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HomeMy WebLinkAbout08-20-12 (2)Reset 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: Kelly Jo Kistler File No: OL ~ ~ ~ ~~~~ ~~ (~/ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 159-52-5494 Date of Death: June 2, 2012 _ Age at death: 49 Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last principal residence at 12 North Enola Drive Enola Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 12 North Enola Drive Enola 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 $ 13,000.00 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.... $ 13.000.00 Real estate in Pennsylvania situated at: (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 December 7, 1989 and Codicil(s) thereto dated n/a 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 parry 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 Grant of Letters of Administration (If applicable) c. t. a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate If Administration, c.t.a. or d.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 additional sheets, if necessary): and h@it'S att 7~ ~~ rr-, 2e. r°~'1 C r C C7 C~3 G7 ~ '~ Name Relationshi Address ~.ert N - ~t, j, ~ C .'S, ~. ~.J C. -r-, -r - C"J rTt Q '.`'t Form RW-02 rev. l0/l1/20/1 PagO 1 Of 2 flats, ,.~ n,......._ _. r. - - - --°--•~~ ~ W..a,t,/ ~r arnrm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioners) 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 me t ~ '~~, day of '.Q ~ ~ Date By' . ~)(,Q~t/9 !n A1A n Date For the Register ~ ~ ~. Date Date BOND Required: Q YES Q NO FEES: Letters ...................... $ ?, '~ )Short Certificate(s)...... ~~_ (~(~ ( )Renunciation(s)........ . ~ )Codicil(s) ............ . ~ )Affidavit(s)........... . Bond ........................ Commission ................. . 'Onth~er 1'~~~ ....... Ih.f~(~ ........ Automation Fee. - JCS Fee ..................... TOTAL ..................... $ To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Supreme Court ID Number: ~ ,.~ ~ x} Firm Name: ~ ~ ~ ~-- Address: r..Z_ O C7~-, Phone: ~j ~ -r ~: ::::._ ~=: Fax: ~ •~ ~~ . ~.~ ~ Email: "~ DECREE OF THE REGISTER Estate of Kell Jo Kistler a/k/a: File No: c~ ~ - ~ ~_~~? (~ AND NOW, ~ ~ ~' -~ satisfactory proof having bee resent efore me, IT IS DECREED~tters Test amenta n of the foregoing Petition, are hereby granted to Richard John Kistler Jr. ~ the instrument(s) dated December 7 1989 in the above estate and (if applicable) that described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. ~~ ~ -~ egister of Willey- /} Form RW-01 rev. /0/l1/201 / (~ , ~ ~~~1 ~~ `k-"~ Pa e`~ of 2 g H105.805 REV 19/i (i L (.R, TRAR'S CERTIFICATION OF ~-EATH .,~p,j ( E ;' I al to duplicate this copy by photostat or photorlr~:ph. f ` ' Fee for this certificate, $6.~g~~ Q~~ ZQ ~~ ~ ~ ~ ~ Thiti is to ~ltift hit thL infoln zt~or (urc gi~ez~ is correctly coC~(e~l 1..)?~ an original (ertit)~.ae of Ueath duly filed ~~lith )~ := as Local ~L_.stTt}'. 'the ori~~ina1 ~;,, certificate u~)i to 1t>rwarded tv t,~e State ~ ital ~~' ( r Records CJtfi4e t,-r per(nauent filir~~~. URPHAfv~~3 ;,ut;R, RLAND CO., PA P 18 5 7 ~. 