HomeMy WebLinkAbout1-13-10PETITION FOR PROBATE AND GRA1V'T OF LETTERS
REGISTER OF WILLS OF COUNTY, PENNSYLVANIA
Estate of--- ~~L~/P~
also known as __ ° /SAIL ~~11®yf ~V /t
Petitioner(s), who is/are 18 years of age or older, apply(ies) For:
(COMPLETE 'A' or 'B' BELOW.)
Deceased
Pile Number _ OG~- OC.D~V~ (J~o
Social Security Number ~ 93 30 o~uq
A. Probate and Grant oC Letters Testamentary and aver that Petitioner(s) is /are the (~~[
last Will of the Decedcnt dated~~~µ-~~9 O named in the
and codicils dated
(Store refevmrt circumsrnnces, e.g., renunciation, death ojexecuror, ete.J
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom 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: tv
_ s~.
^ Q. Grant of Letters of Administration
(/japplicnble, enter: c.r.a.; d.b.n.c.t.a; penderue tire; durnnreabsenria; _ orirare_ ~~'
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived b the followi ~t~ ~ +
p'o~ _S
Adrninistratimr, c.t.a, ord.b.n.c.l.a., enter date of Wil! in Section A above and complete fist ojlreirs.) y ~ ~...? ~(rf any and he •s;
-~~-rte a -_ ,
(COMPLETE IN ALL CASES:J Attach additioaral sGeets if necessary.
t was domiciled at death in
County, Pennsylvania with his 1 her last principal residence at
(List sri~e~ Address, o ,towns ri , u , s ate, ze I
Decedent, then ~ years of age, died on I-r3 -010 at J ~~
/4
Decedent at death owned property with estimated values as follows:
(If domiciled in PA)
(!f not domiciled in PA)
(If not domiciled in PA)
Value of real estate in Pennsylvania
situated as follows:
All personal property g ~DDO, 00
Personal property in Pennsylvania $
Personal property in County $
Fornr RW-0? rNN. 10.13.06 Page 1 Of 2
t-O. I
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letttrs in the appropriate form to
the undersigned:
Oath Of Personal Representative 201p ,JAM 13 AM 9~ 2 I
COMivtONWEALT OF PENNSYLVANIA
Sworn to or affirmed and subscribed
gi~re me the /3`~' day of
/ ss CLFRK OF
COUNTY OF (~{pf aR~'~r~~S '~(~1~iRj
C4)I~RFRI ~I~C CC.. °P.
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hve 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.
Siganture ojPersonn(Represenmtive
Register
Signatm'e ojPersonnl Representntive
Persona! Representntive
FileNumbe. // -A~O/O - 06~
Estate of "n ~CJI~I ,Deceased
Social Security Number: ~ ~.3 " 3o " O y/9 Date of Death; ~ / ~-`~`,1 ~ ~4~0
AND NOW, , ~i~/b , in c/opsideration//of the foregoing Petition, satisfactory proof
having been present befog me IS DECREED that Letters/ / / /171 /Y/Dil.~l ~i~
are hereby granted to
and that the instrument(s) dated~~y~ a~
described in the Petitiar be admitted to probate and filed of r5ecord
FEES
Letters ............... U'
$~-
ShortCertificate(s) ........ $ ~~r7~ W
Renunciation(s) $
.. $~-
.. $
.$
.. $
.. $
TOTAL ..............
in the above estate
the last Will (and odicil(s)) of
s
Register pj iKe
Attorney Signature;
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Pm•in Rw.n? rev. 1p.13.U6 Page 2 oft
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is Illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 16030569
Certification Number
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.
Local Registrar Date Issued
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Will /~ -1X3
of
Rayallen Hoover
I, Rayallen Hoover, also known as Ray Allen Hoover, a resident of
Mechanicsburg, Cumberland County, Pennsylvania, revoke any prior wills and codicils
made by me and declaze this to be my Will.
Article One
Family Information
I am married to Mazy Catherine Hoover.
