HomeMy WebLinkAbout12-27-13 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)far 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 7� 11
Name: EDITH D. STOUFFER File No: �' �I ✓ � '�-/�
�a: (Assigned by Register)
a/k/a:
�a: Social Security No: 188206674
Date of Death: 12/19/2013 Age at death• $9
Decedent was domiciled at death in CUMBERLAND County, PA (State) with his/her last
principal residence at 4833 EAST TRINDLE ROAD CAMP HILL CUMBERLAND
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Carol�n Croxton Hospice HARRISBURG DAUPHIN PA
Street address,Post Office and Zip Code City,Township or Borough County State
Estimate of value of decedent's property at death:
Ifdomiciled in Pennsylvania................................All personal property $ 25.�0�.0�
Ijnot domiciled in Pennsylvania.............................Personal property in Pennsylvania $
Ijnot domiciled in Pennsylvania.............................Personal property in County $
Value of real estate in Pennsylvania.............................................................. $
TOTAL ESTIMATED VALUE.... $ 25,000.00
Real estate in Pennsylvania situated at:
(Atmch additiona!sheets,rjnecessary.) Street address,Post Otfice and Zip Code City,Township or Borough County
� A. Petition for Probate and Grant of Letters Testamentarv
Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated 7/10/1972 and Codicil(s)
thereto dated �l_!L_Y_7, 1978
State relevant circumstances(e.g.renunciation,death oJerecutor,etc.) C� w :� r-;�
� p i�rt �"�
Except as follows:after the execution of the instrument(s)offered for probate Decedent did not marry,was not�Vo�kd,was net�party:te a�nding
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(g),�dr�n�ave's eiidd�pc-�
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. � ,,� r� N € -, � .
r' r°�� -� ,
J� NO EXCEPTIONS ❑EXCEPTIONS � �`' ''' r
. . �.,
c� �._, -r� -,. .,
❑ B. Petition for Grant of Letters of Administration(Ifapplicable) <� °=-� ��,�; �3 -k
M1�
c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente life,�dut,pnte absen�i�durari7e rf�t�aritate
�
If Administration,c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and com�Aete�ist of hie�s. ��� 4?
��
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 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(if any)and heirs(attach
additionalsheets,rfnecessary):
Name Relationship Address
J
Form RW-01 rev.l0/11.'1011 Page 1 Of 2 -�
. `.
� � Oath of Personal Representative o����use o�y
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND }
Petitioner(s)Printed Name Petitioner(s)Printed Address
504 CAROLINA BEACH AVENUE SOUTH
GEORGE D. STOUFFER CAROLINA BEACH NC 28428
The Petitioner(s)above-named swear(s)or�rm(s)the statements in the foregoing Petition are true and correct to the best of the knowledge and belief
of Petitione.(s)and that,as Persc,nal Representative(s)of the Decedent,the Petitioner(s)will well and ly administer the estate according to law.
Sworn to or affirmed and subscribed befare ��• �g ]Z;Z.�)�
me thi � �'daq of -- ' � , ��� � _ � �� �
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For the Register ( E�rt � c�: �e �r-�
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BOND Required: ❑ YES � NO To the Register of Wills: -.:x ,�, t,.., .� '•� "ry"�
FEES: Please enter my appearance by m�Si�n�tiitte bet�v �
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, ` 'a� Cr� �_" �.�,,�
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Letters... ......... ........ . . . $ � '' �' Attomey Signature: � �.� ��,
( � )Short Certificates(s) ...... %'�'�� � �
( )Renunciation(s).. .. ...... � G���i��
( )Codicil(s) ........ . .. . ..
( )�davit(s)... . . ........
