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HomeMy WebLinkAbout03-12-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF ~! /Y! ~~ ~~~ COUNTY, PENNSYLVANIA Petitioner{sj named below, who isiare 13 ;;ears of aQe or older, apply(ies) for Letters as specitled below. and in support thereof aver(s) the following and respectfully recuest(s) the grant of Letters in the appropriate form: Decedent's Information Name: ~ (~' /{' LLLLE y a/k/a: (Assigned by Register) a/lda: Date of Death: ~ Social Security No: _ ~Q - ~(~ - (~' ~~ Age at death: _ /~ ~ Decedent was domiciled at death in 1 r f}~ County, principal residence at t ~ (ware) with his/her last ~ ~ ?i Street address, Post Office and Zip Code City, Township or Borough Count Decedent died at C°7/p j~11fC,(111>~.~y /~/j ~y ~+~ n y Street address Post Office and Ztp Code Ctty, Townshtp or Borough Count Estimate of value of decedent's property at death: Y State If domiciled in Pennsylvania ............................ All personal property $ ~ '; t G' Ijnot domiciled in Penttsy!vania ........................ Personal property in Pennsylvania $ If nor domiciled in Pettnsylrania ........................ Personal property in County $ Value ojreal estate in Pennsylvania ........................... . • $ C TOTAL ESTIMATED VALUE.... $ ~„ p~ Real estate in Pennsylvania situated at: ~ ~/D f j ~~~~{-jyJ ~ ~~ ~~ L~ ~ , ~~~~ (Attach additional sheets, if necessary.) Street address, Post Office and Ztp Code Ctty, Township or Borough ~,, ~ ~ Count A. Petition for Probate and Grant of Letters Testamentar Petitioner(s) aver(s) he/she/they is/are the Executor(s) Warned in die last Will of the Decedent, dated /~ VEYlj _ 2 / thereto dated ~ ~ahd Codicil(s) 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(g), 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. Petition for Grant of Letters of Administration (If applicable) c.t.u., d.b.n., d. b. n.c.t.a., pendente life, durante absentia, durante minoritute If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and com lete list of heirs Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce } ~pegn establisfi~ as de ~, in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ ~j =~ ~- ^NO EXCEPTIONS ^ EXCEPTIONS ' ~ ~ ~ ~ , ~~ ~? Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the followings anY ^~ r ~ additional sheets,i/necessary): ~~Y) a~eirs(att~~h --. 4y.: -n .r=-; %=ri Form 2GV-0_7 r-ev. l0/11/10!1 Page I of 2 uc ,-e::u,oner(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 Decede t, the Petitioner(s) will well and truly administer the estate according to I w. Sworn to or affirmed and subscribed before ~ ~ ~ met ~ ~~` day of ~ ~~ /~- Date ~ /~,Z ~D ~~- By: ~'` ~ a ~, ~ Date i ' ~-~ ~'~ Date For the .2egister ~ / Date BOND Required: ~ YES ~,Af6 FEES: Letters ........ ~~ ( U )Short Certificate(s)...... $--i d~ ( )Renunciation(s)........ . ( )Codicil(s) ............. --- ( )Affidavit(s)........... . Bond ............... Commission ................. . Other ...... ~-:3,~y Automation Fee .............. . JCS Fee . .. .................. TOTAL ..................... $ ~ SL To tl:e Register of Wills: Please enter my appearance by my signature hn~nw• Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phone: Fax: Email: C7 __ rti F~.g t7 ~1:- ~ ~ .;~~ M1 t ~ L, T -+ r -- ~ ~ C.~~ DECREE OF THE REGISTER Estateof!~~4~~1~~1~ ~ ~~ ~ ~~~\f File No: :~~-/,~ ~'~ a/k/a: ~ .~~~~ AND NOW, ~ _~~ ~~ ~~ ~'~,~'~ ,~-~~ /,~ in consideration of the foregoing Petition, satisfactory proof havtng been presented before me, IT IS ECREED that Letters ~ i 'i are hereby granted to (, ~ i ~~~ the instrument(s) dated jVe ~ in the ove estate and (if apppicable) that described in the Petition be admitted to probate a d filed of record as the last Will (and Codicil(s)) of Decedent. ,~. ~~ ~~1- ~ ~` ~ C ~' .-, , r Register of Wills ~ ~ ~ ~ I ~ ~ c ; - (.-, ~ ~ ~~l ~ ~ r`~__ Form RW-0? rev. !0/l1/2011 t " 1 ~~ Page. 2 of 2 Oath of Personal Representative Official Use Only CO~I~IONWEALTH OF PENNSYLVANIA } t } SS: COUVTY OF ~ ~.