The URL can be used to link to this page

Home My WebLink About01-08-14 i��.� � � ,si � 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 �f „ �� _G�}`��j Name: Diane F. O'Connor File No: a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 0 8 6-2 8-5 4 41 Date of Death: Age at death: 8 4 Decedent was domiciled at death in Cumberland County, Pennsylvania (Srate)with his/her last principalresidenceat 659 Sprinq Lane Boili�g snrings, Monroe , Cumberland, PA 17007 Street address,Post Oftice and Z p Code City,Township or Borough County Decedentdiedat 659 Spring Lane, Boiling Springs, Monroe, Cumberland, PA 17007 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 Pennsylvania.. ............ . ............. All personal property $` 1 , 0 0 0� 0 0 0.0 0 If not domiciled in Pennsylvania. ............. . .. . . .. ... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ............. .. . .. . .. . . Personal property in County $ Value oJreal estate in Pennsylvania....... . .... . . . . . . . . ... . .............. . . . ........ . . . .... . $ r • TOTAL ESTIMATED VALUE. .. . $ � � '0.00 RealestateinPennsylvaniasituatedat: 659 �pring Lane, Boilinq Sprinqs, Monroe, Cumberland, PA (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 Testamentary October 27 201 0 Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated ;`-� �d Codicil(s) thereto dated ' � {°t� � � C� � �? � State relevant circumstances(e.g.renunciation,death of executor,et� -� _� �,t Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,wa3'�rrot�vor�ed,�not�a�to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. § �23�),�d did not h�ye�hild born or adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.p n � -�7 -r� -�r� c'� Cy -r,� 7 �NO EXCEPTIONS O EXCEPTION5 �� -- � '�== r-, „ �7 CJ C" i"r i � B. Petition for Grant of Letters of Administration (If applicable) � � �,� � c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente ite,durante als�tia,durante minoritate If Administration,c.t.a. or d.b.n.c.�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(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(if any)and heirs(attach additional sheets,if necessary): Name Relationshi Address Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } �-.: c� � r-r� Petitioner(s)Printed Name Peritioner(s)Printed Add s� �_,,, � Anthony L. DeLuca, Esquire 113 Front St. , P.O. Box 358 rn � c� � � � , Boiling Springs, PA 17007 � z � co ::� �::.' i`a � C, � �� -� <� `:: '"_''" C'y CJ �"' C�1 + °� O � The Petitioner(s)above-named swear(s)or a�rm(s)the statements in the foregoing Petition are true and correct to�e best of the�qwledge ar��belief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,the Petitioner(s)will well and trul administer the estate according to law. �- ,, Sworn to or affirmed and subscribed before ,u� �_- _ Date � me tJ�i �� da�rPf Janu , 201 4 Date By,� �, � "��/ t( �� 'L �4,� Date For the Registe Date BOND Required: Q YES � NO To the Register of R'ills: FEES: Please enter my appearance by my signature below: C3�' Letters. . . . . . . . . . . . . . . . . . . . . . $ � � � Attorney Signature: ( � )Short Certificate(s).. . . . . ��,�. ;�1� ( )Renunciation(s).. . . . . . . . � � � _ . . ( )Codicil(s). . . . . . . . . . . . . ,,- ..