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Home My WebLink About11-23-09PETITION FOR PRROBATE AND GRANT OF LETTERS ~~~~R""EGISTER OF WILLS OF CIA.Y~nb ,r-~CS, d COUNTY,~P~E/~~S/~YLVANIA Estate of ~.~ sp.~j e~ A. ~C~a y~ n... File Number __ (ylJ ` v ~ ~ ~~~ also known as Deceased Social Security Number ~ 4~- 7 2- $3'L~ Petitiorer(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:J A. Probate and Grant of Let ers T stamentary and aver that Petitioner(s) is /are the ~X C . ~ ~ Y named in the last Will of the Decedent dated G and codicil(s) dated (Slate relevmrf cirewnsfnncet, e.g., renunciation, death ofexecufor efe.J Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after executi~of the instnrr~t(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: C n w° _ -,-, ;- ^ B. Cront of Letters of (/fapplicable, enter: c.l.rt.; d.b.n.c.r.a.; pendenfe (i(e; duranfe nbsenfin; dy~pd[Fh~rimfe v i n r _, r-~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followir~~sBCif any~rtd hei,[s, ~ (~~ Administration,c.[.a.ord.b.n.c.t.a., enter dare afWill irc SeerionAabove and complete list ofheirs.) ~ ~ ~~ -_'~> at death inr C:vt~~~r, ~g;. ,( County, Pennsylvania with his /her last principal residence at (Liss sn'eet nddress, town/city. township, county, Decedent, then ~_ years of age, died on 10 ~3 0 at ~r L.i~.l-_-~~o STS-~.w (1 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County ,$ Value of real estate in Pennsylvania g ~~7 S~ Q Fonn RVKO? rev ro. lJ.od Page I of 2 (COMPLETE IN ALL CASES:) Attach additiaral sheets if necessary. situated as follows:__Za''{ ~ lJ~bet~~Q r~g~~ { s L~1 ~ 1 ~J 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 appropriatt form to the undersigned: Oath of Persona( Representative COMMONWEALTH OF PENNSYLVANIA / SS ry COUNTY OF ~((,C.((,/ ° -n o >O ~o r~ " ~ The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are ttjYy cotrect~jthe b~,o~~ r7 the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner Dell a>~truly <,~>.~ ~,-; 37 W -n `--~ administer the estate according to law. ~~ v~ ~ r -1 , 7 Sworn to or affirmed and subscribed ~ Xe~nti.~' ~M l~.~rmn ~'~ ~ N -~ before me the ~J ~ day of Register Signature afPersonal Represen!¢live <~s' , .~ -~~ OD Sign¢ture of Personal Represenlaeive FileNumbetr~:'~(L~ JUG /' (~J Estate of ~~~.Y 71~~ n `~~ ,Deceased . Social Security Number: I-18'a??a~~~~ Date of Death: IJL~~3~.`~~ t AND NOW, ~yC7Jen,~~r `~J `~~ , in consideration of the foregoing Petition, satisfactory proof ^ f i ~ having been presented befo~reme, IT IS DECREED that Letters .lsE~h'1 !1 S are hereby granted to ! ]onn~ n( ~C~.r~ _. and that the instrument(s) dated ~ described in the Petition be admitted to FEES Letters ............... Short Certificate(s) ....... . Renunciation(s) ........... a ... of Personn(Represenlalive in the above estate and filed of record as [he last $ ~ $~ $ ~ $ ` ~ $ 5. .$ .. $ .. $ .. $ .. $ ... $ TOTAL .............. $ (and of Attorney Signature: Attomey Name: Supreme Court LD. No.: Address: Telephone: Pm~ni Rw-n? reg. ru r3.oh Page 2 of 2 105 RpG RCV (O~IJV) LOCAL REGISTRAR'S CERTIFICATION OF DEATH ~~ ~ ~G~~ WARNING: It is illegal to dupllDate this copy by photostat or photograph. Fee for this certificate, $6.00 I P 15839080 Certifteation Nnmber This is [o certify that 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 [he State Vital Records Office for permannent filing. ~.~ ~. ~~r~. ll / 3 / aq Local Registrar Date Issued mas,uxEV nroa COMMONWEAL7N OF PENNSVL~AMA • DEPAgTYEHT OF NEALiN ttPE/Nrra VRAL RECORDS nr ISw ImEwRetl nICYA,W~. ~.me~A~,,....s 1 is C N O t9 ~),' :r1 ~'C'? ~ _ 7 4 -p . w ,~ ~ A N t7~"~ v '>- ' me,E FI,E MMIBEq t.xwa WVbllxw rr. w,.Yra 2W ?Baw arrraY aortlowprga,r 1 Mabel A. Robinson Female 188 _ 22 _ 8828 Oeto~er 31 2008 , a.aNYraarrl ur,i u,aYi sore r. raara -rbraorm m. ,ear ow xr ,... 