Loading...
HomeMy WebLinkAbout03-05-12Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information Name: Bryan F. Ensminger, Jr. a/k/a: a/k/a: a/k/a: Date of Death: 2/28/2012 File No• (Assigned by Register) Social Security No: 199-34-~b47 Age at death: 67 Decedent was domiciled at death in Cumberland County, Pennsylvania (stare) with his/her last principal residence at 65 East Penn Street Carlisle, Carlisle Boroueh ___ Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 500 University Drive Hershey, Derry Townshin Dauuhin PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ....................... . .... All personal property $ 37,000.00 -_____ If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $ --- Ifnot domiciled in Pennsylvania ........................ Personal property in County $ ----- Value of real estate in Pennsylvania ................................................ . ........ $ --- 4~-C)~}Q.QQ TOTAL ESTIMATED VALUE.... $ __ ?5 0000.00 Real estate in Pennsylvania situated at: PIN: 29-21-0316-009B, Trindle Road, 17013 Carlisle North Middleton Tow_n_ship Cumberland (Attach additions! sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated December 11, i~C7___ and:~odici](s) thereto dated - -- -~-1 _ ~; -- State relevant circumstances (e.g, renunciation, death of executor, etc.) ~~~ ~" = :> r-t a t --- Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, iva`s ~a>^~ party pending ;-..- divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did:-nq[~-have a child born or:- adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ ~ -,-, i` _~. -~ . 0 NO EXCEPTIONS O EXCEPTIONS `~- } - ~- - _~ ~^ ~ ~~ © B. Petition for Grant of Letters of Administration (If applieable) ___ . c. t. a., d. b. n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate [f Administration, c.t.a. or d. b. n.c.t.a., enter date of Will in Section A above and complete list oi' heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds far divorce had been established as defined in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS O EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (ifany) and heirs (attach additional sheets, if necessary): Name Relationshi Address Nellie Enstninger Mother Sarah Todd Home - 1000 W. South Street. Carlisle, PA 17013 Form RW-01 rev. l0i l 1,'2(11 ! age I Of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF } } SS: } ,, ~, ~__ ; t,~. ,. e ~~l I'~ . ~~ _ ~ s `1,_~.'~ `~(i1i r~AR -5 PRA t= 51 Petitioner(s) Printed Name Petitioner(s) Printed Address ~ ~PH~!N` r . -~ ,~ ; , The Petitioner(s) above-named swear(s) or affirm(s) 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, the etitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before Date J' S ~ J Z m is ~_ day of 1 C~v C ~ Date B~~~ u1 ~ e ~ ~.~ r~r ~ ~~~~ Date For the Register Date BOND Required: ~ YES Q NO To the Register of Wllls: FEES: Please enter my appearance by my signature below: Letters ..................... . ( ,j )Short Certificate(s)..... . (.rZ )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond .. ...................... Commission. . . Other ~~ ...... l Automation Fee ............... ,`~ JCS Fee ..................... S~ f TOTAL ..................... $ DN8.00 "fi IU t~xrc.Y,~,.c~ Attorney Signature: Printed Name: Michael A. Scherer, Esquire Supreme Court ID Number: 61974 Firm Name Address: Phone Fax: Email: Boric Scherer L1LC 717-249-6873 717-249-5755 mS_ rh__ e_rQrnhari~schPrer_~nm DECREE OF THE REGISTER Estate of Brvan F. Ensmineer Jr File No: ~~_ ~ a. ~ ~ a/k/a: AND NOW, ~~~~/ lof-- , in con 'd ,ration of th foregoing Petition, satisfactory proof ha mg been presented before me, IT IS DECREED that Letters ~,~~'1", ,~ ~~ <<~-~.