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HomeMy WebLinkAbout04-01-10~~~~~~Q~ ~Q~Z ~'~Q~~~~ AIIr~J ~~AIlT~' Q~]~ ~~7~'~'~~~ REGISTER OF u~ILLS OF C ~(. I1'1,~~7~LR-N,,a COUNTY, PENNSYLVANIA Estate of ,gene H. Z~cbQ. also la-town as Deceased File Number ~ ~ /O -' ~,~ ~•(.~ Social Security Number /•S~-'~6-.Si ,79~ Petitioner(s), wl~o is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or '13' I3ELON%) A. Probate and Grant of Letters Testamentary and aver that Petitioner(~j.is /+~e the SpeeG.Stor ~keeu}o,r' named in the last Will of tl~e Decedent dated _~-t/l ~~ /~3 (State relevnnt circrunstances, e.s., reneuzciatlon, death of executa•, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ^ B. Crant of Letters of Administration (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lire; durance absentia; durante miiAoritate) a C~ PetitionerO after a proper search has /have ascertained that Decedent left no V1~i11 and was survived by the following spoe~ ; ~ any) and~irs: (~' -~~ ~ldnzinistratiat, c.t.a. ord.b.n.c.t.a., enter date of Neill in Section A above and complete !!st of hehs.) ' ~-~?,. "C7 ,__~ ~i7 _; _, ~~ Name Relationship Residence - -r-, - ' ,. ~j -,--t `, ---d _ ~ -t ~~- © `~> (COMPLETE IJ1't1LL CASES:) Attach additiatal sheets if ttecessaty. "`-~ Decedent was domiciled at death in Pennsylvania x% his /her last princ~al resjdenc^at (List street addrras, to--~n/cit)~, to>~ship, couuh~, slate, zip code)- - ~ ~ ~ - - /~~T Decedent, then gs years of age, died on ~~"~ 17, 2p~~ at ,/yp~u siO%~''// /'Gt~tSl7/fQ,~, L: • ~V"~°1jl~S~ ~~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All persona] property ~ .J~ DOO- ~~ (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania ~~' iS 6e~ievG~ 1^P.a.l et~e is ~,1~ i h ~~ ~ ~,d t~.k nor sKb~ . ~ pn•bate~ . situated as follows: • Whercl'orc, Pctitioncr(s) respectfully rcquesl(s) the probate of the las( V,rill and Codicil(s) presented with this Petition and the oranl of Letters in the appropriate form to the undersigned: 1 _ ~irnauirc ~ 'l yped or printed name and residence I ~~FfR~~y ~ zuc3A X ~1, /a/ hio~~e~,bu~4 fir. G/ey/ ~~22~nct'~er, /Il.T' o£r&a/o For»~ r,,-r-o~ r•~,~. tais.a~ Pabe 1 of Oath of Persol~~1 Representati~-e CONI1~~l0I~r11~EALTI~ OF YL;I~,'NSl'LVANIA COUNTY OF ~' Lt ~ 1~E1eL/4-/V~I~ SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con~ect 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 accordin<< to law. Sworn to or affirmed and subscribed ~~ before me the ~ day of .~ ~. Signnrur ~c~i`sona 1' pres~i ~c~ SE' F~c~'Y ~/ ~t_-!~- l.-~ I ~ Sioirnttu•c oJPe~so~ia/ llcpre~~enlarive C7 `~ For the Register Si,;nanu•e of Persons! /tepresciuntive r_J ~ ~ `~ ~ 7 w_ ~. . .- F , ~~ ........ ' -r ; File Number: a~" ~d ° ~ 3`~ ~ ~ ~• ~~ '_~ -_ ; -~-..J . Estate of T*"~~~ ~ ~~~ ,Deceased Social Security Number: ~~B- /6-S79y Date of Death: /yl~~eL, /], Zo/~' AND NOW, +L~~ ~ U I ~ , in consideration of the foregoing Petition, satisfactor}~ proof having been presented before me, IT IS DECKED that Letters ~iGT/A/j1~/lfQ/'y are hereby granted to __~JG,{~ry ~ zu ~~. _ in the above estate and that the instrument(s) dated ~7i"i ~ ~, sZOQ_~ described in the Petition be admitted to probate and filed of record as the last V>>ill ~+and Codicil( )) of Decedent. i1 (` I ~ ~, ~ ~~ ~, _ „ Letters .......... r~E~ r~ ..... ~Vu Short Certificate(s) . ....... $~~ ~ ~. Renunciation(s) ... ....... $ _~ .., ... s. ,.. . s; ... S~ ... S~ TOTAL .............. ~ ~~ - ~,~ v ~ ~ r ~ ~ I~egrs~cr of Yi'ills [~ ? Attorney Signahirc: ~. ~ Attorney Name: ~~711/'~~S ~- sl'1'~~P..IQ~S Supreme Court 1.D. No.: 3~5~.3 Address: ~ ~OlLS?l ~~ fyI ee~an, ~sda ,~~/7as-S `Telephone: 7~,- 7~1a ~.