HomeMy WebLinkAbout04-30-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of M. Jane Douglass O'Keefe File Number 21-- (~d1 ~~j~\2j
also known as Jane O'Keefe a/k/a M. Jane O'Keefe alk/a M. Jane
Douglass ,Deceased Social Security Number 174-20-2864
William Bradley Westhafer
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or '8' BELOW.•)
^X A. Probate and Grant of Letters Testamentaryand aver that Petitioner(s) is/are the Executor named in the
last Will of tlhe Decedent, dated 11/27/2006 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
app tca e, en er: c..a.; ..n.c..a.; en e t e; uran e a sen ~a; uran a moron a e
Petitioner(sj after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs(If
Administratlon, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Name Relationship Residence
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~,` ~, ,
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal reside a
210 Bi
Newville, West Pennsboro T
ship, county, state, zip code)
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Decedent, then $2 years of age, died on 0311812009 at Green Ridge Village, Newville, Cumberland County, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) $ 100,000.00
(If nat domiciled in PA)
(If nat domiciled in PA)
Value of real estate in Pennsylvania
situated a:s follows:
All personal property
Personal property in Pennsylvania
Personal property in County
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:
Signature Typed or printed name and residence
William Bradley Westhafer 6604-A Carlisle Pike
Mechanicsburg, PA 17050
~~ ~ ~~~, (717) 697-4062
Cumberland, PA 17241
Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative
COMMON~NEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
The Petitioner(s) above-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 and subscribed ~~~-~ ~ !~
Signature of~rsonal Representative William Bradley Westhafer
before a this ~~ day of
)Y ~ ~ 2~~5 Signature of Personal Representative
(~'`~n
r the Register Signature of Personal Representative
File Number: 21--
Estate of M. Jane Douglass O'Keefe ,Deceased
A/K/A Jane O'Keefe a/kla M. Jane O'Keefe alk/a M. Jane Douglass
Social a urity N tuber: 174-20-2864 ~~''} Date of Death: 03/18/2009
AND NOW, ~~,~'~-,~--- , in consideration of the foregoing Petition, satisfactory proof
having been presented efore me, IT IS DECREED that Letters Testamentary h,
E} e_
are hereby granted to William Bradle Westhafer ~O
~} -v in t abovrs estate
and that the instrument(s) dated 1 112712 0 0 6 '' ~wT-,~ t-" ~ `
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. , 7 ~%tc ~
_ C.;~ ~
FEES
Letters .............. !D()~.Ub(~........ $ 02 ~ ~
Short Certificate(s)....... ~.......... $ ~ oZ
Renunciation(s) ............................. $
l~ ~ i~ $ i
~l ~ ~ $ iv
~ ~c.~ $ S
$
$
$
$
$
TOTAL .................................. $ a~ ~~
Supreme Court I.D. No.: 91402
Law Offices of Susan E. Lederer
Address: 5011 Locust Lane
Harrisburg, PA 17109
Telephone: 7171652-7323
Form R~ OZ Rev. 10.13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2
Attorney Signature: , (Q ~
Attorney Name: Am M. Moya
.
