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HomeMy WebLinkAbout10-07-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of FLORENCE BESSIERES also known as FLORENCE A. BESSIERES Deceased Petitioner(s), who is/are 18 yeazs of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) COUNTY, PENNSYLVANIA File Number /- v~ - 999 Social Security Number 215-22-9102 0 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the nominee of executors last Will of the Decedent dated January 5, 1995 and codicil(s) dated None Warned in the See renunciations of and nomination of Petitioner of executors desi ated in Will (State relevant circumstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution:o~the instrumsn~s) offered . ; ~:-.~ for probate, was not the victim of a killing and was never adjudicated an incapacitated person: None =~-- C C7 m B. Grant of Letters of Administration c.t.a. _- --t -- t 1 (If applicable, enter: c. t. a.; d.b.n.c.t.a.; pendente lire; durance absentia; durante tr~ixoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followin s ~~/= tf an ~ Administration, c.t.a. or d.b.n.c.t.a., enter date of Wlll in Section A above and complete list of heirs.) g ~ _ ( y)~ heirs:. (If . . =i .. PAUL BESSIERES '°""""" Residence ~p SON 51 Sotelo Ave. San Francisco, CA 94116 GRACE BESSIERES DAUGHTER (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County pennsylvania with his /her last principal residence at ___ Green Rid e Villa e 210 Bi S rin Road Newville West Pennsboro Townshi PA 17241 (List street address, town/city, township, county, state, zip code) Decedent, then 93 years of age, died on July 9, 2008 at Green Ridge Village, Newville, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA $_ 1,000.00 ) Personal property in Pennsylvania $_ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $_ situated as follows: None Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters :in the appropriate form to the undersigned: Si ature T ed or rinted name and residence Hamilton C. Davis 20 East Burd St. Suite 6, Shippensburg, PA 17257 Form RW-02 rev. 10.13.06 Page 1 of 2 OCAL REGISTRAR'S CERTIFICATION OF O ~- ~c~c~ DE~-TH WARNING: It is illegal to duplicate this copy by photostat or photograplh„ Fee far this certificate, `6.00 P 1464~16~ Certification Number 1,11'"°p~1H OF pF` ~ lG e ~! - ,,~ z y ~ la This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ~ r~ • ` !,at• c Local Registrar ,~t~oe Date Issued PV csv C .7 `:~: <. ~ "' - - _ ..I C"~ ,.., I _-. • ~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEA ;- ~ ~~ LTH • VITAL RECORDS CERTIFICATE OF DEATH - _ ~' f • (See instructions and examples on reverse) ~``~ I Decedent (Rre1, mitl0b, lest, sulfa( STATE FILE NUMBER l~ st Binhd Florence Bessieres 25ax Female 3. 2115'",'"'",22 9102 <. e.>IDea (M°nm,aay, Year ) ay) 9 3 lmtler I year laonws Days UrMer 1 day Htws Minwea 6. Dale of Birth (MOnm, tlay, year) 4/14/1915 7. Binh lace Ci and stale or f P ( ry areign country) _ 6e, Place of Death (Check ontyone) ~ Y ~ G~~ - ~ Vre. Mt. Vernon NY Hospital: Other. of Death Cumbe rla d &. City, Boca, T of Death ,:~~ Btl. Faaliry Name (II rot inaHlulion, ' e sheet eM number) ^ Inpatie nt ^ ER / Outpetiem ^ DOA 9 Was Dec d m f Hi Nursing Horne ^ Resitlence ^gher ~ Speriry: n West Pennsboro G~'E•~~l ~ G ~/ //~ . e e o s g I>a°is On in? (Ilyea.s~ecifyCaDan. ~No ^Yes 10.Rata;Americen Indian, Black, While, etc. (G ra ~.