HomeMy WebLinkAbout01-10-13PETITION 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 requests the grant of Letters in the appropriate form:
Earl M. Henry
Decedent's Information
Name: Emma Jane Tasek File No: 21 - ~ ~ ~ i`.'."i C
a/k/a: E. Janie Tasek E. Jane Tasek, Jane Tasek and Janie Tasek (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 12114/2012 Age at Death: 90
Decedent was domiciled at death in Cumberland County, pA (State) with his/her last
principal residence at 8 Wayne Circle, Camp Hill 17011 Lower Allen Township Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Messiahs Lifeways, Mechanicsburg, PA 17055 Mechanicsburg Cumberland PA
Street addmss, 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 $
!f not domiciled in Pennsylvania ................ Personal property in County $
25,000.00
Value of rea! estate in Pennsylvania ................................................................... $ 75,000.00
TOTAL ESTIMATED VALUE $ 100,000.00
Real estate in Pennsylvania situated at 8 Wayne CIrCIe Camp Hill, PA 17011 Cumberland
(Attach additional sheets, if necessary )
® A. Petition for Probate ;and Grant of Letters Testamentary
Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated
thereto dated
Street address. Post Office and Zip Code
City. Township or Borough
County
08124/1988 and Codicil(s)
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 rnot a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 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
^ B. Petition for Grant of Letters of Administration (If applicable)
c.t.a., d. b. n., d. b. n. c.t.a., pedente lite, durante absern'ia. durante minoritate
If Administration, c.f.a e~rd.b.n.c.t.a., Pnter date of Will in Section A above and complete list of heirs.
Except as follows: Decedent was not a party to.pending divorce proceedin 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 souse (if any);anti heirs (attach
additionai sheets, if nece:>sary): c ~ ~ rn
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Name Relationship Address rn ~ ~~ -- t-'~ ~~
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Form RW-O2 rev. 10-11-201 f Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Tasek
Petitioner(s) Printed Name Petitioner(s) Printed Address Cti is ~s i ~ : '< is ~' -'-- ~'
Earl M. Henry 924 Macoun Drive
Mechanicsburg, PA 17055 %~ ~ ~ F 1~ i (~ f- ~~ ~' `_ r;}
`71'!'-697-5021
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The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Neutron are true ana correct to the nest or ute rcnowteuyC anu
belief of Petitioner(s) and that, as Personal Representative(s) of the cede t, Petitione s) will well and truly administer the estate according to law.
Sv.orn to or affirmed a d subscribed before ~ ~ ~, Date ~ ~ / ~' ~ ~-~
~ • ~ ~ ~ c _ Date
rite thlit l~ day o` ~ ,
. 1 i1~ r^ 1 : Date
B> ~yl
forth? Register Date
~~.~
BOND Required? ^ YES '~ NO
FEES:
Letters ....................................... . ~•~,
... $ ~ ~ ~ ~ r. ,
(,~) )Short Certificate(s)....... .. -_~`"-): (.~ ~~.
( )Renunciation(s) ............ ..
( )Codicil(s) ...................... ..
( )Affidavit(s) .................... ..
Bond .......................................... ...
Commission .............................. ....
Other
I L : 1 ~ ~~~-~~ ~ ~ ~~
I ~ 1t~ TG X 1~t-1 ~ ~'; (~~ ~ ~;~
Automation Fee....._ ................ ... e j .CL.
JCS Fee .................................... '? ~ r
...
TOTAL ...................................... ... $ ;' L' ~ )~
Estate of Emma Jane Tasek
a/k/a: E. Janie Tasek, E. Jane
Official Use Only
,~
Date of Death: 1 211 4/201 2
Social Security No:
File No: 21 . ~, - L.~~ 1
AND NOW, ~ ~ - i ra ~i 1.3 , in consideration of the foregoing Petition,
satisfactory proof having been presented ore me, IT IS DECREED that Letters Testamentary
are hereby granted to Earl M. Henry __
in the above estate and (if applicable) that the instrument(s) dated 08/24/1988
described in the Petition be aldmitted to probate and filed of record as the last Will (and Codicil(s))~of Decedent.
