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HomeMy WebLinkAbout10-23-12~ Reset ~ 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 specilfied below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriattt form: Decedent's Information Name: JAMES B. MCGOWAN, JR. File No: - ~ "" ~~ a/k/a: SKIP MCGOWAN (Assigned by Regi 'ter) a/k/a: a/k/a: Social Security No: Date of Death: OCTOBER 8, 2012 Age at death: 58 Decedent was domiciled at death in CUMBERLAND County, pENNSYLVANIA (sr re) with his/her last principal residence at 5218 COBBLESTONE DR. MECHANCISBURG 17055 LOWER ALLEN TWP CUMBERLAND Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 5218 COBBLESTONE DR. MECHANICSBURG 17055 LOWER ALLEN TWP CUMB RLAND PA Street address, Post Office and Zip Code City, Township or Borough Co my State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ 1 000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ '~i 5,000.00 TOTAL ESTIMATED VALUE.... $ I 6.000.00 Real estate in Pennsylvania situated at: 5218 COBBLESTONE DR., MEC (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code 17055 LOWER City, Township or Borough _® 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 JULY 7, 2006 thereto dated All Named Executors and Alternate Executors as well as all Residual Heirs have Rennnciate 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, divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and c 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~ `l ~' c. t. a., d.b.n., d.b.n.c.t.a., pendente life, durance a If Administration, c.t.a. or t~b.n.c.i:a., ll in Section A ab~ Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had bee in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS Q EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse additional sheets, if necessary): durante minoritate established as defined and heirs (attach Name Relationshi Address /~ ~ / ~ ~ ~ S t 5 / ~ 7d tPt^ ~. ora T Form RW-02 rev. IO/11/2011 County na _:.-., i rv ~ ~, and ~iicil(~~?,? ~ as Exedlitor ~;- j -t7 N _~C: -~~-_~-n ; r i . :~ c,7 ~7 c__°, f _a a party toi~pending~ n aye achild bom iii<= , ~~ ~~ ~ 9'0~r 6r,~6 Page 1 of 2 ~''~. Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } F~'"lUf ;'"ri'~ ;~'~,~il ~ ~~ Petitioner(s) Printed Name Petitioner(s) Printed Address LISA MARIE COYNE 3901 MARKET STREET CAMP HILL PA 1701-4~ `;' ' ., T ~' ~ ~PA The Petitioner(s) above-named swear(s) or afErm(s) the statements in the foregoing Petition are true and correct to the best of t of Petitioner(s) and that, as Personal Representative(s) of the dent, the Petitioners 'll well and truly administer the esd Sworn to oi• affirmed and suoscribed before ~ Da met d ay of r D ' he knowledge and belief ate according to law. ~e I 0 '2 3- 1 `Z e (~ For the Register D e . i BOND Required: Q YES ~ NO FEES: Letters ..................... . ( 6) Short Certificate(s)..... . ( Ct )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ 5 Automation Fee ............... , j JCS Fee . .................... ,,., TOTAL ..................... $ .'