HomeMy WebLinkAbout08-05-10In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-2008-1056
Estate of Lois.A. Kelley, Deceased
Late of Township of South Middleton
FAMILY SETTLEMENT AGREEMENT
Debra A. Field, Executrix
Date of Death: 10/03/2008
Date of Incapacity, if any: None
Date of Executrix's Appointment: 10/23/2008
Date of First Complete Advertisement: 11/26/2008
Accounting for the period: 10/08/2008. to 07/31/2010.-
Purpose of Account: Debra A. Field, Executrix, offers this Account to acquaint interested parties with
the transactions that have occurred during the Administration.
It is Important that the Account be,carefully examined. Requests for additional information or questions
or'objections can be discussed with:,
John R. Gibbel
Gibbel Kraybill & Hess LLP
P.O. Box 16
Lititz, PA 17543
(717) 626-0291 0 0
Supreme Court I.D. No. 07501 ~o
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SUMMARY OF ACCOUNT
Estate of Lois A. Kelley, Deceased
For the period of October 3, 2008 through Juiy 31, 2010
Receipts This Account 299,634.60
Net Gain (or Loss) on Sales
or Other Dispositions -374.92
299,259.68
Less Disbursements
Debts of Decedent 1,854.61
Funeral Expenses 6,493.44
Administration Expenses 38,865.02
Federal, State & Local Taxes 10,340.00
Commissions 0.00
Fees 10,643.00
Family Exemption 0.00 68,196.07
Balance Before Distributions 231,063.61
Transfer to (from) Principal ~ 0.00
Distributions to Beneficiaries 219,840.54
Principal Balance on Hand 11,223.07
Receipts This Account 367.76
Net Gain (or Loss) on Sales 0.00
or Other Dispositions
367.76
Less Disbursements 0.00
Balance Before Distributions 367.76
Transfer to (from) Income 0.00
Distributions to Beneficiaries 0.00
Income Balance on Hand 367.76
COMBINED BALANCE ON HAND 11,590.83
Verification
RECEIPTS OF PRINCIPAL
Assets Listed in Inventory
(Valued as of Date of Death)
~8~.1]
03/10/2009 Capital One Auto Finance Account #9117206 -refund 4.22
02/25/2009 Department of Veterans Affairs - copay refund 12.53
11/18/2008 Erie Insurance -accidental death benefit 5,000.00
11/12!2009 Erie Insurance -personal injury claim (survival 20,000.00
action)
12/30/2008 Highmark Blue Shield -premium refund 98.88
01/16!2009 Humana -premium refund 50.40
07/30/2010 PA Department of Revenue -inheritance tax refund 342.04
11/09/2009 Sale of real estate -prorated reimbursement of taxes 704.46
(Kltszell Drive) (one-half value reported in spouse's
estate).
12/01/2009 Sale of real estate -prorated reimbursement of taxes 416.37
(Partridge Circle) (one-half value reported in spouse's
estate)
10/03/2008 Sovereign Bank IRA Account #1678179860 - 18,099.36
beneficiary: estate
10/03/2008 Sovereign Bank IRA Account #1678180355 - 10,630.60
beneficiary: estate
12/30/2008 American Express -unused travelers checks 500.00
11/03/2008 Genworth Financial -premium refund 456.76
11/18/2008 Hoffman-Roth Funeral Home -refund 100.00
10/03/2008 Members 1st Federal Credit Union CD Account 5,615.70
#246784-46 -one-half value reported in spouse's
estate
10/0412008 Accrued interest on above item through date of death 1.58
10/03/7008 Members 1st Federal Credit Union Savings Account 25.00
#246784-00
10/03/2008 Orrstown Bank CD Account #4000026106 6,655.11
10/04/2008 Accrued interest on above item through date of death 7.65
70!03/2008 Onstown Bank Checking Account#402362 -one-half 2,191.07
value reported in spouse's estate
