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HomeMy WebLinkAbout03-30-12Reset PETITION 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: Velma Irene W. Gertzen a1k/a: a/k/a: a/k/a: Date of Death: February 29, 2012 File No• ~( "~~~ ~~~~' (Assigned by Register) Social Security No: 293-07-3454 Age at death • 92 Decedent was domiciled at death in Dauphin County, pennsylvania (state) with his/her last principal residence at 835_Maearo Road. Enola. East Pennsboro Township Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 1901 North Fifth Street. Harrisbure 17102 Harrisbure Dauphin PA Street address, Post Office and Z-p Code City, Township or Borough County State Estimate of value of decedent's property at death If domiciled in Pennsylvania ............................All personal property If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania If not domiciled in Pennsylvania ........................ Personal property in County Value of real estate in Pennsylvania ........................................................ . TOTAL ESTIMATED VALUE... . $ 200.00 $ 200 00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough ® 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 thereto dated ,.. _, County rv ~7' ~: m < v ~~7 State relevant circumstances (e.g. renunciation, death of executor, etc.) ~'.~ ~ ~ S~. _ _ , ~, -. "7C~'r! -•~- Except asfollows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorcee not a pactyto a peti~il divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), an~lid-hot have a ehild bgr~t b~ adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. 'r> .~- ~ ---i Q 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 life, durante absentia, durante minoritate If Administration, c.t.a. or db.n.c.za., 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. O NO EXCEPTIONS o 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 Retationshi Address Form RW-02 rev. 10/11/2011 Page 1 of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } Petitioner(s) Printed Name Petitioner(s) Printed Address Barbara L. Gertzen 835 Ma aro Road Enola PA 17025-1918 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(sl 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 and subscribed before ~~~~~ ~. ~.~ Date c30 me thi. day ~`/~ , c~61 c.~ Date By: Date F r t Register ~ Date BOND Required: Q YES Q NO FEES: ~ vc~ Letters ...................... $ ~~ ( ()Short Certificate(s)...... . ~~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ~~~ •••••••• ~' Automation Fee ............... ~', JCS Fee . .................... ~ ' TOTAL ..................... $ ~ s -~06~ 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 Velma Irene W. Gertzen a/k/a: AND NOW, ~~ ~lJl_U' ! ~~ ~~~~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DEC ED that Letters are hereby granted to to the above estate and (if applicable) that the instrurrtent(s) dated ~ ~~ ~ COI described in the Petition be admitted to probate and Form RW-02 rev. 10/11/2011 /~ ~ File No: ~.~~~-' ~~~ _ V ~c~ Page 2 of 2 LOCAL ~L~~~~~~~~ CERTIFICATION OF DEATH WARNING: I~ legal to d~pdcate this copy by photostat or photogra&~h. l~'^,.~. i ,_ ~ .... ~ Fee for this certificate, $6.00 W 1,l ~~ P 1833084__4__ Certification Number Type/Print In Permanent ~~~J~ ~9~R Jti ~~ (~ ~~~hi~; i~ tO _ctti~, ~ui ihr infr)rm,(ti~)n )~u~rc ;.rig(°j) i,~ ~orreetl~ ccl~~)ir.i ~)'~~)t un ((~~eiu~d Ce~tifi( „e r)f~' (~utij duly filed laid) n( .r; I or(I R<~~~isttu. "i~hl~ II) ~-~ir)~a1 CLERK C~ ct(irticate eti~)i, ),~ ~~))',ti ,rde({ tO fire `a<)3c '.,~)i:(l ORPHAN S COUR .~ E'ccurdti ntttc( I ~o.~n~ia)ii~nt lliut~~. CUMBFRI ~r~~ C0 . __CCQ.I~.u~-e~., -~~~~_.