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- 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 n i �I n � f�('j'�/„
Name: NELSON L.BOSTIC File No: �'I f) ll� ��'
a/k/a: (Assigned by Register)
a1k/a:
a/k/a: Social Security No: 183-12-5836
Date of Death: May 17,2013 Age at death: 91
Decedent was domiciled at death in Cumberland County, pq (Srate)with his/her last
principal residence at 43 BAYBERRY DRIVE 17055 MECHANICSBURG PA Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at 43 BAYBERRY DRIVE 17055 MECHANICSBURG 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 Pennsy[vania............................ All personal property $ 10,000.00
If not domiciled in Pennsy[vania. ....................... Personal properry in Pennsylvania $
If not domiciled in Pennsylvania. ....................... Personal property in County $
Value of real estate in Pennsylvania......... ................................................ $ 14(1,0()0.00
TOTAL ESTIMATED VALUE. ... $ I50,000.00
Real estate in Pennsyivania situated at: 43 BAYBERRY DRIVE MECHANICSBURG PA CUMBERLAND
(Attach additional sheets,if necessary.) Street address,Post Office and Zip Code City,Township or Borough County
� A. Petition for Probate and Grant of Letters Testamentarv
Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated JUNE 15, 1992 and Codicil(s)
thereto dated
�
State relevant cirwmstances(e.g.renunciation,death of executor,etc.) C 'U-� rn
�,.` � =�'� G'a �
Except as follows: after the execution ofthe instrument(s)offered for probate Decedent did not marry,was no�'�'iwqced was r��par�o y�ending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §332�)�nc�id not have a-e�il�born or
adopted;and Decedent was neither the victim of a kiiling nor ever adjudicated an incapacitated person. � � � � �� �
�NO EXCEPTIONS �EXCEPTIONS � � � � �
p � �.� -rt ��
� B. Petition for Grant of Letters of Administration (�f appticable) `'� ``' ''� �
c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,; urA�te absent�a�lurafnTP r�ibtontate
� ,,_�.
If Administration,c.t.a. or db.n.c.t.�.,enter date of Will in Section A above and co�plete list o�eirs'�' �
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 foilowing spouse(if any)and heirs(attach
additional sheets,if necessary):
Name Relationshi Address
Form RW-02 rev. loirliznu Page 1 of 2
W _ w ��
Oath of Personal Representative off��a�use oniy . �
a COMMONWEALTH OF PENNSYLVANIA }
� } SS: _
COUNTY OF CUMBERLAND }
Petitioner(s)Printed Name Petirioner(s)Printed Address '
TODD H.BOSTIC 43 BAYBERRY DRIVE MECHANICSBURG PA 17055
The Petitione.r(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and conect to the best of the knowledge and belief
of Petitioner(s)and that,as Personal Representative(s)of the Decedent,the Petirioner(s)will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before �',- ���r,nZ�-- Date ti c/G-s" Z o/,7
me this - ��day of _, 2�,'(� Date
$y; '1„�,�i Date
For the Register Date
BOND Required: Q YES Q NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters. . . . . . . . ... .. . . . . . . . . . $ ��'L� � Attorney Signature:
( )Short Certificate(s). . . . . . � 1 �J � � �
( )Renunciation(s).. . . . . . . . j ` i-s�t �
( )Codicil(s). . . . . . . . ... . . . � 'c. =r.� G7 �'
( )Affidavrt(s).. . . . . . . . . . . � -c� �..� c�
. �� ca
Bond.. . . . . . . . . . . .. . . . . . . . . . . Printed Nam : John M.Eakm ..rn,., � E-- ,-,�, �"�
� w,
Commission. . . . .. . . . . . . . . . .. . Supreme Court �`-' � �'�' � rttl
Other �
. . .. . . . . ID Number: 06351 �..�'` U`? � ��
� �
�
�f . . •. • • I���`�(. Firm Name: John M.Eakin � G'' �� � � - C7
. .
,_..
'r1;f�n}f)Y"l� . . . . . . . . 6�,�� Address: 1 West Main Street • 7'J O r—
. . . . . . .. _ Market�nuare Ruildin� [.J � -n
. .. . . . . . Mechanicsburg,PA 17(#�'S �
. . . . . . . .
