Exhibit 10HH. (i)
Xxxxx X. Xxxxx
Re: Executive Severance Plan and Termination Agreement
Dear Xx. Xxxxx:
On October 15, 1997, the Board of Directors of Summit Bancorp. (the
"Company") amended and restated the Summit Bancorp. Executive Severance Plan (as
amended, the "Plan"). A copy of the Plan, reflecting all amendments, is attached
hereto and made a part hereof as if fully set forth in this letter. Unless the
context otherwise requires or unless otherwise defined in this letter,
capitalized terms used in this letter have the meanings assigned to them in the
Plan.
The Committee, as a matter of separate inducement and not in lieu of any
salary or other compensation for services, has selected you to participate in
the Plan, subject to the terms and conditions of the Plan and this letter. This
letter constitutes your Participation Letter under the Plan.
Your participation in the Plan commences as of the effective date and time
of the merger of Prime Bancorp, Inc. into First Valley Corporation ("Effective
Time"). You cease to be a Participant in the Plan upon the earliest to occur of
(i) October 15, 2002 (the "Expiration Date"), (ii) the Date of Termination, and
(iii) your Retirement. The Expiration Date will be automatically extended for an
additional year (each such anniversary being the new Expiration Date) unless at
least 90 calendar days prior to the then Expiration Date, the Company notifies
you that the then Expiration Date will not be extended (it being understood that
the automatic extension operates in successive years so long as no notice is
given).
The payments and benefits to which you as a Participant in the Plan may
become entitled will be determined under the Plan. It is an express condition to
your entitlement to the payments of amounts and the provision of benefits
provided for by paragraph 5(a) of the Plan that the Company receive on the Date
of Termination a Release, Covenant Not to Xxx, Non-Disclosure and
Non-Solicitation Agreement executed by you, or your legal representative (in the
event of your death or Disability) in the form set forth in Exhibit A to the
Plan, and that such Agreement be effective.
The following special provisions ("Letter Amendments") supplement, amend
and supersede the provisions of the Plan, as applied to you:
A. At the Effective Time, your title shall be Senior Executive Vice
President of Summit Bancorp. Effective at the first meeting of the Board of
Directors of Summit Bank (PA) following the merger of Prime Bank with and
into Summit Bank (PA), you shall also have the titles of Chairman of the
Board, Chief Executive Officer and President of Summit Bank (PA). Your
duties shall be those as assigned to you from time to time by the Boards of
Directors of the Company and Summit Bank (PA) and the Chairman of the Board
and President of the Company and as are appropriate to the position of
Chairman of the Board and Chief Executive Officer of a bank subsidiary of a
publicly held bank holding company. Your base salary shall be not less than
$345,000, and your annual cash bonus shall be not less than $120,750. Your
Welfare Plans and perquisites shall be the welfare plans and perquisites
provided to you by Prime Bancorp, Inc. as of the Effective Time until the
sooner of the integration of the welfare plans and benefits of Prime
Bancorp, Inc. with those of the Company or one year from the Effective
Time, after which they shall be the Welfare Plans and perquisites provided
to a Senior Executive Vice President of the Company.
B. During the period from the Effective Time until the end of the Window
Month, as defined below, Section 6(d) of the Plan is amended to delete the
word "or" at the end of subparagraph 6(d)(vi), to delete the period at the
end of subparagraph 6(d)(vii) and insert "; or" in its place, and to add
the following subparagraph 6(d)(viii):
(viii) A termination of employment by the Participant for any reason
other than Disability or Retirement on or after Participant's
Normal Retirement Date during the calendar month which is the
nineteenth full calendar month following the Effective Date (such
calendar month being referred to herein as the "Window Month").
This Paragraph B of this Participation Letter shall be null and void and of
no effect commencing at the end of the Window Month.
C. During the period from the Effective Time until the end of the Window
Month, subparagraph 5(a)(v) of the Plan shall be null and void and
subparagraph 5(a)(i) shall be revised to read as follows:
(i) receive, promptly following the effective date of
the Release Agreement, a lump sum cash amount
equal to 2.99 times Participant's Base Salary and
Bonus Amount, provided, however, that in the event
that any of the lump sum cash amount and all other
payments and benefits received or to be received
by the Participant from the Company or any
affiliate or under any plan, arrangement or
agreement of or maintained by the Company or any
affiliate, in the opinion of independent tax
counsel to the Company, would be subject to the
excise tax (the "Excise Tax") imposed by Section
4999 of the Code (as hereafter defined), then the
lump sum cash amount shall be reduced to the
largest amount as will result in none of such
payments and benefits being subject to the Excise
Tax. The determination of any reduction in the
lump sum cash amount shall be made by independent
tax counsel to the Company in consultation with
the independent certified public accountants of
the Company.