4 _ _ ~-------_ ~l_~~~- Certification Number Type/Print In Permanent B Local E2e~ stray ()ate I,tiued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS f FRT'I FILD,TE ~F DEATH _. lack Ink - 2. Sex 3. Social Security Number 4. Date o Dwt Mo ay r pe o 1 . Decedent's Legal Name (First, Middle, Las<, Suffix) Kelly Jo Kistler Female 169-62-6494 Jun 2 20'12 Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) der 1 Year Sc Sb U s . . n a. Age-Last Birthtlay (Yrs) Months Days Hors Minutes N A 1K JUIy /6 7962 t . y) 7b. Birthplace (Coun 49 B a. Residence (State Foreign Country) 8b. Residence (Street and Number -Include Apt No.) 8c. Did Decedent LWe In a Township? East Pennsboro twp . PA 12 N. Enola Da wes, decedent used In S d. Residence (County) 7026 Q No, decedent lived within limits of city/boro. CUmt-erlend 8e. Residence (Lp Code) th ~ Married Q Widowed 11. surviving Spouse's Nsme (If wife, give name prior to first marriage) f D 9 ea . Ever In VS Armed Forcesi 10. Marltai Status at Time o Married Q Unknown Richard K1sLer Q N ever Q Yes ®No Q Unknown Q Divorced Mother's Name Prior fp First Marriage (First, Middle, Last) 13 . 12. Father's Name (First, Middle, Last, Suffix) Earl Price Shirts Trout 14b. Relationship io Decedent ' 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) s Name 14a. Informant Richard Kistler HUSBAND 26 ola D . Enol n '12 g ~ .......... ................, ......... ..... ~ ~ -.'- ------- -- -- - ---•. ..--.-.•. - ..'•.--- et on .. .........Sa.....ace o....eat... Y one _ _ _ ~ Hospice Facility w Decedent's ~HOme ltal: Than a Mos h h O tl h O " ¢ I Py .................................. In t1enT : ' ~ ~ f Death Occurred In a Mospltal: U Pa p er ere t Somew ccurre If Deat Other (Specify) ili ° Q Emergency Room/OUipatlent Q Dead on Arrival • ty Nursin Nome/LOn Term Cara Fac Q 8 g- County Of Death 15d a4 Facility Name (If not institution, give street and number; isb . 15c. City or Town, State, and 21p Code Cumberland z . 12 N. Enola Dr. Enola, PA 17028 _ Cremation i l B 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) ~ ~ ur a 16a. Method of Disposition Q p Rempyal rrpm stace Q Donatipn Jun 7, 2012 Evans Cremation Service other lspeafy) and Zip) State wn T Ci 17a. Signature of Funeral 5 Ice Lev Iter•sea qr Person in Charge of Interment 17b. license Number , , ty or a 16d. Location of Disposition ( FD-13846-L ~~ / ~-~ ~ Leola, PA '17640 ~~ fr.no A. Bwow .Y 17c. Name and Complete Address of Funeral Facility Enola Dr. Enola, PA 17026 neral Home 61 N F lli S ~ . u van u Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races t0 Indicate what 19 th ib ~' . es e 18. Decedent's Education -Check the box that best descr t describes whether the decedent the decadent considered himself or herself h t b es a highest degree or level of school completed at the time of death. box t KOrean Check the "NO" ® White Q anic/Latino h/His i . p s Q 8th grade or less Is Span dent Is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese if d b ece ox Q No diploma, 9th - 12th grade anish/Hispanic/Latinq Q American Indian or Alaska Native Q Other Asian n t S N p o, o Q High school graduate or GED completed ® Chicano Q Asian Indian Q Native Hawaiian Mexican American n i M , , ex ca ® Some college cretlit, but no tlegree Q Yes, O Guamanian or Ghamorro Rican ln P Samoan Q Associate degree (e.g. AA, AS) Q Yes, Cuban ~ Flil ino Y es, Q Bachelor's degree (e.g. BA, AB, Bs) Q anish/Hispanic/Latino Q Japanese Q Other Pacific Islander ther S Y p es, o Q Master's de MA, M5, MEn MEd, MSW, MBA) Q gree (e.g. g• Q if ) h S y Ot pec er ( Q Doctorate (e.g. PhD, EtlD) or Professional degree (Specify) .MD DDS DVM LLB JD typeo onsidered himself or herself to be. 22a. Decedent's Usual Occupation -indicate f wor d t c en 