HomeMy WebLinkAbout08-13-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Harriet June Piontkowski
also known as
COUNTY, PENNSYLVANIA
File Number ~I ~~`^•'- -~~~`~
Deceased Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.) ~ ~'
r"._l .~;
c~:~
Executors ~ ~ {_-~
® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the - ; , 'T' named in the
last Will of the Decedent dated December 22 2002 f _ -
> and codicil(s) dated ' ~' t._ <..~
(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 c~1~te instrum`' tint(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: No exceptions ~7% ~~~
® B. Grant of Letters of Administration
(If applicable, enter: c. t. a.;d.b.n.c.t.a.; pendentelite; duranteabsentia; duranteminoritate)
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
(COMPLETE IN ALL CASES:) Anach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
509 Francis Drive, Mechanicsburg (Susquehanna Township), Pennsylvania, 17050
(List street address, town city, township, county, state, zip code)
Decedent, then 77 years of age, died on July 25, 2008 at Carolyn Croxton Slane Residence located in Susquehanna
Township, Dauphin County, Pennsylvania
Decedent at death owned property with estimated values as follows
(If domiciled in PA) All personal property $ 325 , 900.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $_ _ ~ . ~~
situated as follows: None
Form RGf'-02 rev. 10.13.06 Page 1 Of 2.
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:
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA ZQ~'~ ~~~~ _ ~ ~~ i~. I
SS
COUNTY OF Cj),X,fYI~'P~ ICJti`1(~ .
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true `and egrreet;tii'tfiehest of
-
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitiotrer(sjwvll'vvell and~tiu~}~ ~'~~
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~{~ day of
II a~~
~_ M~~
Fpr~the~Register~
File Number:
of
Signature of Personal Representative
Signature of Persona! Representative
Estate of Harriet June Piontkowski
Social Security Number:
Deceased
Date of Death: July 25, 2008
AND NOW, , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Frank J. Kelly and Dorothy J. Martin
in the above estate
and that the instrument(s) dated December 22, 2002
described in the Petition be admitted to probate and filed of record.as the last Will (apd Codicil(s)) of Decedent.
FEES
Letters ............... $ ~V~Q~-
Short Certificate(s) .. ~... $ ~,.
Renunciation(s) .......... $
.11 ... $ IS-~jQ
~'~~ - - - $ ~° l~
... $
... $
... $
._. $
--- $
--• $
TOTAL .............. $ ~'J 0.00
1 Registernof GIs ~ ) {' ~~Y~6"'1`L'
K, ~/ ~sz~~~ J
Attorney Signature: O
S p en P. Paschall, Esquire
Attorney Name: Ju is Varholla, Esquire
b6 18 (SPP)
Supreme Court I.D. No.: 828 (JV)
Address: Lovett Bookman Harmon Marks LLP
Fifth Avenue Place, Suite 2900
120 Fifth Avenue, Pittsburgh, PA 15222
Telephone:
412-392-2220
For,,, RW-02 ,~~. /o.13.0<, Page 2 Of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
. SS
,, ~ ~.
COUNTY OF ~~~,11"l'l~+f ~r"lC~ ,~ ~"~;~ ~~'_' a 1 .~ ~';+ ~~ 1 • ~ ~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are {~~-and (correct to the best of
the irnowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, P~ri~i'wxer~s) wi(i va~l't'a~ac~ truly
~, 1. r'.
administer the estate according to law.
Swom to or affirmed and subscribed
before me the h day of
y~
~ ~'~
~-
~ r the £cegister
Signature of Personal Representative
Signature of Personal Representative
File Number: ~-~ ~ ~~~ r ~~~C~
Estate of Harriet June Piontkowski
Attorney Name:
Social Security Number: 190-24-5867 ~jff~~ Date of Deatli: July 25, 2008
AND NOW, _ ~~ , ~W~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before m , IT IS DECREED that Letters Testamentary
are hereby granted to Frank J. Kelly and Dorothy J. Martin
and that the instrument(s) dated December 22, 2002
described in the Petition be admitted to probate and filed of record as the last Will~~an~~d~~(
FEES (.(JU'~
Re
Letters ............... $ ~ .
