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Home My WebLink About03-19-12~ rceset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF Cut~~~ ~>~ 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• ~L~ n1 L • /~/(A ~J a/k/a: './lJ a/k/a: r`' ~ a/k/a: Date of Death: ~ 3 / ~ ~ j2~ q Decedent was domiciled at death in principal residence at f ~P al,~~ r. Decedent died at Street address, Post Office and Zip Code File No• ~ ` - ~ ~ - ~ (Assigned by Register) Social Security No: ~~ b '~ A~ at death: Borough with hi~,(het; last County 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 $ 5 Q ~~ , E1C If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ...................... ................................... TOTAL ESTIMATED VALUE.... $ $ t, ."0.00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township o Boro County ~' A. Petition for Probate and Grant of Letters Testamentary n ~y ~ry Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~7 l ~ ~ 7 7 ~p and Codicil(s) thereto dated State relevant circumstances (eg. renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS ~ EXCEPTIONS B. Petition for Grant of Letters of Administration (If applicable) c. t. a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate If Administration, c.t.a. or db.n.c.t.a., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for 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. NO EXCEPTIONS ~ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following additional sheets, if necessary): (if any) ~d heirs~it t7 it -- Name Relationshi Address ~~~~ ~. `'~? tt7 _ - _ _. ~J ~ ='r Form RW-02 rev. 10/11/2011 t~ ~t Page 1 of Oath of Personal Representative COMMt~NWEALTH OF PENNSYLVANIA } //;; ~~ ~~ } SS: COUNTY OF VI,~Yy]l~~jQ~ ~/ } Official Use Only ~E` `," , - _ _ -(~~(;;~ CAF I 1._ r•~I_L~ :~ _ ~~~ , Petitioner(s) Printed Name Petitioner(s) Printed Address f~-o ~... l ~ ~ 1~lleix,~ c Q~LrcS~ ER ,. _ ~2 r ~ • l Cp ~ ~ SO ~S ~~ Pl. ~..., PA . . a P ~ ~ (~ 3~9 rr'acr!e~ 19 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, a Petitio er(s) ' 1 well and truly administer the estate according to law. Sworn to or affirmed and subscribed before ~ me 's ~(L day of - "" r sx; ! ~ to o? - i o -1 Zi ~ to - )Z BY °~ Date - -- ..- For the Register -- /"~ - Date BOND Required: ~ YES ~ NO FEES: Letters ...................... $ .J ~ ~;' • L,(i ( ~ )Short Certificate(s)...... 02 ~ U d ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission .................. aG. E?- Other ~. E ~ ~ ........ I ~ - OL Automation Fee .............. . JCS Fee . .................... TOTAL ..................... $ l 0 Estate of ~- ~L LC a/k/a: ~= l t l t ~, File No: ~,1- ~, l - l U AND NOW, ~.,\ ~~( (" ~ ~ ~-C' ,.~C l '~-- , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS ECREED that Letters ~~~~1 `y ~~ V L-{ ('(i~~ are hereby granted to ~ 1. L. ~ 1c - ~ C ~ l V . (~, r -F ~ ~ ~ ~ ~ t T-~ ~ l 1 r (i~'l ('~ ,~ l ;t t l ~ .,( f-l (~.