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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF Cu n~ h~ r f ~n ~ 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 Infor ation r L
Name: ~'~ r ~ h ~ ~ . f 0 U.T ~l
a/k/a:
a/k/a:
a/k/a:
Date of Death: i '~ k i 1 2 012
Decedent was domiciled at death in (_.:. ~ MhP.r IQ-'~d
principal residence at ~~QI U~f~-:
Decedent died at
Street address, Post Office and Zip Code
Street address, Post Office and Zip
Estimate of value of decedent's property at death:
File No: ~ ~ - ` ~ - C.: ~{ ~
(Assigned by//Registerrr), t
Social Security No: ~ ~P Z- ' t0 ~-[ ~ y~2,Z.
Age at death• ~ Zj
state) with 's/her last
liCS~ra (060 - -~nOr~l11-~,UMI!xylQltd
City, Tov~hip or Borough
I' I o n G
~, ownship or Borough
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 ........................................................ .
Tl1TA7 TiCTiMATL'71 VA71TL'
Real estate in Pennsylvania situated at:
(Attach additional sheets, if necessary.)
dA. 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
thereto dated
-CWYIbCY~QY1 d -v ~
County State
and Codicil(s)
State relevant circumstances (eg. renunciation, death of executor, etc)
Except as follows: after the execution ofthe instnunent(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
ado ted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
~NO EXCEPTIONS Q 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, sta. or db.n.c.~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.
Q NO EXCEPTIONS 0 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 Relationshi Address 9G '"'' ~~
~
/l
!
(~
_47
.
_
.~.
'
`-1 O ~rT tea.
~y
C~
~
~Q
Form RW-02 rev. tonli2oll Page 1 of 2
$ 5"oa . dd
$ ~ D0~7. n0
Oath of Personal Representatfve
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF
Official Use Only
t fi f'~ /~ ~~ Rb
~F;P/R~
Petitioner(s) Printed Name Petitioner(s) Printed Address
~~ .~. X11 ~~~ ~r~bw~ a1~~f- ~w~~~~~ R ~s ~ 9
_ f.r ~ _ ,,~ . A
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 t, the Petitioner(s) will el .an truly administer the estate acc/o/rd' to 1 w.
Sworn to or affirmed d subscribed before ~ Date d`~ ~~ ~-O~~j
me this ~C' day of ~ ~ ~ , ~;/~- Date
sy: ~~~ I'1.~ ~~ .~ ,f ~ ~~(,[' 11 ~lP;~ C;f 1 Hate
For the Register Date
BOND Required: Q YES ~ NO
FEES: 1
Letters ...................... $ Ir ~ .
(5 )Short Certificate(s)......
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ........ ~
~ tom, ~,~~ ....... --T
Automation Fee .............. .
JCS Fee . ....................
TOTAL ..................... $
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
YD Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of (~ ~1 (1~ ~Y~ (' ~ ~' ~~~ File No: ~ ~ - ~: ~ D~
a/k/a:
AND NOW, ~--t~~ 4 1 ~ -~~ ' C ' ~-- , in consideration of the foregoing Petition,
satisfactory proof ha ~g been presented before me, IT IS DECREED that Letters _ ^ S -
are hereby granted to % . ~
~ in the above estate and (if applica e) that
the instrtunent(s) dated GC - t ~~ - l ~
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
~ c C ~ +- f~t..
Register of Wills _
Form RW-02 rev. ~oi~ii2o~1 Page 2 of 2
LO~~~AR'S CERTIFICATION OF DEATH
41, 1 L. r_
WA F~-IC;:~-1t is-ill, ~o duplicate this copy by photostat or phatograph.
~I~' . I _, _ ..~IJ
Fee for this certificate, $6.00 _' ~ ~ ~ ~f ~ Zfl ~ ~~ ~~; ~ 4 't'his is to certify that the information hers given is
correctly copied from an original Certificate of Death
d(dy filed with me. as Local Registrar. The original
C~ERK ~J~ certificate will he for~~jarded to the S-:ate Vital
~~~~ S v~' ~~ r Records Office for permanent filing.
C11~,4~r! ~,~,~~;) C;I;1 Pa
P 18388761 ~ ~ ~ 202
Certification Number
Type/Prln[In
Permanent ~s"
~~
Local Registrar Date Issued
COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
f"COTSCS!`AT~ n
State Flle Number:
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo)
Christine L Fouts emale 162 - 64 - 5822 A ri1 17, 2012
Sa. Age-Last Birthday (Vrs) 6b. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country)
Months Days Hours Minutes Harrisbur , PA
43 November 7 1968 fib. Birthplace (cp.,nty) Dau hie
Sa. Residence (State or Foreign Country) 6b. Residence (Street and Number -Include Apt No.) Bc. Did Decedent Live In a Township's
Penns lvania 5201 Deerfield Avenue ®ve,, de~eden[ u..ed In _ Hampden t,,,,p.