This Paragraph C of this Participation Letter shall be null and void and of
no effect commencing at the end of the Window Month, and the original
subparagraphs 5(a)(i) and 5(a)(v) shall be reinstated.
D. Subparagraph 6(d)(iii) is amended by replacing the words
"301 Xxxxxxxx Xxxxxx, Xxxx Xxxxxxx Xxxxxxxx, Xxx Xxxxxx"
with "7411 Valley Green Road, Fort Washington,
Pennsylvania."
E. Paragraph 3a of the Release, Covenant Not to Xxx, Non- Disclosure and
Non-Solicitation Agreement, which is Exhibit A to the Plan and Exhibit A to
the Termination Agreement between the Company and you which is also
effective as of the Effective Time, shall be null and void and paragraph 3a
of Exhibit A to both documents shall read as follows:
a. Non-Competition with SUB. The parties recognize that
Executive is an important officer of SUB, that his
reputation and business and personal relationships are
of significant benefit to SUB, and a consideration in
the price paid to acquire the bank holding company of
which Executive was Chief Executive Officer, and that
he has access to information about SUB's plans and
projections as well as other confidential information.
The parties further agree that SUB is in direct
competition with certain banks and bank holding
companies and thrift institutions and their affiliates
and the Executive agrees that, for a period of two (2)
years from the date hereof, he will not accept
employment or serve in any capacity with any bank,
savings bank or savings and loan association the
deposits or accounts or shares of which are insured by
the Federal Deposit Insurance Corporation or credit
union the deposits or accounts or shares of which are
insured by the National Credit Union Administration or
any holding company for such bank, savings bank,
savings and loan association or credit union or other
entity controlling, controlled by or under common
control with such financial institution at a principal
place of employment within 25 miles of any office of
SUB or any entity controlling, controlled by or under
common control with SUB open to the public at the time
of this Agreement.
For purposes of this letter and the Plan, notices and all communications
provided for in this letter or the Plan shall be in writing and shall be treated
as having been duly given when delivered or mailed by United States certified
mail, return receipt requested, postage prepaid, addressed as follows: (i) if to
you, your address indicated on the first page of this letter; (ii) if to the
Company or the Subsidiary, Summit Bancorp., 000 Xxxxxxxx Xxxxxx, X.X. Xxx 0000,
Xxxxxxxxx, Xxx Xxxxxx 08543- 2066, Attention: Corporate Secretary; or (iii) to
such other address as either party may have furnished to the other in writing in
accordance with this paragraph, except that notices of change of address shall
be effective only upon receipt.
All questions pertaining to the construction, regulation, validity and
effect of the provisions hereof will be determined in accordance with the law of
the State of New Jersey regardless of the law that might otherwise govern under
applicable New Jersey principles of conflict of laws.
Your participation in the Plan is conditioned on your acknowledgment of the
terms of this letter. You also agree that this letter and your participation in
the Plan supersedes all prior participation letters and understandings relating
to severance benefits payable by the Company or the Subsidiary under severance
plans of the Company and its Subsidiaries, and all such prior letters and
understandings shall be null and void except for your Termination Agreement,
dated as of the date of merger of Prime Bancorp, Inc. into Summit Bancorp. You
agree that this letter and your participation in the Plan supersedes your
Employment Agreement with Prime Bancorp, Inc. dated December 18, 1995, as
amended June 17, 1999, other than the terms of such agreement relating to your
stock options, and any other agreements and understandings relating to
employment contracts with or severance benefits payable by Prime Bancorp, Inc.
or Prime Bank and that such Employment Agreement, except as aforesaid, and any
other such agreements and understandings shall be null and void. Please sign the
enclosed copy of this letter and deliver it to the Company in order to evidence
such acknowledgment and agreement.
Sincerely,
SUMMIT BANCORP.
By: /s/ Xxxxxxx X. Xxxx, Xx.