21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the dece done during most of working life. DO NOT USE RETIRED. ® White Q Japanese Q Samoan l d f t an lc Is er Seero ary Q Black or African American Q Korean Q Other Pacl S ' ure f Know/Not Q American Indian or Alaska Native Q Vietnamese Q Don 22b. Kind of Business/Industry ' Q Asian Indian Q Other Asian Q Refused f ~ y) Q Chinese Q Native Hawaiian Q Other (Speci Healthcare Q FIIlpino Q Guamanian or Cha mono Death (Only when applicab a 3c. License Number nouncin P P g ro erson ITEMS 23a - 23 MUST BE COMPLETED 23a. Date Pronounced Dead (Ma/Day r 23b. Signature o BY PERSON WHO PRONOUNCES OR n a. O ~ a ~~ Q N ~ ~ L CERTIFIES DEATH 23d. Data signed (MO/Oay/Yr) 24. Tlm ~ f Death Yes No di<al Examiner or er Contacted? Q ,,, ` ,,r / if 25. s e ,v OI oG im t a e a ATH Approx CAUSE OF or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest. Interval: Injuries th Ons t t De di eas s e o t f , e . even s-- s e 26. Part I. Enter the <h fibrillation without showing the etI logy. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines If necessary o i l ' cu ar ratory arrest, o entr res Pl r v ~ (/~~~'~~ //~~ pp //~~s~ ~' 1.ILLALL..Y-a~LAJ-[LLf. Li IMMEDIATE CAUSE ---------------> a. LJ.~ nce of). ~. LF (Final disease or condition /y [ ~mSL resulting in death) b. Sequentially list conditions, a to (or as a consequence o if any, leading to the cause listed on Ilne a. Enter the pue to (or az a copse quen of): UNDERLYING CAUSE W (disease or Injury that F vitiated the events resulting d. Due to (o as a consequence of): r ,¢~ in death) LAST. aus 26. Part 11. Enter other I ifi t dlti t Ib tine to death but not resulting In the underlying c e given In Part 1 27. Was an autopsy performed? Q Ves No 28. Were autopsy findings available ~ to complete the cause of death? Yes No 30. Did Tobacco Use Contribute io Death? 31. Manner of Death 29. If Female: Q Yes Q Probably (g Natural Q Homicide Not pregnant within past year Q No ~ Vnknown Q Accident Q Pending Investigation Could not be determined f death i i id S $' e Q me o c Pregnant at t u Q Q Not pregnant, but pregnant within 42 days of death of Injury (MO/Day/Yr) (Spell Month) D t 32 a e . Q Not pregnant, but pregnant 43 days to 1 year before death 33. Time of Injury ' Q Unknown if pregnant within She past year nstruction site; farm; school) 35. Location of Injury (Street and Number, City, State, 21p Cotle) 34. Place of Injury (e.g. home; co 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q yes Q Driver/Operator Q Pedestrian Q No Q Passenger Q Other (Specify) 39a. Certifier (Check only one): ® Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated to the cause(s) and manner stated d d - ue Q Pronouncing & Grtifying physician - To the best of my knowledge, death occurred at the Hme, date, and place, an a!Iner stated cause(s antl due to t h e and place date time t th d ~~ ~ , , , a e Q Medical Examiner/ n the b Is and/or Investigation, In my opinion, death occurre a amine p / ~ ) 1109 j7- ( ~ LY ' Title of certifier: M ~ License Number:~` Signature of certifier: 39c. Dace Signed (MO/Day/Yr) 39b,Narpe~ poor s ?~~1g tC,o o~P n Completing Ca of Death (Item 26) ~ a - 4 June 4, 2012 A'17033 or. Ne FS D\U\n~w 5_03 42. Registrar File Date (Mo Da 40. Registrar's District Number 41. Registrar's Signature O i~ 43. Amendments l43 U /eL107 REV 07/2011 Disposition Permit No. L~A~3T WI LL AND O F KELLY J O ~O TESTAME' D -- ~. c7 ~ 7 '~:..