HomeMy WebLinkAbout04-16-14 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 ----
Name: William A. Paul _._______ ___ File No: _____���1� �
---- –-
�a; (Assigned by Register)
a/k/a:
�a; _ Social Security No: _________
Date of Death: 2/4/2014 Age at death: 7�______..______.-- —
Decedent was domiciled at death in Cumberland ____ County, Pen_n�lvania ____ (State) with his/her last
principal residence at 1700 Market Street _______ ___17011_______Camp Hill__Borough_________Cumberland _______.
Street address,Post Oftice and Zip Code City,Township or Borough County
Decedent died at 1700 Market Street_ 17011 ___Camp Hill Borough_______ __ Cumberland_..__PA__
Street address,Post Office and Zip Code City,Township or Borough Counry State
Estimate of value of decedent's property at death:
If domiciled in Penusylvania................................All personal property $ _____100,000.00
Ifnot domiciled in Pennsylvania.............................Personal property in Pennsylvania $
If not domiciled in Pennsylvania.............................Personal property in County $
Valueof real estate in Pennsylvania.............................................................. $
TOTAL ESTIMATED VALUE.... $ _.__._._____�OO,OOO.00
Real estate in Pennsylvania situated at:
(Attach additionaf sheets,ifnecessary.J Street address,Post Office and Zip Code City,Township or Boroug6 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 4L25LZQ� and Codicil(s)
thereto dated —___.__ __
----------- -__ - --- - - -- --._ _ __ _.._ _---- — --------_..
State relevant circumstances(e.g.renunciation,death ojexecutor,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(g),and did not have a child born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
� NO EXCEPTIONS ❑EXCEPTIONS _ __ ___ ___ ____ _. _ _._ ---------- -- --_ _.__--.__.---
❑ B. Petition for Grant of Letters of Administration(If aPP�icab�e) _ __ __ _ ______ _.___ __——_________
c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,durante absentia,durante minorrtate
If Administration,c.t.a. or d.b.n.c.t.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(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
❑ NO EXCEPTIONS ❑EXCEPTIONS ,_ —_�___ __.__—_
Petitioner(s),aftet a proper search has/have ascertained that Decedent left no Will and was survived by the follo�spouse(if ar�nd h�s�ach
additional sheets, rf necessary): � p � � �
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Form RW-02 rev.l0/11/2011 Page 1 of 2
Oath of Personal Representative i or���ai use o��Y 1
COMMONWEALTH OF PENNSYLVANIA }
} SS: ' �
COUNTY OF CUMBERLAND } ', I
�_.__________ _ _-._ I
- --- -- _-- - ___ - -- _._- - - - - ---
Petitioner(s)Printed Name Petrtioner(s)Printed Address �
___- --- -- -— --
707 Shepherdstown Road, Room 612 .. �
Jo Ann J. Paul ____ Mechanicsburq ___ ___ _____ ___ _ PA 055� �0
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The Petitioner(s)above-named sweaz(s)or affirm(s)the statements in the foregoing Petition are true and correct to the best of thg�n6w'"]edge and�gi J,ief r=- M
of Petitioner(s)and that,as Personal Representative(s)of the Deced the Pe' 'oner(s)will well trui dminister the estateacca�ng to law. � 0
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Sworn to o i ed • bs �ib before - , -
� _ ___ _ _ _ _�__----- --___�"Date _�_I�i�--_-
me this � �.`da' o� 014
-- _ .---_..__ Date
_ _ ---- --- ----- -
BY� - • _ . Date .----
egister Date
BOND Required: ❑ YES � NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
,
Letters................... . . . . $ _____- __210.00 ! AttorneySignature: �
(3 )Short Certificates(s) .... . . _________15.00 j �
( )Renunciation(s)....... . . . .....__--__ ____ ' �
( )Codicil(s) I __--_.-----I
� )�davit(s)........ . . . . . �
Bond ' Printed Name: ChfIStB W1. i4 II�_____________--._-_----_—_-�
.............. . .......... - --- --- ! �
Commission ........ . ....... .... Supreme Court
---- ---
Other ; ID Number: 2_07949 �
_.-------- .... ... .. ---- �
--- -------------- -- -
Will 15.00 i
-.... ... .. —
ITR/InventON ___ 30.00 ! F"�"Naz"e: Jan L. Brown Associates _____ ___�
------... . ... ..
address: 845 Sir Thomas Court___
------_- _.. . . . . . .. Suite 12 - - �
--- --- ---- .. . . . . ... _ ---- Harrisbur� _ --- - PA 17109----.
