HomeMy WebLinkAbout04-02-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF ~ ~~~~ ~, ~ COUNT.', PENNSYLVANIA
t'~titioi ~ (,~ :,am:ec' beio~.v. ~~ao i~ are 18 y,ars of a«~ or o'.~ler. appl ;!os fcr L.at~_; as speciTied 'belo~.v, and in
scppor tn".of aver(,j the fol'.uwing and respe;;,fuily r~qu~st~,; ~ the _7rant of Lerzr~ ir. the apprupriate form:
Decedent's Information
dame: :;:~,~ ~ i.C'1 L „JF~C ~~~ ~1 File No: ~~ ~~ ~~~ ~'"
a/k/a:
(Assigned by Register)
a/k/a:
~~a' Social Security No:
Date of Death: ~ 1~~r'c C ~ 2 J~ ~
--~---- Age at death: kz
Decedent was domiciled at death in _~'~,~ ~F„Q/,g ,~y~ County, ~~ (state) with his/her last
principal residence aC-~,L~lf.~r~ /~J ,q . i,.~~ ~Qn ~,~a t A ~,./a l )2..i.., ~,~ s~ ~~N,~ r~9~~ ~~ ar.~l,~
Street address, Post Office and Ztp Code City, Township or Borough Count
Y
Decedent died at ~ 12/7 d2~ ('~m~ J~1LL ~EA~j ~'e!w~j' ~j4 p Ci.M_~'' N/t ~~
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 Pennsylpania ............................ All personal property $ / :.~ 7 Uy . „~
If not domiciled in Penrtsylvania ........................ Personal property in Pennsylvania $ "~~
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ......................................................... $
TOTAL ESTIMATED VALUE.... $ j pTS,~,~, ~;~
Real estate in Pennsylvania situated at:
(Attach additional sheets, ijnecessary.)
~rreer anaress, Post Office and Zip Code City, Township or Borough Count
Y
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated (~ Ju' ~~ and Codicil(s)
thereto dated
State relevant circumstances (eg. renunciation, death of executor, etc.)
Except as follows: after the execution ofthe instrument(s) offered for probate Decedent did oot many, 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.u., pendente lire, durante absentia, durante minoritute
If Administration, e.t.a. or d.b.n.c.t.a., 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 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 C°) `.~-'
,- rv m
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived b the followin s 7sa~ r~
additional sheets,ifnecessury): y g ~ ~~ny)andfllktrs(afdr~C!!:~
fl't ! r~ ,-j
Name Relationshi Address ~~~ {
~~~
D --i r c.~
Fnrm RW-02 rev. 10/!l/2011 Page 1 of 2
Oath of Personal Representative
CObt~tONWEALTH OF PEtiNSYLVAVIA }
} sS:
co~•~TY oP
~;~~ f~ ~F ~
~~
Ofific~a - ,~ my
f2 A~f~ -2 ~~ f0~ ! i
Petiticneru) ?rr.:ed ~ar.":z ~~~... .
Peritionen~) °ru r s v
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are taste 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 or affirmed artd ubs ribed before „¢ ' ~ ~~~ Date _~ /a~~ ZJ/~,Z
met ~ day ~(Jla"
Date
By ' /L~• Date
/,.
or ke Registe Date
BOND Required: ~ Y!ES ~NO
FEES:
Letters ...................... $ ~t;~./~
( 3 )Short Certificate(s)...... 1 G '~
( ~ )Renunciation(s)......... _5 -
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other _ I~~ 11 ........ ~ j --
Automation Fee ...............
JCS Fee . .................... .5 -
TOTAL ..................... $ ,
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of ~~~~~~ 1 try-,~,~ ~
a/k/a:
AND NO ~ ~a , in co ider tion of the f regoing Petition,
satisfactory proof a ing been presented before me, IT IS DECREED that Letters
are hereby granted to
in the above estate and (if applicable) that
the instrument(s) dated "~
described in the Petition be
- -- - ~
to probate and filed of
File No: ~-~ ' ~ _ ~ / v2-~
Will (and Co~cil(s)) pf Decedent.
of ill ~ 4
~ ~ `Page 2 of 2
H105.R05 RF_v ro/I n _ _ - - _ _ - -- _. ---
LOCAL REGIST~R'S CERTIFICATION OF DEATH
WAA~r~~'~`e~ tV~'"duplicate this copy by photostat o~r photo ra h.
