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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
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ESTATE OF ~ ~~~ =~= ~~~'
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Arthur R. Shope, Jr. No. 12-12-01016 ~ , .:_ ' ~~
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Late of Silver Springs Township ~ c -~ - ~, ---
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Cumberland County, PA ~~ l' -= _ ~=
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DISCLAIMER
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WIIEREAS, Arthur R. Shope, Jr., Late of Silver Springs Township, Cumberiand
County, Pennsylvania, died on August 9, 2012, testate, leaving his Last Will and
Testament dated August 24, 2006, which was probated in the Office of the Register of
Wills, for Cumberland County, Pennsylvania on October 16, 2012; and
WHEREAS, Arthur R. Shope, Jr. executed a Living Trust dated August 24, 2006,
as amended October 1, 2007 and November 12, 2008; and
WHEREAS, Arthur R. Shope, Jr.'s niece, Jeanne Ptaszenski, 6112 Linglestown
Road, Harrisburg, PA 17112, was named as a twenty (20%) percent beneficiary under the
Arthur R. Shope, Jr. Living Trust; and
WHEREAS, the Jeanne Ptaszenski has been advised and fully understands that
the result of this Disclaimer shall be that her entire twenty (20%) percent share of the
assets of the Living Trust will be distributed in accordance with his Trust in equal shares
to her then-living children, Erin Ptaszenski, Michael Ptaszenski and Adam Ptaszenski,
specifically as a result of this Disclaimer, will become a part of and be administered
under the terms of the Living Trust; and
WHEREAS, the undersigned, Jeanne Ptaszenski, has not accepted any interest in
or benefit from the Living Trust and pursuant to the provisions of Section 2518 of the
Internal Revenue Code of 1986, as amended, and Section 6201 of the Pennsylvania
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Probate, Estates and Fiduciaries Code, as amended, desires to and does hereby disclaim
any and all interest she may have in and to her interest in the Living Trust and further
disclaims her right to receive a twenty (20%) share of the assets of the Living Trust.
IN WITNESS WHEREOF, and intending to be legally bound hereby, I have
hereunto set my hand and seal this ~~ ~ day of ~~~" 2012.
Witness:
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Jeanne Ptaszenski
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF YORK
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On this, the ~ day of
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2012, before me, the
undersigned officer, personally appeared JEANNE PTASZENSKI, 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 have hereunto set my hand and official seal.
~ / (SEAL
Notary Public
KRSsTar1 L. ~~~~~~~, ~r~t~ry ~~~~~~
Lower Paxto-~ Twp., ~auphir~ County
My Comr~is~i~r~ Expires ~~tober 3t~, 2Q1z
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