HomeMy WebLinkAbout07-16-12PETITION 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 requests the grant of Letters in the appropriate form:
Linda J. Olsen and Donna W. Jomenaen
Decedent's Information n /'~
Name: Evelyn J. Wiener File No: 21-12 U' 1 / _
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 197.16-2885
Date of Death: 0 7/0 812 01 2 Age at Death: 88
Decedent was domiciled at death in Cumberland County, pA (State) with his/her last
principal residence at 335 Wesley Dr., Mechanicsburg 17055 Lower Allen Cumberland
Street adMess, Poat OKice end Zip Code City, Township or Borough County
Decedent died at Forest Park Health Center Carlisle Cumberland PA
Street address, Post Ofri~ and Zip Coda City, Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ...................... All personal property $ 5,730.00
If not domiciledln Pennsylvania ................ Personal property in Pennsylvania $
Ifnotdomlclled In Pennsylvania ................ Personal property in County $
Value of real estate in Pennsylvania ................................................................... $
TOTAL ESTIMATED VALUE $
Real estate in Pennsylvania situated at
(Attach additional sheets, i/necessary.)
6,730.00
Street address, Post Oflice and Zip Code City, Township or Borough County
® A. Petition for Probate and Grant of Letters Testamentary Gp
Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated May 7y // d l0 and Codicil(s)
thereto dated ~{ AUL ~l ~1tEA1F 2 ~R~~ECt=A.SEn rf~ OV• any )g53
State relevant cirwmstences (e.g., renundahon, death of executor, etc.) ,y
Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not mar was not di ,was not arty to a ing
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. ~~3323(g), an t have iid b
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. C
®NO EXCEPTIONS ^ EXCEPTIONS t" = f'"' v?
rT.
^ B. Petition for Grant of Letters of Administration (If applicable) Gn >t" ~ ~
~.~ n
c. t. a., d.b.n., d.b.n.c.t.a.,
If Administration, c.t.a or d.b.n.c.t.a., enter date of Will in Section A above and comolate list of heirs. ~'~v = ~_
Except as follows: Decedent was not a party to pending divorce proceedin wherein the grounds for divorce had b8dd~~ablisheti~ defirl~
in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever a~udicated 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 Relationship Address
form RtN-OZ rev. 1411-2011 Copyright (c) 2011 form software only The Lackner Group, Ix. Pape 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS
COUNTY OF Cumberland } ~ , `uI •'c
~Ln514.~ V'G 4i'1~~7
Petitioner(s) Printed Name Petitioner(s) Printed Address '
Linda J. Olsen 204 Stephanie Dr.
Dilisburg, PA 17019
~'j-~-t;'s `~~~T
Donna W. Jorgensen 120 Woodlane Ct.
Glassboro, NJ 08026 "
The Petitioner(s) above-named swear(s) or anlrm(s) the statements In the toregoing reuuon are [rue anD correct to me Dest or me icnowieage ana
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 med a su cribed before ~~ Date
me this day of Date_
By: Date / ~-
F Register Dats
BOND Required? ~ YES ^X NO
FEES:
Letters . .........................................
( 4 )Short Certificate(s).........
( )Renunciation(s) ..............
( )Codicil(s) ........................
( )Affidavit(s) ......................
Bond ... ..........................................
Commission ..................................
Other
WIII
$ as.oo
16.00
15.00
Automation Fee ............................ 5.00
JCS Fee ....................................... 23.50
TOTAL ......................................... $ 104.50
To the Register of tMlls:
Please enter my appearance Dy my signature oerow:
Attorney Sin re:
Printed Name: Linda .Olsen, Esq.
Supreme Court
ID Number: 92858
Firm Name: Hazen Elder Law
Address: 2000 Linglestown Rd.
Suite 202
Harrisburg, PA 17110
Phone: 717-540332
Fax: 717-540-4313
E-mail: I o Isen~hazenel derlaw.com
DECREE OF THE REGISTER Date of Death: 07/08/2012
Social Security No: 197.16-2685
Estate of Evelyn J. Wiener File No: 21-12 - (~~
a/k/a:
AND NOW, , in consideration of the foregoing Petition,
satisfactory proof havin been sented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Llnda J. Olaen and Donna W. Jorgenaen
in the above estate and (if applicable) that the instrument(s) dated ~_1 / ( ~(// ' ~
described in the Petition be admitted to probate and filed of record as t ~186t Will (and
Register ofWills - ///LJ/
Copyright (c) 2011 form software only The Lack Group, In~ 2 of 2
/ / ? _ -
HIOS.Rn51?F.V for;)
i a -~ ~~
LOCAL CERTIFICATION OF DEATH
WARNIN cote this copy by photostat or photograph.
