HomeMy WebLinkAbout01-28-13PETITION 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 request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name• Shirley E. Peck
a/k/a:
a/k/a:
a/k/a:
Date of Death: 1/17/13
-~ ~ C~
File No: ~ ~ " ~ ~~ ~ ~ ~
(Assigned by Register)
Social Security No:
Age at death: 78
Decedent was domiciled at death in Cumberland County, Pennsylvania (Stare) with his/her last
principal residence at 69 Pine School Road, Gardners, PA 17324 South Middleton Township Cumberland
Street address, Post Office snd Zip Code City, Township or Borough County
Decedent died at 69 Pine School Road, Gardners, PA 17324 South Middleton Township Cumberland Pennsylvania
Street address, Post Office and Zip Code City, Township or Borough County State
Estitnate of value of decedent's property at death: 100000
If domiciled in Pennsylvania ............................All personal property $
Ijnot domiciled in Pennsylvania ........................Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................Personal property in County $
Value of real estate in Pennsylvania ......................................................... $ 16000
TOTAL ESTIMATED VALUE.... $
Real estate in Pennsylvania situated at: 69 Pine School Road, Gardners, PA 17324 South Middleton Township
(Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough
A. Petition for Probate and Grant of Letters Testamentary
August 10, 1994
Petitioner(s) aver(s) he/she/they is/are the Executors) named in the last Will of the Decedent, dated
thereto dated Robert L. Peck, executor named m will, predeceased the Decedent
State relevant circumstances (e.g. renunciation, death of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(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.
Q NO EXCEPTIONS Q EXCEPTIONS
® B. Petition for Grant of Letters of Administration (If applicable)
c. t. a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate
If Administration, c.t.a. or db.n.c.~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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
Q NO EXCEPTIONS Q EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the~llowing spogse (if arry~aheirs (attach
additional sheets, if necessary): ~' Q ~ ~ ~
Name Relationshi ltd .:e~~ <_ -"~a :"s
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Cumberland
County
and Codicil(s)
For,,, xw oz rev. ~o~u;~zorl Page 1 of 2
uatn of rersonal Kepresentahve
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~. ~ ~'^~ -~`~~-~~`
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Petitioner(s) Printed Name Petitioner(s) Pri sires
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~, . ..,.
Kenneth L. Peck, 245 Frost Road, Gardners, PA 17324
VLL~`.~1
me ~ ~ day o Date
13y n
Date
For tke Register Date
The Petitioner(s) above-named swear(s) or affirm(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 D cedent, the Petitioner(s) ' 1 well and truly administer the estate acc rding to law.
Sworn too affirmed subscribed before ~ Date ~ ~2P' ~ Zcf i ~
Letters ...................... ~J~• (i0
( 2) Short Certificate(s)...... .C~SO _
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other
19~i_• . ~........ ,
BOND Required: ~ YES ~NO
FEES:
Automation Fee . .............. ~ (jrJ
JCS Fee . .................... ~'c7
TOTAL ..................... $ ~ - G
DECREE OF THE REGISTER
Estate of Shirley E. Peck
a/kla:
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
~,
Printed Name: Robert G. Frey
Supreme Court
ID Number: 46397
Firm Name: Frey & Tiley
Address: 5 South Hanover Street
Carlisle, PA 17013
Phone: 717 - 243 - 5838
Fax: 717 -243 -6441
Email: rfrey@freytiley.com
File No: ~~ - ~,~ - ~ C
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AND NOW, ' , in consideration of the foregoing Petition,
satisfactory proof having been r sented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Kenneth L. Peck
in the above estate and (if applicable) that
the instrument(s) dated August 10, 1994
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Dece ent.
Register of Wil ~~ ~
FormRW-oz rev. toi~l~znr~ ~' ~`-~ Page 2 of 2
h{I1)5.s11~ E2 F.A' t9ll l i
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
~~C~il~f~Ilal~Ct~i f~gal to duplicate this copy by photostat or photograph.
a~ ~ ) 1
Fee for this certificate, ~5~~,.QO y~,;,~ ~~ ~~ ~ ~~ This is to cextify that the information here given is
_.: ,,! u~ : i t correctly coped from an original Certificate of Death
duly tiled with me as local Registrar. The original
~ t ~. ~ ~ ~ certificate will be forwarded to the State Vita
~ ~ ~ ~ ~ ~,~ JL ~ ~ (~ ~, ~ Records Office far perrnane~~t filing.
