HomeMy WebLinkAbout12-16-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~~'M~~~ COUNTY, PENNSYLVANIA
Estate of EG/ ~ ~ ` C louw~ ~r
also known as
.Deceased
Petitioner(s), who is/are I8 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
File Number ~ I ~~~T II y 1
Social Security Number 19~ / ~- 3~ y8
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is 1 aze the OG/b-'~ '")r«~^~` ~ "K named in the
last Will of the Decedent dated `/^l3 ' `t ~ 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 bom or adopted after execution of the instntment(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ B. Grant of Letters of Administration
(Ijapplicable, enter: c.l.a.; d.b.n.c.t.a.; pendente lire; durante absentin; durance minoritate) N
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (i nd heirs:'
Admittistratiort, c. t. a. or d.b.n.c.t.a., enter date of Wil! in Section A above and complete list of heirs.) ~- !Tt
~_ _ Name Relationship Residence ~%~ ~ ~,? [71 I
~ ~
(COMPLETE IN ALL CASES:) Attac/: additional s/teets if necessary. ~
Decedent was domiciled at death in ~t'tit~l~ County, Pennsylvania with his /her last rincipal residence at ~
l,~ l~ ~.~ Dn tr<. ,, G4..~, I ~ ~ / - /~0 4^v ~1~. To...,tf~p
(List street nddress, town city, township, unty, state, zip code)
Decedent, then ~ years of age, died on - ,~ZQ at ~f~, /l'Z~~+s1 ~,.~
Decedent at death owned property with estimated values as follows: ~k~GC. dd
(If domiciled in PA) All personal property $ jy! ~ 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 LL,, $ ~_
situated as follows: ~ t~lta~ p~l^tf ~~ ,7`~~ Q~ ~ ?~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 appropriate form to
the undersigned:
Si nature T ed or tinted name and residence
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Form RW-0? re~.10.13.oe Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF~~~r
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
b rt me .the ~~ day of
For the Register
f~a~.vY (~ar~.cr ro
Signature ojPersonal Representative
Signature of Persona! Representative
Signnture of Personal Representative
•,~ /a~n~~ ~ C~~
Q~
File Number: ~~' ~ ! - 1 i ~ 1 C7~ ~~ 7
,~ ~y
Estate of L GI ~ L - C ~aNtei .Tr'' , I3~Ceased ~ t,~ ~i
Social Security Number: ~ 4 ~ 3 ~ ~~ Y~ Date of Death: Y~• ~ ~~~ 9
AND NOW, , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters
are hereby granted to 1 k~t ~+~ ~ ~ C~° "~
in the above estate
and that the instrument(s) dated ~- r3- ~'S
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES •
Register of Wills/
Letters ............... $ ~~ /! ~~/I~°'
Short Certificate(s) ........ $ Attorney Signature: ~-
Renunciation(s) .......... $
Attorney Name: ! `cad ~ ~ • C ~~
... $
... $ Supreme Court I.D. No.: g~ ~ ~~
$ Address:
... $ G~~~v~ ~ ~~ l ~ 119
... $
... $
• • • $ Telephone: C7~ ~/ ~~ 3- ~ L `'~
... $
TOTAL .............. $
Form RW-0? ,~ev. lu.l3.o~ Page 2 of 2
_ T - __... __ _._ _. _.. _ _... _.
HIOS.KUS REV VOllU') ~ ~ ~ ~ // ~~
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 This is to 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 the State Vital
Records Office for permanent filing.
DEC 0 91009
15933843 ~~~°~
ertification Number Local Registrar Date Issued
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I PRIM IN
ANK
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS
CERTIFICATE OF DEATH
(See instructions and ezsmplea on reverse) STATE FILE NUMBER
1. Name d (Fkek midde, be4 rebc) ~ 2. Sex 3. Saint Seady Number d. Deb d OeeBr (Monti, dy, Yur)
Earl E. Clouser, Jr. male 195 - 30 - 3148 December 5, 2009
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(n y«,ep.dlycabar, (sQeL*» white
Mexican, Puerto Rkan, ero.)
