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HomeMy WebLinkAbout02-27-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Lynn W. Negley File Number ~ ~ ~ ~~~ ~~ also known as Deceased Social Security Number 194-28-9533 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE A' or 'B' BELOW:) A. Probate and Grant of Letters'Festamentary and aver that Petitioner(s) is /are the Executor named in the last Will of the Decedent dated October 8, 1992 and codicil(s) dated and that the named Co-Executor, Todd William Negley, has executed and filed a Renunciation in favor of Petitioner (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 of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: N/A B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d. b. n. c.t.a.; pendentelite; duranreabsentia; duranteminoritate) 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 Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) r^+3 Decedent, then ~~ at Holy Spirit Hospital, Camp Hill, Pennsylvania Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ([f not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania situated as follows: 23 Crandle Drive, Carlisle, PA 17015 $ 15,000.00 $ 0.00 $ 0.00 g 75,000.00 FormRW-02 rev. 10.]3.06 Page 1 of 2 years of age, died on February 15, 2009 ~ ~~J T) (COMPLETE INALL CASES:) Attach additional sheets if necessary. ~ ;~'- ~' 'T - ' `I7 ._ Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal re~ ne ce at ~_ 23 Crandle_Drive, Upper Frankford Township Carlisle Cumberland County Pennsvlvania 17015 Lr- (Gist street address, town/city, township, county, state, ztp code) 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 annronriate form r~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as persona representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. ~ Sworn to or affirtr~ed and subscribed bef~or`e tm-e the ~~ day of `~- '~. c t e Register Signature of Personal Representative ~'j i co ~-, _~Y, Signature of Persona[ Representative ^'-- - -` :%^; ~j ~c- h) - -`.: "~ File Number: ~ ~ ~ ~\ U1 GI ~ A --~ '- Cft Estate of Lynn W. Kegley ,Deceased Social Security Number: 194-28-9533 Date of Death:February 15, 2009 AND NOW, ~ c~ 1 ~~ O~ ~' ~J, ,~, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED th Letters Testamentary are hereby granted to Kellie L. Kask in the above estate and that the instrument(s) dated October 8, 1992 described in the Petition be admitted to probate and filed of record as the last V~ill (and Codicil(s)) of Decedent. FEES Letters .......ga,.~ .. $ ~( Short Certificate(s) .. `? .... $ ~d Renunciation(s) .... ~...... $ S ... $ IU ~ ... $ .~ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ ~~t, ~"_ Register of Wills Attorney Signature: Attorney Name: Bradley L. Griffie, Esquire Supreme Court I.D. No.: 34349 Address: 200 North Hanover Street Carlisle, PA 17013 Telephone: (717) 243-5551 Form RW-02 rev. 10.13.06 Page 2 of 2 .(~CAL. REGISTR,4~'S ~~7'~F~~A~°It~l~ -' WARNII\#~e It is illegal t0 d~lplicat~ t1iEs, l:aal~~; ~~ ~4~at~stat cs~ ~ahtrt(, Ji.~I~E= . I_~c l~t~f tl)i`` ~_c)'11r-.;r ~. ~,-i)il _~. ('~riif ti,1t, /) \ I , 'SCI ---_ ~~~, P ~r r 1.) t ~~g r z ....!!;, , . ~ .. ~° ,~ a~ 1cL~ .~:i~~ ,3 _ ., ~ * ;' ~~ _ f, - ti - ~'' i, ,- ~~1~ t ~. ~` ~. ~~e,~~.c.~i r^.:I~~~?c~'c' i' E 2 4i OU9 ~=- -- I , Izf , ..,,~ 2 C7 r.~: C C'::? `A '_ ~~~ '' G.:n U= ~.~ N +! - :~~~ D ~ ~- . CJ't H10S743 REV 112006 TYPE / PRINT IN PERMANENT RLACK INK 0 0 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS _ CERTIFICATE OF DEATH 1l ` ~ {.