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Home My WebLink About12-02-11PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF ~ t.1 M~ ~- tz ~' ~ N ~ COUNTY., PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Lt:tters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information w CL h~~K Name: '-~ V~'A.2Q a/k/a: a/k/a: a/k/a: Date of Death d ~.' ~ 'Z v \ \ Decedent was domiciled at death in ~v~t3EW-.~ti'~ County, principal residence at 7 L ~:L-~~-~~ ~ r 1"~ ~ `'~`` C d Decedent died at Street address, Post Office and Zip o e Z ~ccJr~~ ~`~ ~tc~~iC File No: ~ ~ ' I' I~ ~ `'' (Assigned by Register) II z~l -t lp-Z°{ }a~o Social Security No: Age at death: ~- City, with his/har~last s,ouncy Street address, Post Office and Zip Code City, Township or State Estimate of value of decedent's property at death: $ •Zy't p ~ C7 If domiciled in Pennsylvania ............................ All personal property If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................Personal property in County Value of real estate in Pennsylvania .............................. . TOTAL ESTIMATED VALU~jE.)... $ Real estate in Pennsylvania situated at: ~ ~"~ ~-`' "'`t- ~ r ~~ Ci o shi o Borough County (Attnch additional sheets, if necessary.) Street address, Post Office and Zip Code ty+ p A. Petition for Probate and Grant of Letters Testamental \ ~ Zt7 ate- and Codicil(s) Petitioner(s) aver(s) he/she/they is/are the Executor(s) named m the last W~11 of the Decedent, dated t c thereto aatea _ State relevant circumstances (e.g. renunciation, death ojexecutor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS ^ EXCEPTIONS B. Petitlon for rant Of Letters Of Administration (If applicable) endE>nte life, durante absentia, durante minoritate c.t.a., d.b.n., d.b.n.c.t.a., p If Administration, c.t.a. or db.n.c.ta., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. estabhshed-as defined ,~~ y ~~ rs t ~} ~) and~alrs (attaF~ , -r... _.r..# Page 1 of 2 Form RW-02 rev. l0/1l/2011 [~NO EXCEPTIONS ~ EXCEPTIONS ~~ Petitioner(sl. after a proper search has/have as.ertained that Decedent left no W ill and was survived by the following sp Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF C 1 IM t~~ Q~-~- "~ D } Petitioner(s) Printed Name M f~z,~ pF 1,.... W C1.~0~-rZ.K 2. Lo..~lr~l ~ r- ~~J~ ~ ~ -- " tl3 Printeci'Ad~r'~SS ~-~ ~~ The Petitioner(s) above-named swear(s) or affirm(s) 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, the Petitioner(s) will well and truly administer the estate acoording to law. ,, /' Date ~F > ~ ~v, . ~. ~" i~°y /~ Sworn to or affirmed and subsc ibed before /~~(~~~'~ ~' • r ~~3 ~'~ Date me this ~ day ~ Date By: Date Far the Register BOND Required: AYES ~NO FEES: Letters ...................... $ (~ )Short Certificate(s)...... ~D ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ ---- Commiss//~ion ................. . Other I.i•~` •••••••• ...... ~~ Automation Fee .............. . JCS Fee. ~ t~ TOTAL ..................... $ To the Register of Wills: r~......, o...o...,., aonearance by my signature below: ^ waac ........ ...~ Attorney Signature Printed Name: _ Supreme Court ID Number: _ Firm Name: _ Address: _ Phone: Fax: Email: DECREE OF THE REGISTER Estate of ~~t (nJG r cd ~ ~ ~~ r a/k/a: AND NOW, 1 .