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee t~>r this ~~~r[ificate. `~~~.(?U
This is tit rerlil~ t!rA the ii?fr:rnlas~i(m ~1e1'e ~i~cn is
correctly c(Tpied ~r;Ym an uri~inal Certii`icate of Death
duly° ~~ilecl Ysith mr a, Local IZc~ishar 'The original
certificate w~i(I bl_ f~n~~~irdc~! to [he State Vital
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6 Age (Las) Binhdayl Under 7 Year Under I day 6. Date of Binh (Honor, day, year) 7. BinfyAace (CAy arM state a country) Bor. Place d DaaN (Check oNy ono) /
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1fi. DecedarT's Mailing Address ISlydet, city /sown, stale, zip code) Decedem's Did Decedent
Adualflesiderka va sww PA ~a~n~? IIr [~rna,DandnmLwadn West Pennsboro Twp
210 Big Spring Rd
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' 11 PA 17 41 lYb cnanly Cumberland nd ^ ~ ~~,law¢awdn;n
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8. Father
s Name (FUSI. nudde. last, sWlrx} 19. MoNei s Name (Fkst, midde, maiden wrname)
James Bradle Esther Pearl Adams
20a. Informsnl's Nana (Type I Pnnl) 280. Idortnwll's Med'yp AdWes6lSUcel, city / tarn, stale, zip coda)
Brad Westhafer 6604-A Carlisle Pike Mechanicsburg, PA 17050
Zla Mema101 Disposition ^ Cremallen ^ Dmadon
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I 21D. Date d Disposi0on (Mode, day, year) 21c. Place d DisposiUOn INanw d cemetery, aemat a olha
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Was Cremation ar Donation Aulhaiied
C7 o~h¢i sPexy ~ DYYeeica,Examlru„caan.n ^raa^Nn
3/23/2009
Mechanicsburg Cemetery
Mechanicsburg, PA
22a Sgrwture d Frnerd leak kensee for person acting i%~hl
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CAUSE OF DEATH (Sae Instructlona and axamploa) r Approximate inleaal: Pan II: Emez ollrer siYUhceel S1 cooldlMloglp.gB210, 28 DM TuOacra Use CcntraWe to Dealn7
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33a. Ceml et IrDech only met 330. $igrelwa an - r
• Cenifying pnysie6n (Pnyskun cxnityny cauen of Uoem when arwiher pnyrcan Has ponowa;ed d¢am ono conylaal Uem 23) ~ ~ ~ _
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To Ina heal of my luwwkdge doom occurred due to Ne cause(s) and manner as elaled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ •~ ~ ~ .
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bn inn hasis d examination antl / or InvastiyaUOn. In my opinion, tlealh occwred at the time, dale. and pace, and due la tfw cease(s) and nurawr K ctated_ ~~
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Last Will and Testament
of
M. Jane Douglass O'Keefe
I, M. Jane Douglass O'Keefe, also known as Jane O'Keefe, also known as M.
Jane O'Keefe, also known as M. Jane Douglass, a resident of Mechanicsburg,
Cumberland County, Pennsylvania, revoke any prior wills and codicils made by me and
declare this to be my Last Will and Testament.
Article Qne
Family Information
I have made provision for the following individuals in my will:
Name
William Bradley Westhafer
Robin S. Piacine
Annette G. Gilbert
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Relationship ~.,
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nephew
niece
niece
I have made no provision in my will for my nephew, Carl Westhafer, Jr., or my stepson,
Michael John O'Keefe, because I feel they have been otherwise well provided for.
Article Two
Specific and General Gifts
Section 2.01 Specific Distribution to William Bradley Westhafer
As soon as practicable after my death, I give my real estate located at 12 Poplar Drive,
Mechanicsburg, Cumberland County, Pennsylvania to William Bradley Westhafer.
If William Bradley Westhafer should predecease me, I give the property subject to this
distribution to Robin S. Piacine.
Death taxes shall be apportioned to this distribution, notwithstanding the provisions of
Article Eight. Property passing under this Section shall pass subject to all liens, security
interests or other encumbrances on the property.
Page 1
Section 2.02. Disposition of Tangible Personal Property
I give all my remaining tangible personal property, together with any insurance policies
covering such property and claims under such policies in accordance with a
"Memorandum for Distribution of Personal Property" or other similar writing directing
the disposition of such property, which shall be dated and signed by me.
Should I leave multiple written memoranda that conflict as to the disposition of any item
of tangible personal property, the memorandum with the most recent date shall control as
to those items that are in conflict.
If the memorandum with the most recent date conflicts with a provision of this Will as to
the specific distribution of any item of tangible personal property, the provisions of this
Will shall control as to those items that are in conflict.
I intend that the writing qualify to distribute my tangible personal property under
applicable state law.
Section 2.03 Contingent Distribution of Tangible Personal Property
Any tangible personal property not disposed of by a written memorandum, or if I choose
not to leave a written memorandum, all such property shall become part of my residuary
estate.
Section 2.04 Definition of Tangible Personal Property
For purposes of this Article, my tangible personal property shall include but not be
limited to my household furnishings, appliances and fixtures, works of art, motor
vehicles, pictures, collectibles, personal wearing apparel and jewelry, books, sporting
goods, and hobby paraphernalia.
Section 2.05 Encumbrances and Incidental Expenses of Tangible
Personal Property
iviy Executor shall distribute property under this Article subject to liens, security interests
or other encumbrances on the property.
