HomeMy WebLinkAbout11-15-07 (3)
.
COM~ONWEALTH OF VI.f4IA
..
I MARRlAO. RROISTlR
1 FULl NAME
OF GROOM
(first)
(mfddIc )
JOSEPH
65/813
l:::.' '''.'2330
(last)
. .~
.~ I'OR. CISlK OF COURT
~ COURT FOR CITY OR COUr'.flY OF
Alexandria'
2. AGE
JEFFREY
'--'--'---.
3. DflTE OF BIRTH (Month, Dirf. Yoar)
KEENE
4. PlACE OF BlrnH (st.>te or for&gJ CDLrl/ry I
43
CT
5. RACE
(
r--;
t:
r ::J
c: C
!u
6
r: -, .~,
\- r-J'"
)) :-
~.
<<'l
~,
1"1
:;l
C
.~
\..
':ANNA
rum
14 DATE OF BIRTH (Month. Dirf. Yelv)
(II dl'lMnt)
48
H'
15. PLACE OF BIRTH (stale or fOl'e/gn country)
- ~
I:
i'
,.
I'
I'
I'
I
i
16 RACE
Years
8/7/42
17. NUMBER OF (first, second. etC.)
THIS MARRIAGE
College
11-4 or 5+)
Austria
18, MARITAl S-mrus (/I previous(y
metried )
d WIDOWED 0 DIVORCED IX
2Oa. USUAl RESIDENCE: STREET ADDRESS OR RT. NUMBER
BRIDE
19. EDUCATION
(SpecIfy onIt highest
grade oompIeted) ..
2Ob. CITY OR lOWN OF RESIDENCE
ElomAntary (X Secondary I
10-12) I
I
22. FULl MAlDEN NAME OF MOTHER
~~
;, -"",
lt~.
~l":
~
~r.
--r.,
.E
21. NAME OF FATHER
........L...IL........... .L..I...L.~
. ---
----
TO 01 f ICIAI;:
~
26. TYPE OF
CEREMONY
CIVIL all
HELiGIOU~ 0
J
'-
OFFlClANT
intee
(City or cotnty)
, VIrginia, in
1982
(ye?r of authorIzatIon,
1216 King St., J\.l.exar:rlria, VA
(street or rou/e number) (City Of town)
22314
(staIP)
---.-.-----...
.
COMMONWEALTH OF VI.tjIA
MAARlAOB AIIOISTIR
1 FUU. NAME
OF GROOM
(Iirst)
JEFFREY
(mICIdIc )
JOSEPH
65/813
~...
(last)
2330
~
.' FOR ClERJ( OF COURT
~ COURT FOR CITY OR COUNty OF
Alexandria
5. RACE
Yea,,; 9/9/47
KEENE
4, PlACE OF BIRTH (51"16 or /oreJr}l cD<61lry)
43
.----.
3, DArE OF BlRTH (Month, Day, Year)
2,AGE
CT
(
~
t
rIg
!u
~ ...
~,~ :
\.~ ,..
<<)
"I
1"1
7;l
-
.~
I..
(jfdl'~.1
I
"
I
"
I'
I'
I
,
!
~
8
:~Jr ~ I
~,., ,,.., ~ I, , ,
< ! /23 TOANYPERSONLtCENSEDTOPERFORMMARRI~GES MARRIAGE LICENSE .._.~ ~~=...
~ You are her6by authonzed to JOIn the above-named persons In marriage
if '.,' unde.r.DrOCt>dllres """,don I'''' "13t"1.C~0<\\..""'altnOf VI'g:n", Uate Issued ~""mho,... --12 _ 1990 _ _ _ _ _.
:!~Cd':~::f~~~~~,~~~M^,~"_ _ .. _ ~~,~:::;~::::~j?~~::';
TOOfflCiAr~j II
Complel" aryj S"'f: i' u . .. . MARRIAGE CERTIFICATE
Gert,f"",!,., 0" bo'" , G4 DATE OF IMomh. Day, Year) 25. PLACE c!F
copies II MARRIAGE MARRIAqE
Return both cOP",S /'1' September u 199
~~~ or'~r!d?YS to ,07 I CER rtFY THAT I JOII.ED THE A
isSUlnQ license
I'SIGNATURE OF ·
OFFICIANT
~ Sect1Of1321-267
Code 01 Vlrgmia .'
