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HomeMy WebLinkAbout05-12-08PETITION FOR PROBATE AND GRANT C-F LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Estate of Ray C. Brechbill also known as File Number ~' '~C1 ' l~ Z`Z Deceased Social Security Number 578-OS-6217 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) ~/ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the Helen R. Brechbill last Will of the Decedent dated October 28, 2003 and codicil(s) dated named in the (State relevant circumstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered for,pFobate, was~t the victim of a killing and was never adjudicated an incapacitated person: __ O ~y- ~B.~i•ant o~etters ol~dministration i ~ - ~ ~, _ __' ~ ' (If applicable, enter: c. t. a.; d. b.n.e.t.a.; pendente liter durante absentia; chtrante minoritate) --i C.~ - - Pefitioner(s} ai~ a pr se,~rch has I have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If AittistYatiorr,-e.t.a. ~rrt:e.t.a., enter date of Wil! in Section A above and complete list of heirs.) L;---~ '-=:' `r~F'afne Relationship Residence (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County County, Pennsylvania with his /her last principal residence at Messiah Villase Nursing Home, 100 Mount Allen Road, Mechanicsbure Pennsvlvania 17055 (List street address, town/city, township, county, state, zip code) Decedent, then 98 years of age, died on Wednesday, March 19, 2008 at 0034 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (lf not domiciled in PA) Personal property in County Value of real estate in Pennsylvania $ 94,489.24 $ 54,753.03 $ 0.00 0.00 situated as follows: Vanguad Mutual Funds, -Pennsylvania, Hudson City Savings Bank, -New Jersey - CD ~& 1RA Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: Si nature T ed or rimed name and residence ~~ ~ ~ ~ ~ / ~ Helen R. Brechbill 59 Oak Avenue, Tenafly, New Jersey 07670 (~~/,~.` ~ `~~e,l/~, ~ Alan Brechbi11479 English Ivy Court, Hummelstown, Pennsylvania 17036 % ' f Glen O. Brechbi1159 Oak Avenue, Tenafly, New Jersey (17670 Form RW-02 rev. 10.13.06 Page 1 of 2 Oath of Personal Representative `~`' ' ~~ ~~''-~ ~' ~ ~~ COMMONWEALTH OF PENNSYLVANIA ~ ` `~~ ` SS COUNTY OF Cumberland ~~~8 ~~ ~ , 2 ~~ ~~' The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition ar~t~t~~n ect to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, P~~s~w~T(~;_~lTand truly administer the estate according to law. ~~ , ! , ~A' Sworn to or affirmed and subscribed before mryeythe >fo day of /-( > c~ nn t~ r For the Register of Personal Representative ,~. '~ of Personal Representative Signature of Personal Representative File Number: Z~' d 4' ~52Z Estate of ~Y C. Brechbill ,Deceased Social Security Number: 578-OS-6217 Date of Death: March 1'9, 2008 AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters are hereby granted to in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of FEES Letters .... 15~~1a~~~,~.7 $ d (~ Short Certificate(s) .. ~~ . $ Renunciation(s) .......... $ Jc Pte- _...$ ~o /-ft~tfiz.~ ... $ 5 ... $ ... $ ... $ ... $ ... $ ... $ "' -9.9~' TOTAL .............. $~!-- as the last Wi11(and Codicil(s)) of Decedent. Attorney Signature: Attorney Name: Supreme Court LD. No.: Address: Telephone: of li'ills ~;- r "~' h Form RW-01 rev. 10.13.06 Page 2 of 2 Qath of Person_Z1 Repl-es~~~~~~~ 23 N~ l l ~ ~8 CU~~[~ION~,Vf-_\i_.]ri i.~i i'i~V`~iSYLVA~IL\ {~~~~! (/i'- SS Or~~'F'r "j ~~ •~ ; ~r ~~1R ., 1 ilt; t~C(IiIU!1C1"~ ,i ',i ".