Loading...
HomeMy WebLinkAbout12-08-08PETITION FOR PR,O~-BATE AND GRANT OF LETTERS REGISTER OF WILLS OF _~U,f~~~~~iy ~ COL'i~tTY, PEi~Tti SYLVANIA Estate of ~~~~'~'~ (lY`t S~"f~~ File Number ~ ` b ~ ~ ~t~ also known as ~// Deceased Social Security Number '~~~ ~ / ~~~' Pe~ itioner(s), who is; are 13 years of age or older, apply(ies) for: (C(3,LIPLE7E 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~n t~ y ~ %~ 51-!!r~ ~'~ Warned in the last Will of the Decedent dated !tom g. zz- . l ~l ~ ~ and codicil(s) dated (State relevant circumstances, e.g., renuncintian, dentit of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ^ B. Grant of Letters of Administration (lf appiicable, enter-. c. t. a., d. b. n. c. t.a.,~ pendente lire; durante abseratin; dau~ante mirtoritntej Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Administratia7, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) Decedent at death owned property with estimated values as follows: { ,;y J C~ i j f (If domiciled in PA) All personal property $ / ~ is (If not domiciled in PA) Personal property in Pennsylvania $ ~(,~ /~' (If not domiciled in PA) Personal property in County $ ~t p~j Value of real estate in Pennsylvania $ f~ YT situated as follow W'nzrefore, Petitioner(s) respect Fully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriatz form to the undersigned: Sig,nature Typed or printed name and residence ,~ s ~ ~ ~ ~~ ,~a~~ _ ~,~, a ~~ S~r~,~ c~ s y ~~o~~ Form ,41V-01 rev. !0.13.06 Pale I Of 2 (COMPLETE I;V ALL CASES:) Attach additional sheets if necessary. ~-. -~, t - - . --. 3~ ~~;T ~. Decedent was domiciled at death in ~//~ County, Pennsylvania with his /her last princi al ra ~ ace at -~> (List sheet address, town//ci~Jty~, torvnsltip, coautfj~, state, zip code] f J - / ~=' W Decedent, then Y '1 years of age, died on f / p 15 at Ci//11 g~,P(~J~~ L /r-~~ 5 S/~~' ~' Oath of Personal Representative COM~1O1`;~Vi:ALTH OF PENNSY? VANIA SS COUNTY OF l ((~Y1~~'~G~~ The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are m~e a~,d cotlect to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to cr affirmed and subscribed before ine the ~ day of ~_ ~ ~' ;. i ~~ ~ For tl;e Register na Signature ersona! Representative ~.-~ `~ c~ C~ O Signaau-e ojPersenal Representnrive -. r r-, t _ =~ O~ T Signature ojPersonal Representative '~-~ T' ~' '~ ~ t~ --a - J_~ c.~ File Number:,_//9_ ~f~ ~ O ~ /t~r~, `~ Estate of ~C /7 ~" 1lt r ~ ~ ~~~ / /C' r ,Deceased Social Security Number: ~~ ! G~ ~ 70~ lG' Date of Death: 0~ D U /Y~ ~('/ 1 ~ ocC~(/U 0 ~ aov AND NOW, ~),P_ti _~> in consideration of the foregoing Petition, satisfactory proof hzving been presented before me, IT IS DECREED that Letters are hereby granted to and that the instrument(s) dated ~C L7ru~~~Lf ~C ~~..LL- described in the Petition be admitted to probate and filed f record as the last Will FEES ~ x ~ /~ q ~ ( ` ~ ~ L tt s $ rya -o .... ... . .. . e er Short Certificate(s) ... 