~.
~~
Please enter my appearance by my signature below:
To the Register of Wills:
Attorney Signatur
Printed Name: Jennifer B. Hipp
Supreme Court
ID Number: 86556
Firm Name: Bogar and Hipp Law Offices
Address: 1 West Main Street
Shiremanstown, PA 17011
Phone: 717-737-8761
Fax:
E-mail: jhipp@bogarlaw.com
DECREE OF THE REGISTER
Register of Wills ` ' ~
,,
Copyright (c) 2011 form software only The Lackner Group, Inc. ~ { ~ ~J ~ ~ ~~ Page 2 of 2
L.q~vA•IL REGISTRAR"S ~ERTIFI~ATIq~I q~ ®E'ATl~il
V~,IARI't~!lIV~: !t is illegal to duplicate this copy by ;ahotast~t or photoq~r;~p°i.
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e/~{y M B `. ` ~ ` • ~ ~~ ~' ~~ ~ CON~QNtNEALrH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAI RECORDS
k;~kl CERTIFICATE OF DEATH
E ` 1 -, tl, t i~1 > I :< < il~ti)rnration h~ I .~ rl~~en I,
:a'II~LC~ Ll i I4 (; t, 1 ;lilt "II1Q1 ~~Cl~lill.ilt'Ol l~Ca11~
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1 Decedent's Legal Name (first, Mild e, Last, 6uHlx 2. Sez 3. Social Serurity Number e ~ 4. Date of Death (MO/Day/Yr) (Spell Mel
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Sa 4ge~Last Birthday (Yes) $b. Under l Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Yearl (SMII Month) )a Blrthpla<e ICIry and State r Foreign Country)
r`/ Months Days Hours Minutes '
~v I ~ ~i 1 ~ ~ ~ 1b. Birthplace (County)
Ba Residence IS[ate or Foreign Country) 8b. R
esidence (Street and Number ~ Include Apt Npl 8c Dltl Decedent Uve in a Township?
p ~es
de<edentliyedin l~•Di..l~f- Allen tw
ed Residence (County) O W0.LVlt GY~~ ,
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8e. Residence 1210 Code) I I ^ No, dttetlent livetl within limits of city/boro
9. Ever in US Armed Forces? 1D. Marital Status at Tlme of Death ^ MamiM Wltlowed 11. Surviving Spouse's Name Ilf wife, give name poor to tryst marriage)
^ Ves ~NO ^ Unknown ^ Ohrorred ^ Never Married ^ Unknown
12 Father's Name (Firs[, Middle, Last, Sufflz) 13. Mother s Name Prior to Flrzt Marriage (Firs[, Middle, last)
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14x. Informant's Name lab. Relatbnship to Decedent lac In(ormant'f Mailing Address (Street and Numxr, Ciry, State, Zip Code)
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___ _______ ua.ParegDta~ errkonlrgn_
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n Death Qmrred in o HosplbC ~ Inp¢Hent Ht Deaih Occurred Somrwhr~e Other Than a Mospinl ^ Mosplce Facillly t] oecedenPS Home
^ Emergency Room/OUtpatlenl ^ Dead on Amval Nursing Nome/LOnPTerm Care Fatlllry ^ Other (Specify)
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lEb. facility Name 111 not instiN[bn, gve street and number) lSC. City or Town, Sgte, and Zlp Co 1Sd.
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of Death
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I6a. Method of Dliposklon ^ Burial Cremation 16b. Date of DlsppslHan 16c. Place of Ois on (Name of cemetery, crematory, or other place)
^ Removal from State ^ DonaHOn
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^ Other(6pegHy) ?aaa A.~,,.aa
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16d Location of Dlsposltlon (City qr Tewn, State, and Zip)
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S>1 11x. Signa[u f I Service Iron ~~~~~ In Charge o Interment 1)b. License Number
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I]c. Name and Complete Address al Funeral Faculty
8. edent's EtluwHOn - eck the [ax that best desMbes the 19. Decedent of HI nlc Odgln ~ Check tht 2 . Decedent's Rao -Check ONE OR E races to ~tllcate what
highest degree or level of school cempletetl at the time of death, boa Na[ best describes whether the Decedent the decedent cgnsldered hlmsel(or herself to be.