~:,t c'-ii.:'7~~1 a'`. _ il~> i 01 ~:~ l;Cn7(S~ that the State IllentS 111 the fo Cegollzg Pet1i.1011 aCe tllle alld COLTeCt t0 the l;eJt 01 ti,< I~n,~,,;.!~~'; ~c un~l h~!i~t'uP Fcdt;oc;~r~;i ;u~.~ tL:ir, as personal representative(s) of the Decedent, Petitioner(s) will well and tnI?y administer the estate according to law. Sworn to or a[firmed alid subscribed ~~ before nse the .~ day of f ~F r the Register File Number: Signature of Personal Represertta:ive Sfgnurure ,ij Personci Rrpresenlative Srgarttur'a of Perrsonal Representa(ive ~~~ ~~ ~~~ Estate of ~ ^ ~_ C~`~)Y~l,~'f~ CJ/~f Social Security Number: S~ ~ y ~ ~Z~ / Date of Death: AND NO'~V, , in consideration of the having been presented before me, IT IS DECIZE~~ that )~ette s are hereby granted to __1/!l.~" ~ ~Z~ /p~ ~l'l ,.~~~~ Deceased /1 going Petition, satisfactory proof i /~ l,' love ~~ CSr~~~ ~/r~ _ 1 _ in the above estate and that the instrument(s) dated. ~' C~ZJ[~,/' `•2 ~ ~U-3 ~ _ ~-_- described ul the Petition be admitted to probate and filed of rec d as the last Witl ud Codicil(s)) of Decedent. r g 1';V~S ~~ ~~ _'~~ R2grsh>r of Wills ~r,.- ~`~ Letters ...I.y.~.c~-(o7.~~ $ ~~~ v Short Certificate(s) .. ..~... ~ _,_~ Attorney Signature: Renunciation(s) ... ....... S ~ ~ f S ~ ~ Attorney Name: -- _ ____ ... ~---1-C~_______-_ Supreme Court LD. No.: -~~ _ ... S ~ --- ~_. . .. $ Address: ...S ... $ ... $ ' ~ ~ - Telephone: ... $ `i OTAL ....... ....... S Form R%V-11' rev I(11? 0( Pale 2 of 2 ln~~n~ RJ.v ..v ,~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat clr photograph. Fee for thi, certificate. $6.(10 P 1~:~~~`~~~~ Certification Numher MtUi IJ.f REV 112UUb ~~ TY PE ~ PRINT IN PERlAANENT BLACK INK This is to certify that the information here given is correctl~r c<Tpied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate wilt he forwarded to the State Vital Kec~n-as Uffice f<Yr pernulnen[ filing. ~~ 7 ~..~ ~r 4~' Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • pEPARTMENT OF HEALTH • VITAL RE<:OROS CERTIFICATE OF DEATH (See instructions and examples on reversal ry C7 .- ~ ~ ; A t 1 ...~ ( = _~ r ...-~ - __ ! r~ ~ c"} ~~ --~ ~ ~ - ~ ~ - ` rr~ ~ ' © > .,~ _._._..__.._...__.. 1 VU VJaLr L_ 1. Name of Decedem (FVSI rnitldk last, sutlrs) 2. Sex 3. Sa:ia Secant NurMer 4. Data a Deem (MOnm, day, Year) ~/3 ~/ R C B hbill , ay . rec Male 578 - 05 - 6217 March 19, 2008 5 Age (Last BulMay) IAtder 1 year Untler 1 day 6. Date of &M (MOnm, day, year) 7. Bi (Gry and state a la ' ) aa. PWCe a Deem (C71eck ore) xtNUw DAYS Huns alrwlos HOSpnaL O m en ~ ~f 98 Yrs Februa 9 1910 Detroit K$ ^mpalienl ^ER/Oulpalie~t ^DOA LyB Nursing Nome ^Residerlce ^Omer-Speary: 60. County a Dean &. City, Bao, Twp. of Deem W. Facairy Name pl nd insDWtion, giro dredl and munheQ 9. Was Decease d Iispwiic Origin? ®No ^ Yas ao. Rxe~. American hldiall, Bluk, Whde, ek. Cumberland Upper Allen ZWp. I v~ eSS I Q }`) V 1 ~ ~ l° (HB exkBn, P~uwly u H,iGn, ek) 4~ii~e 11. Decedent's Usua Occ Lion Kvul a crock done a ~ most d wo ~ Gle Do nd state reared 12. Was Decedent ever b ale 13. Decedenl'e Education (Seedy ady hgnew grads wmplelyd) tI. Menlo Sblus: Merned, Never Herded. I6. Surviving Spouse (If wee, give maiden rawrw) Kintl a Wok Knd of Business / IMuslry U.S. Amato Forces? EYmenWry / Secondary (P72) College (f ~q a Sa) Wbo"'~, Deaced (SYxar4ly) Sales Mans er Sales ' (Yes ^Nq 4 Married Helen R Renald ue • I6. DeCea'.nI s Maing Ad(kess (Sheet, city) bwn, dale, zip Code) 59 Oak Avenue pecedem's peons lvania ob °~Oa" AaaalReaaenoa a?a Sae Y Wawa „< [~ rea De<emaLireab Upper Allen T Tenafly NJ 07670 , wp Cumberland TowraMp7 y7d. ^ No, Decedent liretl within nD.Camry , A<D,allkn~sa ciry7Bart 10 Famer s Nana IFirst nudtlle, last suffix) 10. Mwha's Name (First, n4rlae, maidwl surrxune) Jesse Brechbill Abi ail Climenha a 20a. Infomanl's Name (TYPe I Pnm) 20D. Iaormanl's Haling Adtress ISheY, cq' / bwn, sYY, zp coast Alan Brechbill 479 F.n fish I Court Humnelstown, PA 17036 2ta Meltwtl a Disposition ^ Cremalbn ^ Donation 27b. Dale d Dispositon (Room, tlay, year) 21c. Place of p sPovlan (Name d <enetery crematory a rtdvrr pknce) 21 d. Lacalion (CM / bwn, sate. UD coda) Burial ® QegtQygl jr~i dye ^ toner s»e<rro. 3~[tl~dARj • Was G•matbn or Danalion Autlgdnd eyY.dbrEx.mm.r/carar»,: ^Yaa^No March 28 2008 George Washington Mstarial Park Paramus, NJ 07652 22a. - F rvk LKehseO {a person acting az sucn) 22b. license Nulnbw 22c. Nana sod AdM1ess a FacJNy - _ FD - 014889 Mal zzi Funeral Hone M (r~ pp WW ectianicsbui~a P~Y1 C < aaY - b9 23a. To ale Desl d my kMwbdge, seam occurre0 at me twb, dale and pace staled. (Sipnalae era aNl 23D. License Nu Mw _ 23c Date signed {1Aaan ea ear) pnyskan is not ava4abb al time a deem to . , r, y cenly cause a death. , Items 2426 mull ce cortpleled DY Verson 24. Time d Dean 25. Dale Proroalcetl Dead (AbMn, day, yawl 26. Was Case Relerrad Exarruner I Coroner for a Reason Omer Than Gemation a Daatbn? - wtw praro~mce5 deem ~ U03`~ M O3 - Iq - 2lx:x° ^Yea CAUSE OF DEATH (See anearucllons and examples) r Approximate iaerval: PaA IC Entw other Sg6uMaBL 28. Dq Tobacco Use Cmtiibue b Orum1 Item 2]. Pan L Enter die N~.fd.BYEBIS - Geeaeba. ayurlea, a cnmpacalbns - mat arecM caused ale doom DO NOT solar lerrrvwwl even6 su<n es cardNC arr t . es , Ansel b Deem OId clef resilbg w me uWedyiq cause yven b pad 1 ^ Yes ^ PrmaDYy respealay artesl. a vearkuw lDrHatbn wnnoul snowing me etwlogy. list only one Cauca ai seen lire. (~No ^ UMlwwn W YEpATE CAUSE FuW dsease w cmam resuXSwbwaml _~ ~~fe?CC i'92 YYLG~ p /J a r fact-Laic L~2~t~d~1L4^_e.p.(~L1C ,aO,vnfe rK~F{emale. Due Io r as a ronsequence DI) .~7 Na progrlaa wldiin past year SequenWYy Wt WrgiNO~s, it anY 0. ,~Q. ~ 1 ^ Pregnam at line a seam l YI4'd~IZZY~ h e t e w use vested on lin e. Ens UNDEpIYdIG CAUSE Due to (w az a consequence oq: ^ NW pepnaM, ba pragrwll w4nin 12 days Iasease a ma,ry mat kkl~aled me a aewn events resupup n deaml uST. /~~Ci/fdA:L~.'[/JZ~I'l'L/ <~ Due b (a as a consequence oq: ~`~` ^ Na gegraV, W pregrwnl I3 mys to I yew d. Dewre deem ^ Urtluiown 1 progvM vermin de pass Year 30a Was an Aulcpsy Penomled? 30b Ware AulopSy FiMigs Available Poor w Conwlatun 31 Marner a Deem 32a. Dale d I ryury (Homo. day, year) 32b. DescAbe How Irryury Dcarre0 32c. Place a bMY. Roma. Fenn. greet. Faddy. Once Baltirq etc (SpeciNl a reties of Deam? Nannal ^ lwnw:ide . , ^ Yes ~ ^ Yes e1 No ~~ Acgtlent ^ PeriWly Invediyatun 32d. Tune a Iryury 32e. tiMaY w Work? 321.11 Transpcsnatirtn k11uY' (Spenly) 32g. Location a InWry (5nllet <lY l bwn, sWw) ^ Suicate ^ Couw Na be Delelminetl ^ yes ^ y4o ^ Dover / Operelor ^ Passenger ^Petlesldan H _ Omer - Sperry: 33a. CaM•et (dick aly aye) Signature orb Title d GWer • CarUlying pnyskian lPnyscwn cenlying quse a dean when another physician has prwlounced loam and comlNeled Item 231 y ~ //~ ~ ~~~ ~~ To Ua hest a mY krwnlzdge, deem occurred due to me causes) end manner as slaled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _______________ - .