-----------------------------
Xxxxxxx X. Xxxx, Xx.,Secretary
Acknowledged and Agreed:
/s/ Xxxxx X. Xxxxx
----------------------
Xxxxx X. Xxxxx
Dated: July 30, 1999
Summit Bancorp. Executive Severance Plan
(Incorporated by reference to Exhibit (10)FF(ii)
on Form 10-Q for the quarter ended June 30, 1998)
EXHIBIT A
RELEASE, COVENANT NOT TO XXX,
NON-DISCLOSURE AND NON-SOLICITATION
AGREEMENT
This RELEASE, COVENANT NOT TO XXX, NON-DISCLOSURE AND NON- SOLICITATION
AGREEMENT (the "AGREEMENT") dated as of_________ among (1)
______________("Executive"), and (2) Summit Bancorp. and all parent and
subsidiary corporations, partnerships and other entities and affiliates
controlled by, controlling or under common control with Summit Bancorp.
(together with any predecessor and successor entities hereinafter being
collectively referred to as "SUB") sets forth the agreements of the parties
hereto with regard to the matters set forth herein:
1. Background. Executive is an Executive of SUB and
participates in SUB's Executive Severance Plan pursuant to a
Participation Letter dated ______________ and a party to a
Termination Agreement dated ________________ [as last amended
_____________](the Plan and the Letter and Agreement, as amended
from time to time, together being collectively referred to as the
"Contracts"). Any capitalized terms used but not defined herein
shall have the meaning set forth in the applicable Contract.
1. A Change of Control [has/has NOT] occurred [on (date)]. If a Change of
Control has NOT occurred, Executive is not entitled to any benefits
under the Termination Agreement.
2. Executive's employment with SUB will or has terminated on
______________, which shall be the Date of Termination for purposes of
the Contracts, notwithstanding any failure to adhere to the provisions
for giving a Notice of Termination and the method of determining the
Date of Termination set forth in the Contracts, any such failures
being hereby waived by the parties.
3. This termination shall constitute a termination "[for cause/
disability /retirement /other than for cause /by mutual agreement]"
for purposes of any stock options and restricted stock which Executive
holds, and the Termination Date shall be the termination date for the
purposes of such options. Attached hereto as Appendix A is a list of
all outstanding SUB options held by Executive on the date hereof.
2. Payment. Executive shall receive within two business days
following the EFFECTIVE DATE (as defined in paragraph 7 hereof)
$_____________, the gross amount due to Executive under the
Contracts, which shall be paid to Executive as $_________________
by check or deposit in Executive's bank account, with the balance
withheld in respect of federal, state and local taxes and
benefits contributions, which Executive acknowledges represents
all amounts currently due Executive under the Contracts.
Executive acknowledges and agrees that Executive is not entitled
to any severance payments under any other severance program of
SUB, the Contracts being intended to substitute for any such
other severance program. SUB continues to be obligated to
provide certain welfare and pension benefits and perquisites, as
more fully set forth in the Contracts.
3. Restrictive Covenants. In consideration of the payments to
Executive as specified in paragraph 2 above, Executive agrees as
follows:
a. Non-Competition with SUB. The parties recognize that
Executive is an important officer of SUB, that his
reputation and business and personal relationships are
of significant benefit to SUB, and a consideration in
the price paid to acquire the bank holding company of
which Executive was Chief Executive Officer, and that
he has access to information about SUB's plans and
projections as well as other confidential information.
The parties further agree that SUB is in direct
competition with certain banks and bank holding
companies and thrift institutions and their affiliates
and the Executive agrees that, for a period of two (2)
years from the date hereof, he will not accept
employment or serve in any capacity with any bank,
savings bank or savings and loan association the
deposits or accounts or shares of which are insured by
the Federal Deposit Insurance Corporation or credit
union the deposits or accounts or shares of which are
insured by the National Credit Union Administration or
any holding company for such bank, savings bank,
savings and loan association or credit union or other
entity controlling, controlled by or under common
control with such financial institution at a principal
place of employment within 25 miles of any office of
SUB or any entity controlling, controlled by or under
common control with SUB open to the public at the time
of this Agreement.
b. Non-Solicitation of SUB Employees. For a period of
five (5) years from the date hereof, Executive will not
solicit or induce any person who is an employee of SUB
or was such at any time within three months prior to
the date hereof to become employed by any other person,
firm or corporation or approach any such employee for
such purpose or authorize or knowingly approve the
taking of such actions by other persons, without the
prior written consent of SUB.