~_~ ~uru~ R~~1'-U' re~~ lU l~.Oc; ~'~~cr~~. ~ 0 f LOCAL REGISTRAR'S CERTIFICA~I~N OF i~lE~-,~'1~ ~I!'A.RNING: It is illegal to duplicate this copy by phclto:tat or photograph. ~ Fee f~~r this cet-til'icat~. ~i(I.(?O P X6244905 CerlEfic~iti(m `vr~tt)~ie r __ n ~N Of p _~- ,~~"''rr~ Q € s hj~, i~ tL) ~_~rill~ ~~~ - ' l .,) Ei~l ~~itc)r-)I~at~~~t~) ~~re ~'.)e ~~tl )~ ~ ' ~ L~ ~ ~ t . `.~ -~ ,J ~, ~~ ~~ r~tt ~~ ~ tI' ~.\ i '' t crl eIt'( C(~~ l(lj)il:~ iC ~ (! 1~: ill 19d~~111~i 7 1C L1C O 4;ilt tl - ~ p~ p ~~ ~,~ ;~~ ~ " ` w ' tlrll~~ iile~! e~'~-h tII~ ~ - " ~(~, , t>, a I~egist ~ ~ ! r~,r. I he O~l~~ina ' ~ , ~ ,. ~ s .~ titit~ale +.ti ~t. ~vr i1( ~r.ai ft)( decl tO lf~e Matt ti i(al {{ __ . ) 'Aj vl ti ~'e;ti'L)?(~'i 5~i~lr':" ~;ti (l~.Sr',t:il7t.",'1C j1~9llt? . _ `, ti f ,`_ .~ '` ,q a C r ' I I~ ~~ c ~~ ~~ ENT Q vV W -_ _ . __. ____.._ _--_._ 1 ~ ~__ _ -- -_-__ ._. 1~~i :~:~ i )Z~ ll ~f ih(It lsstlt~d :~ 1 "j .l l~ •~~~ - , ~~ 11...wJ t H105-143 REV 11(2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PERMANE IN CERTIFICATE OF DEATH BLACK INK (See instructions and examples on reverse) ~Ta>z FII F NI IuRFR a a ti \~ Z W °w w a O w x 1. Name of Decedent (Frst, middle, last suffix) Irene H. Zuba FMassakowski) 2. Se f=emale 3. Social Se Number ~5~8 16 5794 A. Date of DeaN (Month day, year IlAarc 17, 2010 5. Age (Last Birthday) Under 1 ear Under 1 da 6. Date of BiM Month, da , 7. B' p G and state or fo ' n count 6a. Place of Death Check aril one 87 ""°"'~ DaYs "°"'~ """~ September 28, 1922 Dupont, Pennsylvania H~os~p/ital: Other: yrs ~ Inpatient ^ EA I Outpatient ^ DOA ^ Nursing Home ^ Residence ^ Other -Specify: fib. County of Death tic Ciry, Boro, Twp. d Death 8d. Facility Name (If not instittfion, give street and number) 9. Was Decedent of FFspanic Origin? No ^Yes 10. Race: American Indian. Black, White, etc. Cumberland East Pennsboro Holy Spirit Hospital (It yes, specity Cuban, (SPecl~1 White Mexican. Puerto Rican. etc.) 11. Decedent's Usual Occ lien Kind of work done d uri most of life. Do rot spate retlred 12. Was Decedent ever in the 13. Decedents EdlxaCOn (Spedry only highest grade compl eted) t 4. Marital Status: Marred, Never Marred, t 5. Surviving Spo use {It wile, give maiden name) ~>~.k Kind Kind of Bu s~tt~try U.S. Amled Forces? Elementary / Spry (412) College (1-4 or 5+) Widowed, (Spaply) ~i~owed ff~~1f ^ Yes ICY No 16. aili~gA~~l n~ I tq~, slate, rip code) feel IYO! W a t LUifl Decedent's pA Did Decedent Live in a 17 t Li d i T D d ^Y . • Mechanicsburg, PA 17055 ve n _ wp. es, ece en c Actual Resi~nce 17a. State um er an Township? Mechanicsburg 17d ~gc f ~n ~ t ,7b.~nry cityreoro it ILi d t6. Father's Name (First, middle, last, suffix) William Massakowski 19. Mothers Name (Post mddle, maiden surname) Lucy Borkowski 2Da.informanYsName(Type/Prinq Arlene Bohenick 20b.InfomlanfsMaiNngAddress(Sy~pt,.p~y/yQwn,Cli1~?