HomeMy WebLinkAbout07-25-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND _ COUNTY. PENNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name: MARIE S. GR_ELDER File No: ~~~~~ ~~~~
a/k/a: MARIE CHARLES GREIDER (Assigned by Register)
a/k/a: _ _ Social Security No: 168348909
Date of Death: 7/14/2012 ~ _ Age at death: ?0 _-~
Decedent was domiciled at death in CUMBERLAND County, PENNSYLVANIA (State) with his/her last
principal residence at 776 ALLENVIEW DRIVE __ MECHANICSBURG 17~0~~5~5 CUMBERLANQ
Street address, Punt Office and lip Gale City.'fownship nr Borough ~ V ~~~FR ~ZE~ -~~4' 'ounty
Decedent died at C. CROXTON SLANE HOSP HARRISBURG PA 17110 DAUPHIN PA
Street address, I'~wt Office and lip tide City, 'township or [loruugh County State
Estimate of value of decedenCs property at death
Ij'domiciled is Pennsylvania........... .......All persona] property $ S.OOQ•00
If"not domiciled in Pennsyh~ania .............................Personal property in Pennsylvania $
If'not domiciled in Pennsylvania .............................Personal property in County $
Value of'reat estate in Pennsylvania .............................................................. $ 101,000.00
TOTAL ESTIMATED VALUE.... $ 106,000.00
Itcal estate in Pennsylvania situated at: 776 ALLENVIEW DRIVE __ ~ MECHANICSBURG, PA CUMBERLAND
(Attt~iei~ ad~fitinea] sheets, i/ neces~ruw_) Street address, Post Onice and 7.ip Code Ci[y, Township or I3oroagh County
® A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) helshe/they is/arc the Iixecutor(s) named in the last Will of the Decedent, dated 6/13/201 i _ and Codicil(s)
thereto dated (~A__ -
State relevant circumstances (e.g. renru~citr?ion, death of executor, etc.)
P.xccp[ as follows: rifler the cxecuuon of the instrument(s) offered li>r probate Du cden[ did not marry, was not divorced, was nut a party to a pending
divorce proceeding whcri;in the grounds fur divorce had been estahlishcd as dcfinul in 23 Pa. C.S. ss' 3323(8), 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
^ $. Petition for Grant of Letters of Administration gyp. apphcanic) -_.__ _
c.Ga., ~Lb.rt_, d. b. n.c.Ga., pendente life, durance af~.centia, durcrnm nunvrrtate
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.
Iixcep[ as follows: Ueccdunl was not a party to a pending divorce procaading wherein the grounds for divorce had btx;n established as defined
in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
^ NO EXCEPTIONS ^ EXCEPTIONS _ ___-___-____.~
Petitioners}, after a proper search haslhave ascertained that Uecuient left no Wrll and was survived by the liilluwin8 spouse (if any) and hi:irs (apach
additional sheets, rfnecca.rar~~):
Name
hbrm RW-02 rev. 10/1 /2011
Relationship
Address
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Oath of Personal Representative
COMMONWEALTH OF PEN(vSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
Oiticial Use Only
Petitioner(s) Printed Name Petitioner(s) Printed Address
443 ARLINGTON ROAD
B. KENNETH GREIDER_ CAMP HILL,_PA .17011_ _ ~j ~;
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The Petitioner(s) above named swetulsj or aliirm(sj the statements in the foregoing Petitican are true and correct to the best of th~tndledgc and~hcl ~~ (''~
of Petitioner(s) and that, as Personal Rcprtscntative{sj of the Dtu;edent. the Petitaoner(s) will w° 1 ~ nd tr ily administer the estate~°i,~ording to lav<C1'1
Sworn to aftirmed a ,ubs ibed before ~ _ 1>:uc Q~~
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me thi ~ ,~ C ay ~'~ 2012.. uatc
By: 1~~~~--~ ,: ~ ~,4.---
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or hP RegLrter' llate --_
BOND Required: ^ YES ® NO
FEES:
Letters ....................... $ 260.00
(3 )Short Certificates(s) ...... 12.00
( )Renunciation(s) ......... .
( j Codicil(s) ............. .
( )Affidavit(s) ............. _ __.
Bond ......................... _ ____
Commission ................... .