c. Non-Disclosure of Proprietary Information. Executive
acknowledges that during the course of Executive's
employment with SUB Executive received, obtained or
became aware of or had access to proprietary
information, lists and records of customers and trade
secrets which are the property of SUB and which are not
known by competitors or generally by the public
("Proprietary Information") and recognizes such
Proprietary Information to be valuable and unique
assets of SUB. For purposes of this subparagraph: (i)
Proprietary Information is deemed to include, without
limitation, (A) marketing materials, marketing manuals,
policy manuals, procedure manuals, policy and procedure
manuals, operating manuals and procedures and product
documentation, (B) all information about pricing,
products, procedures, practices, business methods,
systems, plans, strategies or personnel of SUB, (C)
circumstances surrounding the relationships with,
knowledge of, or information about the customers,
clients, and accounts of SUB, including but not limited
to the identity of current active customers or
prospects who have been contacted by SUB, the
expiration dates and other terms of loans or deposit or
other banking relationships, details or special product
provisions or special combinations of products, or
special prices, and (D) all other information about SUB
which has not been disclosed in documents filed with
the U.S. Securities and Exchange Commission or
otherwise publicly disseminated by SUB, whether or not
that information is recorded and notwithstanding the
method of recordation, if any; and (ii) Proprietary
Information is deemed to exclude all information
legally in the public domain. Executive agrees to hold
the Proprietary Information in the strictest confidence
and agrees not to use or disclose any Proprietary
Information, directly or indirectly, at any time for
any purpose, without the prior written consent of SUB
or to use for Executive's benefit or the benefit of any
person, firm, corporation or other entity (other than
SUB), any Proprietary Information, and to use
Executive's best efforts to prevent such prohibited use
or disclosure by any other persons. Executive has
returned all Proprietary Information in Executive's
possession or control to SUB.
d. Cooperation, No Detrimental Actions. Executive will
cooperate with SUB in enforcing its claims against
customers and former customers of SUB, including
appearing as a witness for SUB in court or
administrative proceedings, subject to reasonable
reimbursement for Executive's time and expenses.
Executive will not take actions or make disparaging
statements which are detrimental to SUB or the
RELEASEES, as defined in paragraph 5 below.
e. Remedies. Executive hereby acknowledges that
Executive's duties and responsibilities under this
paragraph 3 are unique and extraordinary and that
irreparable injury may result to SUB in the event of a
breach of the terms and conditions of this paragraph 3,
which may be difficult to ascertain, and that the award
of damages would not be adequate relief to SUB and the
RELEASEES. Executive therefore agrees that in the
event of Executive's breach of any of the terms or
conditions of this paragraph 3, SUB shall have the
right, without posting any bond or other security, to
preliminary and permanent injunctive relief as well as
damages and an equitable accounting of all earnings,
profits and other benefits arising from such violation,
which rights shall be cumulative and in addition to any
other rights or remedies in law or equity to which SUB
may be entitled against Executive. The covenants of
Executive in paragraphs 3a, 3b, 3c and 3d of this
Agreement shall each be construed as an agreement
independent of any other provision in this AGREEMENT,
and the existence of any claim or cause of action of
Executive against SUB, whether predicated on this
Agreement or otherwise, shall not constitute a defense
to the enforcement by SUB of paragraphs 3a, 3b, 3c and
3d.
f. Enforcement. If at the time of the enforcement of subparagraphs 3a,
3b, 3c, 3d or 3e above a court shall hold that the period or scope of
the provisions thereof are unreasonable under the circumstances then
existing, the parties hereby agree that the maximum period or scope
under the circumstances shall be substituted for the period or scope
stated in those subparagraphs.
4. Short-Swing Securities Profits. Executive acknowledges that Executive will
remain subject to the short-swing liability provisions of Section 16 of the
federal Securities Exchange Act of 1934 for six months following
termination of employment.
5. Release. In consideration of the payments to Executive as specified in
paragraph 2 above, Executive grants SUB a RELEASE of only all claims, both
known and unknown, that Executive may have that relate to the termination
of Executive's employment (hereafter a "WRONGFUL TERMINATION CLAIM"). The
Executive and SUB agree that a WRONGFUL TERMINATION CLAIM, specifically and
without limitation, does not include claims:
1. for indemnification as a corporate agent of SUB against
claims by third parties;
2. under employee benefit plans, including supplemental employee
retirement plans, maintained by SUB or any of the predecessor
organizations thereof, including but not limited to rights under any
workers compensation program, Section 502(a) of the Employee
Retirement Income Security Act, as amended, 29 U.S.C. 1001 et seq.,
and under the Consolidated Omnibus Budget Reconciliation Act of 1985
("COBRA");
3. arising out of enforcement of the Contracts or this
Agreement by Executive; or
4. constituting cross-claims against SUB as a result of claims brought by
unaffiliated third parties against Executive based on Executive's
service as an executive of SUB.