~('l1" 1 I ~ in the above estate and (f~applicable) that the instrument(s) dated ~ ~' _ l ~ - I C~ G l l described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Form RW-02 rev. 10/11/2011 To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: ~'lc~.ro.a G , ~e~kSOvl Supreme Court ID Number: Z O~ `190 Firm Name: `ri,~,~te.e_r Ar~nilo~-ro~~ Address: 2 Lem aunt D r ; vt L~ ~- ~ AA ~ '70 ~ Phone: -r 1-- - X34 - LI ! t l Fax: "11'1- ~3~. -(ogoa Email: @. ia~c.ICSea~n~ *utk.er•1avJ.Com V • DECREE OF THE REGISTER ~Cl o Gt ) fj ~Yc ~~ f~:(.C of Wills ~~ t ~~~~ C cc~,~.r? CSC' 1> C~~! 1(1 t\ Page 2 of Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } '~~t~~ } SS: COUNTY OF } ~f r n , + .C',.+ ~ i'lE,~~ ~~, `~''~s'`~~ I9 fib I: a`j CLERK GF ,~ , Petitioner(s) Printed Name yr u i ~n~ V J V ' i Petitioner(s) Print ,; 1 1 ,(~ I L . ~~ ~ '~ ~ )1 ~s Tr tZ ~ ~ r (4G( 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) ofthe Decedent, the Petitioner(s) will well and truly administer the estate according to law. Sworn to or~ffirmed an subscribed before ~~_ ~~ ~ ~.~,r_ Date 3-Z - 2ot~ me this ~ day of 2b12 Date _~ By. Date For the Register Dale Letters ...................... $ ( } Sltort Certificate(s)..... . ( )Renunciation(s)......., . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Cotntnission ................. . Other Automation Fee .............. . JCS Fee ..................... TOTAL ..................... $ ®~~ BOND Required: Q YES ~NO FEES: To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: ?`IQI'O rt y C, Q GKCc v1 Supreme Court ID Number: ~OD ~~ Firm Name: ~ (,{C ~ Y`p~/Js"~Q.r- ~' Address: - %70 - Phone: `71 -.• ~3 ~ - / ;Z ~ Fax: -~(~7 - 2 ~ - c~ Email: ;-~ Cc DECREE OF THE REGISTER Estate of - 1 File No: a/k/a: AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters are hereby granted to in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of recor s the last Will (and Codicil(s)) of Decedent. Register of Wills Form RW-n7 ,-ev. tnit tiznr t Pagc ~ o f ~~ F ~ ., • ' ~' cl.+ Oath of Personal Representative `'>'t141"t 0 F CSC (~D ~ ~ D ~`nn,r~,rn+r. . ~.u~vr ~,wx~w } -o-.~-~r. } $ $ COUNTY OF ~ __ _ _ } .'f-~I?~P, 19 P~ I~ 3~ CLERK QF Petitioner(s) Printed Name yr u i u'tr v ~7 'v r Petitioner(s) Pri ,}~ / l ('1 I L . ( ~ ~ ~, ds~ 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) ofthe Decedent, tl titi ) wi nd truly administer the estate according to law. Sworn to or a~~irmed a ubscri ed before ~ Date l~r',j~ Z~/ Z Ida of , ~pJ,2 ,, ~' Date {~~~~ Ite Date ~.~ Date .~ ~ c.. ~uire~ ^ YES ~NO ~~ $ '~~..o,.:.,}-Schort Certificate(s)..... . ( )Renunciation(s)......., . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other Auto nation Fee .............. . JCS Fee ..................... TOTAL ..................... $ To the Register ojWills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: _'`7C~ ~"O~ , C , ~ Q G~C h Supreme Court ID Number: ZOO L} ~ (~ Firm Name: / t,(C~- N(~~'6Q, ~ . Address: ~ ~-Pr'-'1 O to 1 ~0 ~~ Phone: `71 ~.. '1'3 C - l2 ( Fax: (`7 - Z ~ Email: ~ n ~ DECREE OF THE REGISTER AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters are hereby granted to in the above estate and (if applicable) that the instrument(s) dated aescrtoea to the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills Estate of a/k/a: File No: FornvRW-01 rev. (0/l!