- --.... . . . . .. I
-- --
------ --_ __.__ .... . . . . . _ ____ ___ II Phone: 717-54_1-5550_-------- !
_-- -- -- i
----------_ ____ .. . . ... .. I Fax: 717-541 9223 '
_ __----
- - --- -- -------
Automation Fee ......... ........ __ -- 5.00 � • i
I Ema�l: christa a anbrownlaw.com
---- ---
7CS Fee ............... ........ ----- - 23.50
TOTAL ......................$ 298.50 �` -- ------- --- - ___ _--- - ------- ------
DECREE OF THE REGISTER
Estate of William A. Paul------- ------_____ ___ __ __ --_ _---- File No:,�_�����1.��/ --------
a/k/a: - -- ---- --_ __ --_----- - _ ____ __ _ _ _
� � //
AND NOW, _'��________ _____________ , 2014__.__ _. ,in consideration of the foregoing Petitiun,
satisfactory proof having been presented before me,IT IS DECREED that Letters Testamentary __________
- -------------._---- are hereby granted to Jo Ann J. Paul--- --_________-- -
_ _ - ________...__ ___.__.__ ______________ _____ _ _ in the above estate and(if applicable)that
the instrument(s)dated 4/25/2006___----- __ __ _.___ ___ �, __ _ ------ ________-----
described in the Petition be admitted to probate and filed of recard, s e last Will(and Co 'c' s))of Decedent.
'
- _ _ --- -- ---- ------
Register of Wills �'�
Form RW-01 rev.10/lU20/l �
_.,:
_
REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
�
No. 2014- 00365 PA No. 21- 14- 0365
Es ta te Of: WILLIAM A PAUL
(FiisG Middle,Lastl
La te Of: CAMP HILL BOROUGH
CUMBERLAND COUNTY
Deceased
Soci al Securi ty No:
WHEREAS, on the 16th day of April 2014 an instrument dated
April 25th 2006 was admitted to probate as the last will of
WILLIAM A PA UL
(First,Middle,Lastl
Iate of CAMPHILL BOROUGH, CUMBERLAND County,
who died on the 4th day of February 2014 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, L/SA M. GRAYSON, ESQ. , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
JO-ANN J PAUL
who has duly qualified as EXECUTOR(R/XJ
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
tz IN�ESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
o uy e,s� <c
ct�i ?t�y �fi ce�r`iL the 16th da y of April 20�4.
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**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
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LAST WILL AND TESTAMENT � � .?; � o
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WILLIAM A. PAUL ? � �`' � � �
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I, WILLIAM A. PAUL of Cumberland County, Pennsylvania, declare this to be my Last
Will and Testament hereby revoking all prior Wills and Codicils.
ITEM I. I direct that the expenses of my last illness and funeral be paid from my estate as
soon as practicable after my death.
ITEM II. All inheritance, estate, and succession ta�ces (including interest and penalties
thereon,but not including any generation skipping tax)payable by reason of my death shall be
paid out of and be charged generally against the principal of my residuary estate without
reimbursement from any person. In the event that my residuary estate is not sufficient to make
these payments,then these payments shall be equitably apportioned among those beneficiaries to
whom any benefit from my estate accrues, in the proportion that the value of the property or
interest received by a beneficiary bears to the total value of the property and interests received by
all such beneficiaries. This provision is not a waiver of any right which my Executor has to
claim reimbursement for any such taxes which become payable as the result of any property over
which I have the power of appointment.
