HomeMy WebLinkAbout02-22-10,~ - ~o ~ Goys
QUALIFIED DISCLAIMER
In accordance with Internal Revenue Code Section 2518 (b) and pursuant to Section 6201
of the Pennsylvania Probate Estate and Fiduciaries Code, (20 PA.C.S.A. Section 6201), this
Qualified Disclaimer is being executed by the undersigned beneficiary, TODD A. KOCH, in
order to disclaim in whole all of his interest in the ESTATE OF CHRISTINA A. KELLER:
The undersigned, as one of the beneficiaries in the above-referenced Estate is hereby
disclaiming his interest in the estate in favor of the Decedent's mother, KATHRYN M.
KELLER, as evidenced by the undersigned's execution hereof.
This disclaimer is executed as of this ~o?~day of February, 2010, the same being
effective as of the date of death of the decedent, Christina A. Keller on January 2, 2010.
WITNESS:
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TODD A. KOCH ~„~
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COMMONWEALTH OF PENNSYLVANIA ~:°,~ ~ N
SS r.:;,c~;y,
COUNTY OFCUMBERLAND ~~ _~c-yy~-~~ ~ ``~''
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On this, the ~ day of February, 2010, before me, the undersigned ofi~er,
personally appeared Todd A. Koch, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within instrument, and acknowledged that he executed the same
for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
(SEAL)
~, ~ Pi".NNSYtvaNiA Not Pu lic
CpPpMONW EAi~T.y_
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Karec; : ^>"~`, 4d~+tary Public
Carlisle t?or;,. ~~~s~nbr~;arxi County
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Member, Pennsylvania ~SSC'~'`-'`'"~' °` rotaries
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