Stl. Residence (County) -
Cumberland g
R
id
e.
es
ence (Zip Code) 17 OSO ONO, decedenT lived within limits of city/boro.
9. Ever In US Armed Forces] 30. Marital Status at Time of Death ~ Married 0 Widowed 11. Surviving Spouse's Name (If wife
give name prior to first marria
e)
,
g
Q Ves ~ No ~ Unknown ® Divorced ~ Never Marrietl ~ Unknow
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Mitldle, Last)
Norman W. Kauffman Nanc J. Brandt
14a. Informant's Name 14b
Relation
hi
t
D
d
'
.
s
p
o
ece
ent 14c. Informant
s Mailing Address (Street and Number, City, State, Zip Code?
o Nanc J. Kauffman Mother
15 5268 Deerfield Ave. Mechanicsbur PA 17050
¢
-
e a. P ace o Deat C e
.......................................................... ...Pa.. ........... _.................
.. .................................s..pn y one
If Death Occurred in a Hos Ital: .,......... .............................. ........ ........................... .... .......
............
p In dent :If Death Occurred Somewhere Other Than a Hos Its l: ~~~ "'
P Hospice Facility ~ DecetlenY's Home
~ Q Emergency Room/OUtpatlent Dead on Arrival ~ Nursing Home/Long-Term Care Facility Other (Specify)
.
_ 16b. Facility Name (If noT Institution, give street and number;
16c. City or Town, State, and Zlp Code 15d. County of Death
5201 Deerfield Avenue Mechanicabur PA 17050 Cumberland
16a. Method of Disposition Burial 0 Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
R
l
.~ ~
emova
from State ~ Donation
otner(spe~lfy> April 21, 2012 St. Johnts Cemetery
2 16d. Location of Disposition (City or Town, State, and 21p) 1Ta. Signature of Service Licensee or Person in Charge of Interment 17 b. License Number
Shiremanstown, PA 17011
FS 012 849 L
17c. Name and Complete Adtlress of Funeral Facility
Parthemore FH & CS inc., P.O. Box 431 w Cumberland PA 17070
~ 18. Decedent's Education -Check the box Ghat best describes The 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to Indi
t
h
1- ca
e w
at
highest degree or level of school completed a[ the time of death. box that best describes whether the decedent the decedanT considered himself or herself to be
.
~ Bth grade or less is Spanish/Hispanic/Latino. Check [he "NO" ~ White ~ Korean
Q No diploma, 9th - 12th gratle box If decedent is not Spanish/Hispanic/Latino. 0 Black or African American ~ Vietnamese
~ High school graduate or GED completed ® NO, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native ~ Other Asian
~ Some college credit, but no degree ~ Yes, Mexican, Mexican American, Chicano ~ Asian Indian 0 Native Hawaiian
® Associate degree (e.g. AA, A6) Q Ves, Puerto Rican
Q Chinese Q Guamanian or Chamorro
Bachelor's de
BA
gree (e.g.
, AB, B6) Ves, Cuban
~ Filipino Q Samoan
M
t
'
d
as
er
s
egree (e.g. MA, M5, MEng, MEd, MSW, MBA) ~ Ves, other Spanish/Hispanic/La[in0 Q Japanese ~ Other Pacific Islander
Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) Q Oth
S
f
er (
peci
y)
. MD DDS DVM LLB JD -
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be
22a
D
d
t'
.
.
ece
en
s Usual Occ:upa[lon -Indicate type of work
Q White Q Japanese 0 Samoan d
tl
i
one
ur
ng most of work(ng life. DO NOT USE RETIRED.
Black or African American ~ Korean ~ Ocher Pacific Islander
~ American Indian or Alaska Native ~ Vletna mdse ~ Don't Know/Not Sure Pr O~ E! Ct Manager
Q Asian Indian ~ Other Asian ~ Refused 226. Ktnd of Business/Industry
Chinese ~ NaClve Hawaiian ~ Other (Specify)
~ Filipino Q Guamanian or Chamorro Consulting
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day r) 236. Signature of Person Pronouncing Death (Only when applies bie) 23c. License Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH A ril 17 2012
23tl. Date Signed (MO/Day/Yr) 24. Times of Death
A rox . 5 : 1 S A. M_ 26. Was Medical Examiner or Coroner Contacted? Yes ~ No
CAUSE OF DEATH
Approximate
26. Pert 1. Enter the chain of events--diseases, injuries, or tom plicatlons--that directly caused the death. DO NOT enter Terminal events such as cardiac arrest Int
l
erva
:
respiratory arrest, or ventricular fibrillation without showing the eTlology. DO NOT ABBREVIATE. Enter only one cause on a Ilne. Add additional lines IF necessary Onset to 1>eath
IMMEDIATE CAUSE > Gunshot to Cheat
(Final tlisease or condition Due to (o as a consequence of): -
resulting In death)
b.