07.. . $ ty • D~ Attorney Signature: Renunciation(s) .. 1...... ~ ~/ . $ `~ - 04 ~~ Attorney Name: ~ • • l $ ~ ~ - ' .. L ~ . $ ~ U ~ ~ Supreme Court LD. ~-~ .. ---~ . $ 5 :vo $ Address: .. . $ .. . $ .. . $ - • • ~ Telephone: .. TOTAL ............. . -p,~~ --- . $ ~(Js.~ dicil(s)) of Register it the above estate Form RDV-0' rev_ 10.13.0( P3~e 2 Of Z I I QS RU< REV ;fll /U' LOCAL. RECaISTRAR'S CERTIFIC~-TI0N OF ~EATh~ WARNING: It is illegal to duplicate this copy ny photostat or photagrapt~. Fee for Chis certificate. `~~i~.UO P 14.80g$6~ -- Certification Number phis i`; to ~:erti(~ teat the iri,~;rlniuion h,m t~i~cn is correetl~, ccyp)ed fnvli ~In flrieinal (.:f'r,il~icatr of Death duly filed Stith rT~,~e a. Local Re,•IStrar. The original certifir.)te ~~iiE ht for;~~arded tc! the Sla(c• tiital- Recurds C)ftit..: °ru r_(~n;arlent fifin(~. l~~ ~ ~-~N(lV-1~9 ?~- !.ocal Rer~i:~rar S)~lI_C Is.iled __ fV © ~ _0 ') - -' I , ~ ! ~ ' ' ~ '~ . _ , J~ .1 t t _ -" ( ~ aEV rozoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~-„ PRINT IN C.a IANENT CERTIFICATE OF DEATH ;K lNK (See instructions and examples on reverse) ~ ~ Q ~ ~ 2 STATE FILE NUMBER 7. Name of Decedent (First. mitlde, las ,suffix) 2 Sex 3. Social Security Number 4. Dale of Death fMonlh, day. yearl ) ~ ~ j~ Q ~ '1 ~C~~ ' ~ - l y (p November 17 , 2008 5. Age fLast Binhday) Under 1 year Under 7 day 6. Date of Binh (Mpnlh, day, year) 7. Birthplace (City antl slate or for eign country) Ba. Place of Death (Check only one) Months Days Moors Minutes HOSpila: the r. O 93 Yrs. ~ ~ - ~ <- Carlisle , PA ^ Inpatient ^ ER I Outpatient ^ DOA ~ ~ I~Nursing Home ^ Residence ^Other Specdy 6h. County of Death 6c. City. Boro. Twp. of Death 6d. Facility Name (II not inslflution, give street and number) 9. Was Decedent of Hispanic Origin? ~] No ^Ves 10. Race: American Inb~an. Black, Whne. etc. (If yes, spec7ty Cuban, (SDecil» Cumberland Carlisle Cumberland Crossing Mexican,PnednRican,e,c,) White 11. Decetlenfs Usual Occu Lion K'mtl of work d one tl urin most of world life. Do not state retiretl 72. Was Decedent ever in the 13. Decedent's Education (Specify only highest gratle comp leted) 14. Marital Status: Married, Never Married, 75. Surviving Spo use (If wile. give maiden name) Kind of Work ~b Ilir~~4Business! Industry U.S. Armed Forces? Elementary /Secondary (p-12) College (t-4 or Si) Widowed, Divorced (Specify) feteria Em to ee School District ^Yes ®"° 12 Widowed 16. Decedent's Mailing Atltlress ~Streel. city; lawn, stale, zip code) Decedent's Did Decedent Actual Residence 17a State