~-- O ~_- .t., K I STLER ~ -i ~., r~~ c> ~~ ~.+' -.~ r-Lr - .- ; c~ tJ 1 ,.l c. I, KELLY .JO KISTLER, a resident of Camp Hill, Pennsylvania, d{_, +:":'e~;y Yri:3.~e t~~~G12 'h ~.:i•~ det_'1aI'e t1-E .i tai ~~; * T_ "~ ' ttieii ~ ti:? ~~~ iii~~ r ='± (.Ji and Testament, hereby revoking all wills and codicils previo~_isly made by me. I. I direct that all my legally enforceable debts, including funeral expenses, administration expenses, federal estate taxes and state in~ieritance taxes, if any, shall be paid by my Executor hereinafter named as socin after my death as may be practicable, provided that nothing herein shall be construed to require or direct the a.cc°eleration of maturity or the prepayment of any indebtedness owed by me at the time of my death, or arising by reason of my death. iI. All of the rest, residue, and remainder of my property, including all pri:~perty of which I may be seized or possessed or to which i may be ezititled a.t the time of my death, wherever situated and of whatever r;a.ti_rre, be it real, personal, or mixed, including lapsed devises, bequests, and legac-ies, and any property over which I may have a power of appointment, I hereby give, devise, bequeath, and appoint, as follows: A. I give all of the rest, residue, and remainder of niy estate to .i y ~_ p u: ~~ s e, ~ C F~ AP.:.i ~ d hTs; h I~ ~ L E P. ., ~., ,.i T T T _ .~ f u ~.~i r V Z vT 3 t 1 ~" .~. i i i j i\ F' } ;a"1 1 .~ ~~"' 1 t t. 7 -- M~_ Page 1 of 5 Pages -- - - ----iSEAL) specifically excluding any present or after born or adopted children. E. Iri the event that my spouse, RICHARD JGHN KISTLER .JR. ~-:hall riot survive me, I give all of the rest, residue, and remainder of ti:y '-'~ ~ _ r_y -h dYe r, and tC: the descendants {~f a1i~.' red e ,~ LL ~' _ ~ Si 1. ~ f rill iiY , i li L'l~~~~1 uhii.I•l"v ft eY' ~v ± i rrleu r - t 1~ - A the preserit time, i have the following` children: RICHARD JGHly' KISTLER III, REBECCA JG KISTLER, and JASGN LEGNARD KISTLER_ C. In the event that I am not survived by my spouse and there are no issue of mine living at my death, then the rest, residue, and remainder of my estate shall be distributed to my sister'-in-law, JACQUELINE LEA KISTLER, and my brother-in-law, THGMAS KISTLER., both of Shermansdale, Pennsylvania, my sister, WENDY LEE CAMPBELL, of Harrisburg, Pennsylvania, my sister, PENNY CINGERICH, of the State of Pennsylvania, my parents, EARL S. PRICE and SHIRLEY MAY PRICE, of Camp Hill, Pennsylvania, and my father-in-law, RICHARD J. KISTLER SR. of Dauphin, Pennsylvania, in equal shares, per capita and not per stirpes. III. A. Ali references in this Will to "child" or "children" shall be constr~_aed to include those born to me legitimately or adopted by me after the execution of this Will. References to "descendants" shall be construed to mean lawful lineal descendants alive at the time of my death . B. For the p~_irpose of this Will, no person shall be deemed to have survived me if such person dies within sixty (60) days of trcy death- C. Where appropriate in this Will , the masc~uli.-~e s?