10/03/2008 Orrstown Bank Christmas Club Account #450295 - 480.00
one-half value reported in spouse's estate
10/04/2008 Accrued interest on above item through date of death 2.38
10/03/2008 Sovereign Bank CD Account #1675206807 -one-half 5,033.64
value reported in spouse's estate
Fiduciary
Acquisition
Value
RECEIPTS OF PRINCIPAL
Continued
10/04/2008 Accrued interest on above item through date of death 2.69
70103/2008 Sovereign Bank Checking Account #0351059067 - 106.39
one-half value reported in spouse's estate
10/04/2008 Aecrued interest on above item through date of death 0.04
10/03/2008 Sovereign Bank Money Market Account #1674062206 1,791.64
-one-half value reported in spouse's estate
10/04/2008 Accrued interest on above item through date of death 0.30
10/15/2008 United States Treasury -Social Security payments for 399.00
September (one-half value reported in spouse's
estate)
Total Cash
P
l P
10/03/2008 ersona
rnnerty
7 T
Personal property -value per appraisal (one-half
452.50
value reported in spouse's estate)
11/19/2008 2000 Ford Mustang -value per sale price 3,500.00
Total Personal Property
Stocks /Listed
10/03/2008 188.0000 shares Banco Santander, S.A. -one-half value 2,942.20
reported in spouse's estate
FIDELITY BROKERAGE ACCOUNT #61456926
10/03/2008 773.0100 shares Loomis Sayles Bond Instl -one-half value 8,951.46
reported in spouse's estate
10/03/2008 370.8520 shares Pimco Total Retum Fund -one-half value 3,842.03
reported in spouse's estate
10/03/2008 22.1830 shares Dodge & Cox Stock Fund -one-half value 2,039.73
reported in spouse's estate
10/03/2008 Brokerage Money Market -one-half value reported in 5,267.49
spouse's estate
Total Stocks /Listed
R
l E
t
t
10/03/2008 ea
s
a
e
Tract of land with dwelling thereon erected at 56
68,950.00
Partridge Circle, South Middleton Township, Carlisle -
as more fully described in Deed recorded in the Office
of the Recorder of Deeds in and for Cumberland
County, Book 162, page 123. Value per sale price.
One-half value reported in spouse's estate.
Fiduciary
Acquisition
Value
78,727.91
3.952.50
23,042.91
RECEIPTS OF PRINCIPAL
Continued
10/03/2008 Tract of land with dwelling thereon erected at 9
Kitszell Drive, South Middleton Township, Carlisle -
as more fully described in Deed recorded in the Office
of the Recorder of Deeds in and for Cumberland
County, Book K-36, page 679. Value per sale price.
One-half value reported in spouse's estate.
Total Real Estate
Total Receipts
11/28/2008 Subsen~an_ t Principal ReceiR
Brokerage Money Market -one-half value reported in
spouse's estate
12/22/2008 0.0990 share Dodge 8 Cox Stock Fund -dividend
reinvestment
03/30/2009 0.1480 share Dodge & Cox Stock Fund -dividend
reinvestment
06/29/2009 0.0870 share Dodge & Cox Stock Fund -dividend
reinvestment
10/28/2008 6.2170 shares Loomis Sayles Bond Instl -dividend
reinvestment
11/25/2008 6.5350 shares Loomis Sayles Bond Instl -dividend
reinvestment
12/12/2008 Loomis Sayles Bond fnstl -short-term capital gain;
one-half value reported in spouse's estate
12/12/2008 Loomis Sayles Bond Instl -long-term capital gain;
one-half value reported in spouse's estate
01/27/2009 4.9790 shares Loomis Sayles Bond Instl -dividend
reinvestment
02/26/2009 4.7120 shares Loomis Sayles Bond Instl -dividend
reinvestment
03/26/2009 5.1150 shares Loomis Sayles Bond Instl
04/30/2009 4.4300 shares Loomis Sayles Bond Instl -dividend
reinvestment
