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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PrNNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as speciFed below, and in
support thereof aw~rrer,(syy)~~ the following and respectfully request(s) the grant of Letters in the appropriate form:
Decedenf~~ri~![tion
Name• Leona Fink File No• ,,[ ~ - ~ -~ -{~- "'j l . 7
a/k/a: (Assigned by Register)
a/k/a:
a/Wa:
Date of Death: 6/13/2012
Social Security No:
Age at death: 93
Decedent was domiciled at death in Cumberland County, pennsvlvania (Srmte) with his/her last
principal residence at 17 hieh Street. Boilint=_ Sprines, PA 17007 South Middleton Township Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Hamsbure Hospital, Harrisburg, PA 17101 Harrisbure Dauphin PA
Street address, Post Office and Zip Code City, Township or Borough County State
F,stimate of value of decedent's property at death
If domiciled in Pennsylvania ............................ All personal property $ 33,500.(10
If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Penmrylvania ......................................................... $ _ 143 4(?p (10
TOTAL ESTIMATED VALUE.... $ 187.000.00
Real estate in Pennsylvania situated at: 17 High St, Boiling SprinQS PA 17007 South Middleton Township Cumberland
(Attach additional sheets, ifnecessary.) 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/are the Executor(s) named in the last Will of the Decedent, dated
thereto dated
3/01 /2001
and Codicil(s)
State relevant circumstances (eg. renunciation, deatk ojexeeator, 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 bom or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
O NO EXCEPTIONS o 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
1f Administration, c.~a. or db.n.~ta., 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 beers 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 W ill and was survived by the following spouse (ifany) and heirs (attach
additional sheets, if necessary):
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Name Relationshi Address CQ R'
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Page 1 of 2
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF
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Petitioner(s) Printed Name Petitioner(s) Printed Address -- _
James C Fink Jr ihl` ':: ;~ vii
10 Kin s Ct Pennin ton NJ 08534 ~
The Petitioners} above-named swears} 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 d truly administer the estate according to law.
Sworn to or affirmed a d subscribed before I ,Y- Date ~t 3..5 Zv / L
me this -~ day of-~\ (: , ' ~~- ~ llate.
BY~ ~ ,~t (~t l ~ t i `~L ~~~~1~ ~11
For the Register
Date
Date
BOND Required: Q YES ~ NO
FEES:
Letters ................ $--
( ~C )Short Certificate(s)...... Z (, :
( )Renunciation(s)........ .
( )Codicil(s) . ........... .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ._...,,_
~ ~` 1 ~ ....... _
.......
Automation Fee ............... 1
JCS Fee . .................... ~ . '- • ,.
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 THC RECifiTER
Estate of ~k f=C, a~(~ X1,1 ~-i f l ~ File No: ,-y (- (~ ~ ~ ' =~;
a/k/a;
AND NOW, t~ ~ ~ ~.~ -'~,~ „ '' •_, in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DF,CREFD that Letters ~ '
are hereby granted to , ~(~_~~~ (~ ~l ~ ] ~ ~ !
in the above estate and (if applicable) that
the instrument(s) dated ,'•~ l ~CC:2
descnbed m the Petttton be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
/~ - _ / ~ r ~ ~ ~~ ~ l:~ i~~
Register of ~- ~ ~ ~ "~;
Form RW-02 rev. 10/11/2011 1 P e ~ Of
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~dV~l I';(_~: lt=is'~l.~~al to duplicate #R~IZ ~.. ~~';l~agr., -.~ L 't'
~~~~ ,rol~ If,~~; ~:,~(~;fj,~~t~. rr, c,,u:J,2 JUN 25 ~~ 9~ 2
GRP-;P,Iv~~ ~Uui~~
CUMBERLAND CO.. PA
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COMMONWEALTH Of PENNSYLVANIA ~ DEPA0.TMENi OT HEALTH ~ VITA( AECORpS
CERTIFICATE ~F DEATH
1. Decedent's Legal Name iFtrst, Middle, tart, SufTixi 2. Sex 3. Spcial Security Number too} Death (Mo/DaV/yrl (Spell of
Leov,a e '~ ~ ~I
Sa age-ust BlM1htlay Irrsl 6b. Untler 1 Vear Sc. Untler 1 Da 6. Date pl Binh (MO
/D ay/Y
e
ar) ISOtI I MontM1 Ja. BlrtM1place (City antl St or Foreign Country)
Months DPYS Hours Minutes ry
] '
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~u.hL ( J f 1'~ ]b. Brtthplact (County)
Ba Residence (State or Foreign Country) r
. Include Aot No.l
sidence (Street and Nu
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be
8b R
e 8 Did Decedent Live in a townships
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i ~s. d.,c¢dent ,ytd m ~Ol_lSN Y t 1; IF~~V1 twp-
Btl.ResidenCe(000nty)
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yryL Be. Residence (tip Cotlel ~~ ^ No, decedent Ilvetl wlmin limits of __ city/born.
