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RELEASE, RECEIPT, AND INDEMNITY

The undersigned, , hereby acknowledges receipt of payment of services on (Date)___________ interest in the residuary estate of Bonnie Jean Brill (a.k.a. Bonnie W. Brill) . The undersigned hereby releases and forever discharges and [executors], both in their capacity as independent executors of the estate of , and individually, of any and all claims of any kind which distributee ever had, now has or hereafter can, shall or may have, under the Last Will and Testament of decedent and with respect to the administration of the estate of decedent.

Distributee acknowledges that he/she has been provided with sufficient disclosure with respect to the terms, provisions, costs of administration and asset allocation prepared by executor. The undersigned hereby indemnifies executor, both individually and as the independent executors of the estate of decedent, from any and all liability resulting from the accounting and asset allocation in connection with the estate.

This receipt, release, and indemnity shall inure to the benefit of the predecessors and successors of all parties specifically released above and is binding on the undersigned, in his/her individual capacity and as a beneficiary under the Last Will and Testament.

SIGNED: ________________________

[Distributee]

SIGNED:________________________

[Distributor]

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