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Home My WebLink About03-15-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of a/k/a: a/k/a: a/k/a: ROSELLA JEAN HOUSE ., Deceas STATE NO: 21- ~y (~~~~1 SS NO: Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: ~A. Probate and Grant of Letters Testamentary or ^Administration c.t.a., or d.b.n.c.t.a. (complete Part Calso) and aver that Petitioner(s) is/are entitled to the aforementioned Letters Testamentary under the last Will of the above-named Decedent, dated January 20, 2011 and codicil(s) dated None (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 instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person, an d ~ as not a partr~~ to a pending divorce proceeding at the time of death ~~herein 8rouncls for divorce had been established as def'ineci in 23 Pa. C.S.A. § 3323(8}: None _ ^ B. Grant of Letters of Administration (If applicable, enter d.b.n., pendent tite, durante absentia, durante minoritate) C. Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was sun~ived by the following spouse (if any) and heirs (If Adtnirlistratiot~ c:.t.a. or d.b.n.c.ta., enter date of ~~~ill in Se.ctio~rt A and co~T~plote list of heirs); was not the victim of a killing; was never adjudicated an incapacitated person; atxi eras not a part~~ to a l~entling divorce proceeding r~~hercin rirounds f~tr divt)rce had. been established as provided in 23 Pa. C.S.A. § 3323(8), except as follows: ~ --. . Name Address Relati o Decedent ~~=:;; f• t i I _:~-~ : v .. t.; .~7 ry_~- ~` f ~ ~ l._Il ~:_P t';I? AI)I)rl'IO~AI, SIIi~.I~.~rs II' NrcrssAl2'~' - ;~ r, ~t . . THIS SECTION MUST BE COMPLETED: ~~' Decedent was domiciled at death in ~tuliberland County, Pemisylvania, with his/her last family or prirtcl al residence At 815 West Keller Street, Monroe Township (P, 0.: Mechanicsburg, PA 17(55) (Street address ~,vith Post Office and lip Code. Municipality: Township, Borough, City) Decedent, then 77 years of age, diedMarch 5, 2011 at Monooe Township, Cumbezland County (i~`Ionth. Day, Year of death) (City and State where death occun•ed) Estimated value of decedents property at death: If domiciled in PA If not domiciled in PA If not domiciled in PA Value of Real Estate in Pennsylvania All personal property Personal property iu Pennsylvania Personal property in County Total Estimated Value Location of Real Estate in Pennsylvania: (Provide full address if possible.) $ -~~-s ~~ ~---- $ -- ~~ .~ [? ~~'~ +-i ~ t ,- - ~, n_t ~:, ~ -c-~ i~tature(s} \'ame(s) & A~Tailing .Address(es) Robert Lee Strayer 17055 tntenrn rorni KW-UL revisEd il.L6..lU Uy C:umberlaud County pending action by the C;cxiit Page 1 of 2 OATH OF PERSONAL REPRESENTATIVE ~-;> .W~; ~_ r-,. Commonwealth of Pennsylvania ~ SS ~ ~- ~ ~--~ .~ r~n ~„ ~ q. _~ County of Cumberland "~ R~._ -~ ~» ;-~; ° ` k i The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petitionrue and; ~.~ ~~" correct to the best of the knowledge and belief of Petitioner(s) and that, as personal represela~atlve(s} o~the Decedent, Petitioner(s) will well and truly administer the estate according to law. Swam to or affirmed and subscribed r~~ ^th before me this _~ day of Stxaye ci ~ 2 - i'C...~ ~~~ or the Register DECREE OF PROBATE AND GRANT OF LETTERS Estate of ROSELLA JEAN HOUSE ,Deceased File Ntunber: 21-~ - U ~~ in consideration of the Petition on AND NOW, this day of -~-~~-~-~ 2011 the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters X Testamentary of Administration are hereby granted to: (It' applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) __-~.cL_P.~, fi 1 e e S t r a y~r .__ f 111 the above estate and that instruments(s) dated Ja~~axV ~n _ ~n1 ~ ___!._ described in the :petition be admitted to probate and filed of record as the last Will ~~~ of D cadent. ,~ Glenda Earner Stras augh ~ / ~`Qi~% ~; Register of Wills V FEES' Signature of Counsel Required to Enter Aprearance Letters ....................$ ~(~~ 0~ Will ........................ :~ Co ~.il(s) ................. ( )Short Certificates ( )Renunciations....... Bond ............................. Other ............................. Automation FEE......... 5.00 JCS FEE .................... 