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HomeMy WebLinkAbout01-12-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Mabel Givens Cox File Number ~\ d~ ~~~~ also known as Mabel G. Cox Deceased Social Security Number 222-18-9228 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 Executor /Executrix named in the last Will of the Decedent dated October 11, 1999 and codicil(s) dated (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 probate, was not the victim of a killing and was never adjudicated an incapacitated person: © B. Grant of Letters of Administration '"'~ (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durance absentia; dur~Ate minoritate) ~~ _r ~ ~`'~ - -~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse,,(if any) attd,heirs: ~Ff ,l3 .4dm;nicrrntinn c ta. nr d.h_n.c.t.a.. enter date otWill in Section A above and complete list ofheirs.) ~ "'~ O (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Petmsylvania with his /her last principal residence at 403 Reservoir Road Mechanicsburg PA 17055 (Gist street address, town/city, townshtp, county, state, zip code) Decedent, then 83 years of age, died on December 20, 2008 at Holy Spirit Hospital, East Pennsboro Twp, Cumberland County PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~f,/~~ ([f 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 fol 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: or printed name and residence Cynthia L. White 130 Pine Street, Dillsburg, PA 17019 Form RW-02 rev. 10.13.06 Page I Of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND , The Petitioner(s) abave-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. ? ,~ _ Sworn to or affirmed a~ttl subscribed L ~'' - Si tore of Persona! Representative ~~' before me the _ ~ ~-day of (~ c -- / ° ~ ; W= u'~ l' ~Z~ ~ ~ / Signature of Personal Representative r (n ~~ y 0 .' ~) i j -' '•`- g Far the Reglstei Signature of Personal Representative _ T ~ -•' - _~ .. ~ - ..... File Number: ~, \ ~ ~~a~ Estate of Mabel Givens Cox Social Security Number: 222-18-9228 Nh AND NOW, ~ - - (.~~~ , ~_,!n -~*-n ~ ~ ~ having been presented before~rhe, IT IS DECREE at Letters /Fj` are hereby granted to Cynthia L. White in the above estate and that the instrument(s) dated ~~ 1~~ described in the Petition be admitted to probate and filed o FEES DO Letters ....~r .7 vG~ ... $ ~ ~U Short Certificate(s) .. `~ .. $ a Q Renunciation(s) .......... $ (~il~ ... $ !5 ... $ ... $ ... $ Deceased Date of Death: l2/20/2008 the foregoing Petition, satisfactory proof /Z ~ ... $ ... $ ... $ TOTAL .............. $ 1~,, '~~ Attorney Signature: Attorney Name: Supreme Court I.D. 1` Address: Telephone: Form RW-02 rev. 10.!3.06 pagie 2 Of 2 .GCAL. I~EGISTRAR'~ C~RTIF'ICATIta1V G1= C~TI-I ~1lARi~il\1{a: !t is illegal to duplicate this copy by photostat or phott~gr~ph. ~ 150C~0~~7 REV 11/2006 PRINT IN naNENr CK INN ll11 , A Ia~ P ) ~ ~E ~ ~ i )>>~.:~ t k tti l.~ih 1 cL _ _ '~,kr`~ ~y _ _ ' ,'~ i ~~~ ~jlut "-it + t~ t ~ M I ~ ',L ~t ~~i ~ ~' r ". ail ri~c.'ti:°!1.~'~ ~ ~f~ 1~.._ u '! t ,f' `ji[ f '}r' ~~~ _ ~~ rtl G ~ DEC 2 2 2008 "°9i , <-~+~P ,~ ' '"~ n~2,- ~ L ~ r t ~ ,. E"lT ~ ~~ = - - _ _ ___ _ _ - - ,~ ,,>, ~- E_k _,~! 1~ ) ~)~. . ,t xi rv r~ cQ =; ~ ~--- - .z~ -- ..~ :~ = mar art - _ ~ - ,` ~ C~ - ~ C:~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) ____ _. _._ _ ___ ~ \ (~~~ ~",t`r`.~1 1. Name of Decedent (first, middle, last. suflixl 2. Sex 3. Social Security Number 4. Date of Death (MOnlh. day, year) y Mabel Givens Cox F 22 - 18 .L 9228 December 20, 2008 5. Age (Last Birthday) Under 1 year Under 1 day 6. Date of einn (MOnlh, day, year) 7. Sinnplace (City and state or loreign country) 8a. Place of Death (Check onty one) 83 "°"°` nay "°"`~ ""'°°"~ August 30, 1925 Bethel DE HOep"al' omen Vrs. , Inpatient ^ ER / Outpatient ^ DOA ^ Nursing Home ^ Residence ^Otne~ Specity 6b. County of Death 6c. City, Bore, Twp. of Death 6tl. Facility Name (If not Institution, give street and numtxr) 9. Was Decedent of Hispanic Origin? ~ No ^Ves 10 Race American