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HomeMy WebLinkAbout07-11-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Eric P. Winger a/k/a: a/k/a: _ aIk/a: Deceased ESTATE NO: 21- ~ ~ ] („~a ~~ „_____ SS NO: 183-52-7837 Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: ^ A. Probate and Grant of Letters Testamentary or ^ Administration c.t.a., or d.b.n.c.t.a. (complete Part C also) and aver that Petitioner(s) is/aze entitled to the aforementioned Letters under the last Will of the above-named Decedent, dated ____ and codicil(s) dated (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 instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated party to a pending divorce proceeding at the time of death wherein grounds for divorce had been 23 Pa. C.S.A. § 3323(8):_ ~= tion ofTfi'e ~? r-t-- c ~d was t a ~; ~ -~; ~as damned i>~ `' , ' _.., _.E ~T ~-- ,... _ .. ``~ 0 ...~ ...... _ .. ~ _, B. Grant of Letters of Administration -,_ --, ~--- (Itapplicablle, eater d.b.n., pendent life, durante absentia, dnrant orate) ."=" ~- -~~ ---i r - •'~ ~~ ~ C. 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 and complete list of heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(8), except as follows: Priscilla Winger 100 MT Allen Dr. Mechanicsburg, PA 17055 Room 333 MOther Robert Winger Jr. 668 Bridgewater Dr. Williamsburg, VA 23185 Brother Rose Chunik 413 Dorothy Ct. Spring Field, VA 22153 Sister Susan Yasalonis 8 Farm House Ln. Camp Hill, PA 17011 Sister _. __ _~ _~ _, _. _ _ ~ , .. ~~........, ..~ a .., .,. ~... ~. :..,.,. ..~ t , THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At 102 E.Main St. Mechanicsburg, PA 17055 (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 50 yeazs of age, died 6/15/2011 at Camp Hill, PA (Month, Day, Year of death) (City and State where death occuned) Estimated value of decedent's properly at death: If domiciled in PA All personal property $ _ If not domiciled in PA Personal property in Pennsylvania $ _ _ _If not domiciled in PA Personal property in County $ _Value of Real Estate in Pennsylvania $ -- i Total Estimated Value $ _ ' ~ 7 ~' ~~ 0.00 Location of Real Estate in Pennsylvania: (Provide full address if possible.) Signature(s) Name(cl Rr Mailing ArlrlrncclPCl -_~' - w~ ~ ,~ \~..~ Pry i `7 ~. Intvr;.r, i:.~r.,-. 0117 (1'1.....,...:..3 i~ ter. iii L_. ~..___L__i___ ., :Name Address Relationsbi to Decedent C'1 r-- rage i of ~ ~~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WII.LS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Eric P. Winger- a/k/a: _ alk/a: _ a/k/a: Deceased ESTATE NO: 21- SS NO: 183-52-7837 Petitioner(s) who is/are l 8 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: D A. Probate and Grant of Letters Testamentary or ^ Administration c.t.a., or d.b.n.c.t.a. (complete Part C also) and aver that Petitioner(s) is/aze entitled to the aforementioned Letters __ under the last Will of the above-named Decedent, dated and codicil(s) dated c ~ .~_~ . (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 e~~ ' of t1 ~~-~-= ~..~ instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated pers "}$ ~''as no~t..a ~-,_ ,'_ party to a pending divorce proceeding at the time of death wherein grounds for divorce had been estal deffired in ~. _ ~ ~ '- 23 Pa. C.S.A. § 3323(g1:_ :~.