HomeMy WebLinkAbout04-23-10 (2)1
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QUALIFIED DISCLAIMER
In accordance with Internal Revenue Code Title 26, Section 2518 (26 L.S.C. Section
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(SEAL)
S epha ie G. Douglas
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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 1'A.C'.S.A. Section
6201), this Qualified Disclaimer is being made and delivered to Robert S. George and executed
by the undersigned beneficiary, Stephanie G. Douglas in order to irrevocably d.iscl~~im and refuse
in whole her interest in the Estate of Beverly A. George more particularl~~ described as follows:
1 /4t" 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 this2?.~iay of Q r, ,~~~__~ 2C)10, the same being
effective as of the date of death of the decedent, Beverly A. George on February 11, 2010.
WITNESS:
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COMMONWEALTH OF PENNSYLVANIA
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COUNTY OF
On this, the2z~'~y of ~ ~ 2010, before me, the undersigned officer,
personally appeared Stephanie G. Douglas, 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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CQpAMUNUVElAiYH fJF pENNSYLVANl1~
Notarial Seal
Tamara S. Siegrist, Notary Public
Waynesboro Boro, Franklin County
My Commission Exp~~::~ Dec.1,2010
Member, Penns~~v~~s~r~,s~~~.iatiort of NM9rlN