05/29/2009 4.4430 shares Loomis Sayles Bond Instl -dividend
reinvestment
06/25/2009 4.2900 shares Loomis Sayles Bond Instl -dividend
reinvestment
124.000.00
0.10
7.10
9.80
6.73
61.92
63.59
2.75
81.56
52.33
48.63
52.02
46.83
49.$7
49.94
Fiduciary
Acquisition
Value
192,950.00
298,673.32
RECEIPTS OF PRINCIPAL
Continued
Fiduciary
Acquisition
Value
07/30/2009 4.4930 shares Loomis Sayles Bond Instl 54.28
08/27/2009 4.6690 shares Loomis Sayles Bond Instl -dividend. 58.18
reinvestment
09/24/2009 4.0640 shares Loomis Sayles Bond Instl -dividend 52.34
reinvestment
10/31/2008 1.7480 shares Pimco Total Return Fund -dividend 17.72
reinvestment
11/28/2008 1.5440 shares Pimco Total Return Fund -dividend 15.90
relnvestment
12/10/2008 11.8560 shares Pimco Total Retum Fund -short-term capital 117.38
gain; one-half value reported in spouse's estate
12/10/2008 6.7540 shares Pimco Total Retum Fund -long-term capital 66.86
gain; one-half value reported in spouse's estate
12/31/2008 0.8630 share Pimco Total Retum Fund -dividend 8.75
reinvestment
01/30/2009 2.0200 shares Pimco Total Retum Fund -dividend 20.50
reinvestment
02/27/2009 Pimco Total Return Fund 16.40
Total Subsequent Principal Receipts
961.28
Total Adjustments and Subsequent Receipts 961.28
Total Receipts of Principal 299,634.60
GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS -PRINCIPAL
~o Ls~
02/26/2009 188.0000 shares Banco Santander, S.A.
Net Proceeds 7,220.08
Fiduciary Acquisition Value -2,942.20 -1.722.12
09/25/2009 11.5170 shares Dodge & Cox Stock Fund -distributed to
Pamela S. Garrett
Net Proceeds 1,060.37
Fiduciary Acquisition Value -1,055.37 5.00
09/25/2009 11.0000 shares Dodge 8 Cox Stock Fund -distributed to
Debra A. Field
Net Proceeds 1,012.77
Fiduciary Acquisition Value -1.007.99 a.78
09/25/2009 413.9570 shares Loomis Sayles Bond Instl -distributed to
Pamela S. Garrett
Net Proceeds 5,340.05
Fiduciary Acquisition Value -4,776.12 563.93
09/25/2009 413.0000 shares Loomis Sayles Bond Instl -distributed to
Debra A. Field
Net Proceeds 5.327.70
Fiduciary Acquisition Value x,765.07 562.63
09/25/2009 213.6300 shares Pimco Total Retum Fund -distributed to
Pamela S. Garrett
Net Proceeds 2,330.70
Fiduciary Acquisition Value -2,216.85 113.85
09!25/2009 182.0070 shares Pimco Total Retum Fund -distributed to
Debra A. Field
Net Proceeds 7,985.70
Fiduciary Acquisition Value .1,888.69 97.01
DISBURSEMENTS OF PRINCIPAL
CaoitAl One MasterCard A ount #52 1-4920 8273 21'~R
11/06/2008
12/10/2008 finance charge
690.08
Checks clearing personal account after death
10/07/2008 one-half value reported in spouse's estate
687.57
2.51
235.21
235.21
10/14/2008
household fuel; one-half value reported in spouse's
estate
17.18
17.18
Washington Mutual Credit Card A rount dR:185-..407~9~~ 083
11/18/2008
Total Debts of Decedent
Funeral Expenses
Debra A. Field
11/14/2008 reimburse for funeral expenses
912.14
912.14
1.854.61
2,060.00
2,060.00
Hoffman-Roth Funeral Home
11/10/2008 funeral services
3,930.00
DISBURSEMENTS OF PRINCIPAL
Continued
12/31/2008 air transport 503.44
4,433.44
Total Funeral Expenses
Administration Ex enses 6.493.44
Bev Kelchner
10/05/2009
resale certificate for Kitszell Drive
40.00
40.00
Carl Cecil
04/29/2009
house repairs (Kitszell Drive & Partridge Circle)
326.23
05/22/2009 house repaire (Kitszell Drive) 60.00
386.23
Cumberland taw Re
12/02/2008 view
estate notice
75.00
D
b
A
Fi
l 75.00
e
ra
.