9. Ever In U$ A~r 'M Forcesi 10 Martial Status at Time of Death ^ Ma.ded Widpwed 1] Surviving Spouse's Name (If wife, glue an me prior to first marriage)
^ve BNO ^Unknown ^p'rvoeced ^Never Married ^Unknown
ther's Name (First. Middl
e
, Last, SufRvj
] 1. Fa 13. Mother's Name Prior co First Marriage IFtrst. Middle, Last)
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laa. Informant's Name lab. Relationship to Oecedem laclnfprmant's Mailing Address tree[ and Number, City, Slate, Zip Code(
Y. ~ ~ fyzet ~ n ' ~ GO
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. Lsa.Pacto peat c e¢kony
............._...
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...................................................... ..........._...........
1l peath Occurred ina HOS 1 Inpatient
pica ......
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........
.
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WWii
w pta pce ry [Decedent's Nome
It Death Occurrltl Some here Other Than a Hof 1 I LJ Has I Faclll
[J Emergency Room/Outpatient ^ Oead on Arrival
~ ~ Nursing Home/Long-term Care facility ixner Ispeci/vl
IBb. facllMy Name(Il not instkution, give street and number; 35c. Qty or Town, State, and Zip Code SSd. County of Death
rz,- b ?rot ~ ~ h
]6a. Method of Disposition urlal ^ Cremation 16b. Dale o/Disposition ] .Place of Disposition )Name olcemetery,crematory,w other place)
^Rtmoyal from 6tate ^ppna[ion ~(~g~~O
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16d.L Lion of Disposition {CiH or Town, Btate, and Eipl
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1]a.5 gp FFU rat Isa or Per harge of lnterme t IJb. License Number
~am Nell PA Rolf ~~" ~:-~- F'.1~D137U4L
1]c Name aM CpmDlete Address o/Funeral Faculty
ri ~ 37 - A 7 ~3
18.0 eden['s Educatbn eck the boa that best descnbesthe 19. Decedent of nit Origin Check the 2 0. Dettdent's Race-CheckO AMORE rxes tp indicate what
highest degree or level of uhool completed at the time of death. box that best describes whether the decedent t he decedent consitlered himself or herself to be.
~Blh grade pr leis Is Spanish/HlspamC/lahno Check the'NO' ~WM1ite ^NOrean
ND tllploma, 9th -12th grade bpe II tlecedenl is not $panlsN/M'upaNC/Latino ^ Black or African American ^ Vietnamese
HlgM1 icM1OOl graduate or GED Completed No, not Spanish/Hif panic/LaClnp American lndlan or Alaska Native Other ASian
~ Some college cretliE but no degree ^ Yes, Mexican, Mexican American, Chicano ^ Asian lndlan ^ Natve Hawaiian
Associate degree (e. g. AA, AS) ^ Yes, Puertp Rican ^ CM1inese ^ Guamanian or Chamorro
~ Bachelor s degree (e.g. BA, AB, BSI ^ Yes, Cuban ^ Filipino ^ Samoan
~Mastei sdegree (e.g.MA, MS, MEng, MEq MSW. MBA) ^Yes, Omer SpanishjHlspanic)Latinp ^lapan<se ^Otlier Pacific Islander
0 Doctorate(<g. PM10, Ed01 or professional degree ISpecilyi ____,-___ ^ Omer lBpecity) _ __
e.. M0, DDS DVM, lLB 1p
11. Decedent's Single Race Sell-Designati n -Check ONLY ONE b indicate what the decedent Considered himself or nerself lobe
o 22a. Decedent's Usual Occupation -Indicate type of work
~lapanese ^Samoan
White done tludng most or working tile. DO NOT USE AETIPEO.
