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IN THE COURT OF COMMON PLEAS __r ~-; ,~, - = ;
CUMBERLAND COUNTY, PENNSYLVANIA ~ ' ~' -
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IN RE : _ 7 -~ .~
ESTATE OF ELIZABETH W. PASSANANTI, ~ c
Deceased ORPHANS' COURT DIVISION
ESTATE NO. 21-08- ~ ~ Q(p
DISCLAIMER
I, DIANE P. HOPPA, of State College, Pennsylvania, hereby declare that I am the
daughter of Elizabeth W. Passananti, ("Decedent") who died on October 31, 2008. At the time
of the Decedent's death, she left a Last Will and Testament dated June 26, 2000 and a Codicil
dated August 21, 2008.
I, DIANE P. HOPPA, hereby irrevocably and completely disclaim and refuse to accept
any and all interest in the Independent Retirement Accounts in which I am named as a
beneficiary.
Dated the;~_ day of Jc~..t1 ~ ~-.~ , 2009.
WITNESS:
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~~~r=, ;%~ lL~<.T_:~~ ~ ~,t,~ ~, ~~_ (SEAL)
DIANE P. HOPPA
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF C ~_ ,~ ~ ~~~
On this l ~~ ~ day of ~~«,~ ~-may , 2009, before me, the undersigned officer, a
Notary Public, in and for the said county and state, personally appeared DIANE P. HOPPA, who,
being duly sworn according to law, deposes and says that the facts set forth in the foregoing
Disclaimer are true and correct to the best of her knowledge, information <ind belief and that she
executed the same as her voluntary act and deed.
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Notary P blic
My Commission Expires:
(SEAL) C~MMON'YVEALTH ^F PENNSYLVANIA
NOTARIAL SEAL
,MARY B. WERNER -NOTARY PUBLIC
I ~~~ ate College Boro., Centre County
`."'~ "':`MM!SSION EXPIRES JAN. 22, 2011
..-----
.~ . .
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
IN RE:
ESTATE OF ELIZABETH W. PASSANANTI,
Deceased :
RECEIPT OF DISCLAIMER
named Executor of the Estate of Elizabeth W. Passananti, and that on the date and place as
The undersigned being duly sworn according to law, deposes and says that he is the
ORPHANS' (~OURT DIVISION
ESTATE NO.. 21-08-
hereinafter set forth, he received the foregoing signed Disclaimer from Di~~ne P. Hoppa.
Date
~` .
Place
3401 N Front Street
Harrisburg, PA 17110-0950
Sworn to and subscribed before me this / ! i < day of < _ - - , 200
Notary- ubhc
Si nature
My Commission Expires:
(SEAL)
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Vi~;ky F1r ; _~ry Public
SU9gUei"_ ,,,_,iin COUnty
My ~ u~nr, :. 11, 2010
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