HomeMy WebLinkAbout05-25-12PETITIO~i FOR GR~~iT OF LETTERS
REGISTER OF GILLS OF ~~h G-P,~~~,~ol COUiv`TY, PE~~tiSYL~,',-~:~;I_-~
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Decedent's Information
.dame: _ l=~ i ~C~ ~ A~ 5
a/k,~a: ~
a,'k'a:
a/k/a:
Date of Death: .~' a y ~ p /,~
Decedent was domiciled at death in ~m b e /'~~ n County,
principal residence at S`/~~ fe ,.~ 'F~.- ~,~~~/ Me ~ h a n
Street add P Of
File No• ~ i i
~`~
(assigned by Register)
Social Security No: // _- O ~ - 02.E /'~'
Age at death: /o
n
toss, ost Tice and Ztp Code City,
Decedent died at t~~S S ~ <~-<, ~t'~e ~ d ~~' U'd MiL. ~//~r, ~r
Street address, Post Office and Zip Code City, Township or
(stare) with his/her last
or Borough
~l~~n~.csLJur
Couril
Estimate of value of decedent's property at death:
N do
If domiciled in Pennsylvania ........................... All personal property $~ Q ~ Q ,
If trot domiciled in Pennsylvania ........................Personal property in Pennsylvania $ __
If not domiciled in Pennsylvania . ....................... Personal property in County $
I~aG~e of real estate in Pennsylvania ............................................... ---
TOTAL ESTIiVIATED VALUE.... $ ___
Real estate in Pennsylvania situated at: I7 O Yl °t~
(Attnch additional sheets, i~necessory.) Street address, Post Office and Zip Code City, Township or Borough Count
Y
A. Petition for Probate and Grant of Letters Testamentar
Petitioner(s) aver(s) he/she/they is/are the Executor(s) Warned in the last Will of the Decedent, dated •~ ~a ~ OGt vZ.- and Codicil(s)
thereto dated
State relevant circumstances (e.g, renunciation, death ojexecutor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, was not divorced, was not a parry to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
J~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., pendentelite, chtranteabsentia, duranteminoritate
If Administration, c.t.a. ord.b.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(8) 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 anu was survived by the following spouse (ifany) and heirs (attach
additional sheets, if necessary):
Farm RW-01 rev, t0/1!/20!!
County
:~~
7
.... ~~
d ~~
Page 1 of 2
~7vSS
State
Oath of Personal Representative
COwt~tO~W'E.yLTH OF PEVNSY"LVAV(.-~ }
/I / ', S S
COL'~~TY' ~~i'C~ ee'rYi bt/"/arl d
~ ~. ~h,~eidS ih~~~
(,, ~-~ .. if r
1
Officr:I Lsc Only - - ~~
_~. ' r i CJ "~~ Iti~ tJ ~
_~ r
Pei aor. Pr ~3 l~~I~rRi i1~ l-~~ -,
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tn~e and correct to the best ofthe knowledge and belief
of Petitioners} and that, as Personal Representative(s) of the Der dent, the Petitioner s) will w If and truly administer the estate according to law.
Sworn to or affirmed and subscribed before ~ ~. Datf; _ ~p/Z
me this.`` day of i~~ ' ~- v'
Fa'thr. Register ~ Date
BOND Required: AYES `~NO
FEES:
Letters ...................... $ C,l ~ ~'C'
( ~_~ )Short Certificate(s)...... ~C~''I
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ...... .......... .
Other
~~ ....... k~-~. (, ~
Automation Fee . .............. ~ ~ ~ l ~.
JCS Fee . .................... ~ __~,;
~;_ ~.
TOTAL ..................... $ Ir_ ,~ ~ ~.
_;(
To the Register of Wilis:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number.
Firm Name:
Address:
Phone:
Fax:
Email:
~+ DECREE OF THE REGISTER
Estate of 5 ~ i~i~ ` ~-~-: ~ . _ (~---- ~:-i~,21 "'~' File No: _.~1~ ~ ~ :~ - ~ ~ t' j I~
a/k/a: ~ ~ I-~-~ ~
AND NOW, }'~ ~~ ~ l j J ` ~ - ~i(, ~ ~-~. , in consideration of the foregoing Petition,
satisfactory proof having b n presented before me, IT IS DECREED that Letters f . ', { , ~ ~
are hereb ranted to I --'~"-'±"
yg 1(, l~,r- - ~(~~ EI,~I ~ ___
in the above estate and (if applicable) that
the instrument(s) dated
described in the Petition be admitted t probate and filed of record as the last Will (and Codicil(s)) of Decedent.