23.s0 TOTAL ................ S ~ ~ ~, .~~ - -S~iELB ~. & BR N'EN, P . C . Atty's SignatlireE PRINTED Name : 7~-ke~~ d-~-S~~11~,ak P x Supreme Court ID No.: ~f~06355 Address: 44 Wept: Mai:q Stx'eet: ~P ~~,~.n..is ~ u~rg' P~-~Q5 Phone : Z1, 7 ~-h 9 7~-S ~'~ Fay: ~~ ~ Ha~_~t;s~-i Interim Form }2W-02 revised 12.26.1(1 by Cumberland County pending action by the Couii Page 2 of 2 ptn5_R~5 R~'V rnrrn-r, ~,~ • ~ i- Q~~~~ LOCAL REGISTRAR'S CERTIFICATION OF DEA-T'H WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 'his is to ccrtit;~' that the information here given is correctly copied frt:)n~ ,a (1 original Certificate of Death duly filed with mt' as Local Registrar. The original certificate will b~~ 1~t~rwarded to the State Vital Records Office t~or permanent filing. P 17296499 Certification Number I_,ocal Registrar Date Issued C'> _ =' ~: ~ ~ r r~? ~ ~n ~ ~" ..~..e ~. ~~-~ l I `` f. .~ ^ `' J ~~ H105.143 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE / PRMIT IN PERMANENT CERTIFICATE OF DEATH 13LacK INK (See instructions and examples on reverse) STATE FILE NUMBER t. Name M Depdent (First, ntidde March 5, 2011 S. Age (Last Birthday) Under t year Under t day 6. Date d Birth (Monet, ,year) 7. Birthplace (City and stale a for eign can ) 8a. Piece d Deam {Check ate) Months Days Hours MnNa HOSpital: L)dlef. 77 Yrs. December 29, 1933 Dillsburg, Pennsylvania ^Irrpaatlent ^ER/outpatient ^DOA ^NursingFbme ~ Residence ^Olher-Specify: Bb. County of Deam 8c. City, Boro, Twp. of beam 8d. Pottery Name (Knot instittsbrt give street and rxsnber) 9. Was Decedent d Hispanic Origin? ~ No ^ Yes 10. Race: American Indian, Black, White, etc. Cumberland Mechanicsburg 815 West Keller Street (If yes, specity Cuban. Mexican, Pueno Rican, etc.) (Specify) White 11. Decedent's Usrrel tbn Kind d wok date ~ moat tN YFe. DO na state refired t2. Was Decedent ever in the 13. Decedent's Education (Spetfy only highest grade comp leted) ta. Manrel Batty: Matted, Never Married, 15. Surviving Spo use (11 wife, give maiden name) Kind d Wok Kind d Bwitess l Industry U.S. Armed Forces? Elementary /Secondary (0-12) Co9ege (1 d a 5+) Widaved. ~~ (SPecihl Securi Ana fist US Government ^Yea AND 12 Widowed 16. Decedents Mailing Address (Street, dry !town. stare, zip code) Decedents Did Decedent Aawl Rrrsider[ce ,7a. sate PA ~ ,7t:. ^ Yes, Decadent LMed in Twp. 815 West Keller Street ~ ,7b De~^'~"""'i^ Mechanicsburg carnty Cumberland 17d~~~ Mechanicsburg, PA 17055 ~~,/~ . ~, 18. Father's Name (First, middle, Last, suffix) 19. Momar's Name (First, middle. maiden sumarne) Herndon Strayer Bernice Gettys i 20a. Irtbmrertt's Name (Type !Print) 20b. Infornants Mailing Address (, city / btvn, state, zip axis) i Robert_ Strayer. _. _ _ _.._.. _ _ _.. _ _ _ 815 West Ketter Street Mechanicsburg, PA 17055. 2ta. Memod d Disposition ^ Cremation ^ Datation 21b. Date d Dispositat (Harm, day, year) 21 e. Place of Oispasition (Name d cemetery, crentamny a otiter place) ltd. Coelho (City /town, state, zip code) _^ ~Bunal ^ Reraval fran srete ! ,Aa~cr ~.,i~n ~ co, Aut~.a ^ Y~ ^~ March 9, 2011 Mechanicsburg Cemetery Mechanicsburg, Pa. 17055 ~ 22a. re d Funere apng as such) 22b. License Ntxnber 22c. Name and Atldrea d Facility • FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055 Conpbre h 23ar when certifying 23a. To d my knowledge, deem occtxred at the tlme, date and piece sta d. (S ig nat ure and tide) 23 b lice ns N ber e u 23c. Data Signed (Monet. day, Year) d time d deem to re f ~ r ~ ^ ~ r r x ~ 1 m 1 ,, s ~ , / " ~ ~~ ~ ~ ~ ' aNryr caws d deem. ,T`.~.. I \ ` ~+ LS ~1/ 1 ` 1" 'r7 - ' ~ flame 2F26 mwt be competed try parser[ 24.. Time d Deem 25. Date P Dead (Mtxdh, day, Year) 26. Was Case Referred b Medal Examiner I Coroner for a Reason Omer man Cremation a Donetbn? aAto proraunps deem. ~~ t.,1 t7 ~~ pt, )~.. 