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Home My WebLink About08-20-13 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s)the following and respectfully request(s)the grant of Letters in the appropriate form: Decedent's Information � I _ �� r�� n Name: Francis L. Saphore FileNo: �� a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 1 8 4-2 6-4 41 0 Date of Death: Ju 1 y 1 6, 2 01 3 Age at death: 7 9 Decedent was domiciled at death in Cumberland County, Pennsylvania (stare)with his/her last principal residence at 1 329 Church Street,Carlisle 1701 5 Cumharl anr� Street address,Post Office aad Zip Code City,Township or Borough County Decedentdiedat Holy Spirit Hospital, Camp Hill Cumberland PA Street address,Post Office and Zip Code City,Township or Borough County State Estimate of value of decedenYs property at death: If domiciled in Pennsylvania............................ All personal property $ 7 5 a 0 0 0. 0 0 If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ........... ............ Personal property in County $ Value of real estate in Pennsylvania........................ ...... . .... .... . ................. $ R�� fl (Z� TOTAL ESTIMATED VALUE. ... $ 1 5 5� 0(p.00 Real estate in Pennsylvania situated at: 1 3 2 3� 1 3 2 4 & 1 3 2 9 hur h _ 1 7 01 S C�r 1 l R�P�.�('_t�tr�,��1 a n t� (Attach additional sheets,if necessary.) Street address,Post Office and Zip Code City,Townsi�or�orough � C'? County � -�. �';7 .�-a ,:.:,� � A. Petition for Probate and Grant of Letters Testamentary rn '= <�� `" Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will ofthe Decedent,datedDe� ?�:`1 �;,� `I 2 ai�d Codicil(s) thereto dated �-� r`;�, - � ._ - , F `., � State relevant circumstances(e.g.renunciation,death of ezecutor,etc.) , ---� -- x z. .: Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was not di'viprced,wa not a party,.tq a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §332,�(g),and did�have a cl�ild born or adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. �N0 EXCEPTIONS o EXCEPTIONS ❑ B. Petition for Grant of Letters of Administration (If applicable) c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,durante absentia,durante minoritate If Administration,c.t.a. or db.n.c.ta.,enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been_established as defined in 23 Pa.C.S. §3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated persc� � ;ry y�� Q NO EXCEPTIONS O EXCEPTIONS � Q 'LL'� ��3 C� e � Petitioner(s),after a proper seazch has/t►ave ascertained that Decedent left no Will and was survived by the fo�g�°pouse(��any)and�5�}rs(attach additional sheets,ifnecessary): r°" r,� m , ,; � , �, .�__ .. , �;., �,, : ., Name Relationshi A`d'$r�ss,. , "''` � � �:,: — _ :�t:.a r�.) , y'.�a C_,.� i:,,.. _, _..� -�a Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND } � Peritioner(s)Printed Name Petitioner(s)Printed Address _ Farmers & Merchants Trust 20 South Main St. , � �? �� '�' M --. . ,_ . ca _.:. �. ,.�., Com an of Chambersbur P.O. Box 6010 �`� ��' - µ-- � � ` t`�.