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HomeMy WebLinkAbout01-21-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of KaRFN R WOODWORTH also known as Deceased File Number ~ ~ ~ ~ ~ ~ ~~ Social Security Number 507-42-9387 Petitioner(s), who is/aze 18 years of age or older, apply(ies) for: (COMPLETE A' OR 'B' BELOW.) Q A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / aze the FXFCI 1TRIX named in the last Will of the Decedent dated 8/21 /2009 and codicil(s) dated ~/A N/A (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: N/A B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durance minoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Wili and was survived by the following spouse (if any) and heirs: (If e.t...;.,;~t.~~r:nn ~ t ~ nr d h n ~ tn_. enter date of Will in Section A abtrve and complete list of heirs.) Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his /her last principal residence at __ _ _.. _.... (List street address, town/city, township, county, state, zip code) Decedent, then 68 years of age, died on 1/8/2010 at Hn~ Y SPIRIT HOSPITAL ~w.ao w~ i cecT c~~aconon'rwp CUMBERLAND COUNTY PA 17011 __ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 10.000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 186.250.00 situated as follows: 503 Colony Drive Camp Hill, Cumberland County, Pennsyivania Wherefore, Petitioner(s) respectfully request(s) the probate of the last Wilt and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: Typed or printed name and residence JUDITH J. VALENTINE Form RW-02 rev. 10.13.06 Page 1 of 2 (COMPLETE WALL CASES) Attach oddldo~rel alYeda ij,urxasary. = ~ .~,~ .. _ , ~ ~, , Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF ~=~ ~MRERI AND 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 before the the 21ST. day of 910 -..-.- , Signature bf Personal J. Signature of PersonalReprese»tattve N For th stet Signature of Persona! Representative C"? o - ~~ ! `- -`_ --,~ ~~ =xy ~ ~, ~ ~~ ~ ~ N j r-.. •'~- v ~ i`~ Cl . ~ JJ In~ File Number: ~~ - 4 U " ~L~~ - ~,_ ~ ~ ~ ~ . t .. : ,. _ ~ ~ Estate of KAREN R WOODWORTH , Decg~seH ~y , t `'~' `~ ~ } ~ . N „_„t Social Security Number: ~~7-42-9387 Date of Death: 1!8/2010 AND NOW, -!ANl IARY 21. , 201201 Q , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters TESTAMENTARY are hereby granted to JUDITH J VALENTINE in the above estate and that the instrument(s) dated _8121 /2009 - described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s) of Dee~dent~ ' ^ FEES Letters ............................. $ 260.00 Short Certificate(s) •••••••••••• $ ~ 16.00 Renunciation(s) •••••••••••••••• $ JCP .... $ 23.50 AUTOMATION .... $ 5.00 WILL FEE ,.,• $ 15.00 .... $ .... $ .... $ .... $ .... $ .... $ TOTAL ............................. $ 319.50 Attorney Signature: Supreme Court I.D. No.: 36504 Address: 11(10 SPRIN(~_(_ARnF,N DR._ STE A Telephone: (7171939-9806 Forn Rw-o2 rev. 10.13.06 Page 2 of 2 Attorney Name: DAVID C. MILLER. JR: LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 15934686 J 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. ~~ ~ % ~drw~~1AH~l Z Z~10 Local Registrar Date Issued T-J ea C7 i~ -[ ~~rn N ;:I '':~ ,~~ C.. ' . - t ....j r-'1--1 ^~ .~'i . ~ ''..J jyt w ^T...) f ~ ` ~ ....t 3 REV 1112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS aD~ ~ see i^iEY~~ictloFrYls arts ex~amoeE onT reverse) eTC nr c w msco 1. Nra d Daaderd (FYr. aedde, yet ad6x) 2. Sea 3. Sodei Searry Nanar 4. Day of Dean (, mY, Yrr) 42 - 9381 J 8 2010 507 F l - ema e Karen R. Woodworth 6. w9e (Ur BAY) Under 1 lkrdr 1 8. DBy d BMh 7. eord ayy a Be. Place d Deen Check as Modha 0•Ye Han IaruM HaDihl: Other: 68 yrs. February 21, 1941 QnaYla, I3ebraska irrpaeerd ^ ER / Oreprynl ^ Dow ^ Hurdrq Haa ^ Raeiana ^ other . 