71 _ ~ `-•~, ^ / ^ Yes CAUSE OF DEATH (See Insfructlon an s d exampbs) r Approxknare vxervat. Pan 11: Ender other ' 28. Did Tobaxo flee Contridde re Dam? Item 27. Pan t: Emer the t3tarr d events -diseases, iryuries, a cronpACaUorre -mat dwedly caused the deem. DO NOT enter termkrN events such as candies arrest, r Onset m Deem bW not restating in the txrdertyirrg cause given in Pan I. C3"Yes ^ Probably respiretory steer a ventricular fibrgetion wAftaA sfawirg the etiology. List tx[ty one cause on each line. ~ r ^ ~ ^ Ura[noaT[ IMMEDU7E CAUSE ((Foal disease or /+ l! + conddion restating h tiaml __~ a. v rK t ll CG ! L G ~ .. s C ! ,,t_C C ^ + r (/C•4r- -~- `- 29. If Female: ^ ~ - Dw to (e as a correeyuertoe of): ~ ~ ~rrdOioru, A ~,, b. r l r Not pregrraM within past year ^ Pregnant at time d deem re caws isted m line a. Enrer UNDERLYWG CAUSE Due to (or as a consequerwe of): ~ ^ Na pregnant. but pregnant within 42 days disease a in}xy met iniaMad me c. + resuwng m deem) LAST. r d loam Due to (or as a wnseQuence of): r ^ Not pregnant but pregnant 43 days to t year before deem d. i ^ Unknown M pregnant widYn me pest year 30a. Was an Autopsy 30b. Ware Autopsy Findings 3t. Hamer d Deem 32a. Dare d Irqury (Abram, day, Year) 32D. Desaibe How Injury Occurred 32c. Play d Injury: Florte, Fartn, Street Faaory, Performed? Available Prior to CanpeGOrt of Cause of Deam? Natural ^ Homidde Office Building, etc. (Sparely) i ^ Yes '~No ^ Yes ^ No ^ AcddeM ^ Pending Investigation 32tl. Time d In)tnry 32e. mjDry at Work? 321. d Transportation Injury (Specify) 32g. Location of Injury (Brest. ntY' / tovm, state) ^ Suicide ^ Could Na bs Deremrired ^ Yes ^ No ^ Onver /Operate ^ Passenger ^ Pedestrian M Omer - SpecMy: 33a. Certifier (check only are) 33b. Signature and Tale d Certifier • Cenflying physician (Physician cenifyirg cause d deem when arather ptysician has pronounced deem and completed Item 23) To the bat of my knowbdgs, dafA occurred due to tits pose(s) and ntartrra a stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ~~ • Pronour+Grtg and cenltyMg phyakian (Physician bdh pronouncing deem and certifying to awe ddeem) T tM b t f 33c. License 33d. Date Signed (Monet, day. Year) - - _ - - - o as o m knowled dam occurred at the time, date. end _ _ _ _ _ _ y ga, place, and due b the cause(s) and tttatvter as stated.. _ _ _ _ _ • Madipl Examiner /Coroner O!, / O -~ d ~ 4 _L NFL i` ~ On the basis of examination and 1 or invatigetfon, to my opinion, deMh occurred at the time, date, and plea, and dw to ma cause(s) and manner ae stated., ^ 34 Name and Address d Who ~ pause d Death (Item 27) Typo 1 Print ~/~+rK .j4J.0 35. R 'tar's S' lure and Die t N ~ r I ~i / I ~ l / I ~ (Monet day year) to Fled +5~ • v .cJ ~i~ • ..s ~tr r , r , ~ J Dispositon Permi[ No. /~ 1(J /~ I h-....'1 ~~ LAST WILL AND TESTAMENT <a ~ _.__ ,__ r-= f '!1 J ROSF,LLA JEAN HOUSE -~~. -- --- , .::_ ~~~ h ,....- ~_ _a ,,- ~ .--. - I, Rosella Jean House, a resident of Mechanicsburg, Pennsylvania declare tli},~ be my~;`~ ~=~-a Last Will and revoke all former Wills and Codicils. ~'~ ~~ ~-•~ ~ ~: -;--~ ARTICLE I Identification of Family At the present time I am unmarried. In making this Will I have in mind my children, Robert Lee Strayer, born 1951, and Karen LaDawn House, born 1961, but does not include any children hereafter born to or adopted by me. Any reference to a "child of mine" or "my children" shall include the persons named or referred to in this Article. ARTICLE II Disposition of Remains I direct that my remains be buried in Mechanicsburg Cemetery in existing burial plot and tombstone. I authorize my Executor to carry out these directions and wishes, particularly those for the disposition of my remains. ARTICLE III Appointment of Fiduciaries A. Appointment of Personal Representative. I appoint my son, Robert Lee Strayer, as Executor of my estate. If Robert Lee Strayer is or becomes unable or unwilling to serve, I appoint my daughter, Karen LaDawn House as alternate Executor. B. Bond; Court Supervision. My Executor shall have the right to serve without bond and to administer and settle my estate without the intervention or supervision of any court, except to the extent required by law. Nothing herein shall prevent my Executor from seeking the assistance of the court in any situation where my Executor deems it appropriate. ARTICLE IV Specific Gifts A. Gifts of Specified Items of Property. I give all my interest in certain items of tangible personal property to the beneficiaries designated in this section as follows: 1. Specific Gift One. I give all jewelry including a white gold 14K Will of Rosella Jean House Page 1 of 6 Initials: ~ '~ Date: ~ ~' ~ ~ half-carat diamond ring to my daughter, Karen LaDawn House if she survives me. If Karen LaDawn House does not survive me, I give this gift to my granddaughter, Sabrina Rose Vasiliadis. 