ITEM III. I give, devise and bequeath in accordance with any memorandum which I have
either handwritten or signed, located with my Will or with my valuable papers and found within
30 days of the probate of my Will. Gifts may only be to persons who survive me or to
organizations which exist at my death, and if there is a conflict, the memorandum having the
latest date shall govern.
ITEM N. All the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situate, I give, devise and bequeath to my wife, JO-ANN J. PAUL, of Cumberland
County, Pennsylvania. In the event that JO-ANN J. PAUL predeceases me or does not survive
me by thirty(30) days, I give, devise, and bequeath the remainder of my estate, of whatsoever
nature and wheresoever situate according to the following schedule:
A. SEVENTY-FIVE PERCENT (75%) to be held in a Special Supplemental
Care Trust, for my son, WILLIAM M. PAUL,to be held,managed, and administered
according to ITEM IX.
B. TWENTY-FIVE PERCENT (25%) IN EQUAL SHARES to my following
grandchildren: DESTINI A. PAUL,WILLIAM JAMES PAUL, and KAYLEEN J. PAUL.
If any of my beneficiaries predecease me or fail to survive me by thirty(30) days, I give,
devise and bequeath his or her share to his or her issue who survive me,per stirpes, or if he or
she has no issue,the share(s) are to be added equally to the other shares.
ITEM V. If a beneficiary under this Will other than WILLIAM M.PAUL has not attained
the age of twenty-five(25)years,the share of the beneficiary shall be placed in a separate trust, for
the benefit of that beneficiary according to the terms in Article VI.
ITEM VI. In the event that a Trust is created by or as a result of any part of this Will for
beneficiaries other than WILLIAM M. PAUL under the age of twenty-five (25), the terms and
conditions of the Trust shall be as follows:
A. To expend and apply so much of the net income and so much of the principal of the
Trust as the Trustee shall consider advisable for the support,health, care and education(including
2
college,trade school,or other similar training or education)of the child until the child attains the age
of twenty-five(25) years.
B. Upon attaining the age of twenty-five(25),the remaining principal and accumulated
income of the child's share shall be distributed outright to the child.
C. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his or her interest in the principal or income of the Trust in any manner,
nor shall any interest be subj ect to claims of his or her creditors or liable to attachment,execution,or
other processes of law.
ITEM VII. In order to carry out the purposes of the Trust for beneficiaries other than
WILLIAM M.PAUL,outlined in ITEMS V and VI of this Will,the Trustee,in addition to all other
powers granted by this Will or by law,shall have the following powers over the Trust estate,subj ect
to any limitations specified elsewhere in this Will:
(a) to retain in the form received and/or to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(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 principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(fl to file fiduciary/income tax returns and pay the tax due for any year for which such a
return is required,
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(g) to make distributions in cash or in kind,or in both,and to determine the value of any
such property,
(h) to employ any attorney,investment advisor,or other agent deemed necessary by my
Executor; to pay from my estate reasonable compensation for all their services,
(i) to conduct along with or with others, any business in which I am engaged in or have
an interest in at the time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule of fees
in effect while their services are performed.
ITEM VIII. I hereby appoint my sister-in-law, DONNA YOST, of Northumberland
County, Pennsylvania as Trustee of the Trust(s) created in this Will outlined in ITEMS V through
VII for any beneficiary(ies)under the age of twenty-five(25). In the event of the renunciation,
death, or inability to act, for any reason whatsoever of DONNA YOST, I nominate, constitute
and appoint my sister, KATHLEEN O'TOOLE,of Sunbury, Pennsylvania as successor Trustee
with all the same powers of the initial Trustee.
ITEM IX. Snecial Sunnlemental Care Trust for WILLIAM M. PAUL. I hereby
nominate and appoint THE FAMILY TRUST (a division of ACHIEVA), or its successors,
currently of 711 Bingham Street,Pittsburgh,Pennsylvania, 15203 as Trustee of the Special
Supplemental Care Trust under this my Last Will and Testament.
