Loading...
HomeMy WebLinkAbout12-31-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF ~~-~ iytAo~ COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/arc 18 years of age or older, apply{ies) for Letters as specified below. and in support thereof aver(s) the following and respectfully xequest(s) the grant of Letters in the appropriate form: Decedent's Information Name: ~.A~ ~ ~ N •S S Fite No: ~ ~ - ~ ~ - ~ ~~ a/k/a: (Assigned by Register) a/k/a: ~~a' Social Security No: Date of Death: eo Z Zo/~ Age at death• _ "I~ Decedent was domiciled at death in M r~ County, ~ (ware) with his/her last principal residence at 2845 Wlorn; ~ 1-~I ~ /I''St__reet address, Post Offic d Zip Code ~ City, Township or Borough County Decedent died at I'~~S~t ~ ~,~ ( L'~.t•~e~ ~ 2 .~ "'~~ Street address, ost OfIIce and Zip Code City, Townsh orBorou=h County State Estimate of value of decedent's property at death: Ijdomiciled in Pennsylvania ............................ All personal property $_ ~D'j. Ijnot domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ I/alue ojreal estate in Pennsylvania .......................... $~ ............................ TOTAL ESTIMATED VALUE.. $ ~~ Real estate in Pennsylvania situated at: __ 2>3~'S i,W6s'~lE ~tzlviE C/ryy~~~, '~ L,oc~a/tiu,FN (Attach additional sheen, il'necessary.) S rret ~ J Post Yrice~nd Zt Cop _ de City, Township or Borough County II~w "~t.(~, ~~p • O~ r p'~j >~'~+ ~7EJl. i~OK~ 'CSC . -t'k-P ~. Petition for Probate and Grant of Letters Testamentary J~-i~iy- Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated _ _~ 03_ T 1'.e!~ and Codicil(s) thereto dated State relevant circumstances (erg, renunciation, death ojexectttor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, 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(8), and did not have a child born or adop ;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.e.t.a., pendentelite, duranteabeentia, duranterninoritate If Administration, c.t.a. or d.b.n.c.~a., enter date of Will in Section A above and com lete 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 iit 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 W ill and was survived by the~la®ng spouse~if"any) ~ }~ (attach additional sheets, il~necessary): ~ n C)D -~,., ~ G ~ ..,, Form RW-02 rev. l0/11/1011 Page 1 of 2 r ne reuhoner(s) above-named swear(s) or affirm(s) the statements in the far oin Petition are tnie and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, th Peti ' net(s) will and truly administer the estate according to law. Sworn to or affirmed subscribed before` ' me th' day of .~ ~ Date / L ~ Z BY: ~ ~ Date - For the Register Date Date BOND Required:QYES Ltd'i"~ FEES' To the Register of WiI/s: ' Please enter my appearance by my signature below: Letters ...................... S ( $ )Short Certificate(s)..... . (~ )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission.......... . Other 1,11 l t ....... Automation Fee .............. . JCS Fee ..................... TOTAL ..................... $ Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phone: Fax: Email: DECREE OF THE REGISTER Estate of (~ 1'1 0 E ~j~t ~ a/k/a: File No• -~ ~ '. , ~ - ~-r.