/2011 Page ~ of 4 1l II,G ~' c 9r'\' ,~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will he Forwarded to the State Vital Records Office for permanent filing. P 15 2 ~. ~ 7 4 2 ~;~tdr,~,.r ~t ir.~~ ~~ Certificatl`on Number Local Registrar Date Issued :--, 4 ~ ~ hJ % -~ i -~ 'Y7 ~ ~, i C~? .I7 ~ fn_' ~ t t l ~ m cn ~ ~ ~ r ... ~. ~ - - = - _ ~ o -n .;~ _ - Y =A ~ _.... ; - a c.-,a c~ ~~. nlct.la3 REV unoob COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE; PRINT IN PBIACK WKT CERTIFICATE OF DEATH (See instructions and e3camnlaa nn •nMx.rnnY 0 1. Name of Decedml lFnfl, nibok. lael. wdlx) ' C Yllt NUMCtH Helen Louise Mann 2. Seer 3 SocW Securgy Nunber 4. Dak d Dealh (Mmlh, d'ay, year) Female 178 - 16 - 1763 March 10 0 s. Age (last &nhday) Under l ear Uri4r t day 6. Data a &rol IMonm, der .year) 7. BiBgHCe ( aM s4ta a for caairy) &. PkM d beam ICherA aw) I I~nVS Days IWUis Mnwes 88 Hospdq' Dmer: Yr, Jul 13 1920 6b C York PA ^Inpaaem ^ER/oxlpauem ^130A astngrkxne ^Ras,dence ^anar.spe~lry . . ounly of oearn &. City, Bam. Twp. of Deam Bd. Faciby Name (d ro l insMUWn, pve weal aM amber) 9. Was Decedem d Hispanic Orgm7 No [f Ves 10. Race. Nrencan ImYan 8kck V•Tee eb l ~ Cumberland U Allen h I~ 1~'1 e ss/n . , Illa e Iuyaa,eperirycxMn, I i S Mexican Pu6AO Ryan ab) 4dF ' 11. Decedents Usuq Ocn Iqn Kx,d of was done dx, mnt of seal, We Do MI lute retired 12. Was Decoded aver b Aw Ksb of W s U S A , to 13. DeeMed's Edrealbn iSpacAy oNy hgnesl We carplaledl 11. Marilq $letue'. Married, Never Mained, 15. Surviving Spouse (lf wde y,ve maukn MIME a . . mNd Faces? Kind d Business I tibuslry Pastoral Secrete Cl l ^ ] i , EMmemary / Secabary 10-121 Caepe Il-1 a 5r) WRlowed, Drvacad ISpedM Yea 6( er No ca 2 • 15. Decedents Maisrp Address ISlreq, aty I lown dale, xp coMl Decederd'e 1778 Winterhayen Drive aw,l Reabence ,7a sale Pennsylvania ~ ~:"`a ,7e ~.'] Yea Dae4nl Lixed in Uoaer Allen Mechanicsbu PA 17055 °b c""nry . ,„~ Townshp? I7d. ^ No Deneaed Lrvea warm Cumherlarx3 15. Famerb Name IFx51, mb,ae, ksl, wnixl AciMILaNna cdyr0«o ' John Robert Mor art 19. Homer s Name (Full, noddle. nwiden SaIWrN) tbrothy Louise Jacobs 20a. INamant's Name (Type / Pmll Holly Louise Ritche Tip. Inlament's Maienq Adheas (SY6a1, aY / town, eMk, zip aide) 1209 Allendale Road Mechanicsbur PA 17055 21a. Metnod of Disposubn j ~] Cremalim ^ Donaaen 21 b. Dale d Dspoeebn IHOgn, MY Year) 21c. Place d DuPOSitiori It4al11e d cenlelery, cremetay a Omer place) 210 Location ICwy' I k«n, pate, zip coda) ^ Bunq ^ Reinaval Irmi Seale I Waa Cremation a Dmgim AuBwdzed ^ Oater~Speayy: bYtNdkgEAambw/Caawt GdYea^No March 17 2009 Rollin er Cremato 22a. Siq,a / fu~ J $erylcg Lx j e I« person acfng n) 22b. Lkerw NuIMx ~ Mt.Holl Sri zx. NarM aM Address a Facaily ~ ~ FD - 0198A9 R Market Plaza Way Can lea 2 drily wtxm ing 23a. To me Msl W my snowledge, dean occurred q the Ynk. dale Brd place slaletl. ISgneaae alb etla) ~ pnysiaan s nil avaikde al time d degh b 23b. licenae Nwrper 23c. Dale Signed (Mmm, eery, year) cergy cause d deem. .1 u l __ I n ~r v ~C MIM 