w ~ ~~x~. ~~ J ~M 18/ 2 013
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Certification Number Local Registrar Date Issued
S
Typo/Print In COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
Parma"<nt CERTIFICATE OF DEATH
Black Ink State Flla Number:
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1. Decedent's Legal Name (First, Middle, Last, suffix) 2. sax 3. Social security Number 4. Date of Oeath (MO/Day/Yr) (Spell Mo)
Shirley E_ Peck F 185-28-1499 January17, 2013
sa. Age-Last Birthday (Vrs) sb. Under 1 Year sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State Or Foreign Country
Months Days HnurS Minutes Adams Co _ PAT rone w
I 78 October 21 , 1 9 3 4 7b. Birthplace (County)
8 Residence (S t¢ or Foreign Country)
~
~ 86. Residence (street and Number -Include Apt No.) Sc. Did Decedent live In a Tow hlp7
iddl
t
ennsy
vanla 68 Pine School Rd_ e
on twp.
~7Y¢s,tlec¢d<ntlivedin S_ M
gd. Residence (County)
Cumber 1 and 8e. Residence (Zip Code) QNO, decedent IiYed within limits of city/born.
9. Ever In Us Armed ForcesT 10. Marital Status at Time of Death Q Married Widowed 11. surviving Spouse's Name (If wife, give name prior to first marriage)
Q Ves ~ No Q Unknown Q Divorced Q Never Married Q Unknow
12. Father's Nam¢ (First, Middle, Last, suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last)
Archie Starner Marie Gardner
14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (street end Number, Clty, states, Zip Code)
g Kenneth L_ Peck son 245 Frost Rd_ Gardners,PA17324
_ ace o eat a ec f.y
If Death O c rred in a Hospital: ~ Inpatient ~ - if Death Occurred Somewhere Other Than a Hospital: tJ Hospice Facility ~DecedenT'S Home
~ Q Emergency Room/Outpatient Q Dead on Arrlyal Q Nursing Home/long-Term Care Facility Other (specify)
eg lsb. Facility Name (If not institution, give street and number; lSc. city or Town, state, and Zip Code lsd. County of Death
69 Pine School Rd_ Gardners PA 17324 Cumberland
16e. Method of Disposition ~ Burial Q' Cremation 166. Date of Disp051tiOn 16c. Place of Disposition (Name of cemetery, crematory, or other place)
`€ QRemt,yalfrnmstate QDOnatlon
Other (specify) 1 /22/2013 Mt_ Victory Cemetery
16d. Location of Disposition (City or Town, state, and Zip) 12a- signature of Funeral service lice nse¢ or Person in Charge Of Interment 17b. Ucense Number
~
~ Gardners PA 17324 ~
• 011589E
e 17c. Name and Complete Address of Funeral Facility
Ho11in erFH&Cremator Mt_ Hol1 S rin s PA 170 65 501N_ BaltimoreAve_
19. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races Co indicate what
I- highest degree or level of sch OOl completed at the time of death. box that best describes whether Che decedent the decedent considered himself or herself t" be.
Q 8th grade or less Is spa nish/Hispanic/Latino. Check the "No" White Q Korean
~- NO diploma, 9th - 12th grade box If decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese
Q High School graduate or GED completed Q~-NO, not Spanish/Hispa nlc/Latino Q American Indian or Alaska Native Q Other Asian
~ Some college credit, but no degree Q Yes, Mexican, Mexican American, Chlca no Q Asian Indian Q Naiiye Hawaiian
Q Associate degree (e.g. AA, As) Q YeS, Puerto Rican Q Chinese Q Guamanian or Cha mono
Q Bachelor's degree (e.g. BA, AB, Bs) ~ Yes, Cuban Q FIIl plno Q Samoan
Q Master's degree (e.g. MA, Ms, MEng, MEd, MSW, MBA) Q V¢s, other Spanish/Hispanic/Latino Q Japanese Q Other PaclFlC Isla ndar
Q Doctorate (e.g. PhD, Edo) or Professional degree (specify) Q Other (specify)
. MO ^DS, DVM LLB, JD
21. Decedent's single Race Self-Designation -Check ONLY ONE to Indicate whet the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work
White Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
F
Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure ormer owner
Q Asian Indian Q Other Asian Q Refused 226. Kind of Business/Industry
Q Chinese Q NatlyeHawallan Q Other(speclfy) Slap"t1C Service
Q FIIlpino Q Guamanian or Chamorro
ITEMS 23a - 23d MVST BE COMPLETED 23a. Date Pronounced Dead (MO Oay Vr) 236. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number
BY PERSON WNO PRONOVNCES OR
CERTIFIES DEATH Januar 1 7 2
y ~ 0 1 3
23d- Oate signed (MO/Day/Yr) 24. Time of Death
a rox . 3 : 3 QA 25. Was Medical Examiner or Coroner Contacted? Q Yes Q NO
CAUSE OF DEATH Approximate
26. Part 1- Enter the chain of a ants--d lseases, Injuries, or tom plicatlons--that directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval:
respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT
A
BBREVIATE. Enter only one cause on a line. Add addlHOnal lines if nete55ary Onset to Death
y
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IMMEDIATE CAUSE > ~-O~-OP~LPI" Q~Y ~- /L,-'~i R ~ L.J L 5 yy A$ G _
(Final disease or condition Due to (or as a consequence of):
resulting in death)
b_
sequentially list conditf0 ns, Due to (or as a consequence of):
if any, leading to the cause
listed on Tine a. Enter the
UNDERLYING CAUSE Due to (Or as a consequence of):
(d lsease or InJury that
initiated the events re5uitin8 d.
