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LIFE & CASUALTY
THE JETNA CASUALTY AND SURETY COMPANY
Hartford, Connecticut 06115
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POWER OF ATTORNEY AND CERTifiCATE OF AUTHORITY OF ATTORNEV(SI-IN-FACT
KNOW ALL MEN BY THESE PRESENTS, TIlA 1 tilE kiNA CASUAL TY AND ~;IH1L lY COM'ANY,. ""p."""n,, <I"ly n<1.",,,,,,,j "n.jm Ihn Ill",sollho
StalO 01 Connect<cul. .nd having its pnncip,,1 off"e ,n Ihli C,ly olll;",lu"l, C""nlY ;,II1.,,"nr<l, ~i",I" "I enr,,"'''''<:''', h,,<I, m,,<ln, <:on,"',<I",1 .nd
oppo,nled, an<l <1005 t<y Ihose presonts m"le, wnsli'''," ",,<I "ppoinl ';. A. Eel< (' I'd - -
of Camp Ilill, Pennsy 1 v ani a ,il<'lruuand 1"",1011 ^"ornoyl"I.in,f",I, wilh lull power "n<lllu'ho,ilY h"rnby cnnlonud
10 sign, uxocule and acknowledge, 01 any pla,e wilhin Ihe Unitnd States, or, illl", lollowin!] line I", IiIlo<l ,n, w,lh", II", '''Oll ,ho'" ,I\lsig'
n'led ' tholnllow,ng inslr,,,,,,,n'ls):
by his/her solo sign",uro and act, any and.1I bonds, rocoonizancos, conlracts 01 indemnily, and nlhm writ<n\lS nbllgll'ory ,n Iho ,,,<I " re 01" bond,
recognizance, Dr conditional underlakinll, .nd any .nd all r.on"onls ,,,cidentslhere'" not exceeding the sum of FIVE
IIUND\\ED TIIOUSAND ($ 500,000.00) DOLLARS -
and to bind THE AOTNA CASUALTY AND SURE1'I COMPANY, tl",reby as fully cnd In Ihe saOle ex,"nl 05 IIlhe ,"Ole were signed by Ih', duly
authorized officers of THE AOTNACASUAL1'I ANOSURE1'I COMPANY, and all Ihe aelS 01 scidAIIOrneylsl,in,fc", pu'SlIOnlIO Ihe oulhnrity hmein
given, are hel'ElbV ratified and confirmed.
This appointmenl is made under and by .ulhority of the following SlandlOg Resolutions of said Company whICh ResolUlions ore noW in fu!1 force
and effect:
VOTED: That each of the following officers: Chairman, Vice Chairman, President, Any Execulive Vice Presiden', Any Senior Vice President, AnyVlce
Presidenl, Any Ass"tant Vice Presidenl, Any Secretary, Any Assislant Secrelary, may from time 10 lime apPOint Resident Vice Presidents, Resident
Assistanl Secretaries, Altorneys,in,Facl, and Agents to acl for and on behalf ollhe Company and may give any such appoinlee such authority a. his
certificate 01 authorily may prescribe 10 sign wi'h Ihe Company's neme and seal wilh Ihe Company's seal bonds, recognizances, contracts of
indemnilY, and other writings obligatory in the nature of a bond, recognizance, Dr conditionai undertaking, end any of saiel officers or the Board of
Directors may at any time remove any such appoinlee and revoke Ihe powerand aulhority given him,
VOTED: That any bond, recognizance, conlract of indemnilY, or writing obligalOry in Ihe nalure of a bond, recoonizance, Dr conditional undertaking
shall be valid and binding upon the Company when lal signed by ,he Chairman, the Vice Chairm,n, tho President, on E,ecutive Vice President, a
Senior Vice President, a Vice President, an Assistanl Vice President or by a Residenl Vice Presidenl, pursuanl 10 Ihe power prescribed in the
certificate of authorilY of such Resident Vice President, and duly attesled and scaled wilh the Company's s.ill by a Secrelary Dr Assistant Secretary
Dr by a Resident Assistant Secretary, pursuant 10 Ihe power prescribed in Ihe r.ertificale of aulhorily of such Resident Assistanl Secretary; nr (b) duly
executed (under seal, if required) by one Dr more A\lDrneys-in-Facl pursuant 10 Ihe power prescribed in his or Iheir cerliflcale Dr certiflca,es of
authority.