Other WJLL_ ......... 1.5.00
Automation Fee ................. 5..00
JCS Fee ....................... 23.50
TOTAL ......................$ 315,50
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Sim ~ttuze:
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Printed Namc: DAVID R. GETZ, ESQ. ~_
Supreme Court
ID Number: 34838
Firm Name- WIX, WENGER & WEIDNER
Address: 508 NORTH SECOND STREET
PO BOX 845 _
HARRISBURG PA 17108
Phone: (717234-4182 __
Fax: (717 234-4224 __ _ _
Email: daetz@wwwpalaw.com
DECREE OF THE REGISTER
Estate of MARIE S. GREIDER _____
a/k/a: MARIE CHARLES GREIDER ___ _..___
AND NOW, ~. / ~-~t-.~ ~ ~-~ ~ 2_0...12 , in consideration of the foregoing Petition,
satisfactory proof having been ~esented efore me, IT IS DECREED that Letters TESTAMENTARY __ _
__._. are hereby granted to B. KENNETH GREIDER _ i_ __ _
- _ _ ~ _ in the. above estate and cif applicable) that
the instrument(s) dated JUNt 13, ZU11 _
described in the Petition be admitted to probate and filed of record as th~last Will (and Codicil(s)) of
File No: ~~ ~~ " ~) ~~~ -_
ry~~~
Register of Wills G
l~irrn~ KW-02 rev. 10/ll/2011 - ~/ Page' 2
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CUMBERLAND CO., ~,
COMMONWEALTH Of PENNSVIVANIA • DEPA0.TMENT Of HEALTH • VITAI RECORDS
CFRTIFIfATF f1F f]FATN
1. Oecetlent's legal Name IFIrsE Middle, last, sufhxl 2. Sex 3 Social Security Number 4. pate o(Death IMO/Day/Yrl (Spell Mol
Marie Charles Greider em31e 168-34-8909 July 14, 2012
Sa. Age~Last Birthtlay IVrsl 9b. Under t Year sc. Under l Day 6 Date of Birth IMO/pay/Yearl (Spell Month) )a. 8lrthplace IClty and State or Foreign Coun[ryl
Months pays Hours Mrnules V
70 September 7, 1941 )b 8irthplacelCoun[yl Lancaster
8a. Resitlence tSlate or Foreign Country] Bb. Pesrdenre (Street and Number -Include Apt ND.I 8c. Did Oe<edem Live in a Tpwnsh'rp?
776 Allenview Drive fives. deredenuwed in tt{3ppr A11en Iwp
ed. Resrdenre Icppmyl
8e. 0.esrdence l2ip COtlei 17055 ^NO, decedent lived within limits ol_ aty/boro.
9 Fve rn U5 Armed Force 10 Marital Status at Time of peatn ^ Married ^ Wldowetl 11 Surviving Spouse's Name III wife, give name prior tp first marriage)
^Ve ]~Np ^Unknown [}•.Dworced ^Never Married ^Unknown
12. Famei s Name firsE Middle, Last, Suflixl 13 Mp[her'z Name Prior to First Marriage (First, Middle, Last)
Milton Charles Violet Vatter
l4a. Infprmant's Name tab Relanpnzhrp to Decedent Mc. Informant's Marling Atltlress )Street antl Number, City, State, Zip Code',
Ja eline C. Greider Dau hter 776 Allenview Drive Mechanicsbur PA 17055
tSa; Place of Death Check only one)
If Death Occurred n a Hosp tai ^ Inpat ent H
~If Death Occurred Somewhere Other than a Hosp[al: ~ Hosp ce Fad'ty L3 0 ceden[ s Hpme
^ Ernergenry Rpom/Outpatient ^ Dead on Arrival ^ Nursing Nome/Long-Term Care Facility ^ Other (Specify)
19b. fa -lily Name III not rnsntution, gne street and number' lSc City or Town, State, and Zlp Code 19tl. Cpu y of Death
n
rot Croxton Slane Hos ice Harrisbur PA 17110
Dau hin
1Ba. Memoe or oisppslupn p Bprial ~ o-emaepn 19b Date or pisppsnion 1Br. Place Dr Disppstenn (Name pt remerery, r.emarory, or Omer Dlacel
^gempyal npm state ^ppnann" Jui 16
012
Y Hollin er C
an
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^ omer Isperiryl , r
a
or
4 Y
15d. Lpcauon pr oisposdion Icrty or Tawn, state, aria z'rDl va. signor cal sernce ^ arises or Person In charge pr Intermem vb. ucense Number
Mt. Holly Springs, PA 17065 ~ ~~ FD-138630
v[. Name one complete Aderess or w^er» Facility
Mal zzi FUrleral Home 8 Market Plaza Wa Mechanicsbu PA 17055
18. Decedent's Etlucatlon ~ Check [he box mat best describes the 19. Decedent of Hispanic Origin ~ Check the 20. Decedent's Race ~ Check ONE OR MORE races to indlcare what
highest degree or level of school completed at the time of death. box [hat best tlescribes whether the decedent the decedent consideretl himself or herself to be.