~reet Mechanicsburg, PA 17055 l 1 L O ~ ~ K ~ f l 21 a. Method of Disposition I ^ Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) or o er place) , cre m atory t h 21c. Place of Disposition (Name of c em et ery 21 d. Loaltbn (City/town, state, zip code) g,Bural ^ RenavalfranState I WasCremationorponatlonAudarized March 23, 2010 Gate of Heaven Cemetery Mechanicsburg, Pa. 17055 ^ Other - S ' by Medical Examinerlforoner? ^Yes^ No _ 22a. Slgna tmeral Se icery~(or persas such) / 22b. License Number FD-012662 L 22c. Name and Address of I' l~ily~hs Funeral Home Inc 37 East Main Street Mechanicsbur PA 17055 ~ ~ `// - . g, , e items -c only when prtrfying 23a. To best of my kno , death occurtsd at the time, date and place stated. (Signature and titre) 23b. Lx;ense Number 23c. Date Signed (Month, day, year) Is rat available at time of deatA to ce~r~h'Iy mouse of death. ~ j ~ ~ ' ,t i" i~ ~ I ~~ ~ Items 2426 must ro completed by parson 24. rime of Death 26. Dale Prorauncad Dead (Month, day, year) r { 26. Was Case Referted to Medical Examiner /Coroner for a Reason Other than Cremation a Donation? ~ who pronourxxis death. ~ ~ ~ P M, ^ ~ ~ C ~ t ^Yes ~ No ) I Approximate interval: les CAUSE OF DEATH (See Instructions and examp Pan 11: Enter other ;dgpjficant conditions rxxttriblrtinc to death. 26. Did Tobacco Use ConMbute a Death? ttem 27. Part I: Enter the chain of events -diseases, injuries, or corttWicatiens -that directly caused the death. DO NOT enter terminal events such as prrtiac arrest ~ Onset to Death but not resulting in the underlying rouse given in Part I. ^Yes ^ Probably respiratory arrest, or ventricular fibrillation without showing the etiology. Ust only one puss on each line. I ^ No ^ Unknown IMMEDIATE CAUSE IFinai disease a ~ r ~~~ / ~ ~~ ~ ~ 24. If Female: ~ ~~ v ~ cortditien resulting in death) ~ -~" a. t I G ~ !` , ' ^ No[ nant within re ear ast l) Due to (or as~aconsequence a / r ' ~~ ' / Y ~ p g p y ^ Pregnant at time of deaM ri , teall1yy kst conditions, if an , JJ/j(L T/ ~7C.'f J~y1~ ~/ ~, ~( ~[' i a o- ~ 7~ /Oj'N ~(/~j''~/j 7 f- ^ I ng to dte pose listed on fir a. Enter the UNDERLYING CAUSE Due to (or as a coryequepce oQ: / i (disease or injury that initiated the c /(- /p/°~ ~ f ~ ~ ~j~~~ /, ~ 1/ O Not pregnant trot pregnant within 42 days of death e nt b r nt 43 d ^ N t t t 1 `/ ~ events resulting m death) LAST. yp Due to (or as a ~ ~r o1i' r i . , I lie ~ ~ gna o pr u p egna ays year o before death ~ ~ ( ~ ~I / ~r~// ", ~r ~ - • "" ~~ r ~ • d ^ Unknown if pregnant within the past year . 30a. Was an AutoKy 30b. Were Autopsy Findings 31. Manner o th 32a. Date of Injury (Month, day, year) 32b. Descdbe lbw Injury Occurted 32c. Plop of Injury: Home, Farts, Street, Factory, Performed? Available Prar to Completion of Cause of Death? NaWral ^ Homicide Office Building, etc. (SpecilyJ ^ Y ^ ^ N ^ Acddent ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 321. If Transportation Injury (S ~ 32g. Caption of irtjury (Street, dty /town, state) es o Yes o ^ Suicide ^ Could Not be Determined M. ^Yes ^ No ^ Drkrer/Operator Passer r edestrian ^ Other -Specify: 33a. Certifier (check only one) l C tH i h t t Ph i i i d h d It 3 d 33b. Signature Titte of Certi r /~ , ~~L-~V- • sr y ng p ya e ys cian prRtying pose of death when another phys an has pronolxxx+ deat an comp ete em 2 ) an ( c To tM best of my knowledge death occurred due to the rouae(a) and manner ss stated ' _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , • ~ Praaunuyng and urtNying physician (Physician txxh praaurakg death and ceNrykg to pose of death) ^ 33c. L' se umber ~ ~ ~ ~ 33d. Date S' d (Mon day, year) ~3 ~ To the best of my knowledge, death Oeeurred at the time, date, and place, and due to the cause(s) and manner as atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medcal Examhror I Coroner ~ O ~ Z~ 1 On the basis of examinadon artd I or inveatlgation, in my opinion, death oaurred at the tlme, date, and place, and due to the rouse(s) end manner as sated_ ^ 34. Name and Addr ess d P erson Who Completed Cause d Death (Rem 27) Type /Print 35. ' natur Dis ~~ ? ~ j } uymb~er~~1) 36. a Filed (M th. daY, Y°~)r1 /~ /~ [ h ` e' ~ 1 ~~/1//N~ !,! ~ I ,6~' ~ • ~ I~1 I ~~ ~ ~ 1 f rj N K. ~ ~ ~ ~ Z , ~, ~ Disposition Permit No. 0 ~ ~- LAST WILL AND TESTAMENT (Pour-Over Will) ~.., OF r_~ • IRENE H. ZUBA ~-_~ `-~ ~-~- ; ~" ~, t~t ,,~ , ', - ~" C"~? ;rCJ IDENTITY ~ " --. ,--.