HomeMy WebLinkAbout04-01-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~y'~i 13~~l.~hC~( COUNTY, PENNSYLVANIA
Estate of ~~/'/ ~ / ~ ~// (// ' ~ ~Q
also known as
Deceased
File Number ~~~~ ~ e: ~~
Social Security Number ;~rj° ~- 7 ~ '^ 7G~ ~ ~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~A. Probate and Grant of Letter~sr7Testa ry and aver that Petitioner(s) is /are the
last Will of the Decedent dated { ~~iY C- ~ and codicil(s) dated
r~a
o ,
mimed in the ` _;
...p
~r-; ~ .
,.
__- '. ._:
(State relevmit circums[ances, e.g., renunciation, death of executor, etc.) . ~:- -" I ._.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of theaii~~t<=u~rtent(ffeted -;
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ,~'- c=t
=a .. `~ ~7
_~ ~
^ B. Grant of Letters of Administration '~
(Ijapplicable, enter.• c.t.a.; d.b.n.c.t.a.; pendente liter durance absentia; durnnte minoritate)
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: (!f
Administration, c. t. a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
(COMPLETE !1V ALL CASES:) Attach additional sheets if necessary.
~ecedentwas--d~Rlmiciled deaf in f/1/ ~ ~ ~ C.1 County,
street address, towrdcity, township, coup +, state, zip code)
at ~I~I~
Decedent, then ~ ~ years of age, died on J ~ at ~;;/,~~) ~ ~ K ~7 / (~ L // ~ P
Decedent at death owned property with estimated values as follows: ~
(If domiciled in PA) All personal property $ ~~'// r~
(If 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:
Form R6V-0? rev. 10.13.06 Page I of 2
PCv7'~
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:
Oath of Personal Representative
CO~I~fON`rVEALTI-i GF PE~,~~Y LV.=~vIA
SS
/'' ~ ~ .
COUNTY' OF (.. (,lV~~~W /~f
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 belies of Petitioner(s) and that, as personal representative(s) of [he Decedent, Petitioner(s) will well and truly
administer the estate according to law. ~,~~.....-
~,....
Sworn to or affirmed and subscribed N
~
C
St Signature of Pcrsonzl Representative ~ ~ ~' ~ ~"' ' ,: -`-:,
before me the
day of ~ ~
,~ ~ -'-_~~ :. '~•:,
~ `
Signature of Personal Representative " °-r- f~ ,
t ~ +
_._.. ..
~
~._.•_
,
F r ie Registec Signature ofPersaral Rzpresentative >•-~ ~ y - `°
.:~--1 ~ ~ ~: t:
s •3 t~~
File Number:
Estate of ~~ ~ ~~` ~ ~ ~ ~ ufs~ ,Deceased .
Social Security Number: ~p'~ _ ~~~ Date of Death:
AND NOW, , iu consideration of the foregoing Petition, satisfactory proof
having been presented before Ze, IT IS DECREED that Letters ~ eSfQ,~'~en`~C1..x ~,~
are hereby granted to _~ r(~~ ~~~ b(°,r ~'
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to robate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES (/~iC.(. ~1~~r ~ w I~l ~~" ~ 1J ~~, U '' ,l
Letters ...... , . $ ~} Register oJWllls Iz £ '~-- ~ J ~ ~ ~~ ..
....... _=1.~_O
Short Certificate(s) ........ $ Attorney Signature:
Renunciation(s) .......... $ ~ ~ • O~
~' $ , U Attorney Name:
C. • • • $ ~ Supreme Court LD. No.:
$ Address:
... $
... $
... $
' ' ' $ Telephone:
... $
TOTAL .............. $ ~U
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DIMITRI ANDRIUTSA
I, DIMITRI ANDRIUTSA, a resident of Pennsylvania, Cumberland County, being
of sound mind, memory and understanding, do hereby make, publish and declare that this
is my Last Will and Testament.
FIRST: I revoke all wills and codicils that I have previously made.
SECOND: I am married to PAULINE E. ANDRIUTSA and I have the following
adult step-child (my wife's son) now living: KEITH L. DEIBERT.