My Executor shall pay, as an administration expense, the reasonable expenses of storing,
packing, insuring, transporting and otherwise caring for my tangible personal property
until actual delivery of each article of property to the appropriate beneficiary.
Page 2
Article Three
My Residuary Estate
Section 3.01 Definition of My Residuary Estate
All the remainder of my estate, including property referred to above that is not effectively
disposed of, shall be referred to in my will as my "residuary estate."
Section 3.02 Disposition of My Residuary Estate
I give my residuary estate outright to William Bradley Westhafer.
If William Bradley Westhafer predeceases me, I give my residuary estate outright to
Robin S. Piacine.
If Robin S. Piacine predeceases me, I give my residuary estate outright to Annette G.
Gilbert.
If Annette G. Gilbert predeceases me, my Executor shall distribute my residuary estate as
provided in Article Four entitled "Remote Contingent Distribution."
Article Four
Remote Contingent Distribution
If, at any time, there is no person or entity qualified to receive final distribution of my
estate or any part of it, then the portion of my estate with respect to which the failure of
qualified recipients has occurred shall be distributed to those persons who would inherit it
had I then died intestate owning the property, as determined and in the proportions
provided by the laws of Pennsylvania then in effect.
Article Five
Designation of Executor
Section 5.01 Executor
I name William Bradley Westhafer as my Executor. If William Bradley Westhafer fails
or ceases to act as my Executor, I name Robin S. Piacine as my Executor.
Page 3
Article Six
General Administrative Provisions
The provisions of this Article apply to my probate estate.
Section 6.01 No Bond
No Fiduciary shall be required to fizrnish any bond for the faithful performance of the
Fiduciary's duties. If a bond is required by any law or rule of court, no surety shall be
required on such bond.
Section 6.02 Fiduciary Compensation
An individual serving as my Fiduciary shall be entitled to fair and reasonable
compensation for the services rendered as a fiduciary. A corporate fiduciary shall be
compensated by agreement with an individual Fiduciary or, in the absence of an
individual Fiduciary or in the absence of an agreement, in accordance with the corporate
fiduciary's published schedule of fees in effect at the time the services are rendered.
In addition to receiving compensation, my Fiduciary may be reimbursed for reasonable
costs and expenses incurred in carrying out its duties under my will.
Section 6.03 Determination of Principal and Income
The Pennsylvania Uniform Principal and Income Act shall govern beneficiaries' rights
among themselves in matters concerning principal and income. If the Pennsylvania
Uniform Principal and Income Act contains no provision concerning a particular item,
my Fiduciary shall determine in a fair, equitable and practical manner what shall be
credited, charged, and apportioned between principal and income.
Section 6.04 Distributions to Incapacitated Persons and Persons Under
Twenty-Five Years of Age
If my Executor is directed to distribute any share of my probate estate to any beneficiary
who is under the age of 25 years or is in the opinion of my Executor, under any form of
incapacity that renders such beneficiary unable to administer distributions properly when
the distribution is to be made, my Executor may, as Trustee, in my Executor's discretion,
continue to hold such beneficiary's share as a separate trust until the beneficiary reaches
the age of 25 or overcomes the incapacity. My Executor shall then distribute such
beneficiary's trust to him or her.
While any trust is being held under this Section, the Trustee shall pay to the beneficiary
for whom the trust is held such amounts of the net income and principal as the fiduciary
Page 4
determines to be necessary or advisable for the beneficiary's health, education,
maintenance and support.
Upon the death of the beneficiary before that time, the Trustee shall distribute the trust,
including any accrued and undistributed income, to the beneficiary's then living
descendants, per stirpes, or, if none, to the beneficiaries named in Article Three, Section
3.02, in the order in which they are named therein. If I have no then living named
beneficiaries, the property shall be distributed under the provisions of Article Four
entitled "Remote Contingent Distribution."
Section 6.05 Maximum Term for Trusts
Notwithstanding any other provision of my will to the contrary, unless terminated earlier
under other provisions of my will, each trust created under my will shall terminate 21
years after the last to die of the descendants of my maternal and paternal grandparents
who are living at the time of my death.