It 1 yr
Fee for this certificate, $6.00
P 18615048
2Q11 JllL 16 AM 9 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
~,~t.;-,~:, !/i certificate will be forwarded to [he State Vital
'S ('~(~~ Records Office for permanent filing.
~~~~ ~..
Local R tstrar Date Issued
COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH .VITAL RECORDS
CERTIFICATE OF DEATH _.. _.. ..
Certification Number
- _-
Type/P[Int In
Parmanam
~~
3. D@pd@n['i Legal Nam@ (Firs[. Mltldlf, Laf[, BY}flx) 3. $ek 3. SoNal 5@curlly Number 4. Dale oT D@aM (MO/Day r) ape 1 Mo
E~Tel J. Wiener F. 197-16-2685 July 6a 2012
6e. Agtr4rt B K ay (Yrs 5 . Un ar 1 Year Sc. Under 1 Da 6. Date of Birt (M0/Day Veer) (Spell Mgn<h) Ja. Blr~plGq (Cipr aptl a or Fort(n Country)
Months Daya Heurf Mlnu!@s e $ I'A
as tray 4, 1924 >b. glrthplau (Cqun[yl i8
Da. Rasldanu Stab or Forcq[n Country) gb. Residence (5[raaL and Number -Inc utla Ap[ No.) ec. Dltl Decetlent Liye in • TOWnshlpT
Penns ~vania 335 Weele Dr . t . 623 ~yG'' de[.den[ nwa in liQwer Allen [w P.
gCunUarl oqn )
ea. Rasidanlx (Zip CoOa) ~ No, decedent Ilyatl within limits of clry/boro.
9. Ewr In US Armed FercuT 10. Merlfel Sbluf ak Tlm@ of Death Marrlad WI ewe 11. Surviving $powe s Name (If wlTa, gM nam@ prior t0 flry[ mettle{e)
Q V@s ®Np QUnknewn Q DlwrCad Q Nev@r MarrlGO QUnknOWn
12. PatM1ar's Name (First, Mlddl@, Last, SuMx) 13. Mo<M1er'a Name Prior to First Mamisge IFirit, Mitldle, usU
ith Ethel Corb
14a. Inbrmant•a Name 14b. Rel@NOnsM1lp to Decetlent 14c. Informant s Mal in{ Addross (S<rcat and N be Chy. State, ZI COtle
~l
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Linda J Olsen Da ter 204 Stephanie Dr. Di
s
xlrgf P
, 7019
...............
IT D@ath Oeeurrcd In • Heaplbl: Inpallen! ..............................••.T...... ~ ......Y....... ..............................
...... ..
.................
IT Deets Occurrotl SOmewherc O[M1Gr Than • HOapltal; [] Mosplce Facility ~ DeceOen<'s Nome ~~~
Einar an Roern/O atlant Daad On ArcWal Nuraln Hem@/LOn -Term Csrc FacIIRy Other 5
ecl
15 b. FaCilRy Name (If not InrtRYtlOn, glYf HraK antl number, 16c. CI[y er Tgwn, $bte, and Zip COtla ISd. GoVnty of OartM1
Lc Healttl Center r isle PA 17013 Cumberland
~, 16a. MPMOtl oI OlspOaRlon uNal GromatlOn 166. Dote of OIZpONtlon 16c. Place of Disposition (Name of camebry, crcma[ery, or other place)
~ Rem O`h~ S S.G o Dgnaden 07/13/2012 Indiantown G
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16d. Lowdon v1 DlspwRlon (CRV or Tgwn, Stab, and Zip? 3>a urc o1 Funara @rvlce ns a Parson 1 ar{ a Inbrment SJb. License Num er
e P 014819
17C. N@me antl COmpNb AddE•u of Fune[al F Il~~me inc. 1903 Msrtcet St. , Camp Hill, PA 17011
ors-Hamer Hera
~ 1g. Decedent's lduutlon - Check <ha box that hart describes the 19. Dacetl@n[ of Hispanic Orl{In -Check die 20. Decedent's Raee -Check ONE OR MORE rccas t0 indicate what
M1I{host tlagroa er IeVGI of ach0el cOmplefld st tM1e time of death. box [het beat dettdbez wMther the decedent the dacadan<confitlaratl hlmseli or henelf <O be.