e
d
02/03/2009
reimburse for trash removal fee (175.00), carpet
752.83
shampoo (106.00), insurance deductible (60.00), long
distance calls (52.00), car ad (31.00) and gas/travel
(328.83)
E
i
I 752.83
r
e
nsurance
01/16/2009
homeowner policy
386.00
04!16/2009 homeowner policy 90.00
06/20/2009 homeowner policy 251.00
08/03/2009 homeowner policy 256.00
DISBURSEMENTS OF PRINCIPAL
Continued
983.00
10/22/2008 advisor fee; one-half value reported in spouse's 256.85
estate
Gibb
t K
bill & 256.85
e
rav
He
11!12/2009 ss LLP
reimburse for expenses paid for personal injury
189.98
settlement
11/12/2009 fees related to settlement of personal injury claim 4,500.00
01/22/2010 fees related to wrongful death claim 245.00.
0 711 2/2 01 0 reimburse for probate fee (365.00), additional death 475.00
certificates (55.00), additional short certificates {40.00)
and tax return filing fee (15.00)
Herm
Pl
bi 5,409:98
an
um
ng
02/03/2009
winterize Kitszell Drive
75.00
05112/2009 dewinterize and repair master toilet at Kitszell Drive 74.60
h
J
M
H
A
ti 149.60
o
n
.
ess
c
o
06/20/2009 n Service
appraisal fee
45.00
bo's Pl
L
bi
8 H
i 45.00
um
e
ng
71/79/2008 eat
ng
replace water heater (Partridge Circle)
1,117.00
M
a
I Vill
H
^ 1,117.00
~y
~
age
o
03!09/2009 meowners Associ
tion
2009 dues for Patridge Drive
95.00
DISBURSEMENTS OF PRINCIPAL
Continued
Met-Ed
01/16/2009
electric service during estate administration
30.37
02/24/2009 electric service during estate administration 30.48
03/19/2009 electric service during estate administration 2Y,78
04/16/2009 electric service during estate administretion 21,67
05!19/2008 electric service during estate administration 20.24
06/17/2009 electric service during estate administretion 17,64
07/31/2009 electric service during estate administration 22.04
08/19/2009 electric service during estate administration 20.16
09/23/2009 electric service during estate administration 55.98
10/27/2009 electric service during estate administration 21.81
11/24/2009 electric service during estate administration (final) 26.13
North Middleton To wnship
01/16/2009 water/sewer for Partridge Drive 82.30
03/09/2009 water/sewer for Partridge Drive 93.49
05/12/2009 water/sewer for Partridge Drive 82.30
07/13/2009 water/sewer for Partridge Drive 82.30
09!15/2009 water/sewer for Partridge Drive 82.30
11/05/2009 water/sewer for Partridge Drive 104.68
Ocean Pines Owners hip Association
02126/2009 timeshare annual fee 445.00
04/01!2009 remaining fee 11.51
Register of Wilis
05/22/2009
exemplification of record
40.00
12/15!2009 exemplification of record 40.00
07/12/2010 account filing fee 20.00
95.00
289.30
527.37
456.51
DISBURSEMENTS OF PRINCIPAL
Continued
100.00
Rick's Towing
11/07/2008 removal of vehicle 200.00
200.00
Robert C. Cairns. Tax Collector
03/10!2009 real estate tax for Kitszell Drive
07/07/2009 real estate tax for Kitszell Drive
real estate tax for Partridge Circle
real estate tax for Partridge Circle
2,615.67
Robin K. Sollenberaer
03/19/2009
07/07/2009
540.30
2,075.37
351.75
1,382.29
1,734.04
Sale of real estate
11 /09!2009
12/01 /2009
settlement charges (Kitszell Drive) (one-half value 9,069.20
reported in spouse's estate)
settlement charges and seller assist (Partridge Circle) 6,437.38
(one-half value reported in spouse's estate)
15,506.58
Seawatch Island Club
01/27/2009 .
