HomeMy WebLinkAbout06-28-12 (2)nt.w _.~ ~,r,~tit ~ c
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IN RE:
~~ ~2 JUPd 28 F'~~ ~~ 0~
ESTATE OF
HENRY S. C. ~ , ~; ,~ ~~~3
Decea~ g~p~,_pA;D CO.: PA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-11-1209
RECEIPT AND RELEASE
I, JOLT F. CARPENTER, the undersigned, being a beneficiary under the Estate of
HENRY S. CARPENTER, 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 $237,286.24 as a partial distribution to
which I am entitled as a beneficiary of the Estate of HENRY S. CARPENTER;
4. To the extent of said distribution, release GEORGE H. CARPENTER, Executor, of
the Estate of HENRY S. CARPENTER, and his heirs and personal representatives, from all
liabilities, whether due to his negligence or otherwise, which he may have by reason of his
administration of the Estate;
5. Agree to refund to the Estate and to the said GEORGE H. CARPENTER, Executor,
any portion oi'the distribution. to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
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
ti~~ti~- , 2012.
- '~ (SEAL)
.CARPENTER
STATE OF NEW YORK
SS:
On this, the ,~~~~day of 2012, before me, the
undersigned officer, personally appear HN F. CARPENTER, known to me (or satisfactorily
proven) to be the person whose name subscribed to the within instrument and acknowledged
that he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary Public
DALE B. LEACN
Notary Public, State of New York
No.04LE4520249
My Commission Expires May 31, 2014