HomeMy WebLinkAbout04-18-08
15079-2/2.27.08/EGM/DLW/325029
IN RE: ESTATE OF DONNA L. PALENZ
LATE OF HAMPDEN TOWNSHIP,
CUMBERLAND COUNTY , PENNSYLVANIA
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NO. 21-2007-1134
DISCLAIMER
I, CHARLES R. P ALENZ, hereby exercise the rights granted to me in Chapter 62 of the Probate,
Estates and Fiduciaries Code, 20 Pa. C.S.A. SS 6201-6207, and disclaim any right, title and/or interest I may
have as the beneficiary under the UNUM Life Insurance Company, group term policy number 341485,
insuring the life of Donna L. Palenz (formerly Breckenridge), my Wife
IN WITNESS WHEREOF, intending to be legally bound and intending that this Disclaimer shall be
filed with the Clerk of the Orphans' Court Division of the Court of Common Pleas of Cumberland County,
pen';:.y!.v:u;ia, as provided in 20 Pa. C.S.A. S 6204 (a), I hereunto set ~y hand and seal this 1<; [! day of I
I~ ,2008.
Sworn to and s.ubscribed before ;.
me this _ / q -8- day Ot:Febl U'lty,' IUI/t.d.J
'I 2008.
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1i ary Public ~
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[COM Wt:A~~t~:NNSYLVANIA
Margaret E. Ruff, Notary Public
L.emoyne Boro. Cumberland County
MyComr~~ E~~I~e:. May 30. 2011
'~ember. Pew'" .... .."">1 of Notaries
Cli~~
CHARLES R. P ALENZ
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15079-2/2.27.08/EGM/DLW/325032v2
IN RE: ESTATE OF DONNA L. PALENZ
LA TE OF HAMPDEN TOWNSHIP,
CUMBERLAND COUNTY, PENNSYLVANIA
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
NO. 21-2007-1134
DISCLAIMER
L HOLLY A. ANDERSON, hereby exercise the rights granted to me in Chapter 62 of the Probate,
Estates and Fiduciaries Code, 20 Pa. C.S.A. SS 6201-6207, and disclaim any right, title and/or interest I may
have as the beneficiary under the UNUM Life Insurance Company, group term policy number 341485,
insuring the life of Donna L. Palenz (formerly Breckenridge), my Mother.
IN WITNESS WHEREOF, intending to be legally bound and intending that this Disclaimer shall be
filed with the Clerk of the Orphans' Court Division of the Court of Common Pleas of Cumberla-rt- County,
Pennsylvania, as provided in 20 Pa. C.S.A. S 6204 (a), I hereunto set my hand and seal this I [) day of
/J;;~/t~JL ,2008.
Sworn to and _~J.lbscribed befort:)
. v lt1- tYI a. reJL
me this 111 day of.F ebp..uuy;
2008.
"~iML
COMMONWEALTH OF PENNSYLVANIA
[Notarial Seal
Amy Lynn Rivers, Notary Public
Akron Boro, Lancaster County
My Commission Expires Jan. 24, 2012
Member, Pennsyl'/ania Association of Notaries
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