`i <'~' ~~^-1"iO T ~ o`1U I 1 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS ECREE~D~t Letters S !1 r are hereby granted to r ~ ~ C ~ ~ r fi - in th.e above estate and (if applicayle) that the instrument(s) dated ~ `~ described in the Petition be admitted to probate and filed of recordlas the l~ast /W},ill (and Codicils )~of /Deced Register of tlls\ ~ / { L ~ ~~~,~, Page 2 of 2 Form RW-02 rev. 10/11/1011 ;Ip5.805 REV 100071 LOCAL REGISTRAR'S CERTIF bCATI~ONDO~F tDEATH WARNING: It is illegal to duplicate this copy y p Fee for this certificate, $6.00 P 17645943 Certification Number This is to certify that the information here given is correctl~i copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will he forwarded to the State Vital Records Office for perma~n~ent filing. ~~~~ ~ ~~+I~,~-~.. ill ~! l I f Local hegistrar Date Issued -- _ - - -- - r--. -- _- ~Q ~, 1~ t _ _ ~-- -_-- ~J ~r~i _r .? _ - -- -- -- ~~ _,. _.._ _._- _ __ ~ ~ , ~~~~ i'V - __ -' C~ O `r3 J~ ~ `~O t~ .~' COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS HIDSta3 REV 11/.'DOs rYPEa CERTIFICATE OF DEATH BI~VCH ~ (See instructions and examples OFy FeveFae) STATE FILE NUMBER 2. Sr 3. Sodel Sanely Numer 1. Dale d oe.m Iwoan, dM. Ye•r) 1.Hrro et Da«dert lpd. rretldle. reG aorta) Male ~ 201 - 16 - 2966 November 3, 2011 F7dardrd H. Clark 7 . ~a~,« le. Prr a Dann cxrdr «» UMr 1 U«rr 1 de 8. Dde d BYtlr Morel, HrDpw: ghsr. 5. Ape M1ap anna.vl wre Dan Hour MNMa 86 vrs. F 5 1925 Phi lade( id PA ^ 111 ^ ~+~t HleDSeo ~T ~ ^ Yr~ Rerawlu ~ R.o. a„»,;r,,, I„y,,, Bry, wine, em. . a. cat+r a ord. ec. cN. bore, T.n. d Drnl m. Fadry Name m mt irwouon, ve• w.a w mm~M jd yr, ,D„s, ,Wen. ~ its MatcrL Rlerlo nun, ale.) CtmlbPSland Allen 2 laurel Drive d rrAeona ncd w. Do ra etW 12. Wr oaoetlua aw m M 13. Dsrarn's EdarYOn (SpeaF/ oar Q•ae ornDlerd) 1t. Maew Srar: wrriad Nava write, 1S Surving Slbur m air. 9n'• ^~°^ ^•"I.1 • 11. oeeedre'e Ueuw U.S. Amrtl Fortin? NRaoae0. DFVard lsPadM Iwaw«E lwaarwrealerarer Eleroaaryrsemraen(o-1~ CdrBelt-t«s.l lint-tied 1 Wild Anal t Naval De t ^ Yr ®No 12 ~r oe~ya gdD.eaaera Allen ray, 16. lkretlerfe weerp Atlarer (Sues. cly / bwn, date, zipoode) PennSylvaIl].a ~oMrhg4 17c. ®Yr, oeeedea lived b , Rcerl Reeidrr:e t7e. Srr ~~~Y'_^~ ~.uuwc.~+lGau 17d. ^ ~ ~ ~~o grylB«o 2 laurel Drive ,7o.corar 1S. woewe Name (FYd, mdele.aWdn eurrr) 1A FNrfa Name (Fr4 middle, tort slat) Clara xrallt (1'1dr1eS A. Clark ~. mkrnlera'e M.l.v amw Isa••t ar / ben. der, zb ooda) 206. laanrh Nrre (Type I Print) W Cl k 21c. Placed Drpaitlotl (NrrdcwruMy,«rrabrY xaner Dlr•) 21d Lmeon loiry/IOan,eMA rip code) z1• MAre a l ^ Crsrrari ^ oonelon 21n Dine d D'mPoeBOn lam. der. Wr) c ~aaol ^ RemoWlmmSrr ~wrCnelrlorr«tbrrrbnAWrrUed McChanlCSb PA ~ ^ ~. ~ w „~„ Etrwrrlc«erra ^ vr^ No NOVember 8 2011 Gate of Heaven Ceme _~ r ~~ ~_ upYe,ya,m„ zx. Nrr erb Aadrar a FadMy 8 Market Plaza Way ~ m a PA 17055 3 _ ~ FD - 014889 Mal zzi F1u,eral Home Mechani ~ ow slurs ~, ~,, ~ rlyn 23e. omewddmy ,ermowmeadm.5na aldpruderdl~ ~~) ;~'~ a 3~ g 66 L .3.. a;d e! pgelcrnrnet wviWbdrrdaea b tray ralra a OeeIM1 2a wr Car Raanatl b wean E~rnrrr /coroner 1« a Reran Onur mr Clanraon « prraonT za. tint a Deem 2s. Ow Deed (wean, der. r+n ^ rr Ia"f+o 11enr 2426 nerd e. aanpbletl a D.rtan oZ 0 t Ma ~~ daW. : t ~ . M. ~ ~ 2B. OM Tabe¢o Use Cmedrr b Dedh7 AppodmW eaenrd: Pert ll: EMx odr cause of DEATH ls« m.woemne end etanpNe) ~ 13nsel b Drm an rid raeiAa'g b ms undedyer2 ~• 9w•^ ^ Pen 1. ^ Y~ a bin 27. Per( I: Errr lr - drrar, injur¢, or aonpfraa«a - tl11 d1dN rawea Ina aeon. DD Nor amer rmrrW eveNa euN r cardiac ene% mpl/+orr erred, a verNialer fCrXlLan •anat anowinp ma atidogy. lid adY oro sue on rW Wr. 1 ( 28. H Femur: ~py~IE CAUSE~erl alww« /', `L ' ~ GY'r ~~/+7tG1 Y''`fi i ~ t... ~~!"lh, 2 ^Nd DraTant'r~IN^WdYear card6on mdrg r m) _~ a. / / ~C ::Y /1"G'L ~ {•'' j~ -~tA S r Ci ~1 S i .~ ^ PnD^er1 et Arro d aeaN lM b la r a aairpurro M~ 1 ; Z y.