United States of America
State of West Virginia County of Harrison, ss:
Waiver for Appointment of Administrator/Executor
To the County Commission of Harrison County, West Virginia, or the Clerk thereof in vacation or recess:
I, __________________________________ of _____________________________, who died intestate/testate on
(Heir / Beneficiary) (Name of Deceased)
the _____day of ___________________, ________ hereby waive my right to qualify as administrator/rix or
executor/rix of his/her estate.
Given under my hand this, the ________ day of ______________________, _________.
_______________________________________
Heir/Beneficiary
State of ________________________
County of ______________________
The foregoing instrument was acknowledged before me this _____ day of ___________________, _______
by _______________________________________.
My Commission expires: _____________________ _________________________________________
Notary Public