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) IN THE COURT OF COMMON PLEAS O'k'~ ~'
IN RE:
CUMBERLAND COUNTY,
PENNSYLVANIA
ESTATE OF ) ORPHANS' COURT DIVISION
)
MARY R. FORTNEY
Deceased )
NO. 21-12-0926
RECEIPT AND RELEASE
I, JOAN A. BONAWITZ, the undersigned, being a beneficiary under the Estate of Mary
R. Fortney, 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 $105,000.00 as a partial distribution to
which I am entitled as a beneficiary of the Estate of Mary R. Fortney;
4. To the extent of said distribution, release Daniel V. Bonawitz, ExecutorAdministrator,
of the Estate of Mary R. Fortney 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 Daniel V. Bonawitz, Executor, any
ortion of the distribution to which I am not properly entitled, and, to the extent of said
P
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
I ~~ C~~,.'„~°A~, , 2012.
M Y
`~ ~` ~ , (SEAL)
JOAN A. BONAWITZ t.
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND ,~ )
.-,
On this, the ~~~ ~ day of ~ ~ , 2012, before me, the
undersigned officer, personally appeared JOAN A. BONAWITZ known to me (or satisfactdo ed
proven) to be the person whose name is subscribed to the within instrument and acknowle g
that she executed same for the purposes therein contained.
e ,~he~eunto set my hand and official seal
IN WITNESS WHEREOF,
'~
Notary Public r;~
Cdil,~/4!~l4yEALTN OF PENNSYLVANIA
{dQiAR1AL SERI
WenQy K. Straub, Notary Public
lower Allen Township, Cumberland County
ids Commisaton Expires May 10. 2015