HomeMy WebLinkAbout12-22-11I ~~ 1 L - (. z-(,~ 7
DISCLAIMER
-,
_._ _ ..
~; ~
. -:~ ~.
-~~
- -~ ~
. ~.. ~_
---~ ~:.
,~~ , ---
.; - :-
;r
L.
I, FORREST R. LEWIS, Individually and as Administrator of the Estate of
Sherry A. Lewis, declare that I am the widower and a beneficiary of the Estate of
Sherry A. Lewis (Decedent) who died intestate on April 18, 2010 with Letters of
Administration having been issued on May 11, 2010 by the Cumberland County
Register of Wills Office, Carlisle, Pennsylvania, in Docket Book 21-10-00487. As
set forth in the Notice of Beneficial Interest in Estate, as filed on September 24,
2010, the intestate heirs of the Estate of Sherry A. Lewis are Forrest R. Lewis,
her husband, and Michael Freundel, her son.
I, FORREST R. LEWIS, Administrator and beneficiary of the Estate of
Sherry A. Lewis, intending to be legally bound hereby, do hereby irrevocably and
completely disclaim any and all interest I have in the real property of the
Decedent located at 400 East Chestnut Street, Shiremanstown, Lower Allen
Township, Cumberland County, Pennsylvania. Said property is more particularly
bounded and described in the deed dated October 27, 2003 and recorded
November 26, 2003 in the Office of the Cumberland County Recorder of Deeds
in Deed Book 260, page 2768, and in the corrective deed executed on April 18,
2006 was thereafter recorded on April 25, 2006 in the Office of the Cumberland
County Recorder of Deeds in Deed Book 274, page 810.
The foregoing rights, title and interests shall collectively herein be refered
to as the "Disclaimed Interests."
I hereby certify that I have not accepted any benefits or interest with
respect to the Disclaimed Interests on or following the Date of Death.
-~-,
-~_
`, - t-
-,
''
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.
Dated this ~ ~~~ day of ~~~'~ ~ ~ , 2011.
Witness:
Forrest R. Lewis, Individually and as
Administrator of the Estate of
Sherry A. Lewis
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
On this, the
SS
~'~ day of G~ o ~~,,~," I-
2011, before me, a
Notary Public in and for the state and county aforesaid, the undersigned officer,
personally appeared FORREST R. LEWIS, known to me (or satisfactorily
proven) to be the person described in the foregoing instrument, and
acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~~ `'~ ~ L== ~ ~-.------ (SEAL)
Notary Public
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
MINDY S. GOODMAN, Notary Public
Lower Pax'on Twp., Dauphin County
Commission Expires May 21, 2013
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: ESTATE OF SHERRY A. LEWIS,
DECEASED
ORPHANS' COURT DIVISION
NO. 21-10-0487
BENEFICIARY DISCLAIMEF
FILED ON BEHALF OF:
FORREST R. LEWIS, Administrator
COUNSEL OF RECORD FOR THIS PARTY:
MINDY S. GOODMAN
ATTORNEY AT LAW
ATTORNEY I.D. #78407
2215 FOREST HILLS DRIVE
SUITE 35
HARRISBURG, PA 17112
(717) 540-8742