- nys Usual ibn Knd a work da rB tl most a world Ina. Do nd slate retired L ` ~~ 12. Was Decetlenl ever m the 13 Mexican, Puerto Rican, etc.) y y y YY 111 t e M705-143 REY 112006 TYPE /PRINT IN PERMANENT BLACK INK I 1. Nemec 5 A°e IL Bb. `~~ Khrd a . Deca0enYS Etlucatbn (Spedfy Day hi heel atle can let 14. Maraal Status: Ma KiM a Business / Irqust U.S. Annetl Farces? g ~ p ~ nie4 Never Mameq 15. Surviving Spouse gf wife, give maiden name Homema e r ry rq~~ Elementary / Secontlary (0-12) College (1-/ or B+) Widowed, Divorcetl (Specr'!)d 1 ^Yea kpa0 12 Widowed 16. Dacetlent's Meiling Address (Saee4 city! town, slate, np cotle) Decedent's 210 B 1 g Spring R d Aaual ResUenca va. sale PA Dm Decedem 7wownsh p? 77c®ves. Decedem tivetl in WI°St Pennsboro T Newville PA 17241 nb.ctanly Cumberland vd.^rro,Dacman,wadwnhm cap ta. Famr i Name IFIm, miape, msl, aumal Actual Umns a city r aem 19. Mahers Name (FNSt, middle, maitlen wmeme) George Deiter Grace Lent 20a. Inlormanl's Name (Type / Pnnq Pau 1 Bessieres Infamanfs Mailin Address SYreel, lily / tae stare, Elp ~1 Sote~lo ~1ve. Sian Francisco CA 94116 21a. Meinotl of Disposilian ^ Banal ~remetw° ^ Doneaa 21 D. Date yf Di m (Mmm, day, year) 21 c. Place of DisRasitbn (Name of cemetery, crrrerory a Omar place) ppaapp t ~ ome s~° ^ RemovalhomSlare rAh,Drepy,te„rl3autlonaullarrsed 7/ 112008 Hollinger Crematory fit- • ~flf52"1~'°~~rings i DY Medcal Exammr r c°raner. Yes ^ No PA 17 0 6 5 ?29. Signa~ F al Serv L (or parson amp as sucnl 22b. License Nunher FD 13895 L '~"~jt~'~`~°~~11A~ral Home Inc 15 Big Sprint A Newville Conpkte 6tems 23et oNy when c ~ 23a. To aw basl.a my Wwwladga. deem occurred al the 0me. date and ( 1 Plana slated. (Slgieture eM tllls) physiden i of ereilaNe al time of h to PA 17241 _I ve 23b. license Number (r . W w C cerDry reuse d deem. t~'7~~j•;L~ ,~ ~. r 23c. Dale Signed (Month, day, year) ~ i G ~j~Iis~o 3~ y C T ~ Hams z4-zfi moat Da completed Dy parson za. Tama of Daam 75. Dale Prmounoed peed (Madh daY Year) h Jt ( . ed, ~J / ~ VU Q o o prmamces tleam. D M' , . q ~q I ~ V V J 26. Was Case Refenatl to Mr4cal Examiner / Canner iw a Reason ghat man Cremation or Dmalion? CAUSE OF DEATH (See instructions antl examples) Hem 27. Pan I: Enter me tlwn of evens - aseases, Nyunes, or canpfications _ Thal areclty caused me deem. DO NOT enter irminal events such res ireta i r Approximate interval: Pan II ^Yes (J~No •~ : Enter other Sol mntlaiaw Doom t Did T d 26 ~ (~ p as card ac arrest, y area, a vemno,mr 6bralation wnhoul Shari dre a' rg tology. list ony are cause m each fine. Onset to Deam ` bN not rssulfi ng in me untladyirg cause gven in Pan I. . oba¢o Use ConbiMde to Oeam7 ^Yes ^ probaay IMMEDIATE CAUSE Rnal asease a axdlikm rewaing in ~ih) ~(,y.~~ (}~y 1 trv ^ No ^ Unknown D e t (a eq oq. ( Sequentialltyy Ilsl mndlias, d any, b. l 6 d - 29. n Female: ^ Nol pregnant wimin past year es r~g a s gone listed m Gre a. Enter tlr UNDERLYING CAUSE Due to (or as a consequence pQ; (assess or i h ^ Pregnant et tirtie a death njury I et ialieted ins events resuairg m tlealh) LAST t ^ Na pregnam, M pregnant wahln 42 days ( Due to (or as a mnsequerroe oft: d deem `~ C. ~ _ ^ Nol Wegrenl aA pregnant 43 days to 1 year 30e. Was an Aaopsy 30b Were Aum a F F belle deem Penormed? . p y lr ngs Available Prior to Completion 31. Manner a DeaM 32a. Date of Injury (MOnm, day, Peer) 326. Descrme Flow Inlury Occurred - ^ UNawwn if naa wimin the Preg past year a cause a Deam? ~Nalurel ^ Hamidtle 32c. Plata 9 Nprre, Save( Fedory, ~ (1 k ~) t rg ,~ I k\` = ^Yes ~ No ^ yes ^ No ^ A~dant ^ Perging Investigation 32tl. Time a Inju7 32e. Irqury al Wak7 321. If Trarusponatim InN7 /SPectiyJ 320. Lncaf of Injury (Street cpy 1 town state) ` ^ ^ Coultl Nol De Dalemunetl M ^Yes ^ N° ^ Dmer I Operator ^ Passenger ^Pedasaian , , 33a. Cerlgir (cheat only are) ' ^Olher. Spectly' 1 i • Cenitying phyelclan (Rnysiaan cenilying cause of tlaath