Short Certificate(s) . lam.... $ 1-~Q_ ~L1 Attorney Signature:
Renunciation(s) .......... $
~.~tt --. $ I~~.~
Form RW-02 i~ev. 10.13-06
C ... $ 1'0 . ~-'j0
... $
... $
... $
--• $
--~ $
--~ $
0.00
TOTAL .............. $
Supreme Court I.D. No.:
of Wills
Deceased
its the above estate
S hen P. Paschall, Esquire
ul a Varholla, Es uire
60 8 (SPP)
9. 28 (JV)
Address: Lovett Bookman Harmon Marks LLP
Fifth Avenue Place, Suite 2900
120 Fifth Avenue, Pittsburgh, PA !5222
Telephone: 41.2 - 3 9 2- 2 2 2 0
Page 2 of Z
OCAL REGISTRAR'S CERTIFICATION OF DEATH •.dg ~~
WARNING: It is illegal to duplicate this copy by photostat or photograph.
1 Fee for this certificate. $6.00 its is to certify that the information here given is
rrectly copied from an original Certificate of Death
ly filed writh me as Local Registrar. The original
rtificate will be,~forwarded to the State Vital
cords /F')~ficy~ fir ennanent filing.
h }/ J ~~ tl• FrF f)
REV II _'006
PRWT tN
1WNENT
i'K '.NK
P 1489070 •~`~~~~ :1,~~~
,`
Certification Number >J,~cal Re~isll•ar Date ]slued "
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ "`
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER I
t Name G Dxacerv Ifuy inidde. lay, suthxl 2. Sex 3. Socna15ecumy Namur a. Data WDyiarls N, aay. year)
'~°A
~
Harriet June Piontkaaski Female 190 - 24 - 5367 Jul..,-25, 2008 ~
6 Aga iLasl Bin'-]ayt UrvIM 1 yea 1h10er 1 bay 6. Data o7 8rnn IMOnM. Oay, year) 7. &nnplate ICrty an0 iUla ur Ioee~9n counlryl 8a. Plxe OI Deans ICneck JMy onel
tavWrc Oars nws yaninM NOSDiIar. 0111ar'. l ~.
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77 ~rs 6/ 30 / 1931 Pittsburgh, PA ^ mpallenl ^ ER ouypabem ^ DOA ®Nuysxfg Nana ^ RaSrder¢a ^ana
.
spaarY
6o Ca.nry cr ~=e.;tn &. City. Boro. 7wp. of DeaN BC. Facairy Name 111 rot nsururan, ryve Boreal and numcerl 9 Wei Decor fem of Nlspanc Cngin? ®No ^ Yes 10. Rxs'. gr^ancan'vndan, Bladt. W'.liro. ak.
pl yes, speclry Cuoan, ISpea':rYt
Dauphin Susqueharu~a 7wp Carolyn Craxton Slane Residence Meucan PuenpRran etc, White
't Ce<edenl; ~_,.al \:uwaon ,N~nd cl wept a cne a w. mcst a was. ive. Co riot Blare retrial 12. Was Decedent zver in Ne 17 Decedent s Education ISpecM only ngney grade i:cmpi zlcp Is Marnai Su;ui: Maned. Nevis Manned, t6. Surviving `.gc uaa III wore. qve rwaen name)
ream yr waw Krq a Busriess ~ Inuustry U.S Arrtlad Faces' Elementary ; Sxondary tU-72) Cuneye ll-0 or S.l WWS"~~ Owaced r5Vec1M
Baskin ^ Ye5 4Np 12 Divorced
16 Decadent s Awling Aadess t9rear..irY .town. ;late, t.p oaael Decedent's Dia Decedent
509 Francis Dr t]c~Yes. Decedent Lved in ]S(p1Pl'7anna 7wp,
AcWal Residence I'a. Slate FPnnS~Vanla ca~s
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Mechanicsburg, PA 17050 I-b cpnnn~lnhin
AGlual Llmn$ of Cp / Bao
' 3 EaN"r i Noma iFdst .made. easy. sudnl 19 Monier s Name tFrst. mdlNe. maiden iumdmey
James A. Richardson Harriet Ma Kelly
?Oa lnWimantS NanWnType Pnntl 200. InbrtMnl's Maury Address lSlreeL:itytown. iara. tp codel
Frank Ja Kell 719 Seth Dr. Cranberry 'IWp., PA 15212
.'a Mempd _t ~SpOS:wn ~Crertiavan ^ Daldllal 2111. Date of Dispo 00n eMdnm. day teary 21c, Pldca ul Disposilwri lNama a cemetery. uemalury or aIMN pMCe) 21d Lxalwn ICiry town yarn. tip codel
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^ Du>er . Stc~~,A. by Wdcal Examiner /Coroner? ^ Yes ^ No ,
y Squrure cl Fw.er person acrrng as sucnl 220. License Number 22c. Nana arq AdMezs of FanMy Hetrie Funera Home, Zne.
