Loading...
HomeMy WebLinkAbout02-27-09 (2)PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF COUNTY, PENNSYLVANIA Estate of %EFF~c y ~• F,!/~ u.,r1t~E.~ File Number ~ ~ - ~ `7 -~~ also known as ,Deceased Social Security Number /6 ~ ' ~~ _ ~~ -3 Petitioner(s), who is/are 18 years of age or older, apply(ies) for (COrLIPLETE 'A' or 'B' BELOW:) ^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the n rv mimed in the. last Will of the Decedent dated and codicil(s) dated C~ .n L'~ -n t"5"1 ~t~ ~ - r- W (State relevant circumstances, e.g., renunciation, death of executor, etc.) _ < ~ _: __ ~..{ J c:: F ~~ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after exec ution o€t~e;~~~tm enthj offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: !" )~-- -~ ---t Y --- B. Grant of Letters of Administration tip (Ijapplicable, enter: c.t.a.; d. b.n.c.t.n.; peitdente life; durante absentia; durance minoritate) (COMPLETE INALL CASES:) Attach additiatai sheets if necessary. Decedent was domiciled at death in County, Pennsylvania with his /her last principal reside~n7ce at _ .~0~ F.C. (List street address, town/city, township, count), date, zip code) ' `~ Decedent, then S3 years of age, died on~,G ~. d~of' at ~/%/L,feSQu ~G-, yo~'~i i~~ ~~/ SGuJ2G~ /~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All persona' property $ / ~~ d D V (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania ~$~ ooU situated as follows: T~` ~' ~l~K~ S~~C FT ~ ~it/e •csf % ~ ~o '/~' 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~nanire Ty ed or rioted name and residence ~..~~ C~ ~ ~ F ~ •~ ~~ sa ~,~~Cs ; gin, ~~ ~rr~ ~ ~ ~~.~,s~ Farm R6R0? rev. 10.!3.06 Page I Of 2 Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and ]leirs: (If Administratiat, c. t. a. ord. b. n. c.t.a., enter date of Will in Section A above and complete lisl of heirs.) Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF . 'The Petitioner(s) above-named swear(s) or affirm(s) that the statement, in the foregoing Petition are true and con~ect to the best of the knowledge and be]ief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estat; according to law. Sworn to or affirmed and subscribed .,",efore me the ~~±~ day of ~~~ i ~' 1 I For the Register x ~~ ~ ~ hJ Signature o Persatal Reuresentntive C•7 + ~ c~ ~n , ~ ~7 i ~ 'T! - -n r~ t Si,,onature ojPersonal Representative ~- J "~~ e- ~rn N - -4 l/) ~t~ Signatw~e ojPersonnl Representative '~ c~ ~ Ti ~` ~: ~ D ~ -- File Number: ~ I - ~l - U l Estate of ,Deceased Social Security Number. ~l010 - ~-Ido ~ ~~1-I.53 Date of Death: ~ ` ~ 9 - y~ AND NOW, 1 ~ \Q~l_C~~ ~ > iu consideration of the foregoing Petition, satisfactory proof having been presented before e, IT IS DECREED that L ers ~r~ ~ r, ~ ~TfZAZ tUtJ 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 rec FEES Letters ............ ... $ -{© -~%~ Short Certificate(s) ... ..... $~~ • ~~ Renunciation(s) ..... ..... $ ~V C~ ~~ ... $ {C7 'C.X7 S~v;~orr,~~, ~r ... $ 5 . yc3 ... $ ... $ ... $ ... $ ... $ ... $ TOTAL ......... ..... $ ~rJG ~ Ov Attorney Sig~rature: Attorney Name: Supreme Court LD. No.: Address: Telephone: Form RGV-0' rev. l0. (3.06 Page 2 Of 2 ~i~~=> ~ lei ~ ~~~- , LOCAL REGISTRAR'S CERTIFICATION OF DEATH W,4RNING: It is illegal to duplicate this copy by photostat or photograph. Fee ti)r this certificate. ~~6.0O f' ~.