2126 Mst M cmplele0 0 y person w'M prawulxes deem 24. Txne of Oaalh '1 25.OaH PraloaKad Dead (MOdA, Osy, yawl 26. Was Case Referred Medal Examuar! C«Orwr l« a Realm Odwr Own Cremation a Dawum7 . ~ ~ 3O { M. T ~ I O~ ^Yea N~ CAUSE OF OEA1H (Sw InatrslCUona anq aaampNS) Item 2] Part L Emal ma fBdal4l ere,u - axases, mwnes. a cmykauons -mat QxeaH/ Mused me Beam. W NDT order lernanal evw r Appaxmab blarcal: Pan II: Erder adwr gI1p0~oLlarptllaDtadBDr~1n~W, 26. Db iobaeco Use Cantrpde b Oxm7 ds coca as cardwc arro9 fasprabry arrest, a venlncWer MrYMlbn wNwul sMwup Ule 91sM11]y tip aNy One causs m each 4w. , Onsal b Deem ad nil rawabg b ew undanying Musa Divan n Pan I. ^Yae Pr ^ ob~Y Wc~~ TaE nAUSE IFain dwnsn or ') / a. ugn0eeml _~ e r~. )lJ(c lJl[ ~ L L'([d<C~; Gt~ ~L('FC)%( j I [~1a+ ^ IMkrwwn ~ n~ 29.dFemaH: ~~ 3A~ lilt// ( Y S DM to for as a consegMrice d). f r l ~ I LJ Nd peglwrd wdhn peu year Se~uMllMllIyy sal condlbM. d any. b. b ma Cause wtea m WIe a t f~ ^ PrlrpwM al aerie W deem Enkr M UNDERLYWG CAaUdSE Due b for as a consequence afl: bvm~ls raa,am ~~n d~eaN~ IASTw r ~ ~ / Y ^ NW Dra9wrll. W Pragnrud wW~r112 days 1'rKC C 7lC dm n 9 Dub b eat a5 a consequenM ol). . . a + ^ Nd peened, W pegram 43 days Id 1 year d / ~ ~//S/-~/l.! Or Cc1~fL~1 Clc llC`~l~ 30 W A ^ lx+nowna pagwd wwun Yw pall year a. az an WOpsY 30b. Were Awapsy Filbxlgs 31. MMa/urer d Deem 32a Dab d tiM+/' IMonm, mY~ Y•M) 32b. DazcTpe lbw Injury Occurred 32c. Place d alrtY. Home, Ferm, great Faaay, PaAoirtwe? Avadude Pnoi b Compmua C.1 ^ Hom¢we d Cauca W Dea1M Nalaal tMfice BaHvq, ek (Spectiyl ^Yes ~NO [] Yes [-1~'f!o [_] Acn4m [] Pnld,ng Invesugabm 32d. ime d Iryury 32e. ayury aI WoIk9 321. II Trarlspablion Inprry (Specdyl 32 Locaaan d 9 WxY 15weal, c1Y /tam, sHk) ^ SuaWa ^ Coub NW M Dolermbed ^Yes ^ Nu ^ Dnver / Dperala ^ Passerpei ^PedeNrwn M. ~Wwr-Spicily: 33a Cerdwr Idwck tidy awl 33b. SigMlae aM Tak d Ceneier • Cerglying physkian IPr,y~xwn cxary,ng cause d acnm when enolnel prYsk,an has paw«,ced dean and ca,pleled Item 23) To ma MU d mY anowNdge aaldn occwrad doer 1o ma caus a) d / ~ / ~ / ~ Z , g an manMr as sMk4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Prorrouneing and wrglylnq physkian (Pn s,nan lwm ror s _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ( (, ' ~ ~ J ~C. [ L(~ ~(-. / !/ t.- y p quncx,g eam and wNfying to cause d dean) To IM Mal ul my anowkdge, deann occunwd al the ume, dab, aM plau, and dM b IM quae(a) and manrwr as sbled ^ 33c lxeaw NurMar 370 Dale Sgned IMaun, day, yawl _ • Madkq Examiner / D«OMr _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ '/ _ ~, 1 ~ (/~ 5 Y ~, /~3 . _ / ~ _ ~/lU (/ C ( ~ On ma basis d aaamtnatim antl / or Uaeshgabon. in my opimm~, Oeath eccared al tM linre, dale, and place, and tlue Io t M auaels) rxb manrrr as aMka_ ^ 31. Name an d A d dress d Persm Who Ccnpbbd Ca u s e d Deam ple ' m 27) Type I Pml 75 Reryslr a Signatae and DI I tie a yy~~ .. ~ ~ ~ ~ Feed Monm, day, year) LL ~~ ~n ~ ~s / J yrT ~ fs/ /~o nI'[ L3 ~ ~S C~ n ~ J ~~ r i,~ L~ll~~l/ ICI 4G~G~ ~~ ~ ~ ~~ /,OD /)7T AtcEN (~i'ZiVC ~ - ~ ~-~ V Uisposillon Pernul NO 