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~~ 26. Was Case Rzteued' Medical Examner ~ Cacner for a Reason net :Pan Gemabcn a DOnabon?
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WTLL
OF
HARRIET JUNE PIONTKOWSKI
.a_
,_:,
I, HARRIET JUNE PIONTKOWSKI, of Cumberland Cous~~~, `_~
,- ~ --
Pennsylvania, make this my Will, hereby revoking any and:.;a1'1 ~~=
wills and codicils heretofore made by me. ..
,_-~' z
~ ..
ARTICLE I ~,,.>
Payment of Debts
I direct that my debts and the expenses of my last
illness and funeral be paid out of my estate as soon as may be
convenient after my death.
ARTICLE II
Tangible Personal Property;
Identification and Exercise of Power of Appointment
(A) I direct my Executors to distribute my tangible
personal property, together with any policies of insurance
thereon, in accordance with a writing (if any} signed by me,
which writing may be made and changed from time to time by me
after the execution of this Will. I bequeath so much of such
property not effectively disposed of by me by the terms of such
writing, together with any policies of_ insurance thereon, to my
children, FRANK J. KELLY and DOROTHY J. MARTIN, who survive me as
each of them may select and in such shares, whether equal or
unequal, as they may determine. Any property not so selected
shall be sold and the proceeds added to my residuary estate. My
Executors shall make prompt disposition of my tangible personal
property in accordance with this paragraph and shall pay from my
PG FRB-70 i3~ 13 ('~-t rnSC ~,POF
residuary estate all reasonable costs incurred by my Executors in
connection with the maintenance, transportation and sale of such
property.
(B) My aunt, DOROTHY M. KELLY, in Paragraph
Seventeenth of her Will dated October 29, 1996 ("Will"), created
the Harriet June Piontkowski Trust for my benefit ("Trust") By
the terms of subparagraph (A) of Paragraph Seventeenth of the
Will, I possess a limited testamentary power of appointment over
the property of the Trust, to which power of appointment I hereby
specifically make reference. I hereby exercise such power of
appointment in full and direct the Trustees of,the Trust to
divide all property subject to such power of appointment into as
many equal shares as there are, to set apart one of such shares
with respect to each of the, children of the mine then living and
children of mine then deceased but with issue then living and to
hold, administer and dispose of such shares as follows. Each
share so set apart with respect to a child of mine (whether then
living or deceased) shall be held in a separate trust for the
benefit of such child or such child's issue, as the case may be,
in accordance with the subsequent provisions of this paragraph.
In the event the separate trust is created for the benefit of a
living child of mine ("such child"), the Trustees shall quarter-
annually distribute the income of the separate trust to, or
expend the same for the benefit of, such child for life. The
Independent Trustee may at any time and from time to time during
such child's life distribute the whole or any part of the
principal of the separate trust to, or expend the same for the
benefit of, such child, all as the Independent Trustee may
determine for any reason or purpose whatsoever. Upon the death
of such child, if such child is not survived by issue, the
separate trust shall terminate and the Trustees shall distribute
-2-
the trust estate of the separate trust to m:y issue then living,
per stirpes; provided, however, that any property thus
distributable shall be added to such issue's separate trust or
separate grandchild's trust hereunder, as the case may be, if the
same is then in existence. Upon the death of such child, if such
child is survived by issue, or in the event the separate trust is
created with respect to a deceased child of mine, the Trustees
shall divide the trust estate of the separate trust into as many
equal shares as there are, and shall set apart one of such shares
with respect to each of the, children of such child then living
and children of such child then deceased but with issue then
living. Each share so set apart for the issue of a deceased
child of such child shall be distributed to such issue, per
stirpes. Each share so set apart for a living child of such
child shall be held in a separate grandchild's trust for the
benefit of such living child ("such grandchild") The Trustees
shall quarter-annually distribute the income of the separate
grandchild's trust to, or expend the same for the benefit of,
such grandchild for life. The Independent 'Trustee may at any
time and from time to time distribute the whole or any part of
the principal of the separate grandchild's trust to, or expend
the same for the benefit of, such grandchild, all as the
Independent Trustee may determine for any reason or purpose
whatsoever. Such grandchild may withdraw free of trust the
entire trust estate of the separate grandchild's trust at age 45.