Bond Printed Name: R. MARK THOMAS
Commission . ...... . . ......... . . Supreme Court
ID Number: 41301
Ot,he i ......... -, �
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.�� '''' �� �. . Firm Name: LAW OFFICE OF R. MARK THOMAS
� � •r :: ::::::: � , Address: 101 S. MARKET STREET
� � � � � � ���� MECHANICSBURG PA 17055
� � • • • • •�• Phone: 7177962100
. . . . . . . .. F�: 717 796 3600
Automatio�Fee . .............. .. ?'L'� Email: RMARKTHOMAS(p�GMAIL.COM
JCS Fee ...... . . ... .... ... ... . . - •`_��i
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ToTni. . ..... . . . ....... . .. .. .$ �j� �
DECREE OF THE REGISTER
Estate of EDITH D. STOUFFER File No: r� '����/���
a/k/a:
AND NOW, � ���� � .'�-1 ��I 1�6-�t ��� , � =� � ,in consid ration of th forego'ng Petition,
satisfactory proof having been presented before me,IT IS�yECREED that L tters � "�'��
are hereby granted to �ir_��� �- ��Z`'�t E� _ ` _
i n t h e a b o v e e s t a i e a n d(i f a p p l i c a b l z)th a t
the insmiment(s)dated C '7�-
described in the Petition be admitted to probate and fi ed f record as the last Will(and Codicil(s))of Decedent.
�-��f'1��i '����`���'� � � S�f ��_. � -
Register of Wills �,��1 Y �� ������� �I �-�
FormRW-O2 rev.l0/l1/10/1 1��� �'
d ge 2 of 2
H105.805 REV(9/II)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
��CQ�`�'� ` r �;;` �;
Fee for this certificate, $6.00 � � �- ��. , ,,,,����°" This is to certify that the information here given is
����� .� t�� ;�:� ,11��,,��p�.ZH Of pE�;y._ correctly copied from an original Certificate of Death
, � ,�,�'p`t` = _`r�; duly filed with me as Local Registrar. The original
�'�i i � �� c';y �� - __ �: certificate will be forwarded to the State Vital
.3 �.. �7 I}� i � �,� ,� _= .,. z e
?�" �' a� Records Office for permanent filing.
.
P 2a � �. � � 2� �.����� �? r�� �=°��q9 -�P���°''� DEC20 ,
Fh,���S �V;,:�� � .IMENTOF� 3
Certification Numbe�(��s������� r,�s �� ""°����°"'"�����t,/ Local Registrar Date Issued
�., �;
Type/Prini In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH�VITAL RECORDS
°ef'"a"e"` CERTIFICATE OF DEATH
Black Ink State File N�mber:
1.Oecedent's legal Name(Firsf,Middle,Last,Sutfix) 2.Sex 3.Social Security Number 4.�ate of OeatFi(MO/Day/V�)(Speil Mo)
Edith �_Stouffer Famale �88-20-6674 pBO�9,20�3
Sa.Age-Last Birthday(Vrs) Sb.Vntler 1 Year Sc.Untler 1 Oa 6.Date of Birth(MO/Day/Year)(Spell Month) ]a.Birthplace(City and SiaSe or Foreign Country)
Months DayS NourS Min�tCS S �llC@ H{II TQYV(►$I7I PA
^ gg Octobar 26, 7924 7b.Blrthplace�co��cy7 Junla
'� / � Sa.Residence(StaSe�or Fareign Country) Sb.Resitlence(Sireef and Number-Inclutle Apt No.) Sc.Did Decedent Live in a Township2
�!/ F'A 4833 East Trindle Ro�d es,decetlent INed�� Hamodsn t,,,,p.
Bd.Residence(GOUnty)
Cl1TVB�911(� Be.Restdence(21p Code) '�7Q'�'� O No,decetlent Ilvetl within limits of city/boro.