I have seven children. Their names and dates of birth aze:
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Deborah Yvonne Kinard, born on October 3, 1956;
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Rebecca A. Mitalski, born on January 29, 1958; ~~-„ ~ ~"''" T,
Cynthia Susan Drop, born on Mazch 13
1962; a ~ N ~
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Patricia Rayellen Hoover, born on February 28, 1963;
Rayallen Hoover, Jr., born on October 5, 1964;
Michael James Edgaz M. Hoover, born on March 1, 1965; and
Andrew Joseph Hoover, born on July 24, 1970
All references in my will to "my children" are references to these children.
Article Two
Distribution of My Property
Section 2.01 Hoover House Trust
If my spouse has predeceased me, then as soon as practicable after my death, I give my
residence located at 837 Ridgewood Drive, Mechanicsburg, Cumberland County,
Pennsylvania, to Patricia Rayellen Hoover, as Trustee of a sepazate trust known as the
Page 1
Hoover House Trust ("House Trust"), to be held for the benefit of Patricia Rayellen
Hoover and administered and distributed in accordance with the provisions of this
Section 2.01.
If both my spouse and Patricia Rayellen Hoover have predeceased me, this gifr shall
lapse.
(a) Free use and occupancy. Patricia shall have free use and
occupancy of said real estate until her death or the sale of the
property.
(b) Exvenses. Patricia shall be responsible to pay the carrying costs of
the property, to include but not be limited to utilities, property
taxes, assessments, homeowner's insurance, maintenance, and
ordinary repairs arising from her use of the property. The cost of
any major repairs in excess of $5,000 shall be handled as follows:
Patricia shall be responsible for 50% of said costs; and Patricia's
siblings shall equally shaze the remaining 50% of said costs. If any
sibling is unable to contribute to his or her shaze of these costs,
said share shall be subtracted from that sibling's share of the net
proceeds upon sale of the property.
(c) Right of First Refusal. If the Trustee decides to sell the property,
any of my children shall have 90 days to notify the Trustee if they
want to purchase the property. The Trustee shall obtain a certified
appraisal of the property to determine the fair market value and
selling price. If none of the Hoover children exercise their option
to purchase the property, my grandchildren shall have 90 days to
notify the Trustee if they want to purchase the property. If none of
the Hoover children or grandchildren exercise their option to
purchase the property, the Trustee shall sell the property and the
net proceeds shall be distributed in accordance with Section 2.01(f)
hereunder.
(d) Termination of House Trust. The House Trust shall tezminate
upon the first to occur of:
1. The death of Patricia Rayellen Hoover; or
2. The sale of the property by the Trustee.
Page 2
(e) Distribution Upon Termination of House Trust After Death. Upon
termmahon of the House Trust as a result of the death of Patricia
Rayellen Hoover, the Successor Trustee shall sell the property and
distribute the net proceeds from the sale to my surviving children,
pro rata.
(f) Distribution Upon Termination of House Trust by Sale of the
Property. The Trustee shall distribute the net proceeds from the
sale of the property as follows:
50% to Patricia Rayellen Hoover; and
50%, in equal shares, to Deborah Yvonne Kinazd,
Rebecca A. Mitalslci, Cynthia Susan Drop, Patricia
Rayellen Hoover, Rayallen Hoover, Jr., Michael
James Edgar M. Hoover, and Andrew Joseph
Hoover.
(g) Successor Trustee. If Patricia Rayellen Hoover is for any reason
unable to serve as Trustee, Cynthia Susan Drop shall serve as
Trustee in her place and stead. If Cynthia Susan Drop is for any
reason unable to serve as Trustee, Michael James Edgar M. Hoover
shall serve in her place and stead.
(h) Trustee's Powers. The Trustee may exercise the following powers:
(1) Introduction. Except as otherwise specifically provided in
this trust agreement, my Trustee may exercise, without prior
approval from any court, all the powers conferred by this
agreement and any powers conferred by law, including, without
limitation, those powers set forth under the common law or
statutory law of the Commonwealth of Pennsylvania or any other
jurisdiction whose law applies to this trust. The powers set forth in
Pennsylvania Probate, Estates and Fiduciaries Code are
specifically incorporated into this trust agreement. The powers
conferred upon my Trustee by law, including those powers
conferred by Pennsylvania Probate, Estates and Fiduciaries Code,
shall be subject to any express limitations or contrazy directions
contained in this agreement.
