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HomeMy WebLinkAbout02-17-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF W1LLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of GLADYS R. SCHREIBEIS File Number ~~- ~ ~V ! + ~/ ~ w also l:no~vn as V202-28-2309 . Deceased Social Security Number Petitioner(s). who is/are 18 years of age or older. apply(ies) for: (COMPLETE A' or 'B' BELOW:) ® A. Probate and Grant of Lett rs T tamentary and aver that Petitioner(s)/is / re the EXECUTOR named in the last Will of the Decedent dated and codicil(s) dated / ``~~ (Store relernm cirnrmstances, e.g., remmcintion, death of exenrtor, etc.) f:xcept as follows. Decedent did not marry. was not divorced, and did no[ have a child born or adopted after execution of the instrurt~t(s) offered....:, for probate. was not the victim of a killing and was never adjudicated an incapacitated person: ~ `° ~-t ' '~~'". X ~ rrt ~-~ '.t -t7 C..} ~ ~ - © B. Grant of Letters of Administration `Z _ (Ijupplicable, enter c.t.n.; db.n.c.r.n.; pendente lire; drrrnme obsenno daronFE%riuneJ„~ ~ ~ t-~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Wil] and was survived by the followmgsp~t~~j~any)~ heirs ~(If i-,'y Administration, c. t. a. or d b.n.c.t.a., enter date of Will rn Section ,4 above and complete lrst gjheirs.) ~~ ~ ~rj _ t -~ Name Relationshi Resi~ce ,~' -' -t T ....J (COMPLETE IN ALL CASES:) Atta additional sheets if necessary. ed t w s domicile death i ~ ~~Q~i ant nos Ivania with his /her last principal residence at ~ -~ r - ,~ '~d > (List street address, tow ;city, township, roar >t%, state, =ip code / f l n / n~, ~, o Decedent. then ~ years'of age. died on ` ` (`7 at ~~~~ / b~~~` ~ ~•~`~' n "~"~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 15~, 000 (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: 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 Tv ed or anted name and residence ~~~~~~ Form RW'-02 reti•. In.l3.n6 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF ('TTMRFRT'AND The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petiti~~n are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, P'etitioner(s) will well and truly administer the estate according to law. Sworn to or affi~r}m(e~d and subscribed ii~fore me the~'r, day of For the of Personal Representative RUTH KOVACS Signnnn~e ojPersonal Representative ~ 0 ^'~^t .=; ~ ,, --~ -i ~ ~^j ~ CA Sigmm~re q(Personal Representative _~ ',~~.~ ~ ....! 'CJ`~r, - - i .Y File Number: ~'' ,,,,1 Estate of GLADYS R. SCHREIBEIS _, Deceased i ` =-i '4..~ ~._. Cn ~, ~ ,r^ -.~~r -z P:'i Social Security Number: 202-28-2309 Date of Death:~j,J T Q_/OR AND NOW, ~ ~ , ~> in consideration of the foregoing Petition, satisfactory proof having been presented before , IT IS DECREE that Letters TESTAMENTARY are hereby granted to RUTH KOVACS in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of ecedenf. FEES Register of I~Vills Letters ............... $ Short Certificate(s) ........ $ e2 Renunciation(s) .......... $ ... $~~ ... $ ... $ ... $ ... $ --• $ _.. $ ... $ 'T'OTAL .............. $~ Attorney Signature. Attorney Name: Supreme Court l.D. No.: Address: Telephone: Form RW-OZ re,~. lo. r3.n6 Page 2 of 2 105.805 REV (01/0"7) ~r`G` ~`"C((.o(7 LOCAL REGISTRAR'S CERTIFICATION OF DE~4THI WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 14t1~~1 Certification Number This is to certify t gat the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital RecordsyOyf~fice for permanent filing. ~s~ ,' 'l ~aiSQ.~~~ NOV 120 8 Local Registrar Date Issued C'j c _rn :.,:, _..- -.,_ _ .~ ~ ~.. --i .. l._. :~ '~ _~ y _ T' F .