Inb an Bl k Vvn Cumberland East Pennsboro ~P ~ . ac . ne, etc. Hol S irit Hos ital (If yes.aDe°dycuba", Ispe~nyi y P P Mexkan P°enc Rican. ¢tc) White n. Dec¢den~s Usual Occu Lion Klnd o' work done Burin moss of w°rkin life. Do not state retired 12. Was Decetlenl ever in the t3. Decedent's Education (Specify only highest grade completed) 14. Marital Status: Married. Never Maned 15. Surviving Speuse ill wife ive maid n Kind of Work Klnd of Business I Industry AcconIItaIIt Manufacturing . , g e na:nei U.S. Armed Frorrggces? Elements /Second Widowed, Oivometl (Specity) ^ves LINO ry ary (0-12) Co ege (t-4 or 5i) Widow 1E. Decedent's Mailing Address (Street, city /town, slate, zip code) Decedent's Did Decetlenl Pennsylvania 405 Reservoir Road Actual Residence 17a. Slate Live Ina 17c Ves, Decedent Lived .n r r ^ Mechanicsburg Pennsylvania 17055 w . mwnanip? 77h. County 17d. ~] No, Decetlem Lived within Cumberland h , aaualumita°t M r• ani Gburg ;,,,y e°rn 78 Famer's Name fFlrsl, middle, lass, suffix) 19. Momer s Name (Fir t fiddle maiden surname) Andrew Givens . Viola A~~en 20a. Informant's Name (Type /Print) 20b, Informant's Mailing Address (Street, city /town, state, zip cotlel Mrs. Cindy L. White 130 Pine Street, Dillsburg, Pennsylvania 17019 2ta. tnelhotl of Disposllion Cremation ^ Donation ~~ 21 b. Dale of Disposition (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other prate) 21 d- Locetien (City /town, slate rip coder ^ Burial ^ Removal from State ! Was Cremation or Donation Authorized DeC 23 2008 . ~d ^ Other-Specity j byMedicalEzaminerlCOroner? tyYes^NO , CrematlOn $OClet of PA Harrisbur , PA 17109 22a. re of tneml ServiceALicensee}o(person acing as 3uc~ 220, Ucense Number 22c Name and Address of FacililyAlleT (x,TematlOII Services of Penns lvania l ., VVlti1 \r~ l,~.nn/~••v-'G 138453 y , IIC. 4100 Jonestown Road, Harrisburg, Pennsylvania 17109 Comp(e Items 23ac only when cenitying 23a. To the hest of my knowledge, death occurred at the time, dale and Dlace stated. (Signature and title) 23b. License Number 23c Dale Si ned (Month r. da physician is not available at time of tlealh to . g . y. yea certity cause of death. Items 2426 must he wmpletetl by person 2a. Time of Death 26. Date Pronounced Dead (Month, day. year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other than Cremation or Donation wnn pr°n°"n`ea Beam. 10:55 aM. December 20 , 2008 ^vea ^Np CAUSE OF DEATH (See instructions and examples) t Approximate interval. Item 2i. Pan I: Enter Ine chain of events -diseases, injuries, or complications -that directly caused the death DO NOT enter terminal events such as cardiac arrest Pan II'. Enter Omer sionilicant conditions conlnbutine to tle~u, 2B. Did Tobacco Use Contribute to Death? . , Onset to Death respiratory arrest, or venmcular flbrillalion without showing the etiology. List only one cause on each line. r but not resulting in the underlying cause giver In Pan I. ^Ves ^ Probably ( r IMMEDIATE CAUSE Final disease or n ^ No ^ Unknown [ d V~ r condMlon resulting In death) (I 1 Y1 ('i{" ~ a ~~ : •; ~~ ~ 7' •~ C1 1" ~ ` C ~ r ~ 29. If Female: - . t . - •. 2a C c 1 I n S I 1 Due to (or as a consequence ol): ^ Not pregnant wgmn pass year Sequentially list contlifions, d any, b. leading to me cause listed on line a. ^ Pregnant at lime of oea:n Enter the UNDERLYING CAUSE Due 1° (or as a consequence ol): ^ N°t pregnant. bv1 pregnant within a2 days (tliaeaae or Injury Thal nitlatetl me events resulting to tlealh) LAST. of Beam Due to (or as a consequence oq: ^ Not pregnant. bat pregnant a3 days ro I year 0 before Beam ^ Unknown it pregnant rnlNn me pa51 ya2' 30a. Was an Autopsy 30b. Were Autopsy Findings 31 ManPer of Death 32a. Dale of Injury (Month, day. year) 32b. Describe Haw Injury Occurred 32c. Place of Injury: Home Farm Street Facrn Performed? Avalable Prior t° Completion ~ []'frawral ^ Homicide , , ry OAlce Building, etc iSpecily of Cause of Death? ^ Yes [,~l N° ^ Ves ^ No ^ Acndenl ^ Pending investigation 32tl. Time of Injury 32e. Injury al WOrk? 32f. if