~ • X0.00 To the Register of Wills: Please enter my appearance by my signature I~elow: Attorney Signature: c ~-~ Printe ~ e: LISA MARIE COYNE, ESQ. Supreme Court ID Number: 53788 Firm Name: COYNE & COYNE, PC Address: '29(11 TdARKFT ATRFF' Phone: 717-737-0464 Fax: 717-737-5161 Email: lica(p~cn~neandcnvne_cnm DECREE OF THE REGISTER Estate of JAMES B. MCGOWAN, JR. a/k/a: AND NOW, e l •~f )~Qr ~~ , in consideration of the'~,foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters i~~,( ~1,~sS-t(~-}~U~ C' Tl~ are hereby granted to LISA MARIE COYNE in the above estate andll(if applicable) that the instrument(s) dated JULY 7, 2006 described in the Petition be admitted to probate and filed of record^~P~an~s lthe last Will (and Codicil(s)) of 1~ecedent. Y~~U(/L egister of Wills ~r Form RW-02 rev. 10/11/2011 ~Q,~ Page 2 of 2 File No: o~ ~ ~ ~ ~- - ~ (~ T ___ _ _ H105.R05 REV r9/1 n _ _- ---.. T- _- L ~E~TRAR'S CERTIFICATION OF DEATH tlp~;;ft`~Jt gal to duplicate this copy by photostat or photograph. ,..,,r n ~ A "~i ~ ~ r ~,~~ )~~ tSF,S ccnu,cate, ~o.~~~~ ~Ly ~,~ F [ This is to certify that the information here given is FRB Rip Co., PA P 1886136~'~ Certification Number correctly copied from an original Certificate of Death duly filed with met as Local Registrar. The original certificate will b~ forwarded to the State Vital Records Office for' permanent filing. y~ p~ r ~~' 1~ l ~ a .~. Local Registrar Date Issued nnx In COMMONWEALTH OE P[NNSYIVANW • D[PMTMFNT O, NFAtYN • VITAL RECORDS [ #33-359 CERTIFICATE OF DEATH 1. DKMent's W9al Name Iskal. MIddN.last, SuRM) 1. Sn ). S«MI3n«kY Numbx e. DNe d watn IMdDay/Yrl13w11 Mbl James 8 McGowan Jr. Male 210-44-5945 txtober 8, 2012 N. Ne~lnt Nrthdw IYnI St. Urq,r l Ynr Sc. UW,r l S . Oxe al ehn IMO/D w/YeM pwN Mamnl )a l Ny antl xxr « Cwntryl MwNM D,YS Now[ Minuln ~ i PA 58 Janue 29, 1954 )b. wtngx. KwgM N. ReNNrNe Ian w fonNn Cwdrvl W. NtNen[e ISVeN and Number ~ Ilxllge Apt Na.l k. Dq Dxeaent lMr q • TewnsNP? PA 521 B Cohblestlane Dr. rea, ae[rarm INea q IcFwer Al obi _ _____ Iwo. N. Ra.trl _ 18[Ifl N. ItnWmc• 114 Cade) 1 7 ONO, dxedenl nwd wkMn IirMn d <xYNwe. 9. (INr m U3 Nmed sOKnl 10. wmal StNla at nme d DeNn Marled 11. SunnnN SPOUarY Name III Mle. Sive,txr•e wb to Msl maniyel t]Yn 0Ne ^Uldllawn ^M,p([d ~NMrMamM ^Un,nrwn 11.,xMrs Mm, liw, Mfdde, Lnt, Sulllal 13. MRtner's Name Prgr q lint Mxr1a[e l,hst. MWdN, lxn James H. MoGowan Jean s lea. wgrmemv Name ub. RWtbn[nn m Dn.eent 1x. Id«mam•a MNRry Addax Iunrt and NumIN., cxY, u.u, ziP coax: 17050 S Jean B. Mc~owan mother 4905 Tr 8 Il peaM Onwrrea gaNO)wN: Nswtknl :no.xnocwrr.as«nrwMr.aMr)nm,NR[NtN: y~NOyNeExRkv )?J"15:~edrm'.HOme Fmb Raan/OWRxNnI aaa an ArrMN ~ Nur NRmMwlrrxm can Exnxr open MI g ISb. ca[Hkv Nam Ilf not MNNW qn, 9M Vnw aM number' IS[ [IN w )awn, SSaie. aM Iq Cade f Sd. Canty d DwM 5278 Cobblestone give M and ur PA 17055 A j IN. Metlgdd DNpositlon anal Cnmxbn IN Dandpq«itq L&.xxe el ps,nllgnlMmr el [emetery.[nmatary,wdher wa[el ^R,ngarlr,mMat. o~•+~•~+ Oct. 19, 20 2 HollitxJer Crematt]ry oH.r Pox I IN. La[xlan d Dke9Ntlen rckr w Town. une.,nd ziPl 1).. sNn.w.e d terra I NrN[r u[.nne « Px[an q eMr,e d mnrmmt vb. Lkmae N«nbn Mt. Holly Springs, PA FD 011667 L Ih. Nam, arq [wnpl,t• Address d iumrH vamNv ~ 1S. DrnNnl's [dubtbn - Cn,[S tM boa thx IeN Oncnbn 1M I9. Dxederx d IWwrW ~ CMNL tM 10. nt's Rx, ~ CMNY ONE 011 Mplf u[n to'Indkan wMt •°- nNMSI NRIw «NVN d xhad compknd a1 the HrrN d death. boa thN bM dexrdx! wlt.tnw 1M dxetled tlk dendrnl [onsgered nimseM or Mrselr to be. 