THIRD: 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 estate" refers to the rest of my property not 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 more beneficiaries in this will.
FOURTH: 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" means any debt that is secured by collateral but which was not incurred
for the purpose of purchasing that collateral.
FIFTH: 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.
SIXTH: I hereby leave my entire residuary estate to my wife, PAULINE E.
ANDRIUTSA. If my wife has predeceased me, I leave my entire residuary estate to
RANDALL L. HARTMAN, Esq., as TRUSTEE, to be held, managed and disposed of
pursuant to the provisions of the Trust Agreement attached to this will, naming my wife's
son, KEITH L. DEIBERT, as the beneficiary of the trust. If KEITH L. DEIBERT has
predeceased me, I leave my entire residuary estate to RANDALL L. HARTMAN, Esq. , as
TRUSTEE, to be held, managed and disposed of pursuant to the provisions of the
Children's Trust Agreement attached to this will, naming the CHILDREN of my wife's son,
KEITH L. DEIBERT, as beneficiaries of the trust.
Initials: ~~ ; Date: f ~ . / ~' ~ Page 1 of 4
Will of DIMITRI ANDRIUTSA
SEVENTH: 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.
EIGHTH: I name PAULINE E. ANDRIUTSA as my personal representative
(executrix), to serve without bond. If she shall for any reason fail to qualify or cease to act
as personal representative, Iname my son KEITH L. DEIBERT as personal representative
(also to serve without bond), instead. If my son is unable to serve as my personal
representative, I name RANDALL L. HARTMAN, Esq. as my personal representative (also
to serve without bond), instead.
NINTH: 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.
TENTH: 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 as
provided for by the laws of Pennsylvania.
ELEVENTH: I instruct my personal representative to pay all estate and inheritance
taxes assessed against property in my estate or against my beneficiaries as provided for by
the laws of Pennsylvania.
I, DIMITRI ANDRIUTSA, the testator, sign my name to this instrument, this
day of October, 1994. I hereby declare that I sign and 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 of ;erwi~e legally
empowered to make a will, and under no constraint or undue influence.
~ ~ G/
(Si ed)
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.
Initials: ~; Date: ~ ~, / ~ ~ / Page 2 of 4
Will of DIMITRI ANDRIUTSA
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 perjury, that the foregoing is true and correct, this
day of October, 1994.
Witness #1: FRANK J. KAUTZ, II
Residing at: 340 Oak Drive, New Cumberland, PA 17070
Witness #2: DONNA M. YOUNG
Residing at: 1532 Thompson Lane, Mechanicsburg, PA 17055
s
~ Initials: ~ /r!; Date: ~ ~ f ~~
Page 3 of 4
Will of DIMITRI ANDRIUTSA
AFFIDAVIT
We, DIMITRI ANDRIUTSA, FRANK J. KAUTZ, II and DONNA M. YOUNG,
the testator and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument in those capacities, personally appearing before the undersigned
authority and being first duly sworn, declare to the undersigned authority under penalty
of perjury that:
1) the testator declared, signed and executed the instrument as his last will;
2) he signed it willingly or directed another to sign for him;
3) he executed it as his free and voluntary act for the purposes therein expressed; and
4) each of the witnesses, at the request of the testator, in his presence, and in the
presence of each other, signed the will as witness and that to the best of his knowledge
the testator was at that time of full legal age, of sound mind and under no constraint or
undue influence.
Testator: ~~
Witness: l
Witness: ~t~g'x~.~
Subscribed, sworn to and acl:n~wledged before me by DIMITPI A'-STD'-'-T.UTSA, the
testator, and by FRANK J. KAUTZ, II and DONNA M. YOUNG, witnesses, this
~~ day of October, 1994.
._.
j Notarial Seal
I Michele J. Hartman, Notary Public
`: ~ Lemoyne Boro, Cumberland County
My Commission Expires Aug. 3, 1998
Member, Pennsylvania Association of Notara;
[[; Notary Public
1'
~ Initials: ~; Date: n ,- ~ ~ Page 4 of 4
~!