Transponalion Injury (Specity) 32g. Location of Injury (Street city /lows. stafel ^ Suicide ^ Could Not be Determined ^Ves ^ No ^ Driver /Operator ^ Passenger ^Petleslnan M ^Other ~ Specity: 33a. CeniM1er (check only one) 33b. Signature and Title of Cedifier / itying cause of dealn when another physician has pronounced deem and completed Item 23) • yt cl n ~ p 1`~'4~L't To the best of m knowledge tleat y hoccurred due!o the cause(s)and manner as stated_________________________________ ^ . ~ >•'"- ~\ • Pronouncing and cenitying physician ;Physician both pronouncing death and terrifying to cause of death) To the best of m knowled e death occurred at the time d m l d d d t th ^ 33c. License Number ~~• 33d. Date Signed (Month. day. yeaq y g . , , an a D ace, an ue o e cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medical Examiner /Coroner ~rJ't ~ Q ZZ ~ ~' (~? ~ ~ ' q On the basis of examination and / or investigation in m opinion death occurred at the time date and lace nd d t th d ^ _ ~ , y , , , p , a ue o e cause(s) an manner as stated_ ~ Name a n d Addressaof Person Who Completed Cause of Deam (hem 27) Tyne; Print ~~ ~ 35 Registrar's Signature p slrs t N umher Dale File (Momh 36 d ear) // ~~ ( l.; °t ~''h- ~ ~^.lY~ rri ~„'~ rA'~EnS •t?~ / / ~ ~ ' ~ ~~ ~ ~ ~ ~ ~ ~ l ~ii c ~ ~ . , ,y G l ~ ~ . Y/C.i /2L/1Z-fJp r ~ v~L ~ O ~_ l ( c7 i. ^~ ~ -~-___ -- x Disposhion Permit nlo- 0309219 _ I~I't~''"`q't"'"°:.~' ~ .~>^~j t~:.~ ~~f ~ `•'~ ~~ G~L~1 ~a ~ ~_~ ~: cT~ .~, LAST WILL AND TESTAMENT - ~;:.~,-- ~-- OF , r ,-r ~ MABEL G. COX - : ~;;~~~ ~a --,w - --_ _~ =~ cxa IDENTITY "" °-" c~ I, Mabel G. Cox, residing in the County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other and former Wills and Codicils to Wills heretofore made by me. All reference made herein to "spouse" or to "my spouse" refers to the person to whom I am currently married, namely, Essell T. Cox. My children are David L. Cox, Cynthia L. White, and Brian T. Cox. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to my Living Trust as a result of the "ASSIGNMENT OF FURNITURE, FURNISHINGS AND PERSONAL EFFECTS" signed this date. If there is any question regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Living Trust in accordance with the provisions of the section titled "Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devises), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me, which is known as "The Cox Family Trust, dated October 11, 1999, Essell T. Cox and Mabel G. Cox, Trustors and/or Trustees." The Trustee shall add the property bequeathed and devised by this Item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before my death. If for any reason the said Trust shall not be in existence at the time of my death, or if for any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said Trust as it exists at the time of my death to be invalid, then I give all of my estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their substitutes and successors under the Trust, described hereinabove, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms, trusts and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, Cox Last Will and Testament ~ Copyright The Estate Plan® 1999 All Rights Reserved. Pagc I hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. PRIVACY OF TRUST No Clerk of Court, Commissioner of Accounts, or other party (except my Executor, Personal Representative, or other Fiduciary of my Estate, and a Beneficiary of my Estate or Guardian or Fiduciary of such Beneficiary), dealing with a Trustee in relation to The Cox Family Trust, dated October 11, 1999, Essell T. Cox and Mabel G. Cox, Trustors and/or Trustees, will be obligated or privileged to see that the terms of the Trust have been complied with, to inquire into the authority, necessity or expediency of any act of a Trustee, or to inquire into any of the terms of the Trust, except when permitted by the Trustee. EXECUTOR I hereby nominate and appoint Essell T. Cox, as Executor of this my Last Will and Testament to serve without