when another To th Deal of my knowWge, ee.m oceurtetl tlue W the uu ) pnyslaan has prorquncetl deem and canpleletl Item 23) sa(e arM manor as sated 33b. Signature d 'fir '- _ --- _ _ _ _ _ _ _ _ Pronouncl ell in n9 Danny g phyakian (Physician both praquayrg tleam all ceral,ing to reuse a tleaih _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • _ _ Q , ,. ) To the Dasl of my kmwbtlgs, tlaeth teeuwetl et the time, sale, antl place, and tlue to Me cause(s) antl manmr as slaletl_ _ _ _ _ _ _ ^ • Medical Examiner/Coroner ___________ On iha basis a examination antl 7 a Invasigalion in m ° l i B fit' Ucanse ,„^(C~~ S _- C JLI ( 330. Dd!e Signed (MOnlh, tlsy, y~ ( ~ (`L~ ~ , y p n an, eam occurred al the time, dale, end place, antl due It iha tease(s) and manner ea adlW_ ^ ~ ~ 36. R Ir Signature antl DislriaFf4ulrrbar ~ ~~ ,` Date Rled (MOnm, nay, Year) 34. Nam~1ekk all Atlaess of Person Who Ctmpleled Cause tf Death pram 2?) Type / Pnnt r/aNyy ~' V /S ~ c ~ d I I I c~ I ~ 1 01 S. P'7f St Sd 3 ~atl• ~Q PR i 3 Disposition Permit No. ~ n ~ J, V A ~ / U ; ~.~ `y ~ y ~~ ~~ %~~j!;~i~~n~~ .s _ --~ ~~ ~-.~. ~~ ~ _ .. .,..1 - -~ _. -~ .a I, Florence A. Bessieres, a resident of Cumberland County, Pennsylvania declare that this is my will. My Social Security Number is 215 22 9102. FIRST.• I revoke all wills and codicils that I have previously made. SECOND: I have the following children now living: Paul Bessieres and Grace Bessieres. THIRD: I give gifts as listed in my Bequest List to Paul Bessieres However, if the beneficiary named in this paragraph to receive . this property fails to survive me, that beneficiary's living children shall take the property. If the beneficiary named in this paragraph to receive this property fails to survive me and leaves no living children of liis or her own, the property shall go to my residuary estate. FOURTH: I give gifts as listed in my Bequest List to Sandra C. Bessieres. However, if the beneficiary named in this paragraph to receive this property fails to survive me, that beneficiary's living children shall take the property. If the beneficiary named in this paragraph to receive this property fails to survive me and leaves no living children of :his or her own, the property shall go to my residuary estate. FIFTH: I give gifts as listed in my Bequest List to Christianne M. Bessieres. However, if the beneficiary named in this paragraph to receive this property fails to survive me, that beneficiary's living children shall take the property. If the beneficiary named in this paragraph to receive this property fails to survive me and leaves no living children of his or her own, the property shall go to my residuary estate. Page 1 of 7 Initials: _~~ ~/~ ~ ~ _, Date: ~ ~ - ~~~"'~~' Will of Florence A. Bessieres SIXTH: I give gifts as listed in my Bequest List to Marshall Bessieres. However, if the beneficiary named in this paragraph to receive this property fails to survive me, that beneficiary's living children shall take the property. If the beneficiary named in this paragraph to receive this property fails to survive me and leaves no living children of his or her own, the property shall go to my residuary estate. S B° "v'ENTri: I give gifts as :fisted in my Bequest List to Stuart Bessieres. However, if the beneficiary named in this paragraph to receive this property fails to survive me, that beneficiary's living children shall take the property. If the beneficiary named in this paragraph to receive this property fails to survive me and leaves no living children of his or her own, the property shall go to my residuary estate. EIGHTH: I give gifts as listed in my Bequest List to Grace