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in his lifetime. -
IN WITNESS WHERxs"'OF, the said party of the first part
has hereunto set her hand and affixed her seal the~day and
year first above written:
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ALICB B. COOPER, Euocu ix under
- domiciliary proceedings in the
- Commonwealth of Pennsylvania
SIGNED, SEALED AND DELIVERED IN THE PRESENCE OF:
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Witness
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Witness ~
State of
County of
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I HEREBY CERTIFY that on this day, before me, an
officer duly authorized 'to take acknowledgments in the State ~
and County aforesaid, personally appeared:
ALICE B. COOPER, Executrix under the domiciliary proceedings
in the Commonwealth of Pennsylvania for THOMAS F. COOPER a/k/a
THOMAS FRANKLIN COOPER, deceased,
to me known to be the person described in and who executed the
foregoing instrument and she acknowledged before me that she
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execute@ the same.
~ WITNESS MY HAND AND OFFICIAL SEAL in the County and State
last aforesaid, this o~-9
~ day of December, 1978,
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CLARK C~RCUfT COURT
° R 302 2403
~ BOOK SAC.
Thh t~lnunsnt was ~ ~ e=NF~A- ~M i~I~tB:.T~.~ el
~ Gtympic T+t'^ f, A`-Tact C~~prrry, 18060keechoGee Road, fort P"krte, Fbrid= 33450
~ as a necessary ~nadent to tM ftrlfiltment of conditions oontaiMd its a titN 3
inwrance camm~tment issaed Oy it.
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