Fee for this certificate, $6.00
•~~~~ ~~~ _~ ~~ ~~, i~, This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
(;~~~~( (~~' certifi~~ate will be forwarded to the State Vital
~~N'~ C~URr Records Office t<)r permanent filing.
P 18 3 317 3 5 C~JMB=~R~ A1~Q CO.. PA
/.S ~~
Certification rdumber
Type/Print In
Permanent
~y
a
_~
is
~_
Local Re serer Date Issued
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH VITAL ftEGORDS
CERTIFICATE OF DEATH Sirte Flle Numb.n
ae. Residenca ISUte Or Forolgn Coumry) ep. Resulanee (Street ano Numwr- melupe atpt No.a 1 mpr
Penns lvanis ®YH, deoedem lived In SV 80uehanna twp.
ad. Resklenu (County) 1115 Enterline Road
Detl hin M. Raldenu (Zip COW) 17110 QNO, decadent Ihred whhln limits of clry/boro.
9. Ever In US Armed Forcas7 10. erltal stetus at Time of Meth Marred WI owe 11. SuryhAng Speup's Name (1f wNa, gNe name prior to first marriage)
®Yea Q No QUnknown Dhrorced Q Never Married Ounknow Jose nine M. Ellison
12. Father's Neme (Firs4 Middle, Last, 5 x) 13. Mother's Name Prk>r to First Martlege (Firrt, Midde, Last)
Wa Hazel I F
14a. Informam's Nam! 14b. Relationship to DecWent 14e. IMorment's Malling Address (Street. and Number, Chy, State, Zlp Cod.)
Son POA for Wife 1115 E i e d Ha b O
................. ..................................f..t -...-...-.-.--.........-.-...-.-..-... -. ......-!:...!S!.-.......--. on on! .....---..........-........... ..............-.............-..~
N Death Oeeumd in • HoepRal: LJ•InPatlent tIf Death Occurred Somewhere Other Than • Hosplpl: ~I Noipica Facility "~"Weedem's Home
Eme n ROOT/Out tient Dead On Arrival ! Nunin Home/LOn -Tenn Oro FaN11ty Other (Spat
ISb. FacilRy Name (If not nsdtutbn, g1v rtrwt end number; iSe. City or Tewn, seat!, and Zip Cod! lSd. County Of Death
Golden Livin Center Cumberland
lea. Method of Dispositon Burial ® Crematbn 16b. Daft Of DlsposNlon 16c. Place OT Dltpositlon (Name of umetery, cromatory, or other placa)
Q Remowl from StM Q OonaHOn
n Dther rseerNyl March 15, 2012 Cremation Society of PA
'C. Name and Complete Address a1 Funeral Fac11Ry ~-~
Auer Cremation Serv c v
t. Decedent's Education -Check the bo that Wet Wsenbes the 19. Modem of Hispanic OHgin • Gheek the
ghost tlegree or level of uhool completed at the time of death. box that best describes whether tM dlcedlnt
Q Bth grade or less Is Spanbh/lilspenlc/latlno. Check tM "NO'
No diploma, 9th - 12th grade box H deuWnt is not Spanish/Nlspsnic/Letino.
® High school [raduate or GED completed ®No, not Spanish/Nisplnic/Latino
Q Soma college credit, bu[ no degree. O YP, Mexican, Mexlun American, Chicano
Q Associate degree (e.g. AA, AS) Q Yes, Pwrto Rican
Q Bachelor's degree le.g. BA, AB, BS). Q Yes, Cuban
Q MashYS degree (e.g. MA, MS. MEnW MEd, MSW, MBA) Q Yes, other Spanish/Hbpanic/Latlno
Q Doctorate (e.g. PhD, E00) or Prote}sbnal Wgree (Spa<Ify)
. MD DDS DVM LLB JD
1. DeeedeM's Single Rau saN-Designs ion -Check ONLY ON[ tD In dlute what the deeadem considered himself or
® whoa p lapenese O s.mpan
Q Black or African Ameriun Q Koroen Q Other Pedflc Islander
Q AmeNUn Indian or Alaska Native Q Vietnamese Q Don't KnowMot Sure
Q Arian Inpen Q OtMr Nen Q Mfused
Q Chinese ~ Native Hewallan Q OtMr (spaeHy)
Q flllpino O Guamanbn er Chamorte
23e - M D Ke Prono
r)
u Ma
MO sy
u 2 r! o erso
iY PgIKON WNO PRONOUNClS OR 1
~Ar N ^
^
I I. / ^ I / ~,. a •~'
I ~
ueeepenrs nace - c.necx vrtx can mvne cacao
decedent <onsiderod himself or herself to be
Whi[f Q Kereen
Black or African Ameriun Q Vietnamese
American Indian er Aeska Native Q Other Asian
Asian Indian Q Native Hawaiian
ChlMSe Q Guemanlan or Chamorro
FIIlpino Q Samoan
la Panes! Q Other Paeifle Islander
Ocher (specify)
F to W. 22a. Mudent's Usual Oeeupetlon - Indicate type of wore
done dudng molt of working IIN. DO NOT USE RETIRED.