^ eth grade pr less is Spanish/Hispanic/Latino. Check the "Np" ®White ^ Korean
^ No diplpma, 9th ~ 12th grade box it decetlent is not Spanish/Hispanic/Latino. ^ Black or African American ^ Vietnamese
^ Hrgn Schaal graduate or GEp completetl C}] Np, not 90anish/Hrzpamc/farina ~ American Indian or Alaska Native ^ Other Asian
^ Some college credit, but no degree [] Yes, Mexican, Mexican American, Chicano ^ Asian Intlian ^ Native Hawaiian
^ Associate degree (e. g. AA, A9l ^ ve rto Rican ^ Chinese ^ Guamanian or Chamorro
gJ Bachelor's tlegree (e. g. BA, AB, 85) ^ves, Cuban ^ Flllpino ^ Samoan
^ Master's degree (e.g. Mq, MS, MEng, MEtl, M9W, MBA( ^ Yes, other Spanish/Hispanic/Canna ^ lapaneze ^ Other Pacific Islander
^ Doctorate le.g. PhD, Ed Dl pr Professional tlegree (Specify) ^ Omer lSpeci 1
.. M0, DDS, OVM, llB, ID
21. pe<edent's Single Rare SeI1~Designation -Check ONLY ONE to indicate what !tie decetlent consitleretl himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work
White ^ Japanese ^ Samoan done during mast Of working life. DO NOT USE RETIRED.
Black or African American ^Korean ^Other Pacific Islander
1saX Examtner
^ American Indian pr Alaska Native ^ Vietnamese ^ Dan'[ Know/Not Sure
^ Asian Intlian ^ Other Asian ^ getusetl 22b. Kind of Business/Industry
^ Chinese ^ Native Hawaiian ^ Other (Specify)
_
^ Filipino ^ Guamanian pr Chamorro DeParttnent of Revenue
ITEMS 23a - 23tl MUST BE COMPIETEp 23a. Dale Prpnounc d Dead IMO/Day/vrl Z3b. signature of Person Pronouncing Death (Only when applicable) 23c. License Number
BV PERSON WHO PRONOUNCES OR
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23dTDaEe
igne
MO/Oav/Yrl 24. T'rme of Deat~ f
l.!_X.Y./~ ~r" '\ ~ / ~' ~ ~ I
~
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U ,y ,\ 25 Was dlcal Exa or Coroner Contacted? ^ Ves ^ No
CAUSE OF DEATH Appmxrmare
ib. Pan E Encer me rna~ri prat a -diseases, mipnes, pr rpmplirahpns-rnai direrny roused the dean Do Nor enter terminal eye^ts such as cardiac arrest tnteryal.
r
expiratory arrest, pr ventricular tlbrillanon without showing the etiology. DO NOt ABBPE MATE. Enter only one cause on a line Add addltlonal lines it necessary Onset to Dea[M1
I
IMMEDIATE CAUSE a -(~ f i t - .' I I. ~ .. ~' l i -- I ~~ Y-, s.r r 1 L
(fin pndrtrnn pu for as a co^s~p N'
e
resprtmg
n deami
b
sepuennahy Irst cpndhipns. Due tp for as a coriseppenre pfl.