6equenTially Ilst conditions, Due to (or as a consequence of): -
If any, leading t0 the cause
listed on Tine a. Enter [he
UNDERLYING CAUSE Due to (or as a consequence of):
(disease or Injury that
initiatetl the evenTS resulting d.
~ In death) LAST. Due to (Or as a consequence of):
S 26. Part Ii. Enter other s(¢niftca nt conditions contrib tfn¢ to death but not resulting in the underlying cause given In Part I 27. Was a topsy performed?
~ Q Yes No
28. Were autopsy findings available
~
to
co
plete [he taus of deaths
.
3
+ o Yes ~ No
29. If Female:
a
~E 30. Dld Tobacco Use Contribute to Death? 31. Manner of Death
Q NOt pregnant within pas[ year Q Ves 0 Probably ~ Natural Q Homicitl
.~' e
Q Pregnant at time of death ~ No 0 Unknown Accident Fendin Invest)
Not
re
atton
na
t
0 0 g
b
t
~ ~
p
g
n
,
H
u
pregnant within 42 days of death
Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In Ill Sulcitl¢ ~ C:ouid not be da[ermined
lury (MO/Day/Vr) (S
ell Month) rl
p
~ Unknown if pregnant within the past year
April 17, 2012 33. Time of ln)r,ry
A rox. 5.15 A.M_
34. Place of Injury (e.g. home; construction site; farm; school)
35. Location of Injury (Street and Number, City, Slate, Zip Code)
Home 5201 Deerfield Avenue, Mechanicsburg, PA 17050
36. Injury at Work 37. If Tra nsportatlOn Injury, 6peclTy: 38. Describe How Injury Occurred:
~ Yes ~ Driver/OperaTOr ~ Pedestrian
No p Passen
e
S
r pother (speclry) Intentional Self inflicted Gunshot - Handgun.
39a. Certifier (Check only one):
Q Certifying physician - To the best of my knowledge, death occurred due to se(s) and m r slated
Pronouncing !k Certifying physician - To the best of my k letlge, d curved at the time, data, and place, and due to the cause(s) and manner stated
M
di
l E
i
e
ca
xam
ner/Coroner - Is o e minati gation, in my Opini
o
n, death occurred at the time, date, and place, and tlue to the cause(s) and manner stated
f~~
/
Signature of certifier: - Title of certlfl~r':h iaf Daptlty Coroner
License NUmber:_
39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 63 7 5 Bas eho re Road , $l.l it E•_ ~~ 1 39c. Date Signed (MO/Day/Vr)
Matth
S
S
ew
.
toner, Chief Deputy Coroner Mechanicabur PA 17050 A ril 19, 2012
40. Reglstra is District Number 41
Re
istrar's 61
n
a ~ ~ .
g
g
a 42. Registrar File Dat¢ (MO Day r)
43. Amendments -5~/~ ~7 v i
Disposition Permit No. ~~ ~ OI-F 29 M105-143
REV OJ/2011
Last Will and Testament F
?o
~- ~ ~..
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OF c~rn
~ n,,
CHRISTINE FOUTS r.
-~
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~ c-, ,-,
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~"7
Cumberland
I
CHRISTINE FOUTS
of Hampden Township ~.~
County ..
~:
,
,
, , _
Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby
revoking all Wills and Codicils by me heretofore made.
ITEM I: Family Information. I have two (2) children:
LOGAN L. FOUTS and HANNAH M. FOUTS. They are described in this Will as "my
children" or as a "child of mine."
-~.~
;_,~ :.?
~-
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__
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t. i (~
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ITEM II: Death Taxes. I direct that all inheritance and estate
taxes becoming due by reason of my death, whether payable by my estate or by any recipient of
any property, shall be paid by the Executor out of the residue of my estate, as an expense and cost
of administration of my estate, except that no taxes shall be charged against any gift qualifying
for the marital or charitable deduction in my estate. The Executor shall have no duty or
obligation to obtain reimbursement for any such tax so paid, even though on proceeds of
insurance or other property not passing under this Will.
ITEM III: Debts and Final Expenses. I direct the Executor to
pay the expenses of my last illness and funeral expenses from the residue of my estate as an
expense and cost of administration of my estate.