78 rm November 7, 1930 ~~..MWSntown, Pa. Ne1p°` 0°'° ravao.r ar Ose/aMr.s Oow ^wryxmY ^rabe pw..ymr/. r. cmwrao..b tUb WO . . YMaareamaampa+a,ma,aaa,l avrs,rraawr.Yaam gr W Mh'tMrfmMa.aaa wrau Cumberland South Niddlaton CaAlsle Rspion#1 M~dleal Center Isa"°m ~ ~n.nax White r.YC~ n.orra.w a.anav. raa M.rm tE. Wrpsl..wrbb IltYgraa brMam YM M~~ IrYYMr. }s.9uaM Amaaaab, aanwsury raa~ a I b.B..Y.YC ISat fYSart In Iw IH aN~ (BYaJt ~° u` ~ } Laborer an ~ae u r ng pw ire Widowed IAU,sribY,i9M1e14YYaY/bw4ab.WmY1 belt. 284 Redwood Lane MYatmbYm v.. b„ ~ PA uP°,.°n: `"' ,t~~,~,,~~b CaNisle, PA 77015 }m.wy DDmWrland °i"rt na.^r,oY.wumrr 1p h.aura q/ra. t\iwn WY6la wb-m.,Vyl ustW\iY.,IflYaCY. mYmatiM Clanrenca Collins Beasle Miley m wa.nYr.M.fnoa/ran - mwrar,}rq.wr ar Dennis Pschart ~1~'~"eet f~t~ork Road Cadiale PA 17076 , na Yrraowrsm Oor+n Oomar :m ors aw O rrw.resr uwan/basass wl. Na vr.aarrm{mYaa,.rm..rrtYarrr aw bYawp'/bw+r4mM I~ . ^ um. `a,a°i'i Y0~tYYrt~^va,pw Nowmbar 6, 2006 Rolling Oresn Memorial Psrk Camp HIII, Ps. 77077 ~ >m a wramra. muarra. ma~rrYraa.w FD-012682-L Myers Funeral Homa, Inc. 37 East Main Streel tMChaniubur8, PA 77066 aYrr MwbYMtl b iYb aiA'brYlT.lrvvaMYb1YY. Y,YNfb,W.411dM Wly. mlYYrt4aw Ln O,Y aampwe.am NYI rwmraar IYr NffirabmybYaMp~rt N.1ba0,r O.pYPOwW MOrT. r/.Nw BI.Ib4rlYMtlblYtrl EaaiYt/GmVb. Wrm GY,MGbYmvWW9 r°P°OY°~'' L3 53 P N. fo-31-U 4 pw prr w.v.MA eauae moaasa na. srYVaM.w a4b(pyptlppf-mrY.iwM.ariamm,-M6Y1/eW bar.Op~mraarYM W,ratlrn,a amarr~ '. Maw amayt,aaoeysaammpya iplbmUrGMrb Mi M r . m r Y,YI.YrYIL,bYW.Im.arYga, wap WO1'rruamaw,b ,r.gaburlaera, lEY,aMI. ^4 QPrab ~~ ryry al! YYmmua~ee~~My ,ay mLmr~nurVaYr,a ~ ^~ 5 -- .. ~ E P S / S xaxr.b ornwr. mnw.~a.A- ®'ea Y.arsarptly~ 1~J,garpyby~,m9YAw:a'.. P' ^nprYwarr YrrYIVIIKCYMI MY bier. mllYPY,ual. .IW.ir O+Y~'e{~„ ^ wo.aramow+wwer. c ear wawrarmYru a. ' i ^ Wpgmampq ra MablaY a. a,Ww ^u+m.ra.aarabr.aw s NrrMrq mapMbrr p~/ moraaaYMd+; MF wI mMw.r.sbrom.m M1iamaaf Maas Mvb ~ ]I.~y aM mMtlYs~b,~sMV.IM e.a.F aaaY. aWar r Yra ^ l~ e IMb11 rJ awwf -/ tlCw,pbr ^ra Lyr ^ra, ^w ^"da.v OMmuv,.wm saz mYa.Mr m.sMrarwn se.snrwaW wrfR+tltl as ~,a.rr~r~w/an.rw ^w Ow t7m,./onYYY ^tav_bY OM,ab, ^s:m, ^co.Yxu roa..ms a O°"~'~'. m. uxW ww rvaa m. nacasw • rMaaaMa,rypam mraYmm tlar arYVr an~Warramarwaapm Wei mbrawa.,,p.,ararr raw rarmaewrbbpraarlra,b.noon r+MpmwwrrarL-----------------------------•--[~ • Ymwn ar.Y a ' g r aen..maaw xasraawWry,arrwmabb.,ar.war,rrbrry4wrwmrrw ~MOi moraY.apsm w.am __________________ '"'tlr""br/°"'Y MD 0340 8oL 11 1 09 bb WYa.rrrY,r,mb ,awapr.,ran:wraabv.. r, wgo wwrr...yMr,r a LO - - , , , .. Y, Nrr.YabrsavYSmvMeb.arrcYraor ar m rm/M >a I°"r.1 .11 ~111~1 s, ~ SCR MC Tear 9~e h~~. Q ~J - oaamam eYmrw o3IIY~o'-~i~ 6~ - (~~ rv o ~1/r ~ ~ • t ~' ~O ~' 1'T i ~ l L f7,S7zNILL ~N1D 2~ S`~`19VfrE 7V?' O :;:gym ~ O N Gal;, ~' . . ,, , - 9Ka6eC~g6inson -~' Ys ~' i. ") ~ -tt I, Mabel Robinson, a resident of the Commonwealth of Pennsylvania and County of Cumberland; and being of sound mind, do hereby make, publish and declare this to be my Last Will and Testament, thereby, revoking and making null and void any and all other Last Wills and Testaments and/or Codicils to Last Wills and Testaments heretofore made by me. All references herein to this Will shall be rnnstrued as referring to this Last Will and Testament only. FAMILY CLAUSE At the time of executing this Last Will and Testament, I am unmarried. The names of my children are listed below. If I do not leave any property to any