9.Ever In US Armetl ForcesT 10.Marital Siatus at Time of Death O Marrietl OxVJidowed 11.Surviving Spo�se's Name(If wife,give name prior to Frst marriage)
�Yes �,No 0 Unknown � Divorced 0 Never Married 0 Unknow
12.Father's Name(First,Middle,Last,Suffix) 13.Moiher's Name Prior to First Marrlage(First,Middle,Las[)
� Geo g W_�entlgr Phoebs Ray Fisssl
14a.Informan('s Name 14b.RelaSionship to Decedent 14c.InformanS's Mailing Address(Street antl Number,City,Sta[e,Zip Code)
Oeo �.Stouifar SON 504 Garolina Baach Avenue South Caroti�a Bsach,NC 284
G _ -_ -. _ _�_ ._ _ is�_ a�eo oeai c e� omro.,eLa
_ If DeaYh Occurred if�a HOSpital: ❑ Inpatlent �If Death Occurred SOm@where Othe�Than Hospital �HOSpice Facility �[]DecedenC's Fiome
0 Eme�gency Room/OUSpaHent �[] Deaa on Arrival � 0 N�rsing Home/LOng-Term Care Facllity 0 Other(Specify)
� 156.Faclliiy Name(If not Instituii.an,give street and n mber) 15c.City or Tow�,Siate,and Zip Code 15d.County of Death
Carolyn Croxton Slana Hospiea Rasi�Ja�ee Harrisburg,PA 17110 �suphin
16a.Method of Oispositlon Burial Q Crematlon 16b.DaYe of Disposition 16c.Place of DlspoSition(Name of cemetery,cremaTOry,or other place)
� � Removal from Stafe � Donatton
p ocner�sPea+y� Uec 28,2013 Rolling Gres�Cemetery
� 16d.Location of Disposi[lon(City or Town,State,and Zip) 17a.Signat�re of Funeral Service Licensee or Person in Charge of IntermenT 17b.License Number
� � CamP HIII.PA 770�1 ' a�no.a o.FO.....r sr. F�-0141511
E 17c.Name and Complete�Address of Funeral Facility
� Mussalma�FunBral HomB C n Servlcas In 324 Hummei Avanue Lamoyne,PA 17043
'� 18.Decedent's Ed�catlon-Check the box that best describes the 19.Decedent of Hlspanic Origin-Check the 20.Decedent's Race-Check ONE OR MORE races to indicate what
� highest degree o�level of school completetl at tM1e time of tleath. box that bes(describes whether 2he decedent the tlecetlen[considered himseif or herseif to be.
� Bth gratle or less Is Spanish/Hispanic/Latino. Check the"NO" White � Korean
� No diploma,9th-12th grade box if decedent Is not SpanisM1/H(spanic/Latino. 0 Black or Afrtcan American � Vietnamese
�High school graduate or GED completed No,not Spanish/Hispanic/Lattno 0 Amertcan Indian o�Alaska Native O Other Asian
� So ollege redit,but no degree Q Yes,Mexican,Mexican Amerlcan,Chicano � Asian Indlan � Na[ive Hawaiian
� As ociate deg ee(e.g.AA,AS) � �Ves,Puerto Rican � Chinese n o
O Guamania rChamorro
� Bachelor's degree(e.g.BA,AB,BS) 0 Ves,Cuban � Filtpino � Samoan
� Master's degree(e.g.MA,M5,MEng,MEd,MSW,MBA) � Ves,other Spanish/Hispanic/Lafino 0 lapanese � Other Pacific islander
� Docto�ate(e.g.PhD,EdD)or Professional degree (Specify) � Oiher(Specify)
.MD ODS DVM LLB JD
21.Decedent's Single Race Self-Designailon-Check ONLV ONE to indicate what the decedent considered himself or heroelf to be. 22a.Decedent's Usual Occ�pation-Indicate fype of work
�Whi[e �Japanese 0 Samoan � done tluring mosi of working life. DO NOT USE RETIRED.
� Biack or AfNCan American � Korean � Other Pacific Isiander Community Ssrviag
�Ame�lcan Intlian or Alaska NdSivC 0 Vletnamese � Don't Know/NOt S�re
_ � Asian Indian � Other Asian p Refused 22b.Kind of 6iasiness/Ind�stry
� O Ghinese O Naiive Hawallan � Other(Specify)
� Filipino � G�amanian or Chamorro NeyysPaPQr
ITEMS 23a-2 d MIJ5- .BE COMPLETE� 23a.Date Pronounced�ead(MO/Day Yr) 23b.Signature of Person Prono�ncing Death(Only when applicable) 23c.License N�mber
BY PERSON WHO PRONOUNCES OR
CERTIFIES QEATH �.