11. DeadeMe dwoa d aa maMd .Oo nolsbb 72. Wu Decoded ever b tlts 13. Decedents EduceBon (Speoyy Dray hlNlral pratle canp Nlad) Id. Markel Slebe: Medal, Never Merne4 i5. Surviving Spo use (N wife, give meitlen name)
Kid d wok lckrd d Blbkrml kidaby U.S. Ametl Faae? Elem.n~~ 1 Secondary (612) CoNege (1 d a Bs) Widowwd, ONomsd (speadyi
Chia of Surveys Engineering ^vee ®Na 12 Married Patricia A. Miller
18. Deceeslr
2 Meinp Addrm (Strut cBylrown, sbts, zip code)
Colgate Drive Deadenfe Penns lvania D1tl DBtBdan1 Lower Allen
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Earl E. Clouser, Sr. Minnie Ha er
20a. I s Name (Type I Prkd) lob. Idarmenya McBirp Adam (Strut dy / kven, deb, zip code)
Mark E. Clouser 631 White Tail Drive, Lewisberry, PA 17339
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aapaitron Pemdt No. n~7.~ 2G~
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Will of Earl E. Clouser, Jr.
I, Earl E. Clouser, Jr., a resident of Pennsylvania, na
County of Cumberland, declare that this is my will. My c-> ~
Social Security Number is 195-30-3148. ~ ~
E-~ ~ rn
FIRST: I revoke all wills and codicils that I have ~~~ ~
previously made.~~,~ cT
~~
7n~
SECOND: I am married to Patricia A. Clouser. ~~ ~
.~
THIRD: I have the following children now living: a'on,
Earl R. Clouser, a daughter, Sheri L. Segiel, a son, Mirk E.
Clouser, a son, Michael A. Clouser and a daughter, Julie A.
Simpson.
FOURTH: As used in this will, the term "specific
bequest" refers to all specifically identified property, both
real and per,.sonal, that I give to one or more beneficiaries
in this will. The term "residuary estate" refers to the rest
of my property not otherwise specifically disposed of by this
will or in any other manner. The term "residuary bequest"
refers to my residuary estate that I give to one or mope
beneficiaries in this will.
FIFTH: All personal property I give in this will through
a specific or residuary bequest is given subject to and'
purchase-money security interest, and all real property I
give in this will through a specific or residuary bequest is
given subject to any deed of trust, mortgage, lien,
assessment, or real property tax owed on the property. As
used in this will, "purchase-money security interest" means
any debt secured by collateral that was incurred for the
purpose of purchasing that collateral. As used in thi will,
"non-purchase-money security interest" means any debt hat is
secured by collateral but which was not incurred for the
purpose of purchasing that collateral.
SIXTH: When this will states that a beneficiary moat
survive me for tre purpose of receiving a specific beq Est or
residuary bequest,. he or she must survive me by 45 day,
except that property left to my spouse shall pass free'of
this 45 day survivorship requirement.
SEVENTH: I hereby leave $1.00 to each of the following
persons: a son, Earl R. Clouser, a daughter, Sheri L. Segiel,
a son, Mark E. Clouser, a son, Michael A. Clouser and a
daughter, Julie A. Simpson. These bequests are in addition
to and not instead of any other specific bequest that this
will makes to these persons.
EIGHTH: I give my residuary estate to my wife, Patricia
A. Clouser. However, if any beneficiary named in this,
paragraph to receive my residuary estate fails to survive me,
Page 1 Initials: ~~~. ~~ '~ ~-~rC, Date: '/.~ ~~~
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Will of Earl E. Clouser, Jr.
the residuary estate shall go to Earl R. Clouser, Sheri L.
Segiel, Mark E. Clouser, Michael A. Clouser and Julie A.
Simpson, to be divided equally.
NINTH: Any specific bequest or residuary bequest made in
this will to two or more beneficiaries shall be shared
equally among them, unless unequal shares are specifically
indicated.