In the event such grandchild is at the time of the establishment
of the separate grandchild's trust older than the age of 45, such
grandchild shall have the right from and after such time to
withdraw the entire trust estate of the separate grandchild's
trust. Any such withdrawal shall be made b~y written request
therefor delivered to the Trustees at any time after such
grandchi.ld's attaining the age of 45 years. The separate
-3-
~ f
grandchild's trust shall terminate upon the death of such
grandchild and the Trustees shall distribute the trust estate of
the separate grandchild's trust to such grandchild's then living
issue, per stirpes.
ARTICLE III
Residuary Estate
I devise and bequeath all the rest, residue and
remainder of my estate, real, personal and mixed, wherever
situate, to the HARRIET JUNE PIONTKOWSKI REVOCABLE TRUST.
ARTICLE IV
Taxes, Debts, Expenses and Bequests
(A) I direct that (i) all federal estate taxes and all
local, state and foreign estate, inheritance, transfer, legacy,
succession and similar taxes which by reason of my death may be
properly imposed upon, applicable to or payable with respect to
any property or interest in property which may be included as
part of my estate for the purposes of such taxes, or any one or
more of them, including any property that may not be a part of my
estate for administration purposes, and (ii) all generation-
skipping taxes (if any) payable at my death with respect to all
transfers of property constituting direct skips (as defined in
Section 2612 (c) of the Code) of which I shall be the transferor
other than a direct skip resulting from a disclaimer or to the
extent a GST exemption is claimed with respect thereto, and any
interest and penalties on any of the same, except (i) the
additional amount of any of such taxes resulting from the
inclusion in my estate for the purposes of any such tax of
(a) property not included in my estate for administration
-4-
purposes to the extent that a governing insl~rument directs the
fiduciary or other legal owner thereof to pay from such property
a share or portion of such taxes, or (b) property over which I
may have a power of appointment, which power was given by someone
other than myself, or (ii) any generation-sipping tax except as
otherwise specifically provided herein, or any interest or
penalties on any of the same, shall be paid from my residuary
estate passing under Article III of this Will, or, in the manner
hereinafter provided, from the trust estate of the HARRIET JUNE
PIONTKOWSKI REVOCABLE TRUST.
(B) I have directed the Trustees of the HARRIET JUNE
PIONTKOWSKI REVOCABLE TRUST to pay from the trust estate of such
Trust to my Executors, or pay in such manner and at such time as
requested by my Executors, the amounts which my Executors shall
request in writing as necessary or advisable to supplement my
probate estate in order to pay in full the taxes described in
paragraph (A) of this Article, any interest and penalties on any
of the same, debts, expenses of administration of my estate and
all bequests. I authorize my Executors to request such Trustees
to make such payment if and to the extent that my Executors shall
deem it necessary or advisable to have all or any part of such
taxes, interest and penalties, debts, expenses of administration
and bequests paid from such trust estate rather than from my
probate estate.
(C) My Executors shall have full power and authority
to make the allocation of the GST exemption in such manner as my
Executors shall deem to be in the best interest of my estate and
the beneficiaries thereof, and any determination made in good
faith by my Executors with respect to such allocation shall be
binding and conclusive upon each person having an interest in my
-5-
estate and shall not be subject to question or exception in any
manner or proceeding whatsoever or by any pE=rson whomsoever.