�u -c�su � ( )Affidavit(s).. . . . . . . . . . . � A ony L. DeLuca Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: Commission. . . . . . . . . . . . . . . . . . Supreme Court 1 8 0 6 7 Other . . . . . . . . ID Number: � { ; i:�: �1 I .,_,_� . . . . . . ��-c;U �� ' ��.K.�t.Y.l. "� FirmName: ArithOny L, DeLuca, Esquire T '� ",Y� � . . . . . . . . I'-� E'(, Address: 1 1 3 Front Street . . . • . . . . P.O. 8ox 358 . . . . . . . . Boiling Sprinqs, PA 17007 . . . . . . . . Phone: 717-258-6844 Automation Fee. . . . . . . . . . . . . . . c � � Fax: 71 7-2 5 8-3 9 0 2 JCS Fee. . . . . . . . . . . . . . . . . . . . . � Email: anthOn ldeluC ' TOTAL. . . . . . . . . . . . . . . . . . . . . $ L;3 �%�- DECREE OF THE REGISTER Estate of Diane F. O'Connor File No: _ ,��/ `��7—C,��.� a/lc/a: _ AND NOW, �� fi 1 �C�� I"� , ��%�� , in consideration of the foregoing Petition, satisfactory proof having been presented befare ,IT IS DECREED that Letters TP s t a mP n t-a r� are hereby granted to �nt_h�n� I,_ nPr,i�ca, FGC;i�r; P in the above estate and(if applicable)that the instrument(s)dated e��. a 6��—a 81 8 described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s))of D�ecedent. , !'_/�--��Ct ��, %. � ;��t l� � C�#1'� Re ister of Wills�� % : > ,( g , ��:��. �� '�� .1��/ � / � ,J H105.805 REV(9/11) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WAF�I��illgg�#t�o�du��licate"this copy by photastat or photograph. tl F F��GtSTER OF '�i�.LS Fee for this certificate, $6.00 „��"""" This is to certify that the information here given is 7�f � ,��"�p�,jH OF pE�;- correctly copied from an original Certificate of Death �.ly �flN 8 P�1 3 �i7��''�' = ys= ��`�o`Z` = G; duly filed with me as Locai Registrar. The original �� Y� -:° zi certificate will be forwarded to the State Vital C L�R K �i` �� a a Records Office for permanent filing. ORPNANS' COURT �o . _- ��,s � �. g � � � � � � ��lB:ERLAt�D CQ., Pl`{ _ ��'�9 __ �Q'�`'�� `��,�r,��.'� „" � e�.-JAI� 6�201� °-.TMf NT OF� ea Certification Number ""�°�""""��f,, Local Registrar Date Issued Type/Print In _ GOMMONWEALTH OF PENNSVLVANIA�DEPARTMENT OF HEALTH�VITAL RECORDS Pe�manent Blacklnk CERTIFICATE OF DEATH State File Number: 1.Deceden['s Legal Name(First,Middle,Last,S�ffix) 2.Sex 3.Soclal Security Number 4.Date of Death(MO/Day/Vr)(Spell Mo) Diane F_ O•Connor Fem 086-28-5441 January 2, 2014 Sa.Age-Last Birthday(Vrs) 56.Under 1 Year Sc.Under 1 Da 6.Date of Blrth(MO/Day/Year)(Spell Month) 7a.Birth lace jCity d State or Forelgn Co�ntry) ` 84 ano.,tns oavs Ho„�s nni.,��es June 18, 1929 �ssinin NY 76.Blrthpiace(GOUnty) � 9a.Residen<e(SiaSe or Foreign Country) 8b.Residence(Stree[and NumbBr-Include Apt No.) 8c.Ditl Decedent Live In a Township? � 659 Spz'ing Lane ffi1 Yes,decedeni uved in Monso� t,�„P. ea.a�s�de.,�e(co�.,ay� Cu m berlan d 8e.Residence(Zip Code) �No,decedent Ilved within IlmiGS of city/boro. 9.Ever in US Armed Forces7 30.MariSai Status at Time of Deafh � Married W Widowed 11.Surviving Spouse's Name(It wife,give name prlor fo firsS marriage) �Yes �No �Unknown � Divorced � Never Married O Unknow 12.Father's Name(First,Middle,last,Sufflx) 13.Mother's Name Prior to Firsi Marrla � ge(First,Mitldle,Last) Howard L_ Forman Mar :er�i.e T son �4a.Informant's Name 