~ __, jJ REV 172006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN CERTIFICATE OF DEATH (ANENT :K INK (See instructions and examples on reverse) ST4TE FILE NUMBER I. Nerve d Decerler4 (Rrst nsddle, lest, sulRx) 2. Sex 3. Social Secudry Numbs 4 Dala of Death (Month, tlay, year) Glad s R. Schreibeis Female 202 - 28 ~'- 2309 November 19, 2008 5. Age (Last BlMday) Under 1 Untla 1 da 6. Date of Birth (Momh, de ,year) 7. Birtlplacp (Cd and state «fae' caxary) 8a. Place d Death (Check only one) Mmew nays ltwrs Micas Hospital: Omer: 85 rrs. December 1, 1922 Canada ®Inpalient ^ERr Oulpelienl []DOA ^Nursing Home ^Readence ^Omer-Spedfy: BD. County d Oeam tic. City, Born. Trop. of Death Sd. Fedlity Name (II not irelildan, give slrea end number) 9. Was Decetlanl of Hispena Origin? ®No ^Ves 70. Race: American Indaq Black, Wh4e, etc. pf yes, speciy Cuban, (SpeciM Cumberland South Middleton Carlisle Re ions) Medical Center Mexican. Pus"° Raa"' em.) White 11. DecetlenYS Usual son Knd d work d one du ~ mast of ~ tile. Do rot stele retired 12. Was Decedent ever in the 13. Deuredent's Education (Spadty only highest grade wrrp kted) 14. Model Status: Married Never Married, 15. Surviving Spo use (II wile, give maiden name) Kind d Work Hind d &nness / Mastry U.S. Armetl Farces? Elementary /Secondary (D-12) Cdlege (1 d or 5+) WMowed, Ctvorced (SpeciM Re istered Nurse Medical pYea ~]No 3 Widowed 16. Decedalt's Mating Adtlress (SUeel, city! rown, state, zip code) Decetlenps Oitl Decedent slate Pennsylvania Live Ina t7 Adua Residence rte South Middleton ®V D d L d i 30 Abbey Court . a, es, ent we n _ ece Twp. T°~"nanl°? rid, ^ Na, oaedenl Llvetl wnnm ,7E county Cumberland Carlisle, PA 17013 Aduel Lknils or Ciry I Boo 18. Fedla's Name (First. n7iddle, lest. surix) 19. Mother's Name (Brat, mi0dk, maiden eurnamel Geor a Andrew Carruthers Jeannette Pollock 20a. Inl«mad's Name (Type! PnnQ 20b. InlormanYS Mating Atltlrem (Street, city /town, stale, zp codn) Ruth Rovacs 379 Wison Street, Carlisle, PA 17013 21e. Mamod d D'aposdion ®Cremation ^ Oonatan 21b. Dale of psposifion (Month, tlay, year) 21c. Place of Dispmidon (Name of temelery, crematory or dher pbae) ltd Location (City /town, slate, zip code) ^ Bwial ^ Remove howl Slate j Was Crarlatlon a Donation AuUtorized ^ 01 ~ Dy Nedaa Examiner r coroner? Yes ^ No r 22a. S' ee (a person xiing m such) ~ 226. Licerisa Number 22c. Name aM adtlresa a FadiryAner Cremation Services of PA, Inc . ~ ~~ FD 013376 - L 4100 Jonestown Road Harrisb r PA 1 23a< onry n9 23a. To the bast d my knowledge, tlmm averte d at the time, dale and dace stated (Signaaae antl title) ~ 23b. Ucense NUm er b 23c. Dale Signed (Month, day, year) phyapan E rat available at IirtiB d dmm a 1 ^ A must ~.~y~ti M~ ~•C ~1 w / i ~}• 3 ~8 ~ M U s a 20~~, ~M(~~Q ~ 1 a.rory cause a seem. y"'( . \ T y , t Bans 24.26 must ce cortOleted by person 24.7ime d Dea th 26. Date Pmr°rx d D (Modh, day, year) v e eed 26. W as Case Referred to Medical Examiner / C«oner for a Reason Other Than Crematan or Donation? who pmmxx:m deem. ^ ~S:I,l~ P M. u x w ~ ~ NQ~'rW« s 19 y 2~~ g , d ~ W'es ~No CAUSE OF DEATH (See instruetltms eM examples) r Approamate Marva: Pan II: Enter Omer [It car7ddaro conlrbuena to deem, 28. Da Tobago Use Contribute to Deam? Item 27. Pad I: Enter are then d events - dsemm, injures, a amplicafore -mat directly caused the dash. W NOT enter lermirel events such m cardiac artest r Omet to Dean bd not resulting in the untledyklg rouse given in Pan I. ^ Yes ^ Probably respiretay ertesl, «venbaWr fibdletan witlad snowing tlar etiology. List only one cause on each Fre. r f r ,B No ^ Unknown (F ~ ~i~tixg i~dea~m)dlsease or QL _ ~~\lo I ~` tit L ~ ~ ,~• _~ a, a'aA 7 y r '~~•fTOkAi~ /~ l L y,, ~~/7 K( ~T n( ~i 1.ltAC • 29, II Female: ^ Not pre nant wilNn ast ear Due b (« 8e a~ o~D~ `/ ,,k•~ ,•. I}kI-~/~ ~ A ~,~,,~ .,( ~~ ~ ~~~ I g p y ^ Pr r nt t li f tl m $aquentlally fat arl6tiom,tlarry, b. N011.' 