At that time, the remaining trust property shall vest in and be distributed to the persons
entitled to receive mandatory distributions of net income of the trust and in the same
proportions. If no beneficiary is entitled to mandatory distributions of net income, the
remaining trust property shall vest in and be distributed to the beneficiaries entitled to
receive discretionary distributions of net income of the trust, in equal shares per stirpes.
Section 6.06 Representative of a Beneficiary
The guardian of the person of a beneficiary may act for such beneficiary for all purposes
under my will or may receive information on behalf of such beneficiary.
Section 6.07 Ancillary Administration
In the event ancillary administration shall be required or desired and my domiciliary
Executor is unable or unwilling to act as an ancillary fiduciary, my domiciliary Executor
shall have the power to designate, compensate, and remove the ancillary fiduciary. The
ancillary fiduciary may be either a natural person or a corporation. My domiciliary
Executor may delegate to such ancillary fiduciary such powers granted to my original
Executor as my Executor may deem proper, including the right to serve without bond or
surety on bond. The net proceeds of the ancillary estate shall be paid over to the
domiciliary Executor.
Section 6.08 Delegation of Authority; Power of Attorney
Any Fiduciary may, by an instrument in writing, delegate to any other Fiduciary the right
to exercise any power, including a discretionary power, granted the Fiduciary in my will.
During the time a delegation under this Section is in effect, the Fiduciary to whom the
delegation was made may exercise the power to the same extent as if the delegating
Fiduciary had personally joined in the exercise of the power. The delegating Fiduciary
Page 5
may revoke the delegation at any time by giving written notice to the Fiduciary to whom
the power was delegated.
The Fiduciary may execute and deliver a revocable or irrevocable power of attorney
appointing any individual or corporation to transact any and all business on behalf of the
trust. The power of attorney may grant to the attorney-in-fact all of the rights, powers,
and discretion that the Fiduciary could have exercised.
Section 6.09 Merger of Corporate Fiduciary
If any corporate fiduciary acting as my Fiduciary under my will is merged with or
transfers substantially all of its trust assets to another corporation or if a corporate
fiduciary changes its name, the successor shall automatically succeed to the position of
my Fiduciary as if originally named my Fiduciary. No document of acceptance of the
position of my Fiduciary shall be required.
Article Seven
Powers of My Fiduciaries
Section 7.01 Grant of Powers
My Fiduciaries may perform every act reasonably necessary to administer my estate and
any trust established under my will. Specifically, my Fiduciaries may exercise the
following powers:
They may hold, retain, invest, reinvest and manage real or personal
property, including interests in any form of business entity and policies of
life, health and disability insurance, without diversification as to kind,
amount or risk of non-productivity and without limitation by statute or
rule of law.
They may partition, sell, exchange, grant, corwey, deliver, assign, transfer,
lease, option, mortgage, pledge, abandon, borrow, loan, contract, distribute
in cash or kind or partly in each at fair market value on the date of
distribution, without requiring pro rata distribution of specific assets and
without requiring pro rata allocation of the tax bases of such assets.
They may hold in nominee form, continue businesses, carry out
agreements, and deal with themselves, other Fiduciaries and business
organizations in which my fiduciaries may have an interest.
They may establish reserves, release powers, and abandon, settle or
contest claims.
Page 6
They may employ attorneys, accountants, custodians of the trust assets,
and other agents or assistants as deemed advisable to act with or without
discretionary powers and compensate them and pay their expenses from
income or principal or both.
Section 7.02 Fiduciaries' Powers Act
In addition to all of the above powers, my fiduciaries may, without prior authority from
any court, exercise all powers conferred by my will or by common law or by any
fiduciary powers act or other statute of the Commonwealth of Pennsylvania or any other
jurisdiction whose law applies to my will. My Executor shall have absolute discretion in
exercising these powers. Except as specifically limited by my will, these powers shall
extend to all property held by my fiduciaries until the actual distribution of the property.
Section 7.03 Alternative Distribution Methods
My Fiduciary may make any payment provided for under my will as follows:
Directly to the beneficiary;
In any form allowed by applicable state law for gifts or transfers to minors
or persons under a disability;
To the beneficiary's guardian, conservator, agent under a durable power of
attorney or caregiver for the benefit of the beneficiary; or
By direct payment of the beneficiary's expenses, made in a manner
consistent with the proper exercise of the fiduciary's duties hereunder. A
receipt by the recipient for any such distribution shall fully discharge my
Fiduciary.
