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Home My WebLink About11-23-09PETITION FOR PROBATE ANB GRANT OF LETTERS REGISTER OF WILLS OF ~~"~- "^ ~ ~~ L~~ COLL~TY", PE~1SY LVA~IA Estate of 1 y 1 ~~ ILL 1 !-+~ ` 1 ~~ ~'C ~ also known as Deceased // f"' File Number ~ ( l_,~` (~ ~ j Social Security Number ' ~ ~/ _ ~`~y ~`'' ~' ~ 3 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: ,(COaIPLETE A' or 'B' BELOW:) ~I A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the `~.°'-~'t~-'~'~'~C ~ ~Z ~'L`rL~'~~"famed in the last Will of the Decedent dated ~~'( ~a~ ° ~a-Yand codicil(s) dated K o ~ (State relevmd c;rcumstances, e.o., renunciation, death of ececutor, etc.) ~~ ~~ ~, Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ~tinsttumer~) offered - ` i ~.~ - , for probate, was not the victim of a killing and was never adjudicated an incapacitated person: O ^ B. Grant of Letters of Administration - " (IJapplicable, enter: c. t. a.; d. b. n. c. t. a.; pendente life; durante absentia; durante ntirr~r+trrEte,'~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse"(jf any) an~4 eus: (If Adarinistratiat, c. t. a. or d.b n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ ~~t` ~ ~ (CO.YIPLETE LY ALL CASES:) Attach additiata[ sheets if necessnry. Decedent was domiciled at death in C_ u. M4~~-!'~`~'O County, Pennsylvania with his /her last rincipal residence at _ ~~~`~ I`nCss,a,~~. ~.~zc~L ,~ f'`n~~H~~.~~cs ts.~2C- ~A t7~~'~ (List street a'd; ess, low,'city, townsAio, county, state, zip code) Decedent, then -1 ~' years of age, died on ~ ~~ ~'~~'`~( at ~ ~L'f ~~ t ~ F"~` ~~ ~~ J' ~-"s~ '~-- Decedent at death owned property with estimated values as follows (If domiciled in PA) Ali personal property (If not domiciled in PA) Personal property in Pennsylvania (If nct domiciled in PA) Personal property in County Value of real estate in Pennsylvania situated as Poll F'or-rr: RYV-U? rev. 10.13-0~ Pa~~ 1 Of ~ ~~~ ,~ ~~ ~~ ~ ~ti Wherefore, Petitioner(s) respectft~,lly request(s) the probate of the last Will and Codicil(s) presented with this Petition and tl;e gran' of Letters in the appropriate form to the undersigned: Oath of Personal Representative COiviMONbVEALTH OF PEN~iSYLVANIA SS C~~liNTYOF C~y~ )v~ ~~~-iA~ "The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con~ect to the best of the kno~•vledge and belief of Petitioner(s) and that, as personal r°presentati~~e(s) of the Decedent, Petitioner(,) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me the ~ day of C' Signature aJPersonn! t~1-'esentative _~ Signature of Personal Representative ~. ~ '. ~ -~ FOr the eglSteC Signntur'e ojPersona! Representative _ h~ G,} 1 x ~ t ..~ File Number: -~t ~ ~~] " ~ ~~~ ~ -~-~ Lr O Estate of ~~ `~~ ~ L i ~ ~~ . JC \ '~Z ,Deceased O Social Security Number: ~ ~ ~ ` r~-~ - ~'~?3 Date of Death: ~ ~ -- 2-`~- `~ ~C ~,) ( / AND NOW, ~~~~ ~ ~ lr ~~~~lL'~nl~~' , !~ / !~/ , in consideration of the foregoing Petition, satisfactory proof D _T.