TRUST AGREEMENT
This Irrevocable Trust Agreement is made as a testimentary trust by the will of DIMITRI
ANDRIUTSA, herein referred to as Grantor, and RANDALL L. HARTMAN, Esq. of 438
Market Street, Lemoyne, Pennsylvania, herein referred to as Trustee, and PNC Bank of
Camp Hill, Pennsylvania, herein referred to as Successor Trustee or Trustee.
In consideration of the mutual covenants and promises set forth herein, Grantor and Trustee
agree as follows:
1. Transfer of Trust. Grantor herewith assigns, transfers, and conveys to Trustee the
property described in my foregoing Last Will and Testament. Such property, hereafter
designated the Trust Estate, shall be held by Trustee in Trust for the uses and purposes and
on the terms and conditions set forth herein.
2. Disposition of Principal and Income. Trustee shall administer and manage the Trust
Estate, collect the income therefrom, and, after payment of all taxes and assessments
thereon and all charges incident to the management thereof, apply and dispose of the net
income and the principal of the Trust Estate as follows:
For the duration of the life of KEITH L. DEIBERT, Grantor's step-child (grantor's wife's
son), such amounts, from both the net income and principal, to KEITH L. DEIBERT, for
any purpose as requested by the beneficiary, KEITH L. DEIBERT.
Upon the death of KEITH L. DEIBERT, the remaining principal and accrued income of this
Trust is to be distributed to KEITH L. DEIBERT's children, per stirpes with representation,
in equal shares, except that if a child has not reached the age of twenty-five (25), his/her
share shall be conveyed, assigned and transferred to the Trustee and disbursed according to
the provisions of the Children's Trust Agreement as provided for in my Last Will and
Testament.
3. Power of Trustee. Trustee shall have the following powers in addition to those vested
in it by law and by other provisions of trust, applicable to all property, whether principal
or income, exercisable without court approval, and effective until actual distribution of all
property:
A) To hold and retain any or all of the assets of this trust, real or personal, without
regard to any principal of diversification or risk.
B) To sell at public or private sale, to exchange, or to lease for any period of time, any
real or personal property, and to give options for sales, exchanges or leases, for such
prices and upon such terms or conditions as Trustee deems proper.
C) To allocate receipts and expenses to principal or income from time to time as Trustee
thinks proper in Trustee's sole discretion.
ANDRITJTSA TRUST AGREEMENT
D) To compromise any claims or controversy.
4. Additions to Trust. Grantor and any other person shall have the right at any time to add
property acceptable to Trustee to this Trust. Such property, when received and accepted by
Trustee, shall become part of the Trust Estate.
5. Irrevocability of Trust. This trust shall ~e irrevocable and shall not be revoked or
terminated by Grantor or any other person, nor shall it be amended or altered by Grantor
or any other person.
6. Compensation of Trustee. The original Trustee hereunder, and all Successor Trustees,
shall be entitled to reasonable compensation for their services as Trustee.
7. Successor Trustee. If RANDALL L. HARTMAN, Esq. resigns or is unable to continue
to act as Trustee, PNC Bank is hereby appointed as Successor Trustee.
8. Governing Laws. The validity, construction, and effect of this agreement and the Trust
created hereunder and its enforcement shall be determined by the laws of the State of
Pennsylvania.
In Witness Whereof, Grantor and Trustee have executed this Agreement on the date above
written. i
~ r------
~'i
Grantor
~i~
Witnes
c97r~~
Witness 2
Trustee
The foregoing instrument was acknowledged before me this ~ day of October, 1994 by
DIMITRI ANDRIUTSA and RANDALL L. HARTMAN.
My commission expires:
N tary Public
Notarial Seal
Michele J. Hartman, Notary Public
Lemoyne Boro, Cumberland County
My Commission Expires Aug. 3, 1998
Member, Pennsylvania As ~ tion of No?ari~~
n ~ ~ ~~.