~ ~.~ ..,._ ;_: _ .~~ ~B. Grant of Letters of Administration ..o ~ ~ =~ ~=, (If applicable, enter d.bn., pendent life, damnte absentia, durante minoribte) .~".~ . '~ C C. Petitioner(s), after a prover 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 and complete list of heirs); was not the victim of'a killing; was never adjudicated an incapacitated person; and was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(8), except as follows: ="" ~-. Address Relationsbi to Decedent ~ Karen Hilf 50 Sheep Bridge Rd. York Haven, PA 17370 Sister Konrad S. Winger 190 Bald Top Rd. Danville, PA 17821 Brother ~ ~e + t~(; ,~ ~ ~,.- g ~l ~(v Rose.wo~ti Sfi Y~;t~ aysc~ v~ . ~ `tr, t~: o ~~~' USE ADDITIONAL SHEETS IF' NECESSARY' THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At 102 E.Main St. Mechanicsburg, PA 17055 (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 50 years of age, died 6/15/2011 at Camp Hill, PA (Month, Day, Year of death) (City and State where death occurred) Estimated of decedent's property at death: If domiciled in All personal property $ _If not domiciled in PA Personal property in Pennsylvania $ - _If not domiciled in PA Personal property in County $ - -" Value of Real Estate in Pennsylvania $ - Total Estimated Value $ _ _ 0.00 Location of Real Estate in Pennsylvania: (Provide full a ss if possible.) Signature(s) Name(s) & Mailing Address(es) Interim Form RW-02 revised 12.?6.10 by Cumberland County pending action by the Court Page 1 of 2 OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania ~ SS County of Cumberland The Petitioner(s) herein named swear or affirm 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 personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or aff_rrned a.nd subscribed bef~o're, me tY-iis ~_ day of ~.~'+ _.~ ~~_____ c :... ,» r' For the Register ` ` f, --- ~ ~~ DECREE OF PROBATE AND GRANT OF LETTER, :-~ _ ~. .z-. Estate Of ~( J ~ ~ ' ` , ,Deceased File Number: 21- ~~ I~ ~~ ~ " ~. L, , r ~ 1. i2 ~ - ~.J~--' AND NOW, this ~~~~ day of , in consideration of the Petition on the reverse side hereon, satisfactory proof havi g been presented before me, IT IS DECREED that Letters Testamentary ~ of Administration are hereby granted to: ol'; (It' applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) ~, Signature of Counsel Required to Enter Appearance the above estate and that instruments(s) dated ~~ - - described in the petition be admitted to probate and. filed of record as the last Will and Codicil(s) of Decedent. Glenda Farner Strasbaugh, Register of Wills ~~~~~ ~?~'~~~,(~'~?~~~~ G~ ~ . FEES: Will ....................... Codicil(s) ............... _ (l ~) Short Certificates _ ~- (~) Renunciations......._ ~ ~°5 Bond ............................. _ Other ............................. ................................._ Automation FEE......... _ 5.00 JCS FEE .................. 23.50 TOTAL ................ $ ~ ~ `~ ~ ~~~ Atty's Signature PRINTED Name Supreme Court ID No.: Address: Phone: Fax: ~, ~i"i ~.~i ~; 1 -^ ~ is ,-.- . , ~ ,_~.~, .:, -: ;~-, ~.