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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) tht
following and respectfully requests the grant of Letters in the appropriate form:
Karen Sue Hudson
Decedent's Information
Name: James W. Miller
alk/a:
a/k/a:
a/k/a:
Date of Death: 1 0/1 51201 2
File No: 21 (a - -a~q
(Assigned by Register)
Social Security No:
Age at Death:
83
Decedent was domiciled at death in Cumberland County, pA (State) with his/her last
principal residence at 510 West Main Street, Walnut Bottom 17266 South Newton Twp. Cumberland
Street address, Post Office and Zip Code City, 7ownsMp or Borough County
Decedent died at Life Care Hospital Mechanicsburg Cumberland PA
Street address, Poat Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's properly at death:
If domiciled in Pennsy/vania ........................ All personal property $ 25,000.00
If not domiciled in Pennsylvania ................. Personal property in Pennsylvania
Nnot domiciled in Pennsylvania ................. Personal properly in County
Value of real estate in Pennsylvania...........
Real estate in Pennsylvania situated at 510 West Main Street
TOTAL ESTIMATED VALUES
Walnut Bottom
Cumberland
(nnacr, additional sheets, Ir necessary.)
Street address, Post Office and Zip Code Cily, Township or Borough County
~X A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) that helshe/they is/are the Executor(s) named in the Last Will of the Decedent, dated 09/19/2011 and Codicil(s)
thereto dated
(SfefB releVanf CIICUmafanCBa, e.Q., reOUOCIafADn, death Ore%eCUrdl, BrC.)
Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not ma ,was not divorced, was not a party to a pending
divortx proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S.§ 3323(8), and did not have a child bom or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
~X NO EXCEPTIONS Q EXCEPTIONS
^ B. Petition for Grant of Letters of Administration (If appficaWe) ~ ` ~'
c..a.; ..n.; ..n.c..a.; n ~ uran a
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If Administration, c.La or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.
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Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorce had been establie~d?d d6filted ~
nor ever adjudicated an incapacitated person
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in 23 Pa. C.S. § 3323 (g) and was ne
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QX NO EXCEPTIONS ~ EXCEPTIONS 2 V? ~~ ~ ~
Y 9 Po In an~n~eirs (~ch
after a proper search has/have ascertained that Deoedartt left no Will and was survived b the folknvin s use ~j
Petitioner(s) Q
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,
additional sheets, rf necessary):
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Name Relationship Address ~. ~ ~ fJ
Karen Sue Grant Hudson Daughter 92 Hillside Road
Mechanicsburg, PA 17050
Stephen Lawrence Miller Son 111 Julia DNve
Royce City, TX 75189
Nicole Michele Grant Granddaughter 2051 Sandpiper Pt, NE #103
Grand Rapids, M149505
Form RW-O2 rev. 70-1 f-201 f Copyright (c) 2011 form software only The Lackner Group, Inc. Page t of 2
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland 1
Ofridal Use Only
faCrntSnr.. ..____ __-
Petitioner(s) Printed Name Petitioner(s) Printed Address
Karen Sue Hudson
Name as listed in Will: Karen Sue Grent 92 Hillside Rosd '
Mechanicsburg, PA 17105 ,; „
~~~'~ CEC 1
CLER,~ Oi
G~MBERE.AND CO., PA
The Petitioner(s) above-named swear(s) or affirm(s) the,statements in the foregoingg, retroon are true ana correct to me oast or me Knowteage ana
belief of Petitioner(s) and that, as Personal Representatrve(s~f the cadent, Petttoner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscfibed before ~' ~ ~`~. ~L.C~.- ~~~~- Date / t~- ~~--
me th' day of Date
Date
By:
For the Reyistei Date
~~~ --
BOND Required? ~ Yes QX No
FEES /~~``
Letters ............................................ $ ~a • Q V
( ~ )Short Certificate(s).......... ~ • C~C9
( )Renunciation(s) ...............
( )Codicil(s) .........................
( )Affidavit(s) .......................
Bond ..............................................
Commission ...................................