Bessieres. However, if the beneficiary named in this paragraph to receive this property fails to survive me, that beneficiary's living children shall take the property. If the beneficiary named in this paragraph to receive this property fails to survive me and leaves no living children of r~is or her own, the property shall go to my residuary estate. NINTH: I give gifts as listed in my Bequest List to Reyna Batista However, if the beneficiary named in this paragraph t o receive . this property fails to survive me, that beneficiary's living children shall take the property. If the beneficiary named in this paragraph to receive this property fails to survive me and leaves no living children of his or her own, the property shall go to my residuary estate. TENTH: I give gifts as listed in my Bequest List to 1st Presbyterian Church of Newville PA. M. J. Page 2 of 7 Initials: _ ~`~ ~ Kn; (~ _, Date: ! ~~;~ - y5~ Will of Florence A. Bessieres ELEVENTH: As used in this will, the term " specific bequest" refers to all specifically identified property, both real and personal, that I give to one or more beneficiaries in this will. The term " residuary estatf;" refers to the rest of my property n ot otherwise specifically disposed of by this will or in any other manner. The term "residuary bequest" refers to my residuary estate that I give to one or m ore benefici aries in this will. TWELFTH: All personal property i give in this will through a specific or residuary bequest is given subject to any purchase-money security interest, and all real property I give in this will through a specific or residuary bequest is given subject to any deed of trust, mortgage, lien, assessment, or real property tax owed on the property. As used in this will, "purchase-money security interest" means any debt secured by collateral that was incurred for the purpose of purchasing that collateral. As used in this will, "non-purchase-money security interest" nneans any debt that is secured by collateral but which was not incurred for the purpose of purchasing that collateral. THIRTEENTH: When this will states that a beneficiary must survive me for the purpose of receiving a specific bequest or residuary bequest, he or she must survive me by 45 days. FOURTEENTH: I hereby leave $1.00 to each of the following persons: Paul Bessieres and Grace Bessieres. These bequests are in addition to and not instead of any other specific bequest that this will makes to these persons. FIFTEENTH: I give my residuary estate to Paul Bessieres a.nd Grace Bessieres. However, if any beneficiary named in this paragraph t:o receive my residuary estate fails to survive me, that beneficiary's living children shall take that beneficiary's share. If a beneficiary named in this Page 3 of 7 Initials: _ ~'~ ~ {~ /~; ~ _, Date: ~ - °~ - '~s Will of Florence A. Bessieres paragraph to receive my residuary estate fails to survive me and. leaves no living children of his or her own, the other surviving beneficiaries named in this paragraph to receive the residuary estate shall take the deceased beneficiary's share. SIXTEENTH.• Any specific bequest or residuary bequest made in this will to two or more beneficiaries shall be shared equally among them, unless unequal shares are specifically indicated. SEVENTEENTH: I name Paul Bessieres as my personal representative (executor), to serve without bond. If this person or institution shall for any reason fail to qualify or cease to act as personal representative, I name Grace Bessieres as personal representative (also to serve without bond), instead. EIGHTEENTH: I direct my personal representative to take all actions legally permissible to have the probate of my will done as simply and as free of court supervision as possible under the laws of the state having jurisdiction over this will, including filing a petition in the appropriate court for the independent administration of my estate. NINETIETH: I hereby grant to my personal representtative the following powers, to be exercised as he or she deems to be in the best interests of my estate: 1) To retain property without liability for loss or depreciation resulting from such retention. 