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Home My WebLink About03-21-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters 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 Name: PollyKrallMiller File No: 21- t--~ C'--=;~~~~~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 208-24-0296 Date of Death: 2/4/12 Age at death: 80 Decedent was domiciled at death in Cumberland County, PA (State) with his/her last principal residence at 770 S. Hanover Steet 17013 Carlisle Borough Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 770 S. Hanover Street 17013 Carlisle Borou~lt Cumberlnad PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ................................All personal property $ 40,000.00 If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $ Ifnot domiciled in Pennsylvania .............................Personal property in County $ Value of real estate in Pennsylvania .............................................................. $ TOTAL ESTIMATED VALUE.... $ __ 40,000.00 Real estate in Pennsylvania situated at: (Attach additional sheets, ifneces.cary.) Street address, Post Office and Zip Code City, Township or Borough County ® A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/aze the Executor(s) named in the last Will of the Decedent, dated 1 1/15/06 _ and Codicil(s) thereto dated None Douglas Paul Miller has renounced his right to serve as Executor State relevant circumstances (e.g, renunciation, death of executor, 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. a., d.b.n., d. b. n. c. t. a., pendente lite, durante absentia, durante minoritate If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and comtolete list of heirs Except as follows: Decedent 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 was neither the victim of a killing nor ever adjudicated an incapacitated person. ^ NO EXCEPTIONS ^ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationship Address ~ ,...~ c:a ~-- i ~~ :y ~ C~~ 'T~') Z,] - `J `_ - .._ ~ Form RW-O2 rev. 10/!1/2011 °~Page ] of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS. COUNTY OF CUMBERLAND } Use Only ~- `~t~t l~h ;; ~ ett -.4.~J Official ,, ~ .. Petitioner(s) Printed Name Petitioner(s) Printed Address Susan Miller Wimer 5 East Oakwood Drive Carlisle ORPF~;'~~~'S ~~~IT7015 ,., ,~~.••ul ~,. 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 according to law. Sworn to~~°~ affirmed and su r' d before ,~ Date 3 °~~ ~ ~" me t t ~~_ day of 1 ~- i ~T V' ~ 1 ~ ~' ~~ :~ ~~ ~~ Late B : ~- - ~ L>ate or the Register Late BOND Required: ^ YES ®NO To the Register ojWills: FEES: Please enter my appearance by my signature below: Letters ....................... $ "l~? (~~\~ ( ~~ )Short Certificates(s) ...... ~I ~ ~ ~%~~ ( 1 )Renunciation(s) .......... `~~ ~ ( )Codicil(s) ............. . ( )Affidavit(s) ............ . Bond ......................... Commission ................... . Other ~.l t L ~ ......... 1 ~ - ~~ Automation Fee ................ . JCS Fee ....................... TOTAL ......................$ ,__~j-LU ~3 ~L Attorney Signature: C~~ s. Printed Name: Christopher E. Rice Supreme Court ID Number: 90916 Firm Name: Martson Law Offices Address: 10 East High Street Carlisle PA 17013 Phone: (717) 243-3341 _ Fax: (717) 243-1850 _ Email: crice~a martsonlaw.com _ DECREE OF THE REGISTER Estate of Polly Krall Miller File No: 21- 1 =~ - ~~ :j-?. ~~ a/k/a: AND NOW, i`-~ ~, `` C ~ - ~ ~ C! , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Susan Miller Wimer _ in the above estate and (if applicable) that the instrument(s) dated 11/15/06 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills ~ Fnrm RW-02 rev. 10/]];70]1 a .~ I ~r ;.- ~ ,;t~ i c RENUNCIATION ~~~~ ~~ ORPHr1~1'S' rp{~Rr REGISTER OF WILLS Cl1I~RF-~F~ ,~;r,`~fr r^~} PA C~r,~.~rsffic.,..l~ COUNTY, PENNSYLVANIA Estate of _ ~ ~ "~ ~'` ' `"=2 ,Deceased in my capacity/relationship as (Print Name) S® of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and resp~ecltfully request that Letters be issued to ru f a,n/ /L1 r tip.: ~ V V t ,~+^~ z/a)~Z piZ_ ` (Dare) '~ (Signature) '1t ez r`'Yt-.mot-n/!c~ ./ .