~.y U AND NO~V, _-~1~ r ~~ satisfactory proof having been presented before me, IT IS DECREEDL at Letters onsideration of the foregoing Petition, are hereby granted to ~_ n -1...h~~ w N~~ the instrument(s) dated ~ ~ -~ n I I ~ in the above estate and (if applicable) that described in the Petition be Fm-nr RW.II)__,.,,., mir rnnr r to probate and filed of record as the last ti4'ill (and Codicil(s)) of Decedent. V egisterofWills ~ .~~~ ~ ~~~~~"'/ - - - __. -- - - n_ _ n _r_n Oath of Personal Representative REC ~ ~' ^ ~` ' `. ~ °' ' Df t~~is my RE fST~ 0~ '~':'~ COY(~(O:V~.VE.aLTr{ OF Pc~i~;SYLV,~~;[,~ } ~._.. L.J ~~~:~~~_ . ~ r OF C ~ ~ ss ~C~I •EC 31 ~~ - - '--~'^'~ t r 1 a H105.RpS RFC 19nn --__ ~ - LOCAL REGISTRAR'S CERTIFICATIORI OF' DEATH wNARNING: It is illegal to duplicate, this copy by photostat or photograph, RECORpE~} G~~~GE OF` Fee for this certificate, S6.U0 RECIS7zr,R Or t°T1~..LS ,,;;Ills"ailH~ar~f , Cpl? DEC 31 F~1 2 ~~~~~~'~" ~~s`) P 19064535 Certification Number - _ Type/Print In Permanent 's ?~)~ _~: t'. I (tit t ~ the iniul-tuati(~r) here «iven is ~~I,((ectl~ (n~';1 1 I r,. _):) ~)ri~niu s] C'crtificate OiDeath d~-)I~ t~iie(I li=; >It, :, L.~~(.,(1 l~t,~~~titrar. -i~he origi)lal e.~)I +i~atl ~~,~ill ~ )ul nr(lecl tO tl(e State Vita? o, =V' ~ia3 x'"`~ ~cttrt"t{S t'f~ICh I i'tl~,lller)t tl~lll~T- 7 ` CLERK C ~ ~ o,~ +"~"- ~~, , ._ORPNANS' GOURT ~pq~'j ~~~~~` _ --- __-- ~E ~ ~- ` 012 ' G --- -- -- -- -__ _L. _-1 CUMBERlA~1„ GJ., PA ~ ~~<,,,,,~,-~ ~? f -x)i ~e_I ;):_, D~nc Issued COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH -VITAL RECORDS CERTIFICATE OF DEATH state File Number: die, Last, Suffix) 2. Sex 3. Social secu rlty Number 4. Dat¢ of Death Mo Da ( / V/Yr) (Spell Mo) sa Male 204-30-6998 December 2, 2012 er 1 Vear sc_ Under t nom.. ~ .._._ _~ ...._. •- _ ,_ ... - tea. a (Mate or torelgn Country) $b. Residence (street and Numbe Penns lvania 9d. Residence (County) 845 Mornin side Cumberland Be. Residence (zlP code) 3. Ever In US Arm<d Forces? 30. Marital Status at Time of Death Q )~ Yes Q No Q Unknown Q Divorced Q Never Married tember 19 1938 76. Birthplace (county) Cum er~aan Include Apt No.) 8c. Did Decedent Live In a Township? Drive ®Ves, decedent Ilved in Lower Allen [wP ~__ QNO, decedent Ilved within limits of .. .. Unknown name prior to first -~. mcsiner s rvame PrlOr to First Marriage (First, fvilddle, La Archie Noss Sara Kapp 14a. Informant's Name 14b. Relationsh lp To Decedent 14c. Informant's Mailing Address (Street and Number, City, o Noss Son 1821 Fisher Road, Mechanics' i5 If Death Occurred In a Nos ita l: rz~ •• -- •••-•••---•••-•••-•--•~••-•-...1 a. P ace o Deat one -••- ••• _ -•• •--.•••. •• P Ibl In bent ............................ ... ec.. o!!.Y--.. .. .. Pa Jlf Death Occurred Somewhere Other Than a Hos Ital: ~ ----•••••••-----•-"-'-' y Q Emergency Room/OUtpatlent Q Dead on Arrival P [~ Hospice Facility a lsb. Faclliiy Name (If not Institution i Nursing Home/Long-Term Caro Facility Q Other (Soecifvl LL g ve street and number, M.5_ Hershe Medical Center isc. City or Town, stale, and 2Ip Code Hershe Pa. 17033 ~T, 16a Method of Disposition ~ Burial Q Cremation Q Removal from state ~ Donation 16b. Date of Disposition 16c. Place of DI Other (specify) 201 2 ecember 6, Roll 16d. Location of Disposition (City or Town, State, and Zip) i PA 17 0 1 1 17a. si nature pf Fun¢r Ice Lice ~' C/ e ~ 17c. Name and Complete Address of Funeral Fadllty s \r ~ Parthemore FH&CS Inc., PO Bo ' x 431, New Cumberland ~ 18. Decedent s Education -Check the box that best describes the highest degree or level of school completed t th a , 19. Decadent of Hispanic Origin -Check the a e t me of death. Q 8th grade or less box that best describes whether the decedent ~ No diploma, 9th - 12th grade Is Spanish/Hlspa nic/Latino. Check the "NO" High school graduate or GED completed box If decedent is not spa Wish/Hispanic Latino. / Q Some college credit, but no degree (~ No, not spa Wish/Hispanic/Latino [~ Ve M i Q Associate dagr¢e (e.g. AA, AS) s, ex can, Mexican American, Chicano ~ Yes Puerto Rican Q Bachelor's degree (e.g. BA, AB, BS) , Cuban ~ Yes ~ Master's degree (e.g. MA, Ms, MEng, MEd, MS W, MBA , ~ Yes, Other spa Wish/Hispanic/La[in0 Doctorate (e.g. PhD, Ed D) or ProfesslOnal degroe . MO DDS DVM LLB JD (specify) 21. Decedent's Single Rsce Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or ~$ White Q Japanese ~ Black or Afrfcan American Q Korean Q Samoan ~ Other Pacific Islander Q American Indian or Alaska Native ~ Vietnamese Asian Indian Q Don't Know/Not Sure ~ Other Asian Q Chinese ~ Native H ii ~ Refused awa an Q Other (Spec) Q FTllplno Q Guamanian or Chamorro ~) ITEMS 23a - 23d MUST BE COMPL ED BY PERSON WHO PRONOV NOES OR CERTIFIES DEATH 23a. Date renounced Dead (MO Day Vr) ~ ~~ ~ 'tom/ •j ,, f -7 23 b. Signature of Person Pr - 25. Was Medical Examiner Of Coroner Contacted? ~ Yes No CAUSE OF DEATH 26. Part i. Enter the chain of events--diseases, InJurles, or com plicatlons-that directly caused the tleath. DO NOT enter Ter P`p Proximate res irato l l p ry arrest, or ventric m ne events such as cardiac arrest ular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter onl Interval: y one cause o li IMMEDIATE CAVSE -----------.____ n a ne. Add additional Ilnes if necessary Onset to Death ~ 1 ~ a. (Final disease or condition / ~l P resulting In death) Due to (or sequence of): as a con - ~ ~~ J ~ /~ ~ sequentially Ilst conditions, D if any, leading to the cause u t ( as a consequence of). listed on Ilse a. Enter the UNDERLYING CAUSE (disease or Injury that Due to (or as a consequence of): Initiated the events resulting In death) LAST- d. - G ~_ ~~ ~ o_ Omer ~ Not pregnant within past year ~ Pregnant at time Of death 0 Not pregnant, but pregnant within 42 days of death Q Not pregnant, but pregnant a3 days to 1 year before dean Q Vnknown If pregnant within the past year lace of Injury (e.g. home; construction site; farm; school) Due to (or as a consequence of): not reswting In ehe anderlying cause gwen 30. Did Tobaccp Use Contribute to Deat Q Ves Q probably No 0 Unknown ry (Street and Number, GI[y, to complete the cause of death? Nstu ral Q Homicide Accident Q Pending Inv¢stigaYlon Suicide Q Could not be determined Q Drly<r/Operatgr Q Pedestrian Q N Q Passenger Q Dmer (sp¢clfy> 39 C rtif (Gh k ly ) '. ~ Certifying physician - To the beat of my knowledge, death occurred due to [he caus<(s) and manner steted ~] Pronouncing & Certify[ijtnyg~physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Q Medical Examiner/Ci!