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W NO) USE RFTIMD. ^ sxL «Alrk,n Ameman ^ Kann ^ otMr vadM NNMer I T S ecialist . . p p Ameman Ilwan «ANSL. Natwe p vNtwm.n ^ DenT Rnow/Nw are p AsNn Irldlm p error ram ^ Mhsrd :ze. FIM of wxnnannau,try p akn,se ^ Nalnn Nawx4n p aner ISP«arl N8V81 De ot p ^YeNlno ^Gaamxvwwcnamwra MUST eS F 73,.Oxe Pr I aY rl 13 . wtun Peron ProrquMMS Dnt ( N w n apNW k. llemu NwnNr 1Y PlIISON 1NIN) PIWNOINaRS dl CERTIPI6 eGTN October 18r 2012 13a. oxe nerl,d (RtalDwlYTI 1e. Tkne d Drep x. 4:00 P.M. n. wx k1ldiul F,xnkNr a eerwNr caxeded? m v.E p Na OUSE OF DEATH App«nnau ]6. Pan 6 Enter tM nsaMt d ew s•.dfeases.Inlwks. «[amPliW gm~thx dlrectN [aster tM death. W NOT aria temnnal events su[n x urduc arrest RswM«y artex.waentmuw flbrSNNan wRMVtfbwinS lM etk?bSy. 00 NOT AeeR[Vx1E. Fntw,nN one uuxmanne. Add additbWRnes it necesnry OnaN gDexh IMMEDIATE OUSE ~--~---~~~~~> a. Valvular Heart Diaeeae IFIna1 duase w [orllwgn Due m l9r,s a [onseeuenm on. nsuNlry In 4am1 b FeeueMNlr IN[ [artdkims. Due t9IRr x a [onsexkme oil: R arw, Naekle to [ne Dose Ysl<d an Nee a. Enter tlN [ _ ~ _.__..__..__ tN9DFA(wBD CAUSE DvUalor asacorneeu enu al IrRMSUw+nhrry tMt c mowed tM eamte reNdtxt, e. m a.xM wT tNe to I«,a. [omeweme en. 1tl.PM IL Enterxner NRdRUnlrmdliens[,vNNbutlnlo NatnbW rat rewlHllRMtM underNiMCaun RMen In%nl 1). WasmaWap[YpMwmM? i Pancre(dNe Alcotlol Abuse rn xo Y , :e. wen alrtawYlgMgaaraweN m [wnpete the Cast a anM? Yes No Spy 19. II EemNN 30. pd lobac[o USe Contribute to Deaths 11. Mamwr ofaxn E Q M we,nant wxMn Oast Yea, Q Yn Q ProNbN m Na1wN Q NOmklde 9 Olrpnantx tine of death QNb QUnkrown QNMem QPemN,InvesllEalgn i Nd wawm, but wernant vamp et arw o1 dead S ~ suwx p ceaM rot N aeu.mmea Not we,nant, but wglnnr r3 davs to l Year MI«e daxl 31 Date o1 Inlury IMaNn/Yrl ISwll Montnj t] Unknown N pedant wknin IM Pasl vex )l. Time d Inryrv 3a axe of InPky If.,. name, [anaku[tbn Hte: !arm; scnooH )S l«atbn al Imury ISHnt aM Number. CITY, StNe. t1P Codel 1k.Injury atWM )?. IlTUnsponaMn Mlury, so«IM. 3S. DexHN HOw Inwrv OC[urrN. Q Yn Q phm/Owntw 0 Pednvnn ^ He ~ 1aslanRer Q OHNrISPecNVI 19,. [enlNer Knem only wx): ^ [MMwry ahyL[Nn. to tM bet of mr Srnw , deaM tkcunetl due to tM ousels! arq rnxner surd ^ Pranaulklry t CertNykN wNSkkn ~ T9 t 1 d my InowlMSe, dexh «urr,tl x tM Hme, den, aM pNCe, and due to tM uuselN aIW manner Na1N m Medkel E,xmmr/Car«Ier ~ On I IM, and/or Inv,s[Nxbn, q mY aNnbn, NRn xturred at tM Igle. Nle, aM PN[t, aM dw to IM uuulal and manner sntn SiSMWeof eemfler: iitNd[ertIM:A~nA Ca070nef Lkmse Number: 39b. Name, Adwrst aM Zlp Cadr d M1rsan CoIryNHnS Came d Death IRem 36) M[. pre 519nd IM,/D,Y/rrl Msallew S. Stoner, Corona 8375 BaeeAOre Road, State 1, MadlerapWrg, PA 17050 October 17, 2012 b. R•Iwtr,rs ~ I N ~ ~ AI. nrY (~bRe e . ReEMrx r e3. Amxdmenn DnyoH[gn PxmN No. 0819410 NLOS~u3 REV O)/1011 . •_ LAST WILL AND TESTAMENT I OF JAMES B. MCGOWAN JR. ~, I, JAMES B. MCGOWAN, JR., of Dauphin County, Pennsylvania being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and al~ wills by me at any time heretofore made. ~ 1. I direct that all my debts and funeral expenses be paid as soon a practical after my death by my Executrix hereinafter named. I direct that all taxes that maybe assessed as a consequence of rr~y death shall be paid from my residuary estate as part of the expenses of the administration of m~ estate. 