2. Specific Gift Two. I give my dark pine dry sink (belonged to Grandma Gettys) to my niece, Margaret Marie Erickson if she survives me. If Margaret Marie Erickson does not survive me, I give this gift to my brother, Ray Richard Strayer. 3. Specific Gift Three. I give my small oak writing desk (belonged to my mother) to my brother, Ray Richard Strayer if he survives me. If Ray Richard Strayer does not survive me, I give this gift to my nephew, Richard Keith Strayer. 4. Specific Gift Four. I give a crocheted heart shaped pin cushion (green and yellow) made and given to me by Grandma Gettys* as a gift *Sabrina's great great grandmother to my granddaughter, Sabrina Rose Vasiliadis if she survives me. If Sabrina Rose Vasiliadis does not survive me, I give this gift to my daughter, Karen LaDawn House. B. Insurance. I give to each recipient of an item of tangible personal property my interest in any insurance covering the item. My purpose in making this gift is to give each recipient the benefit of insurance coverage for which I have already paid. It is not my intention to give any recipient the proceeds of an insurance claim that exists but is unpaid at my death. ARTICLE V Disposition of Residue A. Provision for Descendants. I give all of the rest and residue of my estate, wherever located (hereafter referred to in this Article as "residue"), to my descendants if they survive me per stirpes. 1. Provision for Others. If I am not survived by any of my descendants, I give the entire residue to my heirs. ARTICLE VI Alternative Methods of Distribution A. Purpose of Article. Recognizing that under certain circumstances the terms of this Will may direct that property be distributed outright to a person who is under age twenty-one (21) or under a legal disability; I make the following provisions to facilitate the distribution of property to such persons. B. Alternative Methods. Whenever the terms of this Will direct my personal representative (referred to in this Article as the "fiduciary") to distribute property outright to a person who is then under age twenty-one (21) or under a legal disability, the fiduciary inay retain pursuant to Paragraph C. of this Article or distribute all or any portion of that property in any one Will of Rosella Jean House Page 2 of 6 Initials: ~~i/~Date: (- c~1 ' (C or more of the following ways: 1. Delivery directly to the beneficiary; 2. Delivery to the parent or stepparent of the beneficiary; 3. Delivery to the guardian of the beneficiary's person or propert}r; 4. Delivery to any Custodian for the beneficiary under the Uniform Gifts to Minors Act; 5. Delivery to any then existing trust created for the beneficiary; 6. Deposit in a financial institution in an account established in the name of the beneficiary alone pursuant to the laws of the State of Pennsylvania; 7. Storage of any tangible personal property in safekeeping with the costs of storage to be borne by the beneficiary; or 8. Sale of any tangible personal property and delivery of the proceeds in any manner permitted by this Article. Provided the fiduciary acts in good faith, upon delivery of any property in accordance with the provisions of this Article, the fiduciary shall be discharged from all responsibilities in connection with the property. C. Discretionary Trust. Any property not distributed as provided in Paragraph B. of this Article shall be retained by the fiduciary in trust for the beneficiary on the following terms and conditions: During any period in which the beneficiary is under a legal disability or under twenty-one (21) years of age, the fiduciary shall pay to or apply for the benefit of the beneficiary so much of the income and principal of the trust as the fiduciary, in its sole and