ITEM IV: Tangible Personal Property. I may leave a written
list in my safe deposit box or elsewhere disposing of certain items of my tangible personal
property. The Executor shall dispose of items of my personal property as specified in the written
list. If no written list is found in my safe deposit box or elsewhere and properly identified by the
Executor within thirty (30) days after the probate of my Will, it shall be presumed that there is no
other statement or list. Any subsequently discovered list shall be ignored.
I give all my tangible personal property, including but not limited to, all of my
household furniture and furnishings, books, pictures, jewelry, silverware, automobiles, wearing
apparel and all other articles of household or personal use or adornment and all policies of
insurance thereon (except as set forth in a written list) to my then living children, to be divided
among them as they shall agree. The Executor shall represent any minors in the division of this
property. Should there be no agreement, this property shall be divided among my then living
children by the Executor in as nearly equal portions as is deemed practical in the sole discretion
of the Executor, having due regard to their personal preferences. If the Executor thinks any
property to which a minor child would become entitled is unsuitable for the child's use, the
property shall be sold and the proceeds shall be added to the share of my residuary estate held for
the benefit of that child.
ITEM V: Residue. I give the residue of my estate, not
disposed of in the preceding portions of this Will, to my children, in equal shares. If any of them
is not living at my death, her share shall be paid to her then living issue, per stirpes.
ITEM VI: Administrative Powers. In addition to the powers
granted at law, the Executor shall possess the following powers, each of which shall be construed
broadly and may be exercised without court approval, but in a fiduciary capacity only:
(a) Retain Investments. To retain any investments I have at my death,
including specifically those consisting of stock of any bank even if I have named.
that bank as the Executor.
(b) Vary Investments. To vary investments and to invest in bonds,
stocks, notes, real estate mortgages or other securities or in other property, real or
~~
personal, without being restricted to so-called "legal investments", and without
being limited by any statute or rule of law regarding investments by fiduciaries.
(c) Division of Assets. In order to divide the principal of my estate or
make distributions, the Executor is authorized to distribute personal property and
real property partly or wholly in kind, and to allocate specific assets among
beneficiaries so long as the total market value of each share is not affected by the
division, distribution or allocation in kind. The Executor is authorized to make,
join in and consummate partitions of lands, voluntarily or involuntarily, including
giving of mutual deeds, or other obligations, with as wide powers as an individual
owner in fee simple.
(d) Sell Assets. To sell either at public or private sale any or all real or
personal property severally or in conjunction with other persons, and to
consummate sale(s) by deed(s) or other instrument(s) to the purchaser(s),
conveying a fee simple title. No purchaser shall be obligated to see to the
application of the purchase money or to make inquiry into the validity of any sale.
The Executor is authorized to make, execute, acknowledge and deliver deeds,
assignments, options or other writings as necessary or convenient to carry out the
powers conferred upon the Executor.
(e) Encumber Real Estate. To mortgage real estate, and to make leases
of real estate.
(f) Borrow Money. To borrow money from any person, including the
Executor, to pay indebtedness of mine or of my estate, expenses of administration
or inheritance, legacy, estate and other taxes, and to assign and pledge assets of
my estate.
(g) Pam. To pay all costs, taxes, expenses and charges in
connection with the administration of my estate.
(h) Distributions without Court Order. To make distributions of
income and of principal to the proper beneficiaries, during the administration of
my estate, with or without court order, in such manner and in such amounts as my
Executor deems prudent and appropriate.
(i) Rights as Stockholder. To exercise voting rights with respect to
securities which form a part of my estate, and to exercise all the powers incident
to the ownership of securities.
(j) Reorganize. To unite with other owners of property similar to
property in my estate to carry out any plans for the reorganization of any company
whose securities form a part of my estate.
(k) Disclaim. To disclaim any interest in property which would
devolve to me or my estate by whatever means, including but not limited to the
following means: as beneficiary under a will, as an appointee under the exercise
of a power of appointment, as a person entitled to take by intestacy, as a donee of
an inter vivos transfer, and as a donee under athird-party beneficiary contract.
(1) Tax Returns. To prepare, execute and file tax returns of any type
required by applicable law, and to make all tax elections authorized by law.
(m) Allocate Expenses. To allocate administrative expenses to income
or to principal, as the Executor deems appropriate. However, no allocation to
income shall be made if the effect of the allocation is to cause a reduction in the
amount of any estate tax marital deduction or estate tax charitable deduction.
(n) Employ Advisors. To employ custodians of property, investment
or business advisors, accountants and attorneys as the Executor deems
appropriate, and to compensate these persons from assets of my estate, without
affecting the compensation to which the Executor is entitled.
