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In re: ESTATE of SHIRLEY C. STONER IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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File No. 21-11-1294 o~ 1 rn C'>
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DISCLAIMER -
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I, ZACHARY KISNER, grandson of Shirley C. Stoner, deceasedT>hereby aowf'edgt
having read and understood the Last Will and Testament of Shirley C. Stoner, deceased, dated
May 5, 2010, and further, as set forth below, and for the reasons set forth hereinafter, do hereby
disclaim and/or renounce my following interest in her estate:
1. Pursuant to Article IV, paragraph 2A, I am entitled to a specific bequest of the sum of
Forty-Five Thousand Dollars ($45,000.00).
2. Prior to the death of Shirley Stoner, my grandmother, she gave me a gift of
$15,000.00.
3. Also, prior to her death, Shirley Stoner, deceased created two (2) Certificates of
Deposit totaling $41,607.56 made payable on her death to me.
4. With full knowledge that pursuant to the Last Will and Testament of Shirley Stoner, I
could legally claim my entitlement to the additional $45,000.00, as set forth in the Last Will
and Testament, I hereby disclaim and/or renounce that interest since I believe the monies
listed above represent the same monies she intended to bequeath to me
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IN WITNESS WHEREOF, I, AjHARY KISNER, have set my hand to this Disclaimer
this day of 2012.
ACHAR SNER
Signed, sealed, published and declared by the above-named ZACHARY KISNER, in the
presence of us, who, at his request and in his presence, and in the presence of each other, have
hereunto subscribed our names as witnesses.
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
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COUNTY OF CUMBERLAND
1, ZACHARY KISNER, whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed the
Disclaimer; that I signed it as my free and voluntary act for the purposes therein expressed.
NOTARIAL SEAL
JEANETTE K RUTH
Notary Public
MECHANICSBURG BORO., CUMBERLAND CNTY CHARY R
My Commission Expires Feb 26, 2016
Sworn or of rmed to and acknowledged before me by ZACHARY KISNER, this
day of (3cJ6 A- , 2012.
otary Public