Other
jA); I 1 15•U
Automation Fee ............................. ij • G
JCS Fee ......................................... 3 • 5 U _
TOTAL ........................................... $ ~ Z3 • ~J
To the Register of Wills:
Please enter my appearence by my signature below:
Attorney Signature:
Printed Name: William C Cramer
Supreme Court
ID Number: 22495
Firm Name:
Address: 14 North Main Street, Ste. 414
Chambereburg, PA 17201
Phone: 7171264-3711
Fax: 7171264-0554
E-mail: williamcremerl~embargmail.com
DECREE OF THE REGISTER
Date of Death:
Social Security No:
Estate of James W. Miller File No:
a/k/a:
10h 512012
21 ~~-~a7
AND NOW, ~~(~ ('1/t,~f~.Q i ~ ~ (Z , in consideration of the foregoing Petition,
satisfactory proof hawng been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Karen Sue Hudson ~-~~- Yin ~l,l.~ )`tr('.t fl ~
in the above estate and (if applicable) that the instrument(s) dated 09119/2011
described in the Petition be admitted to probate and filed of record as the last Will (and Coc
rtegtster of vvms ~k ~ ~-lp~r~ jynn p .
Copyright (c) 2011 form software only The Lackner Group, Inc /C.7 1.~~1`C~F1 age 2 of 2
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.OOREGORDED 4rF~C~ OF
REGISTER OF ~ILl.S
2L1~ DEC 7 Ail 9 Os
f
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be 'forwarded to the State Vital
Records Office for p maven cling.
P 1885167. CLERK Oi:
Certification Number ~ ~ H AN S' ~ 0 ~ RT ,~ egistrar Date Issued
CUMBERLAND CO., PA
Typa/Print In COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH .VITAL RECORDS
P•^"•"•"t CERTIFICATE OF DEATH
eb k Ink $LU Flle Number.
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1. DeudlM'i Legal N!m! (drat, Meddle, Last, Suffix) 2. S!x 3. Social SlNrRy Number 4. Date of Death (Me/Day/Vr) (Spell Mo)
James W. M.eX.eeJC a 159-24-9108 e~obe-c T 5 201 2
(`ItyaRd SUU or Forllgn Country)
Se. Age-lsst Slrthdly (Yrs) Sb. undK 1 Y!!r Sc. Vnder 1 D! B. DK! W Birth (MO/Day ear) (Sp111 Month) 7y J!e pllu
n
M pn[hs Days HOYri MlnutN M YLQ, b
8 3 J(aX. 1 1 7 9 2 9 7b. Birthplau (County) CLf7t n
B Residence UU Or Foreign Country) Sb. Residence (StrlH and Num r - Intlud! Apt No.) 8e. Did Decedent Vve In a Tewnihip7
~en19.6y.~va.J'(,c.a 510 Weber Ma.(.n Serif-eel ®Yes,deudentlNldin South N¢JU~on twp.
Bd. Rlsidenu LCOUnty)
CetmbehX~nd ~ 8!. Rlsldenp (tip Cad!) QNO, dleederK ilwtl within Ilmhs er dty/boro.
9. Ever In US Armed Parcae? 10. Mar1Ul SUtui at Tlm! of Death MlMSd Wldewetl 11. SuMVing Speuw's Nam! (N wife, giv! nam! prior to first mlrriage)
m Yls Q No Q Vnknown Q DNprud Q Never Married Q Unknovm
12. Fa is Ne (FI , Mlddl st. SuNx)
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~ 13. Mother's Name Prier to First Marriage (First. Mkldle, last)
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14a. Informant's Neme 14 RNKI Mhip U Decedent
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~ 14c. InformlM' Mall Address (S et and N bar, City, SUU, Zlp Code
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Kah.en G~ca.nt 92 H.c.f.
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(.awi.eebwcg, P
l 17050
If Death Occurred In ! Hosp1U1: ~ inpltlent If Death Occurred SomewheM Other Than a NospRal: ~( Mosplee Facility ~~ DeptlenYs Home
Eme n Reem/OUtpltllnt Deed en Arrival Nuraln Heme/Len Term Care Fa<II Other (Specify)
15 b. FeelilLy Name (N not Institution, give itrlet and number; lSe. G Town, SULl, nd Zip Code 1Sd. County of Duth
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L.i. a Cwce Hoe (.ccabw
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PA 77050 Cumbe/i.Cand
16a. Method eT Dbpuldon Burial CremaHen 16b. D!N Dlapeiltlon 16c Piau o1 Disposition (Name of umttery, erematery, er other p4a)
Q R.mpY.l tram stet! Q Donaclon
othlr(s l 7 0 -1 7-2 O 1 2 Ha.2X.i.ng efL Fttnelca,C Home & C/(.ema~ohy
18d. LoeKlOn DlipoaRlon (City or Tewn, Stall, and ZJp i]a. S Kure Fu r•I S!M LI or Person In Charge Of Interment 1]b. Llunse Number
Mme. Ha.P~y Sp/c.i.nge, PA 17065 P'D 014357-L
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ena.e Hom e 1 1 2 Weak K.i.n. Ste. Shi_ e.na buh. A 7 7 7
a~ 18. D!u ant's EtluuNen - C aek Me bex that bait deierl ei the 19. Decedent of Hispanic Origin -Cheek the 20. Deudent's Reu -Check ONE OR MORE taus to indicate whet
! q1 death,
hlgMlrt OegrN or level of teheel completed !t the tlm box that best duerlbls whKMr th! deudlnl th! decadent eensidered hlmaaN or hlrseN to be.