(o) Basis Adjustment. To make any adjustment to basis authorized by
law, including, but not limited to increasing the basis of any property included in
my estate, whether or not passing under this Will, by allocating any amount by
which the bases of assets may be increased. The Executor shall be under no duty
and shall not be required to allocate basis increase exclusively, primarily, or at all
to assets which pass as part of my probate estate as opposed to other property for
which a basis adjustment is allowable. The Executor shall allocate basis increase
equitably among those beneficiaries receiving property as a result of my death, but
shall not be liable to any person, nor subject to removal or surcharge, for any
reasonable allocation of basis increase.
(p) Compromise Claims. To compromise claims.
(q) Other Acts. To do all other acts in the Executor's judgment
deemed necessary or desirable for the proper and advantageous management,
investment and distribution of the estate.
ITEM VII: Beneficiaries Under Age 25. If a beneficiary under
the age of twenty-five (25) years is entitled to receive assets under this Will, the person who
served as Executor of my estate shall retain those assets as Custodian for the beneficiary under
and in accordance with the Pennsylvania Uniform Transfers to Minors Act until the beneficiary
reaches the age of twenty-five (25) years. The Custodian may receive and administer all assets
authorized by law, and shall have full authority as provided in the Pennsylvania Uniform
Transfers to Minors Act to use assets in the manner the Custodian deems advisable for the best
interests of the beneficiary.
ITEM VIII: Survival. Any person who has died within thirty
(30) days of my death, or under such circumstances that the order of our deaths cannot be
established by proof, shall be deemed to have predeceased me.
ITEM IX: Guardians. If I survive the father of my children,
Todd Fouts, I appoint my sister, WENDY J. POLITO, to be the Guardian of the person of each of
my minor children.
ITEM X: Executors. I make the following provisions with
respect to Executors:
(a) Primary Executor. I appoint my sister, WENDY J. POLITO, to be
the Executrix.
(b) Contingent Executor. In the event that my sister, WENDY J.
POLITO, is deceased or unable to serve as Executor, I appoint my brother, RICK
W. KAUFFMAN, to serve as Executor.
(c) Compensation. The Executor shall have the right to receive
reasonable compensation for services rendered and reimbursement for reasonable
expenses.
(d) Standard of Care. No Executor shall be liable or accountable for
any loss that may result from the good faith exercise of the authority granted in
this Will.
(e) Securi .The Executor is specifically relieved from the duty of
filing bond or entering security.
IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and
Testament, consisting of this and the preceding six (6) pages, at the end of each~~p~age of which I
have also set my initials for greater security and better identification this -- ~~'~day of ~~
2011.
(SEAL)
CHRISTINE OUTS
We, the undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testatrix as and for her Last Will and Testament, in
the presence of us, who, at her request and in her presence and in the presence of each other, have
hereunto set our hands and seals the day and year first above written, and we certify that at the
time of the execution thereof, the said Testatrix was of sound and disposing mind and memory.
~_~,~` (SEAL)
Residing at '11 0 /2,rov~i c.cu L.gn e..
~~~IG ~A r ~oa.~
Residing at 1~1 1~\\~y k
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF ~G^ti )
I, CHRISTINE FOUTS, Testatrix, 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 Testament; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes therein expressed.
~ (SEAL)
CHRISTiN FOUTS
Sworn to and subscribed before
me this ~S'"^day of ~.~-e....~c-
20th.
(~
o ary Public
My Commission Expires: ~ `\"S ` ~'i~ ~
(SEAL) coM~toN rH FPENNSriVAN1A
NOTARIAL SEAL
ELIZABETH HALLETT, Notary Public
C~ of Harrisburg, Dauphin County
ommission Expires May 15, 2012
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF -~ ~ )
W e, ~ `~ ~~a~ M . ~lar.~ and ~~' o` Q . ~~ ~ ,the
Witnesses whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw Testatrix, CHRISTINE
FOUTS, sign and execute the instrument as her Last Will and Testament; that Testatrix. signed
willingly and that she executed said Will as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testatrix signed the Will as Witnesses;
and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of
age, of sound mind and under no constraint or undue influence.
U~
Witness Witness
Sworn to and subscribed before
me this lS~^'tlay of '~~-~-~'
20 1 ~.
~.
d
of Public
My Commission Expires: ~ ~ l'S \ amt ~
(SEAL)
O~MMOM 'TH OF P NsnvAN{A
NOTARIAL SEAL.
ELIZABETH HALLETT, Notary Public
C~ of Harrisburg, Dauphin County
ommisaion fires Ma 15, 2012