3pedry !b. Carly d Dever Bc. Ciry, Born, Twp. d Dsatlr Bd. Fectly Nerve (B nol Ysydbn, gM etteet end number) 9. Wes Decadent d FkeDank Oagkr? No ^ Vas t0. Race: American IMyn, &ack, Wy+y, etc. l • (1=nberland E. Pennsboro Gkute Hol S irit Eb ital - ~""~^~ ~'~e^~•b) 11. Dasdrl'a lW W d trek d ds mat d W. Do nd ayy 12. Waa Decadrd ever M ds 13. DecadrYe Eduatlon (Speopy arty hiphrt ¢•d• canpleled) 14. Merpr Ssns: Meted, Never Married, 75. Surviving Spouse Id wpe, give maiden name) (! d O Kit d Wak NM d BueMrl hdsey SOIlnel COnsulten ersotmel Recruit U.S. Amrad Fo~rY/a~c? ^ Yee ~ No Eym~n~ty ! Semdary (P12) 1[[ College (1J a 5.) Y~ ~ LI:Cu 1 aM~g wddrer,tdlylfam,ayy,eip coca) Decadanre Pennsylvania ~ Daadrd tivw in E. Pennsbor0 Twp t rrc L~vr ~CAlOny ? . , Ac1u91 Residence 17a. Byte ~b l d nd ^ ~ t Hed"~ Camp Bill, PA 17011 er arl ,ro. cans cwy/Bao ,~I Urt iy M 18. Fetyfa Name (FhaG made, Yet, auAkl Clinton A. Woodworth 19. MdMte Name (Flro6 midde, maiden aumeme) Mary Jordon 20e. Yiprlsrd'a Nsme RyDe! Pdnl) 20b. Inlamrd'a MMnp wddrre (Bart dly / bwn, eyy, ap •e+rd State Ga wood Dr 2294 A t l l PA 16801 ela Ta for u m . u 21e. Mepbd a DMpaaNbn r ~rrsem ^ Dawna 41b. Dap d Dypaida (Mont, deY, Yrrl 21a Plea d DeDaepbn Rlrre d ameNry. crrWrTd alrrlheA ((2fyylam, elev. aP arch) 13 2010 ~ a"`°' ^ """°"°"'""s'r° ~ ^ tti ~ n matio re n Holli er C HDll Sri s _. PA „ er Dao Y„ Ne Ma 1 Eaar ~ ZZ< d Furrr lkrrr (a o^w• r ) 22b. tlarsa Nrrbar ~ .~~.. r ~ ~ 22c. Hems and wddnr d F~lyer3-I'IarCler r e~,Ri ii ~ - 014819 Darpes Mrs 23eo ady when ardlyYq 23a. ro M bar d my psrr•dp•, death acamed r dy tlns, day end D4a regd. (SlgreNre end mel 23ti. ldsrse IdaeY1F '., 276. Day Sgred )Mmn, day. 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Lyf apt' ore uaae a eats pre. r ~ ^ No LTUrarown mrdtlbn reewrq~n drCrl v 1 ~ 1(~~~1) ~i / i ~~1 j ~6 F 1 y ' 7 i` ~i~7~s•)/(/~ ` /11//iSG ~ ^ Nd Pre9ned within Dart year .~ . . „ ( e. -- (o (ay aaaelluNra o :. _ ~ ~ r j1,S7~ ~~" warrapare prn i l1,''~~ ^ Pragnenl St fire d death llhi l 42 d b ^ N , . b, b alye Arad a line a ~ ~T ^"^ te'`'`a w ut pregran n ey9 d Pregnant . IMIDERY.YND c~usE (aleaar a Yrjray 1hr 11JYIed psa 9'l Nan ~ /~ A °~p` r} _ l-'' Y ~ f1/ V~ / r' i 7 ` ~1 ~/~ - d drm nant 43 da s to 1 year ^ Na rram br re re c evere rrulpnq n drnl lA7T. Dab )a r 8 can+eaana oq: r !/ "l~~ , p g y g D orae r1eaM i ! 4 ~ ' - - - ^ Unknown N pegnant wiern the peal year d. 90s. Mye an Aubpey 30b. Nkrs wubP•Y Flalrrgs 31. MrpM a Derv 72a. Day a N3uy (Haan, day. year) 3zb. Daodha Hw Inhay omrrea 32c Pya d In ~ Home, Ferm, Street Factory, Olpa Bakpng, etc. /Spxvly) Perbnrsd7 ~ ' Avalaby Poor b CarplMion ? Nehar ^ Fbnwsda d Caur d Derh ^ AavMnl ^ Prldig ImNtlgelbn 32d TYre d MaY 32e. Irjury el 321. II Trrspaylbn iNreY (Spaay) 32g. Laalbn d irdury Btroel, onY /town. sylel ^ Vr No ^ Yr ^ IIO ^ Yea No ^ Ddvar/Ope2br ^ Paeeengsr ^ Paaaban . ^ Sddde ^ Godtl Nd Ds Dsyrrrrered y, ~, SGed~' 73e. CNYer (deck erYP ar•) 33b. B,9rene• ell .. • C•rBtYkq PYM•~•• (PAYrain oxYWn9 aae d deem •tren errotlsr DMab•^ Iss Pmnaarad d•edr end aergleled Item 23) ________________ ^ _ res aeaead tits alts eeueye)eM mrerreyyd Nd • d b ~ L ______________ __ l a ros ToYMMrd•ry . Day IMOmn day, year) . • PrabusYq rd aNyMg OhWey ( ban prmaertlrrg dean end aapNin9 m our d dean) ~~ ' ~ ~ ~ 'j i TelM brtdmy bywNd7e, darhamendrlM lkr,My, errd pya,anti drbdr eeaeM•)arts metrrrr Wyd__________________ ' 1 ~ _ / ~ /.~. .. (. (. • Wdyr EtuMesrlCeraw Dn Hee ery a eersrrbn rM! ar kxrtlgrlae, b my •Pke•ra dealt oeeweae r ds BaK tire, arts Dye, arts due y tM ewe(e) rrtl mwyr a regd. ^ ehd Ceuee a Deetlr (hem 27) type / PaN P on W ho Cam pl a and A d dr a ee a er 34. Nr n ~ / 1 ~ / ~ , l j C S~!/'/Zl ~i /~/~ ~ ' ~ ~. RegWele .r 0ybk1 36. Dr. Flyd lMareh, ay, yrr) / %1 / , /(• U Dypaiporr P,,,,,d ~ X153314 N LAST WILL AND TESTAMENT c p _ A ^,-,T' , ~ OF ~ ~ ~ C7 - ~ x ~ ;_ -- ;: _~ rn N ;, ;, KAREN R WOODWORTH "~ ~' ~' `.._ ., ,"~-, C _,~ (i (7 "t~ i_k ~~~ -'t'7 ~,'. ~ ,~ W ~ 1J ~ > `/' ' % -r N I, Kazen R Woodworth of Camp Hill, Cumberland County, Pennsylvania, being of sound and- -~ disposing mind, do hereby make, publish, and declare this to be my Last Will and Testament, hereby revoking and making null and void all prior Wills and Codicils made by me at any time heretofore. ITEM I. I direct that all my legally valid debts, funeral and administrative expenses, and debts incurred or payable because of my death, shall be paid by my Executor, hereinafter named, from