Probate Forms

Estate of [DECEASED], Deceased

RECEIPT, RELEASE, AND INDEMNIFICATION AGREEMENT

Background Information

The circumstances leading up to the execution of this Agreement are as follows:

1.[DECEASED] (“Decedent”) died on [DATE OF DEATH], a resident of Philadelphia County, Pennsylvania.

2.Paragraph [PARAGRAPH NUMBER] of Decedent’s Will, dated [DATE OF WILL], provides that the residue of Decedent’s Estate be paid to [RESIDUARY HEIRS], [which this Agreement complies with OR which this Agreement alters by [explain alterations]].

3.I, [NAME OF HEIR], the undersigned, desire that the Estate assets to which I am now entitled be distributed to me without the formality of a court audit in order to save the expenses, publicity, and delay of such audit. I also understand that [PERSONAL REPRESENTATIVE], Personal Representative, is willing to make such an informal distribution upon execution of this Agreement.

Agreement

I, the undersigned, am a party in interest in the above Estate that is now distributable for the reasons set forth above. For the purpose of inducing the Personal Representative to make distribution without seeking a court audit to release and discharge [HIM/HER] from liability for [HIS/HER] administration of the Estate, and in consideration of its distribution without such audit, I hereby:

1.acknowledge that I have read this Agreement, and represent and warrant that the facts set forth above are true and correct to the best of my knowledge, information, and belief. I further acknowledge that I am familiar with the provisions of the Will of [DECEASED], Deceased; that I have examined the First and Final Account of [PERSONAL REPRESENTATIVE], Personal Representative, specifically approve such Account; and acknowledge receipt of

the balances shown in the Account as distributed to me as being my entire interest in the above Estate that is now distributable as shown therein;

2.waive the filing with any court of any Account concerning the assets shown in the First and Final Account;

3.release and discharge the Personal Representative of the above Estate, in [HIS/HER] individual capacity and as Personal Representative, from any and all liability, including specifically but not limited to liability arising in connection with any mistake of fact or law or negligent or careless act or omission by such Personal Representative in connection with the administration and distribution, including the present distribution, of the assets shown in the First and Final Account;

4.to the extent of the value of the Estate that has been or is being distributed to me, agree to indemnify and save harmless the Personal Representative of the above Estate, in [HIS/HER] individual capacity and as Personal Representative, against any and all liability, loss, or expense (including but not limited to costs and counsel fees) that may ever be incurred by the Personal Representative, including specifically but not limited to liability, loss, or expense resulting from any mistake of fact or law or negligent or careless act or omission by the Personal Representative as a result of the settlement upon this Receipt and Release;

5.agree to refund to the Personal Representative such part or all of the Estate or the value thereof that has been or is being distributed to me, if it is hereafter determined by a court of competent jurisdiction, after notice to me, that I am not legally entitled thereto;

6.acknowledge by these presents that, if said distribution to me is or is hereafter found to be erroneous or improper in whole or in part under the governing instrument and applicable law for any reason, including but not limited to any mistake of fact or law or negligent or careless act or omission by the Personal Representative, I will refund such amount improperly distributed to me on demand, and if so, then this obligation shall be void; otherwise, it shall be in full force and virtue;

7.specifically waive hereby any Statute of Limitations that might be applicable against a claim by the Personal Representative and [HIS/HER] attorney or assigns, for refund or indemnification under this instrument;

8.declare that this Agreement shall be governed by the law of the Commonwealth of Pennsylvania and shall be legally binding as an agreement under seal upon me and my heirs, personal representatives, and assigns.

We have hereunto set our hands and seals this ______day of ______, 20 _____.

Witness: ______

[HEIR]

COMMONWEALTH OF PENNSYLVANIA)

)ss.

COUNTY OF PHILADELPHIA)

On this ______day of ______, 20____ , before me, the undersigned, a Notary Public in and for the Commonwealth of Pennsylvania, personally appeared [HEIR], satisfactorily proven to me to be the persons described in the foregoing Agreement, who acknowledged that [HE/SHE] executed the same for the purposes therein contained and that [HE/SHE] desired it to be recorded as such.

______

Notary Public

*Note that this form Agreement is designed for distributions where the entire estate is being distributed pursuant to the Agreement. If only part of the estate is being distributed pursuant to the Agreement, you should make the appropriate changes in the language above to represent this.

**If there are assets other than real property in the estate being distributed, the Personal Representative should only distribute 95% of the estate assets until the Department of Revenue confirms that the initial payment of inheritance tax has been accepted and that no further tax (principal, interest, or penalties) is due. In such a situation, this form Agreement should be amended to reflect that the heirs are only receipt 95% of their interest in the estate and that the heirs acknowledge that 5% of the estate is being retained by the Estate pending receipt of a clearance from the Pennsylvania Department of Revenue, after receipt of which the balance will be distributed to the heirs in proportion to their interests in the Estate.

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