~ ~r ~ ~ ~- are hereby granted to Michael A. Scherer ~ ~ ~ ~ in the abo~/e estate and (if applicable) that the instrument(s) dated _ described in the Petition be Form RW-02 rev. l0/11/2011 to probate and filed of record as the la t Will (and Co i il(s)) f Decedent gister of Wi is 1 i Page 2 of ~;.. . I ~~ ~~ ` .. _ . ~T i V Type/Pr;nt In P81a klnkt ~ '~ CLE~I~ ;,~F _ /,;,, ~ T Cll ,r, .. (,, ~r ~ ` f COMMONWEALTH OF FEN NSYI.VANIA DEPARTMENT OF HEALTH VITAL RECORDS C'FRTIFICATF C)F i'~EAT1-i ~. ~.. Deced nnt's Legal Name (First, Middle, Last, Suffi xJ 2. ,e 3. Social Security Number 4. Dai c-f Death (MO/DaY/Yr) (Spell Mp) x Bzyan F1oyc1 -Gnslninger, Jr_ 199 34 8647 Feb. 2E3, 2012 M Sa. Age-Last RirthrlaY (Yrs) 56. Under 1 Vea Bc. Untler 1 Da 6. Dale of Birth (MO/Day/Near) (Spill Month) 7a. Birthpl dcQ (Ci(y and S~{y or 1=c. [~iKn Country) Months Days Hours MinuCes I~ 3 l 944 Ca$_ 1S LEP, H C ^f iE ~ ~ - - 67 -]y l f , ~tt_n_ _~f r _a n e vb. eirthPlaee (epp ntv) F 8a. Residence (State or orelgn C~ru ntrYj 86. Residence (Street and Number -Include Apt No.) Rc. Did peced¢nt Live in a Township? PA - OY¢s, d¢ted¢nt 'yed _ -_ - _. _- ,- -_twp. 8d. Residence (COLIn[y) ~5 E_ Pc"n2~ St_ C 1 ) l Cisnl~.rlan~~ Be. Residence (ZiP Code) 1 7 Q ] 3 c~] - _ _ city/boro- 0, decedent 1'yed w hln li of _ " ] - E t e (If wife, give n.-r me prior to first marr aged 9. Ever in US Armed F - 10. al 5 sat Time of Death ~ Married ~ Widowed 1 t. Surviving Spr:~use's Nam to c ~ Never Married ~ Unknown --- nk now-i ?~Divorc ed YPS $] N Q t -~- ]Z. Father's Name (First, Middle=, Las[, Suffix) B -a.n Flo d E:n s-I-,~:i.n cr, Sr_ 13_ Mother's Name P or rst cage (First. Middfe, last) _ Nc 11io R_ pKaSS 1~r 1 14a. Informant s Name 46- Relationship to Decedent _ y `it i 14 c. Informant's Mailing Address (Street and Number, Clt Ye, Zip Code o Ne1.1ia R_ En~~nir;gE'r Mother ]000 W_ South ~t_ Carlislcr, YA 17013 Ci .."..........."....... "........... ... a c ........ 15 Place o Death IChe k only one) .......... ..."".".. .. ......... ...... ..".......... ...." .. .. ... - ~ " . "' .. .......... ....."........ i-.. If peath Occurred in a Hosp [al: ly nPatient ; F a I icy ~) Decedent s Home ce r If Death Occurred Somewhere Other Than a Hospital- ~ Hor:p [] Emerge ncy Room/Outpatient Q Dead on Arrival ~ Q Nursing Homef LO ng-Term Care Facility 0 Other (Speci(y) ___. _____ 15 b. Facility Nam¢ (If not t, n, give tree nd number; l l SSC. City or Town, State, and T_ip Code `.d. CounCy f Death edical Center M M.S. Hershey Hershe Pa. 17033 Dauphin 16a- Method of Disposifion t$ Ourial ~ Cre ma[inn 166. Date of Disposi Linn lbc. Place cif Disposition (Name of cemetery, ern mats ry, r .ether place) m ~ R moval from State ~ Donation ¢ v p oche (s tifv). _ 3 `L 201 2 r CO.matEr W~strninste - 16d- Locators oT --p ihnn ( y nr -lown, State, .. nd Zip) ~~y~~~~~~ ~ggCqq~y iZa. Signature of F r I SP ryice ticens harge of ermrn _ "rse Number 7h. Carli.slE~, PA 1-x013 I I) O1'L633 L __ 0 12c. Name and C mPl et e. A[1dre~.ss of (caner al Facility '~ Stain Brotl-r~z= ]~unerai F3c~ma Tnc_ 630 S_ Hanover E~t_ Ca:rlis a, PA 1 'O"13 m 18. Dec-edenC's Edu Check t ~a~ bpx that best describes the r 19. edent f V i ,~ Origin - Check the D 2C]. Decedent's R Check ONE ~ lft MORE r ce o rndica to what t of school si iPleted at the time of death. highest degree o I el that best tl vibes whether the decedc nt ho the d=cede nt co idered hi. rsrlf or herself to be. Q B[h grade or less is Spanish/Hispanic/Latino. Chick tfre No' ~hi[e [~ Korean Q No diplom 9th 12th R ". d- box f decade not Sp- /Hi<pan'r/taT no. ~ Black o AFr'r. clean [~ Vletna mese ~?