my residuary estate as soon after my death as practicable. All death taxes, including federal, state, and other death taxes, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed thereon, shall be considered an expense of administration of my estate, without apportionment or right of reimbursement. Taxes on future interests may be prepaid. ITEM II. I make the following disposition of the real estate located at 503 Colony Drive, Camp Hill, Pennsylvania, if I still own said real estate at the time of my death. If at the time of my death Judith J. Valentine is still residing at the house, I grant her a life estate in the real estate with the following condition. She shall be entitled to live in the house for as long as she is physically able to do so, and is able to maintain the house in good physical repair and pay any bills associated with the upkeep, maintenance and enjoyment of the property, including but not limited to real estate taxes, utilities, maintenance and repairs. When Judith J. Valentine is no longer able to physically or financially manage the house, or at her death, whichever event occurs first, said property shall be sold and the net proceeds disposed of in the same manner as indicated below for my residual estate. Page 1 of 10 Initials: ~Q'~/ ITEM III. I make the follow specific bequests of my personal property to the following named individuals, if they survive me by thirty (30) days. If any such individual does not survive me by thirty (30) days, but leaves issue who so survive me, said bequest shall pass in equal shares to such issue. If any such individual does not survive me by thirty (30) days, and leaves no issue who so survive me, such bequest shall lapse and become part of the residue of my estate. The specific bequests are as follows: A. To my son, Robert J. Berrettini, I give the following 1. My Colt 380 Revolver; 2. The automobile which I own at the time of my death. B. To my daughter, Angela S. Taylor, I give the following: 1. All of my dolls. 2. All of the contents of the curio. C. To my son, Joel C. Berrettini, I give the following: 1. Thirty (30) pieces of silver and mama's silver and china. D. To my friend, Judith J. Valentine, I give the following: 1. The grooming of my dogs. ITEM N. I give, devise and bequeath all my other household and personal effects, jewelry, and other tangible personalty of like nature, except those items specified in Item III, above, in equal shares to my son, Robert J. Berrettini, and my daughter, Angela S. Taylor. Such property shall be divided by my said beneficiaries as they shall agree. As to those items upon which they shall not agree, distribution shall be determined by my Executor. As to any items which Robert J. Berrettini and Angela S. Taylor do not want, such items shall be sold at public or private sale, as directed by my Executor, and the proceeds included in my residual estate. ITEM V. I give, devise and bequeath all of the residue of my estate, whether real, personal, or mixed, and wherever situated, including any property subject to any power of appointment which I may now have or hereafter acquire In Trust in accordance with the provisions of the Trust and the related provisions under this Will. Page 2 of 10 Initials:`"! ITEM VI. The interest of beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM VII. I hereby appoint Judith J. Valentine, of Camp Hill, Cumberland County, Pennsylvania, to serve in such capacity as Executrix (the "Executor"), of this, my Last Will and Testament. In the event of the refusal or inability of such named person to so serve, I then nominate and appoint my son-in-law, James L. Taylor, III, of State College, Pennsylvania, to serve in such capacity as Executor. ITEM VIII. I direct that my Executor and my Trustee shall not be required to give bond or post any other security for the faithful performance of duties in any jurisdiction. ITEM 1X. Any person who shall have died at the same time as me, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased me. ITEM X. The property passing hereunder as part of my residual estate shall be held IN TRUST, by my Trustee, hereinafter