~~1.6421~ Certification Numher 't'his is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Loral Registrar. The original certificate will be forwarded to the State Vital Records 01~fice for permanent filin~~. G 1 l 1 7 r.' / Local Registrar Date Issued n N ~ - C7 ~ ~l ~ ~~ W 7 r-V ~.. t-rt ~ N ~^ ~ ~~ ~ ~T ~ i~r~ -p ~ ~ NIOS.IN REV 11/2006 TYPE / PRWT W PERANNENi &ACK INK y~I 'S • ~. r.i ,~ (~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CORONER'S CERTIFICATE OF DEATH rSea InitruCtloM end aYamolem On reVermel STATE FILE NUMBER 1. Name d Decwtled (Firm, nidde, bm, u~a) 2. Sea 3. SodW Ssculry Nurmw e. DeY d Dean (Milan, mY, yaen sEF~REy s' FRENND[L MACE /66 -'I6 -3dS3 February 19, Zoos S. Ape Ium eireWyl Umm 1 Under 1 m 8. Doe a BiM (Morin. an 7. aM alW a c 1 Ba. Plop a Dun Clydr as emne 0M Man mnn.a .,t Haapw Dorf'. .s3 Yn r~~IRIV .23, /!SS NwRxue(ra(~, PA. ®mpaawa ^ERlrarwaame ^Dw ^NUSegHmm ^R.YidenU ^ou,.r_Sp.ay m Cauny d Dean &. City, Boo, Twp. d Oean Bd Fu+Ny Hems IN w irlarlufk 9M aea and iwrba) 9. w.a Daceaed a Hspusc Oripn7 ®No [] Yes 10. fiaoe Amufon ardn, BYck 1YIrY, ac. Dauphin Harrisburg Harrisburg Hospital Itl yes, sP•vP Cuban, Waican,PwroRipn,ac.) (SpeNN 1AINiTt 17. DeUduA's Uaum ~ Ka4 d wok tl ont ~ mwl a r ~ Nt Do roe more wlr 12. was DeUaent war m Yw 13. DewamA'a Eda;ilbn (Swaly aWy NgINm gram wnp lelM) 11. Manta Seems: MurpO, Nevw Married, 16. SurvWinp Spe w (E wtla, 9A'• nritlan Hoer) Kind a Wod Nod d 8wiwas! kme W U.S. Mmaa Faros? EWfrnwy / Sacordary (0-12) Coaeq I7J or Si) Wimwad, ~~ (~~ N,AiA. Ow fEA 2'NSNAgNt6 ^r•a ~~ /.Z NtvicR MRRRitJ 18. DtaauA's Maikp Aromas l9rew, aM' l nrm, swe, zp roes) DxeAenrs .p Di0 Decemre U I S QiM ~ rA G eZ 6 S • y LI K E 5 T, ve O T , fL/VI . . Aawl Resimrce 17e Sew e a nc (q Yn, DecemN Lied h •v ~' 9 fNOLA PA. lTOEg lTa ^ w, D.oamre Llvea wXlur O1" p Iro-ca,d2 CMM9ERLANp AqualLMba cayreuo 7B. Faew'a Name (Fsm, made. 4q such) 12. Mollw'a Name (RraL mhos, nrmn eumame) 1'OSE~I,f B. FRSuNDEC. icE COTT 2oa. kaomwCS Name (Tws r Pryel 20b. kaomwta Ma1YgAdarew ISU«t dU' / lwm, wm, aP car) f~CEE-J W~CNfriER l80µ M/GN~AND CLW~ CT a ~L, 3'l~L>ZS~ 216. Menotl d Disposaon ^ Gerraban ^ Daulbn 21b. DW d DiyoaWm 111or1n, dry, yam) 21c. Plsce d Ofspwmwi (Narw d carrlmr. mmrrlury m aaw 2bce) 27tl. Lawson (CNy l low,, amM, zq Door) Id B~rW ^ Rwrawal Iron SMr ^ oa,er~sPray: Waa Crammbn a Donatlan Adlxniud byMedkuEaammwlCorarrn ^YU^NO // /E ~ ~ /~ G TYIL~~, CEMETER /~ ~ ,u~V11LL[ ~A. /7Gz 22e ~ al FuneN Service Cremes (, ~ usual) 226. lironsa Number 22c. Nuns ofd AdYeas d Faddy - O1a,92 L Ei~V Fw ~ e 3'n/c. 3el}e1 MAR~cET ST, Gsi ,4iu. P „ell CanpWa Yams 206<amy aweNeq zee. To m hem a my w,owt.ape. man axi.raa m ne n... mu w Pln• wwa. (sgwr..ro wr) zx. unm. Maaar 23c oa sia,.d tMarin. my, teen pnysipn r not avairae u sore a man b omory nor a man. a.ma 2e-x crave m romPwae by person ze core a Dann ronounced: zs. Dam PnrnurcM DeW IMaen, my, ywl zb. was Cue Menetl m Medcd Eamaw r coroner mr a fboan Otlrr am Gurwion a lyorwbn7 wro promrrces aemn. ,, 07:55 P M February 19, 2009 ®res ^No CAUSE OF DEATH (Ste mauuclbne and eaampNa) ~ f ApprwbWe kAUVak Pan M: Emw odw 29. Oia Tdraa Uw CaruOW b Dwn2 Ilnm 27. PN I: Eroar dr rdan d Hems - sseases, mjures. a wmpWlssu - aiu dredy caused IM man. DO NOT user Damn svwra midr as cadac urem, Omer b Dean M mil rawmp n ns un0ulybp Uusa phn m Pap I. ^ Yw ^ Plobmy reapeabry mrem. ar Yanlnulm IibaMMOn wines anowkp tlr ewbgy. Lal m7 ar reuse on eacn Grit. ^ ~ ^ ~'•~ TE CAUSE IFnal mean a ~ asdlsM In de•n~ ~ e. Hemopericardium , n.tlF""ae ^ Duo b la u a conae7wnce an' SepwAry im oomlons, a aM, b, ASCVD ~ Nor pepwa webin Dm y.m ^ PrpwA m rro d morn yadr~p b nt acme kba an Me a. q,e to ease nca o Enw Er UNDEALYNIG CADSE ( ~~Pr O: ~ ~ P'aPr'a. us a'0^a'tl'~" ~ mw «mMynor noalaa ne c. rrmr n maN IAST amen p Duo m (or a a rorisequerre dl: ^ Na pgwq w prpws a9 mys n 7 you a i wan man ^ IAifaaar Y Papnua weM er Pam yam 006. Was an AWpsy 00b Wen AubPay Findnp: at. Memsr d Dean 32r Da4 d HmY pA?ran, dry. yawn 02b. DeeuDe Haw mF~7 Orareatl 02c. Plea d mjuy Her, form, 9rea1, facbry, P fimW9 Avalaaa Pnoi b Complelm a caaa. of Daan? ~ Nawy ^ Honaam Olre fArmrp, an. (SPaaYI ®Yw ^ w Q~ tea ^ No ^ Amaem ^ Paitlkp eweakpwm sea. nor. a e~ury ~. Nrv m wm? ra r rrmmpmmem kjwy (SPxey) aza Lacmion a kpay IsneL ar r man. awe) ^ Surtle ^ Coda Nd be Demmkra ^ Yes ^ No ^ Dmw / Openw ^ Pacwpw ^Peaasaan M Otlrr-SP+UY: 7L. CaNW 1~ anN one) • C N k h i P f f h o H tl m n M W d 23 l ' 30b. ~ Tort d Cw ~ ! ~ 1 ' ~ as prararre a y p p ysk an ( fgsrun Urs man w an arnpw p K an a e mfry eo am ) M cause o l io lh Oem of mysro.ktlpe, man aecuffad Arbllr uuwp)afr maniwusum4------------------------- __^ ---_- / . . - 1_ , ~. / ~ / , Lisa A. Pollegw, Chief Deputy • PrororMnp eft antlsvrp pnYtkun IPnysidan wh prolourraq man and UMyinp b Uwe d man) w a ^ 97c. Navies 3aa. Ome Spnea (MoM, my, ywr) _ _ _ _ _ _ _ _ _ _ __ _ _ _ __ _ e To ne am a my mmwrtlpe. tl..n «cunw d tlr lore, dad, mtl ileac., and aw m nr cwetls) antl mamw w a February 20. 2009 • M.tlbm Ewdrw r corarw on Ilr bud a eamdrr0on mw r a natallpmbrk m my opmon, mom oaaarrta x car sore, am., aft pl.a, and aw b lna aweyel and manrrr u wrd_ ~ ~ Nor cad Aadtu a Person wro ca,rolare Larw a Dan lemn 271 Type r r+au . Lisa A Potteiger x. Irutsgrkre.na Nmber sb. FMal~nn.M.wml . 1271 South 28th Street y ? ~ .~I f I~ I ~ I~ ~ ~ a Harrisbur , PA 17111 DispoeitbnPwmkNO. Q9/?I~S.3l) RENUNCIATION ~ C7 ~ ~ -~ -~~ ~ C> ~ ~ ~ m TO: REGISTER OF WILLS, ;: N "~ CUMBERLAND COUNTY, PENNSYLVANIA V?~~ ~ ~ J ~~ =o Q C. Estate of JEFFREY J. FREUNDEL, Deceased. No.;~l-~~ ~ ~ ~ --- I, EILEEN M. WENGER, in my capacity/relationship as Mother of the above Decedent, hereby renounce the right to Administrator or Executor of the Estate of the Decedent and respectfully request that Letters be issued to decedent's sister, GAYLE M. FARABAUGH. Dated: ° 027 ~DO ~~ COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ss Eileen M. We ger Before the undersigned personally appeared EILEEN M. WENGER, and certified that she executed the above Renunciation for the purposes stated within on this ~~ day of 2009. (Seal) ,~~ ~" ~Y1 /'/f~L~~ Notary Public CO~IM1nC1NWl:~t_i tt cJr ~'tlvi'VSYLVANIA NOTARIAL SEAL GAII. P. STRICKLER, Notary Public Camp Hill Boro, Cumberland C 2UI2 y My Cornniission Expires Jan. fit), ';. r r~ ca RENUNCIATION " - ~ ~, ~,~ -~ =--~ -L n r~, +cv ~,J_ ~~ ~.r~ri iv _ . TO: REGISTER OF WILLS, ` ~ =~ v~ ~: --~ - DAUPHIN COUNTY, PENNSYLVANIA ~ : `~ ~--~ -~ - `.,3 ~ W - Estate of JEFFREY J. FREUNDEL, Deceased. No. ~---i _ I, ROBIN M. GRANZOW, in my capacity/relationship as Sister of the above Decedent, hereby renounce the right to Administrator or Executor of the Estate of the Decedent and respectfully request that Letters be issued to decedent's sister, GAYLE M. FARABAUGH. Dated: ~~~/, ~D4 ~/ ~'~Vv Robin M. Gra w COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND ~~ Before the undersigned personally appeared ROBIN M. GRANZOWjE, and certified that she executed the ab e Renunciation for the purposes stated within on this ~ ~ day of 2009. (Seal) ~ ~"'~`-~ / ~~LL / ~' ~~~ Notary Public ;,,~3~+ta~yN~vtAl_~ H CF PENNSYLVANIA ~ s NOTARIAL SEAL public GAIL P. STRICKLE.R, Notary Camp Hiii Boro, Cumberland C02012 ~ ~y Cnrnnrisston Expires Jar~~3~?