Date
Iii<.. ,.- RP. ,.,.-o
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P~e~ fi/r this cetaificate. `x6.00
P 16~75~63
Certification .umber
43 REV 11/!006
E /PRIM IN
:RMANENi
k HCN INK
7. Name a Decedent (FlrsL mkMb,
Dimitri
s. Aga (teat Blander)
u
83 Yrs.
8b. Coumy d Oeen
Dauphin
Thi.~ is t/~ ccrtiic lh~Lt the il"I~~rnatiuli (~~re <~i•;e(:
correctly ~o~It~Li P±onl cut origins! C;~,~,iriL~tU~ of ll~a
duly I~iIL:d rr~i'I: me a, Lor,~l kr~ri>trar. -l~he fn:«in
certificate ~r;lf Lc: for~~arded try (hc° Siatf' y-,,
Recurus Otfii.~ ~~.1r j~e.~rlfanrnt t~lin~.
~~~'?'n- ~~ ~ MAR 0 20
Local Re~~i~tr4r f~a(L I,titeLl
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
Andriutsa z. sex 3. Sadel Seasay Number 4. Data d Deem (Homo, day, year)
~~.......,... . ,._._ _.~._..- _ Male 058 _ 30, _ 7400 March 5, 2010
Days Fbas MhA•a - - - -- - - - - uiear on one
HoapltaC Other
November 1, 1926 Ukraine ^ Inpatlenl ^ ER I
&. City, Bao, Twp. of Dean Bd. Fedtlly Nvre (N not uetlhdien, give street end nunherl 9. Wes Decedent of m ^ DOA ^ Nureing Hans [
Susquehanna Twp. Carolyn Croxton Slane Residence ("Y~,eea"rcma~? ~ ^Yas
Mettlceq Puerto RWn, ek.)
71. Dxedenrs Uwgelntl otlkon ntl of work done du moat d fde. Ib M state 12. Wes Denedent ever b the 13. DecedanYe Ede:etrm (Seedy eny hbheat grads canlpleteA) 14. Markri SYeWS: ManleQ Never MOrtled,
ElectriCa°1W0fl.ontraCt Kind of BUeneaellnduehy U.S. Armed FamaT FJemenbry/Setnndery (U12) collage Gras.) "''g0'xe°. D1~d('/
electric Contract n ^ Yea ~rw 12 2 Married
18. pecedenrs Meltlrg Address (Street, coy/torn, stets, ap ccde) Deceaettra Pennsylvania Db O•aM•nl k~I
4905 Trindle Rd., Bldg. 1, Apt. 50 Actual Reelderme na. smre livema t7c.yy vas, Decedent wedm_
Mechanicsburg, PA 17055 176 ~~, um er an rownanlp? 17d ^~ Oenedem Lived wihin
18. Pavers Name (Flrsl, middle, lest. suffix)
unknown
20a. Imomtam's Name (T / Print)J
Pauline ~E. Andriutsa
21a. Menod W Dbposltron ^ Cremetbn ^ Donetlon 216.
® Burlel ^ Removal from state i was CnmeBon a Dorotlon Aunortnd
^ Otlbr- ~ tY redbri FxYnlnar/carorrn ^ Yas^ No
22e. S' ~ Lioan~a moo ectlng as each) 71b. Lkeroe Number
phyekbn b not eve9ebb ri nme d dean I
certlly cause d dean.
Actual Um6s of
19. Movers Name (Brat, middle, meitlen wmeme)
Natalie (unknown)
. Inlormam's Medng Address ( , c"Y / tovm e, ap )
05 Trindle R~., B1~g.`°~, Apt
Date of Dlaposltlon (MOmh, day, year) 210. Place of Dhpostllon (Name d cemebry, crematory or other place)
March 10, 2010 Zion Lutheran Church Cemetery
22c. Name end Address d FacIIIN
^"~ I FD 012 848 L IPartk
23e. To the best of my knowtetlga, dean ocwnwd et ne fkne, date end place stated. (SigneNre aM title)
Items 2448 must be campletetl by perwn 124. Thre d Deer 26. Date Prata„ad Deed (Moan, day, year)
wla praqur~ denn. 10:35 P M.