~ r_, --ra in Interim Form RW-02 revised 12.26.10 by CumUerland County pending action by the Court Page 2 of 2 OA-L RE(~ISTRA,Rj ~ . It i~ ~" ~~ ~4~A~tINING; It i!:~ illegal t0 dl9~li~~-~~~~ t~~~~, Fs,$y° .-~+r ~rc;l~~~~~ r~~~ ~~+~~~f;;l= ~r i I~~.:~,• I~t>r thi• i~t~rtifiL~~ft~~. ~(f.f)li --- P - -Z ~'_5 5.6 8 ? 3 ~,~)-tifir~fti~~)i rtii-flfff~~;~l 3 REV 11/2006 / PRINT IN iMANENT ACK INK t. Name of Decedent (Fret, middle, last, suffix) Eric P. Winger 5. Age (Last Birthday) 50 Yrs. ,, t ' ~ -- ,~ ~.~. ~~° s o. ~ ~ ~ et ~ -- ~;,. ;~ ~ - ~~K ~ ~ .r ,~ ~?fir r n~a ,, z ', i~;1~yf~1)7't11~ 1 I' ~' it•l:`41 i~ . •1 `. ~ i-) :lit (, r C IC)t ,, C' t~l ~.)t.':.fttl ,, t ,, .b Putt t1 d ~ 11YL" ''~1~dit' ~'I[(.t~ /G~y,,~,. ~ra~.~~,~c/ Y . ~ N 1 7 2011 _ / _ __ c"^ i ~~ .~..,. J ~ e~ ~ ~ ~ r r ~ f-~~"\ - _ ern ~ .. , . , ' J7 ~ "'~ _ ~ r y1 _y ~~ .~.. -. -.. ._._~ L - t. COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS _ `L7 '~ TM.. >-- ~ T1 CERTIFICATE OF DEATH ~' -`.- ~-~ C 7 (See instructions and examples on reverse) (;' ~ STATE FILE NUMBER 2. Sez 3. Social Security Numtfer 4. Date of Death (Month, day, year) Male 183 - 52 - 7837 June 15 2011 sneer i ear under 1 tla 6. Date of Birth Month, da , ear 7. Birth lace C end state or fore' n count 6a. Place of Death Check on one MonMs Oeys Hours Minutes m Hospital: Other: February 17 , 1961 Germany ®Inpetient ^ ER /Outpatient ^ DOA ^ N ^ ursing Home Residence ^ Other - Specity. 8b. County of Death Bc. Ciry, 8oro, Twp. of Deatii 8d. Faciltty Name (II not InsNNtion, give street and number 9. Was Decedent of Hfapanic Origin? ®N 10 Race: A ^Y i I d o Cumberland E. Pennsboro Trap. Hol S irit Hos ital ofyae,specityCuban, y P P ' M mer can n es ian, Black White, etc. (Specily~ exican, Puerto Rican, etc.) Whit e 11. Decedents Usual Occu atbn Kind of work done dudn most of workin life. Oo not state retired 12. Wes Decedent ever in the 13. Decedents Education (Speafy onry highest grede completed) 14 Marital Status: Marred Ne M i d I , ver arr e , Kind of Work Kind of Business/Industry U.S. Armed Forces? Elementary /Secondary (0.12) College (1-4 or 5+) Widowed, Divorced (Speci/y) Attendant Retail Grocery ^Y ® 5 Surviving Spouse (If wife, give maiden name) es Np 12 Never Married 16 D . ecedents Meiling Address (Street, city /town, state, zip code) Decedent's Did Decedent Actual Residence 17a. state Pennsylvania 10 2 E . Main Street , Apt . 1 Live in a 17 ^Y D c. es, ecedent Lived in Mechanicsburg, PA 17055 17b.ctlunry Cumberland Township? 17d ~No DecedentLi d Rhi Tw p . , ve w n Actual Limits o(__ 16. Father's Name (First, middle, last suffix) Mechanicsburg Gity/8oro 19. Mother's Neme (First, middle, maiden surname) Ma'. Robert Win er Priscilla Fox 20a. InfonnanYs Name (Type / Pdnt) 20b. InfonnenYs Mailing Address (Street, city /town, state, zip code) Priscilla H. Winger 100 Mt. A11en~Drive, Mechanicsburg, PA 17055 21 a. Method of Disposition ~ ^ Cremation ^ Donation 21b. Date of Disposifan (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) ltd. Location (City/town r state zi c d Budal ^ R emoval from State r Was Crematlan w Donation Authorized ^ Other-S tbyMedicalExaminer/Coroner? ^Ves^Np June 18, 2011 St. Joseph Cemetery Mah , , p o e) onin Tw PA 17821 