HomeMy WebLinkAbout06-10-09IN RE: : IN THE COURT OF COMMON PLEAS
ESTATE OF MARY JANE MOWERY :CUMBERLAND COUNTY, PENNSYLVANIA
DECEASED :ORPHANS' COURT DIVISION
NO.2009-00219
DISCLAIMER OF INTEREST IN ACCORDANCE
WITH 20 PA C.S.A. § 6201, et seq.
KNOW ALL MEN BY THESE PRESENTS, THAT:
1. Mary Jane Mowery (the "Decedent")died on February 28, 2009, leaving a Last Will and
Testament that was admitted to probate by the Register of Wills of Cumberland County,
Pennsylvania (the "Will").
2. Donald H. Mowery (the "Disclaimant") pursuant to Section 6201 et sew. of the Probate,
Estates and Fiduciaries Code, Pa. C.S.A.. 6201-6207, and the common law of the
Commonwealth of Pennsylvania, irrevocably disclaims and renounces the following
interests to which he would otherwise be entitled upon the death of the Decedent (the
"Disclaimed Interests"):
(a) The survivorship interest to which the Disclaimant, as the rvivor, veld
succeed by operation of law upon the death of the Decedent, as the joi er of i
following accounts held with Citizens Bank:
-Checking Account No. 6100735478 ca
-Checking Account No. 6200262210 ~ ~
-Certificate of Deposit No. 6247351017
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3. The Disclaimant has not received any benefits from the Disclaimed Interests, and
represents and warrants that he has never exercised any power over or with respect to
the Disclaimed Interests.
4. The Disclaimant represents and warrants that he has not received, and is not to receive,
any consideration in money or money's worth for such renunciation and disclaimer from
any person or persons whose interest is to be accelerated or increased, or from any
other person or persons.
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IN WITNESS WHEREOF, and intending to be legally bound hereby, and intending that a
copy of this Disclaimer shall be provided to Citizens Bank, and to Donald H. Mowery, the
Executor of the Estate of Mary ~ne Mowe as provided in 20 Pa. C.S.A. §6204, I have
hereunto set my hand this ~ day of ~w~.~. , 2009.
Donald H: MoVvery
COMMONWEALTH OF PENNSYLVANIA
pry ~+r~a : ss:
COUNTY OF
On this, the `f' -day of u~c.. _, 2009, before me, a Notary Public, the
undersigned officer, personally appeared Donald H. Mowery, known to me (or satisfactorily
proven) to be the individual who executed the foregoing instrument, and duly acknowledged to
me that he executed the same for the purposes therein.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
~~~ /-f . a-v~-'
Notary Public
(SEAL)
My Commission Expires: co~o~vw [, of
Nors~see~
Ma~iaitne H. Acft p~p~nPubNc
Mi-~"~`"~E~re.~~wlune 10~ 26i0