Item 27. Part I: Emer the main of mrems - dlseeses, In CAUSE OF DEATH (See Inatruetbna end enempba) i Agxo~irmiet '~ ens me
pales, a comPtlcatrona -net duectly caused ne dean. W NOT enter temmaal events such es cardiac arrest, ~ Onset ro Death
rasphatory arrest, a vemdwbr Abrtlbtlon without shawhg ne etbkgy. list any one cause en each Ikre. t
WMEDUITE CAUSE Fl~I aseese or i
caxAden aesullirg n ~) -~ e. /YI<"?R~'/)T! ~ C'//1v~'Yi-?~ 2-l /~1,
Duero (or as a oatseptence dg ~
n6eM Est mnNtlons,"arry,
the h
Ems muNDER~LYIN~G CAUSE a Dus ro (a es a corrsegrence op:
(dbeese a kyury net kYtated the c.
evenly rewl6ng In dean) usr. i
Due W (a as a caNequerxx oft:
t
d. a
30e. wee en Aaopay 30b. were Autopsy findings 31. Harmer al Death 3?e. Dale d In(ury (Moon. deY. Y•ed 326. Desalts stow Inlary ocwmed
Pedomied7 Avelbbb PMa to CanPbtlon
d cease of Deem ^ Natural ^ Homiada
., PO Box 431
23b. Lkenee NumWr
.Twp.
Boro
50, Mechanicsburg, PA 17055
21tl. Locenon (Coy/town, state, sro mtle) '-
Upper Paxton Twp., PA 170
Cumberland, PA 17070-0431
23c. Date Signed (Moon, day, year)
26. Wes Ceae Rrierted to Medkal Examiner /Corona for a Reason Other van Cremator or Donaaen?
^ Yea ^ No
bN not resutlkg in ne underlying cause given in Part I.
^ Vea ^ No ^ Ves ^ No ^ Accident ^ PeMhg krvestlgefbn ~~ Tune d InWry 32e. IMtny et Wark7 321. H Trenaporta8an Injury (Speayl 32g. Lorenon of Injury (Sheet,
^ Suidde ^ CouM Na be Derorminetl M ^ Yes ^ No ^ DrNer/Operate ^ Passenger ^ Petlestnan
^ Over- Sped/y.~
J Ra,idance Other . Specily,.ne a 1
1 D. Roca: American lafian, Black,
( White
urvNing Spouse (" wre, give maiden name)
uline E. Schaffer
Hampden
^ Ves ^ Probably
^ No ^ Unknown
29. "Female:
^~Nd pragnem wehin past year
^ Pregnant et ems of dean
^ Nd pregnant but pregnant within I2 days
d dean
^ Na pregnant, Gn Pregnant 43 tlays to 1 year
helore dean
^ unknown n Pregnent wnhn fhe pest year
32c. Pkce of Injury: Home, Fenn, Sheet, Factory,
Oftlce BuiNling, etc. (Speedy)
y /town, state)
33e. Cerfilbr (check Doty one!
cMlMaw phyalden (Physldan artrlylrg cause d dean when saner physkden vas prona.ced dean and completed Item 23) r
• Total laM Ot mykmwbdge, dean aavmd dwktlr atna(s)and mannrrslabd---------------------------------^ .
Praaundng and artlMne Phyaklen (Phyaiden ton pramurx*p dean end ca6ry:,g to mrroe M dean( Licen
To dte Wriri y1,,~ of 090 L 33d. Date S/'~Q( n, day, year)
mY mow4d9e, deeM aeeumdrithe tlme,date, and pba,aneawblW aua(alend menner aa,tabd__________________ ' 3/ O ~~
• MedkalEnminri/Coroner
On 1M Web ri enmlrptlon arsf I a InwUgetton, In my oplnton, dean ocwmad ri ne Bme, dale, end pbee, eM due to the uuae(a) and manner ae elaterL ^ 31. Name end Address of Person Who
Completed Ceuae d Dean (Item 27) Type / Prbl
3s. Regbtmre hxe aM ~ 38. Dab Flbd Ham,, day, yeert A. Thomas Andrews, M. D.
- ~ I ~ I / I o21 ~ I ~ I ~a 3912 Trindle_ Rd. , Camp Hill, PA 17011
Dbpoaiton Pemm No.