~ ~~ i~-` (See instructions and examples on reverse) STATF FII F NI IMRFR T 1. Narne of Decedent (Frst middle, msl, suMx) LYNN W . NEGLEY z. sex 3. Sodel Security Number a. Date of Deatn (MOntn, day, years Male 194 - 28 - 9533 February 15, 2009 5. Age (Last BinMay) User 1 year UMer 1 day fi. Date of Binh (MOnM, day, year) 7. BiMplace (City and slam w lore ign country) 6a. Place of DeaM (Check only are) wo~ma nova Hw,a Minuwa H ospiml: Other: 72 y March 9, 1936 Boiling Springs PA ,~ m, , ~y mpadem ^ER/Oulpafient ^DOA ^NUreing Home ^Residanw ^Other-Spedly Bb. County of DeaM &. City, Boro, Tyro. of DeaM 6d. Facility Name Qf not insfitudon, give wreel and number) 9. Was Decadent o/ Hispank Origin? ®No ^ Vas 10. Race American boson, Black, White, roc. Cumberland East Pennsboro Holy Spirit Hospital Of yes, specity Cuban, (Spew Mexican, Puerto Rican, etc.) 1 t e 11. Decedent's Usual Occu lion (Kintl el work done dodo most o(wprki Nle. Do m1 slam relk 12. Was Decedent ever in the 13. Decetlenl's Etlucalion (Specify Doty highest grade compmmtl) 14. Merdel Slafus: Marled, Never Married, 15. Surviving Spouse (If woe, give maiden name) of Work Kintl al Busiwas / Intlushy Quality ~ontrol Engines M f i U.S. Amxx1 Forces? Elemenmry / secontl ry (0-12) Collage (i-0 ar 5+) Widowed. DIV°rced lSpeay)7 12 actur ng arni CT~vaz ^No Widowed 16. DecetlenYS Maidng Address (5t;eet dry /town, slate, zip wtlel 23 Crandle Drive Decedent's Did Decedent Aaual Reaitlerrw na. sate Pennsylvania Lne M a rip Deweern LNed m Upper Frankford ~j vee Carlisle, Pa 17015 T~ . , Township? 170. ^ No, DelxMent Lived within nh. county CimdDerland Amual umism cityr Uom 16. Father's Neme (Rmt middle, last, sulTi) 19. MolheYs Name (Fm1, midtlle, maiden surname) Oren W. Negley Mildred K. Wise 20a. InlormanYs Name (Type / Pnnl) 20b. InfommnYS Meinrg Atltlress (street city! tram, smte, zq code) Kellie Kask 35 Maplewood Drive, Etters, Pa 17319 21 a. Method d Disposition i ^ Cremation ^ Donation 21 b. Date of Dispasidan (MwM, day, year) 21c. Platy of Disposnien (Name w cemetery, crematory w other pmw) 21tl. Locadon (City I town, state, zip cotle) [~] Banal ^ Removal lrom Smte I Wes Cremetron orDmatlon Autllorizetl ' Feb. 20 2009 Westminster Memorial Gardens Carlisle Pa 17013 ^ OMer - Speciry:. Medleel Evemirlar / Crooner ! ^Ves ^ No , , 22e. Sgnalure ml Sanity a (w Trig az such) 2ffi. License Numher 22c. Name antl Atlwess of FautiNly ~ ~,~~ FD--012909-L Ronan Funeral Hare, 255 York Road, Carlisle, Pa 17013 Complete Sec Dory when wMNrog 23a. Ta Me txnl w my browletlge, tlwM occurted at the time, date eM place smtetl. (Sigrlalure end doe) 236. License Number 23c. Dare Signed (MOnM, wy, year) physiaen a na availebm et dme m aeaM ro wNN rouse of deaM. hams 24-Tfi maw be completed by person 24. Time of DeaM 26. Dam Praaunwtl Deed (Mamh, tlay, year) 26. Was Case Refined m edical Examiner /Coroner Ica a Reason OMer than Cremadw or Donator? role prorawaes deem. 3'OQ A M. F~L"YU Gty IS ~()n~ ^Yes CAUSE OF DEATH (Sea InetruoUons antl axamplm) , Appoximate interval: Pan II: Enter otller siwdfaant wrlwdons comritxRhld a deaM 2B. Did Tohaao Use Candhule ro DeeM7 own 27. Pen I: Erdw Me rAeM w events- 6seesas, injuries, w tompdcadons - Mat drecMy ceueetl Me deeM. DO NOT enter termiwl evenm such az cardiac artest I Onset to DeaM hul rat rwugirlg m tla undartying wIASB gNen in Pert I. ^ Yes ^ Prohahly mepimlay eaew, w vemdwmr ~rdmtion wanan stawmg tl1e edology. List oMy one wlaB w each line. I IMMEDI TE CAUSE l i ~ ^ ~ A ~me O sww a cwdnron rew,ning in M) , 29. II Femam: Duero (or az a caxsequenw of): ~N01 pregnant wilNn past year Nw wndd'aw, it airy, b. ~ I~e woes Fsmd on line a ^ Pregnenl at rime of tleeM . Due to w az a can rice r Enmr UNDERLYING CAUSE ( seQw off: Not ^ Dregront hN pegwm within 42 days (dLSease w injury Met mitlefed the i evenm meumnq In aeeM) usT. of deaM Due fo (or az e consequence oft: r ^ Nw pregwnt bm pregwnl 43 da to 1 ys ywr d. bemre dwM ^ Unknown d pregnant wwdn the pest year 30a. Was an Aumpsy 30b. Were Autopsy Fxlaings 31. Manwr of OwM 32a. Dwa M Inury (Month, tlay, Year) 320. Describe flew Inury Ocwrted 32c. Pmw of Inryry: flame, Farm, Street Factory, Penamatl? Avadable Prior ro Cemgedon _~N/a mml ^ Hwniade OfFw Suildrg. ek. (Specs!) d cauw a DeeMa ^ Yes [~' JI O ^° ^Ves ~o u ^ Acdlmrn ^ Pendng Invasdgelion 32d. Time w Injury 32e. Inury al Work? 321. H Transponedon Inlury (Specify) 32g. Lowlion d Injury (Strew, dN I mwn, slate) L1C Ild~~ ^ Sukade ^ Cculd Nd he Detemlined ^Ves ^ No ^ Driver / Operemr ^ Passenger ^Petlesldan M Olhw ~ Spea'ry: 33a. CeniHar (check Doty role) 33b. Signature and TAIe of ~ ~ /7 ~ • CetliNinq physician (Physidan wnirying rouse of tleaM when aroMar physiden haz prlxaunced dwM and completed item 23) ' V,'t-f /~ To the beat of my lmowmdge, death alxuned tlw to the wuaealeM menwr as amtetl_________________________________ ^ • Pronouncing eM wrdfying physkian (Physidan hods prwauntirg death end wrdtyin9 m wow al dwM) _ _ _ _ _ _ TO the best of my krrowleage, aeatn olxunetl BY dm time, dam, and place, arltl due to the rouses) end manner az smtad_ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. Liwnse Number 33d. Date ~ den year) q ` • Alediwl liuminar/Corarer ~ (.e L a ~~Jb(s~~a i I On tlK basic of exeminadon end / or inveatigalbn, in my apMion, tlutll oceurted at ifa Hme, dam, eM place, arM dw fo the causes) and manner ea amted_ ^ 3q Name apq+~ e s o P e use of DeaM Qtam 2]) Tyye /Print rs~n NTO Camp/m Ca sr lf ' ~ 36. Registrar's I antl Di r \ °~~+•a: ~~e' t o a l i~ '~ Dale Fled (Month, day, year) ~' i ~,t ~ y r t ,. s _ /~ ( / -' -zT ~~a ~ 1. Vt /k, r W` ' ~ . ~ ~ 1 . I i l I l ~ ~~ , a 1~-, . I i 2Z~ n I ~~,~ L Disposition Permit No. tJ J ~' l ~ ) `v ~~zgt 3~i11 ~tn~ C~TP~~~mPn~ OF LYNN W. NEGLEY I, LYNN W. NEGLEY, of 15 Raylen Drive, Boiling Springs, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST ~~ ., . ... <'\. ~,,. `, r.. I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not own a burial plot or grave marker at the time of my death, I authorize my persona] representative, in his, her or its sole discretion, to purchase z ~~ burial lot and to erect a suitable '~~' P grave marker at m~~ave,~ anc to ex end sums from m estate for this ~~~~' --1 P Y purpose . -' ~- ~ =' s_r ~, .~~; --: _~~ ~; ; w = _-=. .j ~ -~ -F" CIY GRIFFIE & ASSOCIATES ATTORNEYS-AT-LAW 200 NORTH HANOVER STREET NORTH MAIN STREET CARLISLE, PENNSYLVANIA 170'~IAGE C~i/'~Ef72SBURG, PENNSYLVANIA 17201 LAST WILL AND TESTAMENT OF LYNN W. NEGLEY `. ::; ~, y J ', ~~ , SECOND I give, devise and bequeath my entire estate, together with all insurance proceeds, thereon of whatever nature and wheresoever situate to my beloved spouse, LORRAINE L. NEGLEY, providing that she survives me by sixty (60) days. THIRD Should my spouse, LORRAINE L. NEGLEY, predecease me or die on or before the sixtieth (60th) day following my death, then I give, devise and bequeath my entire estate, together with all insurance proceeds thereon of whatsoever nature and wheresoever situate in equal shares to my children, RELLIE LINN NEGLEY and TODD WILLIAM NEGLEY, both of 15 Raylen Drive, Boiling Springs, Pennsylvania, who survive me by sixty (60) days, per stirpes. It is further my desire that my personal representative, after consultation with any heir or heirs of mine who survive me, and i in his, her or its own discretion, choose such articles from my