Article Eight
Provisions for Payment of Debts, Expenses and Taxes
Section 8.01 Payment of Debts and Expenses
I direct that all my legally enforceable debts, secured and unsecured, be paid as soon as
practicable after my death.
Section 8.02 No Apportionment
Except as otherwise provided in this Article or elsewhere in my will, my Executor shall
provide for payment of all estate, inheritance and succession taxes payable by reason of
Page 7
my death ("death taxes") from my residuary estate as an administrative expense without
apportionment and shall not seek contribution toward or recovery of any death tax
payments from any individual.
Section 8.03 Property Passing Outside of My Will
Except as to Qualified Retirement Benefits, death taxes imposed with respect to property
included in my gross estate for purposes of computing the tax and passing other than by
my will shall be apportioned among the persons and entities benefited in the proportion
that the taxable value of the property or interest bears to the total taxable value of the
property and interests received by all persons benefited. The values as finally determined
in the respective tax proceedings shall be the values used for the apportionment of the
respective taxes.
Section 8.04 Tax Elections
In exercising any permitted elections regarding taxes, my fiduciaries may make such
decisions as they deem to be appropriate in all the circumstances and my fiduciaries shall
be under no duty to make any compensatory adjustment as a consequence of any such
election. My Executor may also pay such taxes or interest and deal with any tax refunds,
interest, or credits as it shall deem necessary or advisable in the interest of my estate.
Article Nine
Definitions and General Provisions
Section 9.01 Definitions
For purposes of my will and for the purposes of any trust established under my will, the
following definitions shall apply:
(a) Adopted and Afterborn Persons
A legally adopted person in any generation and his or her descendants,
including adopted descendants, shall have the same rights and shall be
treated in the same manner under my will as natural children of the
adopting parent, provided such person is legally adopted prior to attaining
the age of 18 years. A person shall be deemed to be legally adopted if the
adoption was legal in the jurisdiction in which it occurred at the time that
it occurred.
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(b) Descendants
The term "descendants" shall include a person's lineal descendants of all
generations.
(c) Fiduciary
My "Fiduciary" or "Fiduciaries" shall refer to my Executor. My
"Executor" shall include any executor, ancillary executor, administrator,
or ancillary administrator, whether local or foreign and whether of all or
part of my estate, multiple Executors, and their successors.
(d) Legal Representative
As used in my will, the term "legal representative" means a person's
guardian, conservator, personal representative, executor, administrator,
Trustee, or any other person or entity personally representing a person or
the person's estate.
(e) Per Stirpes
Whenever a distribution is to be made to a person's descendants per
stirpes, the distribution shall be divided into as many shares as there are
then living children of such person and deceased children of such person
who left then living descendants. Each then living child shall receive one
share and the share of each deceased child shall be divided among such
child's then living descendants in the same manner.
(fl Shall and May
Unless otherwise specifically provided in my will or by the context in
which used, I use the word "shall" in my will to command, direct or
require, and the word "may" to allow or permit, but not require. In the
context of my Trustee, when I use the word "may" I intend that my
Trustee may act in its sole and absolute discretion unless otherwise stated
in my will.
(g) Other Definitions
Except as otherwise provided in my will, terms shall be as defined in PA
Probate, Estates and Fiduciaries Code as amended after the date of my will
and after my death.
Section 9.02 Contest Provision
If, after receiving a copy of this Section, any person shall, in any manner, directly or
indirectly, attempt to contest or oppose the validity of my will, (including any codicil to
my will), or commences, continues or prosecutes any legal proceedings to set my will
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aside, then such person shall forfeit his or her share, cease to have any right or interest in
my estate, and shall, for purposes of my will be deemed to have predeceased me.
This Section shall not apply so as to cause a forfeiture of any distribution otherwise
qualifying for the federal estate tax charitable deduction.
Section 9.03 Survivorship Presumption
If any beneficiary shall be living at my death, but die within 30 days thereafter, then such
beneficiary shall be deemed to have predeceased me for all purposes of my will.