of my children, my failure to do so is intentional. Dennis Pechart Debra Allison Donald Wright Peggy Ashwell RESIDENCY CLAUSE cossnsi ooc Having in mind the possibility that I may temporarily reside outside of, or simply be absent from the Commonwealth of Pennsylvania and County of Cumberland, at the time of my death, I elect and hereby declare that this Will and each and every disposition and provision contained herein shall be construed and regulated by and in acrnrdance with the laws of said Commonwealth of Pennsylvania. It is my desire that this Will be probated in the Commonwealth of Pennsylvania, my place of domicile, and that the principal administration of my Estate be made in said Commonwealth of Pennsylvania and that none of the assets of my Estate which may be found in my place of domicile, be remitted to any other jurisdiction for administration or distribution. Page 1 of my Last Will and Testament ~~ °'~"I` R ~e-Q-~-w (Signature) DEBT CLAUSE I duect that the executor named pursuant to this Last Will and Testament review (as soon after my death as practical) all of my just debts and obligations, including funeral expenses and the expenses incident to my last illness; excepting those long teen debts secured by real or personal property which may be assumed by the Heir of such property, unless such assumption is prohibited by law or upon agreement by the Heir. The executor shall pay these just debts only after the creditor provides sufficient evidence to support their claim. My executor shall pay out of my gross Estate, as if they were my debts, and without proration or appointment, all estate and inheritance taxes, by whatever name called; (including any interest due thereon) becoming payable because of my death in respect to all property rnmprising my gross Estate for death tax purposes, whether or not such property passes under this Last Will and Testament. I further direct that if any Heir or Heirs named in this Last Will and Testament should be indebted to me at the time of my death, and evidence of such indebtedness is provided or made available to the Executor of my Estate, then that share of my Estate which I give, devise, and bequeath to any and each such Heir shall be reduced in value by an amount equal to the proven indebtedness of such Heir or Heirs, unless I have specifically provided in this Last Will and Testament for the forbearance of such debt, or unless such Heir is the sole Principal Heir. SPECIAL DIRECTIVES CLAUSE Notwithstanding any other provision of this Last Will and Testament, including those express du•ectives in the Debt Clause above and the Principal Distribution and Specific Bequest clauses below, I furthermore duect that: All assets, money (certificates of deposit, cash, checking, savings), and materials (mobile home, caz, furniture, etc.) should be divided equally among the four children listed in this Will. Contact Citizen s Bank in Mechanicsburg, Pennsylvania for account information and All State Insurance in Mechanicsburg, Pennsylvania for insurance account. Page 2 of my Last Will and Testament '~''J~ _ ~ y4- ~~~ ~,Z. (Signature) PRINCIPAL DISTRIBUTION CLAUSE I give, devise, and bequeath to the persons named below (my "Principal Heirs'), if he or she, whichever the case may be, shall survive me, all of the residue and remainder of my gross Estate after payment of all my just debts, expenses, taxes, administration and specific bequests, if any, in the percentages set forth below. 1. Name: Dennis Pechart Relation: Son Percentage: 25% Incase such Principal Heir does not survive me, I direct that the share of my Estate which would have been given to such Principal Heir shall be distributed to: Ryan Pechart. 