I Authollzed to perform marnages by the Circuit Court for
NAME ()f'
I OFFICIANT Gordon P Peyton
Hype or pnnt) ..
I
I ADDRESS OF OFFIGIA"IT
21, NAME OF FATHER
w~
-__ ~r,
C:. ,..,:...
,E
....;
~ -T~
~ ~.
- --- ----
-----
J
'-
" VIRGINIA
ACE SPECIFIED,
26, TYPE OF
CEREMONY
CIVIL aD
RElIGIOUS 0
mtee
(city Of COtnty)
, Virginia, in
1982
(ye~r of <.HlthonzatK)r0--
1216 King St., Alexandria, VA
(street or route number) (city Of town)
22314
( s/a1P )
nu COpy
.~_...._~--_.
I'
I'
i
"''''Y''''''''-'-~'''I'_''1f'''''~''!'''!'_~
.LAST WILL AND TESTAMENT
I!
I,
ji
,;
'i
I,
I, HAROLD WAGNER MAJOR also known as WILL MAJOR,
#
residing in Trumbull, in Fairfield County, Connecticut,
hereby make and publish this Will and revoke all previous
,
1;
wills.
FIRST
,
I
I I hereby provide that neither the birth of any child
i
, or children to me, nor the adoption by me of any child or
I
Ii
i! children shall operate as a revocation of this Will.
SECOND
I direct that my funeral expenses and all my debts,
except such as shall, at the time of my death, be secured
by mortgage, be paid from my personal estate.
THIRD
I give devise and bequeath my entire estate, real and
personal, wherever situated of which I may die siezed or
~M
~
l!
.,.".~.
.', ~~'ttt,I~.
. _""',!"t::fr:" -",: ...~.~'~';'(
I,
.i
Ii
'I
I!
I'
I!
I: .
I~ possessed of .. or in which I may be or become in any way
I' .
,I
entitled or have any interest, or over which I may have
, a power of appointment to my children, WILLIAM TODD born
I, July 25, 1965, KATHLEEN ALISON born November 17, 1967, and
ADAM BURTON born August 30, 1972. I am making this bequest
because of my separation and contemplated divorce from Julie
Mae Smith Major. My intent is to leave none of my estate
;i
II
Ii to JULIE MAE SMITH MAJOR.
.1
I,
I!
II
'I
II
I
I
I'
II
FOURTH
In the event that I should die before my youngest
surviving child reaches 21, the proceeds of my estate should
be placed in trust for the support, maintenance and education
of my surviving children.
The trustees are authorized to
distribute the income and/or principal of the Trust in dis-
proportionate and unequal shares to or for the benefit of
such child or children of mine most in need of assistance.
I In the absence of a need for such considerations however,
"
I'
I
I
I'
II
Ii
II
II
"
,I
ii
\1
the proceeds of the Trust shall be distributed as fairly
and as equally as i~ possible to or for the benefit of my
...~
r
,
/
I
I
,
said child or children and the Trustees shall be the sole
an~~
-2-
,
...._-,..
Ii
:,
Ii final judges of the ~ethod and amount of distribution to or
I:
./
II
/I
I'
,I
II
Ii
for the benefit of each of my said children.
In the event that the Trust has not been entirely dis-
sipated by the time the youngest child of mine shall reach 21
years, I direct, that upon such occurrence, the Trust shall
cease and terminate and the then balance of principal and
;,
II any accumulated income thereon sh3ll be distributed to my
II
Ii
II
11
II
II
,.
.'
II
I,
i
I
I
I
\
!
.
ti
children who shall be then living equally.
In the event any
of my children predecease me or the distribution of the T~ust
and that child has
issue,
the issue shall share in the said
childs share.
I
I
FIFTH
I hereby appoint, ANNA HICKE MAJOR, my former wife
and the mother of the three aforementioned children as
Executrix of my estate.
I also appoint ANNA MICKE MAJOR
Test.1mentary Guardi.111 of my minor children and Trustee or
.,:......
my estate being held in Trust for any of my children.
If
ANNA HICKE MAJOR should predecease me or should fnil to
qualify or cease to act as Ex~cutrix, then I appoint my son
WILLIAM TODD MAJOR to act as Executor of my last Will and
Testament. If ANNA HICKE MAJOR should predecease me or fa.
