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Home My WebLink About01-25-13PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF _ c(,~1N1 1~~/~.`-~~ 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 vrant of Letters in the appropriate form: Decedent's Info motion Name: P~` s ~vS ,e a/k/a: S ,e a/k/a: a/k/a: Date of Death: Dr'?t^_P~ fi'r'` 3d~ ~D l ~ Decedent was domiciled at death in (,c/ru principal residence at 8 ~ ~iUe° S T Decedent died at Street address, Post Office and Zip Code Street address, Post Office and Zip FileNa• oz~ ~C,- `~ (Assigned by Register) City, Township Social Security No: ~ ~ ~ -1 } - y l'~ Age at death: ~' ~" (sra e) with his/her last ~ ~ n~ nv City, Township or Boroug Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property IJnot domiciled in Pennsy!vania ........................ Personal property in Pennsylvania If not domiciled in Pennsy!vania ........................ Personal property in County Value ojrealestatein Pennsylvania ......................................................... TOTAL ESTIMATED VALUE... . n'l ~~~ ni~ ~~ County State $ / GU, Ur-U Real estate in Pennsylvania situated at: (Attach ndditional sheets, ijnecessary.) Street address, Post Office and Zip Code City, Township or Borough Petition for Probate and Grant of Letters Testamentary Pettttoner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated thereto dated County and Codicil(s) State relevant circumstances (eg. renunciation, death of executor, etc.) t7 ~_ - ;,~y ~ 0 ~-,.-~ ~ ryt Except as follows: after the execution ofthe instrument(s) offered for probate Decedent did not many, was no oiY2d, was no~~arty ~p ding divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 332, a~i ~t not line a ~n or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ _,. r"' --d ~;o F~ ~ N ENO EXCEPTIONS ^ EXCEPTIONS ~s "`~ --~ C ~~ , ~ ~ ~,Y ~~/ ___"' fir, a K-~, ~ s -~ ~,., <i _, ~ B. Petition for Grant of Letters of Administration (If applicable) ~ , ~ ~ ~~ c.t.a., d.b.n., d.b.n.c.t.a., pendente lit~•clhruirteabsentia, duranlemfn~ritate ..t:° }- If Administration, c.t.a, or d.b.n.c.t.a., enter date of Will in Section A above and egtrtpTt~te list of ~tetrs ,, ' Except as follows: Decedent 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) attd 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 (ifany) and heirs (attach atlditional sheets, i/necessary): Name Relationshi Address ~,~wrr ~ cr~ ~ w! Fe ~J~ r,U~ sT~ S1: 5~,~ ~ti 5 ~r /~- (~ i s 7 Fo.-m >;w-nz r~~. loillizoll Page 1 of 2 Oath of Personal Representative CO~f~(0~'svE.~LTi-{ CF Pcv'~iSYLV,~~,~i,~ } ~._ .,Yoe ~ '~/ ~N (~ 1 f -7F! ~ V S ~ ~ D / / ,o I` / ~ ~J ~ r*YD ~ f7~ t~~ G.+ ~ ~ vii ~ /r w /// J ~~ The Petitir~tcer(s) al,ove-named swear(s) or affirm(s) the statements in the foregoing Petition are tn~e attd correct to the best of the knowledge and belief of Petitioner(s) and chat, as Personal Representative(s) ofthe Decedent, tlce Petitioner(s) Il well aitd truly administer the estate accordi g to la . Swcrii to or affirmed and subscribed before ~-~- Date the t .t y o ~ n.//~ , ~O ~3 Date By. Date or the Re, inter Date BOND Required: [~ YES ~ NO To the Register ojWi!!s: FEES: Please enter my appearance by my signature below: Letters ...................... S _ 1.~; (~ )Short Certificate(s)...... f vQ~ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( ) Aftidavit(s)........... . Bottd ........................ Commission ................. . Other ~a Automation Fee .............. . JCS Fee . .................... - "~) V TOTAL ..................... $ ~ r Attorney Si v P~c~ ~ ~ ~~~s~~,~~/ Printed Name: Supreme Court / [D Number. `~j 6 ~ D fCJ Firm Name: Address: v .,; ,~ t Ot(ici~, ~ sc Qnfy R ~ ~', ., . .. ~. , ..._ ..;a L Phone: _ ~ ~ ~ 7 r / -~6 Fax: _ ~ / ~ ~ t/~1 - 2-y'~~Z- Email: DECREE OF THE REGISTER Estate of a/k/a: s U s. File No• _~a~ ` ~<~ - `~ AND NOW, _ ~~'t/v/~/` y -- ~~ , ~ inconsideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters _t~_S7`~/h PNT~Il~/ are hereby granted to ~ ~"/~/~']'' j~ iQ !:S ~ -., in the above estate and (if applicable) that the instrument(s) dated E - ~ i ] .Sr" described in the Petition be admitted to probate and filed of record as the last 1~4'ill (and Codicil(s)) of Decedent. ~A~t~~N~: It is i~9ega6 to +~u~4icf1'~~~ th~:~ 1 ~_;~„i €, f :a"~~~~ _J~I~~~a1 _, ~~y ~.~yra~ ,~-;(~~, `~^ ~'` i': t' i(l:""- II'IIti CI i!Ill':11 ~'. ~)f71;`~V~. ct (/ r I Peal... 'td~ f ~~II i ~, 11 I )i~ t .I I` G~ _S .-.. ~~ r' ., .. ~ 1,. } (i it I 1 :. Illr`' J:II .~. ~ ~. '~r U •~; ~ i P 19067 ~~~~~ ~:~_ '' ~~~- ~~-~~ Y~ ~. ~ ( --~~ 4 c [ ~, ,...iJCi~ ERLAfd~ ~~` , ,~!~ TYPe/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent ~`C QTI CIf'^ATC AC 1'1CATu a~ S ~_ State Flle Number: 1. Osttdent'a Legal Name (FIrz2, Middle, Lest, Suffix) 2. Sex 3. Soclel Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) R bed S_ Robe Mu.Ce 192-22-4088 veeemberL 30 2012 Si. Age-last Birthday (Yrs) 5b. Under 1 Year Sc. Under 1 Da 6. Datc of Birth (Me/Day/Year) (Spell Month) 7a ~ I~rt.plapt~CJ,TILand St>•tpyr Foreign Country) Months Daya Hours Ml t "" ' nu ez }} // ,(~~((~-.. IVJ 80 eeemben 22, 1932 7b.glrthPlace(County) K on 8a. Residence (Stele or Foreign Country) 8b. Ref{dentt (Street end Number -Include Apt No.) gc. Did Decedent Live In a Tewnfhlp7 PA []Yes, decedent Ilved In trop. 8d. Residence (ce~nty) 80 Weber K.Ln S~i(.ee~ umbPJL.eCCYLd ee. Residence (Zip Code) No, decedent Ilved within limits of Shi.l~penb buh.a city/born. 9. Ever In US Armed Forces? 10. MarlTSl SLtus at Time of Death ~ MerNed Widowed 11. Surviving Spouse's Name (If wife glue name prior to first mar i , r age) Yp ~ No QlJnknOWn O Divorced ~ Never Merrill 0 Vnknown SQ.JiPx f{U[7QfL 12. Father's Name (First, Middle, Lest, Suffix) 13. Mother's Name Prior to First Marriage (First Middle Last) , , ChLah.eeb A. Robe Emma V. 'Dou. he/%t 14a. Informant's Name 14b. RtIaLlOnihlp to Decedent J fi b R / 14c. Informant's Malling Addrcsz (Street and Number, Clty, State, Zlp Code)1 7 pg G an (c e L ose W.i. a 80 Wn,s~ K.cn S~lLe.et, Sluppe-'uebb(>JLg, rd S .................................... ........................................ If Death Dccurred in • Hosplb l: ~( Inpatient .........i..~:....e.o.,..~•c......d4..°n,yon... ............................... elf Death Occurred Somewhere Other Than a Hos ital: P Hospice Facility ~ DlGedenYs Hom _ O Emergenry Room/OUtpatlent Deed on Arriwl e Nursin Heme/LOn -Term Care Faclil Other (Specify) lSb. Facl Ity Name (If not InftILVLIOn, give street and number; 80 Weber K.~n SXiLee~ ISC. City or Town, State, •nd 21p Cod! 15d. County of Death Sh b i ~, 16a. Met Od of DlspositlOn ~ Burial Cremation . _ en,a ttn. PA 17257 Cumbeh,earLd 18b. Date W Disposition 16c. Place Of DlapesRion (Name of cemetery, crematory or other place) Q Removal from Sbte Q Donation Ocher (SpeNfy) , 1 -2-2013 flo.P~.fn ex CJ'(,ema to/c.ium 16d. Location Of Dlspgfi[IOn (City or Town, S[Ite, and Zip) 17a. Signature OT nor Ice LIG nsle or Person In Charge Of Interment 17b. License Number M~_ Ho.P.Cy Spni.ngb, PA 17065 ~,,, . P'D-O7 2984-L 17c. Name end COmple[e Address of Funeral