14b.Relacionsliip to Decetlent 14c.informant' Ma Iing Ad Street and bcr,Gity $ ta;21p Code Jeannette Fincl-� daughter 224 G�ac'{e B�vc�. Wa��'cersv '�e, M� 21793 0 G _ _�_ �� isa.v a�e o oeac c e� o..L,o.,e ' . _ If Death Occurred�in a Hospttal �]jnpaHeni �If Death Occurrcd Somewhere OtherThan a Hosplial �Hospice Facility �Q DecedenYs Nome 0 Emergency Raom(OUtpatie�t � Dead on Arrival � � N�rsing Home/long-Term C2re F2c11ity �Other(Speclfy) 15b.Facility Name�{If not InSYitution,give streeC and num6er) 15c.qty or Town,State nd Zip Code i5d.Covnty of De tM1 659 Spri.ng Lane Boiling Springs, PA 17007 CumberaJand � 16a.Method of Disposltion � Burial Cremation 16b.Date f DisposlLan 16c.Place of Dlsposition(Name of cemetery cr matory,or other piace) p ae..�o..ai from stace p oa.,acio� � Jan 4� 2014 � o orhe� spe��r,,> Ho£fman-RotYi Funerale Home & Crematory �Z� 16d.locatiOn of Dispositton(City or Town,Stat�,and Zfp) 17a.51 f Fun al e Licensee or Person ih Cha�ge of Inferment 37b.License Number � Carl3s]s, P A 17013 ` 138504 ,3 1]c.Name antl Complete�Atltlres5 of F�neral F ilit Ho££man-Roth Funera�l. �lome & Crematory, 219 Nortl-i Hanover Street, Carlisle, PA 17013 18.Decedent's Etlucation-Check the box that besf describes the 19.Decedent of Hispanic Origin-Check che 20.Decedent's Race-Check ONE OR MORE ra s to indicate what � highest degree or level of school completed at the time of tleath. box that best descrlbes wheCher the decedent the deccdent consldered himself or herself io be. O 8�h grade or less is Spanish/Hispanlc/Latino. Check the"NO" � White O Korean � No tliploma,9th-12th grade box if decedent is not Spanish/Hispanic/Latino. O Black or Afrlcan American Q Vietnamese � High school graduate o�GEO comple[eG No,nof Spanish/Hlspanic/Latino �American Indian or Alaska NaLive O Other Asian � Some college credit,but no tlegree �Yes,Mexican,Mexican American,Ghicano � Asian Indlan � NaHve Hawailan � Assoclate degre¢(e.g.AA,AS) �Yes,Puerto Rican 0 Chlnese � Guamanian or Chamorro [�Bachelor's dcgree(e.g.BA,AB,BS) � Ves,Cuban Q Filipino � Samoan O Master's degree(e.g.MA,M5,MEng,MEd,MSW,MBA) � Ves,other Spanish/Hispanlc/Latino Q Japanese � Othe�Pacific Islander � Doctorate(e.g.PhD,EdD)or Professional tlegree (Specify) � O[her(Specify) .MD,DDS DVM LLB JD 21.Decedent's Stngle Race Self-Designatlon-Check ONIY ONE to intlicafe what the decetlent consitlered htmself or herself to be. 22a.Decedent's Us�al OccupaTio -InCicaTe iype of work Q�White �Japanese � Samoan done dvring most of working Iife nD0 NOT USE RETIREO. 0 BlackorAfricanAmerican � Korean 0 OtherPacificislander Homema3cer ? 0 American Indian or Alaska Native O Vtetnamese � Don't Know/NOt Sure �Aslan Indian � Oiher Aslan � Refused 226.Kind of Business/Industry � 0 Chinese � Native Hawallan 0 Other(Specify) Q W j'] Home 0 Fllipino � G�amanlan or Chamorro ITEMS 23a-23d MUST BE COMPIETED 23 Da[e Pronounced Dead(M�o Day Vr)� 236.SI ture of Person Pronouncing Deaih(Only when applicable) 23c.License Number BV PERSON WHO PRONQUNCES OH � rj ��i J �� CERTIFIES�DEATH � pC "'f ��, ��w� .