22a. Signature of Fu Lice (or person acting as such) 22b. License Number 22c. Name end Address of Facillry g p., ~ FS 012 849 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland PA 17070 C omplete items 23a-c on certifying 23a. To the best of my knowledge, death occurred at the tlme, date an~ stated, (Si~tature and NNe) 23b. License Number physician is not available at time of death to I~` ~r certify cause of death. ~ ~ / , 23c. Date Signed (Month, day, year) , V 24 T f D h th ~ . ime o ea ems 24-26 must be completed by person 26. Date Pronounced Dead (Month, day, year) r who pronounces death. ~ ', r~~ ^ M y~ 26. Was Case Ref n to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? ~-/ ~ 1 ~~ ^ Ves No CAUSE OF DEATH (Sae Instructions and exampba) r Approximate interval: Item 27. Part I: Enter the chain of events -diseases, injuries, or complications -that dre cN1' caused the death. DO NOT enter terminal events such es cardiac t r Part II: Enter other si°nificent conditions contd dI~ g to =eth 26. Did Tobacco Use Contribute to Death? arres , Onset to Death respiratory arrest, or ventricular fibdlla' without showing the etiology. List only one cause on each line. r but not resulting in the undertying cause given in Part I. ^Yes ^ Probably IMMEDIATE CAUSE (Foal disease or 1 i condition resulting in death) C r ^ No ^ Unknown ~ a. r ~' C~L~ 29. If Female: Due D rase ~ ny' consequence ~ ~ ` ~ r Sequentiallyy list conditions, tt a - w b t ~ ^ Not pregnant within past year n P ~ ~ r V' r leading to the cause Acted on line a. ' q I E t th D t UN - -~- ^ Pregnant at time of death n er ue e , Et~RLYING CAUSE o (or as a consequence oQ: ~ (disease or M u that inNiated the ^ Not pregnant, but pregnant within 42 days events resulting m death) LAST. c ~ or death Due to (or as a consequence oil: r d' i ^ Not pregnant, but pregnart 43 days to t year r 30a. Wea an Autopsy 30b. Were Autopsy Findings 31. M nner of Daelh 32a. Oats of Injury (Month, day, year) 32b. Describe How Injury Occurred Performed? Available Prior to Completion before death ^ Unknown it pregnant within the past year 32 Pl of Cause of Death? Natural ^ Homicide c. ace of Injury: Home, Fann, Street, Factory, Office Building, etc. (Specvly) ^ Yes ~ No ^Yes ^ No ^ Accident ^ Pendin InvesN aNon 9 9 32d. Time of Injury 32e. Injury at Work? 32f. If Tran rtaNon In u ~ 1 ry (SPecl}') 32g. Locaton of injury (Street, ci ty /town, state) ^ Suicide I~ Could Not be Detemuned M ^Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian ^ Other - Spedly: 33a. Certitier (check only aria) 33b. Signature and Title of Cert~er • Certifying physician (Physician certifying cause of death when another physician has pronounced death and corttpleted Item 23) ~ / To the beat of my Imowkdge, death occurred due to the cauae(a) and manner as stated _ _ _ ^ ~ S / ZZ ------------------------------ • Pronouncing and ceriifying physklan (Physician both pronouncing death and certifying to cause of death) 33c. Ucense Number 33d. Dam Signed (Month, day, year) Ta the beat of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner ea stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Medical Examiner/Coroner Q S Q ~Q ~/ ~ / On tlro