Q BtM1 grcda or leas Is Spanish/Nlfpanl4LftlnO. Check Me "NO" Whits Q Koraen
Q No tllploma, 9tM1 - 13th grade bon If decedent Ia no<Spanlsh/Mlspanl4Latlno. [] Black or ATAUn Amlrlun Q Vletnamaaa
MI{h aohool {rcduata Or GED eemplatetl Ne, net $panlaM1/Hiapanic/Latina Q American Indian or Alaska Natlw ~ Other Aflan
Soma toile{@ credit, but no d@{tae Q Yes, Mexican, Mexican Am@riGan, Chicano Q Aflan Indian Q Native Hawaiian
Q Auociata degrae(e.g. M, AS) Q Yez, PuGrtO Rican O Ghineze Q Guamanian or CM1amorro
Q Bach@IOYf tla{r@a (e.g. M, AB, BS) Q Yes, Cuban Q Flllpino Q Samoan
0 Master's da{roa (e.{. MA, M5, MEng, MEd, MSW, MBA) O y@s, other Spanish/Mlspanic/Latino Q Japanese Q O[M1er Pacific Islander
Q Doctorate (a.{. PhD, EtlD) Or Professional tlegrce (Specify) Q Other (Specify)
a. . MD DD OVM LLB JD
31. Decedent's Single Raca SaN-Deal{nation - Check ONLY ONg to Intlica<e whit [he tleeetlan[ conaldercd himself Or herself le be. 22a. Decetlen<'s Usual Occupa[lon - Indlcab HPa oT work
WM1he Q laPanara Q Samoan OOna tlurln{ most of working IIfG. 00 NOT USE RETIRED.
Black Or African American Q Korean Q O[M1er Paclflc islander
Q American Indian or Alaska Na[Na ~ Vle<nameae ~ Don't Know/NO<SUrc Office er
p Asian Indian Q Other Asian Q Re/used 22b. Kind q1 Business/Industry
Cl,lnea@ ~ Natlw Hawaiian 0 O[M1@r (Sp@cl}y)
Q Flllpino Q GuamanlanOrChamorr0 Furniture Store
d3a Dace r nOYnee @a MO ay r 2 .51{natVr@ O P@faen proheuncing est n yw @n app Ica a 23c. Llc.nfa NYm
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{V P{RSON ta/ff0 PROMOUNC{f OR
c wTIPI{S O[AITf /
[~ d ~ ~ ry
KN~ S_~~/`S ~-
23d. D@b {n@tl (MO/Day' f) 24. T e Of D etM1
-
Z 2S. Was Madlc 1 xaminar or Coroner Connc[edT Q Yes
O:S No
CAUSE OF DEATH Apprexlmrte
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as. Part 1. Enter the chain O} ewntf-diseases, In1uM@s, or COmpllca[Igns--that directly caused the loth. Do Nor linter brMnai events such as cardiac arracL
interval:
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(Final tlls@aa@ er rontll[IOn pVe [o (Or as a equanca of):
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5lquen<lally Ilft [Ond1[lons. ~ Due to ter of a con»quenrc 0f): i
If any, leedln{ to the cause 1
Ilabd en Iln@ a. Enbr lM1e i
UND[RLWNO GUf{ Due t0 (qr as a consequence ef):
F
(dla@.:c or Injury <M1.t ~
Inhla[ad [he awnts rcsYlting tl. (
In deatM1) LAfT Due to for as a consequence of):
26. Part 11. Enter e<h@r In but not rcsultin{ In the untlerlYing cause liven In Part 1 2J. Was an autopry Perfo
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mY 2B. Were autopsy flndlnif available
m complete MG cause o etM1T
Yaa o
39. d Fam
O<pre{nant wllhln paf<war 30. Dld TObiCCO Ufe COMdbV<e t0 DeithT
Q Yaf Q Probably 31. Msnn W Death
al Q Hemlcltle
' Q Pregnant a<tlma pI tleath ne
1> Ne QtlRr wn Accident Q Pentling Inws[lia<lOn
~ Q Not pregnant, but prc{non[ wRM1in 42 days of destM1 Q Sul<id@ Q Could ne! be debrminad
ti Q No[ prc{nant, but prognan<43 tlaVS fo 1 year before death 32. De<e of Injury (Me/Day/Yr) (Spell Month)
Q Unknown I£ prcgnent within the part year 33. Time Of Injury
34. Plac@ Of Injury (e.g. 1,OmG; cona<ruc<lon site; ar c 001 33. LocatlOn oT Injury (Strae<antl Numb@r. City, $bta, Zlp Cede)
36. Injury at Work 3>. II Transportation In)ury, $peelfy: 3B. Dezcdbe How Injury Occurred:
0 Vez Q DrlYer/Operator ~ Padas<rlan
Q Ne Q Paibngar Q Other (SPeclly)
i{a. er (Check pnlY on@):
CertllylnL physlclan - To <ha bast of my knowlatlo, tlaa[M1 occurred due t0 <ha cause(s) and manner sbbtl
Q Pronouncln{ S Gerdfyln{ physlclan - Te Me bo[ W my knowledge. death occurred et the time, dab, and pieta, and tlue [O the cause(s) antl manner i[ebtl
Q Medical Cxaminer/C ryr - On LM1a heals of mina ion, and/ inwtji~a
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. Re{IStrar f District Nu ql. Re{IStra 1{na<Yra 43. Re attar a Dale Mo ay
43. Amendments
DISpOSltlon Parmlt No. 0740610 H305-143
REV OJ/2011
/ ~ ~ /~ ~j
t
~~~t dill ~crr.~.~est~rment
EVELYN JEAN WIENER
I, EVELYN JEAN WIENER, of 1921 Robinson Avenue,
Havertown, Delaware County, Pennsylvania, declare this to be my
last Will, hereby revoking all prior wills and codicils.
