HomeMy WebLinkAbout05-19-10 (20)(~~- ~S'
This receipt, re
given this s~ day of
and indemnity agreement (hereinafter called the "RELEASE") is
f 2009, by:
Spirit Physician Services
(hereinafter
GUARDIANSHIP S]
ESTATE (hereinafter
For the purpc
herein, and intending
and agrees as follows:
the "CLAIMANT") to and in favor of KEYSTONE
ES, (ADMINISTRATOR) of the CYNTHIA N. STAGER
'°AIMINSTRATOR").
of inducing the ADMINISTRATOR to make the distribution described
be legally bound, the Claimant hereby represents, warrants, convenants
1. Acknowledgment o Receipt -The Claimant acknowledges that he will receive of and from
the Fiduciary the ollowing securities upon returning this Receipt & Release document
properly signed, wi essed and notarized to the department.
- In the form of a check in the amount of $247.66
2. Release - AND T EREFORE, the Claimant hereby does by these presents remise, release,
quit-claim, and fore er discharge the said Administrator, their heirs, successors and assigns of
and from the said ayments to me and of and from all actions, suits, payments, accounts,
reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act,
matter, cause or th' 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 retu
distributed by
at any time to
such error or i
law or of fact.
it -The Administrator has indicated a willingness to make a distribution
tion by the Court. Accordingly, the Claimant agrees to indemnify the
old them harmless, to the extent of any funds or assets received by the
dministrator hereunder, fram and against the Claimant's gro :rata share of
(including attorney's fees and other costs or expenses of defense) to
ator may be subjected by reason of its administration of the account. In
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 Claimant, whether
igence was or was claimed to have been premised upon a mistake of
Page 1 of 2 Pages
o
_
~ a ~;~~
:u -.c
c.~: f-3`a
-.. z
ii
` ~
~ --i ~ _
~
a _
r
~
~ V
i
b) Modify and dis lace any otherwise applicable period limiting the time within which the
Administrator ction to collect an erroneous or negligent distribution must be
commenced, so as to provide that the Administrator need not commence an action to
collect an erro eous 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.
4. Miscellaneous -The construction, effect, validity and performance of this Release shall be
governed in all respects by the laws of the Commonwealth of Pennsylvania.
The provisions of his Release shall be deemed severable in the event that one or more
thereof shall be d erred invalid or unenforceable, with the effect that the remaining
provisions shall pe ist as if such invalid or unenforceable provision had never been a part
hereof.
This Release shall bind the Claimant his heirs, representatives, successors, and assigns
together with any c ildren with respect to whom the Claimant is a natural guardian.
IN WITNESS WI~REOF, the Claimant has executed and sealed this Release on the date
first above inscribe and the presence of at least two (2) witnesses.
BY:
Spirit Physician Services
Authorized Representative of Claimant
2 of 2 Pages