~j,r~ ^ Na aw~~ ~ v~ waNn a aen ld mrrmar,lry, o a-~ rl h/C~~V•2 T'i2T ~twf ~L /rtcMT T- dman b ranee bled an 6r a o'ab (a r a wrue4u^~ aA~ t ^ Nor pegiant, ore pregiea u days a / Yrr l~ 1«IIO~rALY M~~ a ochedrm swat rsuiq n deYn) LAST. Duero (« r a cpreemurln M: ^ Unkroan Y gagred wlmn me Ird r••r tl. r 32c Pr« d mFtV Home. Farm. SbM, Facbry, 31. Miner d Daam 326. Ddb d Inyuy (. ~'. Y••d 3~. DBegro° How Injury Ocnrtea Olka BuMlq, eb. (SPea$') 306. Wr r Aubpe/ 30e. Was Aubpay Fin«ga Parforilletl'! AveWhr Prior m camprmn ~'wtea ^ Homicide 32g. lnudm d iiSxy (sues. dry / ben, er(e) a twee a 13rm7 3za. rime a Ireay axe. Ir{wy d wodn 3x1. n Tmrrapartlm riot (SVeaM ,., ~ ~,/ ^ Aodtlent ^ PeMnD ImMtllasoe ^ Yes ^ No ^ Drfuar/Dperdor ^ Paeeegx ^ Pedaeren ^ Yea I:dNO ^ Yee 11~J No ^ Suldde ^ Cwrw Nd W Dermrud w. Otlrr - swdM . Sprint aria rte Cantl6r ~ D2/ 39e. CartNsr (drd oay «~•) deem sM wrorra Irm xsl - /'A' 'y/ • CanHylq PM+~•^ IPnrdris^ uraHHtq «uae d deem vArn anoerr pdud•n Ire P aid. Der sera (Moan r. vrd To aMwlamy lmorral..arm oeeundermer cewys)ene mrewasarYe-----------'---"-'------'------- 33c L1wme Mnber 3 • pron«erc4q eM aeNP/Yg lmyderel~/dw^~Dmn^~'q dedn one awaMlgbowrddrml ~ s~ 1! .7 /1 ----- ~ To er ee.ea mr graerew~eernoa«raddnr dina,mr..ne Drn, rrddwmnr rawllem mrnrer asawe--------- ---- ~' wow EtrYnr/Cororw on tlr err a anm4rlbn aria 1 «lrcroedpdbn, m my oped«r, awn oaerrme etmla net, erA antl Pw•. ens ore a me uueN•I end ma«r r etarL ^ 3e. Name ria Ad«ara Paean W1r Comprte0 caws a Daum mein x71 TYDa ~ ~ 36.owFUeelMUeRdq,yaap iaEGFFREY M. JAMES, M.D. Ia I ! I ~ I.1 l~il c,k+' ~r ,fair , t:a_.... ~,..... cr,;.o ,n, ~ - Mechanicsburg, PA 17055 laNa 0693506 (717)591-0961 Last Will and Testament of Edward H. Clark I, Edward H. Clark, a resident of Mechanicsburg, Cumberland County, Pennsylvania, revoke any prior wills and codicils made by me and declare this 1:o be my Last Will and Testament. Article One Family Information I am married to Marydel W. Clark. We were married on October 8, 1566. Any reference in my will to my wife is to Marydel W. Clark. The members of my immediate family are: Name Relationship Date of Birth Michael Edward Clark Son September 10, 1968 Gabriele Mary Ortiz Daughter December 16, 1969 Annjanette Marie Clark Daughter August 30, 1971 Jeremy Paul Clark Son November 7, 1972 References in my will to "my children" are to the children listed above. References to "my descendants" are to my children and their descendants. p-.._'r `, ,.. /~, t"'-1 ~~` J (~~ ~Vl~ ~ '") ~ ~ -~, r-- 8 _., C.. ~~-y-1~ f` '~ ~ ._._ ~.~ ~ ~ Page 1 of 9 Although the following named individuals are not members of my immediate family, I have made provision for them in my estate plan: Name Relationship Joseph E. Pean Grandson Matthew G. Ortiz Grandson Isaac I. Ortiz Grandson Colin Michael Clark Grandson Article Two Distribution of My Property Section 2.01 Disposition of Tangible Personal Property I direct that my executor shall distribute my tangible personal possessions according to a separate "Personal Property Memorandum" or other similar writing, which shall be signed by me. It is my intent that such writing qualifies to distribute my tangible personal possessions under applicable state law. If such writing is not found at the time of my death, or ruled an improper disposition, this bequest shall lapse and my tangible personal possessions shall become part of my living trust. If any items of tangible personal property I happen to own are not mentioned in such list, such items shall become part of my living trust. If any such gift shall lapse, then such items shall become part of my living trust. Section 