HomeMy WebLinkAbout02-05-15 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:
Barbara L.Parsells
Decedent's Information
Name: Regina C.Chonuskie File No: 21 —
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 196-03-3151
Date of Death: 01103/2015 Age at Death: 97
Decedent was domiciled at death in Cumberland County, PA (state)with his/her last
principal residence at 46 Erford Road,Camp Hill 17011 East Pennsboro Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Golden Living Center Camp Hill Cumberland PA
Street address,Post Office and fip Code City,Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania...................... All personal property $ 240000.00
/f not domiciled in Pennsylvania................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania................ Personal property in County $
Value of real estate in Pennsylvania..................................................I................ $ 0.00
TOTAL ESTIMATED VALUE $ 240,000.00
Real estate in Pennsylvania situated at
(Attach additional sheets,if necessary.)
Street address,Post Office and Zip Code City,Township or Borough County
®A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s)aver(s)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated 09/08/2010 and Codicil(s)
thereto dated 01/25/2012
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 mar 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 applicable)
c.t.a.,d.b.n.,d.b.n.c.t.a.,pedente lite,durante absentia.durante minoritate
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 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
additional sheets,if necessary):
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Form RW-02 rev.10-11-2011 Copyright(c)2011 form software only The Lackner Group,Inc. Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Petitioner(s)Printed Name Petitioner(s)Printed Address
Barbara L.Parsells 467 Rupley Road
Camp Hill,PA 17011
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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 A6
belief of Petitioner(s)and that,as Personal Representative(s)of�the Decedent, Petitioner(s)willwell and truly administer the estate(45tord0g t6Taw.
Sworn to or*itmed aA subscribed before c /1L��'s n�d� 7�ilila D Dat'
me this day L o1 Date
By: Date
For the Regis er Date
BOND Required? YES a NO To the Register of tills:
FEES: Please enter my appearance by my signature below:
Letters.......................................... $ 310.00 Attorney Signature:
( 5 )Short Certificate(s)......... 25.00
( )Renunciation(s)..............
( )Codicil(s)........................
( )Affidavit(s)...................... Printed Name: Ronald M.Katzman Esq.
Bond............................................. Supreme Court
Commission.................................. ID Number: 07198
Other
Inheritance Tax Return 15.00 Firm Name: Goldberg Katzman,P.C.
Inventory 15.00 Address: 4250 Crums Mill Road
PO Box 6991
Harrisburg,PA 17112
Phone: 717-234-4161
Automation Fee............................ 5.00
Fax:
JCSFee....................................... 35.50
TOTAL......................................... $ 405.50 E-mail: rmk@goldbergkatzman.com
DECREE OF THE REGISTER
Date of Death: 01/03/2015
Social Security No: 196-03-3151
Estate of Regina C.Chonuskie File No: 21- h I L
a/k/a:
AND NOW, , in consideration of the foregoing Petition,
satisfactory proof having been presentelb fore me,IT IS DECREED that Letters Testamentary
are hereby granted to Barbara L.Pars Is
in the above estate and(if applicable)that the instrument(s)dated 09/08/2010 01/25/2012
described in the Petition be admitted to probate and filed of record as t last Will(and Codicil(s)) f Decedent.
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'11egis er of Wills
Copyright(c)2011 form softwareonly The Lackner Grou ,Inc. 1 P ge 2 of 2
H105.805 REV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
RECORDED OFFICE OF
Fee for this certificate, $6.00 R E C I ST E R (z F 1)14 LLS llilll,,,,,,�f�"�-- This is to certify that the information here given is
�SHOFp"'
correctly copied from an original Certificate of Death
FEB
; duly filed with me as Local Registrar. The original
j $Q `:.y certificate will be forwarded to the State Vital
CLERK Or C5y�` Records Office for permanent filing.
P 21354277oRPHANS' GOUR r =o��q'9T -� r "~ `r` AVID5 15
MENT OF
Certification Number E R L.A`�0 C -^J P'` � ''III
--- _. _-_ .._ LocaLRegtstcar. ____ _ Date Issued _
Type/Print In COMMONWEALTH OF PENNSYLVANIA.DEPARTMENTOF HEALTH•VITAL RECORDS
Permanent CERTIFICATE OF DEATH
Black Ink State File Number:
1.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sex 3.Social Security Number 4.Date of Death(Mo/Day/Yr)(Spell Mo)
Re Ina C. Chonuskle F. 196-03-3151 January 3, 2015
Sa.Age-Last Birthday(Yrs) Sb.Under 1 Year 5c.Under 1 Da 6.Date of Birth(Mo/Day/Year)(Spell Month) 7a.Blnhple SreJCity a d State Or FOrNgn Country)
Month3 Days Hours Minutes Arc alfid PA
'I 1 97 Janueucy 6 1917 7b.Birthplace(eq nty) Lac wanna
i ga.Residence(State or Foreign Country)
gd. e$mente(County) So.Residence(Street and Number-Include Apt NO.) 8c.Did Decedent Live In a Township?