Pennsylvania 17c ^V d D t Li d a 1 Longsdorf Way . es. ece en ve m Twp. Tow~sh p PA 17015 Carlisle rib. cdumy Cumberland rid ®"p, Decedent Lived w"con Carlisle , Actual Limits of Clty ~ Boca 16. Father's Name (Flrsl, middle. last, suXix) 19. Mother's Name (First, middle, maitlen surname) Earl Hefelfin er Estella Jacobs 20a. Informant's Name (Type / Pant) 20b. Informant's Mailing Atltlress (Street city I town, slate, zip code) Eddy B. Dasher 14 Ridge Road, Boiling Springs, PA 17007 21a. Melhotl of Dispostion ~ [Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. Localien (City; town. state, zip code) ^ Burial ^ Removal from Slate !Was Cremation or Donation Authorized ^ Other-Sp iN: byMedicalExaminer/Coroner? Yea^Nd November 19, 200 Cremation Society of PA Harrisburg, PA 17109 22a. Si to I F eral rvice Ucensee (or person acting as such) 22h. License Number 22c. Name antl Atltlress of Facility Aner Crel0at10II Services of Pennsylvania , lIIC . ~ z PD 013376 - L 4100 Jonestown Road, Harrisburg, PA 17109 Complete ms 23ac only wbe enifying 23a. b f my knowledge, death occurred at the lime, tlate and place staletl. (Signature and title) 23h. License Number 23c. Date SlgneO fMOnth, day, year) physician is not available at ti of tleath l0 1 ~ ~ ~~ ~~ ~ G' ~ ' ~ C ~ ~ V ~ cenity cause of death. ~Y~; 1 ~ f ,) > ~ (; ~~v~r,ye~ 1~ ~ ~ ~ Items 24-26 must be completed by person 24. Lme of Death Pronounced d (Month, day, year) 25. Date 26. Was Case Referred to Medical Examiner i Coroner for a Reason Other than Cremation or Donanon~ who pronounces death. ~ '• LI ~ M_ ~ \ ~ C>~~Cy.~~-~ `~ ~~ ~~ ~ ^Yes ~No CAUSE OF DEATH (Se Instructions and examples) I Approximate InlarvaP. Pan IC Enter other signifmant conditions contr bu(ne to death, 26. Did Tobacco Use Contribute to DeatfP Item 27. Pan I. Enter the gBALLr gf~n~ -diseases, injuries, or complications -that directly caused tfte tlealn. DO NOT enter terminal events such as cartliac arrest, I Onset to Death but not resulting in the untlenying cause given in Pan I. ^Yes ^ Probaoly respiratory arest or ventricular libnllation without showing the etiology. List Doty one cause on each line. ~ No ^ Unknown ~ IMMEDIATE CAUSE Final disease or contlihon resulting in ~ath) Ci' hr./=~"S'~/ ('/'I'lVGL~l/Z I ~ a. /h / ~~T~971c !''~~s2s ,d //L~(~~~~5 29. II Female Due to (or as a consequence o%'. ~, Not pregnant wilhi~ pall year Sequentially list conditions. II any, o ~~ t ~ ~~~ E ^ Pregnant at time of death leatlir~g to the cause Ilsfetl on line a. Due to (or as a consequence of): I Enter the UNDERLYING CAUSE ^ Npl pregnant. but pregnam wAhln 42 tleys j (disease or injury that initiated the i events resulting in death) LAST. of tleath ~, Due b (or as a oonsequence op. ^ Not pregnam, but