-3-
,
Ii
II
Ii
Ii
1)
II
II
I;
:;
"
,I
"
II
"
,:
to act or qualify a~ Trustee at any time during the life of
i: the Trust hereinbefore created for the benefit of my sur-
!:
:; viving child or children, I appoint CITY TRUST COMPANY of
Bridgeport, Connecticut, as Alternate or
of the aforesaid
/,
" children.
I
!j
:1
I give my Executrix power to sell any real esta:e or
': personal property. I request that no Executrix, Trustee, or
:!
,: Guardian be required to give any bond, and that if, not~ith-
Ii
II
'I
II
I
I
I
i
standing this request, any bond is required by law, statute
or rule of court, no sureties be required of them.
In witness, whereof, I have hereunto set my hand and
seal at Fairfield, Connecticut, and declare it
to b~' a
1986
,
(L. S.)
Will and Testament on the l6tWay 0
September,
II
Ii
II
II
i:
II
'!
..
-4-
~
,I
.;
'j
j'
,I
"
,
The foregoing instrument, consisting of this and four
.
:! preceding typewritten pages, was signed, published and de-
il
Ii clared by the above named Testator, HAROLD WAGNER MAJOR, also
I
I
known as WILL MAJO~, to be his last Will and Test~ment, ln our
i
i presence, and we at his request and in his presence and in the
i:
presence of each other have hereunto subscribed our names as
witnesses this l6thday of September, 1986, at Fairfield, Connecti-
I cut.
I
Ii
ii
I
,
I
i
\
I
1\
..--.:::> r,
'-,- r _ ,.. " (, /
/' J", '" _.,:' c/' /C/, ? /. '--
/
Elsie A.I Doyle
of
-;,<' > ~.,~,,/:: I"~ :/ .t
./
.~.-i~.~..
........... 4J..:.~...' / C...,,/',,/ r.- ;",e:, .-
, / ., "
.r" -1-'7
,. ~c... ;"y: ,J
of
.--;--. .
//~L. ,.-,j "'1,.:. (. ~->
~.( , {
Kath~ D Agosti~o.../ '
t4 . V .
,I {l {(__.~ ..Jrl t ~L/
.......K.aren L. Barry - J'
--+-- - /".
Tell ~c( ( (( (I.
I /
( . (
of
I
Ii
"
II
I'
,i
I
-5-
II
,
I
I
I
I
I
I
I
I
.iff~'"
~ "'P'" ""..l.")1
\
!
I:
"
i:
"
11
STATE Of CONNECTICU~
COUNTY OF FAIRFIELD
)
S5: Fairfield
September 16, 1986
~
Then and there personally appeared the within named,
. . ~J. .
!; J.~""" .1....,' -./
; j ~,.
,'. '1,~ . _' ,
, --:-' , /, ) -,.~.;::.~ d t 1 I.
'_( ~.~. "'J'/' , ',' 'i ~.f' an o. '""t,
.---'; "
depose-and s~y.khat they witnessed the
'- '" -,
. \, ii{ I ' 1...,
r---
;
J
11 Ylho being duly
sworn
execution of the within Will of the within named Testator,
i HAROLD WAGNER MAJOR also knc~n as WILL MAJOR; th~: thev there-
i!
,I after subscribed the same as ',vitnesses in the presence of each
other and at the request of said testator; that the said test-
ator at the time of the execution of said will appeared to them
to be of full age and sound mind and memory and that they make
this affidavit at the request of the said testator, HAROLD WAGNER
!
I
16thlay of I
I
S. 'MALINOWSKI I
Commissioner of the Superior Ct. \
\
\
i
MAJOR also known as WILL MAJOR.
1986.
/I
Ii
I
I
I
!
)
-Final Page-
,
,I
I'
II
'I
:i
:1
STATE OF CONNECTICUT:
TRUMBULL
OCTOBER 4, 2007
COUNTY OF FAIRFIELD:
AFFIDA VIT
1. My name is Johanna S. Malinowski, an Attorney at Law in Trumbull,
Connecticut.
2. My office is at 8 Daniels Farm Road.
3. I believe in the obligations of an oath.
4. I knew Harold Wagner Major, aka as Will Major, for many years, even
after he moved from Trumbull.