II any
leatling to the cause
,
fed on line a. Enter the ___ ___ _ _______ __
UNDEfl LYINGCAuSE
pus to (pr as a consepuence oft
Idise intury mat
o
Hated
ne events resulting tl _ ___ _ __ _ _ _ _
In death) LAST Due to for asa cpnse9uence oft
26. Part IL Entero[hersi¢nificam<ondinons contrihvtinv wdea hbur not resulting rn the untlerlying causegiven rn Parti 2). Was an autopsy performed]
^ Ves ~No
2g. Were autopsy findings available
to ompiete the cause of death?
c
^Ves No
29. II female 30. Ditl Tobacco Use Contribute to Death? 31 Marine. of peach
~NOt pregna lwimin past year
n ^ves ^ Probably t~(Nalural ^ Hpmicitle
'
^ Pregnant at
time of death ^ No fT Unknown
l" l^
Accident ^ Pending Investigation
^ Not pregnant, but pregna within 42 days of death ^ Suicide ^ Cpuld not be determined
^ Not pregnant, but pregnant 03 days to 1 year before dean 32. Date of Injury IMO/Day/Vr119pe11 Mon[hl
^ Unknown i(pregnant within the past year 33. Time Dl Injury
34. Place o(Injury (e.g. home; cpnstruction site; farm; school) 35. Location of Inlury (Street and Number, City. State, Zlp Cotlel
36. Injury at Work 3]. Il Transpprtatlon Injury, Specify: 38. Describe NOw Injury Occurred'.
^ Yes ^ Driver/Operator ^ Pedestrian
^ No ^ Passenger ^ Other (Specify
39a Certifier (Check only oriel'.
Certifying physician ~ To the best of my knowledge, death occurred due to [he cauzelsl and manner stated
^ Pronouncing & Certifying physician ~ to the best of my knowledge, death occurred at the time. date, and place, and dve to [he cause(s) and manner stated
^ Medical Examiner/Coroner - On the basis of examrna[ipn, and/or investigation, In my ppinron, death occurred at the time, date, and place, and due to the cause(s) and manner statetl
ngriawreorrerngeT ~ nueDfrertiner T I,{> uan,eNpmber,f iUC)I:L/t <.
39b. Name, Atldrezs and Zip Code of Pe son Completing Cause of peach )item 2fi 39c. pate Signed IMO/pay/Yr)
~iEli~'rli S'-. ~>i 7Y, 1 ~/~1. c/1
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00. Registrar's District Number 41. Regis
~}y,s at~~ 42. egistrar File Date (MO/Day/Yrj
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43. Amendments
0729461 Hlos-143
puposrtipn Permn Nn. REV maD] t
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LAST WILL AND TESTAMENT `='
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OF Wiz; ~:.~ <:.-~ _:
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MARIE S. GREIDER °~='~~
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I, Marie S. Greider, of Mechanicsburg, Cumberland County, Pennsylv2~ia,
being of sound and disposing mind and memory, do make, publish and declare this my
Last Will and Testament, hereby revoking all other Wills and Codicils by me at any time
previously made.
Final Arrangements
ITEM I: I have discussed my intentions and desires with my daughter,
Jacqueline C. Greider, and direct that the expense of my final arrangements be paid out of
my estate as a funeral expense.
Provision for Taxes
ITEM II: I direct that all inheritance and estate taxes becoming due by
reason of my death, whether such taxes may be payable by my Estate or by any
recipient of any property, shall be paid by my Executor out of the property passing
under this Will, that is not specifically devised or bequeathed, as an expense and cost of
administration of my Estate. My Executor shall have no duty or obligation to obtain
reimbursement for any such tax paid by my Executor even though on proceeds of
insurance or other property not passing under this Will.
Specific Bequests
ITEM III: I give and bequeath all of my household furniture and
furnishings, automobiles, books, pictures, jewelry, china, linen, silverware, wearing
apparel, and all other like articles of household or personal use and adornment to my
daughter, Jacqueline C. Greider, per stirpes.
ITEM IV: I give my real estate located at 776 Allenview Drive,
Mechanicsburg, Cumberland County, Pennsylvania (the "Property"), or any other
property I may be using as a residence at the time of my death, to my Trustee,
hereinafter named, to hold IN TRUST NEVERTHELESS for the benefit of my daughter,
Jacqueline C. Greider, as follows:
Page 1 of 7
(a) I request that my Trustee hold my said Property as a
residence for my daughter as long as she chooses to occupy it. I
recognize that the Property is anon-income-producing asset.
