HomeMy WebLinkAbout10-01-13 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHAN'S COURT DIVISION
In Re:
Gilbert Prowell Charitable Remainder Unitrust : No. 2013- 1 032
DISCLAIMER OF UNITRUST INTEREST
I, Myra P. Reilly ("Myra"), of 3006 Jason Place, Madison, Wisconsin, hereby declare
that I am the designated unitrust beneficiary in Gilbert Prowell Charitable Remainder Unitrust.
I, Myra, hereby irrevocably and completely disclaim and refuse to accept any and all
interests in the Gilbert Prowell Charitable Remainder Unitrust that I may otherwise be entitled to
receive.
I hereby state and certify that I have not accepted any benefits or interest in the
Disclaimed Property.
This disclaimer is intended to be effective as of January 1, 2013.
This document is intended to qualify as a disclaimer under Section 2518 of the Internal
Revenue Code of 1954, as amended, and under Chapter 62 of the Pennsylvania Probate, Estates
and Fiduciaries Code.
Dated this y day of 2013.
Witness:
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ACKNOWLEDGMENT
STATE OF WISCONSIN
SS.
COUNTY OF RfJ£
On this q 6 day of-IPy4e,sr , 20132, before me, the undersigned officer, a Notary
Public in and for the said county and state, personally appeared Myra P. Reilly, who, being duly
sworn according to law, deposes and says that the facts set forth in the foregoing Disclaimer are
true and correct to the best of her knowledge, information, and belief and that she executed the
same as her voluntary act and deed.
otary lic
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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHAN'S COURT DIVISION
In Re:
Gilbert Prowell Charitable Remainder Unitrust No. 2013-
RECEIPT OF DISCLAIMER
The undersigned, being duly sworn according to law, deposes and says that she is the
Trustee of the Gilbert Prowell Charitable Remainder Unitrust, and that on the date and place as
hereinafter set forth, she received the foregoing signed Disclaimer from herself, Myra P. Reilly.
Date Place Signature
3006 Jason Place, Madison, WI 53719 -
Myra P. Reilly, Trustee
SWORN TO AND SUBSCRIBED before me this 4 day of Saofi— b�
2013, in DANE County, Wisconsin.
N' ary Pubkc
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