~~ ~ ~ ~ ~ } ~~~r
~~ ~ ~ `'
Register of ills _
Form R6V-o2 rev. lOill/20/I Page 2 of 2
H IOi_>;ili Kt1~' io:l i. - _ __ - - _ __ _
LC)CAL REGISTRAR'S ~ERy"~~=~~~T+~IV ~~.,~~~"
`~/~RNING: It is illegal to du~lic~~e t@ia : '.~;_~;~~ ,i'~~Ik, gx ~~r±<:~a,~ ~' ~~~ -,~, 1,i~,F~ ~n/;-
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Cll"11tfC'd[1t Y11 .AUfll~?c.'t -. - l`,ilt ",ili`L'
roe/Print In COMMONWEALTH OF PENNSYIVgNIA • DEPARTMENT DF HEALTH • V!TAl RECORDS +
fCCTI [I/•ATC PIG McATu
SuMx State File Number:
1. De<etlent's Legal Name IFirst, Middle, last
I
,
Z. Sex 3 Social Security Number d. Date of Death (MO/Oay/Vrl (spell MoI
' ~ G
Lk
sir-
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.
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o
ao~7 6s
a~ ~z
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e.
ge-fast BlrthdaY IYrs) 6b. Under 1 Year Sc. Under 1 Da 6. Date of 81rth IMO/Oay/vear) (Spell Month) ]a. Birthplace (City and Slate or F
reign Country)
~
~% Month3 Days Hours Minutes march 8 19i~ °0~
/
/J
Y
1 ]b, Birthplace (CPUntyl B~ [~ ~)-
Ba. ResldeDCr! (State or Foreign Country) Bbr. g`efflidlence (street and Number,~I1
«lude Apt No.l &. Oid Decedent LWe in a Tow Ip? ~J e,n ^_
l
~a
g
U
l
~
Y
~>
~i(A L~Ir
n
Q,V~~I r CIr(,ICU Yes decedentlved n
8
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e
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,
,
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l.um L)C.Y'al'(~ Be
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.
es
ence (Z
p COtlel I~
j~ ^NO, decetl<nt lved vnthin limits of I
~'~
9
. Ever In US rmed forces] ]0 Marital Status al Time of Death ^ Married Widowed 11. survNing Spouse s Name (II wife, give name pr or to first marrlagel
^ Y
es No ^ Unknown ^ Dlvorcetl ^ Never Married ^ Unknow
~'
1Z. Fa[hei s N IFirst, Midtlle, Last, suffix) 13. Mothei s Name Prior to First Marriage (Fin[ Mltltlle
last)
i
,
_
U l
)s Elizabeth rnanieVl _
Ida. Inio.mant's Name lAb
R
l
tb
hi
'
.
e
a
n
p to Decedent
~z0.blFh Shields
1
n
V ldc Informant
s Melling Address (Street and Humbert Ciry State. Zlp Codel
a
G 0.1A
I
~ 5i 4 nn~ .1-Clrc~e n sbler 7 _ C
a
_ ......................................................... .......................................
((Death Occurred in a Mos Ital: YWYf ..
P Ll Inpatient 1 a. ,tap Deal c e
~ ...................................... .... .~...°...^..Y.one...............................W .. ... ....... ...... -
III Oealh Dccurretl Somewhere Other th
H
k
l
°
^ Emergency Room/OUtpatlent ^ Dead on Arrival an a
osp
a
. L2 Hospice Faclllry ^ Decedent's Hprtt~
Nursin
H
/l
T
e4
lSb. Faclllry Name ~l not Ins[I[utl fltgive street and numbeY,
R.S I L.