FIRST: The expenses of my last illness
and funeral shall be paid from my estate.
SECOND•
I hereby give and bequeath,
absolutely and in fee simple, to my spouse, PAUL B. WIENER, all my
household furniture and furnishings, books, pictures, jewelry,
silverware, automobiles, wearing apparel and all other articles of
household or personal use or adornment, provided that if my spouse
dies before the thirtieth (30th) day following the day of my
death, this gift shall lapse or be divested and I make said
bequest to my issue, per stirpes, living at the time of my death,
to be divided among them as they shall agree. If they cannot
agree for any reason, my Executor shall make the decision and its
decision shall be final.
My Executor shall represent any minor child in any
division of such property and shall deliver to the person standing
in the place of a parent to such minor, without bond, such portion
of the minor's share as my Executor, after considering the minor's
wishes, deems appropriate and shall sell the balance and hold the
proceeds for the benefit of said minor under Item FOURTH hereof.
THIRD: i give and devise the residue of
my estate, real and personal, to my spouse, PAUL B. idIENER, if he
survives me. if he does not survive me, i make said bequest and
Page 1 ~~~~~~
devise to my children, LINDA J. OLSEN, of Dillsburq, York County,
Pennsylvania, and DONNA W. JORGENSEN, of Boyertown, Berke County,
Pennsylvania, in equal shares. If either of my eaid children is
not living at my death, the share of said deceased child shall be
paid to the then living issue of eaid deceased child, per
stirpes. If either of my children dies without issue surviving,
that child's share shall be added to the share of my other child
or her issue, as the case may be.
If no issue of my children survive the survivor of my
said spouse and myself, the remaining undistributed principal and
accumulated income shall be divided into two equal shares and one
share shall be paid to my heirs who would be entitled thereto
under the Intestate Laws of Pennsylvania in effect at the death of
the survivor of myself and my spouse; and the other share shall be
paid to my spouse's heirs who would be entitled thereto under the
Intestate Laws of Pennsylvania in effect at the death of the
survivor of myself and my spouse as if my spouse had then died
Intestate.
FOURTH: I appoint my Executor as
Guardian to hold for minors all property payable by law to a
guardian appointed by my Will and use the same for the minor's
maintenance and education, either directly or by payment to any
person selected to disburse it, whose receipt shall be a complete
acquittance therefor. All unexpended income and principal shall
be paid to the minor at majority. For purposes of this Will,
majority shall be construed to be when the individual attains the
age of twenty-one (Z1) years.
FIFTH: No provision of this Will is
intended to exercise any power of appointment, including any power
of appointment granted me under my spouse's will.
Page 2 ~~~~~
SISTH:
All taxes, interest and
penalties thereon payable by reason of my death with respect to
property comprising my gross estate, whether or not passing under
this Will, shall be paid from the principal of my residuary
estate, provided however, that funds of my Trust created herein
may be used to pay taxes, interest and penalties attributed to
such trust assets. Taxes on future interests may be prepaid.
SEVENTH:
No interest of any beneficiary
under this Will or any codicil hereto shall be subject to
anticipation or voluntary or involuntary alienation, and the
personal receipt of such beneficiary shall be the sufficient and
only discharge of my Executor unless otherwise provided herein.
EIGHTH:
In addition to powers given
them by law, my Executor his successors and any guardian acting
hereunder shall have the following discretionary powers
applicable to all real and personal property held by them,
effective without court order and until actual distribution:
(a) To retain all property received by them including
the stock of any corporate fiduciary acting hereunder, provided
such property remains productive;
(b) To invest in all forms of property without
restriction to investments authorized to fiduciaries, so long ae
such investments are productive;
(c) To compromise controversies;
(d) To hold investments in the name of a nominee; and
Page 3
(e) To undertake any and all acts deemed necessary and
proper by it for the proper and advantageous administration and
settlement of my estate.