T.J.S. Navy
- / - - ' P CAUSE OF DEATFI
26. Part 1. Enter the chain M scants-~disaasls, Injuries, or eompllcatlons-that dlnetly caused the death. DO NOT liner Hrmina( wunts such as tard{aC arrest
rospintory arrest, or ventriCUlar~flbrillatlon without sho/w~in~g th/eJetiology. Dq NOT ABBREVI TE. Enter only one uus! on a Ilnl. Add additlona111nes N neussary
IMMEDIATE CAUSE ------"--> a. /rr~ L/ r ~4 ~/Gf._ tit ~~~i4/ /y[.3~~ 1
(Final disease or condition / Due t0 (or as a [ansequence Of):
resulting in death)
b. e7 r~~T /~
Sequemeliy Ilst conditions, D e to (or a consequence on:
if any, eadlnB to the cause /_ / r B GG / r~
ilsted on Ilne e. Enter the Vet. ~ /'J {// r C~J l ~~~\
UNDERLYING CAVSg Ow to (or es a eonsequeno of):
(disease or Injury thK
Initiated cn• .vents resulting e.
In death) LAST. Du! to (or as a consequence of):
3 Co
Approximate
Interne:
Onset to Death
26. PaR 11. Enter other 1 h but not resuting in the underlying nose gNen In PaK 1 27. Was an autopsy peeler
YN
~ 28. wero sutoPSy flndlnP avail
to complete tM wu a eath7
Yes No
29. It female: 30. Dld Tobacco Use GonMbute to DpthT 31. Ma Mrth
{] Not prognant wlth{n part year Q Ya Q ProbabN
~ atural Q Homl<Ide
Q Pregnant at time of derth Q Unknown
®r(~ [~ Accident Q PandlnL Irnestiptlon
~' )~ Not prKnent, but pregnant within 42 dsys of WKh Q Suk:ide Q Coutd not be determined
t. Q Not prognant, but prognem 4~ days to 1 year befero death 32. Date of Injury (MO Day r) (Spell Month)
Q Unknown N program within the past year 33. Time of Injury
34. Place of Injury (e.g. home; constru Lion site; Term; school) 33. Location of Injury (stroet and Number, Clty, state, Zip Coda)
36. Injury at work 37. if TronaportaNOn Injury, specNy: 36. DescrlW How In)ury Ocwrred:
Q Yea Q DrWer/Operator Q Pedestrian
Q No Q Passenger j7 Other lspeclfy)
39a. C er (Check onN one):
Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated
Q Pro ncing a CertMying physician - Te tM bast of my knowledge, Wath occurred at the time, date, and place, and due to tM r_ausa(s) and manner stabd
Q Medlul Examimr/Coroner the basis of exemim e(s) and manner stated
e
cau
s
/Or Investlgatlon, in my opinion, death occurred at the time, tlate,. and place, and due to th
signaturo el cartNilr: Tltla of certlfer: ~'t ~
f
~
l
_ Llunse NumberL// r /J d G G ?o YL
39b. Name Address and Zip C f rson Compet
in-gt Guse
(
~ (Item ) t
~
~ 39c. Mte Slgr~e (MO/Dey/Yr)
~
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rLa // ...y, ~ Td4~Pt i
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i 40. Reglatror s District Num a 41. Rejlst rar f 31 ata ( o
Day
42. Reglstror a
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43. Amendments
07 25 780 H 705-143
Disposition Permit No. REV 07/2011
a~~ is _~r~
RE~ti'~CIATIO~i
REGISTER OF WILLS
`.'G!2 ASR -2 ~ 10~ ! i
CLERK OF
ORPHAN'S COURT
rt1M~~r_ .~~~o ~;~ . Pa
(_~~1n ~~ COUNTY, PEtiNSYLVANIA
Estate of _ i , ~~~/~ L ~ L /~1~~ /v~~~ ~ ,Deceased
I' 7y ~ ~~h ' ~ ~~ ~~ l~ ~ ~~~ ~J , in my capacity/relationship as
(Pant Name)
~~`J ~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Date)
Executed in Register's Office
Sworn to or affi e~~nd subscribed
befo me this ~ ~ day
o ~
~'(((?