1C ~s ~1 V' 1• i it TtlPMt) 0~ ~Q`" k 6 b th i atl Ir ag a e me o ea e q e reuse s on e a. Due to «m a con Erwer fie UNDERLYMIG CAUSE ( sequence ory: r ^ Not pregnant Dul pregnant within 42 days (dime a'ry'ury that iifeled the a i evade rewhkig a deem) UST. r d deem Due to (a m a consequence ol): r ^ Not pregnant. but pregnant 43 tlays to I year d ~ belae tleam ^ Unknown it pregnant within the pest year 30a. Wm en Autopsy 30D. Were Aulapsy Findngs 31. Manner d Deam 32a. Date of Iryury (Month, day, year) 32b. Describe How Injury Occuned 32c. Place of Injury. H«ne, Farm, Street Fanory, Perlorrtad? Available Pray to Cortpletion ~ NeWra ^ H«"~ Office Buildng, ea. (SpeciryJ d Cause d Deem? ^ Ym ~] No ^ yes ~ No ^ ACCidenl ^ Pendng Imestigetan 32tl. Tme d Injury 32e. Injury at Wode? 321. If Traneponation Injury (Specify) 32g. Catalan of Injury (Street. dty /town, state) ^ Sukide ^ DouM Not be Determired ^Ves ^ No ^ Driver / l)perela ^ Passenger ^Pedestrian M ^OOier - Spe4v7y. 33a. Certifier (cnede only are) 33b. Sgrelure antl Trtle of CenHier • CenKying physkten (Phy,ayn certiryxg cause of deem when another pnysicien nos lxorwunced tlaem antl completetl gem 23) t~1t~ t 1 ~ • • ~~ N I ~ To ma best of my knowledge, dash occurted due 7o the cause(s) orb manner as staed_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 1:..~ 1 ~ - ~ ' • Pronouncing antl urtirying physician (Pllysicien Mtn pronouncing tlea!h and certifying to cause d tleam) To the best of my knowledge, death oaurred al the time, date, and place, end due to the cause(s) and manner as sleted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Nedicel Examiner/C«one! 33c. License Number 33tl. Dae Sgned (Month, day. year ~ p A s_ 1 ~5~, .s /~ 1'~t1J '1•,~ ~ Np~~QY ~, s A,sJk~g On the basis of examination and / or investigation, .n my opinion, death acurretl et the time, date, antl place, and due to the cause(s) end manna as staled_ ^ r n ~ )~~ and Adtlrfess of Perso Who CompLled C~9use of Death (Item ?7) Type i Prrn 35 s Sl natwe a I r 36 D F t M } J ~- I ~ } 1 L~ `t rt' ~ `Lt ~ Y7' /"7 ~~ g . ate i ( Onm, y, year) tt v 1, Disposition Permit No. LAST WILL ANI) TESTAMENT OF ~ p ~ ~~~' -,-, ; ; , ~- ~:~ -~ I:-"~ GLADYS SCHREIBEIS ~- ~ z rya ~ , f ::~ ~' a ~ = ~ -> ~ - _ „ < <~ ~~ i ~ ` l ~-J ~ ; ~...~ :""' f 1 I, GLADYS SCHREIBEIS, a resident of Carlisle, Cumberland. County ., E_,~ -, ~ " Y `F 1J Pennsylvania being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ITEM 1: I direct that all my just debts, the expenses of my last illness and funeral expenses be paid as soon after my decease as the same can conveniently be done. ITEM 2: I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this Will or otherwise, excluding, however, any property over which I have a taxable power of appointment, provided, however, that no residuary benef ciary shall by reason of this provision be denied file benefit of any deduction, credit, favorable rate of tax or other benefit which by law enures to such beneficiary. ITEM 3: I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature, and wheresoever situate ~- GLADY SCHREIBEIS LAST WILL•AND TESTAMENT OF GLADYS SCHREIBEIS at the time of my death, unto my husband, LEE SCHREIBEIS, provided, however, that he survives me and is living sixty (60) days after the date of my death. ITEM 4: If and in the event that my husband, LEE SCHREIBEIS, does not survive me and is not living sixty (60) days after the date of my death, then and in such event, I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature, and wheresoever situate at the time of my death, unto my daughter, RUTH S. KOVACS, provided however, that she survives