~ ;. BOND OF PROBATE IN THE O~han's COURT OF THE STATE OF Pennsylvania ~ No. 10519054 IN AND FOR Cuinbertand COUNTY IN THE MATTER OF THE ^x Estate ^ Guardianship ^ Conservatorship OF Jeffrey Freundel ^X Deceased ^ Minor ^ Incompetent KNOW ALL MEN BY THESE PRESENTS: That we, Gayle M Farabaugh as principal, and Travelers Suret} and Casualty ompanv of America , a CT corporation, as Surety, are held and firmly bound unto the State of pA , In the full and dust sum of Twenty tnousana ( 20,000 )Dollars for the payment of which, well and truly to be made, we bind ourselves, our and each of our heirs, executors, administrators, successors and assigns, jointly and severally, by these presents. Sealed with our seals, and dated this 27th day of February 2009 THE CONDITION OF THIS OBLIGATION SUCH, That, WHEREAS Principal was by an order of said Court made on I ^ Guardian the ~ ~ ~ day of ~-10 r^G{JGt/t. , ~j,'-~-~, appointed ^x Administrator of the above named Estate. ^ Executor ^ Conservator ^ Personal Representative NOW, THEREFORE, if the said principal shall faithfully execute the duties of the trust according to law then this obligation to be void; otherwise, to remain in full force and effect. Gavle M Farabaugh By ~~Z., ~, ~ u-~ Principal Atto ey-in-Fact Travelers Surety and Casualty Company of America ~oa ne George N c~ ~ 1 ~: ' - .~ 70" ~i ~2 v ~ 1 i _ _~ yam. N N S-2131 E (7184) 1''' ' TRAVELERS WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY Farmington Casualty Company St. Paul Guardian Insurance Company Fidelity and Guaranty Insurance Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company Seaboard Surety Company Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company Attorney-In Fact No. 218055 Certificate No. ®~ L ~ ~ 1 KNOW ALL MEN BY THESE PRESENTS: That Seaboard Surety Company is a corporation duly organized under the laws of the State of New York, that St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company and St. Paul Mercury Insurance Company are corporations duly organized under the laws of the State of Minnesota, that Farmington Casualty Company, Travelers Casualty and Surety Company, and Travelers Casualty and Surety Company of America are corporations duly organized under the laws of the State of Connecticut, that United States Fidelity and Guaranty Company is a corporation duly organized under the laws of the State of Maryland, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc. is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Beverly J. Durham, Pamela J. VanPelt, Michael J. Miller, Angela S. Mackey, Joanne George, Amy R. Miller, and Nancy L. Alleman of the City of CaI'11S1e ,State of PeIInS~lVallla ,their true and lawful Attorney(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory i^ the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to he signed and their corporate seals to be hereto affixed, this January 2009 day of Farmington Casualty Company Fidelity and Guaranty Tlasurance Company Fidelity and Guaranty Insurance Underwriters, Inc. Seaboard Surety Company St. Paul Fire and Marine Insurance Company 12th St. Paul Guardian Insurance Company St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company r.su ~y1>ri SUHETJ. F\RE 4~, \RN INSV P.