1 /
/ ,ti, /
puty for R gister of Wills
(Signature)
J/~S" ~~,>ti~~ ice/ n
(Street Address)
(ctry, state, zp)
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 Notart or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev, l D.13.06
'r
r,
LAST WILL AND TESTAMENT
,...,
r~ -~,
i .,
GERALD L. HELMAN ~, ~~ ~;, - ~ ~___
., ~_
I, GERALD L. HELMAN, of Enola, Cumberland County, Penns~vania, bang `_ ~~
._.. ~- c,
sound and disposing mind, memory and understanding, do hereby make, publish and
declare this as and for my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me.
FIRST
I direct the payment of my just debts and the expenses of my last illness ar
funeral from my estate as soon after my death as conveniently may be done.
Further, I direct that my body be cremated and that my remains be disposed
as my personal representative shall deem appropriate.
SECOND
I give, devise and bequeath all the rest, residue and remainder of my estate 1
my beloved wife, JOSEPHINE M. HELMAN, absolutely and in fee simple if she survive
me by thirty (30) days.
THIRD
In the event that my wife, JOSEPHINE M. HELMAN, fails to survive me by thirt
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATTORNEYS•AT• LA W
2109 Markel Street
Camp Hill, PA
(30) days, then I give, devise and bequeath all the rest, residue and remainder of
estate, as follows:
(A) One half (1/2) to my son, DANIEL P. HELMAN, or his issue, per stirpes.
(B) One half (1/2) to DANIEL P. HELMAN, IN TRUST, NEVERTHELESS, for
the benefit of my son, JAMES W. HELMAN, upon the following terms and conditions:
~~
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATTORNEYS•AT•I.A W
2109 Market Street
Camp Nill, PA
T
(i) To hold, manage, invest and reinvest the principal so received, a
accumulation of income thereon, and to use, pay and apply the income a
principal or so much thereof as in Trustee's sole discretion may be necessary fc
the health, maintenance and support of my son, JAMES W. HELMAN. Th
payments authorized by this trust shall be made by my trustee directly to said
JAMES W. HELMAN, provided that, in the sole opinion of my trustee, he shall
have the ability to handle properly the funds so paid, or may be made directly to
any person, entity or institution entitled to such payment by reason of services
rendered or to be rendered to said JAMES W. HELMAN.
(ii) The amount to be paid to or for the benefit of JAMES W. HELMAN
shall be determined from time to time by his needs, and the times of said
payments shall be determined by such needs, provided that payments be made
at Fast monthly.
(iii) All payments of principal and income hereby given shall be free
from anticipation, assignment, pledge or obligations of the beneficiary, and shall
not be subject to any execution or attachment.
(iv) All principal and accumulated income not so applied during the
lifetilme of JAMES W. HELMAN, shall be distributed according to the terms of his
Will, or, in the absence of a Will, according to the intestate laws of thi
Commonwealth.
FOURTH
I direct that any and all inheritance, estate, and transfer taxes imposed upon
estate passing under this Will or otherwise shall be paid out of the principal of
residuary estate.
2
I1
• ~ ,
FIFTH
In addition to the powers conferred by law, I authorize any personal
representative, trustee or guardian acting under this instrument, in his/her absolute
discretion:
(a) To retain in the form received, or to sell either at public or private
sale any real or personal property;
(b) To exercise any options to subscribe for stocks, bonds, or other
investments.