__ i,cal z~i~•,trai [~~a1~~ I~,',)ti~,~t COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH VITAL RECORDS f"F QTICg/"ATC AC g1CATu - _ - - State Flle Numbly: 1. Decedent's Legal Name (First, Middle, Last, suHlx) 2. Sax 3. Social Security Number 4 p t f D h . a e o eat (MO/Day r) (Spell Mo) Velma Irene W. Gertzen Female 293-07-3454 fj/-y ~jp ,,~ ~Q~ Sa. Age-Last Birthday (Vrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Data of Birth (MO/Day/Vaar) (Spell Month) 7a. Birthplace (City and State or For•Ign Country) 92 Months Days Hours Mlnutas Meade OH September 23, 1919 7b. Birthplace (County) ge lmont 8 a. Residence (State or Foreign Country) 8b. Resitlencl (Street and Number -Include Apt No.) Bc. Did Decatlent Live In a Township? Btl. Residence (county) 835 Magaro Road ~Y•z, decedent Ilvetl in East Pennabor twp. Cumberland g•. R•sidenu (zip Code) ONO, decadent Ilvetl within limits of city/born. 9. Ever In US Armed Forces? 10. MaNtal S[atus at Tlms of Death ^ Married ® Wldowe 31. Surviving Spouse's Nama (If wife, give name prior to Rrst marria e) g ^ Ves ®No ^ Unknown ^ Divorced ^ Never Married ^ Unknown 32. Father's Name (First, Middle, Lazt, SuMx) 13. Mother's Name Prior [o First Marriage (First, Middle, Lasi) Edward B. Wallace Etl[el Strickler 14a. Informant's Nama 14b. Relationship to Daudent 34c. Informant's Melling Address (Street and Number, City, State, zip Code? Barbara L. Gertzen Daughter 835 Ma aro Road Enola PA 17025 s S Ir Death ott~rred In a Hospl[al: ~(~ Inpa[I•nt (11 o::en ott~r~•d so~,:.wna~: other Tnan a Hos Ital- ...... ...................... ..... ....... ... p Hospice Facilit ~~D d ' y ec• lnt s Home Emer en Room/Outpatient Dead on Arrival _ Nursin Home/LOn -Term Care Faclllty Other (Specify) 1Sb. F clllty Nam! (If not lest ution, give a[roaf and number; 1st. City or Town, Stab, and Ip Code lSd. ry of Death m 16a. Methotl of Dlaposiflon ^ Burial ® Cremation 16b. Date o1 Dlsposltion 16c. Plac f Disposition (Name of cemebry crematory or other place) , , ^ Removal from State ^ Donation Other (specify) 3-2-2012 Cremation Society of PA ~ 16d. LoUtlon of Disposition (City or Town, State, and 2Ip) 17a. Signs a of Fu eral Servic Icansee r Person Charge of Interment 17b. License Number r Harrisburg, PA 17109 FD 138312 17c. Name and Comple[e Address of Funeral Faclllty Auer Cremation Services of Pennsylvania Inc. , 4100 Jon town Road Harriabur PA 17109 ~ 3$. Decedent's Education -Check the box that best deseribes [ha 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to IndlOta what highest degree or level of school completed at the time of dea[h. box that beat describes whether the tlatetlem the tleeadent considered himself or herself to ba . ^ 8th grade or less Is Spanish/HlsDanlc/Latino. Check the "NO" ®Whl[e Korean ^ No diploma, 9th - 12th gratle box if tlaeedent is no< Spanish/Hispanic/Latino. ^ Black or African American ^ Vietnamese ® Hlgh school graduate or GED completetl ®No, not Spanlah/Hispanic/Latino ~ American Indian or Alaska Native ~ Other Aalan ^ S ll ome co age credit, but no degree ^ Yes, Mexican, Mexlun Amerlun, Clilteno ^ Asian Indian ^ N•tlve Hawallan ~ A i ssoc ate tlegro• (e.g. AA, AS) ^ Yes, Puerto Rican ^ Chinese 0 Guamanian or Chamorro Q Bachelor's degree (e g BA AB BS) . . , , ^ Yes, Cuban ^ Filipino ^ Samoan Q Master's degree (e.g. MA, MS, MEng, MEd, MS W, MBA) ^ Ves, other Spanish/Hispanic/Latino ^ Ja anese p ^ Other Patinc Islander ^ Doctorate (e.g. PhD, EtlD) or Professional degroe S ( ( pacl y) ^ Other (Specify) . MD DDS DVM LLB JO 21. Decedent's Single Race Self-Deslgnatlon -Check ONLY ONE to Indlcatl what the decedent considered himself or herself [o be 22a Decedent' U l O i . . s sua ccupat on - Intllcate ryp• of work ® White ^ Japanese Q Samoan tlone during most of working life. DO NOT USE RETIRED . ^ Blaek or African American ^ Korean ^ O[her Pacific Iz4nder ^ American Indian or Alaska Native ^ Vietnamese ^ Don't Know/Not Sure Office Adminia tration ^ Asian Indian ^ Other Asian ~ Refusetl 22b. Kind of Business/Industry ^ Ghinlse Q Native Hawallan ^ Other (Spec) H) Office Q Filipino ^ Guamanian or Chamorro ITEMS 29a - 23d MUST BE COMPLETED 23a. Date Pr noun d Dead Mo Day r 236. Signature Person Pronouncing Deat On y when applicable 23c. Ucense Num er BY PERSON WMO PRONOUNCES OR ~ yT ~D CERTIFIES DEATH Of`! ' / `~c/_ ~C C~ ~-• 23d Date Si n M / ~ ~ r-~ "~ . g ( O (/v/ ay/Yr) 24. Time of D~ja h _ ~~c `~ ~ ~ d' ` V ~ A, N/, 2 .Was Mediol Examiner or Coroner Contac[adi ^ Ves No CAUSE OF DEATH Approxlma[e 26. Part 1. Enter the chain of events--diseases, injuries, or complications-that directly caused the death. DO NOT enter terminal events Such as cardiac arrest Interval: respiratory arrest, or ventricular /lbrilletion withou t show i ng t he etiology. DO N OT ABBREVIATE. Enter only one cause on a line. Add atlditlonal lines If necessary Onset to DeaTh e `~ ( '' / J ~ ~ IMMEDIATE CAUSE ---------------> a. `~~-/ '~ f S JOcJ/~CJC- U/F LCit~..Jit i (Final disease or condition D to (o as a consequence ot): resulting In death) b. Sequentially list conditions, Dua to (or as a consequence ofl: j If any, Ilading to the cause listed on line a. Enter the UNDERLYING GUSE Due to (or es s copse quanta ofl: ~ (elseas. or Injury Tnat CsYt InltlaNtl [hl events resulting d. In death) LAST. Due to (or as a wnsequence of): i 26. Part 11. Enter other sl in dltl b but not resulting In <he underlying cause given in Part I 27. Was an autopsy perfo dT f Yea Ne ~. 2B. Were autopsy endings available $$ to complete the cwze o ath7 Ves 29. If Fe~ 30. Did Tobacco Use Contribute to Death? 31. M Death N t re nant ithi p g w Id n past year ^ y ^ Probably Natural ~ Homlcitle P ^ regnant at time of death o ^ Unknown ^ Accident ^ Pending Investigation ^ Not ro nant b t o I- p g , u pregnant wlehin 42 days of tleath ^ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In u ~ Suicide 0 Could not be determined j ry (MO/Day/Vr) (Spell Month) ^ Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; cons[ructlon site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury ai Work 37. It Transportation Injury, Splclfy: 38. Describe How Injury Occurred: Q Yes ^ Driver/Operator ^ Pedes[rlan ~ No 0 Passenger ~ Other (Specify) 39a. C ar (Check only one): rtiTying physician - To the best of my knowledge, tleath occurred due to the cause(s) and manner stated Pronouncing a Certifying physician - To the best of my knowledge, death occurrod at the time, date, and place, and tlue to [ha cause(s) antl manner stated O Medical Examiner/Coroner the basis oT examine /or Invastigatlon, In my opinion, d• t c d at the e, dab, and place, and tlue to the cause(s) antl manner stated sgnamr. of tertln ~m ~ er: / ^+ nn! of t.rtln.r/// /tit c Lic.n.. N~mb.r: /1s~7 o G G .tea YL 39b. Na e, Address antl 2Ip Co a of Person Completing Cause of eath (Item 26) 39c. Date SI n d jMO Day/Vr) r '~ ~~~ u~s+ /~" ~ f/ Z ell / S ~ 40. Registrar s DISTrItY Num er 41. Registers ILnatu e - 4 .Rag stray 1 e to Mo Day w ~z 43. Amendments 1 ~ ~ _ ~ ` ~Q' Z ~~ -~1 O f] ~ 5 ~ r _ g' H305-143 Dlsposltion Permit No. - r l.s' REV 07/2011 t i .'~.~ - ~- .n n, __~.' '~~~',~~ TX~ ~~~ ~~e~#~rYt~e~rt~R 3c~ Ah I ~ ; ~ 4 CE_ERK CF Off' ORPHAN'S COURT ~EG~A I2~~~E `fN. ~E~`I.ZEN CUMR~RE.A~JI~ CC PA I, VELMA IRENE W. GERTZEN, of Enola, Cumberland County, Pennsylvania, being of sound mind and memory, do make, publish and declare this my Last Will and Testament, hereby revoking all former wills and codicils made by me. A. DEBTS AND EXPENSES: I will and direct my personal representative to pay all legally enforceable debts, including the expenses of my last illness and funeral expenses, current bills and any and all other expenses incurred in administering my estate. B. FAMILY IDENTIFICATION: My husband and parents are deceased. My children are BARRY L. GERTZEN (deceased), BARBARA L. GERTZEN and ARLENE F. WITKOSKI. I have no grandchildren at this time. C. PERSONAL PROPERTY: If my daughter, BARBARA L. GERTZEN, survives me, my personal effects, including automobiles, boats, sporting equipment, jewelry, furniture, furnishings, china, glassware, silver and household equipment (except those items which are specifically given to a beneficiary elsewhere in this Last Will and Testament in which case said specific gift shall take precedence over this paragraph) shall be distributed to my surviving daughter, BARBARA