timeshare annual fee
637.00
637.00
South Middleton To wnshirz Municipal Authorih~
01/16!2009 waterlsewer for Kitszeli Drive
04/08/2009 waterlsewer for Kitszell Drive
07/07/2009 waterlsewer for Kitszell Drive
10/08/2009 waterlsewer for Kitszell Drive
101.00
101.00
101.00
101.00
DISBURSEMENTS OF PRINCIPAL
Continued
The Sentinel
12/02/2008
estate notice
150.64
Thomas H. Orlouskv
06/29/2009
painting at Partridge Circle
2.662.80
07/13/2009 painting at Partridge Circle 230.00
09/23/2009 painting at Kitszell Drive
2,118.50
12/29/2008 household fuel during estate administration 202.61
01/27/2009 household fuel during estate administration YY3,08
02/26/2009 household fuel during estate administration 202.75
03/31/2009 household fuel during estate administration 50.89
05/01/2009 household fuel during estate administration 20.37
06/03/2009 household fuel during estate administration 37.39
06/29/2009 household fuel during estate administration 23.21
07/31/2009 household fuel during estate administration 23:21
09!29/2009 household fuel during estate administration 23.21
10/27/2009 household fuel during estate administration 38,79
Woody's Lawn Gare
04108/2009 yard care
239.45
05/1212009 yard care 107.00
06/17/2009 yard care
140.00
07/07/2009 yard care 137.44
08/19/2009 yard care 111 72
09/15/2009 yard care 140.00
10/08/2009 yard care 112.00
11/06/2009 yard care 89.00
404.00
150.64
5.011.30
845.51
DISBURSEMENTS OF PRINCIPAL
Continued
Total Miscellaneous Administrative Expenses
Federal. State, and Local Taxea
PA Denartment of Revenue
03/11/2010 fiduciary income tax 80.00
Register of Wills
12/29!2008 inheritance tax
Total Taxes
~~~
1,076.61
38.865.02
80.00
10.260.00
10.340.00
Cohick & Associates
09/28/2009 preparation of 2008 income tax returns 348.00
348.00
Saibbel Krayblll ~ Hess LLP
12/29/2009 estate administration
Total Fees
TOTAL DISBURSEMENTS OF PRINCIPAL
10.260.00
10,295.00
10,295.00
10,643.00
68.196.07
DISTRIBUTIONS OF PRINCIPAL
09/18/2009 Debra A. Field -advance distribution (from RBC
account)
10/27/2009 Debra A. Field -advance distribution of 1/2 residue
12/29/2009 Debre A. Field -advance distribution of 112 residue
11103!2008 Pamela S. Garrett -advance distribution of 1/2 residue
11/06/2008 Pamela S. Garrett -advance distribution (Capital One
auto loan payment for Morgan Garrett)
01/29/2009 Pamela S. Garrett -advance distribution (Capital One
car loan payoff)
05!0612009 Pamela S. Garrett -advance distribution (from RBC
account)
07!07/2009 Pamela S. Garrett -advance distribution (from RBC
account)
09/25/2009 Pamela S. Garrett -advance distribution (from RBC
account)
12/09/2009 Pamela S. Garrett -advance distribution (for house
purchase -paid to Debra)
12/29/2009 Pamela S. Garrett -advance distribution of 1/2 residue
500.00
6.000.00
80,900.00
2,500.00
196.28
9.412.43
5,000.00
1,000.00
88.05
64,657.31
32.076.68
202,330.75
Debra A. Field
09/25/2009 11.0000 shares Dodge & Cox Stock Fund 1,012.77
09/25/2009 413.0000 shares Loomis Sayles Bond Instl 5,327.70
11/12/2009 Personal property -one-half value credited to 228.25
beneficiary
09!25/2009 182.0070 shares Pimco Total Return Fund 1,985.70
8,552.42
09/25/2009 11.5170 shares Dodge 8 Cox Stock Fund 1,060.37
DISTRIBUTIONS OF PRINCIPAL
Continued
09/25/2009 413.9570 shares Loomis Sayles Bond Instl
11/12/2009 Personal property -one-half value credited to
beneficiary
09/25/2009 213.6300 shares Pimco Total Return Fund
5,340.05
226.25
2,330.70
8,957.37
TOTAL DISTRIBUTIONS TO BENEFICIARIES 219.840.54