The share of my estate that is set aside for WILLIAM M. PAUL shall be held by my
Trustee, THE FAMILY TRUST, or its successor(s), in trust for WILLIAM M. PAUL's benefit
in a Special Supplemental Care Trust in accordance with the following provisions:
4
A. INTENT
It is my intention by this trust to create a purely discretionary supplemental care fund for
the benefit of WILLIAM M. PAUL and not to displace financial assistance that may otherwise
be available to him. Illustrative of the kinds of supplemental,non-support disbursements that
would be appropriate for my Trustee to make from this trust for WILLIAM M. PAUL include:
sophisticated medical or dental or diagnostic work or treatment for which there are not funds
otherwise available, including plastic surgery or other non-necessary medical procedures; private
rehabilitative training; dental care; recreation and transportation; differentials in cost between
housing and shelter for shared and private rooms in institutional settings; supplemental nursing
care and similar care that assistance programs may not otherwise provide; telephone and
television service, companions for travel,reading, driving and cultural experiences and payments
to bring his children or others for visitation in the event my Trustee deems that appropriate and
reasonable.
B. It is important that WILLIAM M. PAUL maintain a high level of human dignity and
that his care be humane. If this trust were to be eroded by creditors, subjected to liens or
encumbrances, or cause assistance benefits to be unavailable or terminated, it is likely that the
trust corpus would be deleted prior to his death, especially if the cost of care for him would be
high. In such event there would be no coverage for emergencies or supplementation to basic
needs. The trust provisions contained in this instrument should be interpreted by my Trustee in
light of these concerns and this intent.
C. My Trustee shall pay or apply for the benefit of my son for his lifetime such amounts
from the principal or income, or both, of this trust up to the whole thereof, as the Trustee, in the
5
Trustee's sole and absolute discretion, may from time to time deem necessary or advisable for the
satisfaction of WILLIAM M. PAUL's special non-support needs, if any. Any income not
distributed shall be added annually to principal. As used in this instrument, "special non-support
needs" refers to the requisites for maintaining my son's good health, safety and welfare when, in
the discretion of the Trustee, such requisites are not being provided by any public agency, office
or department of the state where he lives or of the United States, or are not otherwise being
provided by other sources of income available to him. Special non-support needs shall include
but shall not be limited to the list of suggested non-support items set out in this article.
D. In the event that he is unable to maintain and support himself independently, the
Trustee may, in the exercise of the Trustee's best judgment and fiduciary duty, seek support and
maintenance for him from all available public and private sources. The Trustee shall take into
consideration the applicable resources and limitations of any public assistance program for which
he is eligible. In carrying out the provisions of this trust, my Trustee shall be mindful of the
probable future needs of my son,but not of the trust remainder beneficiaries.
E. No part of the corpus of the trust created by this article shall be used to supplant or
replace public assistance benefits of any county, state, federal or other governmental agency that
has a legal responsibility to serve persons with disabilities that are the same or similar to those
which WILLIAM M. PAUL may be experiencing. For purposes of determining my son's public
assistance eligibility, no part of the principal or undistributed income of the trust shall be
considered available to him. In the event that the Trustee is required to release principal or
income of the trust to or on behalf of WILLIAM M. PAUL to pay for benefits or services which
such public assistance is otherwise authorized to provide were it not for the existence of this
6
trust, or in the event the Trustee is requested to petition the court or any other administrative
agency for the release of trust principal or income for this purpose,the Trustee is authorized to
deny such request. My Trustee is authorized, in the Trustee's discretion, to take whatever
administrative or judicial steps may be necessary to continue the public assistance program
eligibility of WILLIAM M. PAUL, including obtaining instructions from a court of competent
jurisdiction ruling that the trust corpus is not available to the beneficiary for such eligibility
purposes. Further,my Trustee should cooperate with the beneficiary's conservator, guardian, or
legal representative to seek support and maintenance for the beneficiary from all available
resources, including but not limited to, the Supplemental Social Security Income Program (SSI);
the Medicaid Program; and any additional, similar or successor programs; and from any private
support sources. Any expense of the Trustee, including reasonable attorney fees, shall be a
proper charge to the trust.
