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Home My WebLink About04-12-12Reset 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: Ruth M. Carts File No: ~ ~,~ ~ ~~ G'~~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: April 4, 2012 Age at death: 89 Decedent was domiciled at death in Cumberland County, pennsylvania (scare) with his/her last principal residence at 4905 Trindle Road 17050 Mechanicsbure, Hampden Township Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Holy Spirit, 503 N. 21st Street, 17011 Camp Hill Cumberland 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 $ 300,000.00 If not domiciled in Pennsy!vania ....................... . Personal property in Pennsylvania $ If not domiciled in Pennsy!vania ....................... . Personal property in County $ Value of real estate in Pennsylvania ..................... ............................. ....... $ TOTAL ESTIMATED VAL UE.... $ 300,000.00 Real estate in Pennsylvania situated at: (Attach additional sheets, i/ 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 June 27, 2005 and Codicil(s) thereto dated N/A Paul S. Carle died nn nctnher 1 O 210 and Ram Paul C'arlc rennnnced hie right to serve ac executor 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) e.t.a., d. b. n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate If Administration, e.t.a. or tbb.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 spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationshi Address C'~ '='` A ~7 ~" ~-~ ~ ~ f'Fl ~ i _-. a., ~ _ ~ C7 -~ ~It ~ __ Form RW-02 rev. 10/ll/2011 X~ r~ ' ^_.~ ~: "7 __ , -r , :T ~J ~ ~~ .~ Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF } To the Register of Wills: Please enter my appearance by my signature below: Petitioner(s) Printed Name Petitioner(s) Printed Address - l`? " Ann Marie Carls -.Y C-- _ 801 Keckler Road Harrisbur PA 17111-3168 _ ~ w =- ~ c~ 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 Dec dent,/~tAhe Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before ~/ Y' CSR- ~~ Date `{- ! O - 1 a me this C ~ day of ~ „a t _, a~.,..• Date $y~ ,/ -_ ~ ,~ Date For the Re s er +'~- Date BOND Required: ®YES ~ NO FEES: Letters ...................... $ 3 - o, o0 ( S )Short Certificate(s)...... 20.0 ( \ )Renunciation(s)......... S.ea ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ is ll _........ i5, d~ u~o ~a ~,e., F«......... ~. oa SCS Fsa. •••••••• Z3. Sn Automation Fee .............. . JCS Fee ..................... TOTAL ..................... $ .5 (~~ Attorney Signature: Printed Name: Scott Alan Mitchell, Esquire Supreme Court ID Number: 76124 Firm Name Address: Phone: Fax: Email: Official Use Only r O r-.'r ~'7 ,, ~ ~1 ~ ~ ~_ "i ~~~ -- - ~G7~ _ _. McNees Wallace & Nurick LLC 717-581-3713 DECREE OF THE REGISTER Estate of Ruth M. Carts File No: a/k/a: AND NOW, ( `;~'~~ ~`~ , in consideration of the foregoing Petition, satisfactory proof having b en presented before me, IT IS DECREED that Letters Testflrrtentary are hereby granted to Ann Marie Carls in the above estate and (if applicable) that the instrument(s) dated June 27 2005 described in the Petition be admitted to probate and filed of record as the 1 t Will (an~Codicil(s~) of of Wills FormRW-02 rev. ~nn~iznli Page 2 oft __ _ ~, i a ~ l J ~ __ ,.~_ LOCAL REGISTR_ AR'S CERTIFICATION OF DEA~~"H WARNING: It~~~~!C_tdiiiitl~j~c(~e this copy by photostat or photograpf~. Fee for this certificate, $6.00 ,,Illll~"'~ ~ Th s is to certifi Ih el :_IE( uj(:mrati('n h u iven is ~';~~~ ~f~~ ~ ~ ~i'`~ 3tll I d.P~~~FPfiy "- co)re.ctly ~oF(zd f(I (~ .(~I ~)~(Iri~~al Cer:itic .I I ' De~(th ~~~~`°~~ ~ ~~`~L~ (scaly filed with m( .i..,OI 1' Refi~trti~r [i~' ~a-iginal ~lG [~ p ~~, v rejt)ficate will h( t -1h ir0ed (~ thi° ~,t,u.~ Vita] r : O CI.ER{~ ~' ~ ~ ' z a ~~~,~ v~~ _< ~ ~ a~ kte orcls Offi~•e fu ~~~ ~.r~ai)(°n1 fii)ng. • ~ .