2.02 Pour-Over to My Living Trust All of my probate estate, excluding any property over which I might have a power of appointment, and after payment of expenses and taxes which are paid pursuant to this will, I give to the Trustee of the Edward H. Clark Living Trust dated December 19., 2002, and executed prior to this will, to be added to the property of that trust and disposed of in accordance with its terms and any amendments prior to my death. Section 2.03 Alternate Disposition If the trust referred to in the foregoing paragraph, which I specifically and completely incorporate in this will by reference, is not in effect at my death, or if' there is any other reason the pour-over cannot be accomplished, I direct my executor to establish a trust in accordance with the provisions of such trust. I give the remainder of my estate, excluding any property over which I might have a power of appointment, to the trustee of said trust. Page 2 of 9 Article Three Designation and Succession of Fiduciaries Section 3.01 Executor I nominate Marydel W. Clark as my executor. If Marydel W. Clark fails or ceases to act as my executor, I nominate Samuel M. Barbush, CPA as my successor executor. Article Four Powers of Fiduciaries Section 4.01 Grant My executor may perform every act reasonably necessary to administer my estate and any trust established under my will. Specifically, my executor may exercise the following powers: hold, retain, invest, reinvest, sell, and manage 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. My executor may partition, sell, exchange, grant, convey, deliver, assign, transfer, lease, option, mortgage, pledge, abandon, borrow, loan and contract. My executor may distribute the assets of may estate in cash or 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 allocations of the tax bases of such assets. My executor may hold in nominee form, continue businesses, carry out agreements, deal with itself, other fiduciaries and business organizations in which my executor may have an interest. It may establish reserves, release powers, and abandon, settle or contest claims. It 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 4.02 'Fiduciaries' Powers Act In addition to all of the above powers, my executor may exercise those powers set forth in the Pennsylvania Fiduciaries' Powers Act, as amended after the date of my will. I incorporate such Act as it exists today by reference and make it a part of my will. Page 3 of 9 Section 4.03 Distribution Alternatives My executor may make any payments under my will: • directly to the beneficiary; • in any form allowed by applicable state law for gifts or transfers to minors or persons under disability; • to the beneficiary's guardian or caregiver for the benefit of the beneficiary; or • by direct payment of the beneficiary's expenses. A receipt by the recipient for any such distribution, if such distribution is made in a manner consistent with the proper exercise of my fiduciaries' duties hereunder, shall fully discharge my fiduciaries. Article Five Administrative Provisions Section 5.01 Court Proceedings If any trust is established under my will that trust shall 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 shall be subject only to the jurisdiction of a court being invoked by the trustees or other interested parties or as otherwise provided by law. Section 5.02 No Bond I direct that no fiduciary shall be required to give any bond in any jurisdiction, and if, notwithstanding this direction, any bond is required by ary law, statute, or rule of court, no sureties be required. Section 5.03 Compensation Any