My Trustee shall exercise these powers in the manner my Trustee
determines to be in the best interests of the beneficiaries. My
Trustee shall not exercise any of its powers in a manner that is
inconsistent with the right of the beneficiaries to the beneficial
enjoyment of the trust property in accordance with the general
principles of the law of trusts.
Page 3
(2) Execution of Documents. My Trustee may execute and
deliver any and all instruments in writing that my Trustee
considers necessary to carry out any of the powers granted in this
agreement.
(3) Banking Powers. My Trustee may establish bank
accounts of any type in one or more banking institutions that my
Trustee may choose. My Trustee may open accounts in the name
of my Trustee (with or without disclosing fiduciary capacity) or in
the name of the trust. When an account is in the name of the trust,
checks on that account and authorized signatures need not disclose
the fiduciary nature of the account or refer to any trust or Trustee.
An account from which my Trustee makes frequent disbursements
need not be an interest bearing account. My Trustee may authorize
withdrawals from an account by check, draft or other instrument or
in any other manner.
(4) Contract Powers. My Trustee may sell at public or
private sale, transfer, exchange for other property, and otherwise
dispose of trust property for consideration and upon terms and
conditions that my Trustee deems advisable. My Trustee may
grant options of any duration for any such sales, exchanges, or
transfers of trust property.
My Trustee may enter into contracts, and may deliver deeds or
other instruments, that my Trustee deems appropriate.
(5) Environmental Powers. My Trustee shall have the
right to inspect trust property to determine compliance with or to
respond to any environmental law affecting the trust property.
"Environmental law" shall mean any federal, state, or local law,
rule, regulation, or ordinance relating to protection of the
environment or of human health.
My Trustee may refuse to accept property if my Trustee
determines that the property is or may be contaminated by any
hazazdous substance or is or was used for any purpose involving
hazardous substances that could create liability to the trust or to my
Trustee.
My Trustee may use and expend trust property to (i) conduct
environmental assessments, audits or site monitoring; (ii) take
remedial action to contain, clean up or remove any hazazdous
(...)
substance including a spill, discharge or contamination• iii
Page 4
institute, contest or settle legal proceedings brought by a private
litigant or any local, state, or federal agency concerned with
environmental compliance; (iv) comply with any order issued by
any court or by any local, state, or federal agency directing an
assessment, abatement or clean-up of any hazazdous substance;
and (v) employ agents, consultants and legal counsel to assist my
Trustee in these actions.
My Trustee shall not be liable for any loss or reduction in value
sustained by my trust as a result of my Trustee's retention of
property on which hazardous materials or substances requiring
remedial action are discovered unless my Trustee contributed to
the resulting loss or reduction in value through willful misconduct
or gross negligence.
My Trustee shall not be liable to any beneficiary or to any other
party for any decrease in the value of trust property as a result of
my Trustee's compliance with any environmental law, including
any reporting requirement.
My Trustee may release, relinquish or disclaim any power held by
my Trustee that my Trustee determines may cause my Trustee to
incur individual liability under any environmental law.
(6) Pavment of Taxes and Expenses. Except as otherwise
provided in this agreement, my Trustee is authorized to pay all
property taxes, assessments, fees, chazges, and other expenses
incurred in the administration or protection of the trust. All
payments shall be a charge against the trust property and shall be
paid by my Trustee out of the income, or to the extent that the
income is insufficient, then out of the principal of the trust
property. The determination of my Trustee with respect to the
payment of expenses shall be conclusive upon the beneficiaries.
(7) Real Estate Powers. Except as otherwise specifically
provided in this agreement, my Trustee may sell at public or
private sale, convey, purchase, exchange, lease for any period,
mortgage, manage, alter, improve and in general deal in and with
real property in such manner and on such terms and conditions as
my Trustee deems appropriate.
My Trustee may grant or release easements in or over, subdivide,
partition, develop, raze improvements, and abandon, any real
property.
Page 5
My Trustee may manage real estate in any manner that my Trustee
deems best and shall have all other real estate powers necessary for
this purpose.