~._ Certification Number Type/Print In Permanent L1 J ~_ V L(I~al Registrar COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS e>tTS CSI"ATC At f1CATY ---,~ _ -1--- -- - Datc 1>,5)(ed lack In k 1. Decedent's Le{al Nama (First, Middle, Last, SuMx) 2. Sax 3. Soelal security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) F - la ~ 8S' r a 20 3a. A{.-Last Birthday (Yn) SD. Und<r 1 Y.ar Sc. Untlar 1 Da 6. Dab of Birth (Mo/Day/Year) (Spell Month) 7s. BI ~~(IC~~ j state reign Count `' ~ Months Days Houn Mlnubs .•s ~ s ~ ~ ~ ~ 7b. Birthplace (County) tl $ Ba. Residence (eta or Forei{n Country) Bb. Residence (Street and Number- nclude Apt No.) gc. Did Decedent Llve In a Township?,, // J ~ ~ Yaa, decadent Ilved in Hi9-I+~/4 )~CA'~ U< _twP- 8d. Residents (C unty) ~ Q a,fh Q ~, 8e. Rasidenu (Zip Cod.) Q ~ QNO, decedent Iivetl within limits o1 city/boro. 9. Ever in Us Armed Forces? 10. Mar lbl status at Time of Death MarNed Widows 11. Survlvin{ Spouse's Nama (H wNe, {Iva name prior to first mettle{e) Q Yes Q Unknown 0 Di vorced ~ Never Marrlatl D U n w ~t, SufR 12. Father'f Nama (Pint, MIdtlN, La ) , 13. Mother's Nama Prior t0 Fist Marrla{e Irst, Middle, Last) ` ~ C Y l ( V /~C~--- 14a. Informant's Nam• 14b. Relationship to Decadent 14c. Informant's Illn{ Address (Stye nd tuber, C ,Stets, Zip Code) Z v C r-' S ~ ~ ~~ u ~ ~ -.... ........ . . - ----.... ..--- -•------------- a. ace o set "-"~--on-y cn... ----- -- --- urretl in a Hospital: ~InPetlent ~11 Death Occurtatl Somewhere Other Than •~1-1osPltal:~ -..~ HosPlu facility ~~ Decedent's Homa -- --• If D th O S cc p Emer enry Room/OUtpaNSnt Deatl on ArNVaI Nunin HOmf/LOn -Term Gra Facili Other (specify) lSb. Facility N ma If not InstKUtion, Slue eat and number; r iSC. C or Town, stars, 21p Cods ~ ~ I 1 Coun of Daat , d~ 16a. Math of Dlap sition BuNal Q Cremation 16b. Oats of Disp Itlon 16c. Platt of Dispofltlon (Nama of cemetery, crematory, or other place) ~, 0 Removal from Sbte Q Donation r ` ~ ~ ~ y~_ (~ I_ /` r 1 ' otner(sPedry) - i( iirbC[Q.L~T~~R jNC7- /V 16tl. Location of Dlspositlon (City or Town, Sbte, and Zip) 17a. si{na oral Service Lic n or Person In Ch f 1 tarmant 17 b. Liunse Number sea n t~, ~ -f ` ! •-•+ ` ~~ ~ ~ 17c. Name and Com s dress of Fun ra Facility V v ~' B. Decedent's ducatlon -Check tM box that bast describes the 19. Decadent of Hifp le Orl{In - Chac th• 20. Decaden Race -Check ONE OR MORE races to Indierte what ~- hl{hest da{rse or Iwel 07 school complebd at the time of dpM. box that bast describes whether the decedent the decadent considered himself or herself to be. ~ 8th {tads or lass Is Spanish/Hispanic/Latino. Check the ^NO" White Q Korean 0 No diploma, 9th - 12th {rode box N decadent is not apanlsh/Hitpenic/Latino. Black or Alrlcan Amarlcan Q Vietnamese ~ HI{h school {raduate or GED completed No, not Spanish/Hlspanic/Latino 0 American Indian or Alaska Native 0 Other Asian Q Soma toile{e credit, but no da{tee Yaa, Maxlun, Mexican Aml~i~an, Chicano Q Asian Indian O Native Hawaiian Associate d<{ree (a.{. AA, AS) 0 Y<s, Puerto Rican 0 Chinas! ~ Guamanian or Chamorro ~ Bachelor's ds{r<e (a.{. BA, AB, Ba) Q Vas, Cuban O Flllpino 0 Samoan ~ Mesbr'a da{rea (a.{. MA, MS, MEn{, MEtl, MSW, MBA) Q Yes, other apanlsh/Hispanic/Latino ~ Je Panese ~ Other Pacl}ic Islander O Doctorate (a.{. PhD, EdD) or Profasslonel ds{rae (SpacHy) ~ Other (specify) . MD DDS DVM LLB JD 21. Decatlent's stn{le Raca Self-Dasl{nation -Cheek ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work ~~a/ Whlb Q JePanase ~ Samoan done tlurin{ most o/ workin{ life. DO NOT USE RETIRED. O Other Paclflc Islander " 0 Black or Afrlun Amarlcan ~ Koraan t Sure ~ ~~~ V Q D 't K /N on now o ~ Amarlcan Indian or Alaska Native ~ Vletnamesa ~ Asian Indian ~ Other Asian ~ Refused 22b. KI d of Business/Industry 0 Chinasa Q Native Hawaiian 0 Other (SPecIfY) ~~ w ~ ~~ Q Flllpino Q Guamanian or Chamorro .,Q VT t On y w sn app scab a 23c. Licansa Number o uncl n { Dea 1 S a - MUST 1E PL D to Pronounce Daed Mo Day r 23 turn o Person Pron r - l /~ ~ p {Y PERSON WMO PRONOUNClS OR a ~~ L 4/ ZO I~~ jc..,iv p.