L. GERTZEN. If my daughter, BARBARA L. GERTZEN, does not survive me, then I direct that my personal representative(s) divide my personal effects, as described above (except those items which are specifically given to a beneficiary elsewhere in this Last Will and Testament in which case said specific gift shall take precedence over this paragraph), among the following named beneficiaries who survive, as the surviving named beneficiaries agree or, failing such agreement, in such manner as my personal representative(s) may deem equitable. If my daughter, BARBARA L. GERTZEN, does not survive me and if the surviving named beneficiaries do not agree, I give my personal representative(s) full discretion to determine the division and distribution of the articles above referred to between my surviving named beneficiaries, and such determination shall be binding on all persons. The named beneficiary for purposes of this paragraph is: ARLENE F. WITKOSKI. I attest to the Testator initialing this page: WITNESSES: ~~ 1 y~ Page 1 of 8 I have read and understood this page: TESTATO U'•~. Page 2, Last Will and Testament of Velma Irene W. Gertzen D. SPECIFIC GIFTS Item Beneficiary 1. $1,000.00 ARLENE F. WITKOSKI E. ESTATE TAX PROVISIONS: My residuary estate remaining after compliance with the previous provisions is to be given to my daughter, BARBARA L. GERTZEN, if she survives me, but she shall have the right to disclaim all or any part of said residue. Upon said disclaimer of assets by either, the disclaimed whole or portion shall be distributed to and administered pursuant to the provisions for the Non-Marital Share as described hereunder. 1. NON-MARITAL SHARE Upon my death, the assets of this Non-Marital Share shall be divided among my named beneficiaries in equal shares. The named beneficiaries for purposes of this paragraph are ARLENE F. WITKOSKI. F. DISTRIBUTION OF RESIDUE: If my daughter, BARBARA L. GERTZEN, does not survive me, I give, devise and bequeath all of the rest, residue and remainder of my estate and property, of whatever kind and wherever situated, owned by me at the time of my death to my beneficiary, ARLENE F. WITKOSKI. If a named beneficiary does not survive me, I give the share of said beneficiary to that beneficiary's issue by representation. G. HEIRS INTENTIONALLY NOT NAMED• I have consciously not named any other family member and their issue under the terms of this document. H. NO CONTEST PHRASE: If any beneficiary of this will or any trust created under this will, singly or in conjunction with any other person: 1. Contests or otherwise objects in any court to the validity of any of the following documents or amendments thereto (hereafter "Document" or "Documents") or of any of their provisions: WITNESSES: ~yEJav" ~~~~ TESTATOR: ~~ ,~C ~ . Page 3, Last Will and Testament of Velma Irene W. Gertzen a. this Last Will and Testament, b. any trust created pursuant to this Last Will and Testament, c. any beneficiary designation of an annuity, retirement plan, IRA, Keogh, pension orprofit-sharing plan or insurance policy signed by me, d. a buy-sell agreement signed by me, e. a family partnership agreement, limited liability company, or related operating agreement signed or established by me; or 2. Seeks to obtain an adjudication in any court proceeding that a Document is void, or otherwise seeks to void, nullify or set aside a Document (or any of its provisions); 3. Files suit on a creditor's claim filed in a probate of my estate against the estate, or any other Document, after rejection or lack of action by the respective fiduciary; 4. Files a petition or other pleading to change the character (community, separate, joint tenancy, partnership, domestic partnership) of property already characterized by a Document; 5. Claims ownership of any asset held by me in joint tenancy, other than as a surviving joint tenant; 6. Files a petition to probate homestead in a probate proceeding of my estate; 7. Files a petition for family allowance in a probate of my estate; or 