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Home My WebLink About08-22-12Reset 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• Evelyn Quinn a/k/a: a/k/a: a/k/a: Date of Death: August 4, 2012 File No: ~ ~ ' ~ ~ ~ I ~ ~~ (Assigned by Register) Social Security No: 180-26-5789 Age at death: 79 Decedent was domiciled at death in Cumberland County, Pennsvlvania (state) with his/her last principal residence at 2670 Springy Road Carlisle North Middleton Township Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 2670 Sprint Road Carlisle North Middleton Townshp Cumberland PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in 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 Pens:sylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ / 2 S, ~ o c .0.00 Real estate in Pennsylvania situated at: 2670 Spring Road Carlisle, North Middleton Township Cumberland (Attach additional sheets, if necessary.) 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 July 20, 2004 and Codicil(s) thereto dated nine State relevant circumstances (e.g. renunciation, death of executor, 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 born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~(NO EXCEPTIONS EXCEPTIONS B. Petition for Gran 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, c.t.a. ord. b. n.c.t.a., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS ~ EXCEPTIONS 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 '~~ ~ ~ '~~~ ~•}V~t~ _ 4..~ ~: f,.. h ~! ...~.. ` ~ . ~. t'-`r. ~~ l.._. ~ ~- ~t.! ~ ~ ~ _ tr3 ~ 'a.~ ;-~-i ~_ 1 .r:.l j ~~,_ C O Farm xw o2 rev. ~oirlizol~ Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland Petitioner(s) Printed Name Valerie Use -.. , c~ W ~ __ - r z 4-. Petitioner(s) Printed Address '~ -~~ 2670 S rin Road, Carlisle, PA 17013 C7~=- ~ ~ '= ' f ~? ~,~: , T~ v ~ -i The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are rue and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the De e ent, the Petitioner(s) w• 1 ell and truly administer the estate according to la Date Sworn too ffizrried cribed efore { Date me thi ~ay ~f _ L-" ~~ ,~~ Date By' f Date Register BOND Required: Q YES Q \T O FEES: 7 ~t~: ~~: Letters ...................... ( ~ )Short Certificate(s)...... $ ~~ Ltd ( )Renunciation(s)........ . ( )Codicil(s) . ........... . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ••••~•~ l~ ~~ Ir ........ __._ .~~ ........ L~~7 Automation Fee . .............. d JCS Fee . ................... . TOTAL ..................... $ --6"66'" To the Register of Wills: Please enter my appearance by my signature below: (717) 249-5755 !~~ lr ~~ DECREE OF THE REGISTER File No: ~~~ Estate of Evelyn Quinn a/k/a: AND NOW, '' ~~ !~- ~ ~" , in consideration of the foregoing Petition, satisfactory proof having b ~~ n presented before me, IT IS DECREED that Letters testamentary are hereby granted to Valerie Harrin m the above estate and (if applicable) that the instrument(s) dated Jul 20 2004 described in the Petition be admitted to probate and filed of record ~ s the last Wil (and Codicil(s)) Decedent. V W ~ Register of Wills • ,.~L,~~..t f'~_ ~~~` ~ oft Form RW-02 rev. /0/ll/20/1 ~ ~ ~r 'v L -- r OATH OF SUBSCRIBING WITNESS(ES) r Via. ~~ ~; -~ ~ .. ~~ ~-~ F__.~_~ ~~ _ , ~~.' ~ ~;.; , = ~, :A }~ . ~ REGISTER OF WILLS ~=-~'~- : -. Cumberland COUNTY PENNSYLVANIA ~~_ ~ . _ ~ ~'-t , ~ L / ~ ~ ~ ~ ` ; s ``.