HomeMy WebLinkAbout05-19-10 (8)..
o~- ~s--
This receipt, re ase, and indemnity agreement (hereinafter called the "RELEASE") is
given this ~_ day of (2009, by:
Holy Spirit Hospital
(hereinafter 'lied the "CLAIMANT") to and in favor of KEYSTONE
GOARDIANSHIP S VICES, (ADMINISTRATOR) of the CYNTHIA N. STAGER
ESTATE (hereinafter Iled "ADMINISTRATOR").
For the purpos f 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 . Acknowledgment Receipt -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 $5736.15
2. Release - AND T BEFORE, the Claimant hereby does by these presents remise, release,
quit-claim, and for v 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 Agreem
without the adjudi
Administrator and
Claimant from the
any and all liabili
which the Admini
connection with th
a) Refund. or rett
distributed by
at any time to
such error or
law or of fact.
t -The Administrator has indicated a willingness to make a distribution
ion by the Court. Accordingly, the Claimant agrees to indemnify the
dd them harmless, to the extent of any funds or assets received by the
lministrator hereunder, from and against the Claimant's pro rata share of
(including attorney's fees and other costs or expenses of defense) to
~tor may be subjected by reason of its administration of the account. 1n
agreement, 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 Claim~t whether
igence was or was claimed to have been premised upon take o~
('T'1
C ~ ~
Page 1 of 2 Pages c ~ c~ `-~, a
n~ ~
.p ---a ~D
' _ ~' CJ1
S f ~I
r~ ~
~ r .~
t:, ~ _f
rt-? ~.~~~~ Ali
,I7 t;,
C:. c')
-~ f ri ~I
•~C;y
i
i
b) Modify and dis ace any otherwise applicable period limiting the time within which the
Administrator a 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.
Miscellaneous - TIheJ construction, effect, validity and performance of this Release shall be
governed in all respe~ts by the laws of the Commonwealth of Pennsylvania.
4.
The provisions of
thereof shall be
provisions shall pe
hereof.
This Release sh:
together with any
IN WITNESS
first above ins.
Release shall be deemed severable in the event that one or more
ed invalid or unenforceable, with the effect that the remaining
as if such invalid or unenforceable provision had never been a part
the Claimant his heirs, representatives, successors, and assigns
with respect to whom the Claimant is a natural guardian.
)F, the Claimant has executed and sealed this Release on the date
the presence of at least two (2) witnesses.
BY:
Holy Spirit Hospital
~•
A rued Represents ' f Claimant
Page 2 of 2 Pages