oregnanl 43 days to I year d. r before death ~~ ^ Unknown Il pregnant wdhln the peal year ~ 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (MOnlh, tlay, year) 32b. Describe How Injury Occurretl 32c. Place of Injury: Home. Farm, GbeeL Factory, Pedormed? Available Prior to Completion Natural ^ Homicitle Okice Building. etc. (SpecilyJ of Cause of Death? ^ Yes ~ No ^ Yes ® No ^ Accitlent ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32I. It Transponalion Injury (Speciy) 32g. Location of Injury (Streei city /sown, state) ^ Suicitle ^ Cald Not be Delertnined ^Ves ^ No ^ Dmer I Operator ^ Passenger ^ Pedestrian M ^Other -Specify 33a. Cenifier (check only one) • Cenitying physician (Physcian cenilying cause of death when awther physician nos pronounced death antl completetl Item 23) 330. Sign/yye antl Title of Cenifier (~ !~ / p /~ Q~~ ~i )•J ' (j~~/i~i.) To the best of my krowledge, death occurred tlue to the cause(s) antl manner as statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ , < • Pronouncing and certifying physician (Physician bolo pronouncing death 2nd cenifymq to cause of death) To the bell of my knowledge. death occurred al the time, date, and place, and due to the cause(s) and manner es sWted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Number 330. Date Signed (MOmh. day. yeas \ ~~ ~ ~ . ~ ~ l ~ , , , • MMical Examirrer /Coroner On the basis of examiner on and I or Investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as stated_ ^ ~ v c~ / y ~ , ~ F~ qq Name and Atltlress of Person Wh Cum feted Cause o Deam (Item 271 Type /Print P nalure antl Dstr cl Number ~ / I ~ / I ~ ' Registrar's Slg 36. Date Fletl (Month, ;year) ~ 3 Tn L U i ~ /'vl-/ •`i' ~cx-•-' ~~ I I I nn wwic~ - < ..- -~ -_ Diapoanion Parma Nn. 0309032 ,~ ~ ~3~~02V'~ n N ~-- o _~~ ~, rti, .; r -~ ~ ~ 7~n. " i ''~ ~:'~. rknr 'j`t ~;'~' a, ~ •-r,- `~ ~; , ~ k ~ Tlt~, ; , ~xfi~'rr~ . , l4_. `_, :^..r.jT.~,., rJ. ~?~'1;'~7."'', Of ~'Oli~"a. :~z~_dt'.iet03": ~`CIT~^'lp, ^~imt~=a7~~1~"<~a~d ^cunty, A~ennsy?.v ~n_a, c'e.4~? ".X'E' t'~~i_s i.r.stru~ent tc~ '.>~? r'.yr 3. r<;t ''~17.. ?nC~ `T'~fi~-=arzen"t, i.21 rs~ariner r3nf~ f'~~r„? ~C~i'_C?631P.~; ~.. i. 'r~n~^C~hJ' E'X..)'Y'=.',55~_K,F •X'c ~'t7~C.E' =i~_~. `'V' ~ l.t' ';Tld .,'~>` '~!' ~ ~.S }.~, r,. w('ti.,. rOY'F' 'n .3C~E' hyr I11E'.. ~. T 114 r t'.~'?y C~ 5_rE' C".'~: P?y '~'.XE_C'attar tU p<~y ;`?~ l ?-t t,. Jtl 7i i~C`~~ `> t ~=unera'_ ~anE? adminstr:~tsvE? exnE~nsc~s a~zt- of n~yr Ens"<~tEa, ~; :Uz~n -~~- nracfi~.c~:~i~~~e a~t-er ~v d~n~-~o 3. `~ha~~:lr' €n~~ hush~nc?, !',1_~r~nr~e ~^, ~'ash~r' ~~:r~~~i_vEy. me ~~~~r "' pE'r~Cll~ of t??1_rty days falio~.r~.nb i•ilyr .`.~E'.c"lt~I, T S"'fi~,' S4; r"'il,C' }Jf,~-••~r~r3t`f' thr~ re~-a-`n.der o~° rry estate to Ci~ren.ee C. Dash~.r. ~{•o r~"1OL7~_C~ my 'Xl'.lSb<°~T1C?, ~iarenCe ~o Tl~_,Sher, ~:)':"t R.