NINTH: Any person, other than my
spouse, who shall have died within thirty (30) days of my death,
shall be deemed to have predeceased me. If my spouse and I die
simultaneously. or under such circumstances that the order of our
deaths cannot be established by proof, my spouse shall be deemed
to have predeceased me. Any person (other than myself) who shall
have died at the same time as any then recipient of income or in
a common disaster with such beneficiary, or under such
circumstances that it is difficult or impossible to determine who
died first, shall be deemed to have predeceased such
beneficiary.
TENTH: I appoint my spouse, PAUL B.
WIENER, as Executor of this my Will. In the event my said spouse
cannot act or continue to act as Executor for any reason, i
appoint my daughters, LINDA J. OLSEN and DONNA W. JORGENSEN, to
act together in his place. No fiduciary acting hereunder shall
be required to post bond or enter security in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this ~f~. day of_--i~~~_. 190, to this
and the preceding three (3) pages, and I have also placed my
initials on each preceding page for better identification and
greater security.
t SEAL)
LYN WIENER
SIGNED, SEALED, PUBLISHED and DECLARED by the above-
named Testatrix, EVELYN JEAN WIENER, as and for her Last Will
and Testament, in the presence of us, ~tho at her request, in her
presence and in the presence of each other, have hereunto
subscribed our names as Lritnesses:
Residing a
Residing at /~~~~,~_~,~ e
~j'~_.
AFFIDAVIT OF WITNESSES
WE. ,fQMES ~QR•~IJ and ~ R~Rf~ +'~~~ witnesses to
the Last Will and Testament of EVELYN JEAN WIENER, Testatrix
therein, 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 Testament and that she had signed
willingly 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 that to the best of their knowledge the
Testatrix was at the time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
(SEAL)
tness
Sworn to and subscribed before
me this day of 1986.
NO Y PUBLIC a d
My Commission Expires: ilc~~~ ~ ~7~0
0(a~...~/ •~ ~~-nn„d.,,.i ( SEAL )
Witness
(SEAL)
LINOA J. OLSEN. NOTARY PUBLIC
NARRISBURO. DAUPHIN COUNTY
MY COMMISSION EXPIRES SEPT. 8. 1981
NNtnber, Pennsylvania Association of Notaries
OATH OF NON-SUBSCRIBING WITNESS(ES)
~+ //__ REGISTER OF WILLS
( .i9i'IYJP ff.~ COUNTY, PENNSYLVANIA
Estate of
Deceased
~dpr7Q Vt/ ~/ ora ~e,.-~S~n and ~ ~/') r2 ~~ ~~~e/I _,
(each) being duly qualified according to law, depose(s) and say(s) that she / he / ~ was / ere well-
acquainted with ~~e~h ~ ~~J f r1 cF and am/are familiar
with the handwriting and signature of the decedent, and that the signature of F vP.llf h . ~ r! J/P~1 Pr
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~vP.~~.(~/f~'JP_/'
1'P~~JV t Pl') PF is in his/ er wn proper handwriting.
( rgnatureJ
tree/es Address)
ity. State, ZipJ
Executed in Register's i~frce
Sworn to or affirmed and subscribed
befor this ~~ day
of ~ ~ ~.
for
(Signature)
(Street Address)
(City. state, zip)
0
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Form RW-04 rev. (0.13.06
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
~l/M6E/~(-~ y1L COUNTY, PENNSYLVANIA
Estate of F V F~ YlV J W i ENF /2 ,Deceased
J~, ~®v~lR ~ ~Id~F/~~tN and ~/Nb~ <~ • dLSE/V _
(each) being duly qualified according to law, depose(s) and say(s) that she / he they was / ere well-
acquainted with -~~FL yet/ .I _~ Ltd ~ F/l!F and am/are familiar
with the handwriting and signature of the decedent, and that the signature of F V ELY/V ~ ~ W ~ ~/y~~
to the foregoing instrument purpoprting to be the Last Will and Testament/Codicil of
~V~LYN tT W ! ENE is in his/her own proper handwriting.
(S~gnatureJ
(Sheet Address)
(Cry, Stare, Zip)
Executed in Register's Office
Sworn to or affirmed and s~}bscribed
befo me is ,~/~ day
of ~' f pZ ,
for
Form RW-04 rev. /0.!3.06
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(Strkee Address)
J/t-LSBI/~G P~ / / O~ J
(Cry. Srate, Zip)
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