~~ (c) To join in any plan of lease, mortgage, consolidation, exchange,
~~ reorganization or foreclosure of any corporation in which my estate or any trust,
may hold stocks, bonds or other securities;
(d) To sell, transfer, convey, mortgage, pledge, lease or exchange any
property, real or personal, which at any time may form part of my estate, for the
payment of debts or taxes, or for any purpose of administration or distribution, for
such prices and upon such terms as they, in their sole discretion, may deem
wise, and to execute and deliver deeds of conveyance or transfer thereof;
(e) To make settlements and compromises on such terms as they, in
their sole discretion may deem wise without the necessity of obtaining any court
approval thereof;
SAIDIS
SHUFF, FLOWER (f) To make distribution hereunder either in cash or kind, as they, in
& LINDSAY
ATTORNEYS•AT•f,AW their discretion may deem wise;
1109 Market Street
Camp Hill, PA
(g) To terminate any trust created hereunder, and pay the residue out-
right to the beneficiary, when my Trustee determines, in his discretion, that the
3
J_
. ~,
size of the trust has so diminished as to make its continued administration in trust
impracticable.
SIXTH
In the event that my Trustee hereinabove named shall be unable to continue to
act as trustee by reason of his death or incapacity, I nominate my daughter-in-law,;
Debra Heilman, to serve as successor trustee.
SEVENTH
I do hereby nominate, constitute and appoint my wife, JOSEPHINE M. HELMAN,
to act as Executrix of this my Last Will and Testament. Provided, however, that if she is
unwilling or unable to act as Executrix, I direct the duties of Alternate Executor be
performed by my son, DANIEL P. HELMAN.
EIGHTH
I direct that no personal representative, guardian, trustee or other fiduciary
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATTORNEYS•AT•lA W
2109 Market Street
Camp Hill, PA
appointed under this instrument shall be required to give bond for the faithful
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, GERALD L. HELMAN, have hereunto set my hand
and seal to this my Last Will and Testament, consisting of four (4) typewritten pages,
the first three (3) of which bear my signature in the margin for identification, this
_~_ dby of ~, ~.~ _, 2004.
GERALD L. HELMAN, Testator
4
SAIDIS
SHUFF, FLOWER
& LINDSAY
ATTORNEYS•AT•LA W
2109 Market Street
Camp Hill, PA
Signed, sealed, published and
L. HELMAN, as and for his Last Will
hereunto subscribed our names at hi
said Testator and of each other.
U ti6~~-~~-ow~~ADDRESS
DDRESS
declared by the above-named Testator, GERALD
and Testament in the presence of us, who have
s request as witnesses thereto, in the presence of
2l e ~ ~d,t, l~ Sfi
~' ~ ~~r ~
COMMONJWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss.
WE, GERALD L. HELMAN, Titor~ts ~. /-~.owE,'L and ~iQ4 ~ ~~/~jr,~~,~. ;-the
Testator and witnesses, respectively whose names are signed to the foregoing or
attached instrument, being first duly sworn, do hereby declare to the undersigned
authority that the Testator signed and executed the instrument as his Last Will and
Testament and that he signed willingly and that he executed as his free and voluntary
act for the purposes therein expressed, and that each of the witnesses, in the presence
and heariing of the Testator signed the Will as witness and that to the best of their
knowledge the Testator was at the time 18 or more years of age, of sound mind and
under no constraint or undue influence.
Subscribed, sworn to and acknowledged before me by GERALD L. HELMAN, th
stator, and subscribed ~s-> and sworn or affirmed to befo erne b
,~ - W -- and ~~~ ~~N~jr~f~..~--witn es, this ~S~ll day c
s , 2004.
r, /°-~
COMMONWEALTH OF PE LV NIA ry U IIC
Notarial Seal
Sallie Allshouse, Notary Public
Camp Hill Boro, Cumberland County
My Commission Expires Mar. 29, 2008
5
J`~E? ~,r~,Yzl ~ ~~~~~-
GERALD L. HELMAN. Testator
__
. w ces o
~~~ ~
Sa,~dzs at High Svect 635 North 12th Sveec, Suite 400 CERTIFIEI? COPY:
,?%~~s c, PA 17013 Lemoyne, PA 17043 ,~', ,.'
Swan Phone.(717) 243-6222 Phone (717) 6I2-5800
& Rogers n
GENERAL POWER OF ATTORNEY
NOTICE
THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE PERSON
YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO HANDLE YOUR
PROPERTY, WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE
DISPOSE OF ANY REAL OR PERSONAL PROPERTY WITHOUT ADVANCE
NOTICE TO YOU OR APPROVAL BY YOU.
THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR
AGENT TO EXERCISE GRANTED POWERS, Bt1T WHEN POWERS ARE
EXERCISED, YOUR AGENT MUST USE DUE CARE TO ACT FOR YOUR BENEFIT
AND IN ACCORDANCE WITH THIS POWER OF ATTORNEY.
YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE
THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME
INCAPACITATED, UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THESE
POWERS OR YOU REVOKE THESE POWERS OR A COURT ACTING ON YOUR
BEHALF TERMINATES YOUR AGENT'S AUTHORITY.
YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR
AGENT'S FUNDS.
A COURT CAN TAKE AWAY THE POWER OF YOUR AGENT IF IT FINDS
YOUR AGENT IS NOT ACTING PROPERLY.
THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF
ATTORNEY ARE EXPLAINED MORE FULLY IN 20 PA. C.S. CH. 56.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO
EXPLAIN IT TO YOU.
I HAVE READ OR HAD EXPLAINED TO ME THIS NOTICE AND I
UNDERSTAND ITS CONTENTS.
Y
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GENERAL POWER OF ATTORNEY
I. JOSEPHINE HELMAN, of East Pennsboro To
wnship, Cumberland County,
Pennsylvania (`principal"), hereby appoint my son, DANIEL P, HELM.
after referred to as `'my agent" ~N, as my agent (herem-
)• My agent shall have full power of substitution, for me and in
my name, to transact all my business and to manage all my property and affai
personally present, including, but not limited to exercisin the fol rs as I might do if
g lowing powers:
1• Execution of Contracts.
compromise, enforce, or otherwise act with res ect to tan perform
including but not limited to, leases and mort a es 'modify, extend, cancel,
P y contract of any sort whatsoever,
possession to any real or personal roe g g 'and to pa3' any money or to transfer title and
contract or in the performance of any obligation entered intouor inco be paid or transferred by any
erred by me or on my behalf.
~• Inve~e_ To invest in all forms of real and
restrictipn whatsoever as to the kind of investment, including butnot 1 ~ • rO e
Treasury Bonds which are redeemable at par in a P P rtY without any
p yment of federal estate taxe d to' United States
~• Registration of Prone
nominee. To hold property unregistered or in the Warne of a
4. Personal Property.
Poly for each, exchange, pledge, lease, guVe or acquire obltioor private sale for cash or credit or
or by any other means whatsoever to acquire, dispose of, res~or sales or exchanges or leases,
intangible personal property or any interest therein; and, without li alter or manage tangible or
securities, to comply with any securities laws or regulations, to execute ind
purchase insurance and to a co mitation, with respect to any
P Y mmissions or discounts required b e~'~' agreements, to
Y any underwriting.
5• Real Proner•ty. To buy or sell at public or private sale for cas
for each, e~cchange, mortgage, encumber, lease for an
sales, purcJhases, exchanges or leases, dedicate, orb an h or credit or partly
y period of time, give or acquire options for
dispose of real property or an Y y other means whatsoever to acquire or
manage real roe Y interest therein; to partition and subdivide real ro e
such plans, apple atio~ns opotheraldocumentsr'tear down an P P rty; to
y structure or part thereof; and to file
may be Tequested b m connection there~~vith and do such other acts as
jurisdiction. Y any government or other authority having or
purporting to have
6• Securities, To vote in person or b
reorganization, votin - y proxy at any rneetin t
g trust plan or other concerted action of securi hold~e s~to mnakel amerger,
in connection therewith, and in general to exercise all rights of a sec:Ty
qty holder, P Yments
2
~• Insurance.
