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DISCLAIMER ~' ~ ! Z ~~~~' - 8 PP1 2~ 17
In accordance with Internal Revenue Code Section 2518 (b) and p p-S,ec~i~x} 6201
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of the Pennsylvania Probate Estate and Fiduciaries Code, (20 PA.C.S.A. `62'0~)~ "t14~~l~el~imer
is being executed by the undersigned beneficiary, ROGER B. IRWIN in order to disclaim the
bequest designed to me in Paragraph 4(d) of the Last Will and Testament of Robert H.
Bowersox.
In Witness Whereof, and intending to be legally bound hereby, and intending that this
Disclaimer shall be filed of record in the Office of the Clerk of the Orphans' Court Division of
the Court of Common Pleas of Cumberland County, Pennsylvania as provided in 20 Pa. C.S.
§ 6204(a), I have hereunto set my hand this ~ ~ r day of , 2012, the same being
effective as of the date of death of the decedent, Robert Bowersox on September 10, 2012.
WITNESS:
~ .
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
,~`~ ~ - ~~ (SEAL)
ROGER WIN
SS
On this, the ~ ~ day of October, 2012, before me, the undersigned officer, personally
appeared ROGER B. IRWIN known to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument, and acknowledged that he executed the same for the purposes
therein contained.
In witness whereof, I hereunto set my hand and official seal.
(SEAL)
COMMONWEALTH OF PENNSYLVANIA 1 otar Public
NorarlaF SeN
ICare~ S. Noel, Notary Public
CarMsk Bb% Qnnberland County
ConMnbMon Dec. 8.2015
MEMBER, pENNSYLYANUI ASSOQATION OF NOTARIES
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