HomeMy WebLinkAbout04-12-13 (3) • t
IN RE: ) IN THE COURT OF COMMON PLEAS OF
) CIJMBERLAND COUNTY,
j PENNSYLVANIA
ESTATE OF )
SHIRLEY R. HEARN ) ORPHANS' COURT DIVISION
Deceased )
) NO. 21-13-0064
RECEIPT AND RELEASE
I, KATHY J. HANSON, the undersigned, being a beneficiary under the Estate of Shirley
R. Hearn, 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$21,000.00 as a partial distribution to
which I am entitled as a beneficiary of the Estate of Shirley R. Hearn.
4. To the extent of said distribution, release Kathy J. Hanson, Executrix of the Estate of
Shirley R. Hearn and her heirs and personal representatives, from all liabilities, whether due to
her negligence or otherwise, which she may have by reason of her administration of the Estate;
5. Agree to refund to the Estate and to the said Kathy J. Hanson, Executrix, any portion
of the distribution to which I am not properly entitled, and, to the extent of said distribution,to
indemnify her and the Estate for claims made against her and to reimburse her 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, n}�'��s�al� �, �
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representatives, and assigns. � u� � Q �
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this � day of
.���IL- , 2013.
(SEAL)
KAT J. ON
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF �,���` � )
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On this,the � day of 1 l' , 2013, before me, the
undersigned officer,personally appeared HY J. HANSON, known to me (or satisfactorily
proven)to be the person whose name is subscribed to the within instrument and acknowledged
that she executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
�
Notary Public
l�WEALTH Of PENNSYlVANIA
PSfOTARfAL S�AL
Wer�dy K. Straub, ivc�tsry Public
Lower Alien Townshsp,Cumberland Couniy
ll�y Commisslon Exp-ires May 10,�015