basis of examination end / or Inveatigatbn, In my opinion, death occurred at the time, date, end place, and due to the cauee(a) and manner as atated_ ^ 34. Name annd Address of Person Who`Compl~eQted Cause of Death (Item 27) Type !mint Registrars Sign a and District N r ~/ ~ ~ ~ ~ / 36 Data led (Month, day, year) ~ ~" ~ ~~~ ~~`~ ~ ' `~ Disposition Permit No. ~`tJ RENUNCIATION . ~o ~~ ~ ._ , ~ ~ c7 REGISTER OF WILLS ~ ~` ~ m ~~~ ~' L/~ ~ COUNTY, PENNSYLVANIA ~' c:r`~ ~ ~_ _ U ~ ` _~ ~~ -- ~ D Estate of ~ v ~~~~. -.~_; =`.. :x, c___ ~, ,-,--t r-.-m -~~ _~ , `~~ f -~ ., --~ =- ~-' ~ ~ ~-- 4.~ ~-.- '~ Deceased I' -~~~ ~ ~ ~ - , in my capacity/relationshi as (Print Name) p of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to (late) (SYgnature) '~ ~/~ treet ddress ~- ~ ~..~ (City, State, Zip) ~ ~ ` ~J Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally a eared the before me this pp of day party executing this renunciation and certified -~ that he or she executed the renunciation for the purposes stated within on this ~~ day Deputy for Register of Wills Notary blic _ My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Conunission.l NOTARIAL SEAL. LINQA SAWYER. Notary Public Form RW-06 rev. 10.13.06 Camp Rill Bora, Orland County My Commission Expires February 12,2013 C'~ ,..~„ £~ ~ ~Z7 b t'om'- ~`- ~• -} `~~~ C° RENUI`~CIATI(JN :~ ~:'~ `~, .J ..` ~ i J (""` -.», R.EGZS7'l,R OF tiV1LL,S ~-->~ '~~ .. ~ ' ~t:~~.~ .~•v r, COUNTY, PEI~TNSYLVANIA ~ --f _ ~- ~ •~ . c~ ~- -~ ~ Estate of __ ~=-:~_- c ~- ~~4 i,(Z. t,.~-) ~ ~ C;-~-~ , Deceased (PrintNamr) , 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 (aat~) ------- executed in Register's Office ~tivorn to or affirmed and subscribed before me this day of Deputy for Register of ~'ilis • Fonn RlY-06 rev, ~0.13.OG ~~~~~~ (Srgnatm•e) t:Screet Addrrss) (City. State. Zip) E.reccrted occt of Register's Office .~~r. ~~ 1/r/' ~~1~ ~' ~~ ~ ,{' Before the undersigned personally appeare the ~~ ~r'r party executing this renunciation and certified t}tat iie or she executed the renunciati~~for tl~e purposes stated within on this ~ day • 1' , /,1~ N tary Public iV1y Commission Expires: ~ ~~~~?~i~ sip ~~~r>E~r~~~,~~ (Signature and seal ofNotary or other official c~ua ' d,~~~aMs ~~ administer oaths. Show date afexpiration of N ~'~~~~~' ~A_~~ ~ + . "~ • • i ~ ~' 11`3ti 120 . •' JQ~: ,~: r C_. RENUNCIATION ~' ~' `~' '~-`~' ~=' may) ~ t._n_ r_ Y:',-, ..~r _7 ,~_---. --_, . ; REGISTER OF WILLS -~` ~~'~ _ - ~ r~Q~~~~!~,.~ COUNTY, PENNSYLVANIA ~~~ ~ ~' ::,.: , `~~~ ~=-'. ~; ~T a Estate of ~ ~ / L L, L.. ~(.. } _ ~ ~~ ,Deceased I, - , in my capacity/relationship as (Print Nanie~ S ~ ~~" of the above Decedent, hereby renounce the ri ht to g administer the Estate of~ the Decedent and respectfully request that Letters be issued to ;~ ~, (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of VGTills Furnz RW-06 rer. 10.13.06 r- . /~ (Sigriatzn~e) ~~ r , -.~ ~t1 nJ£~eUJ~. G c c~ (Street Address /y ~ ~ /- (Cih~, 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 of J l day c~ i ~ ..~ .