~ f , / ~ v Q Estate of Evelyn Quinn ,Deceased Robert Frey and Trisha Liess , (each) a subscribing witness to (Print Name/s) the Will ~ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same and that she / he /they signed the same and that she / he /they signed as a witness at the request of the Testator /Testatrix in her /his presence and in the presence of each other. (Signature)'' ----- ~~ `~ ~ (~1~} ~ 1P-~- ~ ~ ~ - (Street Address) (City, State, Zlp) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , ~' ... ----~ _. ~_ (Signature) ~ ~' C~.:.,. '~~ (Street Address) (City, State, Zip) > Executed out of Register's Office Sworn to or affirmed and subscribed before me this ~ day of ~~~~ . /I •. ~ 0~ Deputy for Register of Wills Not y Publi~ ~ U My ommission Exp>res: (Signa ure and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary s Commission.) S3RNlON ~0 NOLL Sd YINd '1„I~SNN~d `ZI~BW~W Si02'6Z ' oN s ldx~ Issiwwa~ W NOTE: To be taken by Officer a~G1M~l0(i~JNi~~ ent the original or copy of)(irut>~~ ~ ~~~~i~~~tion. Notarial Seal ~i1Qnd ~~pN '~( u~I '$ aa~luua[ Jennifer S. Lindsay, Notary Public IeaS I N Form RW-03 rev. 10.13.06 Carlisle Bbro, CUmt~erl8nd County y~~r~~~SNN3d Hl~ MNOWW~~ My Commission Lxpires Nov. 29, X015 MEMBER, PENN5YI.VANtA ASSOCYATION OF NdTARIES ~. ~.. .,. g ~. . ~. ~~6~~Iri,~a. -fit ~,~ ~ ,3 =:. A ' n CIJ~R~P~.AND Ctn., PA ~ ~ . ~ AtlG 7 ~ 2012 ~~.. _ -- - ... ~~ Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS Permanent CERTIFICATE OF DEATH Stale Flle Number: W Q c c C 7 lack In k 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (Mo/Day/V r) (Spell Mo) Evelyn Quinn Fema1 180-26-5789 August 4, 2012 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (Mo/D ay/Year) (Spel l Month) 7a. Birthplace (City and S tate or Foreign Country) P 79 Months Days Hours Minutes DeC 12 , 1932 Hustontown ~ A 7b. Birthplace (County) Residence (State or Foreign Country) Sa Sb. Residence (Street and Number -Include Api No_) Sc. Did Decedent Live in a Township? . pp, 2570 Spring Road W Yes, decedent lived in N • Middleton twp. Sd. Residence (County) Cumberland 8e. Residence (Zip Code) 17013 Q No, decedent lived within limits of city/boro. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married [$ Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Yes ~ No Q Vnknown Q Divorced Q Never Married Q Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Andrew Stevens Luella Ho££man 14a. Informant's Name 14b. Relationship [o Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) V 1 i H in dau 26 rin R li. G .............................._._..r ....................... ............ .... 15a. Place of Death C eck only one _ _ ........ ..... ........ ............. ........... _.... ....... .............. .... . . .. .. ...... .... . ...... ......... .. ... . . ........... _............................ ....... . d ' H Q ~ . ac P ...................... If Death Occurred in a Hospital: ~ In atient ~ = ome Dece ent s Hospice Facility If Death Occurred Somewhere Other Than a Hospital: ~ Q Emergency Room/Outpatient Q Dead on Arrival _ Q Nursing Home/Long-Term Care Facility Q Other (Specify) ~ 15 b. Facility Name (If not institution, give street and number; 15c. City or Town, State, and Zip Code 15d. County of Death Carlisle R Tonal Medical Center Carlisle, PA 17015 Cumberland LL 16a. Method of Disposition ~ Burial Q Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) m p Removal from State Q Donation Au 8 , 2012 g Cumberland Valley Memorial Gardens y_ Q Other (Specify) 16d. Location of Disposition (City or TOW n, State, and Zip) 17a. Signa f Funeral ice nsee or Per arge of Interment 17b. License Number Carlisle, PA 17013 138504 ~ 0 v 17c. Name and Complete Address of Funeral Facility - m 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to indicate what I-° highest degree or level of school completed at the time of death- box that best describes whether the decedent the decedent considered himself or herself to be. 8th grade or less Is Spanish/Hispanic/Latino. Check the "NO" ~J White Q Korean Q No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese Q High school graduate or GED completed ~ No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian Q Some college