~ %`~ ^"~~ `~ • Pronouncing and certiNing pnysieian IPhyskun Wm prawunnn9 death and cenlrying to cause a loam) To Ne fist of mr wwwNdga, death occurred al the nitre, data, and place, end dw m the cause(s) and menrla as sYbd_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. Lkensa Number 33d Dale Sl~ned (Room. day, year) ~yyO , / /r„ ~ .s ,I (j • Yedical E6 3miner /Canna ~~ ~~ ~ - / - 0 „/ /' (/' p! /! O lM me W i of examinalion and / or invesllgalbn, In my opinion, deem occurred at Ina lime, date, and place, and due to lM ease(s) end manrm ea eYted_ ^ 3a Na me and Ad6 s a Pers e s o n Wno Cwno161ed Cause a Deem (nem y 2 7) T pe / Pml 35 Re ~ a s ygnawre adDrsrtk umber ~s ~ / y ~ s ~ l ,I ~ l ~ 7iI'.~!`r.~ / / Q~iQr/7fy1~..s /~ /! Gf/ /J /~ g I,Z I / 4.2 I / I ~ l L ate FAed IMomh, day, year) . lG~,$I7 LIA-~! ri sUO ~T iarG6A/ jYC~v6 ~l'-~'s~n->-/ ~ ~ - ODg ~ 7U S .S J Dispuamon Permd Na. 0193258 LAST WILL AND TESTAMENT of RAY BRECHBILL 'h~. ( I i ~'~h ,r ~" r _ _ J r _ 2D~~ SAY 12 AM IQ~ 04 Ci_i~~i~{ CAF C' ~~`~"~ ~ P~ I, RAY BRECHBILL, presently of Bergen County, New Jersey, do make this my last Will, hereby revoking all prior Wills and Codicils. FIRST: Funeral E~enses. I direct the payment out of my estate of the expenses of rr~y last illness and funeral. SECOND: Tangible Personal Property. I give all of my tangible personal property, together with any insurance thereon, to my Wife, Helen R. Brechbill (hereinafter referred to as my "Wife"), if she shall survive me; or, if she does not so survive me, to such of my children as so survive me, to be divided among them in such manner as they may agree, or if they are unable to agree, then in as nearly equal shares as may be practicable, as determined in the sole discretion of my Executors.. THIRD: Residue. All of the residue of my estate, real and personal, I give an~J devise to my Wife, Helen R. Brechbill. If my Wife does not survive me, then I give all the residue of my estate to my children, Alan L. Brechbill and Glen Brechbill, in equal shares, per sti:rpes. FOURTH: Disclaimer. In the event that my wife, Helen R. Brechbill, shall disclaim any or all of my estate devised to her under this will pursuant to applicable state and federal laws, then and in that event, all such disclaimed property shall be held IN TRUST by my Trustees to be hereafter named, subject to the following conditions: To invest and reinvest the sums and to pay or apply the f;ntire net income to or for the benefit of my wife, Helen R. Brechbill, in at least quarterly installments, for her life. My Trustees are also authorized to pay or apply to or to the use of my said wife at any time and from time to time such part or all of the principal as my Trustees, other than my said wife, in their absolute discretion, deem necessary or advisable for the health, support ,and maintenance of my said wife. It is my hope and wish that my wife be able to maintain, as near as reasonably possible, the standard of living and quality of economic life to which she had been accustomed during our life together. The judgment of my Trustees, other than my said wife, as to the amount of such payments or applications and as to the necessity or advisability thereof shall be final and conclusive upon all persons interested in the trust