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LIVING TRUST ESTATE OF DONALD ~ `~XYV~'~_ ~ #~ ~ w ~ ,~
DISCLAIMER and RENUNCIAT,~,QN, .; ,
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WHEREAS, Donald J. Lowry died on September 16, 2012y~ ~,r~~id~ri~Ce'o1~ tilechanicsburg.
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Cumberland County, Pennsylvania (the "Decedent"). ~ ~,".
WHEREAS, during the Decedent's lifetime, he created the Donald J. Lo~~ry Living Trust
dated January 23, 1995, and any amendments thereto (the "Trust"). The Successor Death Trustee of
the Tnist is Lois D. Lowry.
WHEREAS, the assets of the Trust are to be distributed into two separate shares to be
identified as the Survivor's Share and the Family Share, with the Family Trust to be funded first.
The Trust further provides that the Family Share is to be held, administered and distributed
according to the provisions of the Family Trust.
WHEREAS, Article Seven, Section 4.e of the Trust allows the spouse to disclaim an
interest in any assets set aside as part of the Family Share.
WHEREAS, pursuant to Article Seven, Section 4.e of the Trust, the Trustee shall distribute
the disclaimed interest of the Family Share under the terms of the Family Trust, Article Nine,
Section 2.
WHEREAS, the disclaimed assets of the Family Share consist of those listed on Schedule
A attached hereto (the "Assets").
WHEREAS, less than nine (9) months have elapsed since the date of death of the Decedent
and the undersigned Disclaimant has not accepted any of the Assets nor has she exercised anv
control as beneficial owner over the Assets or any interest therein.
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WHEREAS, the Disclaimant acknowledges that the effect of the execution of this
Disclaimer and Renunciation is that the Assets that would have otherwise been held for her benefit
under the Family Trust shall pass to the Decedent's children, Donald J. Lowry, Jr., Joseph M.
Lowry, and Steven J. Lowry.
NOW, THEREFORE, I, LOIS D. LOWRY, an adult beneficiary residing at 4904
Colonial Drive, Mechanicsburg, do hereby exercise the rights granted to me in the Pennsylvania
Probate, Estates and Fiduciaries Code, 20 Pa. C.S.A. §6201 et seq., to DISCLAIM AND
RENOUNCE all right, title and beneficial interest in and to the Assets. As a consequence of this
instrument and the provisions of the Trust, those Assets shall now pass to Donald J. Lowry, Jr.,
Joseph M. Lowry, and Steven J. Lowry.
IN WITNESS WHEREOF, intending to be legally bound that this Disclaimer and
Renunciation shall be filed of record with the Trustee of the Living Trust, as provided in 20 Pa.
C.S.A. §6204(a), I have hereunto set my hand this /a~ day of /-/~/G,n ~C~' , 2012.
WITNESS:
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LOIS D. LOWRY
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COMMONWEALTH OF PENNSYLVANIA )
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COUNTY OF )
On this, the ~a~~ day of P~n~~~' , 2012, before me, a Notary Public in and for the
Commonwealth of Pennsylvania, the undersigned officer, personally appeared LO1S D. LOWRY.
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.
COMMONtNEALTH OF PrENNSYLVANIA
Notarial Seal
Notary Publ1C Catherine McHenry, Notary Public
Carrofi 7wp., Perry County
~~ ~ ~, ~ O 1 / „ My Commission Expires June 27, 2016
My Commission Expires: ~-f' ~E~$'~~~ ~~~~'~'"°~*"';" ~^G`rn"'?"" of raoraRies
SCHEDULE A
DONALD 1. LOWRY LIVING TRUST DISCLAIMED ASSETS
ASSETS VALUE
MetLife (New England Life) Insurance Policy # 6874479 $109,817.11
Less: Funeral Expenses
$19,817.11
Total disclaimed $90,000.00
SCHEDULE B
DONALD J. LOWRY SURVIVORS TRUST DATED JANUARY 23, 1995
ASSETS VALUE
$0.00