~~~ having been presented before me, IT IS DECREED that Letters ~ ~ L I l ~ ~s~ ~ C~~ ~ C_`Y~~~ ~ , ~ /"l are hereby granted to ~~~ Q ~ (~ ~; y'1 ~%~ • f~1"~ Ci l` fit. t'~ . ~~~ in the above estate and that the instrument(s) dated ~ ~ \ ~ 1 de>>eribed in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. r' -~ RegisferofWills. ~~;~(} </-~ ~~~~~ C~i ~~ -,~ ~ 1y, Letters .............. . $ ~ ~'' Short Certificate(s) ........ $ ~ ~~• ~'~' Attorney Signature: ^'.~ .~ Renunciation(s) .......... $ ~~ ~~ 1 ~~ ... $ ~~)•L7L~ Atton~eyName: _ • • ~ $ ~'• '~ Supreme Court LD. No.: 'Y G` .. ~ ~ .,~ Add]'eSS: ... ... ... ' ' ~ Telephone: ... $ TOTAL .............. $ {> ~ ~ r r~,~,,, R>v_o? rev rv.~~ o~ Page 2 of 2 ~ C~~~ - /C` ~' ~' Y~' ~~ig-1r. Et is iiiQga~ try zia~iieate ~ii:~ w~i~gaY/ =~y ~;kl0tnstat ~r ~?~se?t'~.: .1 I P 1'5838885..._. ,~ I. --,~ ,. ' ' , f `- ~. ~- ~ M~,~ - rr!~w ~ ,~.. .. ~~.; ~: , .'~ , , '., -; ,--' ' ~7~~ _::' ~-~, ~ ' ti7 :~._1 "i7 M1uE li3 HbJ II:LWa T•r PE PRINT M PERMANEN( BLACK INK COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) STAiE FILE NI)MbEH i'- ~-, r: r ,', ~,.. sm:? ,,: ,r`.~ Cl: t~ 1 Name of Deconenl IFusl, mldde Wst. sunixl 2. Sex 7 So«al SecurNy NUnIDer 4 Date of Deam LM mn. OaY yearl 2009 2073 8ctober 24 , Marlin Hess Seitz Male 198 _ 28 _ 5. Age (Last BrtVday) Under t yeti Under I Jay 6. Dale of BiM (Month. day, year) 7. &nnpWCe ICVY ant SUte w lore cautlry) Ba. Place of Death ICheck only one) 96 ~Nma„ Days Id", x,~re January 28, 1913 Fairview Township, Pa. HJSpIIaI' O1neC Yrs tnpaliem ^ ER i OufpaUent ^ DOA ^ Nursarg 11drtre ^ Residerx'a ^Oll~ur - Spealy. Bb. County of Deam &. City, Boro. Twp. of Oeam Bd Facnny Name (11 nd insfifutiwr, give MrBel ant twmbw) 9. Was Decedent of Wspanic OrignP N° ^ Yes 10. Race Amelrcan N Man, Black. Wnne. etc land East Pennsboro C b Holy Spirit Hospital olyea,sµxirycuba" I~'y~ White er um Mexican, Pueno Rrcan. ek.) I7 Dacetlenl's Usual Oct atl«I KIM of work tlone drti mass o1 wurku IAe Do rwl state refired 12. Was Dacedem ever Ni Vre 13. pecetlenl's Educal'ron (Speoty only hignesl grade completed) to Marital Status. Merrietl Never Marned. 15. Survivuy SDase III woe ql.e maiden name) ' KIM of d Kud of B unere I u51ry #a`I~' ~2 ~ IV°rced (Spec ly) U S. Armed Forces? Elementary 1 Secondary (0-12) College (]-4 or 5.) Wx~etl D 4 Widowed e perator Owner- ^ves Nd 16 Decedent's MaWg Address IS1reeL <i1y /town, stale, np cote) Decedents pA Did Dacadem Live ina 3 339 Messiah Circle „e [5 yea, DeLeJem LwaJx iwD Adnat Heaiderke ,1a sate T°w"a'"D' ,~a ^ N° DacedantLwEdwlllxn Cumberland Mechanicsburg, PA 17055 nb caNly ActwlLxrgtsd oty-a,tn ,a FalnersN;vrejFxsl coddle rm snnW 's MolneraNanielFNStrtnade.nwtlenwmamel Elizabeth Hess Johri B. Seitz 20a lnlortnanl's Name lType; Print) 20b-InlormanPa Maibng Addes's($treef, ci stale zrp PA 17019 ~umml~ rive Dillsburg Ann Davis , 21a MaNOtl of Dlsposmon ~ ^ Cremebat ^ DnnatWfl 21E. Date d Orsposnron (Month, day, year) 21c. Pace d Dispovtwn (Name of cemetery, crenralory w other place) 21 d. La:alion ICiry i town, stale ip coast Burial ^ Reinwal Vum State i Wes Cremation or Dertalion Authorized 28 2009 10 Slate Hill Cemetery Camp Hill