~ NSUgy k JP~tY qNp J 11~~f1Y ~Y~ 01 ~r L C7 y/~~jq~o, I~ i p ~,~ORPOR~>F.i ~P: pPORgT' ~.,~ p '~ ~ O ~ 1 ~7/ / ~'~POf~Atlb 1967 z ~ i ~ m W : GO _._ f ~: ~ NIFTIFdRD, ~'! < t 1 9 8 2 O i f[ ~- a HARTFORD, p~ t 1951 m ~'••SE $Lio": f', ~,SBRy a°' ~ CONN. o° ~ ~O< `q' n'nEt~'' JN ~~ 9O ~`g'~~O m a~~'•....... 'y'~~ v:'-.... .` ~a° '~~aec fi`- bO ~' ~ ~xwNCE ! N~ 1 .. ~ s1 ~, ~ v? 'Ayl ANA a ~ R ~ ~ OF IviWW b"mrun~.~~~m, S..M~ ~S ' n 'r.~ State of Connecticut City of Hartford ss. By: Georg Thompson, enior ice President 12th January 2009 before me ersonall a eared Geor e W. Thom son, who acknowled ed himself On this the day of P Y PP g P~ g to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. ~G,T!? In Witness Whereof, I hereunto set my hand and official seal. ~ My Commission expires the 30th day of June, 201 1. ~ At/BU~~* Marie C. Tetreault. Notary Public 58440-5-07 Printed in U.S.A. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, SL Paul Guardian Insurance Company, SL Paul Mercury Insurance Company. Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, xny Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behall" of the Company and may give such appointee such authority as his or her certitcate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided [hat each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (h) duly executed (under seah if required) by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certiticates of authority or by one or more Company officers pursuant to a written delegation of authority: and i~ is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President. any Senior Vice President, any Vice President. any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any power of attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such power of attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kori M. Johanson, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., Seaboard Surety Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casually and Surely tKompany oflAmerica, and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a [rue and correct copy of the Power of Attorney executed by saidCompanies, which is in full force and effect and has not been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companiesthis ~ ~ day of J `'~~~V _ _ 2{) (~ Kori M. Johans Assistant Secretary GASU,~~ ~ SU~fTy F\RE R44M H IM .: •. ww„wr Or ~~t^~' L * t~ yµ~%., ff~~~~--.. .;r(/9 }JPY 1NS~g9 JP~TY gry03 R\W 3~9flp ~TYA~ tl ~W.~.,,. Pi / `:" RPOR ~~ JV.. 'L~`- P G (~ '''\~q ~S ss MCDRPOItATEp - m° ~1La q>f,i i P ~ RPORA -' C,i 9 \C •i.977 1.gZ7 - S :i: _._ .~€ a HARTFORD. ~ruRIRiRD,j~ ~ "~urto ~~i ~ 1951 mrO ~~~ s' ~:.SEAL,'on•' i~t, o; w 1896 6 ~ ~, q # ' $$A.L::3 ~ CONN. o ~CONN• / 8 ~O< To verify the authenticity of this Power of Attorney, call I-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney-Ln-Fact number, the above-named individuals and the details of the bond to which the power is attached. WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER .~ ~ ~ ' 1 TH/S /S A LEGAL DOCUMEN/ -PLEASE ~ good No. 105190684 ~~ Bond Express -PROBATE/COURT BOND APPLICATION This application must be fully completed, as well as signed, witnessed, and dated by the Applicant and all Indemnitors. If you answer "yes" to any question below, please provide details on a separate page. TYPE OR PRINT LEGIBLY Agency Name or Code GV68R Producer Name Jo`,nneGeorQe ~~a~~~~ licant's Name in full (As k should appear on the bond) A Phone: 717-571-8409 pp Fax: Gayle M Farabaugh Email Applicant's Address (Street Address, Ciry, State and Zip Code) Social Security Number 50 Harvest Drive Etters PA 17319 Applicant's CwTent Occupation Years Experience Type of Bond Required Amount of Bond Effective Date Accountant 20 Ad ministrator ~ 20,000 2/27/2009 Applicant's net worth Fair market value of primary residence Balance of mortg.rge prior Surety for this Estate/Conservatorship? ^ Yes ^X No S S $ Prior Surety for this Principal? ^ Yes Q No Has an application for this bond been declined by another company? ^ Yes ^X No If yes, give name and reason for change. If yes, which surety and why? Has the Applicant or anyone involved professionally or personally: d. Ever hart their license suspended, revoked or denied, or been subject to any ^X N a. Had any lawsuits orjudgments against them? ^ Yes ^X No o legal/administrative proceedings resulting in disciplinary action? ^ Yes ? ^ Yes ^X No l i d b. Ever failed in business or declared bankruptcy? ^ Yes ^ Y 0 No ^X No a m c e. Ever been party to a surety bon f. Ever been subject to an IRS or state division taxation audit? Q Yes ^ No es Ever been convicted of a crime? __ c. _ Court Name and Address PLEASE PROVIDE COPIES OF ALL APPLICABLE COURT DOCUMENTS INCLUDING WILLS, PETITIONS, COURT ORDERS, TRUSTS, ETC. 2 Name of: Applicant's relationship to Is the Applicant indebted Does the Applicant share in Freundel -Date of Death: 2/19/2009 Q Deceased Jel'fre Decease.VMinodlncompetent: to the estate or trusf? the estate'? ~ yes ^ No _ ^ Minor __ DOB/Age: Sister ^ Yes ~ No If yes, what %f? DOB/A e: _- g ^ Incompetent* Date Appointed: If es, lease ex lain. Y P P __ _ $ *Describe condition of ward: Applicant's qualifications for handling estate: List liabilities of estate or trust. List assets of estate or trust: Name and Address of Attorney: N Michael Cherewka ~ o ~ ~ . [roods: _ _ __ Stocks: C ~ t Front Street Wormleysburg PA cash: Keel Estate: _ _ __ ~~ ~ *-r '~7 }~~} ~ c` Other Area of expertise: Estate planning ;71 n :~ 1 ~- _ _ ___ _ ^X No '? ^ Y Will the attorney remain involved throughout the dur ion ~"kstate'?~ r ~ es Does the estate include an ongoing business , ~ G1~~ _ If yes, please provide a description. ~ Yes ^ No ~ ~ ~ "C7 Estate planning ~7 ~ Is this bond required on the demand of an interested person other than the court'? Are guardianship fmids to be used for support of the rl o~ ompetent'? •. - ` ~ ^ Yes ^ No If yes, whdl _ hly expeuditure~d incoriYe. ^ Ye; ^ No If yes, please provide copies of mp'Til Does the presiding court require an annual accounting be filed'? ^ Yes ^ No ]s there a will or trust'? ^ Yes Q No If so, please provide a copy. List all heirs and the percentage they share in the estate: Are there any disputes among the heirs? ^ Yes 0 No If yes, provide details. Submission ChecklisC ^ Wills & Codicils ^ Court Papers ^ Financial Inventory ^ Attomey or Applicant Resume .r AGENT'S RECOMMENDATION Describe the lenbnh and nature of your relationship with the Applicant: New client 3 Do you recommend the Applicant for this bond? ^X Yes ^ No Why? INDEMNITY AGREEMENT The undersigned Applicant and Indemnitor(s), all hereinafter referred to as "Indemnitors," hereby certify that the declarations made and answers given are the truth