~~/~ea - pn the b of examin ~ n, and/or Inyastigatlan, In my oPlnlon, death Occurred at the time, date, and Place, and due to the cause(s) and m tat¢d Signature of certifier: /d//~ s 1 ~Zy~ ;4~~`^,(, Title of c¢rtifl<r: ...tr Ocens< Number:l(,t f I'rl st 4a~<~- 39b.Name, Address and Zip GOde of Person COmplating Car~o~<~~~ Medical Center, Hershey, Pa.17033 sne (Mq/Dav/Yr) 'f f Q 39c. Date SI d nd v\ 40. Registrar's District Number l L O'L- ~/y ~ L / / / 41. Registrar's Signer 42. Registrar FI a DJaie (MO Day r 43. Amendments ~ ~3 /3 + e,~0 / L s~oUiD ~,n a: a o p ~n q~ Disposition Permit No. O8' ~ ry ' $ H105-143 REV 07/2011 me OT Cemetery, crematory, or een Cemeter to rge of Interment 17b. Llcens PA 17055 Decedent's Home viii ~ FD 013 340 L PA 17070-0431 20. Decedent's Race -Check ONE Oft MORE races to Indicate what the decedent considered himself or herself to be. White Q Korean Black or African American Q Vletna mese American Indian or Alaska Native Q Other Asian Q Asian Indian Q Native Hawaiian Q Chinese Q Guamanian or Chamorro Q Filipino Q Samoan Q Japanese Q Other Pacific Islander Other (specify) herself to be. 22a. Decedent's usual Occupation -Indicate type of wort done during most of working life. DO NOT USE RETIRED. Com user O erator 22 b. Kind of Business/Indu LrV 3 ' LAST WILL AND TESTAMENT r..., ~:~ -~ ~ rn OF ~~ ~ ~p ~ ~ G~ ~ =~ ~ WAYNE E . NOSS ~ ?> sr,,,= W r`$~ s4n ti ~;~ ~-~,~ ~~ I , WAYNE E . NOSS, of Camp Hill , Cumberland ,~~ounf'y "~' .. ., ' r.~ r = rn Pennsylvania, make, publish and declare this as and tmr~`my Lit ~ ca _- -r, Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, in equal shares, to my children, KATHLEEN M. MULVEY, TIMOTHY W. NOSS, DONALD A. NOSS, SALLIE A. WINBURN and WAYNE E. NOSS, JR., provided that should any of my children predecease me, I give and bequeath such child's share unto his or her issue per stirpes by representa- tion, and if there be a failure of same, then I give and bequeath such deceased child's share, in equal shares, to my surviving children as provided herein. SECOND: Should any of my grandchildren not have at- tained the age of twenty-three (23) years at the time for distri- bution to him or her, I give, devise and bequeath the share of each such grandchild to my hereinafter named Trustee or Trustees, IN SEPARATE TRUSTS, to hold, manage, invest and reinvest the shares so received, and to use and apply from time to time such portion of income and principal for the said grandchild's post- high school education (including college, trade school or other similar training or education), as my Trustee or Trustees, in their sole discretion, deem advisable. Any income or principal not so applied shall be dis- tributed to each grandchild when he or she attains the age of twenty-three (23) years. In the event any of my grandchildren die prior to the termination of the Trust set forth herein for their benefit, the interest of my grandchild in said Trust shall cease with any income and principal being divided evenly between or among that deceased grandchild's natural brothers and sisters or the separate trusts established hereunder for their benefit and, in the absence of any natural brothers and sisters, to my other grandchildren in equal shares. THIRD: In addition to all powers granted to them by law and by other provisions of this Will, I give the fiduciaries acting hereunder the