0.318551 OATH OF NON-SUB SCRIBING WITNESS(ES) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA ~I-~i-IC~~~( Estate of HELEN L. MANN Deceased ~-O C ~ ~ ~ and , (each) being duly qualified acco ding to law, depose(s) and say(s) that she / he /they was /were well- acquainted with HELEN L. MANN and am/are familiar with the handwriting and signature of the decedent, and that the signature of HELEN L. MANN to the foregoing instrument purporting to be the Last Will and Testament/Codicil of is in his/her own proper handwriting. ~'FG' ~~.GLrdC_t ~ ~ ~/ (City, State, Zip) ~ l 7 ~ S ,5 Executed in Register's Office Sworn to or affirmed and subscribed before me this ~ U d~a/y~ ~~~~~~~~ Deputy for Register of Wills (Signature) (Street Address) (Cety, State, Z:p) rn ' r..n ~ ~_~ -'. ;p ~ ! b --~ T "n r ~,? ~'~ ~.C' Form RW-04 rev. 10.13.06 _._ ~ :'J ~ ~ ". OATH OF SUBSCRIBING WITNESS ES `~ - ( ) ~ ~„~ _ - ~~ c-, o _,:, s: -, c ~ -~ - , , ; REGISTER OF WILLS ~-' ~ -:: ~`;; CUMBERLAND COUNTY PENNSYLVANIA v , ~1~11- lC~~~1 Estate of HELEN LOUISE MANN JAMES D. BOGAR Deceased (each) a subscribing witness to (Print Name/s) the ~ Will ~ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same and that she / he /they signed the same and that she / he /they signed as a witness at the request of the Testator /Testatrix in her /his (Signature) (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this of day Deputy for Register of Wills Executed out of Register's Office Sworn to or affirmed and subscribed before me this o~~~ h day of U r o~bl a. . %~~~~ ~ Notary Public _ My Commission Expires: J o~'~d'~J (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Form RW-03 rev. 10.13.06 presence and in the presence of each other. ~' _ ~ (Si lure) _ 1 West Main S et (Street Address) Shiremanstown, PA 17011 (City, State, Zip) ~~~~ lETH /. LENGEI. NO1ARIf PIIBiIE 1NNaEMANSTMNNq 80110, CUMBERLAND ~~~.~ O ,, ~ ~, ;x; ~ OATH OF SUBSCRIBING WITNESS(m ~ ~' -_ ~ ~;,~ ~ , , !~ -_ . 1 ~ ~ REGISTER OF WILLS ~~~ ' ~ _, CUMBERLAND COUNTY, PENNSYLVANI~~ -' ~n o ~"' v ~~ .r _ r~~ -~~ - ~~j~~ Estate of HELEN LOUISE MANN Deceased CATHERINE J. BARRA , (each) a subscribing witness to (Print Name/s) the ~ Will ~ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same and that she / he /they signed the same and that she / he /they signed as a witness at the request of the Testator /Testatrix in her /his presence and in the presence of each other. (Signature) l - (Signature) 1041 MOUNTAIN ROAD (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills (Street Address) DAUPHIN, PA 17018-9421 (City, State, Zip) Executed out of Register's Office Sworn to or affirmed and subscribed before me this ~i ~' day of F~ h 1'~LI.QXr/1. 12. v COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL LESLIE A. HALL, Notary Public N y PUb11C Susquehanna ~ ,., Dauphin County My Comnu is ~ , ~s L~ec2mber 28, 2'014 M Commission Expi . - ~ ` °t" ~"°" (Signature and Seal of Notary or other official qualified to administer oaths. Show date ofexpiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notazization. Form RW-03 rev. 10.13.06