2. Name: Donald Wright Relation Son Percentage: 25% In case such Principal Heir does not survive me, I duect that the share of my Estate which would have been given to such Principal Heir shall be distributed to: Keith Wright. 3. Name: Debra Allison Relation Daughter Percentage: 25% Incase such Principal Heir does not survive me, I duect that the share of my Estate which would have been given to such Principal Heir shall be distributed to: Richart Doibin (RJ}grandson. 4. Name: Peggy Ashwell Relation Daughter Percentage: 25% In case such Principal Heir does not survive me, I direct that the shaze of my Estate which would have been given to such Principal Heir shall be distributed to: Katrina Walters. Page 3 of my Last Will and Testament ~lt.~,.(? I'r ~~„ (Signature) SPECIFIC BEQUESTS I give, devise, and bequeath to the persons named below if he or she, whichever the case may be, shall survive me, the following items of property: 1. To my grandson, Richard Dolbin (Rn, I give: Don's antique tractor. 2. To my grandson, Brandon McKillip, I give: Half of my gun collection, my air compressor, and my press drill. 3. To my son, Dennis Pechart, I give: Half of Don s guns in the gun collection and my power tools. 4. To my son, Donald Wright, I give: 331/3% of any items that he wishes to have. 5. To my sister, Mary Hess, I give: Any of my personal clothing. 6. To my daughter, Debra Allison, I give: 331/3% of any items that she wishes to have. 7. To my daughter, Peggy Ashwell, I give: 331/3% of any items she wishes to have. EXECUTOR APPOINTMENT CLAUSE (A) I nominate, rnnstitute and appoint my son, Dennis Pechart, to be the Executor of my Estate. (B) If, for any reason, my first nominee Executor should fail to qualify or be unable or unwilling to acceptor to rnntinue as the Executor of my Estate, I nominate, constitute and appoint my son, Donald Wright, to be the Executor of my Estate. (C) If for any reason, all of the nominees designated above in Pazagraphs (A) and (B) should fail to qualify or be unable or unwilling to accept or to continue as Executor of my Estate, I nominate, rnnstitute and appoint my daughter, Debra Allison, to be the Executor of my Estate. Page 4 of my Last Will and Testament `~'~a.t,...-~ 4} cn~..,~ ~.o"" (Signature) EXECUTOR POWER OF APPOINTMENT CLAUSE (A) All directives in this Will that use by reference the word Executor mean and include any person named herein as my Executor (or personal representative, as may be defined under state law) and any person who may be acting in either capacity, at any time. Such person shall have broad and reasonable discretion under the directives of this my Last Will and Testament with respect to any property, real or personal, left by or held by me, or acquired by my Executor on behalf of my Estate. (B) I wish my Executor to have broad and reasonable discretion in the administration of my Estate, to have all of the powers permitted to be exercised by an Executor under state law, and to be able to do everything he or she deems advisable for the best interest of my Estate and the Heirs thereof, all without the necessity of mart approval or supervision. I direct that my Executor perform all acts, take all such proceedings, and exercise all such rights and privileges, although not specifically mentioned in this Will, with relation to any such property, as if the absolute owner thereof; and in connection therewith, to make, execute and deliver any instruments, and to enter into any covenants or agreements binding my Estate or any portion thereof. (C) No such person named in, or appointed in connection with this Will in a fiduciary capacity shall be required to file any bond or other security for the faithful performance of his or her duties as such fiduciary in any jurisdiction; and if, despite this directive, a bond should be required, I request that it be accepted without sureties and in a nominal amount. NON-LIABILITY OF FIDUCIARIES Any fiduciary, including my Executor and any trustee, who in good faith endeavor to carry out the provisions of this Last Will and Testament, shall not be liable to me, my Estate, or my heirs, for any damages or claims arising because of their actions or inactions based on this Last Will and Testament. My Estate shall indemnify and hold them harmless. Page 5 of my Last Will and Testament -~'Yl~L~ !~ _..... (Signature) SAVING CLAUSE If a mart of competent jurisdiction shall at any time invalidate or find unenforceable any provision of this Will, such invalidation shall not be construed as invalidating the whole of this Will. All of the rema;n;ng provisions shall be undisturbed as to their legal force and effect. If a court finds that an invalidated or unenforceable provision would become valid if it is limited, then such provision shall be deemed to be written, deemed, construed and enforced as so limited. Page 6 of my Last Will and Testament ~-~a.~.c,L !K" „~_ _ ~,., (Signature) IN WITNESS WHEREOF, I, the undersigned Testator, declaze that I sign and execute this instrument on the date written below as my Last Will and Testament and further declare that I sign it willingly, that I execute it as my free and voluntary act for the purposes expressed in this document and that I am eighteen yeazs of age or older, of sound mind and under no constraint or undue influence. bf (Signature of Mabel Robinson) Date: ~~ ~ ~'- !~ ~ o S' Page 7 of my Last Will and Testament •~YJ~ Gr./ ( /q [~..,~..-.. (Signature) ATTESTATION CLAUSE This Last Will and Testament, which has been separately signed by Mabel Robinson, the Testator, was signed, executed and dec]ared by the above named Tesffitor as his or her Last Will and Testament in the presence of each of us. We, in the presence of fhe Testator and each other, under penalty of perjury, hereby subscribe our names as witnesses to the declaration and execution of the Last Will and Testament by the Tesffitor, and we declare that, to the best of our knowledge, said Testator is eighteen years of age or older, of sound mind and under no constraint or undue influence. 1. ~~~y Y~C ~~~i igia f witness) (Print Name) Date:_~~z~___ ~~~ Cer. a~ Ya~e,~ ~~ (A/yddress) (City, State, Z[P) 2. (Sigiature of witness) (Print Name) Date: (Address) (City, State, ZII~ Page 8 of my Last Will and Testament ~~ ~~ P)' (Si~ature) STATEMENT OF INTERMENT, CREMATION and WISHES I, Mabel Robinson, the undersigned, having previously executed a Last Will and Testament on the date hereof, hereby sffite that, in addition to the directives and bequests set forth in said Last Will and Tesffiment, it is my desire that my remains be interred in a burial plot. My further wishes and directives are as follows: I should be buried in the Rolling Green Cemetery, Lemoyne, Pennsylvania, beside my husband, Donald Robinson. The vault is already paid for and prepared. My funeral arrangements are also already paid for. Myers Funeral Home in Mechanicsburg, Pennsylvania should be contacted to make all necessary arrangements. Dated: ,2? - ~ 0 9 ~_[ ~ ~~ .i'-i~ Do....