-I-gh school graduate - Ff cram pleTed gNO not SP I /Hi.51- /E atlno ~ Ar an nd~ - Alaska Naive ~} Ot6ar Asian n 0 So ollege cred t, b leKree ~ Ves, Mexi Mexic A' rica t rh'cano an nd'an (~ Natlye Hawaian ~ As [] Ass a degree Ie.K. AA. AS) ~ Yes, Puerto Rican ~ Chinese [~ Gu Ian or Cha mono Bachelor's degree (a•.q. BA Af3, 8S) Q Yes, Cuban ~ Gilipino [~ Samoan [] as er s degree (e.g. MA, M'i, MEnE, MEd, MS W, MBAJ M t ' ~ YPS, other Spanish/Hispanic/Latino Q ]aoa nese [~ Other Pacific Islander [] Docto ra to (e.g. PhD, EdD) nr Prr?fesslnnat degree (SPeciiy) _.__ -. __ ___ _ [~ OthF-r (C pe cifV) -_ _... - __ - _.. -- -..--_" (e MD, DOS UV M, L[H, 1D) - 21- edent's Single Race Self DesiKnation Check ONLY ONE to lndica to what the decedent considered himself or herself tr. be. -~ -Indicate ty Pe of work 22a- pecedent's Usual ClcruFP a ^ ~CrV hire Q ]apanese Q Samoan DO NOT USE RETIRED. done during mo.t oY working life Q Black o African Arnerla an ~ Korean Q Oilier Pacific Islander 0 American Indian of Alaska Narlve ~ Vietnamese Q Don't Know/Not Sure ~SC111ci'C=O L'_ R¢fused p Asian ndian O other A p 226. Kind of Business/Indus try Chinese ~ Native Hawaiian Q Other (Specify) ___~ __- - _ _ __ _-__ ___._ p FniPino CJ ~ua.nanian pr a,amprrp Ve~ction 7nt~e~rnational ITEMS 23a - 23d MUST BE COMPLETEp -.. e Prouou need Dead (MO/DaY/Yr) 2 o 23b. 5 K ature of Person Pronounc K Death (Only when ap Plica ble'. 23c. License Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH ~ ~~ [ _ 23d. Date Signed (MO/DaY/Yr) 24- Time of Death ___ _ ~- U 25. Was Medical Examiner or Coro new Co n[a cted? Q ____ jry~~No CAUSE OF DEATH Ap P.pximate 26_ Part I. Enter the chain of e _ --dise as¢s, njUrles, o mpllcadons-that directly c ed the doath. DO NO! en r f ml ale ch a ardiac :e- esT - al: 1 e f ~ates,ary Onset to Death Add add-t anal I n~ T ABRREVIA fE. Fnter only c>ne eau .• on a I"ne i l o g y. DO NO o resp rato 'y arrant. or i trir cal. r 4i6ri11atton without showing the et ~ }1 (t / 1 ' __. _-. -.. __-_.. __ _ _-__. _ IMMEDIATE CAUSF _. __ __-.::. a.. ~li.. ~~ I~1~_'i~-C.~S..~T-1___- -_.._.- __. (F 1 d". se d" to (or as o ) re. I - f in d tY) on ~~~ I r 1 ~r 1- ~t_L _ _ -_. __.. . - - - - -- -- _ ue to (or as a co eG .nee of>. SequenYally I a nd-t n t ci l ie c n n arise it a v, leading t listed nn line a Enter tho c. - -_ - - - -- UNOERLYING CAUSE pUe to (or as a co - "o nc,_ f): d' w (rl isease o nlurV that r LL cots resuliln rf. _ initiated the ey E w _ v In death) LAST. Duc to (or as a co segue--ore o!): _ - __ ause t - _ Way, act med? 26. Part II- Enter other g f_ra nt dit Ions ribulina tp death but not resulting in the u rdnrlying ,'yen in Part I 27 ~ 3 psy per(or [] vesp No ~ e e yfinding<; ailable tr. r mplete the c of death? CJ Ve 29. If Female: 30. Did Tobacco L _ rlbute to pea[h> 3].. MannP of Death Js E O F'tobably ® Natural [] Horn icicle ~ No regnan i[hin p ;ir Q Vas y p ' ~NO ~] Unknown 0 Accident [] P=!nding Inyes[igaTian tb na nt a me of dea Q Preg ~ Not pregna t, but Pregnant. within 42 days of death 0 Suicide [] C"tuld not be determined m Q Not pregn bUr. prcgrian[ 43 days to 1 y.ar before death 32. Date of Injury (MO/DaY/Yr) (Spill Month) __-__ e 33. ]ime of Injury Q Unknown if pre Kna nt wig. hie the past year _ Placa_ of ]ury (e g- hume . r. n..tr,.tnon cite, farm, school) Location oY Injury (Street and Nu,riber, _itY, tat ,Tip Lode) J 36. Injury at Work 3). If T ransnori scion I ury, c ecl(y: 3B. Describe Flow njuty Occurred: a strian o Ye- o Driver/~peratp[ o ed O ther (SP ecify) _ -- Q No ~ Passenger ~ f 39a- Certif er (Check only o c): a Q Certifying physician - Tn thF best. of mY knowledge, death o ed du the e(s) and m stated date, soil place, and due t the r. e(s) and r - r _. ed rn ® rig R tifying phyt.ir..ra the best of my knowledge, death o ed at the t t r e r d ate, a d I- e, a d d _ t th cause(s) and mar er -ta ed m my op'n one death occurred at the tlm E /.