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This receipt, re a e, and indemnity agreement (hereinafter called the "RELEASE") is
given this~_ day of ~+.b'C-~ 2009, by:
West Shore Pathology
(hereinafter qaped the "CLAIMANT") to and in favor of KEYSTONE
GUARDIANSHIP SI'~RVICES, (ADMINISTRATOR) of the CYNTHIA N. STAGER
ESTATE (hereinafter aped "ADMINISTRATOR").
For the purpos of inducing the ADMINISTRATOR to make the distribution described
herein, and intending t be legally bound, the Claimant hereby represents, warrants, convenants
and agrees as follows:
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 $55.36
2. Release -AND BEFORE, 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 thi g whatsoever.
3. Indemnity Agreem nt -The Administrator has indicated a willingness to make a distribution
without the adjudi ation by the Court. Accordingly, the Claimant agrees to indemnify the
Administrator and old them harmless, to the extent of any funds or assets received by the
Claimant from the dministrator hereunder, from and against the Claimant's pro rata share of
any and all liabili • (including attorney's fees and other costs or expenses of defense) to
which the Adminis ator may be subjected by reason of its administration of the account. In
connection with thi Agreement, the Claimant agrees to:
a) Refund or retu ,promptly upon the Administrator written demand, any funds or assets
distributed by t e Administrator to the Claimant, if the distribution thereof is determir~l
at any time to ave been an erroneous or negligent distribution to the Clamant, whet°lg ;r
such error or n gligence was or was claimed to have been premised upo~tistake ~'
law or of fact. 3~ L. .
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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 ous or negligent distribution to the Claimant until two (2) years after
such time as th Administrator shall have obtained actual lrnowledge of such error or
negligence.
4. Miscellaneous - Tl~e 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
first above ins
iREOF, the Claimant has executed and sealed this Release on the date
and the presence of at least two (2) witnesses.
BY:
West Shore Pathology
~~
Authorized Represen ive of Claimant
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