and upon making such payments or applications, my Trustees shall be fully released and discharged from all further liability or accountability thereof. My Trustees, other than my said wife, shall take into consideration any other income or resources of my wife in determining what amounts, if am;~, of principal are to be paid to her pursuant thereto. Upon the death of my wife, the Trustees shall pay over the remainder of the trust in accordance with the provisions of Article Three Herein. FIFTH: Death Taxes. All federal, state and other death taxes, except generation-skipping transfer taxes, payable because of my death on the property forming my gross estate for tax purposes, whether or not such property passes under this Will, shall be paid out of the principal of my residuary estate as though they were debts, and none of those taxes shall be charged against any beneficiary or any outside fund. Death taxes on future interests shall be paid whenever my Fiduciary deems 2 best. No property which would be exempt from federal or state death taxes if not payable to my Executors shall be used to make any payments under this paragraph. SIXTH: Beneficiaries Under TwentX-One or Disabled. If any beneficiary is either under twenty-one (21) years of age, or, in my Fiduciary's opinion, disabled by advanced age, illness or other cause, ar,~d such beneficiary becomes entitled to any income or principal hereunder, then my Fiduciary may hold and invest such income or principal IN TRUST for such beneficiary, in accordance with all powers granted to my Fiduciary under this Will as follows: (a) As much of the income or principal as my Fiduciary deems desirable may be paid to or applied for that beneficiary; (b) The balance of such income and principal shall be paid to such beneficiary when he or she attains twenty-one (21) years of age or becomes, in my Fiiduciary's opinion, free of disability; (c) Any funds to be applied under this paragraph either shall be applied directly by my Fiduciary, or shall be paid to a parent or guardian of the beneficiary or to any person or organization taking care of the beneficiary, and my Fiduciary shall have no further responsibility for any funds so paid or applied. SEVENTH: Protective Provisions. The interests of the beneficiaries under this Will shall be free from anticipation, assignment, pledge or obligation of the beneficiaries, and shall not be subj.°ct to any execution, attachment, levy or sequestration or other claims of the creditors of the said beneficiaries. 3 EIGHTH: Powers of Fiduciaries. Any Executors and Trustees acting hereunder, in addition to the powers given by law and other provisions hereof, shall have the following powers, exercisable without leave of court, both as to principal and income. (a) To retain and to invest in all forms of real and personal property whether or not it is yielding income, regardless of (1) any limitations imposed by law on investments by fiduciaries, (2) any principle of law concerning delegation of investment responsibility by fiduciaries, or (3) any principle of law concerning investment diversification; (b} To keep reasonable amounts of cash in bank uninvested, if deemed advisable; (c) To compromise claims and to abandon any property which, in my Fiduciary's opinion, is of little or no value; (d) To borrow from anyone, even if the lender is a fiduciary hereunder, without liability on the part of the lender to see to the