affecting pro e "~~ To procure, alter, extend or c
P rtY and persons, and against liabili anCel msur
any non-forfeiture provisions of life insurance n', damage or. claim of against any and all risks
policies. any sort and to exercise
8' L~• To borrow
as my agent shall deem money in such amounts for ;;uch
and I speC1ficall PTOper and to secure any l°~ b , periods
the Purpose of Y authorize my agent to borrow y the mortgage or led e upon such terms
purchasing United States Treas money and to pled e P g of any property,
of federal estate taxes. g Pro e
ury Bonds which ~~re redeemablee atas collateral for
Pte' in payment
9• FinancialInstitutions•
instruments °r otherwise Retirement
union, retirement or other deposet cl odrawals from Accounts. 'I'o si
any checkin ~ checks, drafts and other
receive the pr°ceeds thereof in c ~t in my name g, savings, transaction
retirement ash or oche ,and to endorse checks ~ credit
transaction or other de rwise; to o en Payable to me and
certificates, certificates of de P°sit accounts in rri P and close checkin
receipts for Posit or similar ins Y nee' t0 Purchase g, savings,
any funds withdra truments in m and redeem savings
checking account wn or certificates redeemed• Y Warne; to execute
ins ~ savings account ,and to and deliver
trument which I n°~, have ~ savings certificate do all acts regat'din
present. ~ °r may hereafter ac ' Certificate °f de g any
y financial institution gwre, the s Posit or similar
written notice from may continue to rel ame ~ I cold do if
shall be inde me that this power of alto Yon this polder of attorne Personally
heirs a ~ fied and held harmless by me and'mrevoked or actual notice ofumtil it receives
Parties gasnst y liability or loss, includin Y estate Y death and
which it might incur b g lawyers fees ~ my personal representatives and
it receives such Y relying on this ~ costs of suit and claims of third
notice, or at any time P°wer after ternunation or revocation
mY agents with res because of wron
subject to whatever bect to transactions covered b ~ acts, omissions or representations of
ank rules and re Y this Power of attorney.. M a
gulations I would be subject to. Y gent shall be
10. Safe De osit Boxes.
deposit box rented b To have access to
deliver receipts for saf depos t box seine and control ov
posit boxes in m er the contents of an
box which I m Y name, to close out Y safe
now have or may hereafter ac nee' and to do all acts re and execute and
provided that my agent shall not de gwre g~'ding any safe deposit
mY agents have a Posit or kee ~ the same as I could do if
of attorne Personal interest. ~ Pin any such safe de Personally present;
Y until it receives Y financial institution P°S1t any property in which
actual notice of Written notice from may continue to rel
personal re resentatives th and shall be inde me that this power of attorne Y on this power
P and heirs against an ~lfied and held h Y is revoked or
salt and claims of y liabili armless by me and
revocation but before idtpe wives such it ty °r loss, including la mY estate,
or representations °f m a might incur by relying on this ~'yers fees, costs of
h notice, or at any time because of vvron after to
MY agent shall be subject to ents with respect to tr rmination or
~ whatever b ansactions covered b g~ acts, omissions
ank rules and regulations I would bte sub ect to f attorney.
11. Re ei is and
including a bequest, devise A royal of
Accounts. To receive
right or as a fiduci 'gift °r other transfer of real or a Payment of
bond therefor, to ~ for another, and to Personal any kind,
Pprove acco glue full receipt and ac uitt Proper' to me in my own
ants of any business, estate, trustq anCe therefor, or a re
Partnershi funding
p or other transaction
whatsoever in which I may have any interest of any nature whatsoever, and to enter into any
compromise and release in regard thereto.
12• COmpromise and Arbitration of Claims. To compromise or arbitrate any
claim im which I may be m any manner interested, and for that purpose to enter into agreements
to compromise or arbitrate, and either through counsel or otherwise to carry on such compromise
or au'bit~ation and perform or enforce any award entered in arbitration.
13• Institution and Defense of Claims. 7'o institute, prosecute, defend,
comprotise, or otherwise dispose of, and to appear for me in, any proceedings at law or in
equity ar otherwise before any tribunal for the enforcement or for the defense of any claim,
either alone or in conjunction with other persons, relating to me or to any property of mine or
any other person, and to retain, discharge and substitute counsel and authorize appearance of
such counsel to be entered forme in any such action or proceeding.
1~4. Taxes. To prepare, execute and file in my name and on my behalf any return,
report, p#~otest, application for correction of assessed valuation of real or other property, appeal,
brief, claim for refund, or petition, including petition to the United States Tax Court, in
connectipn with any tax imposed or purported to be imposed by any government, authority or
agency, 4r claimed, levied or assessed by any government, authority or agency and to pay any
such tax sand to obtain any extension of time for any of the foregoing; to execute waivers of
restrictiotns on the assessment and collection of deficiency in any tax; to execute closing
agreements and all other documents, instruments and papers relating to any tax liability of mine
of any sort; to institute and carry on either through counsel or otherwise any proceedin in
connection with contesting any such tax or to recover any tax paid, or to resist any claim for
additional tax or any proposed assessment or levy thereof, and to enter into any agreements or
stipulations for compromise or other adjustment or disposition of any tax.