~ Nota Public ~'~, My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths- Show- date of expiration of Notary's Conunission. j rH a Noy rARIAI. s~Ea~ LINDA SAWYER. Notary Public Camp Hill Boro, Cumberland County My Commission Expires February 12, 2~ S RENUNCIATION ~~ - =~ ~j _ ..;__~ ~~ REG STER OF WILLS ~.~ :~ ~, r'~' ~3 ~ , . ; ,__, .;, _ ~ ~ . ' , U ~ ~ COUNTY, PENNSYLVANIA ~ ~ ~~ = `- , -,, ~ .LL ... _ ~~ f-- ~ ~~ , Estate of f,~} / C, ~ . /~L../ 1 J-j Q ,{, ~ I, ~~SG ~ (Print Name) O/y~S of the above Decedent, hereby renounce the right to Deceased m my capacity/relationship as administer the Estate of the Decedent and respectfully request that Letters be issued to i ~ ~~ . ~- --~.~,~ ~~ ~ j (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. 10.13.06 ;~ .~.. (,S~gnature) ~~ (Street Address) --'' ~~ `/~ 1~~fC, (zty, to e, Zi 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 c~ ' of .:..> ~~ day ;s1o i 1 Notary Public C~ My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Not• 's fission.) t (V~TARiAL ~- I.MIDASAWYER. Notary Pubac Camp HiN.F3~oro, C~~l7d (A~~' My Commissgn Expires February 12~} RENUNCIATION RE~ISTER OF u'ILLS C. U ~ ~ ~ COUNTY PEI~ZVSY V L ANIA C'7 ~~ .~ -~ ~~ ~ ~ Y~~ ~ -:_. ~„ ~ ~~:~ 4 ~ c~ _~ :~ -tt ~.~ ~~ • -- ~ Estate of _____~ ~ ~ (> C(,~9 ~-~~~J~~ ~~ ~ ~~ ; ~-, -~, ~ ~ -~~~ G ,:. :~} ti~w. ' , ~`~' .'. __ ~~ _ --, a . -~- ~- ~ ~.~ Deceased ~ 1 , in my ca acit /relationshi (Pant !1 ame) P Y pas ~~ t ~' ~r` ~ of the above Decedent, hereby renounce th ' e right to administer the Estate of the Decedent and respectfully request that Letters be issued to ,i 4 ~ - - ~ ) (Date) (Signature) r ~, ~ i, (.Street Address) -- (Crty. Stole. Zrpi Executed !n Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RTY-/~d rev. 10.13.0F, 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 ' Nota Pu is My C mmis ' Expires: (`j~, ~S``/Z~~l ~~ r (Signature and Seal of Notary or other official yuaiified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWFJILTH OF PENNSYLVANUI NOta11a1 SNI Young S. Surfers, Notary Puwk Newberry TVvp., York Cou~tty My GomrrNalon fib. 15, 2015 MEhIBER, PENNSYI.vANU A55~1QA ON Of NOTARIES f-......_,7 ~~ ~~~ Y-~. ~/ ~ it a.. M ~.~ r-n .~.... ~W~ REGIS TL,R OF WILLS ~~: ~ ~-~- ~ ~ rn$FRI~ tJ ~ COUNTY, PENNSYLVANIA _ -~ `_... .Estate of 1-~~ ~ ~ ~ ~ Y-• ,Deceased 1, ~ 1 ~ ~-•I ~ ~L ~; ~ t` ~~~~ (Pant 1Varne) y , in my cap . acit}~Irelati_ o_nshi~ a,s 1 of the above )ecedent, hcrcby renolmcc the. right to administer t17e Estate of the Decedent and respectfully request that Letters be issued to N~Z ~ ~~ V~D I!~IG~ (Hate} ~'xeeutert in Reb istet•'s ©f~ce Sworn to or affirmed and subscribed before me this da~° of Depot}~ for Register of ti'~•'ills Forr~r R:i'-06 rev l0.I3.0r; • ~ ~~ (s;gnatcrre) {.5~treet rldtiressl ~~lt}', Sldte. Zlr7j Executed olrl o. f ~e~ ister',~ ()• f_ five Before the undersigned personally appeared the party executing this renunciation and certified that lle or she executed the renunciation. for the purposes stated uTithin on this ~~3 d~~y Notary Pu lic 1ti1}~ Commission Expires: i ~ "~' ~ ~ `~~J ~ ~ (S~gna~ure and Seal o!'Notan~ or od~er official qualified to `~,NNt11QU~~HUgq~ administer oaths. Snow date ofexpirition of T~rutar~'s C`moor;,~,TT~,r~~~a>,A9r~ss, `ti ~~ ...... C •~ ~, --{ c `~ ~ i . ~7 ~r~' ~r,. ~ LJ ~ ~ v p1~~,,,