2. All the rest, residue and remainder of my estate, real, personal ar~d mixed, and wheresoever the same maybe situate, I give, devise and bequeath to my mother, JEAN R. MCGOWAN. I! 3. In the event my mother, JEAN R. MCGOWAN, should predece e me, I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same maybe situate, in equal shares to my brother, HUGH J. MCGOWAN, and my sister, CATHERINE MCGOWAN WEST. 4. I hereby nominate, constitute and appoint my mother, JEAN R. CGOWAN, as Executrix under this my Last Will and Testament. In the event my mother, EAN R. MCGOWAN, should predecease me or fail to qualify, I nominate, constitut and appoint KEITH O. BRENNEMAN, ESQUIItE, as Executor under this my Last Will and Testament. I further direct that no person serving as Executrix or Executor hereinder shall be LAW OFFICES SNELBAKER & required to post bond to secure the faithful performance of her or his duties i II~~ the Tl _ BRENNEMAN, f .C. 1 Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal tp this my Last Will and Testament written on Two (2) Pages this 7th day of July, 2006. James B. McGowan, . Signed, sealed, published and declared by JAMES B. MCGOWAN,I JR., the Testator above named, as and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. (SEAL) (SEAL) LAW OFFICES II SNELBAKER & BRENNEMAN. P.C. -2- COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND ~ SS. ) i i We, JAMES B. MCGOWAN, JR., SANDRA K. SHOWERS and !JANE J. GOONEY, 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 undersigned a thority that the Testator signed and executed the instrument as his Last Will and Testame t and that he had signed willingly, and that he executed it as his free and voluntary act for th'~e purposes therein expressed, and that each of the witnesses, in the presence and hearing of thle Testator, signed the Will as witness and that to the best of his or her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue infl>.tence. Testator Witness Witrt® - Subscribed, sworn to and acknowledged before me by JAMES B. MCGOWIAN, JR., Testator, and subscribed and sworn to before me by SANDRA K. SHOWERS and JAi'NE J. GOONEY, witnesses, this 7th day of July, 2006. Nota Public LAW OFFICES SNELBAKER & BRENNEMAN, P.C. COMMONWEALTH OF PENNSYLV NIA Notarial Seal Susan L. Matrazi, Notary Public Mechanicsburg Bono, Cumberland my MY Commissiort Expires Nov. 24, 7 Member, Pennsylvania Association Of No cries _ T _. _ _ _ .,~-t- ~` ~: >~ ' R tai ~ e ~~'#? OCT 23 ~ ! ~ 17 RENUNCIATION Ly , ' ORri-W~~i'S ~ '' ~~~ r c~~M~~R~~ ~o., ~a /~ REGISTER OF WILLS l_ c~ w~ ~r~w„~,~ COUNTY, PENNSYLVANIA Estate of ~~'~ E S (~ . IUD t t~-,-o c~~ n ,~ Tr. '; ,Deceased I, -~ ~ ~ N R • ~ L ~i.J A- ~ , in my capa~ity/relationship as (Pri Name) ee ('~ ~ ~ r . ~ X{' c U~f ~)( C~nn~,~ ~A ,n ~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~ a Oc~o S~ef ~o ~~ (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills ~~o~ ~. is (Street Address) t/~ ~+ ? O e7 ~`-(ec1~ 0.n t ~ C JS ~ ~ ~ (City, State, Zipf Executed out of Register's ncQ~e ~~~ . ~~ X7050 Before the undersigned person lly appeared the party executing this renunciati nand certified that he or she executed the ren nciation for the purposes stated within on this ~ day ~ ~c r _~ z.d~ 2 N to Public ~ My Commission Expires: ~I (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of otary's Commission.) NOTARIAL`SE L lf~a NAO+f~ CO~e+~, No +r wafc Form RW-06 rev. 10.13.06 Na111p~A t01~M~Af~~ C QOWih Nf1~- Co+n+nbrloo hpko~ 10,:01 • OCT-22-12 MON 5:02 PM 4367913126963 __- _ FAX N0, 7177375161 P, 2 ~"~.~e~~~?1~~ a ~?FFi (~ ((''~l~' lTr~ ~ ~ '~1 ~ C a~rr~.vc,>~a~xzo~r ?.llf2 OCT 23 P~ i ~ i 7 ~~ ~~:~ , ORPF-1~~1'S CQi)R'r CUMBERi.AND CO., j PA RFG)'STFR OF WILLS COUNTY, PENNSYLVANIA Estate of ~~. ~- 2 ,Deceased I' ~~ ~ ~ ~ ~ , ~ ~ ~ ~'~ E' rn.