My Trustee may enter into contracts to sell real estate. My Trustee
may enter into leases and grant options to lease trust property even
though the term of the agreement extends beyond the termination
of the trust and beyond the period that is required for an interest
created under this agreement to vest in order to be valid under the
rule against perpetuities. For such purposes, my Trustee may enter
into any contracts, covenants and warranty agreements that my
Trustee deems appropriate.
(8) Settlement Powers. My Trustee may settle, by
compromise, adjustment, arbitration or otherwise any and all
claims and demands in favor of or against the trust. My Trustee
may release or abandon any claim in favor of the trust.
(9) Emnlovment of Professionals. My Trustee 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 2.02 Disposition of Tangible Personal Property
I direct that my Personal Representative distribute my tangible personal possessions
according to a separate "Personal Property Memorandum" or other similar writing signed
by me and kept with my personal records. It is my intent that the writing qualifies to
distribute my tangible personal possessions under applicable state law. If the writing is
not found at the time of my death, or is ruled an improper disposition, this bequest will
lapse and my tangible personal possessions will become part of my living trust. If any
items of tangible personal property I happen to own are not mentioned in the writing,
those items will become part of my living trust. If any gift of tangible personal property
lapses, then the items comprising the lapsed gift will become part of my living trust.
Section 2.03 Pour-Over to My Living Trust
I give the balance of my probate estate, excluding any property over which I have a
power of appointment, after payment of expenses and taxes that are paid under this will,
to the then-acting Trustee of the Rayallen Hoover Living Trust dated January 4, 1996 as
restated on March 12, 2008 and executed before this will, to be added to the property of
that trust. I direct that the Trustee administer the property as provided in the trust
agreement and any amendments prior to my death.
Page 6
Section 2.04 Alternate Disposition
If the trust referred to in Section 2.03 is not in effect at my death, or if for any other
reason the pour-over cannot be accomplished, I specifically and completely incorporate
the terms of the trust into this will by reference. I direct my Personal Representative to
then establish a trust in accordance with the provisions of that trust and distribute the
remainder of my estate, excluding any property over which I have a power of
appointment, to the Trustee of that trust to be administered as provided in the trust
agreement.
Article Three
Designation and Succession of Fiduciaries
Section 3.01 Personal Representative
I nominate Cynthia Susan Drop as my Personal Representative. If Cynthia Susan Drop
fails or ceases to act as my Personal Representative, Inominate the person or persons
serving as Trustee of the Rayallen Hoover Living Trust dated January 4, 1996 to serve as
my Personal Representative.
Article Four
Powers of Fiduciaries
Section 4.01 Grant
My Personal Representative may perform every act reasonably necessazy to administer
my estate and any trust established under my will. In addition to this general grant of
powers, my Personal Representative is specifically authorized to:
Hold, retain, invest, reinvest, sell, and manage any real or personal
property, including interests in any form of business entity including, but
not limited to, limited partnerships and limited liability companies, 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;
Partition, sell, exchange, grant, convey, deliver, assign, transfer, lease,
option, mortgage, pledge, abandon, borrow, loan, and contract;
Page 7
Distribute assets of my estate in cash or in 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;
Hold any interest in nominee form, continue businesses, carry out
agreements, and deal with itself, other .fiduciaries, and business
organizations in which my Personal Representative may have an interest;
Establish reserves, release powers, and abandon, settle or contest claims;
and
Employ attorneys, accountants, custodians for trust assets, and other
agents or assistants as my Personal Representative deems advisable to act
with or without discretionazy powers and compensate them and pay their
expenses from income or principal.
Section 4.02 Powers Granted by State Law
In addition to all of the above powers, my Personal Representative may, without prior
authority from any court, exercise all powers conferred by my will, by common law, or
by the Pennsylvania Probate, Estates and Fiduciaries Code or other statute of the
Commonwealth of Pennsylvania or any other jurisdiction whose law applies to my will.
My Personal Representative has absolute discretion in exercising these powers. Except as
specifically limited by my will, these powers extend to all property held by my
fiduciaries until the actual distribution of the property.