~ ~'~ ~,~/I C~,~~LC~ t WAR G~,~ It is ~all~eg~L ~ dupp~~~~e ~f7i~ ~;cs~y ~y phatrsst~# ~a~. ~~, ?- }~i?e ~<)) ins, ~t~rt ~ is i >~ ~b.t)!"! (~ {" ~~R ~ ~ ~~ ~ ~ ~i.j ..rL( - i 1 i~,i- )'~ a, - ~~+ ~ ~ ~y~ 7 L(! I CLERK rJ~ ~~ ~ 'I), :.; i , r I ORPHA:N'S COURT ~ ~ ~ ~ ~ ~ (I ~ : I ~ ... - - ~ _ 1 X31. ~ 0 5 6.2 ___ ~'~-~ . ~~~~' ~ . 1~~ - ----- ~ ~, ~}.I ~:°I[1fIt,.1:;011 ~c1EI]bCl •-`~~~5) ° - ~ L ~;'~~~L ~ - t(j _); i,a TYPe/Prl of In ~ - Permanent COMMONWEALTH OF PEN NSVLVANIA . DEPARTMENT OF HEALTH .VITAL RECORDS Black ink CERTIFICATE OF DEATH 1. Decedent's Legal Name (First, Middle, Last, Suffix) State Fii¢ Number: Debbie A. Clllle 2. Sex 3. 6o<lal Security Number 4. Date of Death (MO/Des /Yr 5 sa. A 200-,56-0118 y ) ( Pell Mq> ge-Last Birthday (Yrs) 56. Under 1 Year sp. under 1 Da February 19 ~ 2012 Months Da 6. Date of Birth (MO/Day/Yea r) (Spell Month) 7 'r[hplA (~i d State or E4reign Country) 48 Ys Hours Minuses LVEW Y5r1 ).7t OL] ~ 1'A Sa. Residence (state qr Fgrel January 6 0 1964 76. Birthplace (GOLIn gn Country) 8b. Residence (Street and Number- Include A t N N) Beaver Penns lvania p .> ac. Did Decedent u..e In a rownsh;p? 8d. Residence (cp„n[y) 1710 Wyndham Rd. [fives, decedent eyed in Lowc=r Allen Cumberland ae. Residence (Zip Code) 1 Oll twp. 9. Ever in US Armed Forces? 1 vital Status at Time of Death ~ No, tlecetlent lived within limits of ~ Yes ~ No ~ Unknown $~Oiyorced 0 Married 0 Widowed 11. Surviving Spouse's Name (If wife, given city/born. 12. Father's Name (First, Middle, Last, Suffix) ~ Never Married Q Unknow ame prior to first marriage) BrOOLCS Mlle 13. Mother's Name Prior to First Marriage (First, Middle, Last) 14a. Informant's Nam¢ Karen Gable Karen CLllle 146. Relationship t° Decedent 14c. Informant's Maiiin Address (Street and Number, Ci ° Mother G ......................................... lsa. P awe o Deat c Wes s If Death Occurred in a Hospital: L"('j~ -'--' ""'-'•••"'•---•••---•---------- t Sherl.da w, Castle a ...._......r.-- )-----... - New 'cPPA 1610 Parent --'°O -.........g -°-----...... . If Death Occurred Somewherec0[herThan a Hospi{alp".n AVe ~ o Emer -' ......... ................ __ gency Room/Outpatient 0 Dead on Arrival t_I Hos ---'""--' -"'A++~ p Nursin Home/Long-Term Care Facility Other S pace Facility '3Y •ecedent's Home ~~~~~~ 16b. Facility Name (I~f nLot~In~stitution, give street and number; Q ( pecify) 1710 Tl~.. aeaJlf • 15 c. City or Town, State, d Zip Code Rd. Cam Hill PA 17011 lsd. cp„nty of Death 16a. Method of Disposition 0 Burial ~~~~~rr-- matlon 16b. Date of Disposition 16c. Place of Dis Cua)ber land ~,-( e° ~ Removal from State ~ Donatlon~_fe position (Name of cemetery, cremato !€ Other (Specify) ry, or other place) 16d. Location of Dis 02/21/2012 Hollin er Cremator c position (City or Town, State, and 21p) 17a. SI atu re of Funera e Licensee or 4 Mt . Holly Springs , PA 17065 Cha ge of Interment 1]b. ucense Number c 17c. Name and Complet¢ Address of Funeral Facility ^ n 014819 ers-Harney Ehneral Home Inc. 1903 Market St. Cam - ~ 18. Decedent's Education -Check the box that best describes She 19. Decedent of His H111 PA 17011 highest degree or level of school completed at the time of death. box that best describesiwh0ether the de edent thDe decedent co sidered h mOself or herOSelf to be. 8th grade or less o indicate what Q No diploma, 9th - 12th gratle Is Spanish/Hispanic/Latino. Check the "NO" ~ White t High school graduate or GED completed box if decedent is not Spanish/Hispanic/Latinp. 