RECEIPTS OF INCOME
02/25/2009
capital stock dividends
47.88
47.88
03/31 /2009
04!30/2009
05/29/2009
06/30/2009
07/31/2009
Loomis Sayles Bond Instl
12/1 Z/2008
one-half value reported in spouse's estate
0.05
0.05
0.02
0.01
0.01
0.14
106.86
106.86
03/03/2009
04/02/2009
05/04/2009
06/02/2009
07!07/2009
08/04/2009
os/ou2oos
TOTAL DIVIDEND INCOME
21.61
20.99
20.91
20.71
20.57
21.59
21.10
147.48
302.36
RECEIPTS OF INCOME
Continued
Brokerage Money M
10/31/2008, arket
one-half value reported in spouse's estate
10.82
11/28/2008 one-half value reported in spouse's estate 3.31
12/31/2008
01/30/2009 1.68
02/27/2009 1 62
1.01
Members 1~t Federal Credit Union GD Account #246784,6
11/18/2008 one-half value reported in spouse's estate 27.64
Orrstown Bank CD Account #40000 6106
11/03/2008
6.31
Orrstown Bank Ghecking Account x:02362
10/29/2008 one-half value reported in spouse's estate 0.15
Orrstown Bank Ghri~tmas Glib A rount #4 0295
10/20/2008 one-half value reported in spouse's estate 0.07
Sovereign Bank GD Account #167?06807
11/03/2008 one-half value reported in spouse's estate 11.23
Sovereign Bank Ghecking Account #0351059067
11/06/2008 one-half value reported in spouse's estate 0.04
18.44
27.64
6.31
0.15
0.07
11.23
0.04
RECEIPTS OF INCOME
Continued
Sovereign Bank Money Market Account #1674062206
11/03/2008 one-half value reported in spouse's estate
TOTAL BANK INTEREST
TOTAL RECEIPTS OF INCOME
1.52
1.52
65.40
367.76.
SCHEDULE OF DISTRIBUTION
Debra A. Field
07/12/10 Cash -balance of 1/2 of residue
Pamela S. Garrett
07/12/10 Cash -balance of 1/2 of residue
Gibbel Kraybill & Hess LLP
07/12/10 Cash -escrowed amount pending settlement of suit
2,847.32
3, 743.51
5,000.00
TOTAL DISTRIBUTION $11,590.83
SCHEDULES of DLSTRIBUTION
from the ESTATES of JACK F. KELLEY and LOLS A. KELLEY
.isck F. Kelley
Advance distributions:
Remaining funds available for distribution:
TOTAL
Lois A. Kellen
Advance distributions:
Remaining funds available for distribution:
TOTAL
Total of Combined Residuary Estates:
Less funds held in escrow pending settlement of suit
against estate:
TOTAL ASSETS FOR DLST'RIBUTION:
Debra A. Field
Advance distribution received from Jack F. Kelley Estate:
Advance distribution received from Lois A. Kelley Estate:
Remaining amount to be disln7iutad
TOTAL DISTRIBUTION:
Pamela S. Garrett
191,308.33
1,988.28
193,296.61
219,840.54
11,590.83
231,431.37
424,727.98
(5,000.00)
$ 419,727.98
109,075.97
95,952.42
4,833.60
209,863.99
Advance distribution received from Jack F. Kelley Estate: 82,232.36
Advance distribution received from Lois A. Kelley Estate: 123,888.12
~~ng amount ~ ~ ~~~ 3,743.31
TOTAL DISTRIBUTION: 209,863.99
TOTAL DISTRIBUTIONS MADE:
$ 419,727.98
In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-2008-1056
Estate of Lois A. Kelley, Deceased
Verification
Debra A. Field, Executrix under the Last Will and Testament of Lois A. Kelley, Deceased, hereby
declares under oath that he/ahe has fully and faithfully discharged the duties of his/her office; that
the foregoing Account is true and correct and fully discloses all significant transactions occurring
during the accounting period; that all known claims against the Estate have been paid in full; that;
to his/her knowledge, there are no claims now outstanding against the Estate; that all taxes
presently due from the Estate have been paid; and that the grant of Letters Testamentary and the
first complete advertisement thereof occurred more than four months before the foregoing
Account.