named, for the benefit of such Beneficiaries as set forth below, upon the terms and for the purposes and uses, as follows: A. If my son, Robert J. Berrettini, survives me by thirty (30) days, one half (50%) of the residue of my estate shall be held In Trust for Robert. My Trustee shall hold and invest the principal of the Trust corpus, collect the income (any income not so expended or applied to be accumulated and added to principal). Robert shall be entitled to 10 annual payments from said Trust. The first Trust payment shall be made as soon as the value of my residual estate can be determined, but no later than one year from the date of my death. The first payment shall be for 1/10th of the principal and interest held in the Trust created from fifty (50%} percent of my residual estate. The remaining payments shall be as follows: Page 3 of 10 Initials: he~ 1. On the first year anniversary following the initial payment to Robert, he shall receive his second payment from the Trust in the amount of 1/9th of the principal and interest held in the Trust 2. On the second year anniversary following the initial payment to Robert, he shall receive his third payment from the Trust in the amount of 1 /8th of the principal and interest held in the Trust. 3. On the third year anniversary following the initial payment to Robert, he shall receive his fourth payment from the Trust in the amount of 1/7th of the principal and interest held in the Trust. 4. On the fourth yeaz anniversary following the initial payment to Robert, he shall receive his fifth payment from the Trust in the amount of 1 /6th of the principal and interest held in the Trust. 5. On the fifth yeaz anniversary following the initial payment to Robert, he shall receive his sixth payment from the Trust in the amount of 1/5th ofthe principal and interest held in the Trust. 6. On the sixth year anniversary following the initial payment to Robert, he shall receive his seventh pay#nent from the Trust in the amount of 1/4th of the principal and interest held in the Trust. 7. On the seventh yeaz anniversary following the initial payment to Robert, he shall receive his eighth payment from the Trust in the amount of 1/3rd of the principal and interest held in the Trust. 8. On the eighth year anniversary following the initial payment to Robert, he shall receive his ninth payment from the Trust in the amount of 1/2th ofthe principal and interest held in the Trust. 9. On the ninth year anniversary following the initial payment to Robert, he shall receive his tenth payment from the Trust in the amount of the remaining principal and interest held in the Trust and the Trust shall terminate. ``'' 11 Page 4 of 10 Initials:~w B. If my son, Robert J. Berrettini, does not survive me by thirty (30) days, then the entire residue of my estate shall be held In Trust, under the terms and conditions as set forth below, for my ganddaughters, Emily Grace Taylor and Katherine Jane Taylor, together or individually, who survive me by thirty (30) days. If my son, Robert J. Berrettini, does survive me by thirty (30) days, but does not survive the entire period during which the payments outlined above aze to be made, any payments not due and paid prior to his death shall lapse and the remaining funds from that Trust shall be paid to the Trust for my granddaughters, Emily Grace Taylor and Katherine Jane Taylor, together or individually. C. If my son, Robert J. Berrettini, does survive me by thirty (30) days, and fifty (50%) percent of the residue of my estate is placed InTrust for Robert, then the remaining fifty (50%) ofthe residue of my estate shall be held In Trust, under the terms and conditions as set forth below, for my ganddaughters, Emily Grace Taylor and Katherine Jane Taylor, together or individually, who survive me by thirty (30) days. 1. My Trustee shall hold and invest the principal of the Trust corpus, collect the income (any income not so expended or applied to be accumulated and added to principal), and so much of the principal and accumulated income, as my Trustee shall deem necessary or advisable, in the sole and absolute discretion of my Trustee, for