. . . . . . . . Phone: (717)766-3172
Automation Fee. . . . . . . . . . . . . . . ��� Fax: (7171691-3281
JCS Fee. . . . . . . . . . . . . . . . . . . . . • � Email: �nhnPakinncnmcaat net
TOTAL. . . . . . . . . . . . . . . . . . . . . $ �5�.`� 0.00
. DECREE OF THE REGISTER
Estate of NELSON L.BOSTIC File No:
a/k/a:
AND NOW, � �'i �� /�CL�- ��� , ���,in considera 'on of the foregoing Petition,
satisfactory proof having been presente efore me,IT IS�E�R�EE��L�S r� .. ��. t.m P��-I�,r�l
are hereby granted to (' (� -� T-f
in the above estate and(if applicable)that
the instrument(s)dated_��.l 1 Cl P I �, Z-
described in the Petition be admitted to probate and filed of record as the last Will(and C dicil(s ;of Dece ent.
I � � �� t
� � egister of Will� � '� �� ,L���� ^ , ,��-j,
� �,
Form RW-02 rev.10/11/2011 Pag Of 2
H105.805 REV(9/lq
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by phptastat or photograph.
�{E�f3P��� ���-#v� �F
Fee for xhis certificate, $6.00 �.� , ,,,,��N""' This is to certify that the information here given is
����� � r-s i Q�` ,'+''�=-�� 1,,����P�,ZH QF pFN1;__ correctly copied from an original Certificate of Death
���o`t` __ `rl=, duly filed with me as Loca1 Registrar. The original
�Q.13 �i�i1 5 �i� �U „ , ` ya certificate will be forwarded to the State Vital
:�- a� Records Office for permanent filing.
,; , �,e ?* _ ��
� 19 7 � i � 13 C LE�,� .�� _��,, - - �,,,,,,, ' ,
ORPHANS C�URT q9lMfNT�F��P��1 �� f��� ` /a'�'/ ��
Certification Number �,��$�R���a �O., P�_ �"��������""'" Local Registrar Date Issued
'Print In COMMONWEALTH Of DENNSYIVANIp•u�VqqTMENT O{HEAIiN•VIiAI qECONDS
1kInM' CERTIFICATE OF DEATH 5[ahFlleNUmbec
1. ent's legal Na �Flrst,MldEle,l� SufliM) 2. x 3 I Se u Numb I.A�t of De h Mo/ y r� II Mo�
I
Sa.R{e-UZt Birthday(Yrs� Sb.lln r 1 Vear Sc.Under l 0a 6.Dale ol BItM�MO/Day�'/ear(SOall Month) ) B�hplacS ty antl tate or F 1� ntry)
Months DaYS Haurs Minutes a .��, I�]/�I _ . : ..
�� � 76.BirtFp4<elCOUntyI
. . � Ba. e�kattmFOrcl�nCaun[ry) Bb.Pesldence�SVeetandpumher�MCludeAptNO) �Bc. " Oe d tLN InaTOWm Ip7
d<,,d a ���d�� :��uP.r i�_ �w,
� 8 Rniden CWn I .. . . . �. .
� ��Y� Be Meslderce�O�e� . �❑NO�,dtceEenlllvldwiMinllmllsol ��ry/yp�o. .
� �9.Evfi in US Armed forcn7 10.Marlbl SUtus at Tma ol Oeath Married idowed 11.SurvWin�Spovse's Name(If wlfe,9ive name prlo�m first maMa6e)
@�' ❑No ❑Untnown ❑OlvorceE ❑Nerer Msnl�d ❑UnNrawn
]3 F the�'s Name�first,MI le,last,Su(Nv) 13. t er's ame Vrb� irsl Marrlage(Firs[,MlAtlle,Ust�
�
� 1 .Im m�t' ��� lOb.Nala[IOmMptaOecetlent l�c.ln1 an['MaII1n6Adtl IS[rce[a �mber,Gry,Statt,ZlpCade ���. . . . . .
(fJ �
. . G ' � ' 1 Y .at ec oeh[a �� � � . � ..
