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IN THE MATTER OF THE ESTATE . IN THE COURT OF COMMON PLEAS OF
OF RICHARD D. RIFE, DECEASED . CUMBERLAND COUN1'Y, PENNSYLVANIA
. ORPHANS' COURT DNiSION
. NO. 1270 OF 2013 � N
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RECEIPT AND RELEASE :��:�: cr� ��; _� ��
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KNOW ALL MEN BY THESE PRESENTS that the undersi�,�ed,{ ALZ�I�
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�i.ri`J'ii���;�:':�ii�:, t�}'i1CaUv, �i�iI1G1S, Civ�S :10C0�'iy' ackna�.';e��C i'ZCC.�3�i ;T'Giii i.iS2� i�I. S-�venson, r.;iOCliti'�X
under the Last Will and Testament of the above-named decedent, of the follo�ving:
Cash in the sum of$100,000.00;
in absolute payment of and in full satisfaction of the bequest contained in Article III. B. 5. of decedent's
Last Will and Testament. The bequest is of a formula amount which the Executrix has determined to be
the full sum of$100,000.00.
The Undersigned agrees that such sum shall be added to and administered as part of its
general endowment fund with the income therefrom to be expended for its general operating
purposes.
,I�iv l.liivJilT'i�;�C�'rld�1 Gi SiziCi payinen� d:lU �T1�ISiCI', :.le Li11l1c:iSi�..�Cl �Gc.3 ne,-eo-y reiease,
remise, quit claim and forever discharge the said Executrix, her heirs, personal representatives, agents and
assignees, of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever
for or by reason thereof, or any other account, matter, cause or thing whatsoever relating to the Estate of
the said decedent.
AND the undersigned does hereby agree to indemnify and save harmless the said Executrix, her
heirs, personal representatives, agents and assignees, to the extent of said distribution, against any and all
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loss, damage, costs, verdicts, judgments, awards and expenses which said Executrix, or her successor,
may suffer, incur, be put to, pay or lay out by reason of having made distribution of said bequest to the
undersigned, and the undersigned agrees to refund to the Executrix, or her successor, upon receipt of such
a request from the Executrix, or her successor, any portion of the above distribution which the Executrix,
or her successor, determines was not properly payable to the undersigned or which shall at any time be
necessary to discharge any debt, expense or liability of the Estate, including but not limited to any estate,
inheritance,transfer or income tax.
It is the intention of tY►e undersigned to be legally bound by this instrument.
IN WITNESS WHEREOF, the undersigned has caused this instrument to be executed on the
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day of , 2014.
ATTEST: ALZHEIMER ASSOCIATION
(Assi.) S retary By: � � � o
Title: G�,e� ��tt`����:'��•a �°��','�eJ—
STATE OF ILLINOIS )
) SS:
COUNTY OF )
On this,the ��day of �� 1C� , 2014, before me,the undersigned
officer, personally appeared�;cJr�rc� YI. {'�o►�Icv.�( ,who acknowledged [himself/herselfJ to be the
�'�;�� c�e�w���.$�����cer of ALZHEIMER ASSOCIATION, a corporation, and that [he/she] as such
officer, being authorized to do so, executed the foregoing Receipt and Release for the purposes therein
contained by signing the name of the corporation by [himself/herselfJ as such officer.
IN WITNES� WHEREC)F, I hereunto set my hand and official seal.
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MEIKA SLOTSEMA
OFFiCIAL SEAL NO P 11�
��. Notary Pub�ic,State of tllinois
My Commission Expires My mmission Expires:
` August 15,2017 (SEAL)