01ack or 0.Frkan American ^ Korean ^ Dther Pacific Islander rv /
qt
American lndlan or Alaska Native ~ V ^ Don't know/Nat Sure
t ~,Y
~V V
e sASlan ^ Refused
^ Asian Intllan ^ Oth 22b Klnd of Businessltntlurtry
[] Chinese ^ Native Hawaiian ^ Omer ISp¢cityl ~/~
~
I] Filipino ^ Guamanian pr Chamorro ICLt
V f I~
ItEM623a ~ lid MUST BE COMPLETED 23a.Oate Dronounced Dead (Mp/Day r) 23h Signature of Person Pronouncing Death (Only when applicable 13[. License Number
RV PERSON WNO PRONOUNCE8 OR
CERTIFIES DEATH ~ 1 J C J
13d Oate Signed iMOJDay/Yr) 2 sine pi Death
ZS Was Medical E.aminer or Coroner Cpntaned? ^ Yes No
CAUSE OF DEATH i Appmaimate
J6. Part I. Enter the Chain of eyents~~diseases, iryuries, er cpmplicatipns-that directly caused [M1e death DO NOT enter terminal events such as cardla<arrest lntervaL.
espi story arrest, pr ventricular fibrillation without showing the etiology. p0 NOT ABBREVIATE Enter only one cause on a Nne Add atldibonal Imes it necessary ': Onset to Death
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IMMED ATC CAUSE --~~~-----~? a. __ -.--_
IFnal d sease or co d Ion D ( c oN.
residing ndeaml ' ~
b- ~~L'~,` S I IYC ~lT 6f 4 1 (//~ C( d ~4'. '_.~LC ~ICr ____
seapenbabY ust mnd'nbn:, Die to lot as a tnnsepience o0.
,l any, leading to me cause
zsetl on line a. Enter me _ __ __ -_ --
VNDFRlY1NG GUSE Due to (o ar s a conse9uence ol):
Itllsease it injury that
r iba[etl the events rewltrng d. ___ . __ __ -_
in tleath) 01sT. Oue to for as a conse9uen<e of):
26. Part II. Enter Other stars fcant contlltlons contrlbul na to death but not resulting'rn the underlying cause given in Part I 2). Was an autopsy pertormetl?
^ Yei No
28. We.e autopsy Rndings available
b omplete the cause of death)
C
~ Yes ^ Np
29. 11 cemale 3D. DID Tobacco Use Contribute b Death? 31. Manner of Death
I~ Not pregnant within Wit Year
[] Pregnant at time of dean ~ Yes ~ Probably
®No ~ Unknown E/I Natural ~ Homicide
/^„ Accltlent 0 Pending Investigation
~ Not pregnant, but pregnam wkhln a2 tlays of tleatll ^ Suicide ~ Coultl no[ be determined
Not pregnant, but pregnant a3 days to 1 year before death 31. Date pf mlury (Mp/Day/Yrl (Spell Month)
^ Unknown R pregnant within the past year 33. Time of Injury
3a. Place pf Injury le-e- M1ome; construction site; farm: zchppli 35. Location of Injury (Street and Number, City, State, Zip Cade)
36 Injury at Work 3J. 1}Transportation Injury, Bpecify. 3B. Des[ribe How Injury OCCUrred.
Ve ~ DrNer/Operator ^ Pedestrian
No ^ Passenger ^ Omer ISpeclMl
39a. Certifier (Check poly one).