8. Participates in any of the above actions in a manner adverse to the estate, such as conspiring with or assisting any person who takes any of the above actions, then the right of such beneficiary to take any interest given to him or her under this will or any trust created pursuant to this will shall be determined as it would have been determined had such beneficiary predeceased the testator without surviving issue. The personal representative is hereby authorized to defend, at the expense of the estate, any contest or other violation of this paragraph. Notwithstanding the foregoing, a WITNESSES: ~_. ~ ~-~l ~.~/`~ TESTATOR: ~.~ ~ . Page 4, Last Will and Testament of Velma Irene W. Gertzen "contest" shall include any action described above in an arbitration proceeding and shall not include any action described above solely in a mediation not preceded by the filing of a contest with the court. Notwithstanding the foregoing, this paragraph shall not apply so as to cause a forfeiture of any distribution otherwise qualifying for the federal estate tax marital deduction or charitable deduction. I. SURVIVORSHIP PHRASE: If any beneficiary dies prior to the entry of an order, decree, or judgment in my estate distributing the property in question, or within sixty (60) days after the date of my death, whichever is earlier, any interests which would have passed to said beneficiary under the provisions of this Last Will and Testament are to be disposed of according to the plan of distribution which would have been effective under this Last Will and Testament if such beneficiary had predeceased me, except that, if a'Simultaneous Death Provision' is included in this Last Will and Testament or in any codicil thereto, the Simultaneous Death Provision shall take precedence over the provisions of this paragraph in regard to survivorship of my partner. It is my intention that any property or interest which is distributed from my estate as a result of any transfer authorized by my personal representative prior to the death of said beneficiary will not be revoked or otherwise affected by the subsequent death of the distributee. PERSONAL REPRESENTATIVE(S)• I constitute and appoint BARBARA L. GERTZEN personal representative of this my Last Will and Testament. I authorize and empower my personal representative to sell, transfer and convey any and all of the property of my estate, real and personal, and to execute, acknowledge and deliver good and sufficient transfers and conveyances thereof. 2. If BARBARA L. GERTZEN is unable or unwilling to serve as personal representative, Iconstitute and appoint ARLENE F. WITKOSKI as personal representative to serve with all rights and responsibilities given to the original personal representative(s). 3. If no personal representative named in this will is willing and able to act, a personal representative or co-personal representatives maybe selected by the court. The personal representative(s) so selected and appointed shall have all WITNESSES: TESTATOR: ~ ~~ ~ .~ Page 5, Last Will and Testament of Velma Irene W. Gertzen rights and responsibilities hereinbefore given to the named personal representative(s). 4. No bond will be required of the personal representative. K. WILL CONSTRUCTION: 1. Wherever the context requires, the singular includes the plural, and the masculine includes the feminine and neuter. The words "child", "children", "grandchild" and "grandchildren" shall include legally adopted children and grandchildren and children and grandchildren born or adopted before or after the execution of this Last Will and Testament, but shall not include stepchildren or step grandchildren who have not been legally adopted. Also, in construing this will, the terms "lineal descendants" and "issue" shall include legally adopted lineal descendants and issue and lineal descendants and issue born or adopted before or after the execution of this will. 2. The phrases "issue by right of representation" and "issue by representation" shall mean lineal