- - Ot he ba of e on, and/or my t'gat onr oro is xam oat" es ~ n c n s Q Mr1d ~al /j ~~ • [`~ T'tle of certrf er_-.l r /~ -. __ ,_ 1 ions Nurtber - ~~~~~'~ Signature of c¢rt-fi¢r. _£Z l G/ _y' w 396- Name, Addre and /_ip Co of rs Com ing Ca D ~I~KS1t~yy Medical Center r-s9 °S Hershey Pa 17033 3 - .Signed (MO/DaY/YU . . , , . 2~ c k r ~~ c vl r-~-c [~ p Z 4, ~ 40_ Registrar's Distrlc um6nr 41. Re 'sirs r' Signet __ gist ar Ftle Dale (MO/Day lYr) 43. Arne ndn'rents Q ~~ O , j ~ (} H105-143 Disposition Permit N -f/ ~F- 6 _. _. REV O7j2011 ~ _ ~_ L r-, .~ ,; BRYAN F. ENSMINGER, JR. }` `' _ _ I, BRYAN F. ENSMINGER, JR., of Cumberland County, Pennsylvania, do hereby declare this to be my Last Will and Testament and hereby revoke all Wills and Codicils previously made by me. ITEM ONE: I direct the payment of my debts and the expenses of my estate from my estate as soon after my death as conveniently may be done. I have prepaid ' for my funeral at Ewing Brothers Funeral Home and have a lot purchased for my interment. Ki Ii i %~ ~. ITEM TWO: I bequeath all of my firearms and hunting apparel to my Aunt, Helen Tyler, of Landisburg, Pennsylvania, should she survive me by thirty days. ITEM THREE: I give, devise and bequeath such of my personal property as may be lisfied on a signed and dated memorandum kept with my Will to the persons named thereon, provided they survive my death. Should such a memorandum not be found with my Wili, it shall be conclusively presumed teat none was prepared, and aIN of my personal property shall pass according to the remaining provisions of this 1/Vill. ITEM FOUR: I give, devise and bequeath the rest, residue and remainder of my estate, of whatever nature and wherever situate, as follows: Fifty Percent (50"/°) to PINNACLE HEALTH, South Front Street, Harrisburg, Pennsylvania and Fifty Percent (50%) to FIRST CHURCH OF GOD, 705 Glendale Street, Carlisle, Pennsylvania. ITEM FIVE: While in the hands of my fiduciaries, neither the principal nor the income of my estate or any trust created hereunder shall be liable for the debts of any beneficiary hereunder, nor shall the same be subject to seizure or attachment by any creditor of any beneficiary under any writ or proceeding at law or in equity, and no beneficiary hereunder shall have any power to sell, assign, encumber or in any manner to anticipate or dispose of his or her interest in the trust estate or in the incorne produced thereby. ITEM SIX: I direct that no executor or other fiduciary named, nominated, or ,~ i ~i ~; ~, ~; appointed by this my Last Will and Testament shall be required to post any k~ond or give any security of any type for any purpose whatsoever, any law or rule of the Court of the Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. I direct that the law of the Commonwealth of Pennsylvania shall apply to any interpretation or application of the validity of this instrument. ITEM SEVEN: I confer upon my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or time, iri such manner, and for such price or prices, and on such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers of the property, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments, or otherwise, v~rithout liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so- called "legal investments;" to make distribution in cash or in kind; to allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries, in case or in kind, or