TENTH: If my spouse and I should die simultaneously, or
under such circumstances as to render it difficult or
impossible to determine who predeceased the other, I shall be
conclusively presumed to have survived my spouse for purposes
of this will.
ELEVENTH: I name my wife, Patricia A. Clouser as my
personal representative (executor), to serve without bond.
If this person or institution shall for any reason fail to
qualify or cease to act as personal representative, I name
Earl R. Clouser as personal representative (also to serve
without bond), instead.
TWELFTH: I direct my personal representative to take all
actions legally permissible to have the probate of my will
done as simply and as free of court supervision as possible
under the laws of the state having jurisdiction over this
will, including filing a petition in the appropriate court
for the independent administration of my estate.
THIRTEENTH: I hereby grant to my personal representative
the following powers, to be exercised as he or she deems to
be in the best interests of my estate:
1) To retain property without liability for loss or
depreciation resulting from such retention.
2) To dispose of property by public or private sale, or
exchange, or otherwise, and receive and administer the
proceeds as a part of my estate.
3) To vote stock, to exercise any option or privilege to
convert bonds, notes, stocks or otter securities belonging to
my estate into other bonds, notes, stocks or other
securities, and to exercise all other rights and privileges
of a person owning similar property.
4) To lease any real property that may at any time form
part of my estate.
5) To abandon, adjust, arbitrate, compromise, sue on or
defend and otherwise deal with and settle claims in favor of
or against my estate.
6) To continue or participate in any business which is a
part of my estate, and to effect incorporation, dissolution
or other change in the form of organization of the business.
7) To do all other acts which in his or her judgment may
be necessary or appropriate for the proper and advantageous
management, investment and distribution of my estate.
Page 2 Initials: ~ ~~ ~~~ Date: 3 gJ'~
Will of Earl E. Clouser, Jr.
The foregoing powers, authority and discretion granted
to my personal representative are intended to be in addition
to the powers, authority and discretion vested in him or her
by operation of law by virtue of his or her office, and may
be exercised as often as is deemed necessary or advisable,
without application to or approval by any court in any
jurisdiction.
FOURTEENTH: Except for purchase-money security interests
on personal property passed in this will, and deeds of trust,
mortgages, liens, taxes and assessments on real property
passed in this will, I instruct my personal representative to
pay all debts and expenses, including non-purchase-money
secured debts on personal property, owed by my estate as
provided for by the laws of Pennsylvania.
FIFTEENTH: I instruct my personal representative to pay
all estate and inheritance taxes assessed against property in
my estate or against my beneficiaries as provided for by the
laws of Pennsylvania.
SIXTEENTH: If any beneficiary under this will in any
manner, directly or indirectly, contests or attacks this will
or any of its provisions, any share or interest in my estate
given to the contesting beneficiary under this will is
revoked and shall be disposed of in the same manner as if
that contesting beneficiary had failed to survive me and left
no living children.
I, Earl E. Clouser, Jr., t e testator, sign my name to
this instrument, this ~~ ~ day of ~ ,
~~. I hereby declare that I sign and execute his
instrument as my last will, that I sign it willingly, and
that I execute it as my free and voluntary act for the
purposes therein expressed. I declare that I am of the age
of majority or otherwise legally empowered to make a will,
and under no constraint or undue influence.
Signed) '
We, the witnesses, sign our names to this instrument,
and do hereby declare that the testator willingly signed and
executed this instrument as the testator's last will.
Each of us, in the presence of the testator, and in the
presence of each other, hereby sign this will as witness to
the testator's signing.
To the best of our knowledge, the testator is of the age
of majority or otherwise legally empowered to make a will, is
Page 3 Initials : ~~ ~ ~~~ ~~C Date : `~ r3 ~J''-
l ..
Will of Earl E. Clouser, Jr.
mentally competent, and under no constraint or undue
influence .
We declare under penalty of perjury, that the foregoing
i true and correct, this ( 3^ day of
~~_ .