~vi'c (Street Address) Executed in Register's Office Sworn to or affirmed and subscribed before this I' day ~~~~ , ~~ ' ~.. C ~~--~ D puty or R ister of Wills (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the. party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of ,_ Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date ofexpiration ofNotary's Commission.) Form RW-06 rev. 10.13.06 HlO5.R05 RP.v (911 i LOC ~ ,~~~~ 'S CERTIFICATION OF DE~-T~! . ~.j. ~{ WAR I j.,l~~~. iCi; T7~ uplicate this copy by photostat or photographs. Fee for this certificate, $6.00 '.1;i2 ~~R ~ ~ ~~ 2; (~ this is tcl certify ;h:)t t},c information 1)ere +,i~(~n is correctl~~ copied I`r(rm an uri~inal Certificate of Death duly filcd ~~~ith mL.:J5 i octl Re~istr~>r `Cite arJ,inal C~RK 0~ L~ertificalrr ~a~ill hl ~~rn~~.(nded to the State Vital ~p~i5 G~~RT Records Office lo( E~ermanent tiling. a~M~~~a ~r~ co , pA P 18 210 8 8-~ --- ~-~ _c~,~ .~ ~ ~~, 2 012'. -=-~------- --- F _ ~---- Certification Number ~ - Lncal Re~ititra)~ Date Iticu~d Type/Print In COMMONWEALTH OF PENNSYLVANIA _ DEPARTMENT OF HEALTH _ VITAL RECORDS Permanent J 1. Decedent's Legal Name (First, Middle, Last, Sufflx) va ~ ^ State Flle Number: 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) Poll K. Miller F _ Sa. Age-Last Birthday (Vrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a Birth l ' . p ace (City and State or Foreign Country) 80 Months Days Hours Minutes Dec 31 , 1931 ?b. Birthplace (County) 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No ) Bc Did D d . . ece ent Live in a Township? Sd. Residence (COUnty) 700 South Hanover St _ ~ Ves, decedent lived In twp Cumberland 8e. Residence (Zip Code) No, decedent lived within Ilmits of Car11s1e city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death ~ Married Widowed 11 Su rvlyin S ' . g pouse s Name (If wife, give name prior to first marriage) Q Yes S] No Q Unknown ~ Divorced Q Never Married Q Unknow 12. Father's Name (First, Middle, Last, Suffix) ' 13. Mother s Name Prior fp Firzf Marrlag¢ (First, Middle, last) Roy L_ Kra11 Elizabeth R_ Ressler Kral1 14a Informant's Na . me 14b. Relationship to Decedent 14c. Informant's Malling Address (Street and Number, City State Zip Code) Susan Wimer ~ G , , dau bier 5 East Oakwood Dr_~ Carlisle PA 17015 ............. c ............................................. ...... ..............................,...p......a P .. -. ace o eat ,_, .____ _. ec on Y One If Death Occurred in a Hospital: '~ Inpatient .... If e ch O ` ~~~~ ' ; ........... ......... a ......................... ccurred Somewhere Other Thah a Hospital ~ Hospice Facility ~ Decedent's Home Q Emergency Room/OUtpatlent 0 Dead on Arr(val Nursing Home/Lon -Term Car F ili u+ g e ac ty Other 5 Cit ( pecifY) 15 b. Facility Name (If naf institution, give street and number; lSC y or Town State d 21 . , , an p Code 15d. County of Death Cha 1 Pointe at Carlisle C li a 1 P 16a. Method of Disposition 0 Burial [.Cremation S6b. Date of pispositlon 16c. Place of Disposition (Name of cemete cr mat p Rempyal fr st h ¢ ry, ory, or ot pm er place) ate p Dpnaugn Feb 7 , 2012 Ho££man-Roth Other (Specify) F uneral Homo & Crematory 16d Location of Dis iti 2 . pos on (City or Town, State, and Zip) 1?a. 51 of Fu Clc r Person in Char e f I t ~ ~' g o n erment 176. License Number Carlisle, PA 17013 138504 E 1?c. Name and Complete Address of Funeral Facility s _ m 18. Decedent's Education -Check the box thaT best describes t e 19. Deced of Hispanic Or in - C ec t I- g e O. ecedent s MO races to in Cate what highest degree or level of school completed at the time of death. box that best describes whether the d d ece ent the decedent considered Flmseif or herself to be. ~ 8th grade or less NO di I is Spanish/Hispanic/Latino. Check the "NO^ White ~ oma 9th - 12th grade , box if decedent Is not Spanish/Hispanic/Latino. Black or African American ~ Vietnamese s 0 High pool gra uate or GED completed e not Spanish/Hispanic/Latino 0 American Indian or Alaska NaTive ~ Other Asian ~ Some college cr di[, but no degree es Mexi M , can, exican American, Chlca no ~ Asian indlan Q Native Hawaiian Q Assoclace degree (e.g. AA, AS) ~ Ves Puerto Rican , Chinese ~ Bachelor's degree (e.g. BA, AB, BS) ~ Yes Cuban ~ ~ Gua manlan or Cha morro , Master's de ) Q Yes, other S Q Filipino Samoan gree (e.g. MA, M5, MEng, MEd, MSW, MBA