~s~/ Rf~(~ ~ S~ CERTIFIES DEATN I - 2 d. Data SI n d (MO/Day/yr) 24. Time of Death ~ 7. 53 A 25. s Medical Examine rGOronar COntactadT ~ Yas No wL_ ~,'jp12 CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events-Olseeses, Injuries, or compllcatlons--that tllreetly caused the death. DO NOT enter terminal events such as cardiac arrest Interval: ABBREVIATE. Enter Only one taus a Ilne. Add additional Ilnes If necessary Onset to Death respiratory arrest, or ventricular flbrlllation without shpwln{ fhs etlolol[Y. DO NOT 'n//1 IMMEDIATE CAUSE --------> S ~ ~ o~e•.rl X~[~G ~~~~ ~ ~ e -4-- (Flnal disease or condition Due to ( r c nsequenu of): rssultin{ in death) ,t Segwntlally Ilst contlitlons, Due to (or as • consequence of): If any, leadin{ to the cause listed on Ilna a. Enter the UNOERLYIN6 GUSE Due to (or as a consaquenca of). .~ (disease or Injury that 0= Initiated the events rasultlne tl. In a•am) LAST. Due to (or as a oons.quence of): 26. Part il. Enter other but not resu Rln{ in the underlying cause {Ivan In Pa N: I 27. Was an autopsy perto etl7 ~ )~ -/ (' ~ l~ ( ~/~ ~ Yaa No ~ 1 I {"~ 1 `TY-~ `t 1 ~1 ~G~ f"'t / t'~ 1 Y1 n ~~v ( f~(~ ~v t 2g. Ware autopsy flndin{s available ~- V to complab the cause of deaths $ ~ Yes NO 29. N Famala: 30. Dld Tobacco Use Contribute to D<athT 31. Mannar of Death Not pre{nant within past year Q Yes O Probably ,vj~Rgtural ~ Homicide Pregnant at time of death Q No 1-111nknown 0 Accident 0 Pandln{ Invests{atlon ~' ~ Not pre{nant, but pre{nant within 42 days of death S7 ~ suicide ~ Could not bs tleterminatl ~ Q Not pre{nant, but pre{nant 43 days t0 1 year before death 32. Data of Injury (MO/D{Y/Yr) (Spell Month) Q Unknown H pre{nant within the past yur 33. Tama of Injury 34. Plata of Injury (a.g, home; construction site; farm; school) 35. Location of Injury (street and Number, Glty, state, 21p Code) 36. Injury at Work 37. If Transportation Injury, specify: 38. Describe How Injury Occurred: Q Yas ~ Drlv<r/Operator 0 Pedestrian ~ NO ~ Pass<n{ar 0 Other (Specify) 39a. Cartlflar (Check only one): rtifyin{ physician - To the bast of my knowlatl{a, death occurred due to the cause(s) and manner stated Q Pronouneln{ {. Ca N:ifyin{ physician - To the bast of my knowledp, death o tad at the time, dab, and place, antl tlu• to the cause(s) and m stated 0 Medleal Exeminar/Goronar - On M bf axaminatl and/or invastl{atlonr in my opinion, Death occurred st the time, date, and place, antl due to the cause(s) antl manner stated 51{nature of eertiflar: Tltls of urtiflar: ~ fl Licansa Number: M.17 ~ ~ ~ ~lr 39b. Nama, Address and 21p Code o1 Person Comp { Guse W Death (Ibm 26) 39c. Data Si{nad (MO Day/Vr) /rl~dM N ,o LA / 3 t j~. R A / 7 O 2-- ~-~-! Z 40. Rag Istrlct yyplb<f~ 41. RKist 51{natur 42. Re 1st=er Flle Dai Mo y V~ B 43.Amantlmants DifpofitlOn Permit NO. O~~~T-~ ~ REV 07/20]1 ~ - j.= _., . -,:. _L ~ r7 `~ i~Ti~C7 ~ <' - C.? C7 c,-j - LAST WILL ANLi_ TESTAMENT CAF C'~U -r} --°" " C~ r~:7 ~ _ `T; RU'T'H M. CARLS _~ ~' ,,~ ~'~ ~~ I, RUTH M. CARLS, of 801 Keckler Road, Swatara Township, Harrisburg, Dauphin County, Pennsylvania, do hereby make this my Last Will and Testament, revoking any former Wills and Codicils made by me. FIRST: I give my tangible personal property, together with any casualty insurance coverage that I may be carrying on said tangible personal property, to my husband, Paul S. Carls, or. if he does not survive me, to my son, Barry Paul Carls, or if he does not survive me, to my daughter-in-law, Ann Marie Carls. I have complete confidence that my husband, my son or my daughter- in-law