2) To dispose of property by public or private sale, or exchange, or otherwise, and receive and administer the proceeds as a part of m:y estate. 3) To vote stock, to exercise any option or privilege to convert bonds, notes, stocks or other securities belonging to my estate into other bonds, notes, stocks or other securities, and to exercise all other rights and privileges of a person owning similar property. Page 4 of 7 Initials: S I! /~ ~j _, Date: ~ - ~ - >~` Will of Florence A. Bessieres 4) To lease any real property that may at any time form part of my estate. 5) To abandon, adjust, arbitrate, compromise, sue on or ,defend and otherwise deal with and settle claims in favor of or against my estate. 6) To continue or participate in any business which is apart of my estate, and to effect incorporation, dissolution or other change in the form of organization of the business. 7) To do all other acts which in his or her judgment may be necessary or appropriate for the proper and advantageous m;~nagement, investment and distribution of my estate. The foregoing powers, authority and discretion granted to my personal representative are intended to be in addition to the powers, authority and discretion vested in him or her by operation of law by virtue of his or her office, and may be exercised as often as is deemed necessary or advisable, without application to or approval by any court in any jurisdiction. TWENTIETH: Except for purchase-money security interests on personal property passed in this will, and deeds of trust, mortgages, liens, taxes and assessments on real property passed in this will, I instruct my personal representative to pay all debts and expenses, including non- purchase-money secured debts on personal property, owed by my estate using my residuary estate. TWENTY-FIRST: I instruct my personal representative to pay all estate and inheritance taxes assessed against property in my estate or against my beneficiaries using my residuary estate. TWENTY-SECOND: If any beneficiary under this will in any manner, directly or indirectly, contests or attacks this will or any of its provisions, any share or interest in my estate given to the contesting beneficiary Page 5 of 7 Initials: ~_ 1~K/~f f~~ _, Date: i - - y~` Will of Florence A. Bessieres under this will is revoked anal shall be disposed of in the same manner as if that contesting beneficiary had failed to survive me and left no living children. I, Florence A. Bessieres, the testator, sign my name to this instrument, this _____ da of _ ~~ Ps_ I y ---~-------- hereby declare th I sign nd execute this instrument as my last. will, that I sign it willingly, and that I execute it as my free and voluntary act for the purposes therein expressed. I declare that i am of the age of majority or otherwise legally empowered to make a will, and under no constraint or undue influence. .. _ C~"~~- (Signed) Page 6 of 7 Initials: _~"'~y% ~/( /~( n _, Date: ~ " ~ y`~ Will of Florence A. Bessieres, Page 7 of 7 We, the witnesses, sign our names to this instrument, and do hereby declare that the testator willingly signed and executed this instrument as the testator's last will. Each of us, in the presence of the testator, and in the :presence of each other, hereby sign this will as witness to the testator's signing. To the best of our knowledge, the testator is of the age of majority or otherwise legally empowered to make a will, is mentally competent, and under no constraint or undue influence. We declare under penalty of perju y, that the foregoing is true and correct, this _ ~"~ ~ day of ~ i?