LI j! W S g
ome
ong-
erm Care Faclllry Other (Specliy) -
~lsc. Ciry or TpWn, state and Zip Cotle lSd. Co ry of Death
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ethpd
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on (98urlal ^ Cremation
^ g
l f l6b. Date IDl pesltion l6c. Place of Dispo ion Name of cemetery, crematory, or other place)
emeya
rom 61ate ^ DonaNp^
DtM1er,6pecdy, 5/a y ~a a a
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C c~ I va v er>1 ~
Z 16d L«atlon of OlfposlHOn lCiry or Town, Sta[ dZlp(
/~lf ,
,
I)a Si era) ServlceL
erson In Charge of Interment 1 .License Number
oonq,pq /(oGU~i ~~
max. ~DOi~7llkL
c 3]c. Name a C piste ress of Fune Faclliry
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r 3~ ~ In 1 f f~stnicsbi-tr , l~A I X055
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18. cedent
s Educe -Check the box that best tlescrlbes [he 19. Dece en[ o/Hlspanlc Origin -Check [he 20. Decedent's Race -ChecF NE OR MORE races to Indicate what
ni
h
d
g
st
egree or level of school completed at the [Ime of death. bpxthat bes[descrlbes whether [he decedent the decedent considered himself or herself to be
~
.
e[h grade er less is Spanish/Hlspanlc/Latino. CM1etk the "Np' White ^ Korean
/
^ No diploma, 9th - 12th grade boK Ii
decedent is not spanlsh/Hlspanlc/Larino ^ BIacM or gfrican American ^ Vle[namese
H
h
!
o
^
lg
school graduate or GFD completed •R-•y
"••. not Spanish/Hispanic/Latino ^ American Indian or Alaska Native ^ OtM1er Asian
S
^
ome college credit, but no degree ^ Yes, Mexican, Mexican American, CM1kano ^ gsian Indian ^ Native Hawaiian
A
^
fs«lale de8ree Ilg. AA, A61 ^ Yes, Puerto Rican Chinese
^ ^ Guamanian or Chamorro
B
h
l
'
ac
e
or
f d
^ egree le.g. 0A, 4B, Bs) ^ filipi^o S
e
moan
'
n
a
^ Master
s de8ree (e.g. MA, MS, MEng, MEd, MS W, MBgj ^ V s, other
6panlsn/Hlspamc/la[Ino ^lapanese ^ 0 her Pacific Islander
e
^D«toratele.¢. oho, EeDl or Professional degree
ls
eciryi
^
p
__..
Other lip<ciNl,-..____
..MD DDS DVM LLB, 1D -
23 Decetlent's Single Race klf-peSignatlon ~ CM1«k ONLY ONE tp Indicate what the deretlent considered hlmielf or herself to be Z2a
Deced
t
U
l
.
en
s
sua
Occupation -Indicate type of work
Whit ^lapanese ^ Samoan d
d
i
~
e
one
ur
ng m t of working ills. DO NOT USE RETIPEO.
Blad
or African gmencan ^ Korean ^ Other Pacific Islander
L,
^ American Indian or Alaska Native ^ Vktnamese ^ Don't Kno
/N
e S
CI
Q ~ l D~/1fn~^
w
e
ure
I
^ Asian Indian ^ Other Asian ^ Relused 22b. Kintl of Business/Industry
^ Chinese
^ Native Hawaiian ^ Other Ispecityl _ _ __ _ __ _ _ A ^ I I
^ Fillpiiw ^ Guamanian or Chamorro r~,S"~'~u ~`'(~, ~-
fTEMB 23a ~ 23d MUST BE COMplETEO 23a. Date P onounced Dead IMO/Day/Yr) 236. Signatur f Person Pronouncing Death (Only when applicable 23<. Ucense Number
BY pFRSON WNO pRONOUN[ES O
R
CERTIFIES DEATH L~ J ZD I L.
'
23d. Date S
i//etl IMO/D y/Yrl Zd. Timeo Death ,u yg,,,~ ~'/ ~V~.
~Q,~i~~6~~a~
`
S
V
! z~ ,Z OIL( 25. Waf M! tai Examiner«EC,pner EpntatiM] ^ Yes ^ Np
CAUSE OF DEATH
26. part I. Enter the chain o/ events-415eaus, Injuries, or complicatlpm--that dlrectl gpProxlmate
y caused [he death. DO NOT enter terminal events such as cardiac arrest Interval:
respiratory arrest, or ventricular fibrill
atbn w
ithou
t
/showing t
he
etiplogY DO NOT ABBgEVIATC Enter only one ca
u
se an a Ilne. Add addiHenal lines it necessary Onset to Death
~
'
/
/
~a
l
/
f
IMMEOIgTE UUSE ------~-----> a.['L~~~v-~ fit_ /~J~ M~nUn.~
/•, raU
(Final tliseau pr condition Due to for ass nsepuence o/):
resulting in death) ~ L
b. L//•Csn f G (~ ,~1SfyLe.e-G~ HG ,~G(ll/KU'ea/e~
s
6ewlndagy Rat tondkipns, Due ro for open pq:
II any, leading to the cauu /~ ~
li
t
tl
li
may ~~~ °L
H
'~
s
e
on
ne a. Enter the [/
F-"OI
--~f~-~
.
c ,
t/~~~
fi
UNDERLYING GUSF
Due tp Tor
e
aco
nseq f: I
O
~
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(d [ease winjury that
t
.