� IfOeathOC�rtedlnaNasq41 [�Inpatlent �I/DeaNOCCUrredSpmewh <Oth rThi Nospltel d�NOSpI[lFacility cedentsHame � �
. � a �❑e nencvpooMO�ep.p.ni ❑Deadonpnrval � ❑Nunin[HOmNIANTermOreFacllky �❑Other�s�n�� � � � ��
� � 5.a 'NNa e Uf nat kistRUH iHe street aM numberl IS i �o hwn,Shte,a d 210 Lode� ,I�7. 1 . ounN ot Dea�h f . � . ..
� � 16a.Me[�aE I Dispoxl[lo ❑eurbl Crcmatbn 16b.0ate a1 Disposklon 1&.VI f Disposi[ion��m of ttmetery,crcmamry,or oMer olatt)
. ❑PemowlframSla[e OOOnatlo�
� � � ❑OMerlSpedty) ? �� . .
. � 1 .lacatlono(dspositbn([ItyorTmvn,Statt,andZip� � l�a.i �W �IFUne��ISe k orPe nin eoflnhrment l�y Ucense�NiMi���� �.� . �
1 � %y {
I � 1
eN m lete e of Funer i illry � n /�„ .�; , � �
a IB. aOmPS EAuotio � �ck the bor Nat best EescriM the 19.Oecedmt HispaNa Origin�Chetk the .Decetlenfs Nace-ChecM ON M�,«:ro��m�,e..n.�
hbhnt Ee6rn or level of sc�ool compkteE at the tlme of death. box Nat best Eescribes whethr che deceCent M�e,tE'tt'edem considercd Mmself or henelf lo be.
❑BthB�adeorless IsSpanlih/Hispanlc/Latino.ChecMMe"Na' �wAl[e ❑Korcan
❑Nodipoma,9[M1-Ilthgnde b�o�''IEecetlentlsnotSpanlshM�sOanlc/Utlno. ❑BlackorAMcanAmerican ❑Vletnamese �
�H16�school6�atlwteorGEDCOmplehtl BNO,nolSpanlSA/Hlspanlc/latina ❑qmerkanlntllanorAlasMaNative ❑O[�erASlan
O Some college creOLL,but no Ee6ree ❑ves,MeRkan,Me�inn American,Chlcano ❑aslan Indlan ❑NaHVe HawaiWn
❑/ssalate Oegree�e.g.M,F5) ❑Yes,Puerto fllcan ❑Chlnese ❑Guamanian or Chamorro
[�Bachelor's deg�ee(e.8�BA,AB,B5� ❑Ves,C�ban ❑FIIiD��o ❑Samoan
❑Mast<i s tlegrce(e'.MR,M5,MEn4 MEd,MSW,MBR� ❑Yes,otAe�Spanish/HlsOanic/Latlno ❑IaO��se ❑Ot�er Vacifc Islantler
❑Dato�ale�e{.FhO,EdD�or Prolessional tleyree �Specily� ❑Other(Specif
YI
e..MD D�5 OVM u8 lD
21.OeceAent'sSIn9leRaceSell-Desi`nation-CheckONLVONEtoiMkatewhatthedecedentconsltlereEhlmseNorherseNeobe. ]la.DecedenYSUSUaIOCCUOatlon�Indicat�rypeotwork
[�Vhltt �1a0��ese ❑Samoan tlone uMn{mostofworMln911fe.00N0iUSERETIRED.
❑Black o�RMcan ATlNCan ❑No�ean ❑Ofhlr PaclNC Islande� �
❑Amerkan Indian or Rlaska Native ❑Vlelnamese ❑Don't Nnow/NOt Sure
❑RSianlntllan ❑Ot�erAsian ❑Refuxd I7h.KInEOtBUSiness/Industry
❑cmoese O NaWeMawailan O ome�ISOn�ryl ` � �� �
❑rmo��w ❑c�am,�u�o�cn,mo�ro � �
� �REM51ta-3 USTlECOMILETED ]3�Date ra eEDeaE�MODay r� 231i.51� urcoPetfO9P�onounCl� Oea (On napplicab� .LKense umbl��' � �
� Y FERSON WXO MONWNQS ON � /J � �
� [ENTIFIFSOUTN ^ �'� /n-A/ �..A( f` �
� 33d.0aro�6MdIM/b r) 1�.T� f n � G'l+�^��� `--j l-,V �""' ��v . ��
� 25, as Metlical Eaaml�rc r[oro er ConbcNl7 ❑ Yes Na �� . �� � �
.� . . CAUSE OF DEATH � .. � � aon.o.�ma«��. � � . . � ..