In death) LAST. Due to (or as a consequence of):
s 26. PaR 11- Enter other significant conditions contributing to death but not resulting In the underlying cause given in Parr I 27. Was an autopsy pe~rf0~1 ed?
CNRGNfC. cgSTC UGTJ Ve. PKL/J")GfYA/LY ALSGR.S lz QYes C3"No
~ M r T ~q `
1 1 REG-ult G-1rATLO~1 2A. Were auto flndin liable
p5v gs a..a
to complete the cause o~eath7
Yes [~Fj
E 29. If Female:
~ 30. Did Tobacco Vse Csntribute to Death?
Y
l 31. Manner of Death
r
a4 NOt pregnant within past year
Q
Q Pregnant at time of death Q
es (~ Probab
y
Q No Q Unknown [Y
atural Q Homicide
Q Accident Q Pending InyesTlgation
~ Q Not pregnant, but pregnant within 42 days of death Q suicide Q Could not be determined
t-. Q Not pregna nL, but pregnant 43 days to 1 year before deatF 32. Date of Injury (Mo/Oay/Yr) (Spell Month)
Q Vnknown if pregnant within the past veal 33. Times of InJury
34. Place of InJury (e.g. home; construction site; farm; school) 35. Location Of Injury (Street and Number, City, State, Zip Code)
36. InJury at Work 37. If Transportation Injury, specify: 3R. Describe How InJury Occu rred~
Q Yes Q Driver/Operator Q Pedestrian
[y~^No Q Passenger Q Other (specify)
39a. Cyy++~~ifl¢r (Check only one):
[tj'Certlfying physician - To the best of my knowledge, death occurred due to the cause(s) and m r stated
Q Pronouncing 8< Certitying physician - To the bast of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated
Q Medical Examiner/GOroner - On the ba
sis
o
f a
xamination, an
d
/or InyesTlgation, In my opinion, death occurred at the time, date, and plate, and due to the
c
a
u
s~(s) and manner stated
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L Title of certifier:
,
signature of certifier:
- License Number. Ir'r
39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date signed (MO/Day/Yr)
(J.7r~-t-L .tilt[ ~.. VO~JAN MI1. ZZO W7L.son1 ST. R L PA ~ / ~ANf/MrY ~8 ~ ~7)~
40. Registrar s District Number 41. R¢gfstra is ture
~~ 42. R gis[rar Flle Dat< (MO/DSy r)
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43. Amendments
Dis ItiOn Permit No. O b``~~3U ~7 H105-143
pos REV 07/2011
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LAST WILL AND TESTAMENT ~.° `1' ~'
Ys
SHIRLEY E. PECK `: ~. - °
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I, SHIRLEY E. PECK, of South Middleton Township (mailing address: 68'Fine
School Road, Gardners, Pennsylvania 17324), Cumberland County, Pennsylvania, being of
sound and disposing mind, memory and understanding, do hereby make, publish and declare
this as and for my Last Will and Testament hereby revoking and making void any and all Wills by
me at any time heretofore made.
1. I direct my hereinafter named Executor to pay all of my just debts and funeral
expenses as soon after my death as may be found convenient to do so. I direct that my funeral
services and the inte*_ment of my body be as my said Executor shall deem appropriate. I direct
that all transfer, inheritance, estate and death taxes which may be payable on account of my death
shall be paid from the residue of my estate regardless of whether the assets upon which such
taxes are based are included in my probate estate.