PA 17011 ^~-s „y. , ~e MedicalExamineNCOr n ^Yaa^Nn - - 22e. Sg of Funeral Serv lken r s acting a ~ ra 220. License NwMer 22c. Name ant Address W Facility Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055 ~ / ~ FD-012662-L CcnrpK~te Item only wnen nllywg 2 o the best y knowetlga tleaih «curre0 et ale time. tlale and Dtace staled. (Sgrewre aIM title) 23b. License Number 23c Date Signed IM°nth day. year) ;n~ysraah o not a.ananla m Dina ul ~mn m ' cently tense of JaeN 24. Tone of Daeih 25. Date Prwwdrxed Dowd (Monty, day, year) Medical Examiner ! Cwarer for a Reason Other V,en Cremation or DoriaN<n? 26. Was Gase Rele r ratl to Ilems'N 20 mast Ge canplalcJ Gy person ~ M ' . ~ ~ ", ^ Yes ~- . w11u proliouncas Jeew. M. 2 Q O 1 O 9 f CAUSE OF DEATH (Sea Instruetlona and examples) , Approximate interval Pan II. Enter when ~xN..cUpoltwrS lSyilUtwlltlglp.CCa1G. 2B Did iooaaw Uso Corxrdwte a Deem? f Item.] Pelt I'. total Via UIWd to cvVWi Jl~ee>es. uiluiws. o aril V,.aiiuns -toot drNVly causetl th deaN. DO NOT enter teimmal evenl3 such as ceNec arrn>I. Oii>el lu Death oW rnn resullulg ni Vx: «tJerlyiny cause grveri m Part l 1 PrubaWy ^ Yus L ,e.>prlatuiy arru-il.« venlrKdar IwrJletion wnnuul shuwlny the allulogy Llsl only «re Wuse «r each One. ^ No ^ Unlawwn IMMEDIATE CAUSE tFinnl J~s.~:~~e or 1 ~f"N .y- ~' ! 1 ' / /l /~ ~ ~ n IJ ../ 7 K m - /~ S t/ C 1 C eondtiun resulting In afhj ~/ L FBI I` EC (( 1 2q. tl Female ^ N um st ear t t a .-~ .. Due l0 ('~ onseque ce off- 1 U r 1 aJndlians II any >e tiall N pregnan o rv n Ve y ^ Preyrwnl al iln're of deaw . q y , leadng w Ne cause Nsietl tin line a r ^ Nut p,eyiunl out Vra'9nal,t wuMn 12 Jays Erne Ore UNDERLYING CAUSE 5 ~ (" [' /s ~ ualto (or as a oun'u~~e OII~ A ~ M ~ P F R T N I N r v7 V sc or (®s5 ho ' 11 JI Jenllt l ' __ flog Y1 JO,nt~~LA$I n 6 n ^ ~I~QeceeuV. out pmgi Wnl 43 dots 10 I YCer Duo Io IOr as a coruayuef%e oil. I ^ llNUtown n paegltunl wllmn the past year d. 30e Was an Iwtopsy '30tr Wore Autopsy fwdng5 31 Manner VI DebN 32a. Date d Injury (Monty, tlay, year) 32V Describe How Inury Occunetl 32c Place of Lyury Home Fem. Street FaUOry. Ollice BuiMrg ex: (Spscdyl PerlanxJ~ AveJabk Print to ComDk'I~a~ r ttulel ^NOmKxk ul Cnusa of Deam? [ ~ Ac[idanl ^ Pondiny Invesxyelt«t 32d. Time of Injury 32e. Vyury al Work? 321 II Transportaawr Injury (SPaG4'I 72g. Lc:catan of Injury (Street, coy r town, state) [~ Yas tic [ ] Ye> ^ No ^ Yes ^ No ^ Dover I Operat« ^ Pass'erger ^Petlevll ^ ~aa,de ^ Cuuw Nal de DeterniinWl M `loner - ipecdy 330 s' w,a Tnie d cemlrer r 33e. CenVier Ic"eck only one) • CerUlyug physician ~Pnysuian vend,uig rawa of Ju~evl v.l,en soother prry>icwii has pronounced deuN and culnpleletl Item G3) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ Ne cause(s) rind manner as aMted d d t h , ~ ~ 5 P ~. T,~ L I S T • _ _ _ _ _ _ _ _ _ _ _ _ _ occurre ue o To IN Desf of my knowledge, deat of d U 33c Lcense Numoer 33d Daie Sigrwtl IMcmw day genet ea l) • Pronouncing and cenityinq physician IPhyscian ti~w prunuurx:mg death and cen,lying to tau>e ^ Mt a _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ e m the Dent of my kn°wledge, death «anrrea m me tlmn sate. and prate, aria due fo qre tense(s) am manner as : M ~ 3 ~, I0 2 y O • Menicel Examewr I Crooner On the Uasu of ezaminalion and I or investigation, in my cpmion. deaUt occurred al the time, dale, and place, and duo to the Cause(s) and manner as sfated_ ^ ~ Name and Atldess d Person Wno Completed Ceuse of Death Illem 211 Type I Print ~ (~JL! I UQ h 0 r t~.l M D ~ 3 ,awrE anJ Dlsu~ r, Gee n ~ a -. Fjegls' r ~~aa j /1~ (1,wy~'~~,. I I ~ I I l I'~.I 36 Oat FUed IMwllh, day, year) j - ~,~a a ,j~'% 0~1 . , T G(i ~j [.1 St un1 al i~ I"loll na„n.won Panne N° ~-'~ 7~ ~ ~ ~~ L~ WILL ,~~ - -,c> ~ ~~ ,~ ->._. c- -, .:,c;; MARLIN H. SEITZ '~~.: _~-: ~% - ch - -, - ~- A .-; I, MARLIN H. SEITZ, currently of Upper Allen Township, Cumberland=~'ount~~' Pennsylvania, declare this to be my Last Will and Testament, hereby revoking~~ny and a~ prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that alI estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. III. In the event that any of my children have loaned money from me during my lifetime and have not fully repaid it by the time of my death, I direct that any remaining balance shall be forgiven. IV. All the rest, residue and remainder of my estate, of whatever nature and wherever situate, including property over which I hold a power of appointment, I devise and bequeath as follows: A. One-sixth (1/6) unto The Mennonite Foundation, Inc., Goshen, Indiana, to be used for the charitable purposes I intend to outline to it by separate instructions. B. Five-sixths (5/6) to be divided equally among my children, namely Ann E. Davis, Gene B. Seitz, Blair M. Seitz, Mary Jane Melhorn, and Nancy R. Benson. If any child predeceases me, his or her share shall pass unto his or her issue per stirpes. If said child leaves no issue, said share shall lapse and be added to the shares passing to my other children or their issue per stirpes. 1 .-):!l.~ °~ -1- ~~ ~ r"~, ~~~' ~. V. I appoint my daughter, Ann E. Davis, and my son, Gene B. Seitz, Executors, or the survivor of them as sole Executor, of this my Will. VI. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, MARLIN H. SEITZ, herewith set my hand to this my Last Will, typewritten on two (2) sheets of paper including the attestation clause and signatures of witnesses, this ~ `~~ day of S~v z ,~ , 2002. ..-- ~' (SEAL] MA LIN H. SEITZ Signed by MARLIN H. SEITZ, by him declared to be his Will in our presence, who lhave hereunto subscribed our names as witnesses in his presence and at his request, this ~ Y2, day of J _~ L ~ , 2002. ~ __ ~'=-~ G ~--z.~~- residing at .r ~~~.~.c..~~.-- ~..~- ~~ residing at ' -<~ ~ ~ ~ ~'~'~- 4 l -2- COMMONWEALTH OF PENT ,NS~,Y,-SLR VANIA COUNTY OF C~~- u~`-' ~'' WE, MARLIN H. SEITZ, GERALD J. BRINSER and ~~~I~vi~e. ~~ ~~~:~h , the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as witnesses and that to the best of •our knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Subscribed, sworn or affirmed and acknowledged before me by MARLIN H. SEITZ, the testator, ~ F2:4 ~ ~ ;~ _ 6~ r ~r s F2 and !f a.