-._ill include the f errini ne ar.d ;ieuter , the si.:guiar sl-:~~1 i iric~lude t.,e plura~ ~,<;-i IL'. if any benefir_iary entitled to receive distribution of property c_r-r~-i.e,., this Will is a minor at the time of distribution, I direct, ~- - --- --- --- -- -l'~~,~~~- (SEAL ) Page ?. of 5 Pages that my personal representative deliver the property to a c'ustet~3iar: fo-r the beneficiar ~ under the ' Lr:iform Gifts to Nirior~ Acs`s, 'ia":~form Transfers t ;-;r _ a M1 ,ors Act, or a s1:T2iiai' f!?1sLrtdi3,T1 13TFJ Of the :Mate _.f i*_°nr:s 1VaY-:i;~ Or c=± `. Y arty ., .ate wriere the 1-,~-1i°-t .r_~ysr.r t. l: ri: resides; and I give to my personal representative the power tc> desi~Tiate any adult person or trust company, including my personal representative, custodian far the property distributed to each bone f . c iary ~_inder such law. If the law of the designated state does nat. provide far c~.istadianship created in this manner, the distribution shall be mane t.o the custodian as trustee for the minor and the terms of the t~r~_~st• shall be the Uniform Transfers to Minors Act as pramulgated by the Aiational Conference of Commissians on Uniform State Laws with the gust to terminate when the minor is eighteen years of age. V, if my spouse does not survive me, it is my desire that my brother-in-Iaw and sister, JAMES LEROY CAMPBELL and WENDY LEE CAMPBELL, have custody of any minor child of mine. Accordingly, I na..me my brother-in-law and sister, JAMES LERQY CAMPBELL and WENDY LF_,E CAMPBELL, as guardians of my minor children. If my brother-in-law and sister, JAMES LEROY CAMPBELL and WENDY LEE CAMPBELL, shall fail to serve or continue to serve, then I nominate my sister-in-law, JACQUELINE LF_A KISTLER, to serve as guardian. I s~sL4est, ho=avever ±hat there be a ~~alifi_atior: of a `uar'di_~t: as su<-~h only i f it. is necessary to do so in order to h:~.ve physical ~{u~;t--;dy oi' for sc:rrle ether =vt:ipellii r~-';iv'rtr1. To h h + - _ t .. ~ ;t .,,r :.i '._. "" a aY iu : :' t: T SS'+_ i c ~ ~ ~. r. C= }-` 1~ r"V. ;~. i } y vAar;~ ~. v }~` d ~ i i ~S g ~~ ~~. 7 i ~ ~ e~ i : i_ < i :~. .: i '~ i/ ~ :' ~'= u required to give band as guardiar, ar, band being necess,:~ry, to give s~~rety thereon; t•o qualify before, be appointed by ~:r, ir. the ;~rt~:aT-~[F. of a br'G-`aCh Of trLIF.'.t, dccallr:t tG` :fir:y c'GUrt; or t':, ~~~>tal;: tI"Ie order or approval of any court for the expenditure of income or principal r,f the ward's estate. VI. ? hereby appoint my spouse as personal representative of this Will a.n~i of my estate; "persanal representative" means both executor and exec~.Ttrix, as well as independent executor and executrix, and ~JI -- z~- --~!~~- , iSEALl Page 3 of 5 Pages --- - - ~~~"~ -- includes both the singular and the plural. In the event ;hat, my spaus~ shall predecease me, or shall far any reason refuse or be tenable to serve or complete the administration of my estate, then I appoint my sister, WENDY LEE CAMPBELL, as successor personal representative of this Will and my estate, under the same conditions as set forth hereunder for my personal representative. I request that my personal representative be permitted to serve without bond or surety thereon, inventary, appraisement, accounting, ret,_irn to ar appr<-,va.l. of any court, and without the intervention of ar.y court +,,~ the extent as permitted by law. My personal representative is authorized to exercise all powers granted under the laws and statutes of Pennsylvania or other applicable law, including bt_it not limited to the fallowing: t<, sell, exchange, convey, transfer, assign, mortgage, pledges, er.run;her, lease, or abandon the whole or part of my real ar personal I'r~>I'erty, upon sur_h terms as my personal representative shall deem proper; to retain or disease of investments or other property of my estate; to invest and reinvest the assets of my est:~te, a.n,a to perform all ~~cts and execute all documents which my persasi.