2. All of the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, up to a maximum of the amount allowed as an exemption
or credit for purposes of federal estate tax which at the present time is $600,000.00, I give,
devise and bequeath to my hereinafter named Trustee, in trust, to receive and to invest the same,
and to pay the income arising therefrom at least annually to or for the benefit of my husband,
Robert L. Peck, so long as he shall live, and at his death the same shall terminate and be
distributed to my son, Kenneth L. Peck, provided he shall survive me by a period of ninety (90)
days, his heirs and assigns, but should he fail to so survive me then to such of his legitimate
issue as shall survive both my husband and me, their heirs and assigns, per stirpes.
No title in a trust hereby created, or in the income accruing therefrom, or in its
accumulation, shall vest in any beneficiary and no beneficiary shall have the right or power to
sign, transfer, assign, anticipate or encumber his or her interest in said trust, or the income
therefrom, prior to the actual distribution thereof by the Trustee to such beneficiary. Further,
neither the income nor the principal of said trust shall be liable in any manner, in the possession
of the Trustee, for the debts, contracts or engagements of any beneficiary.
3. All of ±hP rest, residue a:.d rer:~aind;;r of ~~~y estate which has not hereinbefore been
disposed of, I give, devise and bequeath to my husband, Robert L. Peck, his heirs and assigns,
to the exclusion of my children, born and unborn, provided he shall survive me by a period of
ninety (90) days, but should he predecease me or fail to so survive me, then I give, devise and
bequeath the same to my son, Kenneth L. Peck, his heirs and assigns, provided he shall survive
me by a period of ninety (90) days, but should he fail to so survive me then the same pass to
such of his legitimate issue as shall survive me by a period of ninety (90) days, their heirs and
assigns, per stirpes.
4. Should neither my said husband, Robert L. Peck, or my said son, Kenneth L. Peck,
survive me, nor any legitimate issue of his survive me by a period of ninety (90) days, then the
same shall be distributed as follows:
a. 10% to the Trustees of Mount Victory United Methodist Church, Gardners,
Pennsylvania, to be used for such purpose or purposes as the Trustees of said Church shall deem
best;
b. 45°Io shall be divided equally among the sons and daughters of my brothers and
sisters who are living at that time; and
c. 45% shall be divided equally among the sons and daughters of my husband's
brothers and sisters who are living at that time.
5. Any share or portion of a share of any trust created hereunder or any other property of
mine that is not disposed of under any other provisions of this Will shall go and be distributed to
my heirs-at-law.
6. If my husband and I should die under such circumstances that the order of our deaths
cannot be established by proof, it shall be conclusively presumed for all purposes of this Will that
my husband survived me.
Page 1 of 3 Pages
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7. I direct my Executor to pay out of the property which would otherwise become a part
of the residuary trust, hereinabove established, all estate, inheritance, transfer and succession
taxes, including interest and penalties thereon, which may be lawfully assessed by reason of my
death. I hereby waive on behalf of my estate and right to recover any part of such taxes, interest
or penalties from any person, including any beneficiary of insurance on my life and anyone who
may have received from me or from my estate any property which is taxable as a part of my
estate.
8. I hereby nominate, constitute and appoint my husband, Robert L. Peck, as Executor
of this my Last Will and Testament but should he predecease me or fail to qualify or cease serving
as such, then in such event I nominate, constitute and appoint my son, Kenneth L. Peck, as
alternate or successor Executor, and I further direct that neither of them shall be required to post
any bond to secure the faithful performance of his duties in the Commonwealth of Pennsylvania
or in any other jurisdiction.
9. I hereby nominate, constitute and appoint my said husband, Robert L. Peck, as
Trustee of each trust hereinbefore created, but should he fail to serve or cease serving as such,
then in such event I nominate, constitute and appoint my son, Kenneth L. Peck, as alternate or
successor Trustee of each trust hereinbefore created.
10. In addition to the powers conferred by law, my Executor and my Trustees
hereinbefore named are empowered:
a. To invest any part of the trust corpus in such securities, investments, or other
property as may be deemed advisable and proper, irrespective of whether the same are authorized
for the investment of trust funds under the laws of any governing jurisdiction.
b. With respect to any corporation, the stocks, bonds, or other securities of which
may be held, to vote in person or by proxy on any shares of stock; to consent to the merger,
consolidation or reorganization of such corporations; to consent to the leasing, mortgaging or sale
of the property of any such corporations; to make any surrender, exchange or substitution of
such stocks, bonds or other securities as an incident to the merger, consolidation or
reorganization of such corporations; to pay all assessments, subscriptions and other sums of
money which may be deemed wise and expedient for the protection and maintenance of the
proportionate interest of the investment in such corporations; to exercise any option or privilege
which may be conferred upon the holders of such stocks, bonds, or other securities of such
corporations either for the conversion of the same into other secu~~ties or for the purchase of
additional securities, and to make any and all necessary payments which may be required in
connection therewith; and generally to have and exercise as to all such stocks, bonds and other
securities, the powers of an individual owner who is under trust obligation.