23tl.Odte Signed(Mo/Day/Yr) 24.Time of Death
� 25.Was Medical ExaTiner or Coroner Contactetl7 � Yes No
� CAUSE OF DEATH � Approzimace
26.Par[1. Enter the chain of e etiSS--diseases,Injurles,o mplicatlons-that direcily caused the death. DO NOT enter terminai e ents such a artliac a esi, � Interval:
respiratory arrest,or veniNCUlar fibrilla�lon wt�houi showing the etlology. DO NOT A6BREVIATE. Enter only one cause on a Ilne. Add adtlitional Ilnes ifrnecessary. Onset to Death
/} 1
IMMEDIATECAUSE -------------> l;�Q'C�CJ��C]Y�����1r.YVACJ R�rPCk- '
(Final d�sease o ontliflon a -� D�e to(or s a consequence of):
resulting In death) ^ �` �
b. ���!�l �-�1- �0�\\„��C "t"ia-��l r�J L_ �
Sequentially Iist contlitions, . Due to(or as a consequence of): � .
if any,i�adfng co the tause � �
Iisted on Iine a..: Entar the � �j��� �Y1 QC \L �
UNDERLVING CAUSE . c-� Due to(or as a consequence of): 1
� (disease orinjury that 1
F Initiated the events resulSing d. ��n�P
� in deaih)LAST. . , Due fo(o as a consequence of):
� 26.Wart il. Enier other si¢nificant conditions contributin¢to dea[h but not resutting In Yhe underlying cause given in Part i. 27.Was an a�topsy pertormed?
� Yes `$_.No
�� � 28.Were a topsy£ndings avaliable
� . co mplete ihe c of death?
cOO Ves e NO
_ 29.If Female: 30.Did Tobacco Use Contribufe So Dea(h? 31.Manner of Oeath
� ��No[pregnant within past year 0 Ves � Probably �Nat�ral � Homicide
O Pregnant af t(me of death �_No � Unknown � Accident � Pending investigation
$' � Not pregnant,but pregnanS withln 42 days of tleaih � S�icide � Could not be defermined
i- � Noi preg�ant,buf pregnant 43 days So 1 year before death 32.Date of Injury(Mo/Day/Yr)(Speil Month)
� Unknown if pregnanS within the past year 33.Time of Injury
34.Place of Injury(e.g.home;const�uctlon sife;fa�m;school) 35.Location of Injury(Street and Number,City,County,Sia[e,Zip Code)
36.Injury at Work 37.If Transportation InJury,Specify: 38.Describe How Injury Occurred:
� Yes � Driver/Operator � PedesVian
� No Q Passenger � Other(Specify)
39a.Certifier-physician,ceKifled nurse practitloner,metlical examine�/coroner(Check only one):
Certlfying only-To ihe besi of my knowledge,tleafh occurred due io the cause(s)and mann r stated.
Pronounci�g 8.Gertifying-To the best of my knowledge,death ocwrred at the tlme,date,and place,and d�e to che ca�se(s)and manner stated.
� Metlical Examiner/COr n r-On the basis of examinaHOn and/or investigation,in my opinlon,deach occurred at the time,daie,and place,and due to the cause(s)and mannar stateC.
SignatureDfcert(fler. TlHeofcertifier: P��S\CLGY� LicenseNUmber: [�L'lJ l�Cj Sa
39b.Na�m¢,Addr¢ss and Zi C de of Person Completing Cause of Deafh(Item 26) �^'.�__�� 39c.Oate Signed(MO/�ay/Yr)
� s c' �-v r. r, �' c-�-c�.c- - P�. -1-� �
40.Regist�ar s DlStrici Number 41.Registrar's 5 ture 42,Hggist r.File Date Mo/Oay/Yr)
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,� as.nrt,e�drt,e�ss _. _.._.,- ._.____ .--
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H105-143
� Disposition Permit No. �1�I -\°�f� REV 07/2012
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I�45T WILL A1�ID T+�'iTAMENT � � �"" �^�� . � �ry
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I, EDITH D. STOUFN'ER of the Bc�roUgh� o�''Iema�r�e,., County o�'a �W� ; = � .