F. SPENDTHRIFT PROVISIONS
No interest in the principal or income of this trust shall be anticipated, assigned or
encumbered or shall be subject to any creditor or to any legal process prior to the actual receipt
by the beneficiary. Furthermore,because this trust is to be conserved and maintained for the
special non-support needs of WILLIAM M. PAUL throughout his life,no part of the corpus
hereof,neither principal nor undistributed income, shall be construed as part of WILLIAM M.
PAUL'S estate or be subject to the claims of voluntary or involuntary creditors for the provision
of care and services, including residential care by any public entity, office, department, or agency
of any state or the United States or any governmental agency. Under no circumstances can the
beneficiary compel a distribution.
�
__ _
G. TRUSTEE AUTHORITY TO TERMINATE TRUST
Notwithstanding anything to the contrary contained in this trust, in the event that the trust
has the effect of rendering WILLIAM M. PAUL ineligible for any program of public benefit,
the Trustee is authorized,but not required, to terminate this trust. In determining whether the
existence of the trust has the effect of rendering WILLIAM M. PAUL ineligible for any
program of public benefit, my Trustee is granted full and complete discretion to initiate either
administrative or judicial proceedings, or both, for the purpose of determining eligibility. All
costs relating thereto, including reasonable attorney fees, shall be a proper charge to the trust. In
the event of voluntary termination, the undistributed balance of this Trust shall be distributed IN
EQUAL SHARES to my grandchildren: DESTINI A. PAUL,WILLIAM JAMES PAUL, and
KAYLEEN J. PAUL.
If any of my beneficiaries predecease me or fail to survive me by thirty(30) days, I give,
devise and bequeath his or her share to his or her issue who survive me,per stirpes, or if he or
she has no issue,the share(s) are to be added equally to the other shares.
H. VOLUNTARY CARE
It is my wish that subsequent to the termination of the trust for the benefit of WILLIAM
M. PAUL, if my contingent beneficiaries are living and distribution has been made outright to
them, if WILLIAM M. PAUL is still living because there has been a voluntary termination of
the trust in accordance with the provisions of this article, that such contingent beneficiaries will
conserve, manage and distribute the proceeds of the former trust for the benefit of WILLIAM
M. PAUL to insure that he receives sufficient funds for his basic living and supplemental needs
when public assistance benefits are unavailable or insufficient. This request pertaining to the use
8
and management of the trust proceeds after the terinination of the trust is not mandatory,but is an
expression of my wishes only.
I. BENEFICIARIES OF TRUST RESIDUE UPON DEATH OF DISABLED
BENEFICIARY
Unless sooner terminated, the trust created for WILLIAM M. PAUL shall terminate
upon his death. At that time all remaining trust assets shall be distributed IN EQUAL SHARES
to my grandchildren: DESTINI A. PAUL,WILLIAM JAMES PAUL, and KAYLEEN J.
PAUL.
If any of my beneficiaries predecease me or fail to survive me by thirty(30) days, I give,
devise and bequeath his or her share to his or her issue who survive me,per stirpes, or if he or
she has no issue, the share(s) are to be added equally to the other shares.
J. TRUSTEE'S POWERS
Subject to the requirement that my Trustee be prudent,my Trustee shall have full power
and authority to manage and control the trust estate and to sell, exchange, lease, rent, assign,
transfer and otherwise dispose of any or part thereof upon such terms and conditions as my
Trustee may, in my Trustee's discretion, deem proper. My Trustee may invest or reinvest all or
any part of the trust estate in such common or preferred stocks,bonds, debentures, mortgages,
deeds, deeds of trust,notes and other securities, investments of property, including common trust
funds,which my Trustee, in my Trustee's absolute discretion, may select or determine. It is my
express intention that the Trustee shall have full power to invest and reinvest the trust funds as I
might do if living, without being restricted to forms of inveshnents which Trustees may be
otherwise permitted by law to make, and without any requirements as to diversification of
9
investments. My Trustee may continue to hold in the form in which received, any securities or
any property which I might own at the time of my death or which my Trustee may at any time
acquire hereunder; and may invest any part of the trust funds in property located within or
outside of the Commonwealth of Pennsylvania.