Certifylnl OhVSician - To the best of mY knowledge, death pc due to (M1e causelsl and manner stated
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th turfed at the time, date, and place, and due to the causelsl and manner stated
^ Pronouncing & Certifyi pM1y~ician ~ To me best of mY kno ed
a d manner stated
^ Medical Evaminer/ - On the pass~~ 1 r Inv my opinion, death pc d at the time, date, and place, and Aue to [he ca (s
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4
LEONAM. FINK ~'c`>-~ `-~ ~~'
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I, LEONA M. FINK, of the Borough of Boiling Springs, Cumberland~~ T'
County, Pennsylvania, do make, publish and declare this to be my Last Will and
Testament, hereby revoking all Wills and Codicils by me at any time made.
ITEM I: 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. 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 II: 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 III: I give 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 to my son, ROBERT L. FINK, if he survives me. If ROBERT L.
FINK does not survive me, then the property shall be sold and the proceeds shall be
added to my residuary estate.
Page 1 d1 ~` ~`
ITEM IV: I give the residue of my estate, not
disposed of in the preceding portions of this Will, to my son, ROBERT L. FINK, if he
survives me. If he does not survive me, I give the residue to my son, JAMES C.
FINK, as Trustee (hereinafter referred to as "Trustee"), IN TRUST, to be
administered and distributed as follows:
(a) The Trustee shall divide the principal of the Trust into as
many equal shares as there are then living grandchildren of mine, and
the Trustee shall set apart for each grandchild one (1) share of the
principal. Each share shall be administered and distributed as follows:
(1) The Trustee shall hold each share as a
separate trust for the benefit of the grandchild for whom
it was established. The Trustee shall pay to or for the
benefit of my grandchild, in convenient, at least quarterly
installments, all of the net income.
(2) The Trustee shall also pay to or for the
benefit of my grandchild, so much of the principal of his or
her separate trust as the Trustee, in the sole discretion of
the Trustee, deems necessary for the proper support,
maintenance, education and medical care of my
grandchild.
(3) At the time my grandchild attains the age of
twenty-five (25) years, the Trustee shall pay to my
grandchild the remaining principal.
Page 2 ~ ~~ ~
(4) Upon the death of a grandchild prior to
attaining the age of twenty-five (25) years, the Trust shall
terminate and the Trustee shall distribute the principal of
the Trust to the then living issue of my grandchild, per
stirpes. If my grandchild is not survived by any then
living issue, the Trustee shall distribute the remaining
principal equally among my other grandchildren who are
living at the time. However, if there is any Trust
established under this Will for the benefit of a grandchild,
the Trustee shall add the share of that grandchild to the
principal of his or her Trust, to be administered and
distributed as provided herein.
ITEM V: No part of the income or principal of any
Trust created by this Will shall be subject to attachment, levy or seizure by any
creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary
prior to his or her actual receipt of income or principal distributed. The Trustee
shall pay the net income and the principal to the beneficiaries specified by me, as
their interests may appear, without regard to any attempted anticipation, pledging
or assignment, and without regard to any claim or attempted levy, attachment,
seizure or other process against the beneficiary.
ITEM VI: The Executor and the Trustee shall each
possess the following powers, each of which may be exercised without court
approval and in a fiduciary capacity only:
(a) 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 or Trustee.
Page 3 ~'~~ • `~ ~~
(b) 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) In order to divide the principal of a Trust or fo~° any other
purpose, including final distributions, the Executor and Trustee are
authorized to divide and distribute personal property and real
property, partly or wholly in kind, and to allocate specific assets among
beneficiaries and Trusts so long as the total market value of each
share is not affected by the division, distribution or allocation in kind.
The Executor and Trustee are each 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) To sell either at public or private sale real and 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(s). The Executor and Trustee are
authorized to execute, acknowledge and deliver deeds, assignments,
options or other writings as necessary or convenient to any of the
power conferred upon the Executor and Trustee.
(e) To mortgage real estate, and to make leases of real estate.
Page 4 U' ~ ~'
(f) To borrow money from any person, including the Executor
or Trustee, 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 or any Trust established by this
Will.
(g) To pay all costs, taxes, expenses and charges in
connection with the administration of my estate or any Trust
established under this Will.
(h) 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 the
Executor deems prudent and appropriate.
(i) To vote shares of stock which form a part of my estate or
any Trust established under this Will, and to exercise all the powers
incident to the ownership of stock.