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Q 8th grade er Ilia is Splnlsh/Flispanle/Latlno. Cheek the ^Ne^ ®WhKe Q Korean
No diploma, 9th - 12th grade bex H d!cltlent Is net Spanish/Hlspanic/Llilnv. Q clack or Afrlun American Q Vletnamase
Q Hlgh school gradvaU er OED completed ®Nv, net Spanlih/Hlapanie/latin0 Q AlnMUn Indian or Alaska Native Q Other Asian
Q Some COIMge credit, but ne degree Q Yea, Mexlun, Mlxlwn American, Chlune Q Aflan Indlln Q Netlve Hawalbn
~ ANOCIate degree (e.g~ AA, AS) Q Yea, PulKO Hun Q Chinoe Q Ouamanlan or Chlmorro
Q BecMkar'a decree (e.g. BA, AB, BS) Q Yu, Cuban Q FlIIPino Q Samwn
Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yei, ether Spanish/Hbplnlc/LaTinv Q J•Penese Q Other PaeMC Islander
Q Dotterate (e.g. PhD, EOD) Or ProfeaslOnal degRe (SpeeHy) Q Other (Speelty)
e. . MD DDS DVM LLB JD
21. Decedent's Single Race SlIRDeslgnetlon - CMC ONLY ONE to intlicate what th! decadent considered himself or herself to be. 22a. DecedeM'i Usual OceupaNen - IndloU type of work
® White Q Japanese Q Samwn tlone during most eT wOrking life. DO NOT VSE RETIRED.
Q Bieck Or Afrlun American Q Korean Q Other Paelfle libnder ~n
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Q American Indlln or A4aW N•HVe Q V(eMamese Q Don't Know/Not Sune ea.V
U.C.. eJ7.t MQChan.c..e
y Q pm
Q Asian Indlln _ Q Other Asian Q Refused 22b. Kind of Bualntls/Industry
Q Chinlae Q NltN! Hawaiian Q Other (SPlCify)
Q Flllpino Q OuamanlanorChamerro LeLteJ2fLenny AhJJty 'Depot
MS d MVST BE GOMPLHTED 23a. Date P De! Mo ay 2 b. Signature a arson Pronouncing Delt (Only when appilw a 23c. Llunse Num er
BY PERSON WNO PRONOUNCES OR
tXRTIFlEi D TH ' O , S x
Sd. DaU Signed (Me y 24. Time fjR~ t
G. ~-- 2S. Was Medlin Examiner or Coroner Comaeted] Q Yes ® No
• CAUSE OF DEATH Approximate
26. Part 1. Enter the chain of wants-diseases, Injuries, or compllutlens-that directly caused tM tleath. DO NOT enter tennlnal events such !s cardiac arrest. E Interval:
reapirltory arrest, or venMCUlar flbrlllltlon without skewing the etlology. DO N
OT ABBREVIATE. Enbr
only eve cause on • line. Add additional Ilnas 11 neussary ~ Onset tq Death
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IMMEDIATE CAUSE -- > Cf~ Y` ~ J O l7 l4 117YJ rl Y~ G~NV C/l~~ ~ ~ ~'/ ~Qi~~
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(Finl1 disease er condition
D~(or a~a consaquen
resulting in death)' _ b. a ~~~~ ~s. ~ ~~, I G / ~cT/ f S t ~ Y10 - ~ ~ //Vf
as eonsequen ot):
Saquantlally Ilst conditions,
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H lny, leatling to the eluse !~ GA:J ! U ~[il t / J !~-'~C~ ~/` b~ N~J1~ ~ %l ~C ~~
listed on line !. Enter the gJ7Y(• ~ Z m'~
_V NDERLYINO UVSE .. / Due to (or ai !consequence ory: _ _
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B III
(disease or Injury that -•'
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InRlatld the events ltsu Ming d. ) f
in death) LAST. ~ Du! t0 (Or of • cpnaegUenca af): S
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26. Pert 11. Enter other
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ot resu ting In the underNing cause given In Pert 1
' 2]. Waa an .utopsy
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~t` (.~/ 'rLX V' l 28. Were autopsy findings available
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Yes
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29. If Female:
Q Not pregnant wlthln past year 30. Dld Tebacw V Contribute <o Death7
Q Yes bably
~ 3 M net of Death
~ N•tursl Q Nomleltle
Q Pregnant at Hme of death Q No
nknown Q A<Cldent Q Pending investigation