panish/Hispanic/Latin O o Q Japanese ~ Doctorate (e.g. PhD, Ed D) or Professional d¢ ~ Other Pacific Islander gree ~ (Specify) ~ Other (Specify) . MD, DDS DVM LLB JD 21. Oecede nt's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to b 22 ' e. a. Decedent s Usual Occupation -Indicate type of work White Q Japanese ~ Samoan done durin Black or Af mo t f i A k g s o r can wor ing Itfe. DO NOT USE RETIRED. merican ~ Korean Q Other Pacific Islander ~ American Indian or Alaska Native 0 Vietnamese Q Don't Know/Not Sure Teacher ~ Asian Indian Q Other ASlan O Refused ~ Chinese Q Native Hawaiian ~ Other 5 226. Kind of Business/Industry ( Peclfy) FIIIPino Q Gua manlan or Cha morro Pub11C SCI-1001 ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (Mp/Day Vr) 23b. SlgnaTU re of Person Pronouncing peath (Only when applicable) 23 By PERSON WHO PRONOUNCES OR Li c. cense Number /~ CERTIFIES DEATH ~ ~ ~ ^ `, 1 ,. -~ ~` ~'yn /~rJ.rR/llln li ~J~t ) ,` 23d. Date Signed (MO/Day r) 24. Time of Death V` tYl VL///W/ /~, t!v s~/`^' /( f'/V '~1vb 3y y~l ,-t -- _ •••/// Y 25. Was Medical Examiner or Coroner Contacted? 0 yes Q Iyp CAUSE OF DEATH Approximate 26. Pe5 1. Enter the chain of events--diseases, InJurfes, or complications--that directly caused the death DO NOT ent t . er erminal events such as cardiac arrest. Interval: r piratory arrest, or ventricular fibrillation with o ut showing the etiology. D O N OT ABBREVIATE Enter onl . y one cause on a line. Add additional Imes If necessary Dnset fo Death l ~ ~t t -J IMMEDIATE CAUSE ---------------> a. C /2B h ~-Q Y 'ri I`7,Lf •,. ~- 5-(_~~.2_ (Final disease or condition Due to (or s¢q uence of): - resulting In death) as a con b. Sequentially Ilst conditions, pue t o (or as a consequence of): If any, leading to the cause Ilsted on line a. Enter the UNDERLYING CAUSE Due to (Or as a conse f quence o ): (disease o Injury that G inlTiated the events resulting d. In death) LAST. Due t0 (or as a c0 nsequence of): 26. PaK 11. Enter other significant condlti t ib TI t d th but not resulting in the underlying cause iven in P rt I g a 2?. Was an autopsy performed? Ves ~8 No m ° 28. Were autopsy Rndings available y to complete the cause of death? 3' E 29. If Female: 30. Did Tobacco Use Contribute to Death? 0 Yes ~ No 31. Manner of Death 0 Not pregnant within ast p year 0 ~ Pregnant at time of death O 8~ Natural (~ Homicide b m No Unkno wn ~ Not pregnant, but pregnant within 42 days of death ~ ~ ~ Accident ~ Pending Investigation r- th ~ Suicide (~ Could not be determined 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (S ell M p on Q Unknown if pregnant within the past year ) 33. Time of Injury 34. Place of Injury (e.g. home; construccion 512¢; farm; school) 35. Location Of Injury (Street and Num Der, City, State, Z(p Code) 36. Injury at Work 37. If Transportation Injury Specify: , 38. Describe How Injury Occurred: Q Ves 0 Driver/Operator ~ Pedestrian ~ No ~ Passenger ~ Other (Specify) 39a. Certifier (Check only one): Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and man t ner s ated Pronouncing 8a Certifying physician - To the best of my knowledge, death occurred at the time date and lace d d , , p , an ue to The cause(s) and manner stated ~ Medical Examiner/Coroner - On [h e basis of examination, and/or Investigation In my opi hlon death oc d n , , curre at the time, date, and place, and due to Che cause(s) and m er stated n Signature of certifier ` l' : Title of certiFler:_ iV~„ $7 _ License Number:~1, [~ "((7 " Jq ] 396. Name, Address antl Zip Code of Perso C mpleting Cause of Deat (Item 26) 39c. Datr_ Signed (My /Day/Vr) G µ 2z w L /7oi oyloL~( zo/~ 40. Reg(sTra is District Number 41 Re trar'S I t . g~ gna ure ,' 42 Registrar Flle Date MO Day r) 43. ~ndments ~ ~ ~: ~ C f ~- ~~ ~ Q ~ Disposition Permit No. ( I ~!J `7 ~ ~O ~J H305-143 "1 REV O?