(j) To unite with other owners of property similar to property
in my estate to carry out plans for the reorganization of any company
', whose securities form a part of my estate.
(k} 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 a
third-party beneficiary contract.
II Pages ~ ~ ~'~~
I
(1) To prepare, execute and file tax returns of any type
required by applicable law, and to make all tax elections authorized by
law.
(m) To employ custodians of property, investment or business
!, advisors, accountants and attorneys as the Executor or Trustee deems
appropriate, and to compensate these persons from assets of my estate
or trust, without affecting the compensation to which the Executor and
Trustee are entitled.
(n) To divide any Trust created in this Will into two or more
separate Trusts so that inclusion ratio for purposes of the generation-
skipping transfer tax shall be either zero or one, in order that an
election under Section 2652(a)(3) of the Internal Revenue Code may be
made with respect to one of the separate Trusts, or for any other
reason.
(o) To do all other acts in their judgment necessary or
desirable for the proper and advantageous management, investment
and distribution of the estate and Trusts established under this Will.
~~ ITEM VII: The Trustee is authorized to distribute
principal and/or income in any one or more of the following ways if the Trustee, in
~~~ the discretion of the Trustee, considers the beneficiary unable to apply distributions
to the beneficiary's own best interests, or if the beneficiary is under a legal
disability:
(a) Directly to the beneficiary;
Page 6 G}~h'1~ ~'/~,
(b) To the legal guardian or conservator of such beneficiary;
(c) To the Trustee, or to my son, JAMES C. FINK, JR., as
custodian under the Pennsylvania Uniform Transfers to Minors Act as
to a beneficiary under the age of twenty-one (21) years;
(d) To a relative of the beneficiary, to be expended by that
relative for the benefit of the beneficiary; or
(e) By directly applying distributions for the benefit of the
beneficiary.
ITEM VIII: 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. Any person (other
than myself) who has died at the same time as any beneficiary under this Will, or in
a common disaster with that beneficiary, or under such circumstances that the
order of deaths cannot be established by proof, shall be deemed to have predeceased
that beneficiary.
ITEM IX: I appoint my son, JAMES C. FINK, JR., to
be the Executor. In the event of his death, inability or refusal to serve, I appoint my
son, ROBERT L. FINK, to be the Executor. The Executor and Trustee are
specifically relieved from the obligation 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 seven (7) pages, at
the end of each page of which I have also set my initials for greater security and
i yf
better identification this ~ S day of d ~/Aic t ~+ , 2Q Q Z
Page 7 ~ ' ~ ~ ~~
~ (SEAL)
LE A M. FINK
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.
~r,~.
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_.:~~t.,k;~ ~ < , - ~ ~~ " ~-~.- (SEAL)
Residing at
Residing at ~;~~~ 7~ ~%' k =~, ~ ~: t:l.. .../~/'r ~~--~----
-;
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF i~y~.~~%c~'~-~ )
I, LEONA M. FINK, 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.
f
~ - l~'~,v,~' (SEAL)
LEO A M. FINK
Sworn to and subscribed before
me this I ~ day of
4 ~~~~= (-. , 20 C ( .
~..
otary Pubic
My Commission. Expires:
(SEAL)
Notarial Sea;
Elyse E. Rogers, f~otary Public
Damp hiiA Born, Cumberland County
r+~y Commission Expires Apr. 5, 2005
PN@niDBr, P@nnSylYci(1l8AssoaationOtNOtarlgS
~ AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF ~~ )
/' ' ~~~.
We, G.l-~ k ~` • ~ t ~ and ,
!, the Witnesses whose names are signed to the attached or foregoing instrument,
I~
being duly qualified according to law, do depose and say that we were present and
saw Testatrix, LEONA M. FINK, 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.
' I~ ,,,~,QQ /~,, Y'~,~ , ,
Witness Witness~T
Sworn to and subscribed before
this ~ STday of
~~. , 204 Z
S
otary Pub 'c
My Commission Expires:
(SEAL) Notarial seal
Elyse E. Rogers, Notary Public
Camp Hill Boro, Cumberland County
My Commission Expires Apr. 5, 2005
Mernber, Perx~syAraniaAasodetlonotNdaries