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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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In Re: ~ i~~~_ -~
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ESTATE OF ALBERT B. SNIZIK, Estate No. 2009-01117 ~ ` _- `_~-; _._
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Late of Lemoyne Borough, Cumberland - _ ~~ c~
County, Pennsylvania, deceased ~ ` -' ~`T'
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DISCLAIMER
I, Richard A. Snizik, hereby declare that I am the son of Albert B. Snizik, who died on
November 15, 2009.
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I hereby irrevocably and completely disclaim and refuse to accept any and all rights, title
and interests that I may be entitled to receive pursuant to Item Fourth and Item Fifth of the Last
Will and Testament of Albert B. Snizik dated May 11, 2005, during the lifetime of my mother,
Mary E. Snizik, which permits the invasion of trust principal for my benefit.
I hereby state and certify that I have not accepted any benefits or interest pursuant to
Item Fourth or Item Fifth of the Last Will and Testament of Albert B. Snizik dated May 1 i , 2005,
with regard to any invasions of trust principal for my benefit.
This document is intended to qualify as a disclaimer under Section 2518 of the Internal
Revenue Code of 1954, as amended, and under Chapter 61 of the Pennsylvania Probate,
Estates and Fiduciaries Code
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Dated this day of ` ~~ , 2010. ~'
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Witness: n
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Richard A. S`r~i`zik
(SEAL)
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
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COUNTY OF 1.~~-~ b-e~.~
On this `~ ` day of ~ ~r • .2010. before me_ the undersianeri nfficPr ~
Notary Public in and for the said county and state, personally appeared Richard A. Snizik, 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 his knowledge, information, and belief and that he
executed the same as his voluntary act and deed for the purposes therein contained.
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N tary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Betty Ann McMullan, Notary Public
Penn Twp., Perry County
My Commisslon Expires ]an. 28, 2014
Member, Pennsylvania Association of Notaries
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
I n Re:
ESTATE OF ALBERT B. SNIZIK, Estate No. 2009-01117
Late of Lemoyne Borough, Cumberland
County, Pennsylvania, deceased
RECEIPT OF DISCLAIMER
Mary E. Snizik, being duly sworn according to law, deposes and says that she is the
Executrix under the Last Will and Testament of Albert B. Snizik dated May 11, 2005, and that
on the date and place as hereinafter set forth, she received the foregoing signed Disclaimer
from Richard A. Snizik.
ESTATE OF ALBERT B. SNIZIK, Deceased
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Mary E. nizik, executrix
Date: 8 1 ~ ~ ~ O
Place: I~ ct ,
SWORN TO AND SUBSCRIBED before me this ~~
2010.
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Notary Pu i
COMMONWEA~TM OF PENNSYLVANIA
Notarial Seal
Betty Ann McMullan, Notary public
Penn Twp., perry County
My Commission Expires )an. 28, 2014
Member, Pennsylvania Assodation of Notaries
524174v1
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