absolute discretion, determines is advisable for the beneficiary's health, support, education and general welfare. At such time as the beneficiary is neither under a legal disability nor under age twenty-one (21), the fiduciary shall distribute any remaining trust assets to the beneficiary. If the beneficiary dies before all of the trust assets have been distributed, the fiduciary shall distribute any remaining trust assets to the beneficiary's estate. ARTICLE VII Administrative Provisions A. Powers and Duties of Personal Representative. My personal representative shall have all of the powers and duties granted to or imposed upon personal representatives serving with non-intervention powers pursuant to the laws of the State of Pennsylvania. B. Debts and Expenses. All expenses of administration chargeable to principal, the Will of Rosella Jean House Page 3 of 6 Initials: ~ Date: ~ ~ ~` ~ ~( expenses of the disposition of my remains, and all my legitimate debts, if and when paid, shall be paid from the principal of my residuary estate. No debt need be paid prior to its maturity in due course and except as otherwise provided in this Will no interest in any property passing under this Will need be exonerated. C. Taxes. All estate, inheritance or other similar death taxes, together with any interest or penalties thereon, arising by reason of my death with respect to any property includable in my taxable estate, and any adjusted taxable gifts, whether passing under or outside of this Will, shall be paid from the principal of my residuary estate without reimbursement from the recipients or beneficiaries of such property, provided, however, that in the event any proceeds of insurance upon my life or any property over which I held a power of appointment are included in my estate for purposes of determining the federal estate tax liability of my estate, then the residue of my estate shall be entitled to receive from the recipients of any such proceeds or property the portion of such federal estate tax liability attributable to such proceeds or property determined in accordance with IRC § § 2206 and 2207. ARTICLE VIII Miscellaneous A. Number and Gender. Unless the context indicates a contrary intent, the plural and singular forms of words shall each include the other, and every noun and pronoun shall have a meaning that includes the masculine, feminine and neuter genders. B. Survival. To "survive" me, as that term is used in this Will, a person must continue to live for thirty (30) days after my death. C. Descendants. The "descendants" of an individual include only the following: 1. All such individual's biological descendants, except any person not born in lawful wedlock and his descendants, unless the biological parent who would otherwise cause him or her to be a descendant has acknowledged paternity or maternity in legitimation proceedings, or in an unambiguous signed writing identifying such person by name, or by raising such. person in the same household; and 2. Persons adopted by such individual or one of his or her descendants, and their descendants. If the parent, who would cause a person to be a descendant as defined above, is replaced in an adoption proceeding, such person shall remain a descendant unless such parent voluntarily consents to the relinquishment of his or her status as parent in connection with such adoption proceedings. D. Heirs. The term "heirs" shall mean those persons entitled to inherit under the then-applicable laws of the State of Pennsylvania governing the descent of an intestate's separate Will of Rosella Jean House Page 4 of 6 Initials: ~ Date: (-~' -_~_ estate. They shall inherit in their statutory proportions. E. Exclusion of Pretermitted Heirs. Other than as set forth in this Will, I make no provision for any child of mine or descendant of a deceased child of mine. I specifically make no provision for any person (whether now living or hereafter born), other than a child named or referred to in Article I or a descendant of mine as defined in this Will, who may be entitled to claim an interest in my estate under the laws of the State of Pennsylvania. F. Legal