� Chambersburg, PA 17201 '::� � ' � �:: ��;� w .. , ^ ;` , ... _._� ; <�m� c:: _ The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and correc€'3b the best'of the krioi7uT��edge and belief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,the Petitioner(s)will ell and trul�dm�inister thce�state,�acc. dmg to law. Sworn to or affirmed and subscribed before �Date 8^ o`�,v me t 's��'�day of us t , 2 01 3 Q•, � �- � , � Date By: �_ , Date For the Register Date BOND Required: Q YES �O To the Register of Wil/s: FEES• Please enter my appearance by my signature below: �� Letters. . . . . . . . . . . . . . . . . . . . . . $ �t(� • Attorney Signature: ( �p ) Short Certificate(s). . . . . . �(�, z� ( )Renunciation(s).. . . . . . . . ,.. L �1 � ( )Codicil(s). . . . . . . . . . . . . � • ( )Affidavit(s).. . . . . . . . . . . Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: An ony L. DeLuca, Esquire Commission. . . . . . . . . . . . . . . . . . Supreme Court O er . . . . . . . . ID Number: 1 8 0 6 7 � I l 5. �� y }�:1 . . . 15. FirmName: Anthony L. DeLuca, Esquire ! . . . . . . . . �S. Address: I'Ori . . . . . . . . . P.O. Box 358 . . . . . . . . Boilinq Sprinqs, PA 17007 . . . . . . . Phone: 717-258-6844 Automation Fee. . . . . . . . . . . . . . . � Fax: 71 7—2 5 8—3 9 0 2 JCS Fee. . . . . . . . . . . . . . . . . . . . . �` .� Emai1: anthonyldelucaesq@embarqmail.c m TOTAL. . . . . . . . . . . . . . . . . . . . . $ J�c+3. . DECREE OF THE REGISTER Estate of Francis L. Saphore File No: �� -� '� �� a/k/a: AND NOW, �� , ,in consideration of the foregoing Petition, satisfactory proof having been es nted before me,IT IS DECREED that Letters Testamentary are hereby granted to Farmer & Merchants Trust Company o ChambersburQ in the above estate and(if applicable)that the instrument(s)dated December 1 8, 201 2 described in the Petition be admitted to probate and filed of record as the last Will(and Codicil(s))of Deced t. ��p,��Q i � l,�X llti� ` ��_ ' � ' , Register of Wills �'� ,(��n�`�.(1, � VUb � H105.805 REV(9/11) � , LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: it is illegal to duplicate this copy by photastat or photogr�ph. fl�.C��.' =�' ' v��^�- �r Fee for this certificate, $6.00 � ,', � ��N""' This is to certify that the information here given is � � � °' �- ' ,�°°��,P�tH�F pFi�%`=- correctly copied from an original Certificate of Death ��°��a,'�-`� _- y`�1=; duly filed with me as Loca1 Registrar. The original }�--� �� !� F,� '�y �� - °- 9' certificate WIll be forwarded to the State Vital 2 v i ,�_- .,, . za ��- y a� Records Office for permanent filing. P 1. 9 � 2929 . � _ _, =o�, _- =. �,,,; 0 r=�` r�� `' "`;,;, x,� �q9lMENT�E�'EP~'P �Z�ux�.�.�a.��.,�o�c-a�e�r Jt�1. 1 7�2 013 Certification Numbe£U A�4""B E R�.'��{� ;Q � ��,� ""�%��"""�� Local Registrar Date Issued h �\ Type/P�Int In GOMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH�VITAL RECORDS P°""a"°"` CERTIFICATE OF DEATH Black nk State Flle Number: � 1.Decedent's Legal Name(Firsi,Middle,Last,Sufflx) 21.�S�e�� 3. la Se N 4.Date of Death(MO1 Day (Spell Mo) Francis L_ Sapl-iore ��-�r�-�� July 'I 6�ZO�� Sa.Age-la5t Birthday(Yrs) Sb.Vnder 1 Year Sc.Under 1 Oa 6.Date of Birth(MO/Day/Vear)(Spell Month) 7a.Birthpiac (Ciiy and State o F eign Country) 7 9 ^^o^�n• oavs Ho��s r�^i^�ce� Novembez- 9 7, '1 9 3 3 Churc�town �F*$i � 7b.Hirthplace(Couhty}Cum� eX'��:..an � � � 9a.R�Side�c0(Siace or Forafgn Country) eb.Residence(Street antl Number-I.nclude Apt No.)