HomeMy WebLinkAbout11-17-11IN RE: )
ESTATE OF )
PHYLLIS MARLENE McCLELLAN )
Deceased )
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
N0.21-11-0382
RECEIPT AND RELEASE
I, MARK E. McCLELLAN, the undersigned, being a beneficiary under the Estate of
Phyllis Marlene McClellan, deceased, do hereby:
1. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received the sum of $63,000.00, as a partial distribution to
which I am entitled as a benef ciary of the Estate of Phyllis Marlene McClellan;
4. To the extent of said distribution, release Kimbra Jo Kurtz and Mark Edward
McClellan, Co-Executors of the Estate of Phyllis Marlene McClellan, and their heirs and
personal representatives, from all liabilities, whether due to their negligence or otherwise, which
they may have by reason of their administration of the Estate;
5. Agree to 'refund to the Estate and to the said Kimbra Jo Kurtz and Mark Edward
McClellan, Co-Executors, any portion of the distribution to which I am not properly entitled,
and, to the extent of said distribution, to indemnify them and the Estate for claims made against
them and to reimburse them and the Estate all expenses and costs incurred in connectic~iwith M.. 'S
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6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 1~ day of
~o~16ry1~2 , 2011.
~i~'' ~vI ~~ ~~~ -(SEAL)
MARK E. McCLELLAN
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND )
On this, the'`'y"' ' day of N C)~~(~ Y~Q~ , 2011, before me, the
undersigned officer, personally appeared MARK E. McCLELLAN, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within instrument and
acknowledged that (s)he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
Cindy A. Bolton, Notary Public
City of Harrisburg, Dauphin County Notary Publi
My commission expires September 15, 2012