0 Black or African American ~ Korean Q Some college credit, but no de ~N°• ^ot Spanish/H(spanic/Latino 0 American Indian or Alaska Native ~ Vietnamese Q Associate de gfee Yes, Mexican, Mexican American, Chicano O Other Asian gree (eg, qq, A6) ~ Yes, Puerto Rican ~ Asian Indian Q Native Hawaiian [][Bachelor's tlegreee( .g. BA, AH, BS) 0 Ves, Cuban ~ Chinese Q Guamanian or Chamorro ~ Master's degree ( .g. MA, MS, MEng, MEd, MS W, MBA) ~ Filipino O O Doctorate O Yes, other Spanish/Hispanic/Latino ~ Japanese Samoan (e.g. PhD, Ed D) or Professional degree (Specify) ~ Other Pacific Islander - MD DDS DVM LLB JD O Other (Specify) 21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the Decedent co nsitlered himself or herself to be. 22a. Decedent's Usual Occu White ~ Japanese ~ Samoan Black or African Amer(can 0 Korean tlone Burin gation -Indicate type of work u~ Q American Indian or Alaska Native 0 Vietnamese ~ Other Pacific Islander g most of workin life. DO NOT USE RETIRED. _ ~ Asian Intlian ~ Other Asian ~ Don't Know/N O[ Sure Labor Mediator Q Chinese Q Native Hawaiian ~ Refused 226. Kind of Business/Industry Q Filipino 0 Gua manien or Chamorro ~ Other (Specl(y) ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronouncetl Dead (MO Day Yr) 23 . 51 BV PERSON WHO PRONOUNCES OR y'~ gnatu re of Person Pronouncing Death (Only when applicable) 23c. License Number CERTIFIES DEATH /- G d y~w.ca~- ' ~ /'~ 23d. Dat Signed (MO/Day/V r) 24. T(me f Death L- "~® i ~C ~Y/Q tY ~o ~ ~,• C8 26. Was edical Examiner or Coroner Contacted? R^~~~5/St7 CAUSE OF DEATH ~ Yes O No 26. Part 1. Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal a errs such a ardiac arrest respiratory arrest, or ventricular fib rlilation without showing She etiolo v s c - Approximate gy. DO NOT ABBREVIATE. Enter only One cause on a line. Add additional lines if recesses Interval: _______________> a. IMMEDIATE CAUSE ~1'r.Y~J"ri't,Tj` ~ nt~ ~r ~ ry Onset to Death (Final disease or condition D t ( l r~ resulting in death) q ence of). - b. Sequentially Ilst conditions, Due to 0 if any, leading to the cause ( r as a consequence of): listed on line a. Enter the UNDERLYING CAVSE (disease or injury that Oue ip (or as a consequence of): initiated the events resulting d. to tleath) LAST. Due to (p as a consequence of): - 0 26. Part 11. Enter other sgificant c dtSi t ib it d th but not resulting in the under) - ying cause given In Part I 27. Was an a ~ ~ Ves opsy pert ed? ~ 28. Were autops No Y findings available w 29. If Female: to complete the cause of deathT c Q Not pregnant within past 30. Did Tobacco Use Contribute to Death? 31. Ma ~ Ves Q No 0 Pregnant at time of deathyear 0 Ves ~ Probe biy I'p/{.ly~~~~'~~ of Death Not pre ~ Unknown - ai 'a ~ pregnant, but grant within 42 days of death No ~ Accident ~ Homicide i- ~ Not pregnant, but pregnant 43 days to 1 year before death O Suicide O Pentlin'gotnvestigation ~ Unknown if pregnant within the past year 32. Date of Injury (MO/Day/Yr) (Spell Month) ~ ~ Could be tletermined - - •- ~ •--~__~ =..a, ~.umo ,City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: ~ Yes 0 Passers Operator 0 Pedestrian 38. Describe How Injury Occurred: No Q ger Q Other 5 ( pecify) 39a. rtifier (Check only one): Certifying physician - To the best of my knowledge, death occurred due io the Pronou nctng Sa Certifying physician - To the best of my knowled cause(s) and manner statetl Q Medical Examiner/Coroner - O t ge, death occurred at the time, date, and place, antl due to the cause(s) antl m r stated sis of examination, and/or investigation, In my opinion, death o tl t the time, date, and place, and tlue to the c Signafu re of certifier: <c ~e ~ se(s) and m rated 396. Name, Atldress and Zip Code o Person Completing Cause of Death (Item 26) Titles of certifier:_ l_ ~ License Number: ' ~nn 2 J ~ 39c. Date Signed /Mo Oa /V r) 4D. Registrar's District Number r41. Registrar's ature Gn- Ir ~?~ ~+~~ •.o ~~ / _. ~ / / ~ 42. Registrar File Date (Mo/Oay/Vr) 43. Amendments rJ /~ O /_7 G / Z Disposition Permit No. 0670884 H1O5-ides WILL OF DEBBIE A. CULLEY I, DEBBIE A. CULLEY, of Cumberland County, Pennsylvania Last Will h b ki , make this my, , , ere y revo ng any and all former Wills or Codicils made by me. C? - ' ~ - -.~ ~,- ~ ._ ~ , -~~, ARTICLE ONE r 7 ~ r~~ ~ ~= - .