� Sc.Old D cEtlent Live In a Towns I � � � penns lvania y L�Pbnroe . . GTYes,decedenf Ilved In �� tyyP, 8d.Resldence cco�„c�.� � � '1 3 2 9 C2zurch St_ . .... � � -Cumber 1 and ge.Re�me„�e�z�P code� o No,a��ea�.,�u„�d wlthln Iimits of clty/boro. 9.Ever i�US Armed Forces7 10.Marital Siatus at Time of Oeath �Marrled � Widowetl 11.Survlving Spouse's Name(If wife,give name prlor[o flrsC marrlage) �Ves 0 No �Unknown � Divorced ffi Never Marrled �Unknow 12.Father's Name(Flrst,Mltltlle,�ast,Suffix) 13.M hCr's Name lor t i f iddle,LasC) Daniel W_ Saphore Sr_ A`�ice �r_ `��'�f4�63c��`3$�" 14a.Informant's Name 14b.Rclatlonship to Decetlent 14c.Informant's Mailing Address(SCreet anE N�mber,City,State,.�21p Code).. � � Marlin K. SapYiore Brother 1329 Churcti St_CarlisZe, ' PA 470'I5 "_,� G - .._ - � - ^� - - � - - - i � co .�at. ec .onY,one �.�. - �. �.. .�. .. {]� c If Death OcGU d In a H' .pital: . � .InpeHent �If Death O�� ed 4 �� t�ere OchgrTli n a Hospital ❑Hosp{ce Facfllty.y� � b�Oecedent's Wome V � Emerga y Raom/OUtpatlen[ �� Dead on Arrival � 0 N Sln No e/L g-T tm Care FadHty � �Oiher(Specify) . �� o� 156.Facility Nem¢f�fi not Insiltution�,glvE stteec and number) 15c.Q[y or Town,5Sate,and Zip Code � 15d.County of peath o � Hol S irit Hos ital Cam E-Iill PA 'I701 'I umberland m 16a.MeChod of Dlsposition � Burlal Cremailon 16b.Date of DlspoSltion 16c Place of Disposltlon(Name of cernetery,cremafory,.or�oth�r place) .� O Re.*+oLa�r�om siece o oa�acio� �7/�g�2 O 1 3 Ho11 ingQx' Crematory O oxher(Specify} � � ��. � . �. � 16d.Loca;bn of Dlsposltton(GiYy or Town,State,and Z{p) �. 17a:Slgnaturc of Funerai Service Licensee o�Person in CF{arge of Interment 176:LlCense umber � Mt_ Ho11y Springs,PA't 70 5 ��,� �. � O 1 '1 58'9L �17c.Nam HO[ q,p)n Address of Funeral Facility � � ,g � 111 gerFH&Crematory, S01N.Baltimore Ave_ Mt_ Ho11y Springs,PA'17065 °r� 18.Decedent's Educailon-Check the box that best describes the 19.Decedent of Hlspanic Origln-Check fhe 20.Decetleni's Race-Check ONE OR MORE reces io indicate what f- highest degree or level of school completed at fhe time of death. box that besi describes whether the decedent the decedenS considered himself or herself to be. O 8th grede or less Is Spanish/Hlspanic/Laiino. Clieck the"NO" �White Q Korean � No diploma,9th-12Sh grade box If decedent is not Spanlzh/Hispanic/LaHno. � Black or African Amerlcan � Vletnamese �$ High school graduafe or GED wmpleied No,not Spanfsh/Hlspanic/Latlno �Amerlcan Indlan or Alaska Native O Other Aslan � Some college credlf,but no degree �Ves,Mexlcan,Mexican Ame�icen,Chicano O P.sian Indian Q Native Hewail2n � Assoclafe degrea(a.g.AA,AS) O Yes,Puerto Rican �Chinese � Guamanian or Chamo��o � Bachelo�'S degree(e.g.BA,AB,BS) � Yes,Cuban � Filipino � Samoan 0 MasteYS degree(e.g.MA,M5,MEng,MEtl,MSW,MBA) 0 Yes,othe�5panish/Hispanlc/Latino �Japancse O Other Pacific Islander � Doctorate(e.g.PhD,EdD)or Professional degree (Specify) � Other 5 � ( Pecify) .MD ODS DVM LLB JD 21.Decedsnt's Single Race Self-Designatlon-Check ONLY ONE to intlicaYe what the decedent considered himself or herself to be. 22a.DecedenYs Vsual Occ�paNOn-Indicata type of work OWhlta O Japanese