credit, but no degree Q Yes, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) Q Yes, Puerto Rican Q Chinese Q Guamanian or Chamorro Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q Filipino ~ Samoan Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) Q Other (Specify) DDS, DVM, LLB, JD e. MD , 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work White Q Japanese Q Samoan r ifi I l d h P done during most of working life. DO NOT USE RETIRED. ' s an e er ac c Black or African American [~ Korean Q Ot tive Q Vietnamese ~ Don't Know/Not Sure Al k N I di ertl £1ed Nurses Assistant C an or as a a n Q American Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry Q Chinese Q Native Hawaiian ~ Other (Specify) Nursing Home Q Filipino ~ Guamanian or Chamorro ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (Mo/Day/Yr) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH ~ j • 1 "7 Q \ a `1 4~[ /J _ / / ~'/~ ~ e ~~f~ /~(~ "~ j~~~yS a.1 _ ~- r) 23d. Date Signed (MO/Day/V 24. Time of Death ~ C ! / mss[ N \ a ~ ~ of ~ 6 S ~ A r o 25. Was Me is I Examiner or Coroner Contacted? Q Yes CAUSE OF SEAT Approximate Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest. Interval: Part 1 26 . . . Enter only one cause on a line. Add additional lines if necessary Onset to Death ABBREVI A T E T tiology. DO N O e e t sh wing t h o respiratory arrest, or ventricular fibrillation withou ~ i ~ f , J ^ T f v /j ~ ~ j ¢ ~ IMMEDIATE CAUSE > a. ~ • ~• ~ `~'v~ r ~ • " ~~'~ r~ ~ ~~ (Final disease or condition Due to (or as a consequence of): resulting in death) b ~ ~1 ~~ ~~ Ate/ ~, A!4-S~ Sequentially list conditions, Due to (or as a consequence of): if any, leading to the cause listed on line a. Enter the c. UNDERLYING CAUSE Due to (or as a consequence of). (disease or injury that W Initiated the events resulting d. ~ u Due to or as a copse uence of): in death) LAST. ( q _ Dior, ificant conditions contributing to death but not resulting in the underlying cause given in Part I th E t 27. Was an autopsy performed? a er n er o 26. Part 11. Q Yes No ~ 28. Were autopsy findings available to complete the ~a u~sj of death? Q Yes $J No If Female: 29 30. Did Tobacco Use Contribute to Death? 31. Manner of Death ~ . (~ Not pregnant within past year Q Yes Q Probably ~ Natural 0 Homicide v Q Pregnant at time of death ~ No Q Unknown Q Accident Q Pending Investigation °J but pregnant within 42 days of deatY nant Not re Q Suicide ~ Could not be determined m I-° , p g Q Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (Mo/Day/Yr) (Spell Month) Q Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Yes Q Driver/Operator Q Pedestrian ~ No Q Passenger Q Other (Specify) 39a. Certifier (Check only one): Q Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated Q~ Pronouncing ffi Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated death occurred at the time, date, and place, and due to the cause(s) and manner stated in my opinion ation d/or investi ti i - , , g on, an na Medical Examiner/Coroner - On the sis xam b G s ~'~~~ ~~ Dbax 8 ~ c License Number: Signature of certifier: ~ Title of certifier: ~~" 396. Name, Address and Zip Code f erson Completing Cause of Death (Item 26) '7 ' 39c. Date Signed (Mo/Day/Yr) O ~- U G %J~ V v~ 1/ it-t.v6S o/} l /u4'D y~--G-d v~Lv+oD, f 3SFf t v-rZ 7vty w/ R-!~ f3 of C.yitL fr S - Registrar's District Number 41. Registrar's Sign e 40 te (Mo Day Vr) a 42. Registrar File D . ~ ~ j 43. Amendments Disposition Permit No. ~ ) ~ ~ ~ ~S~ REV 07/2011 H105905MS REV.