HomeMy WebLinkAbout03-27-13 QUALIFIED DISCLAIMER
In accordance with Internal Revenue Code Section 2518 (b)and pursuant to Section 6201
of the Pennsylvania Probate Estate and Fiduciaries Code, (20 PA.C.S.A. Section 6201), this
Qualified Disclaimer is being executed by the undersigned beneficiary, HANNAH
BRICKNER, in order to disclaim in whole all of her interest in the ESTATE OF BARRY R.
BRICKNER:
The undersigned, as one of the beneficiaries in the above-referenced Estate is hereby
disclaiming her interest in the estate in favor of her mother, JONI BRICKNER, as evidenced by
the undersigned's execution hereof.
This disclaimer is executed as of this 93 day of March, 2013, the same being
effective as of the date of death of the decedent, Barry R. Brickner on September 11, 2012.
WITNESS:
� (SEAS m
�. HANNAH BRICKNER co �a --m �? e�>
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STATE OF
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COUNTY OF Ck
On this, the day of March, 2013, before me, the undersigned officer, personally
appeared Hannah Brickner, 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 hereunto set my hand and official seal.
�MOMNEALTH OF PENLIOVIVANIA
NOTARIAL SEAL
MORGAN DEMARK;Notary Public (SEAL)
Carlisle Borough,Cumberland County Notary P c
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