/2011 Will of Polly Krall Miller Part 1. Personal Information I, Polly Krall Miller, a resident of the State of Pennsylvania, Cumberland Cou~y, declares:: ~~ that this is my will. My Social Security number is 208-24-0296. ~~ ~ ~' c; Part 2. Revocation of Previous Wills '~~ ~ ~ ~r n ~" " ; '-=; ,. _ ~ _ I revoke all wills and codicils that I have previously made. ~'~~ Ca -n `---~ '_-' ' Part 3. Children ~ ~~ rv ._ ~, rn ~~ O I have the following children now living: Douglas Paul Miller and Susan Miller Wimer. ~, , . Part 4. Grandchildren I have the following grandchildren now living: Erin Leigh Miller, Grant Douglas Ankabrandt Miller, Hannah Miller Wimer and Lauren Elizabeth Wimer. Part 5. Disposition of Property All beneficiaries must survive me for 45 days to receive property under this will. As used in this will, the phrase "survive me" means to be alive or in existence as an organization on the 45th day after my death. All personal and real property that I leave in this will shall pass subject to any encumbrances or liens placed on the property as security for the repayment of a loan or debt. If I leave property to be shared by two or more beneficiaries, it shall be shared equally by them unless this will provides otherwise. If I leave property to be shared by two or more beneficiaries, and any of them does not survive me, I leave his or her share to the others equally unless this will provides otherwise for that share. "Entire estate" means all property I own at my death that is subject to this will. I leave my entire estate to my children Douglas Paul Miller and Susan Miller Wimer in equal shares. If Douglas Paul Miller does not survive me, I leave his share of my entire estate to Erin Leigh Miller and Grant Douglas Ankabrandt Miller. If Susan Miller Wimer does not survive me, I leave her share of my entire estate to Lauren Elizabeth Wimer and Hannah Miller Wimer. //// //// Page 1 of 4 Initials: Date: /~5~ Q fG' Will of Polly Krall Miller Part 6. Custodianships Under the Uniform Transfers to Minors Act All property left in this will to Erin Leigh Miller shall be given to Luann Ankabrandt Miller, to be held until Erin Leigh Miller reaches age 25, as custodian for Erin Leigh Miller under the Pennsylvania Uniform Transfers to Minors Act. If Luann Ankabrandt Miller is unwilling or unable to serve as custodian of property left to Erin Leigh Miller under this will, Susan Miller Wimer shall serve instead. All property left in this will to Grant Douglas Ankabrandt Miller shall be given to Luann Ankabrandt Miller, to be held until Grant Douglas Ankabrandt Miller reaches age 25, as custodian for Grant Douglas Ankabrandt Miller under the Pennsylvania Uniform Transfers to Minors Act. If Luann Ankabrandt Miller is unwilling or unable to serve as custodian of property left to Grant Douglas Ankabrandt Miller under this will, Susan Miller Wimer shall serve instead. All property left in this will to Hannah Miller Wimer shall be given to Dennis A. Wimer, to be held until Hannah Miller Wimer reaches age 25, as custodian for Hannah Miller Wimer under the Pennsylvania Uniform Transfers to Minors Act. If Dennis A. Wimer is unwilling or unable to serve as custodian of property left to Hannah Miller Wimer under this will, Douglas Paul Miller shall serve instead. All property left in this will to Lauren Elizabeth Wimer shall be given to Dennis A. Wimer, to be held until Lauren Elizabeth Wimer reaches age 25, as custodian for Lauren Elizabeth Wimer under the Pennsylvania Uniform Transfers to Minors Act. If Dennis A. Wimer is unwilling or unable to serve as custodian of property left to Lauren Elizabeth Wimer under this will, Douglas Paul Miller shall serve instead. Part 7. Executors I name Susan Miller Wimer and Douglas Paul Miller to serve together as my joint executors. If Susan Miller Wimer or Douglas Paul Miller is unwilling or unable to serve as executor, the other executor shall continue to serve. No executor shall be required to post bond. Part 8. Executor's Powers I direct my executor to take all actions legally permissible to have the probate of my will done as simply and as free of court supervision as possible under the laws of the state having jurisdiction over this will, including filing a petition in the appropriate court for Page 2 of 4 Initials: Date: % /S ~o Will of Polly Krall Miller the independent administration of my estate. I grant to my executor the following powers, to be exercised as he or she deems to be in the best interests of my estate: 1) To retain property without liability for loss or depreciation. Z) To dispose of property by public or private sale, or exchange, or otherwise, and receive and administer the proceeds as a part of my estate. 