. Release - AND T BEFORE, the Claimant hereby does by these presents remise, release,
quit-claim, and fore r dischazge the said Administrator, their heirs, successors and assigns of
and from the said ents 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 g 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 ret~
distributed by
at any time to
such error or.
law 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 shaze 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
Page 1 of 2 Pages
rw
CJ{~
Cam{) o
~7 Z
r~~~ a.
.c? ~ ~ \D
C~C~J~n ~`
~~ ~ ~
~~ t0
CJt
W
~7
~:, .. ~
~~-,
s; : ~-~
~~~,
r;
~... c >
r z~
:~ Cr-rat
~.,r~ ~)
,i
,I
~~
b) Modify and di p ace any otherwise applicable period limiting the time within which the
Administrator tion 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 ous or negligent distribution to the Claimant until two (2) years after
such time as Administrator shall have obtained actual knowledge of such error or
negligence. i
4. Miscellaneous - ~~ 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 Itl~is Release shall be deemed severable in the event that one or more
thereof shall be e~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. i
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 d the presence of at least two (2) witnesses.
BY:
Healthsouth of Mechanicsburg
Authorized Representative of Claimant
SES:
(WITNESS dNlr) ~ ~ ~ _ - - ~.
Page 2 of 2 Pages