~ :~ . Payment of Last Exaenses ~. ~ t ,., `- ~ `' -~- :~-~ ~-pry _ I direct my Personal Representative to pay the expenses of my last illness and m~ . ~~l funeral expenses as soon as may be convenient after my death. , ARTICLE TWO Tangible Personal Proaerty I give my automobiles, household and personal effects, and other tangible personal property of like nature (not including cash or securities), together with any existing insurance thereon, as I may have provided in a memorandum kept with the original of this Will, or to the extent not so provided, to my mother, KAREN C. CULLEY, provided she is living on the thirty-first (31S`) day after my death. Any such property not so distributed shall be sold and the proceeds added to my residuary estate and pass under Article Three hereof. ARTICLE THREE Residue Section 1. I give all the residue of my estate remaining after application of Article Two to my mother, KAREN C. CULLEY, provided she survives me by thirty (30) days. If KAREN C. CULLEY does not survive me by thirty (30) days, I give all the residue of my estate to my brother, SCOTT B. CULLEY. Section 2. Ultimate Distribution of Certain Reversions. In the event that any portion of my residue originally distributed by Section 1 of this Article Three reverts to my estate, then such assets should be distributed to such persons who would have been entitled thereto if I had died at that time intestate, unmarried, without children surviving, and domiciled in the Commonwealth of Pennsylvania. ~~oab~ob~.i} ARTICLE FOUR Personal Representative I appoint my mother, KAREN C. CULLEY, as my Personal Representative under this Will. My said Personal Representative, or any successor Personal Representative, shall have the authority, in his or her sole discretion, to appoint another individual or bank as an additional or successor Personal Representative, or to renounce his or her appointment in favor of another individual or a bank. If my above-named Personal Representative is unable or unwilling to act or to continue to act as my Personal Representative under this Will, I appoint my brother, SCOTT B. CULLEY, as successor Personal Representative. In addition to the powers conferred by law, my Personal Representative shall have the following discretionary powers, exercisable without the need to obtain court approval: Section 1. Power to Retain Assets. To retain as part of my estate any property received hereunder, without any duty of diversification. Section 2. Power to Invest. To invest and reinvest the principal of my estate in such stocks, bonds, mortgages, securities or other property, real or personal, without being limited to the classes of securities or investments in which fiduciaries are by law authorized to invest funds. Section 3. Power to Deal With Assets. To sell, exchange, lease, encumber, option or otherwise dispose of all or any portion of my estate, real or personal in such manner and upon such terms and conditions as are deemed advisable, and to make, execute and deliver any documents necessary to effectuate any powers herein granted. Section 4. Tax Powers. In connection with the making and filing of all income tax, estate, inheritance and other death tax, gift tax and other tax returns and the paying of such taxes, to make such elections, decisions, concessions and settlements, including extensions of time for the payment of any Federal estate taxes or other taxes due, as may be deemed proper, without liability to any person thereby affected, and without the necessity of making compensating adjustments. Section 5. Power to Distribute in Kind. To make distributions of my estate in cash, in kind, or partly in cash and partly in kind; and to make non-pro rata distributions in kind without consideration of the income tax basis of the assets distributed. Section 6. Advance Distributions. To make advance distributions in an estimated amount to fund the respective Trusts established under my Revocable Trust. Section 7. Allocation of Generation-Skip ink Exem tion. I expressly authorize my Personal Representative to allocate, pursuant to Section 2631(a) of the Internal Revenue Code of 1986, as amended, any unused Federal generation-skipping transfer tax exemption which may be available as of the date of my death to any property with respect to -2- which I am the transferor for generation-skipping tax purposes, whether or not such property passes under this Will or otherwise