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IN THE COURT OF COMMONPLEAS OF THE NINTH JUDICIAL DISTRICT
OFPENNSYLVANL4 —CUMBERLAND COUNTY BRANCH
ORPHANS'COURT DIVISION
In Re. Estate of Winifred S. Rockey, late 5r�
of Dickinson Township, Cumberland No. 2- 1 - 11A
I
County,Pennsylvania, deceased
QUALIFIED DISCLAIMER OFINTERESTS
IN THE ESTATE OF WINIFRED S. ROCKEY T< r T
f,:
PURSUANT TO 20 PA.C.S.A. §6201 :; ' c-: r
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Jenne D. Rockey("disclaimant"),respectfully states that:
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1. Winifred S. Rockey ("decedent") died testate May 8, 2014,. a resident of Dickinson
Township, Cumberland Count, Pennsylvania. Her last will and testament dated December 11,
1989, was duly probated by the Register of Wills for Cumberland County, Pennsylvania, and is
recorded at Cumberland County No. 2014-00521. By her will, she appointed Marianne Rockey,
also known as Marianne R. Besaw (hereinafter Marianne R. Besaw) as Executrix of her estate.
On May 28, 2014, Marianne R. Besaw duly qualified as such and Letters Testamentary were
duly issued by the Register of Wills of Cumberland. County, Pennsylvania, to Marianne R.
Besaw.
2. Less than nine months have elapsed since the date of death of Winifred S. Rockey, the
decedent, and the undersigned disclaimant has not accepted any interests in or benefits of the
herein disclaimed property, nor has she exercised any control as beneficial owner over that
property, or over any interests therein.
NOW,THEREFORE, intending to be legally bound hereby, the undersigned, Jenne D.
Rockey,does hereby forever, absolutely, irrevocably, unconditionally, and for no consideration,
disclaim any and all interest in the Estate of Winifred S. Rockey late of Dickinson Township and
any described interests in the hereinafter described property which might
otherwise inure to her benefit as a result of the death of Winifred S. Rockey on May 8, 2014.
Descriptions of the disclaimed interests and property are as follows:
1) One-fourth (1/4th) Survivorship interest in Free Business Checking
Account No. 2197987 at ACNB Bank,having a total value at date of death
of$4,775.33; a one-fourth (1/4th) interest is valued at $1,1.93.83, [titled to
"Ken Four Partnership."]
2) One-fourth (1/0) Survivorship interest in 333 Centerville Road,
Gardners, West Pennsboro Township, Cumberland County, Pennsylvania,
having a total Clean and Green value at date of death of$57,000; a one-
fourth (1/4`h) interest is valued at $14,250.00, [titled to "Mickey D.
Rockcy, Marianne R. Besaw,Jennie L. Rockey and Winifred S. Rockey."]
3) One-fourth (1/4th) Survivorship interest in Meals Road, Gardners, South
Middleton Township, Cumberland County, Pennsylvania, having a total
Clean and Green value at date of death of$2,600.00; a one-fourth (1/0)
interest is valued at $650.00, [titled to "Mickey D. Rockey, Marianne R.
Besaw,Jennie L. Rockey and Winifred S.Rockey."]
It is suggested that the interests in the property disclaimed hereunder might be devised
and disbursed to the three surviving interest owners,Mickey D. Rockey, Marianne R. Besaw and
Jennie L. Rockey,who are the surviving children of the disclaimant.
For purposes of clarification, it is suggested that this disclaimer be construed in no way
other than in the unconditional manner in which it is intended.
This instrument is intended to be a valid disclaimer under 20 Pa. C.S.A., Section 6201,
and is to be governed by the laws of the Commonwealth of Pennsylvania. In the event that this
disclaimer is defective in any way as to any interest attempted to be disclaimed, it shall
nevertheless be valid for any other interest as to which it is not defective.
WITNESS the due execution hereof the 2A`` day of 7✓Wy 12014.
Witness:
/ / une D. Rockey (Disclaim
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ACKNOWLEDGMENT
STATE OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND :
On this d'day of , 2014, before me, the undersigned officer, personally
appeared Jeune D. Rockey,Disclaimant, known to me 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.
JU
Notary Public
COMMONWEkTH OF PENNMVANIA
NotvW Seel
Tamers S.Slegi Notary Public
1;W th Nlddlptoa 7wP„gob�q county
CArrerpS510a ErOw Der—3,2014
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