HomeMy WebLinkAbout04-23-10~~~
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QUALIFIED DISCLAIMER
In accordance with Internal Revenue Code Title 26, Section 2518 (26 U.S.C. Section
2518), the U. S. Code of Federal Regulations (26 CFR Section 25.2518-2) 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 made and delivered to Robert S. George and executed
by the undersigned beneficiary, Angela A. Lane in order to irrevocably disclaim and refuse in
whole her interest in the Estate of Beverly A. George more particularly described as follows:
1 /4th balance of the intestate estate.
This Qualified Disclaimer is being made within nine (9) months after the later of: (a) the
day on which the transfer creating said interest is made, or (b) the day on which such person
attains age 21. Further it is hereby stated and certified that the said beneficiary has not accepted
the interest in any way or any of its benefits.
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This disclaimer is executed on this~.day of , 2010, the same being
effective as of the date of death of the decedent, Beverly A. George on February 11, 2010.
WITNESS:
(SEAL)
Angela .Lane
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COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF ;
On this, the ~^~lay of r-~ 2010, before me, the undersigned officer,
personally appeared Angela A. Lane, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within instrument, and acknowledged that she executed the
same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seal.
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ONWEAL'fi~ t~.dF PEN ~y~.~'AIVIA.
Notanal Seal
Te-mera 5• giegrist, Notary Pabiic
We-ynesboro i3oro~ Fri ~~
N~,t Gomrri~ion Expires OrC~ 1 ~ ~~...,~
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