O Samoan dotie during mosi of working Ilfe. DO NOT VSE RETIRED. Black or African American � Karean � Other Paciflc Isiander USAF � �American Indlan o�Alaska Native �Vietnamese � Don't Know/NOf Sure 0 Asian Indian �Other Aslan � Refusetl 226.Kintl of Business/Industry � O Chinese � NaHVeHawallan � Other(Specify) (z'OV� t � � Filipin0 - 0 Guamanian or Chamorro ITEM5�23a-23d�.MUST�BE COMPLET D 23a.Date Pronouncetl O¢ad(Mo/Day/Yr) 23 .Signatufe o Person Pr.onouncing Oea�h(Only wPe�app�ica6le �. 23c.Ltcense uM 0r �� BY PERSOIV WHD PA2ONOUNCES oR � � � . ��I�� GERTIFIfiSDEATH � � � 1 �: �� -� 23d.Da� Slg d(Mo/Day/Yr) .� 24.Time of Deat� Q � . . �. . �. 25.Wes MBtlical Examinlr o�Coroner Contacted7 Vei � � No � � - � CAUSE OF DEATH � �� Approxlmate 26.Part/. Enter the chain of avents--dlseases injuries,or compllcations--that dire tly�aused the th. DO NOT enter terminal evencs Such as cardlac arresi, � InServal: respiratory arrest,or ventricular flbr Ithout showing the eilolo y. 00 NO ABBREVI E. t�� ly one/ca�use o A(d'd adfdiHOnal lir�es if necessary. 1 Onset to Death [ w�,/� /� ))) /y n r/on � IMMEDIATECAUSE --------------> � ru��G �/.��`'//�� ✓�Y'/O�M1/iJ l�JrjJ'f 1 (Final tlizeasa or contlition p e o(or a e conse�f� 1 resulting i�death). � . . . �. . � � b. . � . . .. � ��. . Sequentlally.list condklons, . Ouelo(o as a co sequ nce of):� . � �� . �� . � � ir aoy,ieaa��a m me�ause � � � �� Iist�d on Ilrte a: Encer slie . � � � �. � � � � UNDERLYING CAUSE Due to(o�as a cons�quence of):.� � � � �� I�� (dlseaseorinJurythat�� . � � � � inlifatetl the events resultlng d. 1 . � . tn.death)LAST. . Due to(or as a consequence of): . � � � �� 1 .�� 26.PaR 11. Enter other ifitant c i I t but not r0sulting In ihe unde�lying cause given In PaYt I�. � � 27.Was e eutopsy pertormedT � � . � . . . � . � . '' ��Yes �� 28.Wer�autopsy flndings availabl� . � �� to co'rtiplet�the y �of d�ath7 $ � �� O Ycs <a Q No a 29.If Female: 30.Dld Tob o Use Contrlbute fo Death7 31.Ma��er of D�ath S O Notpregnantwithinpastyear � � Probably m�l4atural � Homicid� � Pregnani aT tlme of death � No � Unknown � Accident � Pending InvestlgaSion .� � Not pregnant,but pregnant within 42 days af death Q Sulcide � Could nof be determined ^ t- � Not pregnant,but pregnant 43 days fo 1 year before death 32.Date of InJury(MO/Day/Yr)(Spell Month) \ � Vnknow�if pregnant w(thin the past year 33.Time of InJury �+'� 34.Place of Injury(e.g.home;construction site;farm;school) 35.Location of InJ�ry(Street and Numb�r,City,CounTy,State,Zip Code) 1..,, f j 36.InJury at Work 3].If Transportatlon Injury,Specify: 38.Describe How InJury Occu�red: �,�� O ves O oriver/oPeracor O P�a�:�nao p Ne o ve:s�r,se� � ocner esveo�rv) ._�.� 39a�.C��ifler-physician,eertified nurse practitioner,metlical examiner/coroner(Check only one): � B'Certifying only To the best of my k wledge,death occurred due to the cause(s)and manne�si t d. d o P noun i g&Certlfying T of my knowledge,deaeh occurred at the ilme,date,and pl and due co the cause(s)and manner stated. � O M dlcal E I r/COro - � basis of examinaHOn and/or Inveseigation,in my pinion urr d ai ihe time,date,and plare,a d Cue to t �e(�/�ina� � G �J /7 Slg .i rc�.of rtIfl TlNeof ��rtifl Llcen e Nu.mb 39b. and f Peta Comple i C of�eath(1[em 26j � �.