Disability. A person is under a legal disability if my personal representative determines, in good faith, that the person is incapable of managing her property or of caring for herself, or both, or is in need of protection or assistance by reason of physical injury or illness, mental illness, developmental disability, senility, alcoholism, excessive use of drugs, or other physical or mental incapacity. G. Title to Real Property. Upon my death, title to any real property passing under this Will shall vest in my personal representative in his fiduciary capacity and shall remain so vested until my personal representative distributes or sells that property, at which time title shall vest in the distributee or purchaser. H. Disclaimer. Except as may be otherwise specifically provided in this Will, in the event that any beneficiary disclaims an interest arising out of this Will or any trust created herein it is my intention that the interest disclaimed shall be distributed in the same manner a:nd at the same time as if the disclaiming beneficiary had died immediately preceding the event pursuant to the laws of the State of Pennsylvania. I. Governing Law. The provisions of this Will shall be interpreted in accordance with and in light of the laws of the State of Pennsylvania. J. Corporate Successors. Whenever a corporation or other business entity is referred to herein, the reference shall include any successor organization. K. References to Statutes. In this Will, the abbreviation "IRC" shall refer to the Internal Revenue Code of 1 X86 as amended. Will of Rosella Jean House Pa e 5 f 6 ' i /-~ ~ f U~ ~ ~ g o Init als~ Date. _ ~~ I have initialed and dated for identification purposes all pa es of this, my Last Will, and have executed the entire instrument b signing this page on the ~ day of ~.11uC~r~ , 20 I I , at ~Y1 e V ~ UIIf ,Pennsylvania. Rosella can House Attestation and Statement of Witnesses Each of us declares under penalty of perjury under the laws of Pennsylvania that Rosella Jean House, the Testator, signed this instrument as her Last Will in our presence, all of us being present at the same time, and we now, at the Testator's request, in the Testator's presence, and in the presence of each.. other, sign below as the witnesses, declaring that the Testator appears to be of sound mi d undo o duress, fraud, or undue influence. .~ _ ~ ~~'` ~~- -- [ W fitness Signature] [Witness Signature] [Print Name] [Print Name] Residi at Residi at Will of Rosella Jean House Page 6 of 6 Initials: ate: ~ -~1J-- r SELF-PROVING AFFIDAVIT STATE OF PENNSYLVANIA } } ss. COUNTY OF Cum ber I an d } I, the undersigned, an officer authorized to administer oaths, certify that Rosella Jean House, the Testator, and Rtmhe~r Soy-,SSa-rn e~-r. ,and N_ oh_ ~~d i ~ ,the witnesses, whose names are signed to the attached or foregoing instrument and whose signatures appear below, having appeared together before me and having been first duly sworn, each then declared to me that: 1) the attached or foregoing instrument is the last will of the Testator; 2) the Testator willingly and voluntarily declared, signed and executed the will in the presence of the witnesses; 3) the witnesses signed the will upon request by the Testator, in the presence and hearing of the Testator, and in the presence of each other; 4) to the best knowledge of each witness the Testator was, at that time of the signing, of the age of majority (or otherwise legally competent to make a will), of sound mind. and memory, and under no constraint or undue influence; and 5) each witness was and is competent and of the proper age to witness a will. .~C~ Rosella Jean House [W ness Signature] [Print Name] [Print Name] Residing at Residin -~ ~'' --- Section for Notary Public: Subscribed, sworn and a~nowledged before me by the said Rosella Jean House, Testator, and by the said ~'~'~~ L ~ S s c~ rn a,,~ ,and >-1 ~ 1 \ ~ ~ ~ ~~ is witnesses, this ~ day of ~~~, 20 (I . Signature of otary] .~ I< (n ~ r a~ n __ [Print or stamp name o otary] n~ of ~~snv~ww raw s..i eere~y K +. ~- P~allo Uppsr A~Ist~ 7wp.. Cwt~DNl~o ~, ~ My ContnthNon ExpNN r~~Qml~. l~ennsvhrania of Notaries