the support, maintenance, medical care, and education (including college education, both gaduate and undergaduate) of my granddaughters, Emily Grace Taylor and Katherine Jane Taylor, together or individually, after taking into consideration other readily available assets and sources of income. During illness or emergency, my Trustee may either pay a distribution to my granddaughters, Emily Grace Taylor and Katherine Jane Taylor, together or individually, or may Page 5 of 10 Initials:~w! make a distribution for the benefit of my granddaughters, Emily Grace Taylor and Katherine Jane Taylor, together or individually. 2. At the time when each of my granddaughters attains the age oftwenty-five (25), the Trust pertaining to that granddaughter shall terminate, and my Trustee shall distribute that granddaughter's share of the then remaining principal and accumulated or undistributed income to that granddaughter. 3. If one of my granddaughters should die during the existence of this Trust, it shall be divided and then continued for the benefit of any then-living issue of that granddaughter, per stirpes, with such beneficiaries being substituted for my granddaughter for all purposes including distribution at age twenty-five (25). 4. If one of my granddaughters should die before attaining the age of twenty-flue (25) without leaving issue surviving as aforesaid, then that Trust shall terminate and its assets shall pass to my remaining granddaughter, or her surviving issue, per stiraes, living at the time of the death of said granddaughter; Provided, however, that if a Trust established hereunder for any such Beneficiaries exists at the time of such distribution, then such distribution shall be made to that Trust for such Beneficiary. ITEM XI. I hereby appoint Judith J. Valentine as Trustee for any assets passing hereunder to any Trust established for my son, Robert J. Berrettini. In the event of her inability or unwillingness to so serve, I hereby appoint James L. Taylor, III, of State College, Pennsylvania, as Trustee. I hereby appoint James L. Taylor, III, of State College, Pennsylvania, as the Trustee for any assets passing hereunder to any Trust established for my granddaughters, Emily Grace Taylor and Katherine Jane Taylor, together or individually. In the event of his inability or unwillingness to so serve, I hereby appoint Judith J. Valentine as' Trustee. Page 6 of 10 Initials:~,"v ITEM XII. My Executor and Trustee shall have the following powers in addition to those invested by law and by other provisions of my Will applicable to all property, whether principal or income, exercisable without Court approval, and effective until distribution of all property: A. To retain any investments I may have at my death so long as my Executor or Trustee may deem it advisable to my Estate or Trust so to do. B. To vary investments, when deemed desirable by my Executor or Trustee, and to invest in such bonds, common trust funds, stocks, notes, real estate mortgages, or other securities or in such other property, real or personal, as my Executor or Trustee deems wise, without being restricted to so-called "legal investments". C. In order to effect a division of the principal of my Estate or Trust, or for any other purpose, including any final distribution, my Executor or Trustee is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind. If such division or distribution is made in kind, said assets are required to be divided or distributed at their respective values on the date or dates of their division or distribution. D. To sell either at public or private sale and upon such terms and conditions as my Executor or Trustee may deem advantageous to my Estate or Trust, any or all real or personal estate or interests therein owned by my Estate or Trust severally or in conjunction with other persons or acquired after my death by my Executor or Trustee, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the '_ 1 Page 7 of 10 Initials:~~ validity of said sale or sales; also, to make, execute, acknowledge, and deliver any and all deeds, assignments, options, or other writings which may be necessary or