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(b) Tho names. relationships and addresses of all dist~ibutees, of each person de~ignatcd in the Last ~Vill
herewith presented as primary executor, of all persons adversely affected by the purported exercise by such Wili o(
any power of appointment, of all persoru adversely atfected by any codicd and of ali persons having an interest
under any p~ior will of the dececient on file in the Surrogate s oFfice. are herci~a[ter stt forth in subdivisions (a) and
( h):
(a) All persons and parties so interested who are of fulf age and sound mind, or which a~e corporations
o~ associations, a~e as (ollows:
hame and Address Relationship Description o( Legacy, Devise or
Eugene StaCk ~.'teeutor Other Interest, or Nature of
~ ~ Gloucester Court Fiduciary Seacus
L~~
Great Neck, r?.Y. NO*_dE
Jerry Cervenka Bro - axecutor 1/4 R~sidue & Furnishings
1235 North ~~Tater St. Petitioner
Owosso, Pti..chigan - ~ -
\r`Frank Cervenka Brother 1/4 Residue & Furnishings
UV 6437 2iiramar Parkâ˘aay ,
Miramar, rla. ~
~
(b) All persons so interested who are persons under disability. are as lollows:
(PJease jurnish all injormation s~ecifted in NOTE below.)
- 1\TCIJE
t
(Note: In the case o( ach infant, state (a) name, birth date, age, relationship to Gecodcnt, residence address, and ~he person wiih' ~
whom he resida; (b) whcthet or not fx hu a genenl or tawmentary gua~dian, and whcther or not his father, or i(dead, ha mothcr. is Z
living; aqd (c) the name and raidence address o[any gwrdian and any liring parent. In thecaseOteach othcr pcrson underdisability i
sate (a) name, rclationship to decedrnt, and re~idena addras; (b) facts rcgardu?g his disability, i~Iudingwhether or not a committee
has been appointed and whether or not he has been wmmitted to any instnution; and (c) tfic names and addrasa of any committee, , t
any penon or institution having care and cvstody of him, and any relati~~e or friend having an intcrcst in his wclfare. !n the cax of
persom m~fined as a p~soner, state place of incararation. ln the case of unknowns, desaibe such persom in the same language as will
~ be used in ~he process. In each case 8ve a brief description o( the pa~ty kgacy, devise or o~her interest u in paragraph(6)(a) hacot.)
~ (7) The names and domiciliary addresses of all substitute or successor executors and otall trustees, guardians,
~ legatees and devisees, and other bcneficiaries named in the Last Will herewith presented. othec than those named in
; Paragraph (6), are hercinafter set forth in subdivisions (a) and (b):
~ (a) All such other legatees and devisees who are of full age and sound mind, or which are corporations or
~ associations, are as follows:
~ Name Address LTescription of Legacy, Devise or
~ Other interest, or Nature of
~ Fiduciary Status
~ 3arbara Brewer 1225 Ada St. O~osso, t4ich. r^urnishings & l/4 R~sidu2
48867
J~rry Cervenka, Jr. 525 E_ tlain St. O~osso, Mi.chFurnishings & 1/4 Residue
48867
(b) All such other legatees, devisea and other beneGciaries who are persons under disability, are as
follows:
~ NONr.
~ .
~
(Please fu~nish a/J informalioR speeiTed in Note ~o paralt~nph (h) (h) irereo! -
~ (S) There are no persons. corporations or associations. interested in this proceeding other than those ~
~ 1 hereinabove mention~d. 3
(9) T~ the best o( the knowledge of the undersigned, he o' ate total value Il onstituting ~
~ i ~~Pd ~8~~b ~
the decedent's gross testamentary estate is more than d less than S_....... ~
~ (10) U pon information and belief, no other petition for the probate of any ill of the decrdent or for the ~
~ granting of letters of administration on the decedent's estate has heretofore been Filed in any Court. ~
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~ BOOK ~t7J PAGE 5~0 - ~
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