� ��U��,jL z .oa�e 5�g.,ed�Ma�o�,�2z�/� z4. .3a3 �9rY7 25.Was M¢dical Ezaminer or Coroner ContactedT � Yes CAUSE OF DEATH a Approximate 26.PaR 1. Enter SFie chain of evencs--dlseases,injuries,or complfcations--Shat directly caused the d�ath. DO NOT anter terminal even�s such as cardtac arr�st, � interval: respiratory arrest,or ventricular fibrillafion with�o�t showing the etiology. DO NOT ABBREVIATE. Ente�only one cause on a Iine. Add additlonal Iines if necessary. � Onset Yo Death IMMEDIATECAUSE -------------> a. ` _�'S\� C4 �D�"/ �/s�_� � �� 1 (Final disease o nditlon Duc to(or a a conseq�ence of): resulHng In death) � t,. �-r+��-, s�..�-. Sequentlally Iis2 conditlons, ue to(or as a consequence of): � If any,leading So YM1e cause uscea o.,r�e a..E„cer tne `T o� � ic.a /�`..S°Z ' UNUERLYIN6 CAUSE . Due to(or as a conseque�ce of): (disease or inJvry thai � F Initiatetl the events resulting tl. In death)LAST. � Due to(o as a consequence of): � � 26.Part 11..Enter other sianificant condti'ons contr'butina to deatF�but not res�lting in ihe derlying cause given in Part I. 2l.Was an a�topsy pertormetl? � � �3 z.s:�Y , c v�,c-c.�:� ♦c.�r 1.� ��k S'��, �� zs.we�aucaa�v fi.,e;��s�enebie ��'FUS�.. 03'Z0.0 rYL-C�aR..�-•3 to comple[e the cause of death7 $ � O Ves C�-�No 29.If Fertyale: 30.Did Tobacco Use ConGribute to OeathT 31.Manner of Dea[h e0 Not pregnant within past year �s O Probably �.1C3tural 0 Pregnant at tlme of death � No 0 Unknown � Homictde C � � Not pregnant,but pregnant within 42 tlays of deaih � A«�dent 0 Pendi^golnvestigatlon � f- � Not pregnant,but pregnant 43 days to 1 year betore deafh 32.Daie ot InJury(Mo/Da /Yr 5 Sulc(de � Could t be determined O Unknown If pregnant within the past year Y )! pell Month) 33.Time of InJury �� 34.Piace of Injury(e.g.home;constructlon site;farm;school) 35.Location of Injury(Streei and Number,Ctty,CounYy,State,21p Code) 36.Inj�ry at Wo�k 37.If TranSportaClon Injury,Spccify: 38.Ocstribe How Injury Occurred: �1�- � Yes � Oriver/Operator � Pedestrlan �� O No � Passenger � Othar(Specify) � 39a.C�e ifler-physiclan,certified nurse practitioner,medi<al examiner/coroner(Check only one): Q Certifying only-To the best of my knowledge,death occ�rred due to the ca�se(s)antl m r stated. � � Pronouncing Sa Certlfying-To the best of my knowledge,death occurred at the time,datenand place,and due to[he cause(s)and manner sfated. 0 Metlical Examiner/COroner-On th asis of examinailon and/or investigation,in my op(nlon,death o d at the time,date,and place,and tlue to the cause(s)and m r stated. Signature of certlfier: b Title of certifler. cc�" 0 Licet�se Number: O�^�C'�/i�-L 39b.Namc,Address an i Tip Ceda of Pcrsan Completing Cause of Death(Item 26) 39c.�ete SI nc�d(�7p/Day/Yr) �Y.r �a ��:se+� �s �. zzc�1�,�:`sw �!- C....cL�-�L.s-. �� '�o�3 \�-s_ / � 40.ReglstYa�s District Number 41.Regtstrar's Signature 42.Registra�Flle�ace(MO Day r) � t- O A.'��L.�1�-=- ex- , � o�S(`� ° as.a..,endmencs 0 � z Dlspositlon Permit No. LJ'l�Q�I..J''r' H105-143 REV 07/2012 �-.., n � � LAST WILL AND TESTAMENT � c� �_ � � w �; � �, �r rn � c> ...� r� OF � �,. r- ,-� r��w r ;� r*3 pp ;;� v �' V? � C, r.� DIANE F. O'CONNOR � �., �,` � -n �,s � �, _�.. � ._ � C� "== � � :.t3 c..� t-~ rr-E ,-- � � -� 'r� -�.