HomeMy WebLinkAbout10-24-11 (4)1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHAN'S COURT DIVISION
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ESTATE OF THOMAS J. HULL :Estate No. 21-11-0909 ~ r''
Late of Borough of Shiremanstown, -- ; ;_~-~
Cumberland County, Pennsylvania, deceased "
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DISCLAIMER
I, Patricia Taylor, hereby declare that I am the cousin of Thomas J. Hu11, who died on July
31, 2011 (the "Date of Death").
I hereby irrevocably and completely disclaim and refuse to accept any and all rights, title
and interests that I may have to receive pursuant to the intestacy laws of the Commonwealth of
Pennsylvania, specifically 20 Pa.C.S. § 2104, all with respect to the Estate of Thomas J. Hull.
The foregoing rights, title and interests shall collectively herein be referred to as the "Disclaimed
Interests".
I hereby state and certify that I have not accepted any benefits or interest with respect to
the Disclaimed Interests on or following the Date of Death.
This document is intended to qualify as a disclaimer under Section 251.8 of the Internal
Revenue Code of 1954, as amended, and under Chapter 61 of the Pennsylvania Probate, I3states
and Fiduciaries Code.
Dated this day of ~~~~~. ~ , 2011.
Witness:
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PATRICIA TAYLOR
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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On this ~ day of ~~ ~.~ , 2011, before me, the
undersigned officer, a Notary Public in and for the said county and state, personally appeared
PATRICIA TAYLOR, 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 her knowledge,
information, and belief and that she executed the same as her voluntary act and deed for the
purposes therein contained.
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Notary Public