~v~. _,,, in my eapacit~/relationship as f (Prw NamrJ `"~-'"~~~ ~~ k~~~x oi'the above Decedent, hereby renounce the right to adrr-inister the )"state of the Decadent and respectfiilIy request that Letters be issued to ~' L ~" c p M a-n i ~ C~.r ~ ~ r~~ ~ October 23, 2012 I ~'s"""°'e~ Keith 0. Brenneman 44 West Main Street (StreetAddresaJ i "' Mechanicsburg, PA 17b55 (City, State, ZipJ Executed in Register's O, fJ`~ce Sworn to or affirmed and subscribed before me this day of fleput_y fir Register of Wills Form RW-D6 rev. I0.13.D6 Executed out of Register's Offcce. ~I Before the andersigneri personally ppeared the party executing this renunciation amid certif ed that he or she executed the renunci~tton for the purposes stated within on this _ day of October ~n~.~ Notary Public ' My Commission Expires; ($ignature and Seal of Notnry or other ofFciat qualifi~ to administcroaths. ShowdateofexpirahonofNotary' Commission.) Notarial5eal Susan l.. Matrazi, Nosy Meohantrsburg eoro, Cumberland County Cammisslon Expkes Nov. 24 2015 _- - -- RENUNCIATIO R~~co~~~~~ ~~~+c~ r,r ,~ ., ~ ~, ~,: i~ I C 212 4CT 23 PIS I ~ 117 N L_~; ORPH~,~'S CflUn iI~ CU~IDERtAI~D CO.. PiA /~ REGISTER OF WILLS (: t~ v~ ~ 2.~ I a,,,~ ~ COUNTY, PENNSYLVANIA Estate of I, ~ ~ ~ X11 Q _ ~l C ~c~v.f-cw. 1!~ e 5 t , in my ca (Print Name) ~Q ~ t• li. r~.l ~ 1 S ~r of the above Decedent, hereby administer the Estate of the Decedent and respectfully request that Letters be issued to I S 1~ /~l ~-~2. i E C-~ y N t E C S Q ~d~~~~ ~ ~ (Date) Deceased ity/relationship as the right to (Signature) ~~~~ (Street Address) Lt3-Q.0(~f~c~O ~SC~~t ~1 q a~'~ ~0 ~ (Oct (city, state, Zipf Executed in Register's Office Executed out of Register's O ice Sworn to or affirmed and subscribed Before the undersigned perso ally appeared the before me this day party executing this renunciati nand certified of that he or she executed the ren nciation for the purposes stated within on this 2't~ day of DC ~ Zvi t Deputy for Register of Wills of y Public My Commission Expires: (Signature and Seal of Notary or other officia qualified to administer oaths.. Shovsr.date.of expiration of otary's Commission.) Lido Ilo-IO coYno. No1or~ -rblfc 11o~pan toinMl~. C~ wsM1MM Qowal Form RW-06 rev. 10.13.06 ~ ~~~+ `~. to ~" 1 rCr, t~~:r~, ^~:~'~'G F r~l.udl,~~~-_v v. t ILA. ~ac~'+~~-~ ~ ~~~~'~ tP,rl~ ~ ~. ?~?12 OCT 23 P~ 1~ II ~ RENUNCIATION - ~_.~ :~~ o~~r~~~~ ~u~R~ REGISTER OF WILLS CUMBERl..~lD CO., P~ ~U ~ ~ ~>~ COUNTY, PENNSYLVANIA Estate of ~ /3 . M e. ~ Ow cc Deceased I, ~ V % `' ~ ~ Ivl ~- W ~ n , in my cap~city/relationship as (Prent me) ~P ~ r r~„"0 ~~-~'{.,t,~- of the above Decedent, hereby r~nounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~~ 0~~ 1~ (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. 10.13.06 ~ O~y~,~ (Signat e) ~/~ /e?~ ~5,~,vDO yap (St/reet Address) r~ 1. EAcl~.t~u90JLt~ I~ ~G~r7'/~ (City, stare, Zip) Executed out of Register's Of~ce Before the undersigned person Ily appeared the party executing this renunciati nand certified that he or she executed the ten nciation for the purposes stated within on this +~"-`~` day of ~~~T .I 2olz c 111 ~ otary Public t ommission Expires: (Signature and Seal of Notary or other official ualified to administer oaths. Show date of expiration of otary's Commission.) llsO Mo~N coyrM. Noio -ubtic ~~ONe , C Qorn11 MM Co~a~bpp~ Errpkw l0, ZON