c. To hold the trust corpus in one or more consolidated funds in which separate
shares shall have undivided interests.
d. To sell at public or private sale for cash or upon credit, or partly for cash and
partly on credit, and upon such terms and conditions as shall be deemed proper, any part or parts
of the trust estate, and no purchaser at any such sale shall be bound to inquire into the expediency
or propriety of any such sale or to see to the application of the purchase moneys arising
therefrom.
e. To keep on hand and uninvested such money as may be deemed proper and for
such period as may be found expedient.
f. To compromise, settle or arbitrate any claim or demand in favor of or against the
trust estate.
g. In the discharge of fiduciary duties, to employ counsel and to determine and to
pay such counsel reasonable compensation which shall be charged against the principal or income
of the trust fiand, and shall further be entitled to charge against the principal or income such other
reasonable expenses and charges as may be necessary and proper to incur for the proper
discharge of fiduciary duties and for the proper management and administration of the trust
estate.
h. In making any division of property into shares for the purpose of any distribution
thereof directed by the provisions of the trust, to make such division or distribution, either in
cash or in kind, or partly in cash and partly in kind, as shall be deemed most expedient, and in
making any division or distribution in kind may allot any specific security or property or any
undivided interest therein to any one or more of such shares, and to that end may appraise any or
all of the property so to be allotted and the judgment as to the propriety of such allotment and as
Page 2 of 3 Pages ~~
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to the relative value for purposes of distribution of the securities or property so allotted shall be
final and conclusive upon all persons interested in the trust or in the division or distribution
thereof.
i. To register any shares of stock or other assets of any trust in their own names or
in the name of a nominee.
11. A11 powers, duties, and discretionary authority granted to my Executor and my
Trustee, or their successors, may be exercised without posting any bond and without obtaining
any order or approval of any court, and without any notice to or consent of anyone.
12. If any provision of this Will shall be unenforceable, the remaining provisions shall
nevertheless be carried into effect.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will
and Testament written on three (3) pages, this 10th day of August, 19 9 4 .
~~~ (SEAL)
Shirley E. Pec
Signed., sealed, published and declared by SHIRLEY E. PECK, the Testatrix above-
named, as and for her Last Will and Testament, in our presence, who, in her presence, at her
request, and in the presence of each other, have hereunto subscribed our names as attesting
witnesses.
~~ ~ ~
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OATH OF SUBSCRIBING WITNESS(F~~ (._:
~ _
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REGISTER OF WILLS ~' ~~~ r`j ~ '" ~ `
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CUMBERLAND COUNTY, PENNSYLVAN~A''r --.1 ~-~
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Estate of Shirley L. Peck
Robert M. Frey
Deceased
. (each) a subscribing witness to
(Print Name/s)
the ~ Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same
and that she / he /they signed the same and that she / he /they signed as a witness at the request of
the Testator /Testatrix in her /his presence and in the presence of each other.
(Signature)
5 South Hanover Street
(Street Address)
Carlisle, PA 17013
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
~MMOI~IWFJILTH CJF PENNSYLVMIIA
Nor,~it-~ sFa.
Rt7BERT G. FREY, Notary Pubile
Borough of CaAlele, Cumbedend County tpA
iiAy Commission E~ires June 12014
(Signature)
(Street Address)
(City, State, Zip)
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this ~ ~"~ day
%~
Notary Public
My Commission Expires:
(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 RW-03 rev. 10.13..06
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Shirley L. Peck
Robert G. Frey
and Sharon J. DeVos
Deceased
(each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well-
acquainted with Mary E. Gensler
and am/are familiar
with the handwriting and signature of the decedent, and that the signature of Mary Gensler
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of
Shirley L. Peck is in his/her own proper handwriting.
(Signature)
5 South Hanover St.
(Street Address)
Carlisle, PA 17013
(City, State, ZipJ
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5 South Hanover St.
(Street Address)
Carlisle, PA 17013
(Crty, State, Zip)
Executed in Register's Office
Sworn to or affirnled and subscribed
before me this ~ ~ day
of , -----9 _~~~
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eputy for Register of Wills
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Form RW-0.1 rev. 10.13.06