The statutes which could form the basis for a WRONGFUL TERMINATION CLAIM
include, but are not limited to, Title VII of the Civil Rights Act of 1964,
as amended, 42 U.S.C. 1971 et seq.; the Age Discrimination in Employment
Act of 1967, as amended, 29 U.S.C. 621 et seq.; Section 510 of the Employee
Retirement Income Security Act of 1974, as amended, 29 U.S.C. 1001 et seq.;
the Americans With Disabilities Act, as amended, 42 U.S.C. 12101 et seq.;
the Older Workers Benefit Protection Act, as amended, 29 U.S.C. 621 et
seq.; the Civil Rights Act of 1866, as amended, 42 U.S.C. 1981 et seq.; the
New Jersey Law Against Discrimination, as amended, N.J.S.A. 10:5-1 et seq.;
the New Jersey Conscientious Employee Protection Act, as amended, N.J.S.A.
34:19-1 et seq.; the New York Human Rights Law, Executive Law 290 et seq.;
the Pennsylvania Human Relations Act, as amended, 43 P.S. 951 et seq.; and
the Pennsylvania Whistleblower Law, as amended, 43 P.S. 1421 et seq. The
common law (non-statutory) theories under which a WRONGFUL TERMINATION
CLAIM could be made include, but are not limited to, breach of an express
employment contract, breach of a contract implied from a personnel handbook
or manual, or commission of a civil wrong (known as a "tort") resulting in
Executive's termination, or for alleged violation of the public policy of
the United States or any state. Granting a RELEASE of any WRONGFUL
TERMINATION CLAIM pursuant to this AGREEMENT means that on behalf of
Executive and all who succeed to Executive's rights and responsibilities,
Executive releases and gives up only any and all WRONGFUL TERMINATION
CLAIMS that Executive may have against SUB, and any of its subsidiaries,
affiliates or divisions, and all of their directors, officers,
representatives, shareholders, agents, employees, and all who succeed to
their rights and responsibilities (collectively referred to as "RELEASEES".
With respect to any charges filed concerning events or actions relating to
a WRONGFUL TERMINATION CLAIM that occurred on or before the date of this
AGREEMENT or Executive's Termination Date (whichever is later), Executive
waives and releases any right that Executive may have to recover in any
lawsuit or proceeding brought by Executive or by an administrative agency
on Executive's behalf against the RELEASEES.
6. Covenant Not to Xxx. Executive covenants not to xxx the
RELEASEES over any WRONGFUL TERMINATION CLAIM. Such a covenant
not to xxx the RELEASEES means that Executive represents that
Executive has not through the date of execution of this Agreement
filed a WRONGFUL TERMINATION CLAIM, charge or lawsuit with any
court or government agency against the RELEASEES, and that
Executive will not file such a lawsuit subsequent to execution of
this Agreement. Executive also waives any right to become, and
promises not to become, a member of any class in a case in which
WRONGFUL TERMINATION CLAIMS are asserted against any of the
RELEASEES.
7. Review Period. Executive acknowledges that Executive has up
to 21 days to review this AGREEMENT, and was advised to review it
with an attorney of Executive's choice. Executive also
acknowledges that Executive was further advised that Executive
has seven days after Executive signs this AGREEMENT to revoke it
by notifying SUB in writing, of such revocation as set forth
under Notices below. This AGREEMENT shall become effective on
the tenth (10th) day following its execution by Executive (the
"EFFECTIVE DATE"), unless revoked in accordance with the preceding
sentence.
8. Revocation of Authority. Executive agrees and acknowledges
that as of the Termination Date Executive shall no longer be
empowered to bind SUB in any agreement, whether verbal or
written, and that Executive shall have no authority to execute
any documents, deeds, leases, or other contracts on behalf of
SUB. To the extent not effected by termination of Executive
under the Contracts, Executive resigns from all offices and
positions with SUB.