-~--' Signature of Mabe~ n WITNESS ATTESTATION CLAUSE This Sffitement of Interment, Cremation and Wishes, which has been separately signed by Mabel Robinson was signed, executed and declared in the presence of each of us. We, in the presence Mabel Robinson and each other, under penalty of perjury, hereby subscribe our names as witnesses to the declaration and execution of the Statement of Interment, Cremation and Wishes by Mabel Robinson and we declare that, to the best of our knowledge, Mabel Robinson is eighteen years of age or older, of sound mind ~n under n onstraint or undue influence. I. // /~~Y ~KI~A~ei (Si of ess) (Print Name) a7 ~v .OL, ~aeK (Address) ~~,eL/.cL~ .~/ - / ~o~s (City, State, ZIP) 2. (Signature of witness) Date: (Print Name) (Address) (City, Slate, ZIP) SELF-PROVING AFFIDAVIT Commonwealth of Pennsylvania County of Cumberland I, Mabel Robinson, the undersigned Testator, being first duly sworn, do declaze to the undersigned authority that I signed and executed the attached or annexed instrument as my Last Will and Testament and that I signed it willingly, that I executed it as my free and voluntary act for the purposes expressed in that docwnent and that at the time I signed the document I was eighteen years of age or older, of sound mind and under no constraint or undue influence. Date: 'f ' 2 ff - ~-o0 9 ~,~t .L IT ~ u~'a~ (Signature of Mabel Robinson) We, the undersigned witnesses, being first duly sworn, do each declare to the undersigned authority the following: (1) the Testator declared to each of us that the attached or annexed instrument is his or her Last Will and Testament; (2) the Testator executed the will in our presence; (3) each of us, in the presence of the Testator, signed the will as witness; and (4) to the best of our knowledge the Testator is eighteen yeazs of age or older, d min d under no constraint /~or~un~d~ue inf-lu,~en~ce' .'' (Signs witness) (Print Name) 2. (Signature of witness) (Print Name) Acknowledgement of Notary Public• Subscribed, sworn and acknowledged to me on this _ day of 20_, by Mabel Robinson, as Testator, and and as witnesses. Witness my hand and seal. Signature of Notary Public: 6~ - loci OATH OF SUBSCRIBING WITNESS(ES) N //1~ REGISTER OF WILLS o ~~~ I .~I,+~bty' ~s_i COUNTY, PENNSYLVANIA ~~~ ° ` ~=' ~ ri ~. < .~ U _... C%~ ~ r .70~rp S -.' ;; Estateof_I -~Ca,1'~Qr` Q, ~~t~11,~~M ~~ ,.LleceAs2dr; *'~ - ~ , (each) a subscribing witness to (Prim Name/sJ the D Will ^ Codicil )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. (signs ~a7 ~. QGD yo~ek ~~ (Street Address) C~R~/S.CL' ~A /70/ S" (cty, smte, z;PJ Executed in Register's Office Swom to or affirmed and subs this for (Signature) (Street Address) (City, State, ZipJ Executed out of Register's Office Swom to or affirmed and subscribed before me this day of Notary Public My Commission Expires: (Signature and Seal ofNotary 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 notariza[ion. Form RW-03 rev. 10.13.06 6°I - (oF ~ OATH OF NON-SUBSCRIBING WITNESS(ES) REGISTER OF WILLS Curnba,~`~.,,,. LG COUNTY, PENNSYLVANIA Estate of I 'L!1 ~~ ~ ~. l~0 b ~ y1 -f Cn~ ,Deceased 2~, [~ ~ ! "l ~ l ~ ~ cI YL~ and (each) being duly qualified according to la^w, depose(s) and say(s) that she / he /they was /were well- acquainted with IY~,O~~O.Q, 'P - \<O~ ~ V~ S r~.~ and am/are;~familiar with the handwriting and signature of the decedent, and that the signature of ~al~.+~ ~ ~ • I ~u ~ n S rn-. to the foregoing instrument purporting to be the Last Will and Testament/Codicil of lu4.t~~ ~ -'4~~. -~ ~ v..~ is in his/her own proper handwriting. (Sig~mtu) ~J~~ ~a~ ~ OI York ~~ ( reef Address ~~I sle- ~~ 17615' (Cety. SMte, Zip) (Street Address) (Gry, Stale, Zip) Executed in Register's Office Sworn to or affirmed and subscribed n z~ H '~ ~ //~.~~ .-o ~ x ~~, ; , , before me this /,d~ayy f J ~ 7 n~m c c.~, ~~ r y , o ~/ l 0 `~ ~~ w : , zj )OO 'V ~ ~~~~-> _ ~n a t T`i eputy for e e f Wills -... <_, `1; Form RW-04 rev. 10 /3.06