This power of Attorney and Certificale of Authority is signed and se.led by facsimile under and by aUlhority ollhe lollowing Standing Resolution
vOled by Ihe Board of Directors of THE AOTNA CASUAL1'I ANll SURE1'I COMPANY which Resolulion is noW in fuillorce and effect:
VOTED: That the signeture of each o!the following ollicers: Chairman, Vice Chairman, President, Any Executivo Vice President, Any Senior Vice
President, Any Vice President, Any Assistant Vice President, Any Secretary, Any Assislant Secretary, and the seal of the Company may be affixed by
facsimile to any power of attorney Dr 10 eny certificale reiating thereto appoin'ing Re.ident Vice Presidents, Resident Assistant Secretaries or
Attorneys,in-Fact lor purposes oniy of execuling and allesting bonds and undertakings and other writings obligatory in Ihe nature thereof, and any
such powel 01 aHorney 0' certificate bearing such la"imile signature Dr facsimile seal shell be valid and binding upon Ihe Company and any such
power so ex.euled and certified by such facsimile signature and lacsimile seal sh.ll be valid and binding upon Ihe Con'pany in Ihe fulure with
respect to any bond or undertaking to which it is attached.
IN WITNESS WHEREOF, THE AOTNA CASUALTY AND SURE1'I COMPANY has caused Ihis instrumenl to be signed by its
Vice President ,and its corporale seal 10 be hereto .ffixed 'his 3rd
day of August ,1979
Assistant
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:! CO"" r~]
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THE
IETNA
CASUALTY
AND
SURETY
COMPANY
By
ZL~-;;2'r-t: -
Assistant Vice President
State of Connecticut \
55. Hartford
County of Ha~ford
On this 3rd day of August ,'979 ,beforo me p.rsona11ycame R. T. RIPPE
to me known, who, being by mo duly sworn, did depose and say: thai he/she is Assi 5 tan t V ice Pre, iden t of
THE JETNA CASUAL 1'1 AND SURE1'I COMPANY, tho corporation doscribed in and which oxeculed tho abow instrllonen>: thai he/'.Iu I""NS th.
se.1 of said corporation; Ihatlhe seal affixed to Iho said instrumonl issuch corpor." se.l; and th.1 ho/she exer.uled Ihe said inSltuu","IO" "ehelf
of Ihe corporation by authority 01 his/her office under Ihe Slanding Resolutinns Iheooof,
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My rnmlnion ellpl!05 M.rclo 31, '9 84. 0 N.,UHV Public
CERTIFICATE
I, Ihe undersignod, Assistant Secretary ofTliE JETNA CASUALTY AND SURElY COMPANY, a stOCk corporaUon of the
Slato of Connecticut, DO HEREBY CERTIFY thatlhe foregoing and att.chod power of Attorney .nd Certiflale of Aulhonty .omains ,n 1"lIlolCe and
has nol beon r.vokad; and furthermoro, thatlhe Slanding Resolution. of Ihe Board of DireclorS, 05 sel forth in Ihe Ce,,;ficate of AUlllorit" "e noW
in force.
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To ""/fill:.r.f.!l"".,./?...,,....If! ~...,.. ,~"~~~..../,,,. (~t..ft~.."
I\el(ist('r of \\'il\s f'JI' the ('rEI)' of ('JlIl1I'l'r1a~l' lh:' !..:fllJlIlIl(,IIIl'allh "I' I'ellll"yl\'allia,
TIll! PetitiOJl of "..,...fu"c.:v't....,:':)...,,}H. . ",.J ...... ,.CJ,A,~.:::...,,,...,";"..."'nl.'."'.'i!f:.'"
""'''''''''''''''''''''''''''''''''''''''''''''''''''''' rl."peel I 111\)' "ho\\'el h I hat "",9b.~,-:,,,,,,,,,,,,,,,,,,,4<'"M'''''~'''''''
'I t f Uft",:l J71'-ul..A.'U!-t.'U" 'I~", ",I oil' '(' 11' '1' III ('ouul \' SI'lle of Pellllsyl
WIlS, II reSI( en" (~ ,,,,,,,,,,,,,,,,,,,,,,,y,,,,,,""""''''''''''''''''''''!lOl:lIIlKh , ' 1111 '~1 ,\ ',' " " ' ?' oJ
:=~:::~:,,~:',~":,:f '~':'~~~'~~~".t~',:':":::'";",:",u:",,:::,,:,,,..~
on "~~p.,,,, the "",2?~:::,:.:;!!.""""", day of """""",,,Y.:t.Y),.:.;>,,,,,,,,,,,,,,,, A, D" 19]"'>'".
at the IIge of ,?"",~"".. yellrs, ~ T7 o. -r.-
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That the said """'''''''''~,',,'''''' ",,,,,,,..,,,,,,,,,,,,,,,,,,"'"'''''''''''''' deceased, left surviving the following
nllmed widow or -husband, heirs and next to kin, 10 wil:
Name Relatiollship Residence
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'o.a.~'j""''j''''''~~r. ""'",..,''~''''''''''''' """""""""""""".~,'""",,"""""
~t2,J~'~,"'m" ?&fi.H;!i5.f,,~~ r,
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................................................................ ......................".................... ................................................................