Therefore, I direct that in the event my daughter chooses to occupy
the Property as her residence, she will be solely responsible for all
costs of maintenance, utilities, repairs, real estate taxes, and any
interest or penalties thereon, insurance premiums for the real
estate and its contents, any mortgage payments and special
assessments. If my daughter fails to make such payments within
the time period provided by the creditor, then my Trustee may sell
the Property and discharge said debts thereby as Trustee, in his
absolute discretion, shall determine.
(b) For any period in which my daughter does not wish to
use the Property as her residence, my Trustee shall have the
authority to rent said Property in order to accumulate income for the
upkeep thereof. Any unused rental income shall be accumulated.
It is my desire and direction that my daughter be responsible for
moving my furniture out of the Property if it is not rented as a
furnished property.
(c) My Trustee may, in his absolute discretion, enter into
agreements for alterations and renovations of the Property and pay
for same either by assessing my daughter or securing a mortgage
loan on the Property, or a combination of both, to pay the charges
therefor.
(d) This trust shall terminate on the second anniversary
of my death, or earlier in the sole discretion of my Trustee. At that
time, I direct my Trustee to transfer title to the Property to my
daughter and to pay to my daughter, outright, any remaining funds
accrued in the rental of the Property, if applicable.
ITEM V: I give, devise and bequeath unto my daughter, Jacqueline C.
Greider, per stirpes, all the rest, residue and remainder of my property, real, personal
and mixed.
Appointment of Fiduciaries
ITEM VI: I hereby nominate, constitute and appoint my ex-husband and
father of my daughter, B. Kenneth Greider of Camp Hill, Pennsylvania, to be my
Executor. In the event of the death, resignation, refusal or inability of B. Kenneth
Greider to serve as Executor, I nominate, constitute and appoint my daughter,
Jacqueline C. Greider, to serve as Executor in his place.
Page 2 of 7
ITEM VII: I hereby nominate, constitute and appoint B. Kenneth Greider to
be my Trustee. In the event of the death, resignation, refusal or inability of B. Kenneth
Greider to serve as Trustee, I nominate, constitute and appoint the sister of my ex-
husband and her husband, Carole J. Fetzer and Alvie H. Fetzer, of Landisville,
Pennsylvania, to serve as Trustee in his place.
ITEM VIII: If at any time, any minor child or mentally incapacitated person
shall be entitled to receive any assets hereunder, my Trustee shall act as Guardian of
the assets payable to such person and shall have full authority to use such assets in
any manner as such Guardian shall deem advisable for the best interests of such
person, including proper support, maintenance, medical, hospital, nursing and nursing
home care, high school, college, university, post-graduate or other education, without
securing court order.
ITEM IX: My Executor, Trustee, and Guardian are specifically relieved from
the duty or obligation of filing any bond or other security.
Powers of Fiduciaries
ITEM X: In the settlement of my Estate and during the continued existence
of the foregoing trusts, my Executor and Trustee of each trust shall possess, among
others, the following powers to be exercised for the best interests of the beneficiaries:
(a) To retain any investment I may have at my death, so long as my
Executor or Trustee may deem it advisable to my Estate or trusts to
do so.
(b) To vary investments, when deemed desirable by my Executor or
Trustee, and to invest in such bonds, stocks, notes, money
markets, real estate mortgages or other securities, other than
options or futures, and in such other real or personal property as
my Executor or Trustee shall deem wise, without being restricted to
so-called "legal investments."
(c) In order to effect a division of the principal of my Estate or a trust or
for any other purpose, including any final distribution of my Estate
or any trust, my Executor or Trustee is authorized to make said
divisions or distributions of the personalty and realty, partly or
wholly in kind. If such division or distribution is made in kind, said
assets are required to be divided or distributed at their respective
values on the date(s) of their division or distribution.
(d) To sell, either at public or private sale, and upon such terms and
conditions as my Executor or Trustee may deem advantageous to
Page 3 of 7
my Estate or trusts, any or all real or personal estate or interest
therein owned by my Estate or trusts, severally or in conjunction
with other persons, or acquired after my death by my Executor or
Trustee, and to consummate said sale(s) by sufficient deeds or
other instruments to the purchaser(s) conveying a fee simple title,
free and clear of all trust, and without obligation or liability of the
purchaser(s) to see to the application of the purchase money or to
make inquiry into the validity of said sale(s); also, to make, execute,
acknowledge and deliver any and all deeds, assignments, options
or other writings that may be necessary or desirable to effect any of
the bequests or devises made in my Will or in carrying out any of
the powers conferred upon my Executor or Trustee in this Item X(d)
or elsewhere in my Will.