~ --t, . ,~ ~~ s I, IIZENE H. ZUBA, residing in the County of Cumberland, Commonwealth o€t-~ennsyLuania, .: ~ ~ ~, being of sound mind and memory, and not acting under duress or undue influene~ ~a~ any meson ~- ~~~ L= ~-~~; whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all-e#her former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 158-16-5794. All reference made herein to "spouse or my spouse" refers to the person to whom l am currently married, namely, JOSEPH S. ZUBA By the ensuing provisions of this Will, it is my intention to dispose of my interest in our property; I do not intend to dispose of anything belonging to my husband or to put him to any election. I have the following children: Jeffrey F. Zuba, born October 9, 1957, and Joseph S. Zuba, II, born January 28, 1955, and Arlene A. A. Bohenick, born August 1, 1954. DEBTS, TAXES AND ADMINISTRATION EXPENSES I have provided for the payment of all my debts, expenses of administration of property wherever situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other • than any tax on ageneration-skipping transfer that is not a liability of my Estate (including; interest and penalties, if any) that become due by reason of my death, under THE JOSEPH S. ZUBA AND IRENE H. ZUBA REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust";-, or if my spouse predeceases me, under the Survivor's Trust created by the said Revocable Trust. If the Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In the alternative, my Executor may demand in a writing addressed to the Trustee of the Tru;yt an amount necessary to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court order. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to the Revocable Trust as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, :>igned by me this date in accordance with the provisions of the section titled "Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devices), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance • with the provisions of the said Trust, including any amendments thereto made before my death. POUR-OVER WILLS Page 1 Testatrix If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. EXECUTOR I hereby nominate and appoint Joseph S. Zuba as my Independent Executor of this, my Last Will and Testament, to serve without bond. In the event the first named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint Jeffrey F. Zuba to serve without bond as my Independent Executor. In the event the second named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appc-int Joseph S. Zuba, II to serve without bond as my Independent Executor. In the event the third named Executor shall predecease me or is unable or unwilling; to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint Arlene A. A. • Bohenick to serve without bond as my Independent Executor. Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally named herein. EXECUTOR POWERS By way of Illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purpose of this my Will, without being limited in any way by the specific grants or power made, and without the necessity of a court order. POUR-OVER WILLS Page 2 z~ estatrix My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any Beneficiaries, or among the principal and income accounts to compensate for the • consequences of any tax decision or election, or of any investment or administrative decision, that my executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions and shall have the discretion to file a joint income tax return with my spouse. CONTESTS AND SPECIFIC OMISSIONS If any beneficiary under this will, singly or in conjunction with any other person or persons, directly or indirectly: 1. contests in any court the validity of this will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 2. contests in any court the validity of the Testator's/Testatrix's Will or, in any manner, attacks or seeks to impair or invalidate any of its provisions; 3. seeks to obtain an adjudication in any proceeding in any court that this trust or any of its provisions or that Testator's/Testatrix's Will or any of its provisions is void; 4. claims entitlement by way of any written or oral contract to any portion of the Testator's/Testatrix's estate, whether in probate or under this instrument; 5. unsuccessfully challenges the appointment of any person named as Executor or successor Executor of the Testator's/Testatrix's Will; . 6. objects in any manner to any action taken or proposed to be taken in good faith by the Executor of the Testator's/Testatrix's Will; 7. objects to any construction or interpretation of this Will, or any provision of it, that is adopted or is proposed in good faith by the Executor; 8. unsuccessfully seeks the removal of any person acting as the Executor of the Testator's/Testatrix's Will; 9. files any creditor's claim in Testator's/Testatrix's estate (without regard to its validity), whether the claim arose before or after the date of this instrument, but excepting claims for cash advanced or paid for expenses of the Testator's/Testatrix's last illness or funeral paid by said claimant; 10. attacks or seeks to invalidate any designation of beneficiaries for any life insurance policy on Testator's/Testatrix's life; 11. attacks or seeks to invalidate any designation of beneficiaries for any pension or ][BABA. or other form of qualified or non-qualified asset or deferred compensation account, agreement or arrangement; 12. attacks or seeks to invalidate any will which TestatorlTestatrix has created or may create during Testator's/Testatrix's lifetime, or any provision thereof, as well as any gift which Testator/Testatrix has made or will made during Testator's/Testatrix's lifetime, whether before or after the date of this instrument; 13. attacks or seeks to invalidate any transaction by which Testator/Testatrix sold any as~~,ets (whether to a relative of Testator's/Testatrix's or otherwise); or 14. refuses a request of Testator'slTestatrix's, Executor or other fiduciary to assist in the defense against any of the foregoing acts or proceedings, POUR-OVER WILLS Page 3 , i . ~, ' estatrix then that person's right to take any interest given to him or her by this trust shall be determined as it would have been determined if the person had predeceased the execution of this will instrument without issue • surviving. The provisions of the foregoing paragraph shall not apply to any disclaimer by any person of any benefit