partly in each; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. ITEM EIGHT: Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to an heir, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. ITEM NINE: I appoint M&T Bank, executor of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of four (4) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identification, on this the _~~_ day of D ~ c+ , 2007. __(SEAL) Bryan F. Ensuring , Jr. Signed, sealed, published and declared by the above named testator.. Bryan F. Ensminger, Jr., as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~~ ~^~ ADDRESS ~ ~ '~' ~ '~ ~~` fr ;~~.r r ~~ ~SG~~~LDDRESS;-~~:li~t'1~~1C~~.k'~ f=,~' ~-~ ~.~,.~~ ~~ ~ ;~~qr~~1~ ~`1~.~x~ . COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, Bryan F. Ensminger, Jr., ~~1~~~ ~~,st ~ ~ ~ ~:~~~~ and }:1-r~u~lr'.t.~t. 9 i_Y~~~~~~~ the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the unclersigned authority that the Testator signed and executed the instrument of his Last Will and Testament, and that he signed willingly and that he executed 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 their knowledge, the Testator was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this the ?' n, day of ~ ~--cµ- ~ ,_~-__ , 2007. ,.. ~.oMn~ur:~h~Eu ,,-~ c~ ~r~r~s~r_~sv,NyA ~"~`2~t z.r;2l,~_~Z_-~% ~ _~> ~?2 ~. LZ~3-~~ ~~ ----- '-~~ ~ ~ c~ianal sea! - - i ,W-na'?~;z~ t. ; `.=~r~i;is~l, Ncrary ~'ublic i ,;,<<~;i~iN c3ci ~ i_,;3,nbwlarx~ county ! pd:y Ct:tnr i ~ ~~ i`a~Ar~ ?~~ri; 17.2Q1Q Pv9~mb_~, Pe;s~ t s ~ ..a,i~~ .~~'sUc~r „f ~~zaricaM RENUNCIATION ~ ~= o ~- ~, ^~ ~.~: ~-, ~; r-r-a REGISTER OF WILLS ~~~ rn ~' `= 3 Cumberland COUNTY PENNSYLVANIA ~~'~~ ~ ~ ;-'' , - { - "`; - ~ -, ~ ==~ _.. .~r ~ n _ ~ ~ Estate of Bryan F. Ensminger Deceased I, .First Church Of God (PrintNameJ in my capacity/relationship as residual beneficiary of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Michael A. Scherer (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of (Stree! Address) Carlisle, Pennsylvania 17013 (Crry, Stare, 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 renunc t'on for the purpo es stated wi in on this _ day of D ~ -~-~ Deputy for Register of Wills Farm RW-06 rev. 10.13.06 Not~ry Public My ommission (Signature and Seal of Notary or other official qualified to administer oaths. Show date of eicpiration of Notary's Commission.) COMMONWEAL'Tli OF PENNSYLVANIA Notarial Seal Trida D. Naylor, Notary Public Carlisle Boro, Cumberland County MY Commission Expires Oct, Z, 2014 705 Glendale Street n ~,~~ ~ ~ ~' ~ ~~ RENUNCIATION ~ ~ ~ ~ ~ ~ rn ~' `~-' ~ < REGISTER OF WILLS ~ , ~ .~,? ~ ' ' ;~ Cumberland COI~Ty~ pENNSYLVANIA ~~~ '= n ~ ~ ~'T' ~i ,~, Estate of BD'an F. Ensminger Deceased I, Pinnacle Health (P,i~u+vaaie) in my capacitylrelationship as residual beneficiazy of the above Decedent, hereby renounce the right to administer the Estate of the"Decedent and respectfully request that Letters be issued to Michael A. Scherer (~~) `T i (SlSnarure) ~a~ s st~~.ti/ sf~~ ~'a ~~x ~s~o (SrreerAddresrs) ~iwfShctii ~4~ ~~~G~ ~ ~70(~ (City, Same, Z/p) 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 she executed the renunc~ia~t~ipn for the purposes stated within on this _ Y~ day oft / _ a Deputy for Register of Wills L~-"~~ ~=~~ No Public My Commission Expires: iSignaare m>d Seal ofNoWry or odmr ot2icial qualified to administer oaths. Show date ofexpinuion of Notary's Commission.) OOMMONW~AL~N tll' ~~NN3'fLVANIA Forn,R[5=06 rev.10.I3.Ob Notarial Seal Judith A. Geyer, Notary Public City of Harrisburg, Dauphin County My Commission Expires Sept. 24, 2012 Member. Pennsylvania .Association of Notarlss