Section 4.03 Distribution Alternatives
My Personal Representative may make any payments under my will:
Directly to a beneficiazy;
In any form allowed by applicable state law for gifts or transfers to minors
or persons under disability;
To a beneficiary's guardian, conservator, or caregiver for the benefit of the
beneficiary; or
By direct payment of the beneficiary's expenses.
A receipt by the recipient for any distribution will fully dischazge my Personal
Representative, if the distribution is made in a manner consistent with the proper exercise
of my Personal Representative's duties under my will.
Page 8
Article Five
Administrative Provisions
Section 5.01 Court Proceedings
If any trust is established under my will, that trust will be administered in a timely and
efficient manner consistent with its terms, free of active judicial intervention and without
order, approval, or other action by any court. It will be subject only to the jurisdiction of a
court being invoked by the trustees or by other interested parties, or as otherwise
provided by law.
Section 5.02 No Bond
I direct that no Personal Representative be required to give any bond in any jurisdiction.
Notwithstanding this direction, if a bond is required by law or by court determination, no
sureties will be required on the bond.
Section 5.03 Compensation and Reimbursement
Any fiduciary serving under my will is entitled to reasonable compensation
commensurate with services actually performed. In addition, any fiduciazy serving under
my will is entitled to reimbursement for expenses properly incurred.
Section 5.04 Ancillary Fiduciary
If any ancillary administration is required or desired and my domiciliary Personal
Representative is unable or unwilling to act as an ancillary fiduciary, my domiciliazy
Personal Representative may have power to designate, compensate, direct, and remove an
ancillary fiduciary. The ancillary fiduciary may either be a natural person or a
corporation. My domiciliary Personal Representative may delegate to the ancillary
fiduciary any powers granted to my domiciliary Personal Representative as my
domiciliary Personal Representative deems to be proper, including the right to serve
without bond or without surety on bond. The net proceeds of the ancillary estate will be
paid over to the domiciliazy Personal Representative.
Page 9
Article Six
Taxes, Claims and Expenses
Section 6.01 Payment of Death Taxes, Claims and Expenses
The Trustee of the trust referred to in this will is authorized to pay expenses incurred for
my funeral and for the disposition of my remains, claims against my estate, and expenses
of estate administration. Accordingly, I direct my Personal Representative to consult with
the Trustee to determine which expenses and claims should be paid by my personal
representative from property passing under my will, and which expenses and claims
should be paid by the trustee from the trust.
I direct my Personal Representative to follow any instructions contained in the Rayallen
Hoover Living Trust in making any tax elections, including, but not limited to, the
allocation of my GST Exemption. Any taxes imposed by reason of my death on property
passing under and outside my will aze to be apportioned and paid in the manner provided
in the Rayallen Hoover Living Trust, and I incorporate the tax apportionment provisions
of the Rayallen Hoover Living Trust as part of my will.
In no event may any death taxes be allocated to or paid from property that is not included
in my gross estate for federal estate tax purposes or which qualifies for the federal estate
tax marital or charitable deductions.
Section 6.02 Tax and Administrative Elections
My Personal Representative may exercise any available elections under any applicable
income, inheritance, estate, succession, or gift tax law. This authority includes the power
to select any alternate valuation date for death tax purposes and the power to determine
whether any administration expenses of my estate aze to be used as estate tax deductions
or as income tax deductions. No compensating adjustments aze required between income
and principal as a result of those determinations unless my Personal Representative
determines otherwise, or unless required by law.
My Personal Representative, in its sole and absolute discretion, may elect to have all,
none, or part of the property comprising my estate for federal estate tax purposes qualify
for the federal estate tax marital deduction as qualified terminable interest property under
Section 2056(b)(7) of the Internal Revenue Code (the "QTIP Election").
Any tax paid as a result of the inclusion in my taxable estate of property held in a
qualified terminable interest property (QTIP) trust created for me by my wife will be
apportioned to and collected from the qualified terminable interest property (QTIP) as
provided in Section 2207A.
My Personal Representative is not liable to any beneficiary of my estate for tax
consequences that arise as a result of the exercise or nonexercise of any tax elections or
Page 10
for decisions made concerning the allocation and distribution of property in kind in full or
partial satisfaction of any beneficiary's interest in my estate.