My Trustee is further authorized to invest in life, annuity, accident, sickness, including
disability, and medical insurance on behalf of and for the benefit of the trust beneficiaries.
My Trustee shall not be obligated to undertake litigation for collection of any benefits or
assets payable by reason of my death including,but not limited to, such benefits under life
insurance policies, employee benefit plans or other contracts,plans or arrangements providing for
payment or transfer at death which are payable to my Trustee unless my Trustee is indemnified to
my Trustee's satisfaction against any liability and the expense of such litigation. Payment to my
Trustee and the receipt of or release by my Trustee shall fully discharge any payor, and no payor
need inquire into or take notice of my Will to see to the application of such payment.
My Trustee shall, in addition to the powers granted above, have all powers otherwise
granted under the Pennsylvania Fiduciaries'Powers Act as amended after the date of my Will and
after my death.
My Trustee shall specifically have the powers to invest in non-income producing assets.
In the event that the Beneficiary relocates to another State, then the Trustee is authorized,
in its sole and absolute discretion, to amend this Trust for the purpose of carrying out the
expressed intent of the Settlor.
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K. UNSUPERVISED ADMIl�IISTRATION
The trust created by this Will may be administered by my Trustee free from the control of
any court that may otherwise have jurisdiction over my estate.
ITEM X. I nominate and appoint my wife, JO-ANN J. PAUL as Executrix of my Will.
If JO-ANN J. PAUL is unable or unwilling to act as Executrix, I appoint GAIL M.
FELDMAN, of Cumberland County,Pennsylvania as successor Executrix of my Will. If GAIL
M. FELDMAN is unable or unwilling to act as Executrix, I appoint BRUCE A. FELDMAN
successor Executor of my Will. I direct that my Executrix or Successor Executors be permitted
to serve without bond and in addition to those powers granted by law, I grant them power to sell
both real and personal property, at private or public sale, to invest cash without being limited to
statutory investments, to distribute in cash or in kind in like or in unlike shares and to file any
qualified disclaimer I could have filed if living.
IN WITNESS WHEREOF, I, WILLIAM A. PAUL,hereby set my hand to this my Last Will
and Testament, on ��_� 2006.
���
WILL AM A. PAUL
In our presence, the above-named WILLIAM A. PAUL signed this and declared this to
be his Last Will and now at his request, in his presence, and in the presence of each other,we
sign as witnesses.
�e Address
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I, WILLIAM A. PAUL, Testator,who signed the foregoing instrument, having been
duly qualified according to law, acknowledge that I signed and executed this instrument as my
Will, and that I signed it willingly as my free and voluntary act for the purposes therein �
expressed.
Sworn to or affirmed and
acknowledged before me by
WILLI A PAUL, the Testator,
on - � , 2006.
C: • !' , � ,,�/ �,/��,1/
ot ublic WILLIAM A. PAUL ~
��ro��n+o�r�rNSnv�u
NOTARIAL SEAL
LOWER PN(TOM TWP.L DAUPN N COUNIY
AIY COMMiSSlON EXPIRES DEC.lI,1001
We, the undersigned witnesses who signed the foregoing instrument,being duly qualified
according to law, depose and say that we were present and saw the Testator sign and execute this
instrument as his Will; that he signed and executed it willingly as his free and voluntary act for
the purposes therein expressed; that each of us in his sight and hearing signed the Will as
witnesses, and that to the best of our knowledge, that he was at that time eighteen(18)years or
more of age, of sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscriped to before me
by ��.`� �C GJ`4SI
and 7�D�k15 �'• �OK�n�I� y itnes
witnesses, on �`d5 , 2006. �
� Witness
_.... _ �,t�, L
�, N tary ublic
COMMONWEALTH OF PENNS'1lYAN1A
NOTARIAL�SEAL
UlCOUELINE A.KELLY,NOTARY PUBLIC 12
LpyVER ppXTWI T1MP.,DAUPHIM COUNTr
MY COMMISSION EXPIRES DEC.11,2007