Facility art -$/(..i. k¢lc 1=ccneJ[.ae {-tome Zne. 112 WebZ K.i-n Sx`i(-eex Sh,~ ercbb(,n PA 17257 ~ t- 18. Dace ant's Eduutlon -Check the box that best describes the 19. Daptlent of Hispanic Origin -Cheek the 20. Decedent's Ratt -Check ONE OR MORE races to Intllu[e whet highest degree or level of school completed at the time of d h b eat . ox that best describes whether the decedent She decedent considered himself or herself to be. Q ath grade or less I " ^ s Spanlah/HlspanlcfUtinO. Check the NO - ~ White Q Korean ~ NO diploma, 9th - 12th grade box if decedent Is not Spanish/Hispa nic/Lstinq Black or Afric n A N . a me <an Q Vietnamese Q Hlgh school graduate or GED completed (~' No, net Spanish/H4panIG/Latino 0 Amerlttn Indian or Alaska Na[IVe ~ Other As4n Some college credit but no degree , Q Yes, Mexican, Mexlun American, Chipno Q Asian Indian ('~ NaThre Hawallen Q Azspefate degree (e.g- AA, AS) ~ Yes Puerto Riwn , Q Chinese p Guamanian or Chamorro ~ Ba. helot's degre e(e.g. BA, AB, BS) Q Yes, Cuban Q FIIIpinO ' ~ Samoan M star s degree ( .i. MA, MS, MEng, MEd, MSW, MBA) 0 Yet, e[her Spanish/Hlspenlc/Letlno ~ Japanese ~ Ocher Paelfle Islander Doctorate (e.g. PhD, Ed D) Or professional degree (gpeclfy) ~ Other (Specify) . MD DOS OVM LLB JD 21. Deco ant's Single Race Self-Designation -Check ONLY ONE t0 Indicate what the decedent eonslderatl himself or herself to be. 22a. Dettdent's Usual Occupation - Indittte type Of Work White ~ Ja Panefe ~ Samoan done during moat of working 11}e. DO NOT USE RETIRED. (~ Black Or African American p Korean Q Other pacific Islander - ~ American Indian or Alaska Native ~ Vietnamese O Don't Know/Net Sure CO.eO ne.Z - Q Aalan Indian ~ Other ASlan O Refused 22b. Kind of Buslnfai/Industry Q Chihese ~.Natlw Hewallan Q Other (SpeeHy) ~ Filipino O'GUam Mlan or Chamorro ^ (.(. S . A/(.m ITEMS 2B - 29d M ST ^E COMPLETED 23a. Date Pronounced Des (MO/Day/Yr) 29b. PerfOn Pronouncing Death (On y when applicable 23c. License Number BY PlRSON WHO PRONOV NCES OR CERTIFIES DEATH 1 23d. Date lined (MO/Day/Yr) 24. Time of Bath ~ f (~ !1 _sVGiL ) a Z 25. Was Medleal aminer r Coroner Contacted? Q Yes No CAUSE OF DEATH 4 Appreximste 26. Pert 1. Enter the Ghaln of events-diseases, InJurlls, or compllutions-Shat tllrectly roused the des[h. D NOT enter terminal evens such as cardiac arrest Interv res irato r l t l p ry a a : res , or ventr GUlar flbrlllatlon without showi ng the etiology. DO NOT ABBREVIATE. Enter Iy ne cause On • Tine. Add additional Imes If necessary Onset to Death n IMMEDIATE CAUSE ------> ~ ._ _F_ i_/~t (^+ - ~ I ~ ~ ~ ~ (Final disease or condition Due ~ quenee f~ _ as a copse ~'S ., resulting In death) - b- SequenRlslly Ilat cenditfons, ~ - Due to (or as • Consequence af): if any, leading to the cause ~ - Ilsted on line a. Enter the _ c ~ VNDERLYING CAVSE Due to (or as a consequence of): - (discos! or Injury that e ~ Inltlatetl She events-resulting d, P-5 O In death) LAST. Due to (or as a consequence q t 26. Part 11. Enter other sl¢niflcanL cendltlons t Ib tl t d th b ut not resulting In the underlying cause given In Part I 27. Was an autopsy erformed7 e ~' 28. Wer~ uto fld in psy gs avallabie ~i ~' 29. If Female: to complete the c ae of death? Yes E t°> 30. Dld Tobacco Use Contribute to Death? Manner of Death Q Not pregnant within past ural ~ Homicide ~ Pregnant at time of deathyasr 0 Vei a ~ ~' ( Unknown Q Not pregnant, but pregnsn2 within 42 days of death ~o ~ Accident (~ Pending Investigation t- Nee Q Suicide ~ Could not be determined Q pregnant, but pregnant 43 days tq 1 year before death 