me and is living sixty (60) days after the date of my death. ITEM 5: If and in the event that my daughter, RUTH S. KOV.ACS, does not survive me and is not living sixty (60) days after the date of my death, then and in such event, I give, devise and bequeath the interest in my estate, which such deceased daughter would have received, if living, as follows: a. Twenty-five percent (25%) of my estate unto my son-iri-law, DONALD KOVACS; and b. Seventy-Five percent (75%) of my estate unto ORRSTOWN BANK, as Trustee in Trust, for the benefit of my grandchildren, J17LIA R. KOVACS and HANNAH J. KOVACS. Y ~- ~ ~ ~ - GL S SCHRE EI 2 LAST WILL AND TESTAMENT OF GLADYS SCHREIBEIS The Trustee shall hold one such share as a separate Trust for the benefit of each living grandchild of mine. In each Trust thus established for a then living lnandchild of mine, the Trustee shall quarterly pay to or for the benefit of such grandchild all of the income and so much of the principal of said Trust, as, in the discretion of the 'Crustee, maybe necessary to maintain such grandchild in the proper station in life, including proper support, maintenance, medical care and college or higher education. Upon such grandchild attaining the age of thirty (30) years, the Trustee shall pay to such grandchild one-half (1/2) of the then principal. Upon such grandchild attaining the age of thirty-five (35) years, the Trustee shall pay to such grandchild the balance of the then principal and said Trust shall terminate. Should a grandchild die before final distribution of the assets of said Trust, but be survived by then living issue, the Trustee shall quarterly pay the net income from said Trust to or for the benefit of said issue, per stirpes, living at each ~~time ofquarterly distribution; as soon as any one of said issue attains the age of twenty-one (21) years, and in no event later than twenty (20) years following the death of my grandchild, the Trustee shall pay over all of the then assets in the Trust to the then living issue of my deceased ~ ~c, :T- GLAD S SCHREIBEIS LAST WILL AND TESTAMENT OF GLADYS SCHREIBEIS grandchild, per stirpes. Should a grandchild of mine die before final distribution and not be survived by then living issue the provisions of subparagraph (2) herein shall obtain. 2. If at any time before final distribution of the assets of any of the Trusts established for my grandchildren, there are no living beneficiaries of said Trust, the Trust shall terminate, and its assets shall be added to the other there existent Trust(s) created herein for the benefit of my grandchildren. Provided, that if any of said Trusts herein created has previously been terminated by payment of its principal to its beneficiary, said beneficiary who received payment of the principal of that Trust shall be considered an "existent Trust" for the purpose of this paragraph and shall be entitled to receive all of the assets of the terminated Trust. ITEM 6: The Trustee shall possess, among others, the following powers: A. To vary or to retain investments, including the stock of any corporate Trustee named herein, when deemed desirable by the Trustee, and to invest in such bonds, stocks, notes, real es~ate mortgages or szcurities or in such other property, real or personal as the Trustee shall deem wise, without being restricted to so-called "legal investments" and without being limited to any statute or rule of law regarding investments by fiduciaries. GLAD ~ SCHREIBEIS 4 LAST WILL AND TESTAMENT OF GLADYS SCHREIBEIS B. In order to affect a division of the principal of a Trust or for any other purpose, including any final distribution of a Trust, the Tnistee is authorized to make said division or distributions of the personality and