This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn
falsification to authorities.
.~
br A. Field, Executrix
Dated: /z ~/~
IN THE COURT OF COMMON PLEAB OF CUMBERLAND COUNTY, PENN8YLVANIA
ORPHAN8' COURT DIVI810N
IN RE: THE ESTATE OF
LOTS A. KELLEY
("the Deceased")
LATE OF SOUTH MIDDLETON TWP
EXECUTRIX: Debra A. Field
("the Executrix")
No. 21-200&1056
RECEIPT, RELEASE, REFUNDING AND INDEMNIFICATION AGREEMENT
The undersigned beneficiary under the Will of the Deceased:
1. Acknowledges that the undersigned has examined and approved the
attached Account, including the Schedules of Distribution;
2. Waives the filing of the Account and Schedules of Distribution in the Court;
3. Acknowledges that combined distributions to the undersigned .totaling
$98,799.74, as shown in the Account, will be in full satisfaction of the amount payable to
the undersigned from the Estate of the Deceased;
4. Agrees to refund to the Executrix any portion of such distributions to
which the undersigned is not properly entitled; agrees, to the extent of such
distributions, to indemnify the Executrix for claims made against her as Executrix, and
to reimburse the Executrix for all expenses and costs incurred in connection with any
such claims;
5. Releases the Executrix and her heirs and personal representatives from
all liabilities which the Executrix may have by reason of administration of the Estate;
and
6. Declares that this instrument shall be legally binding upon the
undersigned and the undersigned's heirs and assigns.
IN WITNESS WH~REOF, intendin to be legally bound, I have hereunto set my
hand and seal this ~~ day of v , 2010.
E RA A. FIELD
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENN8YLVANIA
ORPHANS' COURT DIV1810N
IN RE: THE ESTATE OF )
LOTS A. KELLEY )
("the Deceased") )
LATE OF SOUTH MIDDLETON TWP. ) No. 21-2008-1056
EXECUTRIX: Debra A. Field )
("the Executrix") )
RECEIPT, RELEASE, REFUNDING AND INDEMNIFICATION AGREEMENT
The undersigned beneficiary under the Will of the Deceased:
1. Acknowledges that the undersigned has examined and approved the
attached Account, including the Schedules of Distribution;
2. Waives the filing of the Account and Schedules of Distribution in the Court;
3. Acknowledges that combined distributions to the undersigned totaling
$127,631.63, as shown in the Account, will be in full satisfaction of the amount payable
to the undersigned from the Estate of the Deceased;
4. Agrees to refund to the Executrix any portion of such distributions to
which the undersigned is not properly entitled; agrees, to the extent of such
distributions, to indemnify the Executrix for claims made against her as Executrix, and
to reimburse the Executrix for all expenses and costs incurred in connection with any
such claims;
5. Releases the Executrix and her-heirs and personal representatives from
all liabilities which the Executrix may have by reason of administration of the Estate;
and
6. Declares that this instrument shall be legally binding upon the
undersigned and the undersigned's heirs and assigns.
IN WITNESS WHEREOF, int nding to be legally bound, I have hereunto set my
hand and seal this ~ day of , 2010.
7tirn ~ .X t Gr1Jr n ~
PAMELA S. GARRETT