~' representative rnay= deern necessary , convenient r ar• erop.ur ir; rega•,~ ~ ~' y A e fu2~egci7Tt; ~:o~^,;e~~:; ;32~e - - '•--_ eiieT';:i."ed 66=]t•hoL't order, $L'tYlorl,ctti[.:7i, or apprc=Val ':~_ 3;iyr ,~0?17_•!'•._• -. _vy,r :~~ 7'e_Yul ~ ed b,.= laT~ - , VII. If it becomes necessary to have ancillary administration of my estate in any jurisdictior: where my eersanal repre~~entwtive is t_inab)-e ar does not desire to qualify as ancillary leg=1. rNpre:~~•r.ta+,ive, Iappoint as sur_h ancillary legal representative such individt_ial ar corporation as my personal representative shall desi.gn~-t.te, in writing. I direct that any balance of my property remaining after such ancillary administration be delivered, to the extent permitted by law, to my personal representative far disposition in accordance with the terms of this Will. I f,_irther d;.rect that such ancillary legal representative shall not be required to give any band or other security far the faithful _C !~~_ Page 4 ,f 5 vage`. J +J - - - -- -- ~'~~~-J-f--~---- r SEA, , performanr_e of his, her, or its duties, or if any bond is required, that it be without surety thereon. IN WzTNESS WHEREOF, day r,f ~ I have at 198 Fort Knox, Kentur_ky, this ~~~yy Last Wi].1 and Testament ___ 9, cons fisting set of 5 my hand and sea? to this~my pages, this ir.c•luded. Signed, sealed, published, and declared by the ,above-named testatrix, KELLY JO KISTLER, as her Last Will and Testament, in the presence of ,al.l of us at or.e time, and at the same ti ~- 2Y.e , ~~~e ~. t h e r e - r r ~.;e~ _ and fir: he presence grid in the presence of _ -.t heY'eu:; },p sT_:bsc!r i bed oL.12' names as *Ni trte~:"ti.,., ~ ~'~ _~ ~: ~-tt..i; ' ~;-:tr•~• C C8C ani~ vNP dv hYr i +. r, thN sound and dis osir• 5 ;~ -a a eb,~ attes}. :: p .S ?Y. ]. tc. nt, Y:leY:iC~ry Cif Sai!~ +e~_±.,tY'i .~.y ~.e ere c, f -~ _ .. ~ .u x a t~:e 3.ttu tL= tl:t' pP;zfL~:'2:t;7Yt?r .•t vT-tt=~C ,Y..f~tY'C~~;.r exerut i on at Fort Knox , , , ~,~` -' acts ._ f L'~CE~r.~~ ~ ~ ~ Kenti.cky this • -~-----`~-~------ ~ :.9819. --~ ---- day o f f~ --- ------- ---------------residing a t_.,~ ~~(/C litr/ ~ ~ ! /~_~ ----- . . -- ~- ----------residing at ~~~ =L ---~~-- _-- -- _residing at ~ ~c-' -~ - -- --- _ ~ ~~~_~- f SEA I~ } Page 5 of 5 Pages PENNSYLVANIA SELF PROVING CLAUSE C01~10NWEALTH OF IQ~VT[JCKY COUNTY' OF HARDIN We , me zeszaLrix ana me ~.tnesses, respect~;vely, whose ntettGS are sign~~o ~T'e attached or fgregoing instr~anGnt, Tje~g ~ir~t duly s~rQ~Cn,, dq hereby declare to the undersigned a~~thgri~t~ thst the testatrix pied and eX~cuted the instru~-ent as \fiex last wiall -and t~.t ~~ signed ~cfilli~;ngl~ (or ~~lli:r~gly d;re..cted another tq sign for hurl,, and tit sRe ex~t~d, i~t as. Pier free and voluntar.~-act ~wr. tfi~ purposes th~re~ exprc~~ed, and tPtat ez~cY~ ©~ tfie ws:~tness~~, in tPte~ presence and I~i.riszg ~ of the testatr~c, signed tFre ~ri~ll as w~.~tness azid tRat to the: Hit of ~';^ ~fla~,3edge tpie testatrix ,bras; at tft~t time ei~gF~tteen yy~eears 4f agC or older, o$ sound ml'~d and under no coa~trai'nt or undue ~iuence. ~-~~- ~~- ~~ ~-~ 1'N~ me ~`o (~~ `~._ ~~ ~` ~~ ' Subscribed, sworn to and aclrnowiedged before me T~~j/ :~~ ~,sTjE.~ ~ the testatr.-3~c, -and ~sut~scr~ed~ and , rn to , e ore ,. ~~~ ~ ~~` ' ~~ ;~ ~~1~~ ~ ~~'1 ~ ~ .~~~~a~ ~ and HN ~~ ~C~?~ ~~ wgtnes~ses , zs~ ay of