bond. In the event the first named Executor shall predecease me, or is unable or unwilling to act as my Executor for any reason whatsoever, then and in that event I hereby nominate and appoint Cynthia L. White to serve without bond as Executor (Co-Executors if more than one person). In the event the second named Executor shall predecease me, or is unable or unwilling to act as my Executor for any reason whatsoever, then and in that event I hereby nominate and appoint David L. Cox to serve without bond as Executor (Co-Executors if more than one person). In the event the third named Executor shall predecease me, or is unable or unwilling to act as my Executor for any reason whatsoever, then and in that event I hereby nominate and appoint Brian T. Cox to serve without bond as Executor (Co-Executors if more than one person). When more than one person is named with others to act as Co-Executors and one of the named persons is unable or unwilling for any reason to serve or to continue to serve, and no additional persons are named herein to take the place of such declining or retiring Executor, I hereby direct that the remaining named Co-Executor(s) shall continue to serve as Co-Executors (or if one only remains, Executor) hereof without the approval of any court. Whenever the word "Executor" or any modifying or substituted pronoun therefor is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor or substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers and duties, authority and responsibility conferred upon the Executor originally named herein. C'ox Las[ Will and Testament Copyright The Esta[e Plan 1999 All Rights Reserved. Page 2 EXECUTOR POWERS By way of illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to Executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind or partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purposes of this my Will, without being limited in any way by the specific grants of power made, and without the necessity of a court order. My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my Executor believes has had the effect, directly or indirectly, of preferring one beneficiary or group of beneficiaries over others. In determining the federal estate and income tax liabilities of my estate, my Executor shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my estate shall be used as federal estate tax deductions or as federal income tax deductions and shall have the discretion to file a joint income tax return with my spouse. GLOSSARY OF TERMS For the purposes of this my Will, "children" means the lawful blood descendants in the first degree of the parent designated; and "issue" and "descendants" mean the lawful blood descendants in any degree of the ancestor designated; provided, however, that if a person has been adopted, that person shall be considered a child of such adopting parent and such adopted child and his issue shall be considered as issue of the adopting parent or parents and of anyone who is by blood or adoption an ancestor of the adopting parent or either of the adopting parents. The terms "child," "children," "issue," "descendant" and "descendants" or those terms preceded by the terms "living" or "then living" shall include the lawful blood descendant in the first degree of the parent designated even though such descendant is born after the death of such parent. Cox Last Will and Testament Copyright The Estate Plan® 1999 All Rights Reserved. Page 3 SPECIFIC OMISSIONS I have intentionally omitted any and all persons and entities from this, my Last Will and Testament, except those persons and entities specifically named herein, and I have also intentionally omitted any and all persons and entities from this, my Last Will and Testament, who are not persons or entities specifically named in The Cox Family Trust, dated October 1 I, 1999. It is my intention that any and all persons and entities, whether or not named in this Will or said Trust, shall have an interest in my estate and property, including the said Trust, if and only