fiduciary under this instrument shall be entitled to reasonable compensation commensurate with services actually performed and to be reimbursed for expenses properly incurred. Page 4 of 9 Section 5.04 Ancillary Fiduciary In the event ancillary administration shall be required or desired and rr~y domiciliary executor is unable or unwilling to act as an ancillary fiduciary, my domiciliary exectutor shall have the power to designate, compensate, and remove the ancillary fiduciary. The ancillary fiduciary may either be a natural person or a corporation. My domiciliary executor may cielegate to such ancillary fiduciary such powers granted to my original executor as my executor may deem proper, including the right to serve without bond or surety on bond. The net proceeds of the ancillary estate shall be paid over to the domiciliary executor. Article Six Tax Provisions Section 6.01 Death Taxes and Payment of Expenses The trustee of the trust referred to in this will is authorized to pay my funeral and burial expenses, claims against my estate, and expenses of estate administration. Accordingly, I direct my executor to consult with the trustee to determine the preferable source for payment of such amounts and which, if any, should be requested from the trust. I direct my executor to follow any instructions contained in the Edward H. Clark Living Trust in making any tax election, including, but not limited to, the allocation of my GST Exemption. I direct that the taxes imposed by reason of my death upon property passing under and outside my will be apportioned and paid in the manner provided in the Edward H. Clark Living Trust, and I incorporate the tax apportionment provisions of that the Edward H. Clark Living Trust as part of my will. In no event shall any of such taxes be allocated to or paid from property which 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 executor may exercise any available elections under any applicable income, inheritance, estate, succession, or gift tax law. This authority specifically includes the power to select any alternate valuation date for death tax purposes and the power to determine whether any or all of the administration expenses of my estate are to be used as estate tax deductions or as income tax deductions, and no compensating adjustments need be made between income and principal as a result of such determinations unless my executor shall determine otherwise, in the discretion of my executor, or unless required by law. Page 5 of 9 My executor, 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"). However, such taxes shall not be apportioned to any property included in my gross estate under Section 2044 of the Internal Revenue Code, to the extent my Trustee or my executor waives any right of recovery granted by Section 2207A and corresponding provisions of applicable state law. My executor shall not be liable to any beneficiary of my estate for tax consequences occasioned by reason of the exercise or non-exercise of any such elections or by reason of the allocation and distribution of property in kind in full or partial satisfaction of any be;neficiary's interest in my estate. Article Seven General Provisions Section 7.01 Adopted and Afterborn Children If a child is adopted by any person by legal proceeding while the child is under the age of 18, that child shall be considered the child of such adopting person for all purposes under my will. A child conceived before a person's death but born thereafter shall be considered a child of that person if the child lives sixty days or more after birth. Section 7.02 Applicable Law The