]6.Vartl.Enterthethaino(evenb-�Elseasez,in�uries,orcompllcations--[hatdlrectlyta sedMedeath.UONOTen[erhrminaleventss�chascardiacarrcs[, � Interval:
rcspintory anest,o�ventrkular Hbr111aHOn wlMwt ihowin(the etiobry.DO NOT ABBREVIATE.Ente�nN oM c/u�e on a Nna.Add additbnal Iines If r�ecessary. 1 Onut lo Death
l � J !+�(� /'� yp�� �)��� 1
IMMEOIATF UlISE --�-�-�-�-�----� a. �eq�{�'���1`�^"'t r l�l.�-'I✓"\Y� �
�Fin�tlls�s��w coMitron , 1_ � ou�m�u-�) / ,+ �
. rcmmmeindea�hl e. C�-X��7'V� �u_.o-L.J'f �6�..l��-cz� �GL'�_,�s�s-�'1_>. � . .. � � .
sequam�aNy��:�mnarclom, oue ro(or ae a m c e oq� � � � � � �
� �ram,ie.m�mmeume � }�` I � � .
.� u:�wa�n�,.e��nm� L���-`�.'Y�.-dL.�. ^5'i i(��t,�.-i U-�-°�-"-s'-.ak- i � . : � ..
� uNnEa�riN�uuse � o�.�o ,s:000 � �aor1� r . � i � � . . .. �
. I41se�xmin�urytNt � � . � � � �.. . .
' InitlattE Me events resuhing E. � �
� In ONN�IAST. Due t0�or Ds a c0�eequGnct o�'. .�... .
� � � � . � g ]fi.VartlLEnteraMer�enlflcantcoMkbmcon[�IbutlntoGea[hWtnotres�king�in[lleuMerM�8�au5eglvenlnVartl. ]1Wasanaumpsype�tory�tlT � �
. . � . .D Yes�� �Na . .
� � � �. . f . � . 28:WeleautopsY��dingtavailabk . .. �
� � ta�ompletl�h<tauslOitleathi �
� . . . � � � ❑Yes�� :C�No . �
d 19.1(female: 30.Dld toy�co Use Contrib�le to DeaMT 31.Ma�n r of DeaM
E ❑NotO�egnanlwltAlnputyear ,y�^,/ ❑Probably �Qatural ❑HomlclAe
9 ❑PrcgnantatNmeaideath ❑No C ❑Unknown ❑A<cident ❑VentlinglnvestKatlon
}' ❑NotpreSnant.Eulprt{nantwithin<2dayzoltleath �Sukitle ❑Couldnolbede[ermined
_ ❑Notpregnant,hulO�eB^���03Eaystalyearbe(oredeath 33.�ateollnWry�MO/Day/Yr115peIlMOnth)
❑UnknownilpregnantwlthlnMepas[year 33.rmeollnJury
34 Vlace of Inlury�e.g.home;mnshucNOn site;hrm;school) 35.location a!In�ury(Shee[and Number,City,County,Shte,2ip CoEe�
36.InjuryatWOrk 3].IlTranspartatbnlnjury,5pecify: 38.DescribeHOwln�uryOCCUrred�.
❑Yes �Oriver/Operator ❑Vedeshlan
❑Na ❑Vassen/er ❑Other�5pecity�
39a. Ifler�physklan,certltieA nurse O�actitior�er,medical evaminer/coroner�Check anly one�-
' Certlfyin{only�TO[hebestofmyMrwwledge,dea�hoccunetlduetothecauu�s)andmannerstatttl.
❑Vronouncing&Certifying�To ehe best ol mY knowleGBe,Aeath octurred at the time,date,and pla[e,and due to ihe cause�s)and manne�staled.