^ 8th grade or less is Spanish/Hispanic/Latino. Check the "NO' White ^ Korean
~NO dlplpma, 9th ~ 12th grade boz if decedent ii rsot Spanish/Hispanic/Latino ^ Black or AMCan American ^ Vietnamese
^ High school graduate or GED completed ~NO, at Spanish/Hispanic/latlno ^ American Indian or Alaska Native ^ Other Asian
^ Same college ctedlt, but no d<eree ^ v s, Mez n, Mew an American, Chicano ^ Asian Indian ^ Native Hawaiian
N
^ Assgcla[e degree le.g. AA, ASI ^ Yes, Puerto Rkan
^ Chmese ^ Guamanian or Chamorro
^ Bachelor's degree (e g. BA, AB, Bil ^ Yes, Cuban ^ Filipino ^ Samoan
^ Master's degree le.g. MA, MS, MEng, MEd, MSW, MBA) ^Ves, other Spanish/Hispanic/tatino ^ Japanese ^ Other Oacl/k Islander
^ Doctorate (e.g. PhD, EtlD)or Professional degree (Specify) ^ Other lSpeclfy) _
.. MD, DDS, DVM, Lta, ID
]1 Decedent's Single pace Sell-peslgna[lon ~ Check ONIY ONF [o indicate what [he Decedent considered himself or herself to be. 2Za. Decedent's Usual Occupation ~ Indicate type of work
[.]'~Nhite ^Japanese ^Samoan done during most glworking ll/e. 00 NOT USE RETIRED
Q Black or AfricanAmerlcan ^ Korean ^ OtherPacificlslander Flo>zEl
,`] American Indian or Alaska Na rive ^ Vietnamese ^ Oon't Know/Not Sure
^ Asian Indian ^ Other ASlan ^ Refused 22b. Kind of Business/Industry
^ Chinese ^ Native Hawaiian ^ Other (SOeclfy) _.
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^ Filipino ^ Guamanun or Chamorro r~ ..I,arulu~
ITEM623a ~ 23d MUST gE COMPLETED 23x. Date Pronounced Dead IMO/Day/Yr) 23b. Signature q( Person Pronouncing Death lonly when applicable) 23c. license Number
BY PERSON WHD PRONOVNCES OR
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CERTIFIES DEATH ~ i>
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23d Date Signed IMq/Day/Yr)
24. rime of Death
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.~ C2f ~ 26. Was Medl Examiner pr Coroner Con[actetl7 ^ Yes Nq
CAUSE OF DEATH
Ap^mKimare
26. Part 1. Enter the chain of events-~dlseas<s, Inlurles, or compllcatlons~-[hat tllrertly caused the death. DO N01 enter terminal events such as cardiac arrest, [erval.
esp~ratory arrest, or ventricular fibrilati
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Showing the etiology. DO NOT ABBRE
VIATE. Ente
r only one cause on a line. Add additional litres if necessary Onset to Death
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IMMEDIATE CAUSE -~~~-~~~~~-~-~-> a. IV\T'~VTS~4~1! v ~C\I~C1K l'p~t{(''tNC' ' '
(Final disease or contlltlon pue to for at a consequence qf. - ~
resul[Ing in death)
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Eequen[I¢Ily Ilst contllhgnf, Due to Ipr as a consequence nFl'.
' any, leatling to the cause ~
listed on line a. Enter the l
UNDERLYING GUSE Due to (or as a consequence o(1.
(disease or Iniury that
Initiated the events resulting d.
in death) (AST. Due to for as a consequence of):
I
26. Part II. Enter other sienifican[ rondl[ipns conMbufn¢ to death but not resulting in the undertying rouse given In Part i. Z]. Wai an autopsy performed?
^ Yes No
28. Were autopsy /findings available
to complete [he cause of death?