5. I scripted his Last Will and Testament dated September 16, 1986
accordin;g to Mr. Major's instructions.
6. Mr. Major executed the document in front of three witnesses at my
office at 1210 Post Road, Fairfield, CT on Sept. 16, 1986.
7. His execution was witnessed by three people who worked in the office
and took an oath before me that they witnessed his execution.
8. The original Last Will and Testament was sent to Mr. Major by
certified mail and a copy remained in my file.
9. I saw Mr. Major a number of times since the execution and he did not
indicate that he had changed' ill.
Jo nna S. Mali owski
ommissioner of the Superior Court
Personally appeared, Johanna S. Malinowski, who is known by me to
be the person who signed the above affidavit and took an oath before me as
to the truth of the statement this 4 th day of October, 2007.
... ~CfI1.~
Robin M. Dougherty
Notary
My commission expires: I {13, I' 2.
DURABLE HEALTH CARE
POWER OF ATTORNEY
I, HAROLD WAGNER MAJOR, JR., of York Springs, Cumberland County,
Pennsylvania, appoint the person named below to be my health care agent to make health and
personal care decisions for me. Effective immediately and continuously until my death or
revocation by a writing signed by me or someone authorized to make health care treatment
decisions for me, I authorize all health care providers or other covered entities to disclose to my
health care agent, upon my agent's request, any information, oral or written, regarding my
physical or mental health, including, but not limited to, medical and hospital records and what is
otherwise private, privileged, protected or personal health information, such as health
information as defined and described in the Health Insurance Portability and Accountability Act
of 1996 (Public Law 104-191, 110 Stat. 1936), the regulations promulgated thereunder and any
other State or local laws and rules. Information disclosed by a health care provider or other
covered entity may be redisclosed and may no longer be subject to the privacy rules provided by
45 C.F.R. Pt. 164. The remainder of this document will take effect when and only when I lack the
ability to understand, make or communicate a choice regarding a health or personal care decision
as verified by my attending physician. My health care agent may not delegate the authority to
make decisions. My health care agent has all of the following powers subject to the health care
treatment instructions that follow in Part III (cross out any powers you do not want to give your
health care agent):
1. To authorize, withhold or withdraw medical care and surgical procedures.
2. To authorize, withhold or withdraw nutrition (food) or hydration (water)
medically supplied by tube through my nose, stomach, intestines, arteries or veins.
3. To authorize my admission to or discharge from a medical, nursing, residential or
similar facility and to make agreements for my care and health insurance for my care,
including hospice and/or palliative care.
4. To hire and fire medical, social service and other support personnel responsible
for my care.
5. To take any legal action necessary to do what I have directed.
6. To request that a physician responsible for my care issue a do-not-resuscitate
(DNR) order, including an out-of-hospital DNR order, and sign any required documents
and consents.
~AM~
--
~~~
Second Alternative health care Agent: -fj--
(Name and relationship)
.m
Address:
/D~ ~~ Pd.
~~ A4 /7~1J
/
Telephone Number: Hom~/1) 1?(P-G8t..J /
Work
---
Cell
E-mail
Address:J'l S1am.~. Net<JUllk fA- I1Z<I (
The declarant or the person on behalf of and at the direc on of the declarant knowingly and
voluntarily signed this writing by signature or mark in our presence:
l!~.~
tZuv ~h~
Witness 2
117 Race Street
BoilinQ: Springs. P A 17007
Address
. 812 Parcheytown Road
Lewistown. P A 17044
Address
4f
"I
tJVIUA~LE~UK HEALI H LAKf1.. AljE~ I
."
I direct my attending physician to withhold or withdraw life-sustaining treatment that serves only
to prolong the process of my dying, if I should be in a terminal condition or in a state of
permanent unconsciousness.
GOALS
If I have an end-stage medical condition or other extreme irreversible medical condition, my
goals in making medical decisions are as follows (insert your personal priorities such as comfort,
care, preservation of mental function, etc.):
SEVERE BRAIN DAMAGE OR BRAIN DISEASE
If I should suffer from severe and irreversible brain damage or brain disease with no realistic
hope of significant recovery, I would consider such a condition intolerable and the application of
aggressive medical care to be burdensome.