Z~ R T' T ('' T. F' S 7
Executors
I hereby appoint my son, FRANK J. KELLY, and my
daughter, DOROTHY J. MARTIN, as Executors of this Will. In the
event of the inability or unwillingness of either of my said son
or my said daughter to serve or to continue to serve as such an
Executor, the remaining Executor shall serve as sole Executor
hereunder. In the further event that neither my said son nor my
said daughter is able or willing to serve or continue to serve as
such an Executor, I appoint MELLON BANK, N..A., as successor
Executor. In the event that at any time there is one Executor
serving hereunder, references in this Will to Executors shall
mean such Executor.
ARTICLE VI
Powers of Fiduciaries
(A) I give to each fiduciary serving under this Will
(whether or not named herein) in addition to the authority
conferred by law and without the necessity of obtaining the order
of any court the following powers: to retain any property
received in kind; to sell, pledge, mortgage, lease for any term
whatsoever, exchange and dispose of, either publicly or
privately, any or all property, real, personal or mixed, at such
times and for such prices and amounts and upon such terms and
conditions as such fiduciary may determine; to invest and
reinvest in such stock, bonds and other real, personal or mixed
property of whatsoever character as such fiduciary may determine,
-6-
all statutory and other limitations now or Yiereafter enacted or
in force being hereby waived and without such fiduciary being
subject to any liability by reason of the keeping of any cash
uninvested for any length of time; to exercise any option that
may be owned by me at the time of my death; to borrow money; to
compromise and settle claims; to determine income and principal
and to allocate receipts and disbursements (including without
limitation gains and losses) as between income and principal, all
as such fiduciary determines to be advisable under the
circumstances; to continue any business, incorporated or
unincorporated, in which I may have had an :interest at the time
of my death for such period, or to liquidate the same at such
time and upon such terms, as such fiduciaries may determine, to
invest additional sums in any such business even to the extent
that the estate may be invested largely or ~°ntirely.in such
business, to act as, or select other persons, including any
fiduciary, officer of any corporate fiduciary or any beneficiary
hereunder to act as, directors, officers or employees of any such
business, to pay compensation for so acting without regard to
whether the person so acting is a fiduciary, an officer of a
corporate fiduciary or a beneficiary hereunder, and to make such
other arrangements in respect thereof as such fiduciaries shall
determine; and to make any distribution or division of property
either in cash or in kind, or partly in cash and partly in kind,
and to allot different kinds of, or interests in, property to
different shares, all as such fiduciary shall determine to be
equitable to effect any such distribution. The powers herein
given to such fiduciary shall include the power to retain and
invest in common trust funds maintained by any corporate
fiduciary, the securities of any corporate fiduciary, interest-
bearing accounts in, or certificates issued. by, the banking
department of any corporate fiduciary, and securities
-7-
underwritten by syndicates of which any corporate fiduciary is a
member but not purchased from such corporates fiduciary, and the
stock of any corporation which controls or i.s affiliated with
such corporate fiduciary, provided, however, that any fiduciaries
shall vote the shares of stock of any corporate fiduciary or of
any corporation which controls or is affiliated with such
corporate fiduciary only as directed by the individual fiduciary,
or, in the event there shall be no individual fiduciary then
serving, by an adult beneficiary of the fiduciary account in
which such shares are held.
(B) No bond shall be required in any jurisdiction of
any fiduciary serving under this Will (whether or not named
herein), including any administrator c.t.a. or ancillary
administrator appointed to administer my esi~ate, or, if a bond is
required by law, no surety on such bond sha:11 be required.
(C) In the event any expense of administration of my
estate shall, at the option of my Executors, be deductible either
in computing any federal income tax payable during the
administration of my estate or in computing the federal estate
tax payable with respect to my estate, my Executors shall
exercise such option as my Executors shall deem to be in the best
interests of my estate and the beneficiaries thereof. In the
event any such expense is deducted for federal income tax
purposes, my Executors may, but shall not be required to,
transfer from income to principal an amount equal to the
additional federal estate tax which my estate may be required to
pay by reason of the failure to claim such expense as a deduction
for federal estate tax purposes.
-8-
h
(D) I authorize my Executors to disclaim in whole or
in part any property or interest therein pa~:sing to me or to my
estate by reason of a testamentary or inter vivos transfer or an
intestate disposition or by any other means.