^ Yes ^ No
29. If Female. 30. Oitl Tobacco Use Contribute to Oeath7 31, Manner of Death
'p Not pregnant wghin past year ^ Yes ^ Probably ~] Natural ^ Homicide
^ PreB^anr at time of death ^ No ~ Unknown Accident
^ ^ Pending lnveitrgation
^ No[ pregnant, but pregnant wRhln A2 tlays of death ^ Suicitle ^ Could not be determined
^ Not pregnant, but pregnant a3 dayf [o l year before death 32. Date of Iniury IMO/Dayhr) ISxll Month)
^ Unknown If pregnant within th<past year 33. Time of Injury
34. Place of Injury (e.g. home; cons[ruclign site; farm, school) 35. Location of Injury (Street and Number, Clry, County, State, 210 Code)
36. injury at Work 3). If Transports JOn Injury, Sperify~ 36. Describe Haw Injury Occurred.
^ ref ^ Driver/Operator ^ Pedestrian
~NO ^ Passenger ^ Other lSpecity) __
39a Certifl<r ~ physician, rertlfled nurse practitioner, medical <Kaminer/coy er ([heck only one)'
'Q Certih/Ing only ~ To the best of my knowledge, death occurred due to the causel5j and manner stated.
^ Pronouncing R Certifying ~ To the best o/ my knowledge, death occurred at the time, tlate, and place, and due to the cause(s) and manner statetl.
^ Medical Ezaminer/Coroner - On [he basis of examinatign and/or invrstigatipn, in my opinion, death occurred at the time, date, and place, and du! to [he cause(s) and manner stated
Signature of clrtifiec
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396 Name, Address and Zip Code ^/ Person Completing Cause of peach Iltem 26) 39[. Date Signed (MO/Day/Yr)
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40. Registrar's Dis[r1~N~mb ~ 41. Registrar's, Signature i I
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E . JAMIE TASEK - ~ r-..
"L, E. JAMIE TASEK, of Lower Allen Township, C~nberla~:e~
~; ~. ,
-- ~
County, Pennsylvania, make, publish and declare this as and for my
i
Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me.
~EIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, unto my husband,
JOHN C. TASEK, provided he survives me by sixty (60) days.
;SECOND: Should my husband, John C. Tasek, predecease me
or die on or before the sixty-first (61st) day following my death,
I devise and bequeath all the rest, residue and remainder of my
estate of whatever nature and wherever situate, including any
property over which I hold power of appointment and together with
any insurance policies thereon, in equal shares, to my son, EARL
M. HENRY, .JR. and my son, JOHN C. TASEK, JR. If Earl M. Henry,
Jr. predeceases me, I direct that his share under this, my Last
Will and Testament, pass directly to JOHN C. TASEK, JR. If John
C. Tasek, .Jr. predeceases me, I direct that his share under this,
my Last Will and Testament, pass directly to EARL M. HENRY, JR.
,.``~~ I
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(A) To sell at public or private sale, or to lease, for
any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
~ 1
~~'' such terms (including credit, with or without security) or
~~
~ ~,,
THIRD: In addition to all powers granted to them by law
and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all property,
exercisable without court approval and effective until actual
distributi~~n of all property:
~~conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and to
_ _ _ __
receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate and
to enter into agreements concerning the partition, subdivision,
improvement:, zoning or management of real estate and to impose or
extinguish restrictions on real estate.
(.C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
I;D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduc:i-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insuranc;e policies or in other investments.
(:F) To exercise any election or privilege given by the
Federal anc~ other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax ',
laws.
(G) To make distributions to my herein named bene:Eici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualifi<sd
retirement plan (pension plan, profit sharing plan, employee stock
ownership plan, or any other type of qualified plan) to the Extent
..., the plan or the law permits them to do so, and to exercise any
,..
''other righter which they may have under the plan, in whatever
<,:
,~' `~' manner they consider advisable.
°•;
~, FOURTH: I direct that all inheritance, estate,
,*J' -
~~transfer, succession and death taxes, of any kind whatsoever„
-~--~~ which may be payable by reason of my death, whether or not with
,•, respect to property passing under this Will, shall be paid out of
~•~~~•~~
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2
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the principal of my residuary estate.