C7 r.~
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RENUNCIATION ~_~
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REGISTER OF WILLS ~ \
CUMBERLAND COUNTY, PENNSYLVANIA -, ~-"~
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Estate of DIMITRI ANDRIUTSA
I, RANDALL L. HARTMAN
(Print Name)
EXECUTOR
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
ANDREW DEIBERT
MARCH 31,_2010
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
(Signature)
137 LINCOLN AVENUE
(Street Address)
STATE COLLEGE, PA 16801
(Ctty, 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 renunciatign for the
purposes stated within on this ~~ day
of ~~~~ , ,-~' L (~
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
Notary Public U
My Commission Expires: t~ _ 3 ~ ~~ ~
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
n,r~~- ..~r,l_ .,- .~
SN~ERRY RC33. NOT.~,~=~~ FUB;.IC
COLL~Oi=?v~F, `rvT'._ ~OLNTI'
1VtY COMMiSSiON EXPIRES SCP? 3, 20?2
RENUNCIATION
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REGISTER OF WILLS ~~ ~ ~
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~l~~~~d COUNTY
PEI~TISYLVANIA ''
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Estate of ~ I ~ ~~ IZ ~ ~ ~ Z1 v ~ S R
Deceased
1, ~~UL~~-~ ~-N~ ~Z~v ~ 'S~ ~~cZ
(Print Name) , in my capacity/relationship as
~=~ i Fi= ~ E-x,L-LUTIZ~X btZ So^l of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~-~.i ~ ZEW ~ ~ ~ E~ t ~~ ~ ~ ~vtZ~ -~g
Z5 nrl,~~zc~-~ 2v 10
(Date)
Executed in Register's Office
Sworn to or affirmed ar~d suhscf iced
before me this day
of
(Signature) \ l ,~~
-~-~OS E , f IZ~nIDLE ~-P
(Street Address)
(City, State, Zip)
Executed out of Register's Offce
LL. VrV tllV UItUVI JI~ll~+4 " ^ tt r a po ri `t~v
~j i.l Va JV11N.la~ K~~yµi V4
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this _ Z 5 day
of ~ 1~'~1~1 '" (r ti~~ ~~ ~/ D
/ J ( \f 1 J r
Deputy for Register of Wills
FormRW-O6 rev. !0.!3.06
Ndta~Public U v
3~iy Coi~-r„ission Expires:
(Signature and Sea( of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEA TIi OF' PEkN'Yt_YANiA
NOTARIAL SEAL
ROLAND L. DOYLE, JR., Notary Public
Mechanicsburg Boro., Cumberland County
_._._.. ___. _ ~ ~ Tres December 31, 2A12
N
O
RENUNCIATION `-=~ ° ~ ~
,
~c~ ~
REGISTER OF WILLS ;_; ;' ~ ,
Cl/~1?l~~ll1'l4' COUNTY, PENNSYLVANIA ~_;`=; ~,
c."t
Estate of ~ ~ n~ ~ ~ 1Z._.1 ~ ~ ~" ` U ~ ~ ~ ,Deceased
P(~~~iN tc H-Nf~"Z\V 1 Sly Ut~L ~L,ITlk J~i~~~~
r in my cananity/relatinnchin ac
-~ - ~ - -
(Print Name)
+,~ I ~~ ~ ~?C E~.U i ~ 1 x o~ ~~``~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
2 ~ r~,~i~ 2~ t ~
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
of
Deputy for Register of Wills
h'ormRW-06 rev. !0.!3.06
day
~Gt.
(Signature)
~19~5' E rr'hd~~ i2d
(Street Address)
iNICG~i0~1~Gtf~~/l /~4 ~ 7Q SQ
(city, stare, 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 /yi~'l,^ C' ~ , ~2 ~/
otar blic \J L
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEAj.TH OF PENNSYLVANIA
NOTARIAL SEAL
ROLAND L. DOYLE, JR., Notary Public
Mechanicsburg Boro., Cumberland County
__ ~Qmmission Expires December 31, 2012