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Gua►berla�l, Com�c>nwealth of Penr�sylvania, having made m,3r � Will�and a , ,
. ��, .
Testament dated Ju].y 10, 19'�2, a copy of which is attached hereto �snd
ma.de part hereof, do hereby mak�, publish and declare this �a be a GflDICIL
to my said Iast Will and 'I�estaanent.
FIRST: tahereas, in my said Iast W1I1 and Testament� I
appointed Geargs D. St�ouffer and ]ae,uphin Deposit �rus� Campa�y, (�a-executars
under �a.r�raph "FOUR'1'Ii", ar�d. xhereas, it is a►y inteution to rem�ve the
said Dauphin DepQ�it Trust Gompany as ec�-executor and I hereby appoin�
GEORGE D. STOI3FFFER, 5qle r'�ceeutor �nd wS,th the s�ne force and effect as
if he ha�l been ori�inally na.med Sale Execut�r a.r�d. therewAder.
SECOI�ID c Whereas, in �q,y sa.id Iast kIi11 and T�Bta�ent x�o
provision xas mad� �'ar an alternate EaceQUtor in the event sri�her or al.l of us,
being Wi111a� W. Stouffer, Edith D. Stouffer, aru3 now George D. Stouffer,
shall fail to act as �ecutor as the ca,se may be for any reason whatsaav�sr,
arbd ir� tha�t ca�e anly, T hereby appoint, naminate my daughter-in-law, MARY
ANN STOUF�R aa Executrlx #.o serve vritY�aut band. or eursty thereon with the
same foree and effec�t as i.f she had besn ariginally n,amed F�ceoutsix thereu�der.
FOURTH a I hereby rati.fy and conf'irm �a,y Iast vtiZl and
Testament a.fores�.id except iz�sofar as any past thereof is revoked, modified
or added there�tu by this Godicil.
IN TdIT�ZL+'SS �rHER�OF, I have ma.de this a Codicil to my I.�.st �'ilZ
and Testament dated July ].0, 1972, subsaribed my n�ne and set my seal this
� day of , 19?8.
Sworn �rx�. subscribed to ����, ._ (SEAL�
befa me this;
=� tia,y pf l � _„_, 19'j8. (SEAL}
`�.LLS.�
1
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.� .� �,'Yd �df . ,L`��t f�f_��..✓
Notasy Pub�ic
SUSAN A.RUPNIK,Notary Publ'�C
My Commission Expires Oct.22, 19�
,
A.C.E, 6338-6 06/15/72 ,_ • _
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LAST WILL AND TESTAMENT � � �`� �� �-;
s-�-r �-, c T_. ,.r� ,.:<..r
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OF �'� 7� r.� -'-° ��
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EDITH B. STOUFFER : ,..... . ::--, _,, . °,
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I, EDITH D. STOUFFER, of the Borough of Lemdqne, Cumb�*xland �'';
County, Pennsylvania, being of sound mind, memory and understanding, but
realizing the uncertainty of human life, do hereby make, publish and declare
this as and for my Last Will and Testament, hereby revoking and making void
any and all Wills and Codicils thereto by me at any time heretofore made.
FIRST: I direct that all my just debts and
funeral expenses be paid as soon after my decease as practicable.
SECOND: All of my estate, real, personal and
mixed, of whatsoever nature and wheresoever situate, I give, bequeath and
devise unto my husband, WILLIAM W. STOUFFER, if he survives me for a period
of thirty (30) days. In the event my said husband fails to survive me for
a period of thirty (30) days, I then give, bequeath and devise all of my
estate unto my son, GEORGE D� STOUFFER.