3) To vote stock, to exercise any option or privilege to convert bonds, notes, stocks or other securities belonging to my estate into other bonds, notes, stocks or other securities, and to exercise all other rights and privileges of a person owning similar property. 4) To lease any real property in my estate. 5) To abandon, adjust, arbitrate, compromise, sue on or defend and otherwise deal with and settle claims in favor of or against my estate. 6) To continue or participate in any business which is a part of my estate, and to incorporate, dissolve or otherwise change the form of organization of the business. The powers, authority and discretion I grant to my executor are intended to be in addition to the powers, authority and discretion vested in him or herby operation of law by virtue of his or her office, and maybe exercised as often as is deemed necessary or advisable, without application to or approval by any court. Part 9. Payment of Debts Except for liens and encumbrances placed on property as security for the repayment of a loan or debt, I want all debts and expenses owed by my estate to be paid in the manner provided for by the laws of Pennsylvania. Part 10. Payment of Taxes I want all estate and inheritance taxes assessed against property in my estate or against my beneficiaries to be paid in the manner provided for by the laws of Pennsylvania. Part 11. No Contest Provision If any beneficiary under this will contests this will or any of its provisions, any share or interest in my estate given to the contesting beneficiary under this will is revoked and shall be disposed of as if that contesting beneficiary had not survived me. Page 3 of 4 Initials: Date: ~'/ C~ 6 Will of Polly Krall Miller Part 12. Severability If any provision of this will is held invalid, that shall not affect other provisions that can be given effect without the invalid provision. Signature I, Polly Krall Miller, the testator, sign my name to this instrument, this day of Il~oVemb.Q/ ,a00~ ,at ~ar~t`S~?, PA 1`joi,3 I declare that I sign and execute this instrument as my last will, that I sign it willingly, and that I execute it as my free and voluntary act. I declare that I am of the age of majority or otherwise legally empowered to make a will, and under no constraint or undue influence. ~ ~~ Signature: 4 Witnesses We, the witnesses, sign our names to this instrument, and declare that the testator willingly signed and executed this instrument as the testator's last will. In the presence of the testator, and in the presence of each other, we sign this will as witnesses to the testator's signing. To the best of our knowledge, the testator is of the age of majority or otherwise legally empowered to make a will, is mentally competent and under no constraint or undue influence. We declare under penalty of perjury that the foregoing is true and correct, this ~S~ day of lave-rn 62i a-0pL , at ~Qrl~s Imo. f~~1 I`7o~3 . Witness #1: Residing at: ~ , Witness #2: Residing at: ~ ~rl~ 1~lDOd ~-G~ ~ Page 4 of 4 Initials: ~/~"`' ~1~~1:c P~ ~7vJs Date: ~~7~~~p~ Affidavit ACKNOWLEDGMENT Commonwealth of Pennsylvania County of: C~~,,~IQ ~ I, ~1 0 (~~f Kfa ~ ( ~~ ~ ~~~'' ,the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that 1: signed it willingly and as my free and voluntary act for the purposes therein expressed. Testator: Officer: Nofarfal seal Detxa L , Plofary PuWfc Math N6ddleton Tl~up~, cur~be,k,nd Canty nny com-nrsslon ~nes,~x,e s, Zoos Affidavit -Page 1 of 2 Affidavit AFFIDAVIT Commonwealth of Pennsylvania County of: C~~~~0. n ~. We, ~~Y'~ ~h~a, ~`~ ~Gun~-+m and ~ ~ C.~~~2 ~J. ~wl~ ,the witnesses whose names are signed to the attached or foregoing instrument, having been duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his/her Last Will; that the testator signed willingly and executed it as his/her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by ro i i 4 ~~ G n ~ and 'Y~l c~ e ~ ~ e /3. Q~ x' ~fu,-, ,witnesses, this 1 s~ day of (~ aUe rn b-ef ao0 ~ . Witness: Witness: Officer: Nokarial Seel ~~ Wortl~ Nlddlebon Twp., Cumbederd Cooky My Commi~eion Ekes ,Nxis 8, 2008 Affidavit -Page 2 of 2