(Ol/O3) This is to certify that this is a true copy of the record «•hich is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly, dune 29, 1.953. WARNING: It is illegal to draplicate this copy by photostat or photograph. Military Status ~-~ ~~ ~ ~`F ~ ~~ ~- No. ~4 H 105. ;+3 Rev. 2'B7 i YPE/PAINT IN PEAMANEN BLACK INK z w U O O a Z II'I'II~~,~,SH UF-P f~,~'_ ~; ~ iZ ~~ _, ~, ,_ ~ ~, ~~~9~~~E~'T 4~~~`i'`t~, Charles Hardesrer State Registrar O C T 2 8 200 Date COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH T NAME OF DECEDENT (first. M~ddte..as) ~~ l~vvi-~~ ~ v_- ~-_ SEX SGCIAL SECURITY NUMBER DATE OF DEATH rMCnm. Day.'+ear) ,. Jack E. Quinn _. Male ~. 421 - 38 - 9049 .. October 12, 2004 AGE (Last Brnhdayl UNDER 1 YEAR UNDER t DAY DATE OF BIRTH BIRTHPLACE (C,ry and PLACE OF DEATH (Che ck only one - gee :nstruclAn9 nn otF!er srdel Months r Oays Houn . Minutes ~.Mon>h. Day '+eer) April 10 Stale a Fcregn Country) HOSPITAL OTHER: N _' 71 Yrs. s. e. 1933 Jasper / AL 7 Inpatient ® ERlOutpauenl ^ OOA ^ ~. ~ ^ Rosrdsnn ^ v~Ml ^ COUNTY OF DEQH CTTY, BORO, TWP OF DEATH FACILfTY NAME (II not ins~tuaon, give street and numbers WAS DECEDENT OF HISPANIC ORIGINT RACE -American Indian, Black, White. etc. Cumberland Carlisle Carlisle Regional Medical Center ^~ ® w• ^ aY•~•wo~nc~~wa (5~, ~~ tlb. lle. ad. 9 exican, Puerto Rican, «~. i0- yvl rite DECEDENT'S USUAL OCCUPQION KIND OF BUSINESS/INDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCATION MARITAL STATUS -Yarned SURVIVING SPOUSE (G~ve kind M work done dunng most U.S. ARMED FORCES? S i oM ni esl atde can feted Never Married. Widowed, pt wde. gn+• maden rwne) of working hte; do not use reared) Yes ® No ^ Elemenlaryl5econdary College Divorced (Spectfyl - ,,,_ Su rvisor „b- U.S. Government ,_• „ 'o-'2' 12 (,•"5} ,~ Married „- Evelyn Stevens DECEDENT'S MAILING ADDRESS (Street. CilyRown. Slake. Z4 Codel IK=CEDENT'S N ,7 Middleton ACTUAL ® Yt d d li d i 7 PA s 2670 Spring Road _ c. ea, eca arr , a. tate ve n ,~_ Did RESIDENCE Carlisle PA 17013 dacerlerp (see.ngructans liwm. ___ on aher s,del Cumberland ~"~T ^ 16. 17tl. wRhi actual Iknils of c;,ybe,p. 17b. County FQHER'S NAME (First, M~ddte. Last) MOTHER'S NAME (Fvsl. Mddle. Marden Surname) „- John Quinn „- Zola Cottingham INFORMANT'S NAME (fyparPrinl) I NFORMANT'S MAILING ADDRESS (Shea:. City/town, Stale, Ztp Code) _,,. Evelyn Quinn = ~ 2670 Spring Road, Carlisle PA 17013 METHOD OF DISPOSITION DATE OF DISPOSITION PUCE OF DISPOSRKNI -Name of Cemetery, Crematory LOC/QION - CirylTarat, State, Ztp Corse • Banal ® Cremation ^ Removal hom State ^ (MOnm, Day, Yoar) a Other Place Donation^ aner(Specrryl ^ October 16, 2004 Cumberland Valley Mem Grd Carlisle PA 17013 =te. =,b. = . ,c. ittl. ' SIGNATU F FUNE S VICE L S E ACTING AS SUCH LICENSE NUMBER NAME ANDADDRESSOF FACILITY Hof fman-Roth Funeral Home ==b. u~. i 1 PA 17013 m to items 23a-c only when ifying Tp the Vest of my knowbdge, death occurred at me hme, date and place stated. ~ LICENSE NUMBER DATE SIGNED _ ' . physician is not available al hme of Beam to cand cause of death (Sgnarure and Tgle) _ //f ~ ~+ !~ /~ ~ / ( 3 S~ ~l L MOnm. DaY. Year) y . ~ , // / / 1 / + / ~~-~ A ' 4Y~.-.. ~.. ~-• ~1~ -. v -/r' =>b. ~ 3 = o ~. ~a. 0 ~ ~ Items 2x•26 must be completed by TIME OF DEATH DATE PRONOUNCED DEAD (Month. Day. Veer) WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER7 • Parton veto pronounces deem. } Nee ^ No r / 2~. ! ~ ~ M. =5. ! G / ~. ~/ M 27. PRAT I: Enter me diseases, in(uries of compiicalgns which caused the death. Do net enter the mode of dying, such as cardiac r respiratory arrest, stwck or heap lailuro. t Approximate PART Ii: Other SignitlcaM rnnditions contridAirg 1o death, but List Dory one cause on each kne. - ~ imerval Datwaen nq rssuhing in dte urid•rA^n9 cause given h PART I. I orrset and deem IYYEDIATE CAUSE (F~nai a~sease a conditron _ i resuaxlg in seam) --- a._ r r T0 (OFi AS A CONSEQUENCE OF): r _ Sagwntially hat pondilions b. ~t ~. A G ~ t . if arty, leading to immediate OUE 70 (OR AS A SEQUENCE OFI: I _ cause. Enter UNDERLYING 1 CAUSE (Disease a ~nryry c. r - mat inrliated events DUE TO (Cfl AS A GONSEOUE NCE OFI: '~ - -- I rr>Srltatg n deem) LAST r d. WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH / DATE OF INJURY TIME OF INJURY INJURY AT WOAK7 DESCRIBE MOW INJURY OCCURRED. PERFORMED? AVAILABLE PRIOR TD COMPLETION OF CAUSE f ~ ^ Natural H i i (Monm. Day. Year) O OEQH7 om c de Yes ^ No ^ Accrdanl ^ Pending lnvealigalbn ^ YLa ^ No Vas ^ No ^ Suicide ^ Could not t>o determined ^ 30a. ~Ob. M. 90c. ~Od. PLACE OF INJURY - AI home. farm, street, laaory, office LOCATION (Street. Gty/Town, Slate) (wilding, «c. ISpecrlvl =N. =ab. 29. 