tangible personal property (exclusive of cash, stock certificates, bonds, and all other tangible evidences of intangible personal property) as he, she or it believes will be ;useful to such heir or heirs or desirable for him or her or them to have, either from a sentimental point of view or otherwise, and to deliver such articles to such heir or heirs or among such heirs in equal or unequal shares as determined by the further exercise of his, her or its discretion, provided no other heir objects to the distribution. All tangible personal property not so distributed is to be sold, either publicly or privately, by my GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 14 NORTH MAIN STREET 200 NORTH HANOVER STREET SUITE 307 CARLISLE, PA 17013 PAGE 2 OF 6 CHAMBERSBURG, PA 17201 LAST WILL AND TESTAMENT OF LYNN W. NEGLEY personal representative, adding the proceeds of such sale or sales to my residuary estate and to be disposed of in equal shares among my surviving heirs after payment of my estate debts, taking into account the tangible personal property otherwise provided to them. FOURTH 1 ,. -.; . I grant my personal representative the following powers in addition to and not in limitation of such powers as my personal representative shall hold by law: (a) To retain all property received including the stock of any corporate fiduciary acting hereunder, provided such property remains productive. (b) To join in any corporation, partnership, recapitalization, merger, reorganization or voting trust plan; to delegate authority with respect thereto; i to deposit investments under agreements and pay 1 assessments; and generally to exercise all rights of t investors, including but not limited to, the voting of , shares. (c) To manage, operate, repair, improve, mortgage or lease on any terms any real estate held or owned by my estate. (d) To operate any business that I may own at my death. (e) To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 200 NORTH HANOVER STREET 14 NORTH MAIN STREET CARLISLE, PA 17013 suITE 307 PAGE 3 OF 6 CHAMBERSBURG, PA 17201 LAST WILL AND TESTAMENT OF LYNN W. NEGLEY diversification or any other statute or general rule of law in his, her or its absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. 4 ,~ . ~ ~~ ~, ~~ ~. ~~, ~; ~;~ .;~ ~ tti (f) To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my personal representative shall see fit in his, her or its absolute discretion. (g) To borrow money for the payment of taxes or for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as security. (h) To compromise claims without court approval including, but not limited to, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. (i) To distribute in cash or in kind upon any division or distribution of my estate. (j) To undertake any and all acts deemed necessary and proper by my personal representative for the proper, GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 14 NORTH MAIN STREET 200 NORTH HANOVER STREET SUITE 307 CARLISLE, PA 17013 PAGE 4 OF 6 CHAMBERSBURG, PA 17201 LAST WILL AND TESTAMENT OF LYNN W. NEGLEY advantageous and prompt management of the settlement of my estate. (k) In general, to exercise all powers in the management of my estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to him, her or it may seem best and to execute and deliver all instruments and to do all acts which he, she or it deems necessary or proper to carry out the purposes of this, my Last Will and Testament. FIFTH .