Article Seven
General Provisions
Section 7.01 Applicable Law
The validity and construction of my will shall be determined by the laws of the
Commonwealth of Pennsylvania.
Section 7.02 Contest Provision
If any person, directly or indirectly attempts to contest or oppose the validity of my will
or my living trust, including any amendments to my trust, or commences, continues, or
prosecutes any legal proceedings to set my will or living trust aside, then .that person will
forfeit his or her share, cease to have any right or interest in my property, and will, for the
purposes of my will, be deemed to have predeceased me.
This Section may not be applied so as to cause forfeiture of any distribution that
otherwise qualifies for the federal estate tax charitable or marital deduction.
Section 7.03 Construction
Unless the context requires otherwise, words denoting the singulaz may be construed as
denoting the plural, and words indicating the plural may be construed as denoting the
singulaz. Words of one gender may be construed as denoting another gender, as context
requires.
Section 7.04 Headings and Titles
The headings and paragraph titles are for reference only.
Section 7.05 Internal Revenue Code, IRC or Code
References to the Internal Revenue Code, the IRC or the "Code" refer to the Internal
Revenue Code of the United States. References to specific sections of the Code apply to
any sections of like or similaz import that replace the specific sections as a result of
changes to the Internal Revenue Code made after the date of my will.
Page 11
Section 7.06 Other Definitions
Except as otherwise provided in my will, terms will be interpreted as defined in the
Pennsylvania Probate, Estates and Fiduciaries Code as amended after the date of my will
and after my death.
Section 7.07 Survivorship
For purposes of this will, if my wife actually survives me by any period of time or if the
order of our deaths is not known, then my wife will be deemed to have survived me. Any
other beneficiary will be deemed to have predeceased me if the beneficiary dies within 30
days after the date of my death.
Section 7.08- Severability
If any part of this instrument is determined to be void or invalid, the remaining provisions
will remain in full force and effect.
I, Rayallen oover, having signed this Will in the presence of
and ~ .,~ = . ~ who attested it at my
request on is day, ~ 1 , 2009 at Harrisburg, Pennsylvania, declare
this to be my Will.
Page 12
The above and foregoing Will of Rayallen Hoover was declared by Rayallen Hoover in
our view and presence to be his Will and was signed and subscribed by the said Rayallen
Hoover in our view and presence and at his request and in the view and presence of
Rayallen Hoover and in the view and presence of each other, we, the undersigned,
witnessed and attested the due execution of the Will of Rayallen Hoover on this day,
~ ~~' ~ ~ , 2009.
residing at 1 /OI ~i/~q~~id~n ./~Dii~s~
~~~~-sue, ~ ~~r~sc-,
~`X~~ ~Q -~ ~' - residing at S
1--=
PENNSYLVANIA SELF PROVING AFFIDAVIT n ~ ~
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF DAUPHIN ~
I, Rayallen Hoover, the testator 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 Rayallen Hoover, the testator, this
day, ~ ~~ 1~ , 2009.
No u is
COMMONW IY VANIA
No1Nta13eet
JBOqueNne M. Mindact4 Notary Pub1C
Lower Pexlon'1Yrp, DeupFAn ~r~Y
Page 13 My OanrikMon E~rae oa 25, 2010
MNnber, P~nraylvenle Aeeoclatbn of Notaries
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF DAUPHIN ~
We' A and S ~sw^ E . '~,1~~--e{ ,the witnesses whose
names are sign d to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw the testator sign and execute the
instrument as his Last Will; that the testator signed willingly and executed it as his free
and voluntary act for the purposes therein expressed; that each subscribing witness in the
hearing and sight of the testator signed the will as a witness; and that to the best of our
knowledge the testator was at that time 18 or more years of age, of sound mind, and
under no constraint or undue influence.
Witness
Witness
Notary P lic
eOM IFS NON YWANIA
Lower PexfonM. p~~~Y Pu'~(C
My QomrrA9ebn E~q*ee OcL 250
Msmber, PerMrYtyeMe Aseooiefbn of Notaries
Page 14