will. carry out arty written instructions that I may leave with regard to said tangible personal property. SECOND: I give, devise and bequeath all the rest. and remainder of my estate, real, personal and mixed, to my husband, Paul S. Carls. In the event that my husband, Paul S. Carls, fails to survive me, I give, devise and bequeath all the rest and remain- der of my estate, real, personal and mixed, to my issue, per stripes. In the event that neither husband nor issue survive me, I give, devise and bequeath the rest and remainder of my estate, real, personal and mixed, as follows: -1- (a) Fifty percent (50~) to my daughter-in- law, Ann Marie Carls; (b) Twenty-five percent (250) to my hus- band's heirs-at-law; (c) Twelve and one-half percent (12~~) to my brother, Gerald Jenkins, or his issue; and (d) Twelve and one-half percent (120) to the issue of my late sister, Verna R. Trinkley. THIRD: If any individual beneficiary who would otherwise receive an interest in my probate estate through Item SECOND is under thirty (30) years of age, I direct that his (the masculine to include the feminine) interest be held in trust by my Trustee, hereinafter named, until such beneficiary reaches thirty (30) years of age. My Trustee shall apply such amounts of income and principal as it, in its sole discretion, deems proper for the support, education and welfare of such beneficiary, and may accumulate ar.y unexpended balance of income to the extent permitted by law. Without the intervention of a guardian, such amounts may be applied directly or may be paid to the beneficiary or to the person with whom such beneficiary resides or to the person who has the care and control of such beneficiary. My Trustee shall not be obliged to supervise or inquire into the application of such amounts by such person, and the receipt of such person shall be a complete release of my Trustee. Should the share of a ~~ -2- beneficiary, in the sole opinion of my Trustee, be or become too small to warrant continuing such fund in trust, or should its administration be or become impractical for any other reason, my Trustee, in its sole discretion, may pay such share, absolutely, without the intervention of a guardian, to the beneficiary, to the person with whom such beneficiary resides, to the person who has the care and control of such beneficiary, or may deposit such share in the beneficiary's name in a savings account in a savings institution of its choosing, payable to the beneficiary at majority, which I define as twenty-one (21) years. Shauld a beneficiary die prior to reaching the age of thirty (30) years leaving issue, his interest shall be allocated among said issue by my Trustee and held in trust for said issue, subject to the same trust provisions of this Will, but subject to the additiona]. qualification that final distribution be made to each said issue upon his reaching the age of twenty-one (21) years, or to his estate in the event of his death. Should a beneficiary die after reaching the age of twenty- one (21) years, but prior to reaching the age of thirty (30) years, leaving no issue, his interest shall be distributed as he may specifically direct in a valid Last Will and Testament. Unless such specific direction is made, the interest of a benefi- ciary who dies at any age prior to reaching the age of thirty (30) years leaving no issue shall be divided among his brothers and sisters and the issue of deceased brothers and sisters, per ~ C -3- stirpes, or, if none exists, among my issue, per stirpes, or, if none exists, among the persons and in the proportions set forth in the final paragraph of Item SECOND, provided that, any portion of such interest payable to a person who is the beneficiary of a subsisting trust under this Will shall be added to said trust, and be paid over to said beneficiary in accordance