HomeMy WebLinkAbout12-18-12F:\FILES\Clienta\14895 Mary Levine\Estate\14895.1.Disclaimer Kenneth Levine.wpd
REC4ROEQ r~~-~~;E QF
IN RE: EST?C ~ R 01= '~~~~ ~ ~w ° S
MARY LE~E~ ~ ~ 1$ ~' ~ ~ Z Q
DECEASED C 1' E R ~ 'J ~
QRPNANS' OOvRT
CUMBERLAND CO., PA
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
:ORPHANS' COURT DIVISION
N0.21-12-0962
DISCLAIMER
WHEREAS, I, Kenneth Levine, am a beneficiary in the above captioned Estate of Mary
Levine; and
WHEREAS, I desire to disclaim a portion of my interest in the Estate of Mary Levine
pursuant to 20 Pa.C.S.A. Section 6201 et seq.
NOW, THEREFORE, I hereby disclaim my portion of the Estate of Mary Levine consisting
of the first $250,000.00 in funds to be distributed to me pursuant to the Will of Mary Levine and the
administration of the Mary Levine Estate. I specifically hereby reserve and do not disclaim any
interest I may have in the Estate of Mary Levine over and above the sum of $250,00.00.
IN WITNESS WHEREOF, 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 Please of Cumberland County, Pennsylvania, have hereunto set my hand and
seal, this day of December, 2012.
Keene Levine
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
On this, the / 3 ~~ day of , 2012, before me, a Notary Public
personally appeared Kenneth Levine, -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.
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL Lip y
Victoria L. Otto, Notary Public l ~
Carlisle Boro, Cumberland County Notary Public
M commission ex fires December 20, 2014
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