� � I, DIANE F. O'CONNOR, a resident of Boiling Springs, Cumberland County, Pennsylvania being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ITEM 1: I direct that all my just debts, the expenses of my last illness and funeral expenses be paid as soon after my decease as the same can conveniently be done. ITEM 2: I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, v��hether the property passes under this Will or otherwise, excluding, however, any property over which I have a taxable power of appointrnent, provided, however, that no residuary beneficiary shall by reason of this provision be denied the benefit of any deduction, credit, favorable rate of tax or other benefit which by law enures to such beneficiary. I'TEM 3: I direct that all items of personal property except for those items listed in ITEM 4 below be sold and the proceeds be added to my resi�uary estate. ',�.�;�f-�y f I ��i' DIANE F. O'CONNOR 1 LAST WILL AND TESTAMENT OF DIANE F. O'CONNOR ITEM 4: I direct that the vase on my hutch which is from China and possibly a Ming vase, the bronze dog and painting of Jemima Ryder be appraised by a certified appraiser and thereafter sold with the proceeds to be added to my residuary estate. ITEM 5: I give, devise and bequeath all of the rest, residue and remainder of my estate, real,personal and mixed, of whatsoever kind and nature, and wheresoever situate at the time of my death, in equal shares, unto my children, JEANNETTE FINCH, and MICHAEL J. O'CONNOR, provided, however, that they survive me and are living sixty (60) days after the date of my death. ITEM 6: If and in the event that a child of mine does not survive me and is not living sixty(60) days after the date of my death, then and in such event, I give, devise and bequeath the interest in my estate, which such deceased child would ha��e received, if living, to the issue of said deceased child, per stirpes. ITEM 7: I hereby nominate, constitute and appoint ANTHONY L. DELUCA, ESQLIIRE, Executor of this my Last Will and Testament, with full power to do an}�and all things necessary for the complete admitiistration of my estate, and direct that no bond or other surety is required of him in this or any other jurisdiction for his performance of this office. f . : F ' i 'ji�,.. � 7,�y E 1 � V .�.f✓_1'�.L%'�l � L-` (�j'iws��:;/. DIANE F. O'CONNOR � LAST WIL,L AND TESTAMENT OF DIANE F. O'CONNOR If and in the event that ANT�ONY L. DELUCA, ESQUIRE, does not survive me and is not living sixty(60) days after the date of my death, or does not complete his duties as Executor, then and in such event, I hereby nominate, constitute and appoint CAROL KELLEY, Executrix of this my Last Will and Testament, with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of her in this or any other jurisdiction for her performance of this office. ITEM 8: If any provision of this Will or of any Codicil hereto is held to be inoperative, invalid or illegal, it is my intention that all the remaining provisions thereof shall continue to be fully operative and effective, so far as is possible and reasonable. P�1 WITNESS WHEREOF, I, DIANE F. O'CONNOR, the Testatrix, have to this my Last Will and Testament, typewrittE�n. on (4) four consecutively numbered pages, subscribed my name and affixed my seal this ��'`/"�iay of �-�'t�=�r��-�'� , 2010. ' ,,'`� �t s`` C:�,-��L�.�,=�G�.