~e ~t~ . ~~~~ ,witnesses, this day of~~(t,~ , 2002. Notarial Seal ___1e. Jennifer R. Freeland, Notary Public Upper Allen Twp., Cumberland County AAy Commission Expires Dec. 13, 2004 Member, Pennsylvania Asso~iatlon of Notaries -3- ~~~,~ J .:,-.1L~~~ WITNESS 11/09/:?009 67:56 7177661695 1/ERNON MARTIN RENUNCIATION REGISTER OF WILLS j _~ _'~-, ' ., ; ~~ M (~E~-~+~ COUNTY, PENNSYLVANIA , PAGE 0Z `~;: 5.. :~~N <-; >Vstate of ~ ~/t-~-~ k ~ , SF ~^~ Z- ,Deceased I, ~ ~-N a u ~ ~~E (- ~~ r y PYc~o ~. ~.~~... , in my capacity/relationship as (Pr1nl Name) _ ~ ~ ~ ~~~~ A~~1 _ of the above Decedent, hereby renounce the right to administ'erJthe Estate of the Decedent and respectfully request that Letters be issued to V ~_ 2 is a .,,c ~ _ ~M A~ ~•-r~ ~..~ ~ /~ rr~ {-y- o '~ ~=t~{~j,~ C~1Gtt^,~VriS• ~'I •;. Assistant Treas. (Darr) (S~gnarure~ Gary L. S e ler ~5e mTa`r Ring 1110 North Main Street, PO Box 483 (Sn•~er Adirscs) Executed ix Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills Form RW-06 rtv. /0.13.06 ~ Goshen, IN 46527 (Cllr, Sla/6. Z;p) F.~cecuted 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 9th day pf No embe , 2009 Notary Public My Commission Expires: (Signature and Seal of Notary or odxt official qualified to administer oaths, Show date of expiration of Notat~rs Commission.) •~~''""'••. DOROTHEA TROYER `'~^p? ~'•-~ Elkhart County :*: ~~ •~ .~ a My Commission Expires •~•!?~M°~' November 1, 2016 r-.`+ ., ,~, ~I~TUI'+1CIAT~~'~ °~ ~- -~~ _ '' r' 4.~ REGISTER OF WILLS ~ _ . ~, s~-r lu.w - a <~ COUNTY, PENNSYLVANIA % ^' ~~ Estate of r~i'~ u r i t~ vt ~ t' ~ s S ~ % ~ Z ,Deceased ~~, I, f-t ~ ~ ~'~ ~ ~ -~ ~`t t/ 4 `> , in my capacity/relationship as _ (Print Name) _ , ~~~ ~ ~ G 1` ~ ~ ~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ,, ,f (Date) (Signature) LC r) i F'YL ~ ? ~ i ~ :_ (Sn-e et Adr~i ess) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~-'~ day of N DV~m f1P,r , ~Q12~. ~~ 1/-eputy for Register of lls _._ ~__ ~~ ~ ~ ~ c,_ ,- ,~, f'~ t`~1 i ' ~' ~ ,~ (City, State. Zip) Executed out ofRegisfer'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 Seaf of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) :~orrn.R6V-06 rev. l0-1.06 ~.-~ :., c. _ -,~ _~ I~l\T~JI~TCYA'I'I~~ -' ~ ~_> ,_t, ;-, REGISTER OF FILLS -:.-m -: ; ~;; - ~~~N ~~ ~~ ~ -COUNTY, PENNSYLVANIA ~ ~~ ~~ ;~ c? ~~ f ~ L/ ~ ~ 7L 7_ ,Deceased Estate of ~ ~ ~l I ~~ ~ ~, f' ~ ~r~~' ~-~ _, in my capacity/relationship as (Print Name) ~~,,~ j of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to /v ~N (Date) ~,'xectrted in Register's Office Sworn to or affirmed and subscribed befor me this ~ day Deputy for Register of ills -. ~i __ i (Signature) _/ 1/ ~,~c- /,~~~ .~~-- ~ ---- (Street Address) (City, Stale, 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 Notary Public My Commission Expires: (Signature and Seat of No[ary or other official qualified ro administer oaths. show date of expiration of Notary's Commission.) ForntF.i'r=06 rev. !0.13.06 RENUNCIATION REGISTER OF WILLS Lug ~\C~~~c\ COUNTY, ~~`~.