and whether or not such property was transferred during my lifetime or by reason of my death; provided, however, that it is my desire, but not my direction, that my Personal Representative allocate said exemption in the following order of priority: (a) to all direct skips other than any direct skips resulting from a disclaimer; and (b) to property distributed to the Family Trust established under Article Three of my Revocable Trust, unless my Personal Representative shall determine otherwise for good reason. My Personal Representative also shall be authorized to exclude any property with respect to which I am the transferor from any such allocation of such exemption. My Personal Representative shall be authorized to make any election relating to the allocation of such exemption. Any such allocation or election made by my Personal Representative shall be made without the necessity of obtaining court approval and shall be binding on the transferee of any inter vivos generation- skipping transfer I may have made and on all persons interested in my estate or in any trust established or to be established therefrom. Any good faith exercise, partial exercise or failure to exercise the authority granted to my Personal Representative hereunder shall not be subject to complaint or appeal by any party, and I hereby indemnify my Personal Representative against any and all such claims and costs (including attorneys' fees) associated therewith. Section 8. Business Powers. My Personal Representative may carry on any business owned and operated by me or my estate as a sole proprietorship or any business conducted by a limited or general partnership of which I or my estate was a partner for whatever period of time my Personal Representative may deem advisable, and to that end my Personal Representative shall have the power to do any and all things deemed necessary or appropriate, including the power to pay any negative cash flow, the power to incorporate any such business or hold the stock as an investment, the power to borrow and pledge assets held in trust as security for such borrowing, the power to liquidate or sell any such business or such interests therein at public or private sale and at such times and upon such terms as my Personal Representative deems advisable, and the power to employ agents to manage and operate such business without liability for the actions of any such agents, or for any loss, liability, or indebtedness of such business, if the management is selected or retained with reasonable care. Section 9. Real Estate and Proceeds. I do not wish to have the value of my estate reduced by the forced sale of any real estate which I may own at my death. I therefore authorize my Personal Representative to retain such real estate until such time as it can be sold for its fair market value and, if necessary in order to provide funds for the payment of any debts, expenses, estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death, I authorize my Personal Representative to borrow money and for that purpose to mortgage any such real estate and to execute and deliver all notes, bonds, mortgages, and other instruments and to perform all acts necessary, proper or convenient in connection therewith, any and all such loans and mortgages to be made in the sole discretion of my Personal Representative and for such amounts and upon such terms as my Personal Representative deems proper. I authorize my Personal Representative, without the necessity of petitioning any court for approval or confirmation, to sell at any time all or part of the real estate in my residuary estate to any one or more of my children or their issue for such price and upon such terms and conditions as all of my surviving children may agree. -3- ARTICLE FIVE Waiver of Bond I direct that no Personal Representative or any other fiduciary named hereunder shall be required to give bond for the faithful performance of duty in any jurisdiction. ARTICLE SIX Source of Payment of Debts Expenses and Taxes All estate taxes, inheritance taxes, transfer taxes