~; No interest of any beneficiary of my estate, either in '~~~:~ income or in principal, shall be subject to anticipation or -~~ ~>pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have the power in any manner to charge or encumber .y his interest either in income or principal, nor shall the >\~ interest of any beneficiary be liable or subject in any manner `~-'~'~, while in the possession of my personal representative for the ,, ~~ ~: liability of such beneficiary. SIXTH I nominate, constitute and appoint my spouse, LORRAINE L. NEGLEY, as Executrix of this my Last Will and Testament. In the event my spouse is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and appoint my children, RELLIE LIMN NEGLEY and TODD WILLIAM NEGLEY, or their survivor, as personal representative of GR[FFIE & ASSOCIATES ATTORNEYS AT LAW 74 NORTH MAIN STREET 200 NORTH HANOVER STREET CARLISLE, PA 17013 SUITE soy PAGE 5 OF 6 CHAMBERSBURG, PA 17201 LAST WILL AND TESTAMENT OF LYNN W. NEGLEY this my Last Will and Testament. I direct that my personal representative shall not be required to give or post bond for the faithful performance of his, her or its duties in this or any other jurisdiction. SEVENTH i I hereby declare it to be my expressed desire that my personal representative employ the law firm of Griffie & Associates, of Carlisle, Pennsylvania, for legal advice and assistance regarding this my Last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and the execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this °'~f`` day of ~~ ~ ~ ~~,~ ,r' ~- , 19 9 2 . WITNESS: >, ~"~ J ~ /~ ~-' ? ~ i P- i ~ s! ...-std ~ uc c[` f ft i ` r ,~ `, ~ L~bYN W . NEGLEY`' ~' rr t GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 200 NORTH HANOVER STREET 14 NORTH MAIN STREET CARLISLE, PA 17075 SUITE 307 PAGE 6 OF F) CHAMBERSBURG, PA 17201 LAST WILL AND TESTAMENT OF LYNN W. NEGLEY ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA . SS. COUNTY OF CUMBERLAND I, LYNN W. NEGLEY, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. ~%' ..' LYNN W. NEGLEY ~, Sworn or affirmed and acknowledged before me by LYNN W. NEGLEY, the Testator, this "l'~ day of /- r ~ ~ l , 1992. `~ 3 r'~r t NOTARIAL SEAL TRACY L LEHMAN, NOTARY PUBLlC CARLISLE BORO, CUMBERLAND CO., PA MY COMMISSION EXPIRES MAY 16,1994 GRIFFIE & ASSOCIATES ATTORNEYS AT LAW 74 NORTH MAIN STREET 200 NORTH HANOVER STREET SUITE 307 CARLISLE, PA 17013 CHAMBERSBURG, PA 17201 LAST WILL AND TESTAMENT OF LYNN W. NEGLEY AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA . SS. COUNTY OF CUMBERLAND .- , WE, f;tj"~rtt_ ~ ,~ ~, ,~t~°~.s and ~ ~ _~`'~j_ ~~ ~~f t~~f ~ , the ~° witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. f' ; 1~ ~ ~~ .~ Sworn or affirmed and subscribed before me by -, t~~~r~;. ~~.. ~ ~~~ ~~ , ~ rl_- and ~~ ~. -~_ ;~,.. t.~`~ ~"~ ~j~Gtf~-this %'~r` y day of ~, ~ _ _ ~~ , 1992 . ,, TRACY L. IENMAN, OT~RYA PUBLIC CARLISLE BORO, CUMBERLAND CO,, PA. _ MY COMMRSSION EXPIRES MAY 16, 1994 GRIFFIE & ASSOCIATES ~~ ATTORNEYS AT LAW 14 NORTH MAIN STREET 200 NORTH HANOVER STREET SUITE 307 CARLISLE, PA 17013 PAGE 8 OF 6 CHAMBERSBURG, PA 17201 ~ ~ `"1 ~ f"\lU C"3 :~ ~. `` ~ O "' RENUNCIATION ~ ~ `' ~~ `~' _a f, ~ -~ REGISTER OF WILLS ~" ~ ~~' ~' CUMBERLAND COUNTY, PENNSYLVANIA v ~ ~, u: Estate of LYNN W. NEGLEY I, TODD WILLIAM NEGLEY (Print Name) named executor and son Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Kellie Linn (Negley) Kask ~t~rycz, , ~..0 .e2~U1 (Date) 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. ]0.73.06 (Signature) 224 Larue Drive (StreetAddress) Coraopolis, PA 15108 (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 t~~bti~Ltic~. ~ ~~ ~~yE) r'I ,~ Notar Publi My Commis ~ n Expires: - (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) ~Ii1~ ~~ ~Y~~ Ir0101y'i~INC IMr Com~nlalon ixpha Jon i. 16i!