~
J
-" _
C
ni latetl the events resulting d. ~//ice/~
In seethe LAST. p Ipr as a tonsegpena pN. ~""--~
S 26. Part II. Enter other s1enN.Sant cpnd'to Ib tl [ d [n but not resulting in the undedying cause given in Part l 2]. Was an autopsy per/prmetl?
f ^ Yes ^ No
28. Were autopsy Nndings available
& to co plea tM1e cause o/death?
p 19. fFe ale. ^ Yes ^ No
3D
Dld t
b
E .
o
acco Use Contribute tp Death? 31 Manner of Death
Np[pregnant wl[M1in wst year
(
~ ^ ves ^ rpbablV iy~/a
`~aturai ^ Homicide
Pregnant at time of tlea[h ^ No ~nknown
A
][
ccident ^ Pending mvesUgatlon
^ Not prrynant, but pregnant within d2 days of deatM1
^ Sulclde ^ Could not be determined
^ Not pregnant, but pregnant 43 days to ]year before death 32. Date of Injury IMO/Day/vrl (spell Month)
^ Unknown 1/ preg^ant within the Oast year
33
Ti
.
me of Injury
Place of Injury (e.g. home: construction site; farm: school) 35. location pl Inlurv (Street and Number City, State. Ilp Cptlej
3 6. Injury at Work 3]. 11 TransportaM1pn Injury, specify. 38. Describe How Injury Occurred:
^ Yei ^ Driver/Operator ^ Pedes[nan
^ No ^ Passenger ^ Other lSpeci
M_ _
3 9 Certifier (Check only one).
/r~~f cercirymg pnvfitlan - Tp the nest of my knowledge, seam «turree dice ro the tamNfl ane manner:rotes
/ U Pronouncing 6 Cerclfying Pnr+ltian - ro the best pl my knpwkege, death octunea al the nme. Gate, and Diets, one due to the c se(s and m r
t
d
a
e
^ Medical Exa r - O sis of examination, and/or invesOgat on, in my opinbn, de h «curred at the time, Bate, and plate, and tlue to
t
he causelsl and ma
n n
er stated
~
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FF
~~
Slgna Title oft rtifier~ License NUmbeVS~~~~u0
and Zlp Cod<of Person ampleting Cause of Death Iltem 61
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4 39c Date Sgned /Dry rl
a L
(/
Goo ~ G/e~F f ~s ~w /
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. Regis
trais IfMGt Number di. rar's Signature
11
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~ 02. Registrar Fik Date (M
o Day/vrl
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3. Amendme~ 1. O / ""-' y
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Dlsppsition Permit No. L_/LY / , 3 ~ /ti HI05-ld3
PEV OJ/2011
LAST WILL AND TESTAMENT
~~_, ~=
OF ~ ~ ~ -~~
~; -~~.
c'n
~.; -.
~:
GILDA G. ALUISE ~ ~ ~''
-_~
c-~ ~ "`
,-. ;: __ .
~,_ _
n ,..
( 1'
I, GILDA G. ALUISE, of 5235 Cobblestone Drive, Mechanicsburg, Cumberland
County, Pennsylvania, do make, publish and declare this to be my Last Will and
Testament, hereby revoking all Wills and Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate taxes becoming due by reason
of my death, whether such taxes may be payable by my estate or by any recipient of any
property, shall be paid by the Executrix out of the property passing under ITEM III of
this Will, as an expense and cost of administration of my estate. The Executrix shall
have no duty or obligation to obtain reimbursement for any such tax so paid, even though
on proceeds of insurance or other property not passing under this Will.
ITEM IL I direct the Executrix to pay my just debts and the expenses of my
last illness and funeral expenses from the property passing under this Will as an expense
and cost of administration of my estate.
~~
~~~.
:-- r~
`•'~ ~
'T~
,, ~ ~~
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ITEM III: I devise and bequeath all the rest, residue and remainder of my estate
whatsoever nature to my daughter, JOANNA E. SHIELDS. In the event my daughter
predeceases me or does not survive me by thirty (30) days, I devise and bequeath my
estate to be divided as follows:
(a) Twenty-five percent (25%) to my son-in-law, WILLIAM T. SHIELDS.