£''t^C~~?Ski C"';t? C?r %.. C`: Can. ?~"' ~E: ~!?rC_' t~'1'c'. ~'i7.1.?"t_'th c ~y faliad`7i_ng i"1yr t~ . 4-)'., 7 ..'rryt' i. fin C' ,; „ T?C! :_E CIln;:i.~'i~ t ~ rc'?i'.%??l.GC-'_r '.`~ rn~c7 ?r' F- iv ti1E'. t;~'?? ~'~"`J--'~ 7_rSt C' ny fa~.~_Ea~J1 T1~%` my r'E'a th, TIc r ct? ?^~,' c' e Sa ~ na~in^tc> ~an~ ~pno_rzt ~'~,zm?~c~r3 and ~o3~r~t~= '~t~ nn~.? "-+nk ~,,~ Tr,_~s ~: -j,,~.„~~-,no's .`~rE~~•,~ '",RZmhk~,..?_~~T1d, PE?n1'~sv'v~?i1_~, `~'r~xtee ~f th; ., .. ~ r,p ir„.~ ~ sh~rf~ ^` .^n°v heref_~_r..~f~ry ~•:~ha ~:r:yr ~~ under the ~r_. 4~.i' t ~~ntv n~. t~•:•,~r5. `~'~~ ~.nCC)me, and,~or pr~nC'~_D~1_ a~ S^;_d tx'l1St r l~tec~ ar E~~pended for the m~i.nt°enaneE~., ec'uc<~tiox~. .=nd ~;~~~port o st:c~h ~~.nef;c_<~ry as ttty Tr.~;xstE>e A.n -its sale dscrE~t'<~r tray _?~?-er.. ne ; ,=ar. ~ r~,~~ '?'ru.stee, u_n t~:e c~xnenc~~.ture of ~_ns~n~,~ta fi.~.c~,.,o~ Tyr ; n•~ r~ ~ ?,ai far <:~~ch nurnoses }:~~ a t. ~_ts r' scret ar_ ~`~~~ ~T `-~ ,~ 1. A. ~~.r 2,,. J_. ~~ `*~~:. i...~y~+tl 1. !.-~~ ?.t: Li}, L ~T 1. t:9.. 1. \,'tl a~ C.A. ~~L.I CT r\.? ~.. fldl '..l Y. ~3.L~T L.A t~~ `~C"~~y?. • v t: v ~~ny n~. ;~~.an have n~ tahe care ar ennt~^oi of sa~.d ~:E?n~~', e ~ ~>.r. yr s:~r ~,~..th ti~J~~a~z yhE, ?-~E'nEsfic.ary resicles, wa_th~.ut ,~uty Y, tak^,a~ n,-art c,f this Trustee to sup4~rvise. ar in~u_irE~ into the :~~niirw ~-~~en ~f thc~ fa~?ds ~,.,, -any per~~an tc .-ho~°s any pavnent i.s so madE>. `?"he tan~_,-~,.ne~-~ O ,' - t , ~ St1C`.}1 ,t1C'd~r"te K+T'iC~Jar ??~?^7_T'lC_:..p~31. ~Ra~~. ~~ r`f~.~rl to r;Is"S* i~C~~4~r,C3:"1L^y .. ~ .. ~~an ~.~, r~ch~i.nr; thy, arse. ~*~ tr~~e.nty-once y~:~rs, ar #: ,_, t;~,.~~ ban^ ~=. C~ r~rPC f ~t~~2 ZTl t"`tc~. ~V~'_nt `J~ ~{'c?t~ '~7'1~r ~~':P"~".' ~ s ~~~ S nc~mi.nata anc~ a~pc~int my husb<anrl, t~~.~=;renc+~ 4". ~~~3, r, as ~~°~:c~~ter of tha_s my Last t;'i l~ anci Testament, ~~~?. as s~~b=~t~ t:ti~e ?,.x~c~{~f•r, T nc~tt,.~.nat~ <~nc? apnoi.nt any sons, ?3arry r . ~~~~sher ;~~~ r u-~3~= r . ~'i~sh~r . ~~. ~~n~:~. T~~~tee I d ir~~ ct t~ ^t riy ~ersc~na? reT}re sent~~t i <r~ , As weS?_ ~s Their succcG~~.ars, 5h-' S nat be rec~u:ire.c t~c~ f°. ?.e bc~n-? ~r sec°:~r~.ty in any -~uris~~~ ctian. SN ~?IT``NESS G1HE?~OF, r h~.ve ~e junta set my h~ n~ <~nc sc~ ~l n ~. s Z, ~ d a ~~ o f ~ :~....:k j e.•..y 19 7 7. :y ~~ ~~~~t t r~`artha ~. ~as?-~c r -~I4r~~ . ,r ;' ~ ~ ~ .. a ~.,~ ~`i,~ ,~,.r•.._A, rti ~_.~.,,. _.._~._ ~ t. .. 2 ,'+t^,]~,t*:`(~1~c ... ", TF'7'*I r-:n pr *,sr,*riYrI ctR ~T-~,?1 . c~ ~ C'+C~T.''*i 1. ~' (`~' ~;t~,iR,^i?~~~" ~!11~ ~.... . 7• T°~r~-T't~l~ ~s• ~~.S~l~X'~ `7'C'S~1~'T'l_X~ e,,rhC~SL-' TIrT":£' 1.E'.; S',_f?IIEG~' k~ ~:A1+^' att:~cher~ nr ~or~ys~o~.nn instrr~ir~ent, h~~vinK been c~~~1.v n~_4-~I~f.";°~~i. a+rc:or{~:~,n~ to later, c{.c~ hPrC*by a.C:?uno~~.?