32. Date of Injury (MO/Oay/Yr) (Spell Month) _ Q Unknown If pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; construcilOn site; farm; school) 35. Location of Injury (Street snd Number, Clty, State, Zip Code) 96. Injury at Werk 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Yes Q Driver/O peratOr ~ Pedestrian ~ NO ~ Passenger ~ Other (Specify) - ` 39s. Certl r (Cheek Only On Certifying physician - e best of my knowledge, death occurred due to the uuse(s) and manner stated ~ Pronbuncing 6 CeRI hysician - To [he beat of my knowledge, death occurred at the Hm<, date, end place, and tlue to Lhe cause(s) end manner stated O Medical Examiner/ r - Lhe basis of exeminaHon, and/or Investgation, In my opinion, death occurred at fhe time, date, end place, end due to th se(a) end man u n e r st at ed . - ~7 p . Signature of certifier Title of certlfler.__~'~ ~ License Number:n~ E ~I(7A,~ 396 N t5_eaL eme, Address an 2]p de of Person Completing Cause Of Death (1[em 26) 39c. Date 51 nod ( o/Day/Yr) 40. Registrar: istritt Number 41. Registr g lure v 42. glstrar file Date (MO/Day/Yrj ~ ~ -- a ~s- a3. Amendments Q Z' ZQ Disposition Permit NO. V V V ~ I.JtJQ H305-143 -- --- REV 07/031 LAST W= LL AND TESTAMENT O F ROBERT S . RO S E I, ROBERT S. ROSE of 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 all other wills and codicils heretofore made by me. I direct the payment of my debts and expenses of my last i l lness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefore funds from my estate, in such amount as my personal representative shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, in this connection, I authorize my personal r~presentat7ve t ~__; ~ ~ r~ expend funds from my estate, in such amount as m r._ ° i~~ y persona 1 rep~entat i ~e, shl i - A .d consider necessary and desirable, for the purchase, erection and~.irFsc~~ptfion of e suitable marker for my grave. ~~ ~T~' ~r i r •i ;~h~~ -~~ ' : 4 I give and bequeath all tangible personal property owned by me at the time of my death, together with all insurance policies thereon, unto my spouse, JANET H. ROSE if she survives me by sixty (60) days. In the event she fails to survive me by sixty (60) days, I give and bequeath said tangible personal property and all insurance policies thereon in as nearly equal shares as is practicable unto such of my children as survive me by sixty (60) days, provided, however, that if a child of mine does not survive me by sixty (60) days, the share which that child would have received is bequeathed to that child's issue, per stirpes. I give, devise and bequeath a 11 the rest, residue and remainder of my estate unto my spouse, JANET H. ROSE if she survives me by sixty days. In the event she fails to survive me by sixty (60) days, I give, devise and bequeath all the rest, residue and remainder of my estate, in equal shares, unto such of my children as shall survive me by sixty (60) days, provided, however, that if a child of mine does not survive me by sixty (60) days, the share which that child would have received is bequeathed to that child's issue, per stirpes. I authorize my Executor to deliver such articles to which a minor may be entitled under this testament to the guardian of the minor or to the person having custody of the minor, or to retain such property until an age at which my Executor considers it appropriate to deliver the property to him or to her, provided in no event shall such property be retained by my Executor beyond the time the minor attains his or her majority. The receipt of such of the above enumerated persons as may be selected to receive delivery of such property shall be a full and complete discharge to my Executor. In the event my Executor at any time decides it is desirable to sell any item or items of tangible personal property held hereunder for a minor, the proceeds of such sale or sales shall be delivered to the guardian of the property of the minor appointed in paragraph SIXTH hereinafter to be held under the terms and conditions thereof. 