~' Q Not pregnant, but pregnant wlthln 42 days of death Q Suicide Q Could not be determined
Q Not pregnant, but prepnanS 43 days to 1 yelr before death 32. Date of Injury (MO/Day/Yr) (Spell Month)
Q Vnknown If pregnant within [he past yeal 33. Time of Injury
34. Place oT In)ury (e.g• home; construction site; faint; school) 3S. Location of Injury f5troet and Number, City, SUte, Zip Code)
36. Injury at Work 9]. It TranaportKlon Injury, Speel/y: 38r Describe How Injury Occurred:
Q Yes Q Driver/Operator Q Pedestrian
Q No Q Passenger Q Other (Specify)
39a. CeKMer (Check only one):
~4.'e Rifying Physician - To the bas[ of my knowledge, death occurred due to the cause(s) and manner mated
Q Pronouncing 6 CeKifying Physician - To the best of my knowledge, death otturred at the time, date, and place, and due to the cause(s) and manner stated
Q Medical Examiner/l=.OrO^er
On the pails of examination
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or Investigation, In my opinion, death rred at the time, date, and place, and due to the uuse(aJ and manner stated
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Signature of certlfler: -._
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39b. e, Address and 2J0 Code o1 Pers n ComplHing Ceusa of Death (Item 6/~
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40. Registrar's District Number 41. strlr Slgnetur 42. ReBls ar FI a Date Mo Day Yr)
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43. Amendments
Dispgsltion Permit Np. O 8 O 2 tf! 9 5 H 705-143
REV 0]/2011
LAST WILL AND TESTAMENT
OF
JAMES W. MILLER
Dated: September 19, 2011
Prepared by:
Captain Jessica E. Guise
22 Ashburn Drive
Carlisle Barracks, Pennsylvania 17013
717 245 4940
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LAST WILL AND TESTAMENT
OF
JAMES W. MILLER
I, James W. Miller, a resident of the Commonwealth of Pennsylvania, make,
publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any
time heretofore made by me. I am retired from the military service of the United States.
FIRST: I direct that the expenses of my last illness and funeral, the expenses of
the administration of my estate, and all estate, inheritance and similar taxes payable with respect
to property included in my estate, whether or not passing under this will, and any interest or
penalties thereon, shall be paid out of my residuary estate, without apportionment and with no
right of reimbursement from any recipient of any such property.
SECOND: It is my desire that, upon my death, my body be cremated with full
military honors.
THIRD: I give the items of tangible personal property listed below, if owned by
me at the time of my death, as follows:
My 20 gauge Winchester pump model 12 shotgun to my son Stephen Lawrence
Miller;
My grandfather clock to my daughter Karen Sue Grant.
All other tangible personal property is given as hereafter provided with respect to
my residuary estate.
FOURTH: I give the sum of Six Thousand Dollars ($6,OOO.UO) to my
granddaughter Nicole Michele Grant, if she survives me.
FIFTH: I give all the rest, residue and remainder of my property and estate, both
real and personal, of whatever kind and wherever located, that I own or to which I shall be in any
manner entitled at the time of my death (collectively referred to as my "residuary estate"}, as
follows:
(a) In substantially equal shares to those of my daughter Karen Sue Grant and
my son Stephen Lawrence Miller who survive me and to the issue who survive
me of those of my children who shall not survive me, per stirpes.
~~~
(b) If no issue of mine survives me, my residuary estate shall be paid and
distributed to the American Cancer Society.