~~ _ ~_, , ~ ,, ` , Witness #1: Residing at: Witness #2: ~ / /0 ,, .-- _. Residin at: _~ ~ IGL - ~~ ~ ~ ~~ g ~--- Witness #3: ~..~~~~~ ~ ~ C~(/i,/~~~Ct e< Residing at: OATH OF NON-SUBSCRIBING WITNESS(ES) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of FLORENCE BESSIERES (AKA FLORENCE A. BESSIERES) Deceased i ~ k c . ~~, ~-~. ~ R ~ ~~ ~, and ~ o ~ H ~., ,~ - 1\ u_T~ (each) being duly qualified according to law, depose(s) and say(s) that she / he /they eras /were well- acquainted with FLORENCE A. BESSIERES and am/are familiar with the handwriting and signature of the decedent, and that the signature of FLORENCE .A. BESSIERES to the foregoing instrument purporting to be the Last Will and Testament/Codicil of FLORENCE A. BESSIERES is in his/her own proper handwriting. c ,~ (S afore) (Street Address) (Cay, State, Zip) Executed in Register's Of¢ice Sworn t~ or affirmed and subscribed before me thislI,,`` ,~~ ~~ `~ day of ~~C~J~- , ~~~ eputy for R 'ster f Wills Signature) P~ ~ a ~~I I (Street Address) ;~ (City, State, Zip) ~:-s Form RW-04 rev. 10.13.06 ~, ~c~c1 RENUNCIATION Z~O~- OCT -~7 p~ ! ~ 29 ~, ,: - r I ` I~,T ~~' REGISTER OF WILLS ~, , ~:- ~~ '~~, CUMBERLAND COUNTY, PENNSYLVANIA Estate of FLORENCE BESSIERES (AKA FLORENCE A. BESSIERES) Deceased I, GRACE BESSIERES , in my capacity/relationship as (Print Name) designated executor and daughter of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Hamilton C. Davis (~-~ ~C9 ( te) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 L~ .. -~ •~-~-~ (Signature) r- 15 Stevenson Road (Street Address) Hewlett, NY 11557 (City, State, zip) Executed out of Register's Offic°e Before the undersigned personaiiy appeared the party executing this renunciation and certified that he or she executed the renunciation for the purpo es stated within on this _ r ~ day of ~ _~,b6 `~ ~ J_ Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) PATRICIA RENNER NOTARY PUBLIC, Stag of Na~w York No.O1RE81t8d82 Q.ua~tMd M Nassau County Commission Expire dctobar 4, a~/.~ RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of FLORENCE BESSIERES (AKA FLORENCE A. BESSTF.RF.~I ~~-~;,c f ~, ~'1~~ ~~ 29 -,, t r f ~, ~ Ir+.T \/ L f( ~~;; ,_, I, PAUL BESSIERES Deceased in my capacity/relationship as (Print Name) designated executor and son of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Hamilton C. Davis %3,~~~ (Date) o'/- ~~ --~, ~-_ -~ (Signature) 51 Sotelo Ave (Street Address) San Francisco, CA 94116 Executed in Register's Office Sworn to or affirmed and subscribed before me this day of (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this _ day of ~_ Deputy for Register of Wills Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of No1:ary's Commission.) Form RW-06 rev. 10.13.06 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT ~`..F; C'~, .CSC'.CSC.C`C~~C'C~.'FAc.10iv0cQO~,~Oc~lO'~Sf `C.~~C,p~~`C~ .C`C'.C~C'.C`C' - -~J'~."YM State of California County of S-p,~1 ~1c~Sc~ On - 13_ ~C before me, _~~~ '~~1~10 ~' ~V(~, (C Date ere I serf ame and Tit a of the Officer ' personally appeared P~ 11 ~ gE SS ( ~~ S -- Name(s) of Signer(s) who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/st~eLthe~c executed the same in his/I9e~ftf~ekr authorized capacity(ies), and that by his/faerir signature() on the instrument the person(s}; or the entity upon behalf of which the persorT{s} acted, executed the instrument. S. PATEL I certify under PENALTY OF PERJURY winder the laws Con~ra.