❑MeCic�lEMaminer/COr4�/�-Onthebaslso�eaam'patlonaM/orimesuPtlon,Inmyopinion,OeaMO«\urliedatMe[Ime,da[e,antlplace,andtluerotheuuse�s�an(E�..mannerstatetl].,
S16�iN/!OI[<M1lf r: I\�-�-✓� ���1,"" �TiH!al clrti/IH: 7 I�./ LI[Cn5!NumOlr' (��� 1���� '"/ . �
� 39b Name�tlAress entl Zi0 Ee of Person[ pktln Guse of DeatM1 fite 36 � � 39c Da[e Slgnetl�MO/0 y/Yr� � �
K���t iV �i-r A iZ� � t�7 v, �I� c� �,s� ��, b � z� a.z�.3
. � � Q0.Nep slrar's DkMCE Number�� <I Re{ nsture� i�� � _ 93.Negl�[ra�Flle Data�MO Day r��� � . �
.;��- a �°,, � , :�-i,.�� ., , .
93.Amendmenfs
�1 I� 6 ��ie�,l�. �e.�` '��2,3 ( �� u�K
Diseosilion Permit No.l/�Y .' I,I t tJ H105-1C3
RN 11i/)fl1)
LAS2 �rdILL ���D TESTA�X'IET}IT OF �,�'ELSCIN L. B��TIC
T , I��L�sN L. B4S'�TC, of' �the �ownship of �i3ver Spring,
Coun�y af �umberland and State c�f Penns�lvania, b�ing af saund
and disposing m�.nd, �nemory and understandi�g, do make, publish
and declare this rriy Last �Till and Testame��, hereb�r revaking and
making vc�id any and all prior Wills b� me at any�time he�''�tofc�e
c � � �
rnade. � ° _'•"' �? �
�7 -�� c-:
� ,.� � G� Cti %�
...¢ C�
� �' r� � �� r�.;.�i
_�
. � �:rs �ti � �
� � r� � �T� �
<7 � —�;
I direct the payment of all my just debts &n� fun ,�'r�al� �
G� N
axpe�ses as soon af�Ger m�r decease as the aame ca�'i' be co�►eniez�ly
d c�ne. .
2.
I give and bequeath all m� personal belongings, househo�.d
furn3shings , includ3.ng any an all �the con�ents of my personal
�fi 1'�► �",�� �',rsc1� �'�.f'c�'%
residence, . . , absolu�el� and un-
�f o�°f}
conditionally, a�d d�.rect that the inheritanca tax on this beques�
be pa3.d out of m;� res�.duary es�ate.
�a
I direct �hat a�.l the rest, residue and remainder of m.y
�s�a�e, of wha�aoever nature and wheresoever sztuate, be ec�nver�ed
into cash, and f or �his purpose I autnorize, ernp4wer and �iir�ct �n.y
perso�al repreaen�a�ive, herein�fter named, to sell any and all
real eatata which I may own at the time c�fin� dscaase, at ei�her
z�ubl3.c ar �rivate sale c�r sales.
iY=i
, • , < <. , ,
After my estate h�s thus been converted intcr ca�h, and
upon the nayment of all my just debts and obl.igatians, the cc�sts
of ad�ninistration of my estata, and the payrr�.ent c�f all inhers.tance,
estate and suecessir�n taxes, I direc� �ny �ecutrix or Executor,
whichever ��xe case �nay be, �o divide the b�lance of r�y entire
estate then remaining, .i�ta six (6) equal shares, and ta pay aut
and distribute the sarne as follows, to wi�:
{a } S give ar�d bequeat�� one �I� suc'h equal sha�e to m.y
san, P��`TER BOSTIC.
��+� T give arid bequeath r�ne (1) such equal share �cr �ny
san, SCO�"� BOSTIC.
{cj I give an+� bequeath one t3) such equal share to my
SrJri, 'I'C}i3�1 $C3S'3.'TC1.
(cl) I �ive and bequeath one (1) such equal �hare to my
son, TII�iOTHY BOS'�IC.
(e ) S give and bequeath one (1} such equa� �hare to my
daugh�er, ANN P. SMSTH.