(e) To mortgage real estate and to make leases of real estate.
(f) To borrow money from any party to pay indebtedness of mine or of
my Estate or trusts, expenses of administration, or inheritance,
legacy, estate and other taxes.
(g) To pay all costs, taxes, expenses and charges, except as herein
noted, in connection with the administration of my Estate or a trust.
My Executor shall pay expenses of my last illness and funeral
expenses.
(h) To vote any shares of stock that form a part of my Estate or a trust
and otherwise to exercise all the powers incident to the ownership
of such stock.
(i) To assign to and hold in a trust an undivided portion of any asset.
(j) In the discretion of my Trustee, if the size of any trust herein
established shall become so small that it is impractical or
uneconomical to continue said trust, my Trustee may distribute all
accumulated income and principal to the then income beneficiaries
in proportion to their income interests.
(k) The right and discretion to elect the most appropriate settlement
options for any pension plans, individual retirement accounts or
other employee benefit options payable to my Estate or any trust,
assuming such election shall be in accordance with procedures
established by the plan's administrative committee or administrator,
as the case may be.
Page 4 of 7
(I) The right to engage accountants, attorneys, appraisers and other
agents, as deemed necessary by my Executor or Trustee, to render
advice to and/or to represent my Executor or Trustee, as my
Executor or Trustee deem necessary or appropriate to the
administration and preservation of my Estate or the assets of any
trust.
(m) To do all other acts in the judgment of my Executor or Trustee
necessary or desirable for the proper and advantageous
management, investment and distribution of my Estate.
Miscellaneous Provisions
ITEM XI: Any person who shall have died at the same time as me, or in a
common disaster with me, or who shall fail to survive me by ninety (90) days, shall be
deemed to have predeceased me.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my
Last Will and Testament, consis 'ng of this page, the next two pages, and the preceding
six pages, this '.~ ~`TY1 day of `~~. ,, - , 2011.
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Marie S. Greider
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-
named Testator, Marie S. Greider, as and for her Will, in the presence of us, who, at her
request, in her presence and in the presence of each other, have hereunto subscribed
our names as witnesses in attestation thereof.
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Page 5 of 7
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SS.
I, Marie S. Greider, 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.
Sworn to or affirmed and acknowledged before me by Marie S. Greider, the
Testator, this ~3 r°~ day of t z~ . ` ~ , 2011.
j~
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Marie S. Greider, Teat~tor
_ I C_
C`~ ~ >t
N tary Public
''My Commission Expires:
~lIMC3{`d1N~F1wi ~'t~' ~)~~aY`'~RNiA
N07ArilAl. SEAL public
,-ANtCE E. YC~CUiv1, Notan County
City of Pia?isbure~,' Da ~Phrch 02, 2014
aay Commission Exp . ~..,.,...~
Page6of7
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF DAUPHIN -
we, `{~ ~i ~ ~~ ~ ~~-d and '~ ~~_~~.1~C1 \~~~ . ~y~`~~~~k'~'1
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the witnesses whose names are sign d to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we were present and saw the
Testator sign and execute the instrument as her Last Will; that the Testator signed
willingly and executed it as her free and voluntary act for the purposes therein
expressed; that each subscribing witness, in the hearing and sight of the Testator,
signed the Will as a witness; and that to the best of our knowledge the Testator was at
that time 18 or more years of age, of sound mind and under no constraint or undue
influence.
S or to or affirmed an subscrib d t~b~fQre me
y )~~L\~ ~ ~ ~l' ~1 and ~ ~~ ~1~~1 l~ ~ ~ ~ ; it k i ~
day of ,~. ,.~ , 2011.
Witness
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witnesses, this /~'
~~
~otary Public
My Commission Expires:
C AflfVi P7l1V~fih&. s i~ taf._-'E:~;~;W ~)'~'~.~%t%ei'~;Ila
NOTARiPL :~feR~.
JANICE E. YpCl3M, P1~~te=z:y ~"e~~dic
City of Ha.risbury, i_~~upiy~ri County
nny Commission ~xpir€ss ~~~rs~h f~2, 2~1~
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