without reservation, and are made for the purpose of inducing TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, ST. PAUL FIRE AND MARINE INSURANCE COMPANY, any of their present or future direct or indirect parent companies, any of the respective present or future direct or indirect affiliates or subsidiaries of such companies and parent companies, and/or any of the aforementioned entities' successors or assigns, hereinafter referred to, individually and/or collectively, as "Company," to furnish a certain bond or undertaking applied for and any renewal and increase of the same or of any bond or undertaking of similar nature given in substitution or renewal thereof (all comprehended in the word "Bond" as herein used). Indemnitors agree that Company may decline the Bond applied for or may cancel or terminate same without incurring liability whatsoever to Indemnitors. In consideration of Company executing said Bond or the forbearance of cancellation of said Bond, Indemnitors do undertake and agree as follows: lndemnitors will pay all premiums, as they fall due, until Company has been provided with competent legal evidence that the Bond has been duly discharged. Indemnitors will at all times indemnify and exonerate Company from and against any and all loss, cost and expense of whatever kind which it may incur or sustain as a result of or in connection with the furnishing of the Bond and/or the enforcement of this Agreement, including unpaid premiums, interest, court costs and counsel fees, and any expense incurred or sustained by reason of making any investigation. To this end Indemnitors promise: a) to promptly reimburse Company for all sums paid and b) to deposit with Company on demand an amount sufficient to discharge any claim made against the Company on the Bond. This sum may be used by Company to pay such claim or be held by Company as collateral security against loss or cost on the Bond. Indemnitors hereby expressly authorize Company to access credit records and to make such pertinent inquiries as may be necessary from third party sources for underwriting purposes, claim purposes and/or debt collection. To the extent required by law, Company will, upon request, provide notice whether or not a consumer report has been requested by Company, and if so, the name and address of the consumer reporting agency furnishing the report. Regardless of the date of signature(s), this Agreement is effective as of the date of execution of the Bond and is continuous until Company is satisfactorily discharged from liability pursuant to the terms and conditions contained herein. Attention: Any person who knowingly and with intent to defraud a surety company or arty other person files an application for a surety bond containing any materially false information, or conceals, for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act and may be subject to civil and/or criminal penalties. Sig d this 27th day of February 2009 ~-~ X ~ ~~1 ~1 ~- it ss Sign Here ~«.v~, e L I ~~~ ~~ ~ Print Name 4pplic Sign Here Ga le Farabau h Print Name and Social Security Number of Above ADDITIONAL INDEMNITORS MUST SIGN BELOW Witness Sign here Print Namc Witness Sign Here Print Name X Indemnitor Sign Here Prin[ Name and Social Security Number of Above Indemnitor Sign Here Print Name and Social Security Number of Above S-7124 (5/07) All applicntions are avnilnble online vin the Bond Pbrrns Library at _ti~wFV_drnk~~(ers(~or;d,crm .