to the extent that I have provided for them in this Will and in the said Trust. If any person or entity shall challenge this Will or any term or condition hereof, or of the Living Trust to which I have herein made reference, or any term or condition thereof, then, to that person or entity I give and bequeath the sum of one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that person or interest may have in my general and Probate Estate or the Living Trust and its Estate. I specifically disinherit any person or persons claiming an interest in my estate through this, my Last Will and Testament, or through the previously named Trust, as my child, the issue of my body, who are born more than nine and one-half months after my death. QUALIFIED TERMINABLE INTEREST ELECTION -TRUST B I have established a Revocable Living Trust as part of my estate plan. I give my Executor of this, my Last Will and Testament, the authority to elect to treat all or a fractional share of the assets in Trust B as qualified terminable interest property. In addition, my Executor shall have the authority to make an election under any applicable state law to treat all or a fractional share of Trust B property (including a different fractional share than selected in any federal law election) as qualifying for any state law marital deduction. SIMULTANEOUS DEATH If my spouse should not survive me, but I die within sixty (60) days of my spouse's demise, then it shall be conclusively presumed for the purposes of this my Will that I predeceased my spouse. If any other beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed for the purposes of this my Will that said beneficiary predeceased me. Cox Last Will and Testament © Copyright The Estate Plan® 1999 All Rights Reserved. Page 4 NO CONTRACTUAL AGREEMENT NOT TO REVOKE Although at approximately the same time my husband and I are executing wills and a living trust containing provisions which are substantially the same, this shall not be interpreted as an agreement by either of us not to amend or revoke our wills or living trust without the consent of the other. IN WITNESS WHEREOF, I have hereunto set my hand and declared this to be my Last Will and Testament this 11th day of October, 1999. ~~~~ ~ ~~ Mabel G. Cox SIGNED, SEALED, PUBLISHED and DECLARED by the above testator as and for her last will, in the presence of us, who thereupon at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses: ~. .~ E' ti. fitness / -~- itness Cox Last Will and Testament residing at 113 North Crawford Road Grantville, Pennsylvania ~~, residing at ~ 3 ~;j~u ~ ~~'~ ~ ~ c~-~ ,Pennsylvania © Copyright The Estate Plan® 1999 All Rights Reserved. Page 5 SELF-PROOF OF WILL COMMONWEALTH OF PENNSYLVANIA ) ss. COUNTY OF CUMBERLAND ) We Mabel G. Cox, ~(~ tom' (n. ~,~~is-(C and -~,~Y~r~ ~~j rt"~ ~- ,the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witness and that to the best of each witness's knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Mabel G. Cox ,, J(/`//~ r ~r` t~ / Witness ~.~~ , Witness SUBSCRIBED, SWORN TO AND ACKNOWLEDGED before me, by Mabel G. Cox, the Te tatrix, an subscrib d and sworn to before me by ~~U ~~r `~~rr~ ~~ and /,~'it ~ '~l'~? ' ~ ,witnesses, this 11th day of October, 1999. ~. l NOTARY SEAL N TARY P>rT LIC ` My Commission Expires: ~.~C ~. ~ Z,Ei(~Z NOTMIAL fEl1t MOLL1r C. 31#RK, Eat Monovp Twp., Dauphin C~w,N, pA ~' ~ann~irion Expiry ~ ~. 100? Cox Last Will and Testament © Copyright The Estate Plan® 1999 All Rights Reserved. Page G CERTIFICATE OF ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) ss. COUNTY OF CUMBERLAND ) On this 11th day of October, 1999, before me, C~~~ ~~~ ~ , (here insert name of notary) a Notary Public, personally appeared Mabel G. x, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. ,~ ,_ Signature: ~ ~ (Seal) ,,' ~ -----~-+.~.^w ttor~t sEu +aouY c. sfMiac. -+o+o-r East Manow- Twp., CoVp~in Gu~Mp, RA AAr Ca"^^~iaion lxPin,s S~P't• 4. 2000 Cox Last Will and Testament Copyright The Estate Plan® 1999 All Rights Reserved. Pale 7