# 1697141 of the State of California that the fore oinc ara ra h is N NOTARY PUBLIC•CU.IFtMN1A ~ g a P g p an a co:~tr or sa.r F~ true and correct. IAr Gnuu. EXP. ocT. 2, tote WITNESS my hand and official eal. Signature _ Place Notary Seal Above Signature of Notary Public OPTIONAL ' Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: __ ~ E ~~,~ NS~~~o~ Document Date: Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: __ ^ Individual ^ Corporate Officer -Title(s): ^ Partner - ^ Limited ^ General _ ^ Attorney in Fact ^ Trustee Top of thumb Here ^ Guardian or Conservator ^ Other: Signer Is Representing: Number of Pages: Signer's Name: _ ^ Individual ^ Corporate Officer -Title(s): _ ^ Partner - ^ Limited ^ General ^ Attorney in Fact ^ Trustee Tip of thumb here ^ Guardian or Conservator ^ Other: Signer Is Representing: ©2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • www.NationalNotary.org Item #5907 Reorder CaII~ToII-Free 1-800-876-6827 STATE OF CALIFORNIA COUNTY OF SAN FRANCISCO :SS ~c(- ~~, ~f~~i5 I, PAUL BESSIERES, a resident of 51 Sotelo Avenue, San Francisco, CA 94116, do hereby swear that to the best of my knowledge, information and belief, the following facts are true and correct: 1. I am the son and designated executor of the Last Will of Florence Bessieres (a.k.a. Florence A. Bessieres), which Will is dated January 5, 1995, a complete acid exact copy of which Will is attached hereto. 2. That after the death, on July 9, 2008, of the said Florence Bessieres (a.k.a. Florence A. Bessieres) a complete and thorough search was made of her residence and personal belongings and there was not found with her will or among her belongings and papers any writing which indicated to be or would qualify as a "Bequest List" as referenced in her will or as a codicil thereto. 3. Further, that the Will of Florence Bessieres (a.k.a. Florence A. Bessieres) was prepared by her without the benefit of legal counsel and it is likely that there never was any "Bequest List". Witness: ( -Jl S Sworn to and subscribed before me this day of September, 2008. Notary Public -~ PAUL B SSI~E r~ N __ C~ ~ °; =~ o -;-r-; c . - _R, .. ~ _,, _ ;~- ~ . -~ _~ __t.: --, ~ - c,1 c..a - - - ~~ CALIFORNIA JURAT WITH AFFIANT STATEMENT J~J'See Attached Document (Notary to cross out lines 1-6 below) ~ See Statement Below (Lines 1-5 to be completed only by document signer[s], not Notary) Signature of Document Signer No. 1 State of California County of ~N ~.>D~I~CISC.~ S. PATEL ~ COMM. # 1697141 -~ NOTFiRY PUBLIC•CALIFORNIA =, Cn'f i CWfm 0- Sul Ftulratco IAY COMM. EXP. OCT. 2, 2010 t...- Place Notary Seal Above Signature of Document Signer No. 2 (if any) Subscribed and sworn to (or affirmed) before me on this ~~ day of ~~ _, 20~, by Date Month Year Name of Signer proved to me on the basis of satisfactory evidence to be the person who appeared before me (.) (,) (and Name of Signer proved to me on the basis of satisfactory evidence to be the person who appea ed before me.) Signature Signature of Notary Public (2) OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document Further Description of Any Attached Document Title or Type of Document: 1~~SS~~I~~T~R~~->A~T~en1 Document Date: Number of Pages: Signer(s) Other Than Named Above: • • Top of thumb here Top of thumb here ©2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313-2402 • www.NationalNotary.org Item #5910 Reorder: Call ~TOII-Free 1-800-876-6827