9. Successors and Assigns. All rights and duties of SUB under this Agreement
shall be binding on and inure to the benefit of SUB, its successors and
assigns. All rights of Executive hereunder shall be binding upon and inure
to the benefit of Executive's personal or legal representatives.
10. Notices. All notices, requests, demands and other
communications hereunder shall be in writing and shall be deemed
to have been duly given if delivered personally with receipt
acknowledged or sent by registered or certified mail, postage
prepaid or by reputable national overnight delivery service, to
the addresses shown below, unless changed by notices given as
herein provided, except that notice of change of address only
shall be effective upon actual receipt:
If to SUB, to:
Summit Bancorp.
000 Xxxxxxxx Xxxxxx
X.X. Xxx 0000
Xxxxxxxxx, Xxx Xxxxxx 00000-0000
Attention: Executive Vice President of
Human Resources
With a copy to:
Summit Bancorp.
000 Xxxxxxxx Xxxxxx
X.X. Xxx 0000
Xxxxxxxxx, Xxx Xxxxxx 00000-0000
Attention: General Counsel
If to the Executive, to:
With a copy to:
11. Covenant Not to Challenge Enforceability. Both Executive and SUB understand
that this AGREEMENT is final and binding when executed by both parties,
subject to paragraph 7 above, and both agree not to thereafter challenge
its enforceability.
12. Applicable Law. This AGREEMENT shall be deemed to have been made within the
State of New Jersey, and it shall be interpreted, construed, and enforced
in accordance with the law of the State of New Jersey, and before the
Courts of the State of New Jersey.
13. Amendments, Modifications, Waivers. This AGREEMENT cannot be amended or
modified except by a written document signed by both SUB and Executive and
no provision can be waived except by a written document signed by the
waiving party.
14. By signing this AGREEMENT, Executive acknowledges:
1. EXECUTIVE HAS READ THIS AGREEMENT COMPLETELY.
2. EXECUTIVE HAS HAD AN OPPORTUNITY TO CONSIDER THE TERMS OF THIS
AGREEMENT.
3. EXECUTIVE HAS BEEN ADVISED TO CONSULT WITH AN ATTORNEY OF EXECUTIVE'S
CHOOSING PRIOR TO EXECUTING THIS AGREEMENT.
4. EXECUTIVE KNOWS THAT EXECUTIVE MAY BE GIVING UP IMPORTANT LEGAL RIGHTS
BY SIGNING THIS AGREEMENT.
5. EXECUTIVE UNDERSTANDS AND MEANS EVERYTHING THAT EXECUTIVE HAS SAID IN
THIS AGREEMENT, AND EXECUTIVE AGREES TO ALL ITS TERMS.
6. EXECUTIVE IS NOT RELYING ON SUB OR ANY REPRESENTATIVE OF SUB TO
EXPLAIN THIS AGREEMENT AND RELEASE TO EXECUTIVE. EXECUTIVE HAS HAD AN
OPPORTUNITY TO CONSULT AN ATTORNEY OR OTHER ADVISOR TO EXPLAIN THIS
AGREEMENT AND ITS CONSEQUENCES TO EXECUTIVE BEFORE EXECUTIVE SIGNED
IT, AND EXECUTIVE HAS AVAILED HIMSELF OR HERSELF OF THIS OPPORTUNITY
TO WHATEVER EXTENT EXECUTIVE DESIRED.
7. EXECUTIVE HAS SIGNED THIS AGREEMENT VOLUNTARILY AND ENTIRELY OF
EXECUTIVE'S OWN FREE WILL, WITHOUT ANY PRESSURE FROM SUB OR ANY
REPRESENTATIVE OF SUB, OR ANYONE ELSE.
IN WITNESS WHEREOF, and intending to be legally bound hereby, this
Agreement has been executed as of the day and year first above
written.
ATTEST: SUMMIT BANCORP.
______________________________By:______________________________
Secretary Executive Vice President
------------------------------
EXECUTIVE
--------------------------------
(Social Security Number)
STATE OF NEW JERSEY:
COUNTY OF _______________________:
I certify that on this _______ day of ____________, _______ personally came
before me _______________(Executive), who, being duly sworn, acknowledged under
oath to my satisfaction that such person is named in and personally executed the
foregoing Receipt and Release as such person's voluntary act and deed, for the
purposes set forth therein.
IN WITNESS WHEREOF, I have set my hand this ____ day of
-------------, ------.
By: ___________________________________
Notary Public of the State of New Jersey
My Commission expires __________________