Witness #1:
Residing at:
Witness #2: ~rjl~.r7~C
Residing at : /\} ~,rrJ ~,~.~v+---~ ~DDv,c~ P ~ ~ ~ ° ~ a
Witness #3 : `~. ~ ~~-~-- ~.c.G~~>
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Residing at: ~A~t~j( M /~ L7 ds S
Page 4 Initials: ~~~~.~ ~~~~C Date: /3 d
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AFFIDAVIT
We, , 5~ • C ,
nd the
to or and the witnesses, respective y, who a nam are
sig ed to the attached or foregoing instrument in those
capacities, personally appearing before the undersigned
authority and being first duly sworn, declare to the
undersigned authority under penalty of perjury that:
1) the testator declared, signed and executed the instrument
as his/her last will;
2) he/she signed it willingly or directed another to sign
for him/her;
3) he/she executed it as his/her free and voluntary act for
the purposes therein expressed; and
4) each of the witnesses, at the request of the testator, in
his/her presence, and in the presence of each other, signed
the will as witness and that to the best of his/her knowledge
the testator was at that time of full legal age, of sound
mind and under no constraint or undue influence.
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Testator : ~ --~ ~ ~ ° n
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Witness: ,"~, ~~rn !~`~ ~ `~'
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Witness : ~ ~D - ~~ _ ~T '"''
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Witness: ~. ~t,(,c..~.,,`~~~
Subscribed, s orn to and acknowledged before me by
the testat r, and by
~~ , and
wit sses, this /,3 tk
day o f Sw?a.~b L 4 QS .
dr.~ ~._., ~..
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Notarial seal
Lake V. Richart Il; Notary Publlc
Lower Aden Twp„ Cumberland County
My Comma Expires March 21,19$7
PENNSYLVANIA GENERAL DURABLE POWER OF ATTORNEY
THE POWERS YOU GRANT BELOW ARE EFFECTIVE
EVEN IF YOU BECOME DISABLED OR INCOMPETENT
NOTICE
THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON YOU
DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR PROPERTY,
WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE DISPOSE OF ANY REAL
I, OR PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL
BY YOU.
THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO
EXERCISE GRANTED POWERS, BUT WHEN POWERS ARE EXERCISED, YOUR
AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE
WITH THIS POWER OF ATTORNEY.
YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE THROUGHOUT YOUR
LIFETIME, EVEN AFTER YOU BECOME INCAPACITATED, UNLESS YOU EXPRESSLY
LIMIT THE DURATION OF THESE POWERS OR YOU REVOKE THESE POWERS OR A
COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.
YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S FUNDS.
A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR
AGENT IS NOT ACTING PROPERLY.
THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE
EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU
SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU.
I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I UNDERSTAND ITS
CONTENTS.
J
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DATE: 1 Z 7~ r p m
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PENNSYLVANIA GENERAL DURABLE POWER OF ATTORNEY
THE POWERS YOU GRANT BELOW ARE EFFECTIVE
EVEN IF YOU BECOME DISABLED OR INCOMPETENT
NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND
SWEEPING. THEY ARE .EXPLAINED IN THE UNIFORM STATUTORY FORM
POWER OF ATTORNEY ACT. IF YOU HAVE ANY QUESTIONS ABOUT
THESE POWERS, OBTAIN COMPETENT LEGAL ADVICE. THIS DOCUMENT
DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL AND OTHER
HEALTH-CARE DECISIONS FOR YOU. YOU MAY REVOKE THIS POWER OF
ATTORNEY IF YOU LATER WISH TO DO SO.
' P~~ ~ ~~ ~ ~ ~ C I d~~~r
appoint Mark E. Clouser, 631 White Tail Drive, Lewisberry, PA 17339 as my
Agent (attorney-in-fact) to act for me in any lawful way with respect to the
following initialed subjects:
TO GRANT ALL OF THE FOLLOWING POWERS, INITIAL THE LINE IN FRONT
OF (N) AND IGNORE THE LINES IN FRONT OF THE OTHER POWERS.
TO GRANT ONE OR MORE, BUT FEWER THAN ALL, OF THE FOLLOWING
POWERS, INITIAL THE LINE IN FRONT OF EACH POWER YOU ARE
GRANTING.