FIFTH: All interests hereunder, whether principal or
'income, which are undistributed and in the possession of the
s
fiduciarie:> acting hereunder, even though vested or distributable,
shall not be subject to attachment, execution or sequestration for
any debt, contract, obligation or liability of any beneficiary,
and furthermore, shall not be subject to pledge, assignment,
conveyance or anticipation.
aIXTH: I nominate and appoint my husband, JOHN C.
TASEK, Executor of this, my Last Will and Testament. In the event
of the death, resignation or inability to serve for any reason
whatsoever of the said John C. Tasek, I nominate and appoint EARL
M. HENRY, RJR. and JOHN C. TASEK, JR., or the survivor thereof,
Executor oi: this, my Last Will and Testament. I direct that my
Executor acid his successors, shall not be required to post
security O1. a bond for the performance of their duties in any
jurisdiction.
RCN WITNESS WHEREOF, I have hereunto set my hand and seal
to this, my Last Will and Testament, this ~ ~~'day of ~l ~' ~ ,~~ ,r..~.~ ,
E 1988.
:. ~ ~ ~~
~-
' ~ r < ~ _.~,~~, ( SEAL )
- .. ~.~
E. Janie Tasek
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in ou:r
presence, who, at her request, in her presence and in the presence
s
of each other, have hereunto subscribed our names as attesting
;witnesses.
Address
Address
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OATH OF SUBSCRIBING WITNESSy(F ~~~~ y ~ r'. ~ ~ 55
L, i. ~_ . . ~ ~~ r
REGISTER OF WILLS ~'' ~ ~' ~ _
CUMBERLAND COUNTY, PENNSYLVANI~~' ' ~'` `'+ `` ~~ r ~
Estate of Emma Jane Tasek, a/k/a E. Janie Tasek, E. Jane Tasek, Janie Tasek and Jane Tasek ,Deceased
Joan E. Brothers , (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.
(Signatti~re)
(Street Address)
(City, State, ZipJ
(S nature)
3401 N. Front Street
(Street Address)
Harrisburg, PA 17110-0950
(City, State. Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed
before me this _ day before me this ~`~` daw
of _ of oZ O l
~~~_-
Deputy for Register of Wills _
N tary P c
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date ofexpiration of Notary's Commission.)
NOTE: To be taken by Officer authorized to adrrtinister oaths. 'T}i F pENN51(LVANIA
Please have present the original or copy o ization.
Betty Ann Mglullan, Notary publk
Form RW-03 rev. 10. l3.OC~ ~n~ ' ~n zg, Zp14
~ ~
Member, penn~ylvanla gssodatlon of Notaries
OATH OF SUBSCRIBING WI~E,~~() r i:~ t~
REGISTER OF WILLS C ~ ~ ~ ~ ~ ~ ~-
CUMBERLAND COUNTY, PENN~$~~~,~~~~, E ~ t, ;
ttKKll.. .~
Estate of Emma Jane Tasek, a/k/a E. Janie Tasek, E. Jane Tasek, Jane Tasek and Janie Tasek _~ Deceased
James D. Bogar , (each) a subscribing witness to
(Print Name/sJ
the ~ Will ®Codici I(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
the Testator /Testatrix
signed the same and that she / he /they signed as a witness at the request of
in her /his
(Signature)
(Street Address)
presence and in the presence of each other.
(.Sig lure)
_ One West Main Street
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
of
day
Deputy for Register of Wills
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this ~r~~ day
of ~ f ~C~1
~ ~ ~ ~ ~~
. ~~
Notary Public /
My Commission Expires: ~~~~~~~ ~s
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
Form R6V-03 rev. 10.13.06
Shiremanstown, PA 17011
(City, State, Zip)
NoraRial sEal -
BE1H & LENGEL, NOTARY PUBLIC
ljNIREMANSTOWN BORO, CUMBERLAND COUttR
MY COMMISSION E%PIRES DECEMBER 12, 2015
~~,1.e .a