following powers, applicable to all proper- ty, exercisable without court approval and effective until actual distribution of all property: (A) To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivi- sion, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. (C) To compromise any claim or controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduci- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise any option, right or privilege granted in insurance policies or in other investments. 2 (F) To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. (G) To make distributions to my herein named benefici- aries in cash or in kind or partly in each. (H) To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. (I) To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. FOURTH: I nominate and appoint my son, TIMOTHY W. NOSS, as Trustee of the hereinabove described trusts. In the event TIMOTHY W. NOSS is unable or unwilling to serve as Trustee, I nominate and appoint my daughter, KATHLEEN M. MULVEY, as Trustee of the hereinabove described trusts. My Trustees shall serve without bond and shall receive fair and reasonable compen- sation. C FIFTH: I direct that all inheritance, estate, trans- ,, fer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. SIXTH: All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distribut- able, shall not be subject to attachment, execution or sequestra- 3 tion for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. SEVENTH: I nominate and appoint my children, KATHLEEN M. MULVEY, TIMOTHY W. NOSS, DONALD A. NOSS, SALLIE A. WINBURN and WAYNE E. NOSS, JR., as Co-Executors of this, my Last Will and Testament. I direct that my Co-Executors, Trustee or Trustees, and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~ R,p day of '~yf~~ 2011. ~~! ( SEAL ) WAYNE E. OSS Signed, sealed, published and declared by the above- named Testator as and for his Last Will and Testament in our presence, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. Address Address ~~,~< ~-~ 4 t~., t~ a cn cv a w ; ;,, ~(~-ATH OF NON-SUBSCRIBING WITNESS(ES) ~~ --~ „.:Y: I a ,.., 1 v .. L.L.. ~ u r, ... V ..../ . \ .J Y ~ ° ~ - ~ REGISTER OF WILLS w I~ i '~ ~:~ ~ "~ ~.r~~~e -/zral COUNTY PENNSYLVANIA . ca w~ c~ ,. _, . , --~ -~t ~ U z CIC CPr ~ ~ c_~ W o4 c j W ~ C% tr L~ a ;~ ~ c.~ C.7 ~~'J Estate of _ W ~,~,~~ ~ . ~o~ 5 ,Deceased i ~i y~~, ~~~/ W No55 and ~-~~'~ ~er,•~ ~1 V~~ ~ye~/ , (each) being duly qualified according to law, depose(s) and say(s) that she e they was / w re well- acquainted with i~V Z~n~ E, (~os s and a are iliar with the handwriting and signature of the decedent, and that the signature of _ l~eJz I/nc ~ . I~osS to the foregoing instrument purporting to be e Last Will d Testament/Codicil of ~---- ~ h e Goss is in his/her own proper handwriting. 1 y~- Signalu i ~ _~ $ 'Z( ,/'' ,~g~ l~ s ~ ~/ 17.E r (St ee t Address) ` ~ ~ (City, State, Zrp) Executed in Register's Office Sworn to or affirmed and subscribed before.ir~e this~~ day of ~Q~r11~` -, as i ~ . ep~rty for Register of Wills (S~ atureJ SaS ~(~f~ nC ~~~-!~ / (Street Address) 1 (aty, Stare, Z~pJ T- Form RW-04 rev. !0.13.06 ° ~ cra ~ ~-- °~ RENUNCIATION ~ ~.d CV ~ t~ "s" ~ ~.. ta." c:a C.7 ~ `~ ° ~'-• `- ° ~'--' REGISTER OF WILLS :~r . ' 1 ° ~ r-~+ w ~ ~~-- COUNTY, PENNSYLVANIA 1.a~1 l i A C`') J '~ ~ ~ ~ C:? ~-~ L...l [l.. t~ ~~ ~ ~ ~ 0 ~ ~ ~ ~`~ :'~; U Estate of L~ ~ ~( Iti~ ~ . ~ 0 ~ S ,Deceased I, ~c>N/-~C.