TO WITHHOLD A POWER, DO NOT INITIAL THE LINE IN FRONT OF IT. YOU
MAY, BUT NEED NOT, CROSS OUT EACH POWER WITHHELD.
INITIAL
(A) Real property transactions. To lease, sell, mortgage, purchase,
exchange, and acquire, and to agree, bargain, and contract for the lease, sale,
purchase, exchange, and acquisition of, and to accept, take, receive, and
possess any interest in real property whatsoever, on such terms and conditions,
and under such covenants, as my Agent shall deem proper; and to maintain,
repair, tear down, alter, rebuild, improve manage, insure, move, rent, lease, sell,
convey, subject to liens, mortgages, and security deeds, and in any way or
manner deal with all or any part of any interest in real property whatsoever,
including specifically, but without limitation, real property lying and being situated
in the Commonwealth of Pennsylvania, under such terms and conditions, and
under such covenants, as my Agent shall deem proper and may for all deferred
payments accept purchase money notes payable to me and secured by
mortgages or deeds to secure debt, and may from time to time collect and cancel
any of said notes, mortgages, security interests, or deeds to secure debt.
(B) Tangible personal property transactions. To lease, sell,
mortgage, purchase, exchange, and acquire, and to agree, bargain, and contract
for the lease, sale, purchase, exchange, and acquisition of, and to accept, take,
receive, and possess any personal properly whatsoever, tangible or intangible, or
interest thereto, on such terms and conditions, and under such covenants, as my
Agent shall deem proper; and to maintain, repair, improve, manage, insure, rent,
lease, sell, convey, subject to liens or mortgages, or to take any other security
interests in said property which are recognized under the Uniform Commercial
Code as adopted at that time under the laws of the Commonwealth of
Pennsylvania or any applicable state, or otherwise hypothecate (pledge), and in
any way or manner deal with all or any part of any real or personal property
whatsoever, tangible or intangible, or any interest therein, that I own at the time
of execution or may thereafter acquire, under such terms and conditions, and
under such covenants, as my Agent shall deem proper.
(C) Stock and bond transactions. To purchase, sell, exchange,
surrender, assign, redeem, vote at any meeting, or otherwise transfer any and all
shares of stock, bonds, or other securities in any business, association,
corporation, partnership, or other legal entity, whether private or public, now or
hereafter belonging to me.
(D) Commodity and option transactions. To buy, sell, exchange,
assign, convey, settle and exercise commodities futures contracts and call and
put options on stocks and stock indices traded on a regulated options exchange
and collect and receipt for all proceeds of any such transactions; establish or
continue option accounts for the principal with any securities or futures broker;
and, in general, exercise all powers with respect to commodities and options
which the principal could if present and under no disability.
(E) Banking and other financial institution transactions. To make,
receive, sign, endorse, execute, acknowledge, deliver and possess checks,
drafts, bills of exchange, letters of credit, notes, stock certificates, withdrawal
receipts and deposit instruments relating to accounts or deposits in, or
certificates of deposit of banks, savings and loans, credit unions, or other
institutions or associations. To pay all sums of money, at any time or times, that
may hereafter be owing by me upon any account, bill of exchange, check, draft,
purchase, contract, note, or trade acceptance made, executed, endorsed,
accepted, and delivered by me or for me in my name, by my Agent. To borrow
from time to time such sums of money as my Agent may deem proper and
execute promissory notes, security deeds or agreements, financing statements,
or other security instruments in such form as the lender may request and renew
said notes and security instruments from time to time in whole or in part. To
have free access at any time or times to any safe deposit box or vault to which I
might have access.