I therefore request that my health care agent respond to any intervening (other and separate) life-
threatening conditions in the same manner as directed for an end-stage medical condition or state
~rmanent unconsciousness as I have indicated below.
I agree _Idisagr. e this I~y of
2007.
400 Main Street. York Springs. P A
Address
t~/~~~j1f~
lofp ~ pj,. ~~.fJA /12Af
Address ./ I
The declarant or the person on behalf of and at the direction of the declarant knowingly and
v luntarily sign"f this writing by signature or mark in our presence:
'~ ~ ~.)
Witness 1 Witness 2
117 Race Street 812 Parcheytown Road
Boiling Springs. P A 17007 hewistown. P A 17044
LIVING WILL OF HAROLD WAGNER MAJOR. JR.
The following health care treatment instructions exercise my right to make my own health care
decisions. These instructions' are intended to provide clear and convincing evidence of my wishes
to be followed when I lack the capacity to understand, make or communicate my treatment decisions:
If I have an end-stage medical condition (which will result in my death, despite the introduction
or continuation of medical treatment) or am permanently unconscious such as an irreversible
coma or an irreversible vegetative state and there is no realistic hope of significant recovery, all
of the following apply (cross out any treatment instructions with which you do not agree):
1. 1 direct that I be given health care treatment to relieve pain or provide comfort even if such
treatment might shorten my life, suppress my appetite or my breathing, or be habit forming.
2. I direct that all life prolonging procedures be withheld or withdrawn.
3. I specifically do not want any of the following as life prolonging procedures: (If you wish to
receive any of these treatments, write "I do want" after the treatment)
heart-lung resuscitation (CPR)
mechanical ventilator (breathing machine)
dialysis (kidney machine)
surgery
chemotherapy
radiation treatment
antibiotics
Please indicate whether you want nutrition (food) or hydration (water) medically supplied by a
tube into your nose, stomach, intestine, arteries, or veins if you have an end-stage medical
condition or are permanently unconscious and there is no realistic hope of significant recovery.
(Initial only one statement.)
TUBE FEEDINGS
_ I want tube feedings to be given.
d.iJ!J do not want tube feedings to be given.
---.------...---..-.---...--....-.---.......------..
Health care agent's use of instructions (initial one option only).
~y health care agent must follow these instructions.
-
OR
_These instructions are only guidance.
My health care agent shall have final say and may override any of my instructions.
(Indicate any exceptions)
If I did not appoint a health care agent, these instructions shall be followed.
LEGAL PROTECTION
Pennsylvania law protects my Health care agent and health care providers from any legal liability
for their good faith actions in following my wishes as expressed in this form or in complying
with my health care agent's direction. On behalf of myself, my executors and heirs, I further hold
my health care agent and my health care providers harmless and indemnify them against any
claim for their good faith actions in recognizing my health care agent's authority or in following
my treatment instructions.
ORGAN DONATION
(INITIAL ONE OPTION ONLY.)
_1 consent to donate my organs and tissues at the time of my death
for the purpose of transplant, medical study or education. (Insert any
limitations you desire on donation of specific organs or tissues or uses for
donation of organs and tissues.)
.OR
~ do not consent to donate my organs or tissues at ~he lme of my
death. ~
HAROLQn WAGNER M
Having carefully read this document, I have signed it this L~ay of
2007, revoking all previous health care powers of attorney and health care treatment instructions.
HAROLD WAGNER 0 JR.
ign full name here for health care power of attorney and health care treatment instructions)
h O/M& ~A-J'
Witness
Address
Address
117 Race Street 812 Parcheytown Road
Boiling Springs. P A 17007 Lewistown. P A 17044
On this 2jfi day of ~ ' 2007, before me personally appeared the aforesaid
declarant and principal, Known to me to be the person described in and who executed the
foregoing instrument and acknowledged that he/she executed the same as hislher free act and deed.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official
seal in the County of Cumberlana, Commonwealth of Pennsylvania the day and year
first above written. A])A 1115 .
~.R~ {2. ~~
Notary Public
My commission expires:
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Frances A. Aumiller, Notary Public
South Middleton Twp., Cumberland County
My Commission Expires Mar. 16, 2010
Member. Pennsylvania Association aI Notaries