and other taxes of similar nature, together with any interest and penalties thereon, payable by reason of my death upon the property constituting my gross estate for death tax purposes, whether or not such property passes under this Will, and all debts, costs of administration and other proper expenses, paid by my Personal Representative shall, except to the extent paid by my Trustees, be paid from the principal of my residuary estate passing under Article Three, without reimbursement from or apportionment among the legatees or devisees or persons having a beneficial interest in any such property. Assets sold by my Personal Representative to make payments hereunder shall be selected, to the extent advisable, so as to minimize the recognition by my estate of gain for income tax purposes. My Personal Representative may enter into such agreement to pay all or any part of the death taxes on any future interest as may be deemed appropriate, and such agreement shall be binding upon all parties in interest. ARTICLE SEVEN Interpretation of Will Section 1. Singular and Plural• Use of Gender. Whenever used herein, the singular shall include the plural, the plural the singular and the use of any gender shall be applicable to all genders. Section 2. Definition of Child Children or Issue. Whenever the terms "child," "children" and "issue" are used herein, such terms shall be interpreted to include adopted children, regardless of the date of adoption, with full effect as if they were the natural children of the adopting parents. Such terms are also intended to include persons in gestation at any pertinent time under this Will, provided such persons survive birth by thirty (30) days. Section 3. Captions. The captions of articles and sections of this Will are for convenience of reference only and shall not affect the interpretation of this Will. -4- Section 4. Governing Law. I hereby declare that I am a domiciliary of the Commonwealth of Pennsylvania and that the succession laws and other applicable laws of the Commonwealth of Pennsylvania shall control the interpretation of this Will and the ownership of any other property passing at the time of my death other than under this Will, and that no succession laws of any other nation or state shall have any applicability to this Will or the ownership of any other property passing at the time of my death other than under this Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal to the original of this Will only this 1 sc day of November, 2011. /~ Witness AL) _~~.~~ ~_ Wit ess ~~ ~ -~ D BBIE A. CULLEY Signed, sealed, published and declared by the above-named DEBBIE A. CULLEY, as and for said person's Will in the presence of us and each of us, who, at said person's request, in said person's presence and in the presence of each other, have hereunto subscribed our names as witn sses thereto the day and year last above written. /~ ~ Residing at Harrisburg Pennsylvania r ~ ~ Residing at Harrisburg Pennsylvania -5- ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF DAUPHIN ) SS: We, DEBBIE A. CULLEY, Thomas P. Gacki, and Kelley M. O'Brien, the Maker of this Will and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Maker signed and executed the instrument as the Maker's Last Will and that the Maker signed willingly, and that the Maker executed it as the Maker's free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Maker, signed the Will as witnesses and that to the best of their knowledge the Maker was at that time teen ye of a or older, of sound mind and under no constraint or undue influence. r ~ ~ ,. Witness DE IE A. CULLEY d ' C SUBSCRIBED, sworn to and acknowledged before me by DEBBIE A. CULLEY, the Maker, and subscribed and sworn to before me by Thomas P. Gacki, and Kelley M .O'Brien, witnesses, this ls` day of November, 2011. k ~~ ~ - Ca~~~a ~ No P lic My Commission Expires: COMMONWEALTH OF PENNSYLVANIA Notarial Seal Judy M. Cadenhead, Notary Public City of Harrisburg, Rauphin County My Commission Expires June 18, 2013 Member, Pennsylvania Association of Notaries -6-