(F) Business operating transactions. To conduct, engage in, and
otherwise transact the affairs of any and all lawful business ventures of whatever
nature or kind that I may now or hereafter be involved in. To organize or cantinue
and conduct any business which term includes, without limitation, any farming,
manufacturing, service, mining, retailing or other type of business operation in
any form, whether as a proprietorship, joint venture, partnership, corporatian,
trust or other legal entity; operate, buy, sell, expand, contract, terminate or
liquidate any business; direct, control, supervise, manage or participate in the
operation of any business and engage, compensate and discharge business
managers, employees, agents, attorneys, accountants and consultants; and, in
general, exercise all powers with respect to business interests and operations
which the principal could if present and under no disability.
(G) Insurance and annuity transactions. To exercise or perform any
act, power, duty, right, or obligation, in regard to any contract of life, accident,
health, disability, liability, or other type of insurance or any combination of
insurance; and to procure new or additional contracts of insurance forme and to
designate the beneficiary of same; provided, however, that my Agent cannot
designate himself or herself as beneficiary of any such insurance contracts:
(H) Estate, trust, and other beneficiary transactions. To accept,
receipt for, exercise, release, reject, renounce, assign, disclaim, demand, sue for,
claim and recover any legacy, bequest, devise, gift or other property interest or
payment due or payable to or for the principal; assert any interest in and exercise
any power over any trust, estate or property subject to fiduciary control; establish
a revocable trust solely for the benefit of the principal that terminates at the death
of the principal and is then distributable to the legal representative of the estate
of the principal; and, in general, exercise all powers with respect to estates and
trusts which the principal could exercise if present and under no disability;
provided, however, that the Agent may not make or change a will and may not
revoke or amend a trust revocable or amendable by the principal or require the
trustee of any trust for the benefit of the principal to pay income or principal to the
Agent unless specific authority to that end is given.
(I) Claims and litigation. To commence, prosecute, discontinue, or
defend all actions or other legal proceedings touching my property, real or
personal, or any part thereof, or touching any matter in which 1 or my property,
real or personal, may be in any way concerned. To defend, settle, adjust, make
allowances, compound, submit to arbitration, and compromise all accounts,
reckonings, claims, and demands whatsoever that now are, or hereafter shall be,
pending between me and any person, firm, corporation, or other legal entity, in
such manner and in all respects as my Agent shall deem proper.
(J) Personal and family maintenance. To hire accountants, attorneys
at law, consultants, clerks, physicians, nurses, agents, servants, workmen, and
others and to remove them, and to appoint others in their place, and to pay and
allow the persons so employed such salaries, wages, or other remunerations, as
my Agent shall deem proper.
(K) Benefits from Social Security, Medicare, Medicaid, or other
governmental programs, or military service. To prepare, sign and file any
claim or application for Social Security, unemployment or military service
benefits; sue for, settle or abandon any claims to any benefit or assistance under
any federal, state, local or foreign statute or regulation; control, deposit to any
account, collect, receipt for, and take title to and hold all benefits under any
Social Security, unemployment, military service or other state, federal, local or
foreign statute or regulation; and, in general, exercise all powers with respect to
Social Security, unemployment, military service, and governmental benefits,
including but not limited to Medicare and Medicaid, which the principal could
exercise if present and under no disability.
(L) Retirement plan transactions. To contribute to, withdraw from
and deposit funds in any type of retirement plan (which term includes, without
limitation, any tax qualified or nonqualified pension, profit sharing, stock bonus,
employee savings and other retirement plan, individual retirement account,
deferred compensation plan and any other type of employee benefit plan); select
and change payment options for the principal under any retirement plan; make
rollover contributions from any retirement plan to other retirement plans or
individual retirement accounts; exercise all investment powers available under
any type of self-directed retirement plan; and, in general, exercise all powers with
respect to retirement plans and retirement plan account balances which the
principal could if present and under no disability.
(M) Tax matters. To prepare, to make elections, to execute and to file
ail tax, social security, unemployment insurance, and informational returns
required by the laws of the United States, or of any state or subdivision thereof,
or of any foreign government; to prepare, to execute, and to file all other papers
and instruments which the Agent shall think to be desirable or necessary for
safeguarding of me against excess or illegal taxation or against penalties
imposed for claimed violation of any law or other governmental regulation; and to
pay, to compromise, or to contest or to apply for refunds in connection with any
taxes or assessments for which I am or may be liable.