~ ~ L L,u N ~ o S S (PrmtName) , in my capacity/relationship as S o N of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ,--~ ~ f ~2 (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 /~ (Signature) (Street Address) ~= ~-erS ~~ 1-? 3 1 ~ (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 ~(O da of 1~L'Ce.y,Se.r y Zo~L ~~~ -. Ndrtary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) ~~~ V~~ _ NOtar181 Sep ~Dpe' ANert Twp., Gimbeflend ~ ~ ~' MHA9ER, PENNSYLVA A AaStk j/~jlpN ~~ ti cYa o v> cv ~ ~ ..w..t ~_ o_ _„~ ca `-~ '~~ ~ ~ ~ ~~ RENUNCIATION ~~ ~ ~ ~ "'~ c~ ~~ 1.e.1 ~ as r"~ r~ ~~ W ~ "~ M U ~ ~. REnGISTER OF WILLS ~ ~'~ ~ ~ w w c © 4 r` a COUNTY, PENNSYLVANIA ~ =~" rr -.:~ _~ v Estate of «y ~ ~ ~~ ~ Deceased I, ~alll"L ~. ~nbt~t'rZ CC'~Ilahan~ in my capacity/relationship as (Prrnt Name) C.~au `' hfP''- of the above Decedent, hereby renounce the right to C administer the Estate of the Dec\e/dent and respectfully request that Letters be issued to rn a-+h~ ~. I y o~S la~ac~ i~ (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. ]0.13.OC ~_ ~ (Signature) .~ 1 E.. I e c..~ rn ~ h ~ V`~Yl u-~ (Street Address) ~ra~'h ~r-e I~~ ~ v~ ~~ (City, Stale, 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 pu oses stated within on this ~ (~ ~h day of ~ u +~a ~' ~ 0 1 ~.- N tary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) ~~ ~ Notarlsl Seel ~ ~ ~ ~1RMAS10~~ Ild COIMI~ . 1N.vA w A~CUd' 24 2016 NOTA~ ~- O ~ C'7 CV ~ ~ ~ +~ -.~ cv a ;~ ~ ~ ~ t-' RENUNCIATION ~ ,c ~~ ~ c.' ~~ ``~' ~ ,.... M ~: ~c ~ Q ~ REGISTER OF WILLS -`•°~ ~~ ~.~ c ~ z ~~ ~•r. 1s,.~ r ~ ~,~~ COUNTY, PENNSYLVANIA . © ~ ~ ;`, ~~=_. c ~ Estate of ~,~) a„ ,~ ~ Noss ,Deceased (Print Name) , 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 (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of (Si a[ure) S~3 S S ; r ~, ~. r (Street Address) ~,~~ ~t~~-; ~ ~ ~ 1~ A 1700 7 (City, Stare, 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 a ~ day Of 7~cer.~~~ ~U \ Z Deputy for Register of Wills FormRW-06 rev. /0.]3.06 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.) QOM TH OF ~AI~IA Notaaial Seal ~arod A. Buck, Notary PubNc Up fret' Allai 71Mp.. Cad C.otrwnlssiott Oct ~ Me~eER,o~frw RENUNCIATION ~ ~ c~ va cv a ~~ ~ ~, ~ °_ REGISTER OF WILLS ea ;-~- ;,,~, ~jµ E._. ~.,, ,-~,"~} c? u t1n ~e r ~ an d COUNTY,1?ENNSYLVANIA ~.~.. ~ cam. cis ~, ca ~ ~ r.~ rx° ~= cs va ~,~ '_'' ~a ~ ,,,~ ca r•-- c~ ~..~ <t ~ Cr_'~ c~ U=W p r....; GL, m ~ W ~ 1 ~ ~ Est @f G ~@ ~ o S S Deceased I' _ W ~~'~~ ~ ~~ a S~ ~T , in my capacity/relationship as (Prrnt Name) ~ ~~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~i rh o--~ ~ y {,~ 1~ d ~~-~~-~a (Dare) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills v v (Signature) (Street Address) ~cc~avt~c ~ ~t~r~ P~ (~7aS0 (Crty, State, Z:p) 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 ~~ day of_ ~C~Yn b2r CAL ~~ Notary Public My Commission Expires: (Y~ ~(~ ~ ~ a p~rj (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTMIAL >fEAI Farm RW-06 rev. 10.13.06 K~T~~ LA(~p~~QH t ow~A a~xroNiwP. oi~iM couNrr Mit ComMssbn Expires Ms~- 4, 21115