=~ Estate of ~u ~ /,., ~~t ~,~ Deceased ~y -~ I, /~ t~G . ~' /~1 ~~' ~~~. in my capacitytr~lationship~s _. c:ey ~e? '~ of the above Decedent, hereby renouncer=ri ht ,.~. _. ~ t~9 -- ~~ administer the Estate of the Decedent and respectfully request that Letters be issued to" --.'-~, ~ ~//r~ ~ ~. (Dare) Executed in Register's Office Sworn to or affirmed and subscribed Before me this _day of~ Deputy for Register of Wills Faun RGt'-06~ rev.10.l3.06 ,~ ; ~/v~, /~~ ~v/J G'~~~' Z (City, State, Zip) Executed out of Register's O/fcce 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 ~+h __ day y~v~nbe~ ~ :~C~Cr Notar~Public `~ My ommission Expires: ~- ~ ~(- c~C~ ( 3 (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of notary's Commissiun) JOHN 5TARN-NOTARY PUII<LIC Comeli~asion # 2300629 STATE OF NEW JERSEY Mp ('~mmission Expires May 19, 2013 ~s~~ /~ ~~ <' .S/ (Street Address) ~ rJ r..~. r: ~^_ I~N~iJ1~TCIAT~Oi~ <-. t_ ~ ~' =, r..~ REGISTER OF `VICES i ` ~~~' , Cam ~a_~~ I ~w~ ~ COUNTY, PENNSYLVANIA ~' . ; _.~ L' ~ _ 1 Z -' >/state of ~'~' ~ L~ r' 1 ~ ~ ~' - °~ ~ ; Deceaseu I, )n tr ~c.~__ I {~l ~ (Vi ~ a~ n , in my capacity; relationship as (P int Name) _ ~~_a.~,~ . ~, ~ r f of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respe%ct~fully request that Letters be issued to ~l Co U ~ ~ , (Date) (Signal/ure) / ~ ~9 Z l ~ C_~ ~e'~e.c~ah-i~ ~G~ ___ (S7reet Address) ~r~~ ~ ~~ J ~ ~ ~ ~ (City, State. Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified of that he or h,~ executed the renunciation for the pure s t'ated within on this day of I c. ~ ,, Deputy for Register of Wills NotaryP Iic My,,~oi mission Expires• ~! '- ~°~;~~,~(,~"~'i~-~ (Signature and Seal of Notary or other officia'}~ualified to administer oaths. Show date of expiration of Notary's Commission.) SUZ; ,_,. ,~ ~ tictary Fubllc Forrn RYG'-06 re-:. 10.13.06 Ca"'~~~ .°~ll Ei,-r,. Comber~and County ~;ny ;;~;m,~,i;s~c~^ Expires August 25, 2013 xa®..e, r~~ ~-. ,~ ,~' - -, ;_ ~~ TT - _ ~-:i-} sv ~~T U ~C~AT~oi~ c,~ _ ,, .- ., ~ _-> - REGISTER OF WILLS `-'~-' `:~ -.~ ' ~ t rn br_ r ! «-~~a COUNTY, PENNSYLVANIA - ,Deceased Estate of ~~\ t~ ~ I ~ ~ }-~ ~ s t, `~ 6_. , ~ ~ I, N ;'w~ ~-~~ ~~ ~ S c ~~ __ , in my capacity relationship as (Print N'ameJ ~;; u, a ~~ (,, -~ ~ t'' of the above Decedent, hereb,~ renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to _; iData) ls'xecuted in Register's Office Sworn to or affirmed and subscribed before me this of day Deputy for Register of Wills ~~ ~ ~ (Signature) (Sn~eet Addre rs) /~- ~.~~ ~ ~~ ~ ~ ? ~ r-~-' (City, State. Zrp) 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 AiLSerw~e~' 2c~.: ,: /-' t ~' Public ~My Commission Expires: `~~Z.Z~~/ IgNVUCest-rta iar• ~cNiya~t~ln/iNEb1 Signature and Seal of Notary or other cffcial qualified co iUot2.ral Sea! dminister oaths. Show date of expiration of Notary's Commission.) i3Fxtjamin iaeF~eli, Itiotary Public East Hempfieir Twp., (_ancaster County My Commission Er~aires Marry 22, 2011 Member. Pennsylvania A<.saciation of Notaries FonnRib=G6 rav.l0.i3.06