15. Disclaimer. To execute, deliver and file for record disclaimers of any part or all
of any pro;~erty, power or interest passing to or for me under any will, deed of trust or otherwise.
16, Creation of Trust. To create a revocable trust for my benefit under the terms of
which (i) ~,my agent or any one or more other persons or corporations with fiduciary powers
selected by my agent is named as the trustee or trustees, (ii) during my lifetime the entire net
income and as much of the principal as I or my agent directs or my trustee thinks desirable shall
be paid to me or as I or my agent direct, and (iii) upon my death the principal and any undis-
tributed income shall be payable to the executor or administrator of my estate, and to transfer
property to' the trustee or trustees thereunder.
17• Gi_ fling. To make such gifts of my property to one or more of my issue and
charities in such form and amounts as my agent believes would be in accordance with my
wishes.
18. Emnlovment of Others. To employ accountants, attorneys-at-law, investment
counsel, custodians, agents, servants, and others, to delegate to them, to remove them, to appoint
others in their places, and to pay them such remuneration as my agent shall deem proper.
19. Execution of Documents. To execute, deliver, file for record, cancel, modify,
endorse, acquire or dispose of any instrument, including but not limited to, stock and bond
powers, vehicle registrations, financing statements and related filing documents, reports of any
sort to any government, authority or agency, as required or permitted by law, deeds with or
without covenants or warranties, and any other document appropriate for carrying out any of the
foregoing powers.
20. Health Care. To arrange for my entrance to and care at any hospital, nursing
home, health center, convalescent home, retirement home, or similar institution, and to arrange
for, consent to, waive and terminate any and all medical and surgical procedures on my behalf,
including the administration of drugs, and to pay all bills for my care.
21. General. To do all things, which my agent shall deem proper in order to carry
out any of the foregoing enumerated powers, which shall be construed in the broadest possible
manner. The descriptive headings of this general power of attorney are inserted for convenience
only and shall not be deemed to affect the meaning or construction of any of the provisions
hereof or to limit in any way the construction thereof in the broadest possible manner.
22. Substitution. My agent shall have full power of substitution and revocation, and
such substitution or revocation may relate to, or be limited to, any one or more or all of the
foregoing acts or powers, or be limited as to time or in such other respect as my agent shall deem
proper.
~3. Effect of My Disability. This is a durable power of attorney and it shall not be
affected by my subsequent disability or incapacity. All acts done by my agent pursuant to this
power shall have the same effect and shall inure to my benefit and bind me and my successors in
interest as if I were competent and not disabled.
24. Ratification. I hereby ratify and confirm all that my agent or the substitute or
substitutes therefor shall lawfully do or cause to be done by virtue hereof.
25. Governing Law. This power of attorney shall be governed by and interpreted in
accordance with Pennsylvania law.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the /' ~ day
of _ (JZ ~~" uti , 2011.
~,~n., r,~~~, 5~ `~--~'y~c~~~t~ (SEAL)
J . SEPH E HELMAN
5
WITNESS:
LUMMUNWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
On this, the ~~~-day of ~~~ , 2011, before me, the undersigned officer,
personally appeared John E. Slike, .Esquire, known to me (or satisfactorily proven) to be a
member of the bar of the highest court of said state, Supreme Court attorney license no. 06262,
and a subscribing witness to the within instrument, and certified that he was personally present
wh~n JOSEPHINE HELMAN, whose name is subscribed to the within instrument, executed
the~ame, and that the said person has acknowledged that she executed the same for the purposes
the~ein contained.
IN WITNESS WHEREOF, I have hereunto set m hand and official seal.
Y
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6
ACKNOWLEDGMENT BY AGENT
I, ~ANIEL P. HELMAN, have read the attached power of attorney and am the person
identified) as the agent for the principal. I hereby acknowledge that in the absence of a specific
provisionto the contrary in the power of attorney or in 20 Pa. C.S. when I act as agent:
I hall exercise the powers for the benefit of the principal.
I hall keep the assets of the principal separate from my,~our assets.
I Shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions, receipts and disbursements on
behalf of'~he principal.
.~
~ ~ ~
TE DANIEL P. ELMAN, Agent