under this will. In the event that any of this provision is held to be invalid, void or illegal, the same shall be deemed severable from the remainder of this provision and shall in no way affect, impair or invalidate any other provision in this will; and if such provision shall be deemed invalid due to its scope or breadth, such provision shall be deemed to exist to the extent of the scope or breadth permitted by law. SIMULTANEOUS DEATH If my spouse and I should die under circumstances such that the order of our deaths cannot be determined, then it shall be conclusively presumed for the purpose of this Will that my spouse survived me. If any other Beneficiary should not survive me for sixty (60) days, then it shall bey conclusively presumed for the purpose of this my Will that said Beneficiary predeceased me. POUR-OVER WILLS Page 4 This instrument consists of 6 typewritten pages, including the Attestation Clause, Self-Proving Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at;tl~e bottom of • each o the receding pages. This instrument is being signed by me on this ~ - day of ~~-. ATTESTATION CLAUSE • • The Testatrix whose name appears above declared to us, the undersigned, that 'the foregoing instrument was his Last Will and Testament, and she requested us to act as witnesses to such instrument and to her signature thereon. The Testatrix thereupon signed such instrument in our presence. At the Testatrixr's request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence of the Testatrix. The undersigned hereby declare, in the presence of each of us, that we believe the Testatrix to be of sound and disposing mind and memory. Signed by us on the same day and year as this Last Will and Testament was signed by the Testatrix. WITNESSES: ADDRESSES: 6 ~ . a ~1 s (Printed Name of Witness) s (Printed Name of Witness) City, State, Zip (, ~ ~ 7 d ~ - . ~`-- ~ ~JG~D rGrfcz ~% ~S J ,- City, State, Zip j POUR-OVER WILLS Page 5 ~, Testatrix COMMONWEALTH OF PENNSYLVANIA • COUNTY OF CUMBERLAND SELF-PROVING CLAUSE r' EFORE ~, e dersigned autho ~ n this ay p~erso lly appeared IRENE H. ZUBA, ~'"1l,.vC.~- ~- and ,known to ine to be the Testatrix and the witnesses, respectively, whose names are subscr~ ed to the foregoing instrument in their respective capacities, and all of them being by me duly sworn, IRENE H. ZUBA, Testatrix, declared to me and to the witnesses, in my presence, that the instrument is her Will and that she had willingly made and executed it as her free act and deed for the purposes therein expressed; and the Witnesses, each on his or her oath, stated to me in the presence and hearing of the Testator, that the Testator had declared to them that the instrument is her Will and that she executed the same as such and wanted each of them to sign it as a witness; and upon their oaths, each witness stated further that she did the same as a witness in the presence of the Testatrix, and at her request and that she was at that time eighteen (18) years of age or over and was of sound mind, and that each of the witnesses was then at least fourteen (14) yf;ars of age. G~ ~'~--- NE H. ZUBA Testatrix • Witness (Printed Name of Witness) Wi ~`~.~~ (Printed Name of Witness) SUBSCRIBED AND ACKNOWLEDGED efore Eby H. ZUBA, Testatrix, and sub rib an orn to efore me by ~ • ~, and witnesses, this the L -,-- _ day of ~3. Public, Commonwealth of Pennsylvania pOTAR1A4. SEAT ~ERflME ~• E~~S~CHES ER COUN 6 TREpYfFRIN'iWp;,~erc COPT ~~ ?00 • POUR-OVER WILLS Page 6