ARTICLE VII
Certain Definitions
(A) References at any particular time to Sections of
the Code shall mean the specified sections of the Internal
Revenue Code of 1986, as amended, or the corresponding provisions
of any future United States internal revenue law.
(B) "GST exemption" shall mean the generation-skipping
tax exemption amount allowed to an individual pursuant to Section
2631(a) of the Code.
(C) "HARRIET JUNE PIONTKOWSKI RE`JOCABLE TRUST" shall
mean the trust created under the Declaration of Trust entered
into by me on even date herewith (but executed prior to the
execution of this Will) as the same may be amended at any time
after the execution of this Will, or, in thy? event that such
Declaration of Trust shall not be in effect at the time of my
death, such term shall mean a trust, the terms and conditions of
which shall be the same as those specified in such Declaration of
Trust as the same existed at the time of the execution of this
Wi11 or of the last codicil hereto (which terms and conditions
are incorporated herein by reference with like effect as if the
same were set forth herein verbatim) and the Trustees of which
shall be determined in accordance with such Declaration of Trust.
-9-
(D) "Independent Trustee" shall mean at any particular
time with respect to any trust such a Trustee as at such time
(i) has no interest, vested or contingent, direct or indirect, in
the trust estate of such trust, (ii) cannot be benefited by the
exercise or nonexercise of any power, authority or discretion
given exclusively to or vested exclusively i_n the Independent
Trustee by the provisions of this Will or by law, (iii) can alone
(as though such Trustee were the only Trustee) possess and
exercise each such power, authority and discretion without
causing income or principal of the trust estate of such trust to
be attributable to any beneficiary of such trust for income or
gift tax purposes, or for estate tax purposes under the United
States internal revenue laws in force and effect at such time
prior to the time such income or principal is distributed to or
for the account of, or used or expended for the benefit of, such
beneficiary. If at any time there shall be more than one
-10-
r
Independent Trustee acting as Trustee of such trust, the term
"Independent Trustee" shall mean all such Trustees.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this J~~ day of ,~~~,~v _, 2002.
'~
~ / ,~~~ ~ ( SEAL )
RRIET~1 E PIONTKOWSKI
V
SIGNED, SEALED, PUBLISHED and DECLARED by the above-
named Testator, HARRIET JUNE PIONTKOWSKI, as and for her Will, in
the presence of us who, at her request, in her presence and in
the presence of each other, have hereunto subscribed our names as
witnesses.
l~ R""'
Address='~ j,3 ~"!-~~/Ye~S ~`; . Address /5"g'(f ((/~`~~tMnS ~r(ll.~{ ~~ #~ 3~
/~l~"C~/~~~i'CSi3 u~ G, ~,9P ~ ~a_5"a ~7'j ~ ~~ /70 SS
-11-
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
~G1/7~,1~r ~l~/yO( COUNTY, PENNSYLVANIA
Estate of ~~r/"/e f' ~~ / la ~~~~~~/ ~ ,Deceased
,~~ ~~ ~Nc ~4H ~ ~ and r ~ ~~~ ~y l () I -T ~~ _
(each) being duly qualif~~ie""d according to law, depose(s) and say(s) that, he the was ;~ ere well-
acquainted with T7~t~'/'/~~" ~~G/~ ~on1i'~~~~/~j ~ and a are miliar
with the handwriting and signature of the decedent, and that the signature of ~~'/~~' ~~ ~oN~o~~~
t~~o11the foregoing instrument purporting to be the Last Will and Testament/Codicil of
/lki~r/e7`Z/^L~it~ ~~~~~~ is in h~ her wn proper handwriting.
(Sig~uture)
,~~ ~.~~s 1~ri ve
(Street Address)
/~~c~tiV/c~sba%~ ~/}- l ~~s0
(City, State, ZipJ
Executed in Register's Office
Sworn to or affirmed anti subscribed
before me this
of
day
~~s~~~
of Wills
(Signature)
~~ IY~mc~~ Street
(Street Address)
~-~ 13C~ ~ ~ 11 11 ~-
(City, Stare, Zip)
rj
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Form RW-04 rev. !0.13.0(