realty partly or wholly in kind. In the event of division or distribution is made in kind, such division c-r distribution shall be made at the fair market value of the property at the date of division or distribution. Should it appear desirable to partition any real estate, the Trustee is authorized to make, join in and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, recognizances, or other obligations with as wide po~-ers as can be exercised by an individual owner in fee simple. C. To sell either at public or private sale and upon such terms and conditions as the Trustee may deem advantageous to a Trust, any or all real or personal estate or interests therein owned by a Trust severally or in conjunction. with other persons, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conve}ping a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money, or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which maybe necessary or desirable in carrying out any of the powers conferred ~.~~~~. GL S SCHREIBEIS LAST WILL AND TESTAMENT OF GLADYS SCHREIBEIS upon the Trustee in this paragraph or elsewhere in this instrument. D. To mortgage real estate, and to make leases of'real estate, extending beyond the term of the Trusts hereunder. E. To borrow money from any party, including the Trustee, to pay indebtedness of a Trust and taxes, and to assign and pledge assets of a Trust therefor. F. To pay all costs, taxes, expenses and charges in connection with the administration of a Trust, including a reasonable compensation to agents. G. To assign to and hold in trust an undivided portion of any asset. H. To do all other acts in its judgment deemed necessary or desirable for the proper and advantageous management, investment and distribution of the Trusts. ITEM 7: If and in the event that my daughter, RUTH S. KOVACS, her husband, DONALD J. KOVACS and their two (2) daughters, JULIA R. KOVACS and HANNAH J. KOVACS, do not survive me and are not living sixty (60) days after the date of my death, then and in such event, I give, devise and bequeath the following to the individuals and institutions listed below: a. To my nephew, ROBERT SCHREIBIS, if he shall survive me, the sum of Twenty-Thousand Dollars ($20,000.00); GLAD S SCHREIBEIS 6 LAST WILL AND TESTAMENT OF GLADYS SCHREIBEIS b. To my niece, JOAN MANSFIELD, if she shall survive me, the sum of Twenty-Thousand Dollars ($20,000.00); and The balance of my residuary estate shall be divided in equal shares among the following: 1. ALLISON UNITED METHODIST CHURCH, of Carlisle, Pennsylvania, which sum of money shall be for the sole use of the church in Carlisle, Pennsylvania; 2. SALVATION ARMY of Carlisle, Pennsylvania; 3. THE UNIVERSITY OF PITTSBURGH, Pittsburgh, Pennsylvania; 4. UNIVERSITY OF MICHIGAN, Ann Arbor, Michigan; 5. AMERICAN RED CROSS, National Headquarters; 6. UNITED NEGRO COLLEGE FUND; 7. UNICEF; AND 8. GOODWILL INDUSTRIES OF AMERICA, National Headquarters. These bequests are unrestricted and the Board of Trustees or other governing body may use and expend the same in any manner it deems appropriate. ITEM 8: I hereby nominate, constitute and appoint my husband, LEE SCHREIBIS, Executor of this my Last Will and Testament, with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of him in this or any other jurisdiction for h.is performance of this office. If and in the event that my husband, LEE SCHREIBEIS, does not survive me Ylidl2e:~`j GLAD S SCHREIBEIS 7 LAST WILL AND TESTAMENT OF GLADYS SCHREIBEIS and is not living sixty (60) days after the date of my death, or does not complete his duties as Executor, then and in such event, I hereby nominate, constitute and appoint my daughter, RUTH S. KOVACS, Executrix of this my Last Will and