descendants, per stirpes. The phrase "his/her and/or their issue by representation" shall be interpreted so that if a beneficiary of this will is alive at the applicable date, the beneficiary's share is distributed to said beneficiary and issue do not take as beneficiaries, but if a beneficiary of this will is deceased as of the applicable date and the will provisions provide that the beneficiary's "issue by representation" take the deceased beneficiary's share, then that beneficiary's lineal descendants, per stirpes, take, inherit, and/or benefit as the deceased beneficiary's issue by representation or issue by right of representation. Issue shall mean lineal blood descendants and legally adopted descendants, unless stated otherwise. The phrase per stirpes shall mean (1) the division of distributable property into the number of equal shares sufficient to create one such share with respect to each then living descendant occupying the oldest generation in which there is at least one then living person, and one such share with respect to each deceased descendant occupying the same generation who is then survived by one or more descendants, and (2) distribution of each share so created with respect to a then living descendant to such descendant, and distribution of each deceased descendant's share equally among or between the deceased descendant's children, also per stirpes as defined in (1) above. 3. The word "testamentary" shall be construed as meaning arising after death, and shall not be construed to imply any requirement of a probate proceeding of any type. All references to I.R.C. § and/or Reg. § or Regulation § shall include any WITNESSES: TESTATOR: U • ' ,~ " J~-~i/ Page 6, Last Will and Testament of Velma Irene W. Gertzen amendments and/or equivalent successor section to said code or regulation. Trustee(s) includes any person(s), corporation(s) or other entity(ies) from time to time holding that office as sole or co-trustee. Personal Representative includes any person or corporation from time to time holding that office and also includes a special administrator. ~tne s: Testa ~~ Page 7, Last Will and Testament of Velma Irene W. Gertzen IN WITNESS WHEREOF, I have hereunto set my hand and seal this 22°a day of May, 2010. WITNESSES: ,//,, __ II.. -- TESTATOR: ~. VELMA IRENE W. GERTZEN Pennsylvania Self-Proving Clause Commonwealth of Pennsylvania County of Dauphin I, VELMA IRENE W. GERTZEN, 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 I signed it willingly and as my free and voluntary act for the purposes therein expressed. `"' ` LMA IRE W. GERTZEN Sworn or affirmed to and acknowledged before me by VELMA IRENE W. GERTZEN, the testator, this 22°a day of May, 2010. co~oNVVFA~rH of PENNSnv~wu- (Seal j NotaAal Seal leo L. Dunn, Notary Public susquenanna Twp., osuphM County LEO L. DLTNN Notar Public My Commisalon Exptraa Jan. 17, 2012 ~ y Member, Pennsylvania Aasodatlon a Notaries My commission expires Jan. 17, 2012 Affidavit Commonwealth of Pennsylvania County of Dauphin We, ~1f~.~ ~ 1J l ,2~f~~, 1`~~~ ~~~E- ~- and «l~s~.~l ~,, /4~ ~= ,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 testator sign and execute this will as his Last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us 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. Page 8, Last Will and Testament of Velma Irene W. Gertzen S orn or affirmed to and subscribed to before me by ~~i5 •. ~, lber~ , ~ ~ ~0~~3~' and /`~ ~ ~ ~--~~ D ~'~ (b~~- ,witnesses, this 22°d day of May, 2010. Wit s / l Pri Name;,,1~p~J/~ ~~21~b~ Print Address: 3~ ~~( ~ j arr~~5 v ~i~D Witness ,- // Print Name: ~ ~c ~fj-~~ ~ ~~1~~~ Print Address: ~ ' ,.,/ a~ S.~-• ~5c~~1) co~cx~vvEA~Tfi of PENNasnva~w- Notarial Seal Leo L. Dunn, Notary Public Susquehanna Twp., Dauphin County MY COrmrissbn ExpNbs Jan. 17, 2012 AAembsr, Pennsylvania Assodstion o/ Notaries -~- Witness Print Name: ~„ ~ ~ ,QK,~ .~- Print Address: o~ /5/ dva Sr L ~4.4/s,FSU.cs G ill/o L O L. DLTNN, Notary Public My commission expires Jan. 17, 2012