(f) I �iv� and bequeat�. one (1} such equal �hars �o my
dau�;h�er, SU�AN L. S2Ai�SI�S.
.�"d�°
� /� ��� '� nom3.nate, cor�st3.�u�e and appoint my r�,g�rC�3'F,
��
. I , Executrix of this my Las� Wi�l and '�estamen�, and
in the��rf� that m� said c�� should p�edecease me, or
shauld s�he be unable or unwillin� ta serve in such ca�aeit� for
_2-�
any reason, then in such event, I nominate, constitute and
appoint my son, �� �� BOSTIC, Executor of this my Last Will and
����
Teatament, in her place and stead.
Ii� WITTdE'SS �,�REOF, T have hereunto set my hand and seal
this j,�day of June , A. D. , 1992.
�� r
(SF..A.L)
Nelson L. Bostic
Si�ned, sealed, published and declared by �he above named,
IV�LSON L. BOSTIC, as and for his Last T�ill and Testament, in the
presence of us, who have subscribed our names hereto as witnesses,
at the request of said testator, in his presence and in the
presence of eaen ather.
r,:
�';y �
r �
!
s
/', ..��L ,`n',��Ls(�w =�%�s'+Z--�..�-�'� .lw �
-3-
C4MMONWEALTH OF PEI3NSYLt7ANIA }
. SS.
COUNTY OF CUM$ERLAND )
I, NELSON L. BOSTIG , the te�tatn�
whose name is signed ta the attached or faregoing instrument, having
been duly qualified according Co law, do hereby actcnowledge �hat I
signed and executed the instrument as my Last Wi11 and TestamenC;
that I signed it willingly; and that I signed it as my free and volun-
tazy act and deed, for the purposes therein cantained.
Swarn and affirmed to and acknowledged before me bX.�
NELS�ON L. �IC , the testator , this /` �
day af _�� , A. D. � 1,992.
_ �L��
�
�
`J''�����i�
M�����`�a�a►�
COMMONWEALTH OF PENNSYLVANIA ) �p�x��A�e�dt�
. SS.
COUNTY OF CUMBERLAND }
s
We, the undersigned, J. RCIBERT ST�.UFFER
�n� RUTH ANi� �'ULWT]"�F.R , the witnesses whose names are
signed to the attached or foregoing instrument, being duly qual3fied
according ta law, depose and say that we were present ar�d saw the
testat n�, I�IELSO�.T.�.� RS�S.,TT�" , sign and exe-
cute the instrument as his/,�� Last Will and Testament; that the
said testat or , N�;I,SON L. BOST;�� , exeeuted it as
his/�free and voluntary act for the purposes therein expressed;
that each of us, in the nearin� and sight of the testat pY+ , signed
Che Will as witnesses; and that to the best of our knowledge, the
tes�att7z' was, at the time, eighteen (1$} or more years of age,
af sound mind, and under no consCraint, duress ar undue influence.
�'""'"�.�.,....
;
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Sworn and s��ribed to befare '
me �his � s day of
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REl�LTNCIA'I'I��T � � � � � �
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REGISTER OF WILLS -o � L,� �,-, c�
CUMBERLAND COU1vTY, PE?�1NSYLVANIA � ° �'
Estate of NELSON L. BOSTIC , Deceased
I, ANN P. SMITH , in my capacity/relationship as
� (Print Name)
EXECUTRIX of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
TODD H. BOSTIC
AUGUST 2. 2013 ,r''�/"""" � ����`'�
(DateJ (Srgnature) r
8733 CARDINAL FOREST CIRCLE
(Street Address)
LAUREL, MD 20723
� (City,State,Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
before me this day party executing this renunciation and certified
of , that he or she executed the renunciation for the
purposes stated within on this � "--°� day
of_s�� u� , �`3
`�Q- � L/l+--
Deputy for Register of Wills Notary Public
My Commission Expires: - v7� �� ��
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVAN
Npbrial Se,
Form RW-06 rev.10.13.06 &EY1da E.T►Ump, Nptaiy pUbljC
MetFwnicsfwr9 Boro,Cumberimd County
MY�►r►Assion Expi►es Sept.26,2013
M TI OF NOTMI�,i