SIXTH: If any property of my estate vests in absolute ownership in a minor or
incompetent, my Executor, at any time and without court authorization, may: distribute the
whole or any part of such property to the beneficiary; or use the whole or any part for the health,
education, maintenance and support of the beneficiary; or distribute the whole or any part to a
guardian, committee or other legal representative of the beneficiary, or to a custodian for the
beneficiary under any gifts to minors or transfers to minors act, or to the person or persons with
whom the beneficiary resides. Evidence of any such distribution or the receipt therefor executed
by the person to whom the distribution is made shall be a full discharge of my Executor from any
liability with respect thereto, even though my Executor may be such person. If such beneficiary
is a minor, my Executor may defer the distribution of the whole or any part of such property until
the beneficiary attains the age of eighteen (18) years, and may hold the same as a separate fund
for the beneficiary with all of the powers described in Article EIGHTH hereof. If the
beneficiary dies before attaining said age, any balance shall be paid and distributed to the estate
of the beneficiary.
SEVENTH: I appoint my daughter Karen Sue Grant to be my Executor. If
Karen Sue Grant shall fail to qualify for any reason as my Executor, or having qualified shall die,
resign or cease to act for any reason as my Executor, I appoint my son Stephen Lawrence Miller
as my Executor. I direct that no Executor shall be required to file or furnish any bond, surety or
other security in any jurisdiction.
EIGHTH: I grant to my Executor all powers conferred on executors under the
Pennsylvania Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, and
all powers conferred upon executors wherever my Executor may act. I also grant to my
Executor power to retain, sell at public or private sale, exchange, grant options on, invest and
reinvest, and otherwise deal with any kind of property, real or personal, for cash or on credit; to
borrow money and encumber or pledge any property to secure loans; to exercise all powers of an
absolute owner of property; to compromise and release claims with or without consideration; and
to employ attorneys, accountants and other persons for services or advice. The term "Executor"
wherever used herein shall mean the executors, executor, executrix or administrator in office
from time to time.
NINTH: I direct that for purposes of this will a beneficiary shall be deemed to
predecease me unless such beneficiary survives me by more than thirty days. The terms "child"
and "children" as used in this will include only the child and children of the person designated,
but not any adopted child and children of such person. The term "issue" includes only the
children and other issue of the person designated, but not any adopted or step children or issue of
such person. The terms "child," "children" and "issue" of the Testator shall not include any
stepchild of the Testator.
TENTH: I have served in the Armed Forces of the United States. I therefore
request that my Executor make appropriate inquiries to ascertain whether there are any benefits
to which I, my dependents or my heirs may be entitled by virtue of any military affiliation. I
2 ~~~
specifically request that my Executor consult with a retired affairs officer at the nearest military
installation, the Department of Veterans Affairs, and the Social Security Administration.
This document was prepared under the authority of 10 U.S.C. §1044 and
implementing military regulations and instructions, by CPT Jessica E. Guise, who is licensed to
practice law in Pennsylvania.
IN WITNESS.WHEREOF, I, James W. Miller, sign my name and publish and
declare this instrument as my last will and testament this 19th day of September, 2011.
James W. Miller
The foregoing instrument was signed, published and declared by James W. Miller,
the above-named Testator, to be his last will and testament in our presence, all being present at
the same time, and we, at his request and in his presence and in the presence of each other, have
subscribed our names as witnesses on the date above written.
having an address at
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having an address at
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,013
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ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA, COUNTY OF , ss.
We, the Testator and the witnesses, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that
the Testator, James W. Miller, signed and executed said instrument as his last will and testament
in the presence and hearing of the witnesses, and that he stated that said instrument was his last
will and testament, and that he had signed willingly, and that he executed it as his free and
voluntary act and deed for the purposes therein expressed, and that each of the witnesses at the
request of the Testator, in the presence and hearing of the Testator and each other, signed the will
as witness, and that to the best of his or her knowledge the Testator was at the time at least
eighteen years of age or emancipated, of sound mind and under no constraint, duress, fraud or
undue influence.
James W. Miller
Testator '
print: D C ~~ SG ~ 8Y
Witness
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Gam'
nt: ~'h
Witness
Subscribed, sworn to and acknowledged before me by the said James W. Miller,
Testator, and subscribed and sworn to before me by the above-named witnesses, this 19th day of
September, 2011.
Notary is
My commission expires on
COAAM NWEALTH OF PENNSYLVANIA
NohrGd Sal
Kami ~Y H~rttler, Nogry Public
C~dkle 8oro, CumbeAand County
~ 16, 2018
Wlember, •tlon of Notaries