�/ � ''' 39[ ! .(. / a ): �j 4 .ite6�st�ar s �s �cS.NU . � � 41.Regisirar's Slgnaiure � . � � �� 42 eg strar File oa�e(MoJDay f � �l=a�� .,�f�.�.:;,.�.� ex-- v.� t? o� � 43.Amendments - O � � ��.c\�r ( H305-143 � Disposltlon Permii No. �C' \OIO REV 07/2012 � � , • r � LAST WILL AND TESTAMENT OF - �-� � �.,� . ,°i� FRANCIS L. SAPHORE c `-> - '� :�,, -� �:: . ; � �_,, � _ . ,. , .Y _ _ �,., ,� � . �� . . � I, FRANCIS L. SAPHORE, a resident of Carlisle, Cumberland��nty; �-_3 � .. � , , , �, , , ' ; r�� : t Pennsylvania being of sound mind, memory and understanding, do hereby make,pubcish � ;, :_, _,, , •.J and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ITEM 1: I direct that all my just debts,the expenses of my last illness and funeral expenses be paid as soon after my decease as the same can conveniently be done. ITEM 2: I direct that there shall be paid out of my residuary estate all estate, inheritance and like taa�es together with any interest or penalty thereon imposed by the government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this Will or otherwise, excluding, however, any property over which I have a taxable power of appointment,provided, however, that no residuary beneficiary shall by reason of this provision be denied the benefit of any deduction, credit, favorable rate of tax or other benefit which by law enures to such beneficiary. ITEM 3: To the individual and Institutions listed below, I bequeath the following: � Fr ��''' � � FRANCIS L. SAPHORE 1 _ ,� .�., _ ., �� , �.,�.� n_,��,..��. �,�,��,�.,..� .,,�:� .��,.-...,.�.w��..:�x�.�...,.�. �.��.,� ,� LAST WILL AND TESTAMENT OF FRANCIS L. SAPHORE A. To my brother, RICHARD C. SAPHORE, if he shall survive me, all of the remaining proceeds and benefits from my pension as a retired employee of Cumberland County. B. To the Ronald McDonald House of Hershey, Pennsylvania, my entire collections of Beanie Babies and Quarter Collection Bears. This bequest is unrestricted and the Board of Trustees or other governing body may use and expend the same for the benefit of the children at Ronald McDonald House of Hershey, Pennsylvania in any manner it deems appropriate. C. To the Toys for Tots Foundation of Carlisle, Pennsylvania my Hess Truck collection. This bequest is unrestricted and the Board of Trustees or other governing body may use and expend the same for the benefit of the children in any manner it deems appropriate. ITEM 4: I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature, and wheresoever situate at the time of my death, unto my brother, MARLIN K. SAPHORE, provided, however,that he survives me and is living sixty (60) days after the date of my death. G�i • �r-�-� FRANCIS L. SAP 2 LAST WILL AND TESTAMENT OF FRANCIS L. SAPHORE ITEM 5: If and in the event that my brother, MARLIN K. SAPHORE, does not survive me and is not living sixty (60) days after the date of my death,then and in such event, I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature, and wheresoever situate at the time of my death, in equal shares, unto my brothers and sister, RICHARD C. SAPHORE, PAUL R. SAPHORE, MURIEL DOWD and GLENN L. SAPHORE, provided however, that they survive me and are living sixty (60) days after the date of my death. ITEM 6: I hereby nominate, constitute and appoint F&M TRUST of Boiling Springs, Pennsylvania, Executor of this my Last Will and Testament, with full power to do any and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of it in this or any other jurisdiction for it's performance of this office. ITEM 7: If any provision of this Will or of any Codicil hereto is held to be inoperative, invalid or illegal, it is my intention that all the remaining provisions thereof shall continue to be fully operative and effective, so far as is possible and reasonable. � �� FRANCIS L. SAPHORE 3 .. �� . �, ..�. ��.�„� .�,� �, ,��.� �� .�. ��.�,�� ..��.t..,�.� _ �, � , LAST WILL AND TESTAMENT OF FRANCIS L. SAPHORE IN WIT'NESS WHEREOF, I, FRANCIS L. SAPHORE, the Testator,have to this my Last Will and Testament,typewritten on four(4) consecutively numbered pages, subscribed my name and affixed my seal this /��day of December, 2012. �v�o ,� �i�� SEAL) Signed, sealed,published and declared by the above named FRANCIS L. SAPHORE, as and for his Last Will and Testament, in the presence of us, who have hereunto subscribed our names at his request, as witnesses hereto, in the presence of the said Testator, and of each other. ��T�� . � �.: . � .. �� .- esi 'ng at d� � � / �/� ��`� �;� .�- � ' ��. ., , �� . , ��2��residing at �z'.L�i%F� _ .�-��' �� 4 .:��,�.�..�,. � �:. �:��..��.�-..,�_LL .�M� : ,� . ��. r,-- � - _� O�TH OF SUBSCRIBING WITNESS(ES) =' �� ' '''1 REGISTER OF WILLS _ _ �_ CUMBERLAND COUNTY,PENNSYLVANIA � �.., ... � C�� , -�,; ; . .. . ti��.�,'v, ...�. • , Estateof Francis L. Saphore ,Deceased Anthon�i r._ D r. �c-a� F� ,�; rP ,(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. �' _.� _._ el �� ti.�'. � �� .�� ( ignature) (Signature) 113 Front Street (Street Address) (Street Address) Boiling Springs, PA 17007 (City,State,Zip) (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 � ��l day before me this day of ��.� �� , �� of , � �� . y l� 7 �eputy for Register of W,ill Notary Public � My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expirarion of Notary's Commission.) NOTE: To be taken by Officer authorized[o administer oaths. Please have present the original or copy of instrwnent(s)at Nme of notarization. Form RW-03 rev.10.13.06 . _ . � � , �.. _ _ . _� _ . _ _ � _ � 4EiTH OF SUBSCRIBING WITNESS(ES) '! , ;�; ; ; r� f� � � - REGISTER OF WILLS L v- CUMBERLAND COUNTY,PENNSYLVANIA �± � VFit`,�,� `j _ C��L�i` .� �..�?., .`:=': Estate of Francis L. Saphore ,Deceased Marj orie A. DeLuca ,(each) a subscribing witness to (Print Name%r) 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. . - � � (Sigrtature) (Signature) 113 Frnnt StrPPt (Street Address) (Street Address) Boiling Springs, PA 17007 (City,State,Zip) (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 2�► day j COMMONWEALTH OF PENNSYLVANIA of , of v u s t , o r�a��ai n M, oner,Notary Public South Middleton Twp.,Cumberland County My GOmmisslOn 6qJires Aprll 16,2015 MEMBER,PENNSYLVANUTASSOCiATtqN ry upTARIES Deputy for Register of Wills N ry Public My Commission Expires: �j-�6-Z��S (Signature and Seal of Notary or other official qual�ed 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