Testament, with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of her in this or any other jurisdiction for her performance of this office. If and in the event that my daughter, RUTH S. KOVACS, does not survive me and is not living sixty (60) days after the date of my death, or does not. complete her duties as Executrix, then and in such event, I hereby nominate, constitute and appoint my son-in-law, DONALD J. KOVACS, Executor of this my Last Will and Testament, with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of him in this or any other jurisdiction for his performance of this office. ITEM 9: If any provision of this Will or of any Codicil hereto is held to be inoperative, invalid or illegal, it is my intention that all the remaining provisions thereof shall continue to be fully operative and effective, so far as is possible and reasonable. ~ .. ~ec.~.e: GLAD SCHREIBEIS 8 LAST WILL AND TESTAMENT OF GLADYS SCHREIBEIS IN WITNESS WHEREOF, I, GLADYS SCHREIBEIS, the Testatrix, have to this my Last Will and Testament, typewritten on nine (9) consecutively numbered pages, subscribed my name and affixed my seal this j 7~ day of February, 2006. ~' ,~~ f~~(SEAL) GLAD S SCHREIBEIS Signed, sealed, published and declared by the above named GLADYS SCHREIBEIS, as and for her Last Will and Testament, in the presence of us, who have Hereunto subscribed our names at her request, as witnesses hereto, in the presence of the said Testatrix, and of each other. ~,. -~ ~` ~ ~ .~ siding at ~~~~ (/ _ !f~ro~ ~~~ `~ ~ ~L.~~.~~~-cat ,~ :~ ~ ~~~. ~-'~i ;~ = ~ ~-zc,..~,, ~ C - ~:.~~~, residing at ~~0 c.~ . f ~' ~~ ~, _,_-, .~:~ _~ ~;~ ~ ~a u 9 C"~ ra c ~ OATH OF SUBSCRIBING WITNESS(ES~° ~ ' ' ~-' ~ t--- :. _ . - ' _ ~''"' REGISTER. OF WILLS r'7 t ~ t C :; . PENNSYLVANIA -~~-`' aNn COUNTY rr>vtRFUT x~ ~ , ~ . ~ ~ r- , -~ Estate of GLADYS R SCHREIBEIS _ ,Deceased ANTHONY L . DELUCA , (each) a subscribing witness to (Print Nmne/s) the ®Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same and that she / he /they signed the same and that she / he /they signed as a witness at the request of the Testator /Testatrix in her /his presence and in the presence of each other. r ~~ (Signature) 113 FRONT STREET (Street Address) (Signature) (Street Address) BOTL.TNG SPRINGS. PA 17007 (City, State, Zip) Execaated in Register's Office Sworn to or affirmed and subscribed before me this ~,,Zf_ln day oft ~ -~ ~, { 7. , ~~ ~1 U Deputy for Register of ~ ills (City, State, "lip) Execaated oast of Register's Office Sworn to or affirmed and subscribed before me this - day of , Notary Public My Commission Fixpires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Form RW-03 rev. /0.!3.06 OATH OF SUBSCRIBING WITNESS(ES) ~© ^~ ~ t'- ^. REGISTER OF WILLS ~' ~' ~U~jv~~~ ,tr,~ COUNTY, PENNSYLVANIA =~c~~-7 ,~.~T _~.--1 Estate of >,hPI~ rv .~ ~ '- ~'.ti .~ -+ ~_:- -.J r, "~~ ~ , c-- _ , ~:, w ; . , ~~ .~- -.a . Deceased ~~ ,x' ,~`" /f . ~~ ~ v ~~ _, (each) a subscribing witness to (Print Names) they Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / lae~/ tl~ was / ~ue>:e present and saw the above for /Testatrix sign the same and that she / 1}a / try signed the same and that she / 13a / tl~y signed as a witness at the request of the Tamar /Testatrix in her /mss presence and in the presence of each other. (Signature) (Street Address) (City, State. Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills G' ~ (Signaku-e) (Street Address) (City, State, Zip) Executed oast of Register's Office Sworn to or affirrrted and subscribed before me this -~--L=--- day of ~~.~ ' ~~.` 0 Notary Public !! My Commission Expires:, (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrurnent(s) at time of notarization. ForntRW-03 rev. !0./3.06