2 Fov~ I direct that any and all Inheritance, Estate and Transfer Taxes imposed upon my estate passing under by will or otherwise, shall be paid out of the principal of my residuary estate. In addition to the powers conferred by law, I authorize my Executor, in his or her absolute discretion: (a) to retain in the form received, and to sell either at public or private sale any real or personal property; (b) to manage real estate; (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principle of diversification; (d) to exercise any option or rights arising from ownership of investments; (e) to compromise claims without court approval, and without the consent of any beneficiary, and to abandon any property which, in my Executor's opinion, is of little or no value; (f) to join with my spouse, JANET H. ROSE, or my spouse's personal representative in the filing of any state or federal income tax return for any year for which I have not filed. such return prior to my death, and to consent to the treatment of any gifts made by my spouse as being made one-half by me for gift tax purposes notwithstanding the fact that such action may result in additional 1 iabi 1 ities for my estate. Any income or aift taxes rii~p nn ci~rh rnt~~r~nc ~.,a .,..,, deficiencies, interest, penalties or refunds thereon, shall be allocated between my gestate and my said spouse or my spouse's estate, or all to any of them, in such 3 manner as my Executor and my said spouse or my spouse's personal representative may r~,. t,~ r, ''~ ~~ i agree. I appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY of Harrisburg, Pennsylva- nia, guardian of any property, including but not limited to all proceeds of insur- ance on my life, which passes to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so. In addition to the powers given by law, I authorize the guardian of the property: (a} to use such amounts of both income and principal as they in their sole discretion deem proper for the support, education and welfare of such minor without leave of any Court; (b) to invest in any property without leave of any Court; (c) to invest in any property without restriction to legal investments. The guardian shall not be required to give bond or furnish sureties in any jurisdiction, and shall hold the property IN TRUST for the minor. I hereby direct majority to be defined as the age of eighteen and that no funds be turned over to the minor or adult until they attain the age of eighteen years. If my trustee, in its sole discretion, determines that it is desirable to do so, my trustee may end any trust under this deed. This may be done by paying the then-remaining principal and income of that trust to the person then eligible to receive the income. If anv nercnn is a minnr ~~ ;~ .., ,..., ~~.._i__i_ ___ _ . disabled by illness or other cause and unable to properly manage the funds, my trustee may pay the funds to his or her guardian or to any person or organization taking care of the person. In the case of a minor, my trustee also may deposit the 4 funds in an interest bearing account in the minor's name payable to the minor at majority, or appoint and pay the funds to a custodian for the minor under the Uniform Gifts to Minors Act of any state. My trustee shall have no further responsibility for funds so paid or deposited. I further direct my trustee distribute his or her share of the corpus and any accumulated earnings to the beneficiary upon the attainment of their majority. Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to the said beneficiaries or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, p 1 edge, or ob 1 i gat i ons of any beneficiary, and sha 11 not be subject to any execution or attachment. I nominate, constitute and appoint my spouse, JANET H. ROSE, Executrix of this my last will and testament. In the event of the renunciation_ riPath_ resignation or inability to act for any reason whatsoever of my said spouse, I nominate, constitute and appoint my daughter, NANCY LIN ROSE, Executrix of this my last will and testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said daughter, I nominate, constitute and appoint my daughter, ELLEN R. JESSEN, Executrix of this my last will and testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said daughter, I nominate, constitute and appoint my daughter, MARJORIE 6. ROSE, Executrix of this my last will and testament. 5 In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said daughter, I nominate, constitute and appoint my son, ROBERT H. ROSE, Executrix of this my last will and testament. I hereby relieve my Executor from the necessity of posting security in connection with the Executor's duties as such in any jurisdiction in which my Executor may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last will and testament, consisting of eight pages, the first five of which bear my signature in the margin for the purpose of identification this 16th day of September, 1995. ROBERT S. ROSE Signed, sealed, published and declared by the above named Testator, ROBERT S. ROSE, as and for his last will and testament, in the presence of us, who, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~ ~~ ~--~ Address ~~ c~ Address 6 ACKNON~LEDGEMENT STATE OF PENNSYLVANIA SS. COUNTY OF FRANKLIN . I , ROBERT S . ROSE, the testator whose name i s s i gned 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 ROBERT S. ROSE, the testator, this 16th day of September, 1995. ~~-- es~ator ~!'jiChar~i If. B~s~rinan, Attorney Admitted to the Bar of Pennsylvania C~IMONWEALTH OF PENNSYLVANIA SS. COUNTY OF FRANKLIN . We, Elaine L. Bushman and George Rae the witnesses whose names are signed 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 his Last Will; that the testator signed willingly and executed it as his 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. 7 Sworn to or affirmed and subscribed to before me by Elaine L. Bushman and George Rae, witnesses, this 16th day of September, 1995. ~' l `; ' - ~_ Elaine L. Bush~ma-n--,Witness ~, _ ~ _ -1 ~z. ~ 6~i'~har~d L: uB"srt'tman, ttorney Admitted to the Bar of Pennsylva is STATE OF PENNSYLVANIA SS. COUNTY OF FRANKLIN On this, the /~~~iay of September, 1995, before me, the undersigned officer, personally appeared RICHARD L. BUSHMAN, known to me or satisfactorily proven to be a member of the bar of the highest court of Pennsylvania, and certified that he was personally present when the foregoing acknowledgement and affidavit were signed by the testator and witnesses. In witness whereof, I hereto set my hand and official seal. ~/~`-~ y P bl is rv s~ ,,n,diU, ~. c~aywn, Notary ~c Fannett 7th., Fran~n County My Commission Ex(~~r~s Aug. x,1997 8