THIP,D: Far the purpose of administering my estate,
I hereby authorize and empower my personal representatives, hereinafter named,
to:
(a) make distribution in cash or in kind, or both;
(b) retain any real or personal property which may at any
time form part of my estate as long as they may deem advisa'ille;
(c) invest in any real or personal groperty, without re-
striction by laws limiting investments by fiduciaries ;
(d) repair, alter, improve or lease for any period of time
any real or personal property, and to give options for leases;
(e) sell at public or private sale, for cash or cre3it, with
or without security, or to exchange or partition, real or personal
D„C.E� 6338-6 06/15/72 --
� -
� _ . � ,
property forming any part of my estate;
(f) compromise claims;
{g) borrow money from any person or corporation.
FOU�:TH: I hereby nominate, constitute and appoint
DAUPi3IN DEPOSIT T:L'ST Ci�MPANY and my son, GEORGE D. STOLTFFER, as Co-Executors
of this my Last ��lill and Testament.
IN GIITNESS WHEREOF, I, EDITH D. STQUFFER, the Testatrix, have
hereunto set my iiand and seal to this my Last Will and Testament, written on
��
two (2) sheets, this _��`,; daq of •. I9�2.
__._. �
1
P�RSO,'.�1ALLY APP�ARE� BEFORE
1�'!E THIS 7th DAY OF JULY, 1978
ST,,�?OR1V' AS BE I�TG THE S IG�IATUR� AND
BEING �X�CUTED BY EDITH D.
STOUFFER.
_ C�'j 9� �. .
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� Edith D. Stouffer��='�����
�1JSAN A,kIJPNIK.Notary PubtiO
:.. .. _ o , :_ _
�+Iq Comrrtiscion Expires Oct.22,1979
Signed, sealed, published and declared by the said Testatrix, as and for
her Last Will and Testament, in our presence who, in her presence, at her re-
quest, and in the presence of each other, have hereunto set our hands as
attesting witnesses.
�� �f � w � ;�
Name �,,�y�� Address �'��,�,
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Name_����`L�,��'�� �/�,/��Addres
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2������
-2-
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
�l -1� - 1 �`�l�
Estate of �</���!/I �� �����``'� , Deceased
�
�C�' ' ° � �J��( v,�— and �������?�
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(each) being duly qualified according to law, depg,s e(s) and say(s) that she/he/they was/were well-
acquainted with ��i�j ��/ `�L(��Z°/ and am/are fam4i,�iar
with the handwritin and si nature of the decedent and that the si nature of � ������
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to the foregoing instrument pu�porting to be the Last Will and Testament/Codicil of
�/� !/_ ��G7u��� is in his/her own proper handwriting.
C..� �� f�
(Signat�ire) (Sig�iature)
,�� �o ,� Q��� � �� s� �;��-��5�`
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Sworn to or affir d and subscribed 1 ���
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before me this l � day � `F ..� C:f = ;
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Deputy for Regi r of W lls
Form RW-04 rev. l0.13.06
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
COUNTY,PENNSYLVANIA
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Estate of ��l � ���G���--°'`� , Deceased
' � � � S/C��/�'i^ and ��'��l�"�� /�/_/%Y�1G�5
,
(each) being duly qualified according to law, d��) and say(s) that ��-��/they was/were well-
acquainted with � J�� and �/are famili
with the handwriting and signature of the decedent, and that the signature of ^l/Z� � .�/��r-�`�`-'r'�
to the foregoing instrume urporting to be the Last Will and Testament/Codicil of
CG(!� ���� is in�s/her own rroper handwritin�.
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(Signu re) (Signatu e)
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(Street Ad�ress ,/ r� fK (Street Address)
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Execcited in Register's Of�ce c � `"' � �`i
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Sworn to or affirmed and subscribed rn -�� C.� �-� �:.r7 �,'^?
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before me this % �day � � r� �i .
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Deputy for Reg� er of Will
Form RW-04 rev. !0.l . �