HomeMy WebLinkAbout10-15-14 IN RE: ) IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
ESTATE OF )
DORIS J. BROUDE, ) ORPHANS' COURT DIVISION
Deceased )
NO. 21-14-0120
RECEIPT AND RELEASE
I, AMY ORTEGA FORTNEY,the undersigned, being a beneficiary under the Estate of
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Dor $ J '3roj��ae,'�yC*e' ;.r.to 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$50,000.00 as a partial distribution to
which I am entitled as a beneficiary of the Estate of Doris J. Broude;
4. To the extent.of said distribution, release=James C. Buck, Executor of.the 'Estate of
Doris J. Broude, 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 James C. Buck, Executor, any portion of
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the distribution to which I am not properly entitled, and, to the extent of said d8 rj�ution,TFTrn a
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indemnify him and the Estate for claims made against him and to reimburse higasnni Pe to
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 pef--s'biEl ►� r= rn
representatives, and assigns. c�
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IN WITNESS WHEREOF, I'have hereunto set my hand and seal this day of
2014.
SEAL)
AMY OR EGA ORTN
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF )_DAACYIO )
On this,the_ 1 day of rd� _ 2014, before me, the
undersigned..offtcer4 personally appeared Alv1v-ORTEGA FORTNEY, known to me (or,
satisfactorily proven)to be the person whose name is subscribed to the within instrument and
acknowledged that she executed salve for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary ublic
COMMONWEALTH OF PENNSYLVANIA
Notarial seat x
Cheryl L.Baker,Notary Public
upper Allen Twp.,Cumberland County
My Commission Expires Jan.13,2016
'DR,PENNSYLVANIA ASSOCIATION OF NOTARIES