_e~~;e that T s ~~.n~: c? ~ryniel ~~a;~~~Y~~. tec? ;-'-e -nstr~snent as r:;f List "T..11.; that ~ s ~~*ne~ ._fi T.:r~ ~ _;,,-~~~., <at1~ fi'h-_?'": :. S v~~?t^.Gry' 1 t" %lC m4'° f7'~'i' =~+~li~ LrO~..IZtlt~rj7 ~"f'. _~'.ng' ~hty ~1~„..~c Sworn ror af~i.~ne~}.}t.,o ~~nri atrknow7e died be 7ao~re ~~~-, by ~"ari~h~ T..7~ ~'~ShC'w`9 i~,~'±_~tr~.~' L-:1~.°C ^y t~h~ (~)rv ~~ ~:. ~~~~~ A ` Tes~atr' ,, ~ t , ~ ~ r, ~ ~' L ~. i ~~ t 1 APB: Y s " ~~ 4~.1 {~ ~----`.,, ~ (~ ~ ~ n..~ ~ L:t;rr~ n~ ,,i ~_x~}i~eu .~:. z:~%}rY ~; , ,.. ,~~ c~ - -~---~-_ ~'}?.n,'~ i'prr~'.TTT (]~` i7 ~~~~Ta,l~.a~,~d`~+Tc1 €``(1~T':,d i V f1'C:' (33 JI,S~T,J'i~~~'lT:Tj-~ '~a, 'I`nrz~ TI. Bietsch an.Ca ~'o~,~r ~'o "-`or~enthal, thc~ ~,,~ i-nes~t~s ;,ri~•.r~se names are s ~*ne~' to the attached or ~ore~oin~ ~.nstx~t~lent, ~'C '_n :~L~.~T C"~:c`~1. ~ ~lE'.'i c~G.'C~C)~{.z~_t'4~:; '~`.CY Z ~T+"~ Co C~C',I7C1Se c~i1L`~. ~'£1`T t~ls^-. ~ ''.,~E~ Sd.Y',=~ ?~~`E.Sc?.T1~" ?nC~ S?EI T~r1'raY~^1_X a.-r .p-t-`,, t7 r)~.fir1 ;: ,•n _a~•~ ~ ~yccute t-h~w. ~_nstrument as her T ash` T.,~_1? ; that sh:~ ~. ~~-,,°°,~ ca;1-' ~- "n~,lZ' e nC? f"~'x.at shs:; £?XE'.~5_lt''_C~ Zt ~-.5 j'tYY° frcee ?nC~ i`Cti'.*3"7}::a7'V c7C~: ~'4Y' i Ala,: I~L:Y'?7C7:'s'~5 the rein P.XDrt'~SS£'<' ~ t~":~ t ~Ow~"1 C):~ L1S ~a.71 t't"i~'' ~'i'.=~~'.n~; <'Cl'' 51.~~'~~~` f7¢ +i'?'?2 TeSt~tr3.X S?.~~nr'C'' 4'hE'. ~y~_ll ~S ItiTl..r'X1t°_~' 7$°~; ~ s?T'iC~ #°}1,`;~' t o thy. ~ac.st r~~ oi.r know~_c~d e the T~.~-,tatri.x ~=as at t~h:~+', t ;~e ' ? ,~,r~ ;^~~'~ Fyyt,9ro, (~~ :xcr~ of Gt?+1nC~ ',''~"a~ nn~ Linder ?10 C:'~Tl.`i~`r<~.1.1'Lt t~:2` ._ s - 1; ??t"}iiP lily) l:~x'FlC:E' '~T~IraT"tl t)r Ci~-'~'..:r'tl1E?~ to =?TLC~ Si?'~J~'S.1":i'")f..f~ t7 t?E~.~C3rE` :"l E' ~~' ''t7FiZ `_'s F7'~.^;tSC~1!. :~T1'' ~.~rrPZ' ~-"~ `>t0r''re'nthal, CtiT~.~T?~SS:-'S' t411.S _~ c°`t"~~* !='... ~ 7..9~' ." ~~ r Y ~ _ - ~~..~ ~ ^~ C ~ ~ ~ ti (~ ,,. t,. a ~ a 1... /" y yy~ '~ ?`. .,. 7 .. RENUNCIATION N .~ ~ _~ ;-, ~ , ~ : REGISTER OF WILLS Fj E~ . ~ ` ~-_ C (/ryl ~~ ~' 1. ~ Nl ~ COLNTY, PENNSYLVANIA ''~ - - ~1~~~, .~ -~~ ;.~ ~ s-= c~ Estate of ~ ~ ~ ~~ ~~ ~ ~~-s ~~ ~ ,Deceased I ~ f~k'~~~ ~, Y'~/~S f(~~' , in my capacity/relationship as (Print Name) ~°~U.- ~"X~C7-D/~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~ ~~c, G. G c`~ (Date) (Signature) 3u~7~ 6~~Y Of1Ks C~Rctr (Street Address) ~N~ G~"WOD.D, ~~ ~~ 2 2~3 (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this _ ~ day n ~ ~' ~ / 1 t L'epu.t; for Reg er of Wills 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 Notary Public My Commission Expires: (Signature and Seat of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Forrn RW'-06 rev. 10.!3.06