In the event he predeceases me or does not survive me by thirty (30) days,
this share shall be paid in equal shares to his issue, per stirpes;
(b) Twenty-five percent (25%) to my grandson, DOUGLAS SHIELLDS. In
the event he predeceases me or does not survive me by thirty (30) days, this
share shall be paid in equal shares to his issue, per stirpes;
(c) Twenty-five percent (25%) to my granddaughter, ANN SHIELDDS
YOUNG. In the event she predeceases me or does not survive me by thirty
(30) days, this share shall be paid in equal shares to her issue, per stirpes;
and
(d) Twenty-five percent (25%) to my granddaughter, CAROLYN
PLUMMER. In the event she predeceases me or does not survive me by
thirty (30) days, this share shall be paid in equal shares to her issue, per
stirpes;
ITEM IVs In the settlement of my estate, my Executrix shall possess, among others,
the following powers:
(a) To retain any investments I may have at my death, as long as the Executrix may
deem it advisable to my estate to do so;
2
~V 7 ~ ,
(b) To sell either at private or public sale and upon such terms and conditions as the
Executrix may deem advantageous to the estate, any or all real or personal property or interest
therein owned by the estate;
(c) To pay all costs, taxes, expenses and charges in connection with the
administration of my estate;
(d) To compromise controversies; and
(e) To do all other acts in the Executrix's judgment deemed necessary or desirable for
the proper and advantageous management, investment and distribution of the estate.
ITEM V: Any person who shall have died at the same time as I shall have, or in a
common disaster with me, or under circumstance that the order of deaths cannot be established
by proof, or within thirty (30) days of my death, shall be deemed to have predeceased me.
ITEM VI: I appoint my daughter, JOANNA E. SHIELDS, to be Executrix of my
Estate. In the event my daughter, JOANNA E. SHIELDS, cannot act or refuses to act as
Executrix for any reason, I nominate, constitute and appoint my son-in-law, WILLI~~M T.
SHIELDS, as alternate Executrix. Any Executrix or Executor is specifically relieved from the
duty or obligation. of filing any bond or other security.
3 ~ if ~ 'i
&J ,ti/
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, consisting of this and the preceding three (3) pages, at the end of each page of
which I have also set my initials for greater security and better identification this ~_?'~ _ day
of February, 2002.
GILDA G. ALUISE
We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published
and declared by the above-named Testatrix as and for her Last Will and Testament, in the
presence of each other, have hereunto set our hands and seals the day and year first above
written, and we certify that at the time of the execution thereof, the said Testatrix was of sound
mind and memory.
" ~
~{ ~~--~- `~~?~ Residing at: 4216 Nantucket Drive
Basil Sumple Mechanicsburg, PA 17050
~__~ ~ Residing at: 4216 Nantucket Drive
Irene Sumple J Mechanicsburg, PA 17050
4
ACKNOWLED MENT
COMMONWEALTH OF PENNSYLVANIA ,
. SS.
COUNTY OF CUMBERLAND ,
I, GILDA G. ALUISE, Testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I
signed it as my free and voluntary act for the purposes therein expressed.
GILDA G. ALUISE
Sworn to and subscribed
before me this /~~ day
of February, 242.
~-
--~
~.
NOTARY PUBLIC
My Commission Expires:
(SEAL)
Material Seal
Qoaamlre~op Eames Mwwaber sa,
S
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
. SS.
COUNTY OF CUMBERLAND ,
We, Basil Sumple and Irene Sumple, the witnesses whose names are signed to the
attached or foregoing instrument, being duly qualified according to law, do depose and say that
we were present and saw Testatrix, GILDA G. ALUISE, sign and execute the instrument as her
Last Will and Testament; that Testatrix signed willingly and she executed said Will as her free
and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of
the Testatrix signed the Will as Witnesses; and that to the best of our knowledge the Testatrix
was at that time eighteen (18) or more years of age, of sound mind and under no constraint or
undue influence.
.,
r , . ,~
~.
WITNESS t WITNESS ~,
Sworn to and subscribed
before me this .-': ' day
of February, 20b2. ,
NOTARY PUBLIC
My Commission Expires:
(SEAL)
~~ ~~
won ~TeB Nov~nbef f5
6