30e. 701. CERTIFIER (Check only one) IG ATURE AND 1TLE OF CERTIFIER 'CERTIFYING PHYSICIAN I.Physrc~an candying cause d death when another phyyc~an has pronounced death and canpteleU hem 231 v To the beat of my krawNdge, death occurred due W me caux(s) and manner as stated ....... . ............................................. ]1 b. t C.Q.Q." - l!• • v LICENSE NUMBER DATE GNE m. Day, h3arl 'PRONOUNCING AND CERTIFYING PHYSICJAN (Physician twin arnnou~c~ng death and cernying to cause of deaiml To lha heat of my knowledge, deem occurred at the tlma, data, and place, and due to the caux(a) and manner ^a staled ............ ^ . . . ... „~, GS - O I O~~-{ ~ L 31 d. td ~ i I ~vy . . ... . .. NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH 'MEDICAL EXAMINER/CORONER (Item 27) Type or Print 1 _ L ~d ~ ~(. Qrjr ~-~ ~ - V ~l On the basis of examination and/or investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and ^ ted manner t I ~N t~ -'Ty It ~ (:put •} .................. ................ as s a Jta. ................................................................ 32. ~tre.l. f:1< {'A 1701 Y - 10'50 REGISTRAR'S SIGNATURE AND NUMBER / ~ l/ ` A DATE FILED (MOnlh. Oay. P arl p ~ ~ ~ ~^ ' L S e ~.-.~\.,~ tlrf\T 1~..{(~ LAST WILL AND TESTAMENT OF EVELYN QUINN I, EVELYN QUINN married woman, of 2670 Spring Road, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all Wills by me at any time heretofore made. 1. I direct my hereinafter named Executor or Executrices to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I further direct that all inheritance, transfer, succession, estate and death taxes, including interest and penalties thereon, which may be payable on account of my death shall be payable from the residue of my estate regardless of whether the assets upon which such taxes are based are included in my probate estate. 2. I declare that I am married to Jack E. Quinn and that I have one (1) child, VALERIE HARRING. I further declare that I have no other children. 3. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my husband, JACK E. QUINN, his heirs and assigns, to the exclusion of my child or children, born or unborn, provided my said husband shall survive me by a period of ninety (90) days. In the event that my said husband should predecease me or fail to survive me by the aforesaid period of ninety (90) days, then in such event all of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to my daughter, VALERIE HARRING, but should she predecease me or fail to survive me by a period of ninety (90) days, then the share she would have otherwise received shall pass to her issue per stirpes. 4. I hereby nominate, constitute and appoint my daughter, VALERIE HARRING, as Executrix of this my Last Will and Testament, and I further direct that she shall not be required to post any bond to secure the faithful performance of her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on one (1) page, this ~v ~ day of ~,> ~ , 2004. I L ~.--t?~W~)i1 --~(il.~~ it , (SEAL) EVELYN UINN Signed, sealed, published, and declared by EVELYN QUINN the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. F"°.. C~ v~ t.,t.S.~:: a Q'1 ~~ :: . _, .. -~ ~ '~ '. ~..1 ~ ~~a ~' ~~ ~,~_ ~ .~.. t--- {r ~ _.,. ~~ ~~ '_: ,r~~ ~: ~~ O~ U Page 1 of 1