..............................."............................... ,...............................,..,."..... .....................................,............."...........
.."............................................................ ...............................,..".,...... ................"..............................................
That those above named include 1111 of the next of kin. so far as known,
The said decedent was possessed of personal property to the estimated value of $"","i"~,~,,,!.?.,,,,..
and of Real Estate. less incumbrance, to the estimated value of $"",,'~'" liS near as can be
ascertained.
........................,...........................................,.."...,.,......................,'''',........."..............."......".........................,...............
That the said Real Estate in so far as is known is located in ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"""""""",,..,,
Therefore, your petitioner(s) respectfully appl)'(ies) fOl' Letters of Administration in the above
namec estate,
Dated ,,," " "" ,'!Cl,ll,:" "2,,, " '"",,,,,,,,,,,, A, D" l!l,~,o.,,, ./J
Signature and Addl'eSH ~,,,/.!:.,o,~,t:.4.if,,,,,Ih,,,,,/,J!?,~,,,,,,,,,,
of Petitioner(")
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......,.,...........".."......,"",.....,..........".................,..,...........
".."......,.."..,................."..".............................................
COMMONWEALTH OF PEKl'SYLVANIA 1
f ss:
COUNTY OF CUMB[~RLAN[)" l J ' ~
tv &l7-:rl~ - }\,~, l ')_<::o,^~ '
""""""""'"'''''''''''''''''''''''''''' :::::,~::J."""".""""",,"""""""""""""""""""""""""""""'''''''''''''.''''.'''''''''''''' named
in the above application beinl( dilly """.:4.0.D..::~,,,,,""'"'''''' aceol'dillK to law, say that Ihe facts set
forth in the above application are tl'lle tll the hest of ,,,~:k: kllowlelll(e and helief.
"",..,""""..,,'"''''''''''~:o:'(),r.~''''''''''''' and "ubscrihed 1 ""''''''''''''''''''''''''''''''''
I
t
I
before me.
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He~i~ter
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Filed: "'~,ill,l\ll!,r.Y.l~!,.~.9.~,~""
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Altol'ltl'Y:
Robe rtM}'e rs. III.
(o\'er)
INFORMATION
To insuro propor credit 10 your accounl, Ihe n"n'" of Ihe ,,5\010 nnd flln numb'" shollld he clearly prlnl'
ed on tho check or money order.
This nssessment is made Ie accNdnnce wnh SeCHon 706 01 lhe Inl,",,\Onco and Es,ate Tax ACI of
1961 (72 P,S, 9 2485,7081,
To the exlent lhot inheritanCe \Ux " paid within .hroo 131 months olter the death of the decedont. a
discount of fivo (5) percent 15 allowed (72 P.S. S 2485.716),
Inheritance Tax. olher Ihan lax on a future interest, " due", Ille date of Ihe decedenl's death and becomes
delinquent at tho expiration of nine (91 months after the decedent's dealh 172 P,S, \ 2485,711), Inheritance
Tax on a future interest is payable wilhin three (3) months ofter Ihe transfor takes ellect In possession and
enjoyment and is delinquent thereafter 172 P,S, 9 2485,7121, Calculate interest Irom Ihe delinquent date shown
on the face of this form to the date of actual payment uSing the 10110wing ,ntere" table,
------------ ------------------- --- ---- --------- - - --- - --- --,------ -- -- -- - ----
1 month ,005 4 months ,020 7 monthS ,035 10 months ,050
2 monthS ,010 5 months ,025 8 months ,040 11 months ,055
3 months ,015 6 monthS ,030 9 months ,045 '2 months ,060
I days ,00017 11 d~Y5 ,00186 21 days ,00352
2 days ,00034 12 days ,00203 22 days ,00369
3 days ,00051 13 days ,00220 23 days ,00386
4 days ,00068 14 days ,00237 24 days ,00403
5 days ,00085 15 days 00250 25 days ,00420
6 days ,00101 16 days ,00267 26 days ,00437
7 days ,00118 17 days 00284 27 days ,00454
8 days ,00135 18 days ,00301 28 days ,00471
9 days ,00152 19 days ,00318 29 days ,00488
10 days ,00169 20 days ,00335 30 days ,00500
- - - -- - ----- ---------- - -- - - -- - - -- -- -- - - - --- -- - --- ---- - - - - --------- -- ---'
Any party m ,nterest, ,ncluding lhe Commonwealth "nd Ihe person,,1 represenlat"e. nol satislied with
the assessmenl may obiect therelo witllln si'IY (601 days ,ltrH receipl of thIS NOlice as pr"ided by Section
,001 of the Inheritance Clod Eswte Tax. Act of 1961 (72 PS, S 2485-100\1
Make check or money order payable to:
"Register of Wills, Agent"
MUll to the address listed below: