HomeMy WebLinkAbout11-17-11 (2)IN 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, KIMBRA JO KURTZ, the undersigned, being a beneficiary under the Estate of
Phyllis" 1~Ia~lene Mr,Clel:lait~, 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 beneficiary 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;
S. 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 connection with
any such claim; and
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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 ~~ day of
2011.
(SEAL)
KIMBRA JO KURT
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND ,~~ )
On this, the ~ day of i1i01/~i~i~~E~ , 2011, before me, the
undersigned officer, personally appeared KIMBRA JO KURTZ, 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.
Notary Publi ~~NS~"
Notarial 5eai
Riiey D. Notz, Notary Pubic
SNver Spring Twp., Cumberland County
My Commis~on 6cplres Oct. 18, 2014
u.,...he, onnncdvani7l 4ccndatiotl Of Notaries