with the provisions of said trust. FOURTH: I name my husband, Paul S. Carls, as my Executor, herein referred to as my Executor, regardless of number or gender. If he is unable or unwilling to serve, I name my son, Barry Paul Carls, as my Executor. If he is unable or unwilling to serve, I name my daughter-in-law, Ann Marie Carls, as my Executrix. If she is unable or unwilling to serve, I name Fulton Bank, 200 North Third Street, Harrisburg, Dauphin County, Penn- sylvania, as my Executor. I direct that my Executor serve without bond in any jurisdiction in which called upon to act. I name Fulton Bank as my Trustee. I direct that my Trustee serve without bond in any jurisdiction in which called upon to act. FIFTH: I give to any Executor or Executors and to any Trustee or Trustees named in this Will or any Codicil hereto all of the powers now applicable by law to fiduciaries in the Common- wealth of Pennsylvania and in particular, through the Probate, Estates and Fiduciaries Code, as effective and as in effect on -4- the date hereof, during the administration and until the comple- tion of the distribution of my estate, and until the termination of all trusts created hereunder and until the completion of the distribution of the assets of such trusts, including the power to hold and to invest in any corporate fiduciary's stock, notes, certificates of deposit, and common funds, and the power to register securities in the name of a nominee. SIXTH: The words "issue" and "children" whenever used in triis Last Will and Testament shall include adopted children. SEVENTH: No interest of any beneficiary under this Will or any Codicil hereto shall be subject to anticipation or to volun- tary or involuntary alienation. EIGHTH: All estate, inheritance, succession and other death taxes imposed or payable by reason of my death, and any interest and penalties thereon, with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the residue of my estate as if such taxes were expenses of administration, without apportionment. or right of reimbursement. I authorize my Executor -5- and my Trustee to pay all such taxes at such time or times as deemed advisable. IN WITNESS WHEREOF, I have set my hand and seal on this my Last Will and Testament this d'7 day of ~ 2005. SIGNED, SEALED, PUBLISHED, and DECLARED by RUTH M. CARLS, as and for her Last Will and Testament, on the day and year last above written, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses: ~~~ ~'t ~--~-~~-/ ( SEAL ) RUTH M. CARLS .~~" ,~ ~e ~1`z!~.1~ L- ~~ -6- SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA . SS. COUNTY OF CUMBERLAND WE, RIJTH M. CARLS, and J \ ~ - l W c~~~~ ~ . ~I ~,~-t'--~ and ~' 1 -r~c.a,.-~~, l~ r..~~~- the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. RUTH M. CARLS, Testatrix Witness a. ~ Wi ness Witness Subscribed, sworn to, and acknowledged before me by RUTH M. CARLS, the Testatrix, and subscribed and sworn to before me by witnesses, this ~~~_ day of 2005. ~ ~.n~~~~ Not -7- CC NMON /CLTH OF PENNf1rLV, NOTARIAL SEAL CYNTHIA J. RULE, Notary Public Camp Hill Boro., Cumberland Coum r Commission Expires February 3, 2 RMAAv3YLNr9_-~ .,. r~..,t.fr~,.. i F , e.: :-~, -- ._~ ._._ ~; - +~~= a. ~ Cl.. C ' : ~j C_ry C_. ~ C~ U~u- i , , ~ - ~ ~ _ ~ RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of Ruth M. Carls I, Barry Paul Carls (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 Ann Marie Carls April 10, 2012 (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.!3.06 ,.. ~~ ~~ ~~ ~ ~- (Signature) 801 Keckler Road (Street Address) Harrisburg, PA 17111 (city, 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 L~ ~ day of .~p~~l Z' -t Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Notarial Seal Marianne H. Acri, Notary Public Gty of Harrisburg, Dauphin County My Commission Expires Tune 10, 2014