Section 9.04 General Provisions
The following general provisions and rules of construction shall apply to my will:
(a) Singular and Plural; Gender
Unless the context requires otherwise, words denoting the singular may be
construed as plural and words of the plural may be construed as denoting
the singular. Words of one gender may be construed as denoting another
gender as is appropriate within the context. The word "or" when used in a
list of more than two items may function as both a conjunction and a
disjunction as the context requires or permits.
(b) Headings of Articles, Sections, and Subsections
The headings of Articles, Sections, and subsections used within my will
are included solely for the convenience and reference of the reader. They
shall have no significance in the interpretation or construction of my will.
(c) Governing State Law
My will shall be governed, construed and administered according to the
laws of the Commonwealth of Pennsylvania as from time to time
amended. Questions of administration of any trust established under my
will shall be determined by the laws of the situs of administration of such
trust.
(d) Notices
Unless otherwise stated, whenever my will calls for notice, the notice shall
be in writing and shall be personally delivered with proof of delivery, or
mailed postage prepaid by certified mail, return receipt requested, to the
last known address of the party requiring notice. Notice shall be effective
on the date personally delivered or on the date of the return receipt. If a
party giving notice does not receive the return receipt but has proof that he
or she mailed the notice, notice shall be effective on the date it would
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normally have been received via certified mail. If notice is required to be
given to a minor or incapacitated individual, notice shall be given to the
parent or legal representative of the minor or incapacitated individual.
(e) Severability
The invalidity or unenforceability of any provision of my will shall not
affect the validity or enforceability of any other provision of my will. If a
court of competent jurisdiction determines that any provision is invalid,
the remaining provisions of my will shall be interpreted and construed as
if any invalid provision had never been included in my will.
~ I, M. Jane Douglass O'Keefe, hav'ng signed this Will in the presence of
~~jr,s ~a~c?,f~sU~/ and ~r'1~(~ ~~• Y~~o't. who attested it at my request on this
day, ~~-e,tis,.~ a-'~ , 2006 at Harrisburg, Pennsylvania, declare this to be my
Last Will and Testament.
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i.
M. ane Douglass 'Keefe, Testatri
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The above and foregoing Will of M. Jane Douglass O'Keefe was declared by M. Jane
Douglass O'Keefe in our view and presence to be her Will and was signed and
subscribed by the said M. Jane Douglass O'Keefe in our view and presence and at her
request and in the view and presence of M. Jane Douglass O'Keefe and in the view and
presence of each other, we, the undersigned, witnessed and attested the due execution of
the Will of M. Jane Douglass O'Keefe on this day, ~ ~-,~S~ei ~~ , 2006.
\~~ri s ~jy~JC.f -~S U~ residing at
I lv(v C~ n~ l ~~ lCC'A~i ~1 ~ ~~~
(, ~ ~ - C~~ residing at -~ C ~~ Ss~c~~ l.-o~ ~
~~i~r`J ~J~~'J ~ ~~
PENNSYLVANIA SELF AUTHENTICATING AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
I, M. Jane Douglass O'Keefe, the testatrix whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; and that I signed
it willingly and as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowledged before me by M. Jane Douglass O'Keefe, the
testatrix, this day, ~W„re,,..~,~~ a7 , 2006.
~~~
M. ne Douglass 'Keefe, Testatri
No y Public
COMMONWEgLTH OF PENNSYLVANIA
Nofari~ Seal
~aaiueline M. Mi DNotary~ublic
My ~m~ssion E~ires Oct. 25, p
Member, Pennsylvania Asaoclation of Notaries
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COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF DAUPHIN )
We, ~~ ~ ~ ~~ ~~-~ and v 1~ : ~ ~ ,the witnesses whose names are
signed to the attached or foregoing instrument, eing duly qualified according to law, do
depose and say that we were present and saw the testatrix sign and execute the instrument
as her Last Will; that the testatrix signed willingly and executed it as her free and
voluntary act for the purposes therein expressed; that each subscribing witness in the
hearing and sight of the testatrix signed the will as a witness; and that to the best of our
knowledge the testatrix was at that time 18 or more years of age, of sound mind, and
under no constraint or undue influence.
1
Witness
~1~' ~~~, i X16
Witne
ota y Public ~
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Jacqueline M. Mirxteck, Notary Public
Lower Paxton Twp., Dauphin County
MY Cornmisslon Expires Oct. 25, 2010
Member, Pennsylvania Association of Notaries
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