(N) ALL OF THE POWERS LISTED ABOVE. YOU NEED NOT INITIAL
ANY OTHER LINES IF YOU INITIAL LINE (N).
THIS POWER OF ATTORNEY IS EFFECTIVE IMMEDIATELY AND WILL
CONTINUE UNTIL IT IS REVOKED.
THIS POWER OF ATTORNEY SHALL BE CONSTRUED AS A GENERAL
DURABLE POWER OF ATTORNEY AND SHALL CONTINUE TO BE
EFFECTIVE EVEN IF I BECOME DISABLED, INCAPACITATED, OR
INCOMPETENT.
(YOUR AGENT WILL HAVE AUTHORITY TO EMPLOY OTHER PERSONS AS
NECESSARY TO ENABLE THE AGENT TO PROPERLY EXERCISE THE
POWERS GRANTED IN THIS FORM, BUT YOUR AGENT WILL HAVE TO
MAKE ALL DISCRETIONARY DECISIONS.)
(YOUR AGENT WILL BE ENTITLED TO REIMBURSEMENT FOR ALL
REASONABLE EXPENSES INCURRED IN ACTING UNDER THIS POWER OF
ATTORNEY.)
Right to Compensation. My Agent shall be entitled to reasonable
compensation for services rendered as agent under this power of attorney.
Choice of Law. THIS POWER OF ATTORNEY WILL BE GOVERNED BY THE
LAWS OF THE COMMONWEALTH OF PENNSYLVANIA WITHOUT REGARD
FOR CONFLICTS OF LAWS PRINCIPLES. IT WAS EXECUTED IN THE
COMMONWEALTH OF PENNSYLVANIA AND IS INTENDED TO BE VALID IN
ALL JURISDICTIONS OF THE UNITED STATES OF AMERICA AND ALL
FOREIGN NATIONS.
I am fully informed as to all the contents of this form and understand the full
import of this grant of powers to my Agent.
I agree that any third party who receives a copy of this document may act under
it. Revocation of the power of attorney is not effective as to a third party until the
third party learns of the revocation. I agree to indemnify the third party for any
claims that arise against the third party because of reliance on this power of
attorney.
Signed thisT day of ~~CCZ~t~c.i , 20U~~
/a:Tiy,~[ -c~ ~ C ,n-r .rte nom, ~
~~e~i~~; ,~{, Cl'~uf~
ACKNOWLEDGMENT EXECUTED BY AGENT
I, Mark E. Clouser, have read the attached power of attorney and am the person identified
as the agent for the principal. I hereby acknowledge that in the absence of a specific
provision to the contrary in the power of attorney or in 20 Pa.C.S. when I act as agent:
I shall exercise the powers for the benefit of the principal.
I shall keep the assets of the principal separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions, receipts and disbursements on behalf
of the pringipaL. ~ _
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ia- ~ -off
Date
STATEMENT OF WITNESS
On the date written above, the principal declared to me in my presence that this
instrument is her general durable power of attorney and that she had willingly
signed, and that she executed it as her free and voluntary act for the purposes
therein expressed. /~ /
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CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
COMMONWEALT, H OF P NNSYLVANI4
COUNTY OF ~~ x n
On this, the ~I day of
20~, before me
_, the undersigned officer, personally appeared
known to me (or satisfactorily proven) ~'o be the erson(s) whose nam~(s) is/are subscribed to the
within instrument, and acknowledged that ~+~tn~ ca ,~ /cu! c~ ~ executed
the same for the purposes therein contained.
In witness whereof, I hereunto set my hand and official seals.
(Notary Seal, if any]:
COMMONWEALTH OF PENNSYLVANIA
' NOTARIAL SEAL
NANCY E. WIRFEL, Notary Public
Hampden Twp., Cumberland County
? Niy Commission Ex fires Dec. 25, 2011
(Sigi ature of tarial Office
Notary Public for the Commonwealth of
Pennsylvania
My commission expires: / ~ -n1~' a~C)%/