application of the proceeds thereof, and to mortgage or pledge real and personal property as security for repayment of the funds borrowed; (e) To sell at public or private sale, for cash or credit, to exchange or to lease for any period of time, any real or personal property, and to give options fir sales or leases; (f) To make loans to, to borrow from, to sell to, and to buy property from, my or my Wife's Executor or Administrator or the Trustee of any generation-skipping trust of which I am a deemed transferor; (g) To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; 4 (h) To register securities and other property in bearer form or in the name of a nominee; (i) To give proxies, both ministerial and discretionary; (j) To allocate any property received or charge incurred to principal or income or partly to each, without regard to any law defining principal and income; NINTH: Definitions. The following definitions and rules of construction are ap~~licable to this Will and the trusts created herein, unless in the particular case, the context clearly .requires otherwise: "Fiduciary" shall mean the Executor or Trustee serving hereunder. "Executor" or "Trustee" shall mean not only the person or persons designated as such in this Will, but shall, for all purposes of this Will and the trusts created herein, also mean any person or persons acting at any time as my Executor, Administtrator or Trustee under this Will and any trust created herein, and shall be construed in the plural or the singular, and as the masculine, feminine or neuter, as the context and circumstances may require. References herein to "child," "children" or "issue" shall be ~3eemed to include legally adopted persons, and persons born or legally adopted hereafter. Pr~~nouns shall be construed as feminine, masculine or neuter, and as the singular or plural as'. the context and circumstances may require. TENTH: Fiduciaries. I appoint Helen R. Brechbill, Alan L. Brechbill and Glen Brechbill, as Co- Executors and Co-Trustees under this Will. 5 I direct that no fiduciary acting hereunder shall be required to enter any security or bond in any jurisdiction in which such fiduciary may act. IN WITNESS WHEREOF, I have hereunto set my hand and Neal this~,.gday of ~~ /~ , 20 ~" i~ BILL SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testator as and for his Last Will and Testament, in the presence of us, who at his request, in his presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses. Name ~~ ~ ~~ ~ ~ G~ire.,.~..y- Address ~~ C~ )~ ~~ Name Address 6 Acknowledgment State of County of I, Ray Brechbill, the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed day o~~ RAY BRE Notary Public ~ State of County of ~d before me by ~Ci.~ ~~~'~C-~1 ~J~ (( ,the testator, this 200. NOTARY PUui_( U° Pv:_V'a~ . ~~ t~i;;:~'~~Y 1'dy Commission Expira~ ~~4y 2 , ZG~4 Affidavit We, ~ ~- v,. ll . ~ t ~~~ ~ ~ ~~~~ and ,~o p~~~~20,,,~~p the witnesses whose names are signed to the attached or foregoing instrument, being duly quah~.fied according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his Last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Witness Witness Sworn to or affirmed and subscribed to before me by ~~~~ c,3~e~ h k'- ~ M; and ~-~~ n ~ . ~~~ C h h i (~ ,witnesses, this 2~~ day of _~l-z; ~~" 20~~. - I~ C~?CL Pv~, sf,r~~,~^ j,~,~ ( ~~ , N©TARY PUtsL(C OF N~V'd Jf~R;~~Y Notary Public MY Commission Expiras lay 2g, 2C04 7