desirable, in carrying out any of the powers conferred upon my Executor or Trustee in this paragraph or elsewhere in my Will. E. To mortgage real estate, and to make leases of real estate for any period of time as my Executor or Trustee may deem reasonable. F. To borrow money from any party to pay indebtedness of mine or of my Estate or Trust, expenses of administration, or inheritance, legacy, estate, or other taxes. G. To pay all costs, taxes, expenses, and chazges in connection with the administration of my Estate or Trust. My Executor shall pay expenses of my last illness and funeral expenses. H. To vote any shares of stock which form a part of my Estate or Trust, and to otherwise exercise all the powers incident to the ownership of such stock. I. To compromise claims and to abandon any property which, in my Executor's or Trustee's opinion, is of little or no value. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting often (10) typewritten pages, .this ~~day of August, 2009. (~ ~~~ ~~~ "~ • SEAL) Kazen R. Woodworth Page 8 of 10 Initials:~Q `~ We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declazed by the above-named Testatrix, Kazen R. Woodworth as and for her Last Will and Testament, in the presence of us, who at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and yeaz above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. residing at: // ~- ,~~~ ~~ ~~~ ~~ 1~7D11 ~, a~ ~~~6 Initials:_~w Page 9 of 10 col~nKONwEALTg of rErnvsYLVANrA COUNTY OF DAUPHII~T . ss.. We, Karen R. Woodworth the Testatrix, and ~ ~ ~ A rU W • ~f~t~Sl~i and ~I VYl Q0. ~ • ~/~'I 5~- the witnesses, respectively, whose names are signed to the f ero g mo g instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary aet for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ta,.~, ~. ~,~,~,~ cam: Wi ess / ~~ Witness Subscribed, sworn to and acknowledged before me by the Testatrix, Kazen R. Woodworth and subscribed and sworn to before me by N - I a r u y . F e) r r~IGI and ~' m ~ QA 1 ~ ~~ ~ ~ ~ , witnesses, this o2_~- day of August, 2009 ~cmn ~ ~ ~.~~,~ Notary Public Cp~pNVYEALTH OF PENNSYLVANW (SEAL) Nolarfei SAN eoiNds L. VVUema. NoteMy PubMc Lowsr 8waten TwP•. ~auptYn O~Y Nh- CwrMnialon ExpNas MrN 16, Zol a Page 10 of 10 Initials: ~ ~~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN AFFIDAVIT In accordance with Section 2502(3) of the Pennsylvania Probate Estates and Fiduciaries Code, the attached Will was executed by signature of another. Section 2502(3) states that when a testatrix is unable to sign her name or make her mark for any reason, a will to which her name is subscribed in her presence and by her express direction shall be as valid as though she had signed her name thereto, provided that she declares the instrument to be her will in the presence of two witnesses who sign their names to it in her presence. On Friday, August 21, 2009, the attached Will of Kazen R. Woodworth was executed at the Holy Spirit Hospital, Fifth Floor, Room 513. Karen R. Woodworth was not able to sign the Will because of her medical condition at that time. However, she was able to give direction to the individuals present regarding the signing of her Will. The Will was reviewed with Karen R. Woodworth by her attorney, David C. Miller, Jr., Esquire. Present at the time were witnesses, Hilary H. Felinski and Elmira L. Welsh. Also present was Bonnie L. Williams, a notary public, and Angela S. Taylor, the Testatrix's daughter. When the Testatrix was asked whether she wanted the Will executed as her Last Will and Testament she responded "absolutely." At that point the Will was signed for the Testatrix by David C. Miller, Jr., Esquire and witnessed by Hilary H. Felinski and Elmira L.Welsh. The signatures of the Testatrix and the witnesses were then notarized by Bonnie L. Williams. The above facts aze sworn to as true ect. David C. Miller, Jr. Subscribed, sworn to and acknowledged before me by David C. Miller, Jr., this ~ ~- day of August, 2009. ~an n ~ o~ L~,~a~o Notary Public (SEAL) coNwwriw~au.~+ of Peru~sY~vEww ~o~a seM BonrNe L. WlNlertr, Nofery PubNe lower Swafeie Twp., DeuP~~ My Conwnledo~ ~e