validity and construction of my will shall be determined by the laws of Pennsylvania. Sec#ion 7.03 !Vo Contract to Make Will I have not entered into any contract, actual or implied, to make a will. Section 7.04 Contest Provision If, after receiving a copy of this paragraph, any person shall in any manner, directly or indirectly, attempt to contest or oppose the validity of my will or my living trust, including any amendments thereto, or commences, continues or prosecutes any legal proceedings to set this agreement aside, Page 6 of 9 then such person shall forfeit his or her share, cease to have any right or interest in the trust property, and shall for the purposes of this agreement be deemed to havE; predeceased me. This Section shall not apply so as to cause a forfeiture of any distribution otherwise qualifying for the federal estate tax charitable or marital deduction. Section 7.05 Construction Unless the context requires otherwise, words denoting the singular may be construed as denoting the plural. Words of the plural may be construed as denoting the singular. Words of one gender may be construed as denoting another gender, if appropriate. Section 7.06 Headings and Titles The headings and paragraph titles are for reference only. Section 7.07 Internal Revenue Code, IRC or Code References to the Internal Revenue Code, the IRC or the Code shall rei-er to the Internal Revenue Code of the United States. References to specific sections of the Code shall be to any sections of like or similar import that replace the specific sections as a result of changes to the Internal Revenue Code made after the date of my will. Section 7.08 Other Definitions Except as otherwise provided in my will, terms shall be as defined in the Pennsylvania Probate Code as amended after the date of my will and after my death. Section 7.09 Survivorship For purposes of this will, if my wife in fact survives me by any period of time or if the order of our deaths is nat known, then my wife shall be deemed to have survived me. Any other beneficiary shall be deemed to have predeceased me if such beneficiary dies within 30 days after the date of my death. Page 7 of 9 Section 7.10 Severability If any part of this instrument shall be adjudicated to be void or invalid, the remaining provisions not specifically so adjudicated shall remain in full force and effect. I, Edward H. Clark, having signed this Will in the presence of _ ~ and ~jC,I~CaX1 ~ . L,e~.y(~P.Ir who attested it at my request on this day,, Dece ber 19, 2002 at Harrisburg, Pennsylvania, declare this to be my Last Will and Testament. Edward H. Clark, Testator Signed, sealed, published and declared by EDWARD H. CLARK, the testator above named, as and for his Last Will and Testament, in our presence, and we in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses: Witnesses: Witness Address: .~~ ~ r~~ irc `!~A ~~~~o Witness Page 8 of 9 SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF DAUPHIN ) We, EDWARD H. CLARK, ~ Vt ee and s~~~~~ ~, ~ 2d2,relr , the t stator and the witnesses, respectiively, whose names are subscribed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as witness and that to the best of each such witness's knowledge the testator was at that time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. EDWARD H. CLARK Witness ~`- ~ Witness Subscribed, sworn to and acknowledged before me by EDWARD H. CLARK, the testator, and subscribed and sworn to before me by T eed and ~, L~Q~( 2.~ witn~this 19`'' day of December, 2002. uSC~x~ , Notary Notarial Seal Mind S. Beaver„ Pu(bbliocoty My Com~mi~on~F.x~c~ea~~18. 2006 Page 9 of 9