PROBATE FORMS
Register of Wills Estate No. _________ of 20___
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
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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.
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We have hereunto set our hands and seals this _______ day of ___________________, 20 _____.
Witness: _____________________________
_______________________________________
[HEIR]
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF PHILADELPHIA
)ss.
)
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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