�EAL) DIANE F. O'CONNOR z LAST WILL AND TESTAMENT OF DIANE F. O'CONNOR Signed, sealed, published and declared by the above named DIANE F. O'CONNOR, as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at her request, as witnesses hereto, in the presence of the said Testatrix, and of each other. � � ,�f �� a� ,�� , r .- . � � ,�' residing at��.�� / , f��`f'�' ..�;s.4.G�,�'t _ ._� - /�� - --- - -� t � l, }c-�.� ,' )-�!��t:��residing at x��.e.�%-r�,� ��r��. `�=� ��".',� - � ._��, � f 4 �-�� c'> - � � c a _`_ � c� T �p � � CJ ET] -� � �y �M OATH OF SUBSCRIBING WITNESS(ES)r a � � � � � � � � o � �, r, � -�' -" �; REGISTER OF WILLS � c� -,-� � :�� CUMBERLAND COUNTY, PENNSYLVANIA `° � cv �r,,, rn -� ,� o � � � Estate of n; anP F n�C`nnnnr , Deceased Dorothy P. Carew , (each) a subscribing witness to (Print Name/s) the�Will �Codicil(s)presented herewith, (each)being duly qualified according to law, depose(s) and say(s) that she/he/they was/were present and saw the above Testator/Testatrix sign the same and that she/he/they signed the same and that she/he/they signed as a witness at the request of the Testator/Testatrix in her/his presence and in the presence of each other. t� ��--�>--z.E.e�)" (Signafure) (S�gnatureJ pOI' thy p. Carew 35 Abbey Court (Slreet Address) (Street Address) Carlisle, Pennsylvania 17015 (City,Sta1e,Zip) (City,State,Zip) Z � �o ��.. J j O N Z Executed in Register's Office Executed out of Register's Office Z �,g N ? � o Sworn to or a f firme d an d su bscri be d Sworn to or a f firme d an d su bscri be d a �z�� 4 � � �� (o�' da � ='� a�s before me this day before me this y � � 3 � Z�� o � of , of �u.,1ua_r�c� , a o f . � � � �� - z ��EZ - � £f� � � 1` � �� ,,W ' f�1�ux�l.cL �. ,L�� ° �� w Deputy for Register of Wills tary Public � My Commission Expires: ��/�Z/�i� (Signature and Sea(of Notary or other o�cial qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s)at time of notarization. Form RW-03 rev.10.I3.06 � 4 c:__ � t'+� pp � �3 4? G? OATH OF SUBSCRIBING WITNESS(ES) � � � � �' � r- � rn r�� rn y,. � �, oo �, �+ REGISTER OF WILLS � ' � ° ° CUMBERLAIVD t7 c� � � .m � COUNTY, PENNSYLVANIA q � � _..� . �1 GJ T'- � .� --i �""' � ....0 � � � Estate of n; anP F n�C`nnnnr , Deceased Sh�-ron Bender , (each) a subscribing witness to (Print Name/s) the�Will �Codicil(s)presented herewith, (each)being duly qualified according to law, depose(s) and say(s)that she/he/they was/were present and saw the above Testator/Testatrix sign the same and that she/he/they signed the same and that she/he/they signed as a witness at the request of the Testator/Testatrix in her/his presence and in the presence f each other. (Signature) � (Signature / Sharon Bender R�7 Fn�P R�aCL (Slree!Address) (Street AddressJ Carlisle, Pennsylvania 17015 (City,Sta1e,Zip) (City,State,Zipf � ZQs �� < j ,p(�jN 2 Executed in Register's Office Executed out of Register's Office N a g�z z '3�_� � Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed � �,Z�� o ��"-� � before me this day before me this � day � �� 3�s of , of .��-�arc� , ao i , � Z�� ¢ o > J Z f�p'�O � z � �� a , � �� T� "L��C� (�^'x.i,�t.F� � �o� f w Deputy for Register of Wills N tary Public � My Commission Expires: o'�l zZl�f (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s)at time of notarization. Form RW-03 rev.!0./3.06