Penns lvani40
a M Yea,decedent lived In E. Pennsboro _P.
R
Cumberland 8e.Resident¢(Zip Code) 1 ol-t I Q No,decedent lived-[thin limits of City/born.
9.Ever In U��S��A(( ¢d Forces. 30.Marital Status at Time of Death Q Married �Wldowed 11.Surviving Spouse's Name(If wife,give name prior to first marriage)
Q Ves SYSNo Q Unknown Q Divorced Q Never Married Q Unknow
12.Father's Name(First,Middle,Last,Suffix) 13.Mother's Name Prior to First Marriage(First,Middle,Last)
Isadore Milouka Mary Wasclousky
14a.Informant's Name 14b.Relatlonshlp to Decedent 14c.informant's Mailing Address(Street and Number,City,State,ZIP Code)
Barbara Parsells Executrix 462 Ru le Rd. Hill PA 17011
G _ -- _ _ ___ _ _ _ 15e.Place or Daae c ¢t only.o e _ _ _ _ _ _ __
If Death Occurred In a Hosplta l: ❑Inpatient It Death Occurred Somewhere other Than a Hospital: ❑Holpic¢Facility b Decedent's Nom¢
Q Emergency Room/Outpatlent Q Dead On Arrival IM Nursing Home/Long-Term Care Facility Q Other(Specify)
Gl
15b Fact It Name(lf not Institution,give street and number) 15c.CI[y or TOwn� tate,and Zip Code 15tl.County f Oea
Golden Living Center Camp F3i511, PA 17011 Cu tt_!;Tand
168.Method of Disposition Burial Q Cremation 16b.Date Of Disposition 16c.Place of Dls Posltlon(Name of cIrrat ry,crematory,or other place)
Q Removal from State Q Donation
Q o[her(Specify) 01/08/2015 Indiantown Gap:.National Cemetery
led.Location of Dlsposl[lon(City or Town,State,and Zip) 17 nature of Funeral Se a Ute n In Charge of Interment 17b.License Number
Annville PA 17003 - 014819
17MNe=Hasne3: PuneralF¢Home Inc. 1903 Market,-St. Hill PA 17011
18.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 t0 Indicate what
i- highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be.
Q 8th grade or less Is Spanish/Hispanic/Latino. Check the"No" LDt White Q Korean
Q No diploma,9th-12th grade box if decedent Is not Spanish/Hispanic/Latino.
Black or African American r3 mese
Q[High school graduate or GED completed (X No,not Spa nlsh/Hisponic/Latino Q American Indian or Alaska Native Q Oth Otherr Aslan
Q Some college credit,but no degree O Yes,Mexican,Mexican American,Chicano Q Asian Indian Q Native Hawaiian
Q Associate degree(e.g.AA,AS) Q Yes,Puerto Rican
Q Bachelor's degree(e.g.BA,AB,BS) Q Yes,Cuban Q Chinese Q Gu amanlan or Chamorro
Q Master's degree(e.g.MA,MS,Milne,MEd,MSW,MOA) Q Yes,other 5 E3 Filipino Q Se moan
panlsh/Hlspe nit/Latino Q Japanese Q Other PeCIfiG Islander
Q Doctorate(e.g.PhD,CdD)or Professional degree (Specify) Q Other(Specify)
.MD 005 DVM LL.,lD
21.Decedent's Single Race Self-Designation-Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a.Decedent's Usual Occupation-Indicate type of work
W White Q Japanese Q Samoan
Q Black or African American Q Korean Q Other Pacific Islander dens during most of working II/e. 00 NOT USE RETIRED.
q O American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure Clerk Typist
= Q Asian Indian O Other Aslan Q Refused 22b.Kind of Business/Industry
O Chinese Q Native Hawalian Q Other(Specify)
O Filipino Q Guamanian or Chamorro Naval Depot.
ITEMS 23a-23tl MUSTBE COMPLETED 23a.Date Pronouncetl Dead(Mo Da Yr) 23b.Signature of Person Pronouncing Death(Only when appllca ble) 23c.License Number
CERTIFIES DEATH B PERSON WHOPRONOUNCES OR 6
23tl.Date 51 n (Mo/Day/OVr)/ 24.Time of Death
25.Was Metlltal Examiner or Coroner Contacted? � Yes No
CAUSE OF DEATH I Approximate
26.Pan 1. Enter thechain o1 -diseases,InJurles,or complications-that directly caused the death. 00 NOT enter terminal events such as cardiac arrest, 1 Interval:
respiratory arrest,or ventriculareventsfibrillation without showing the etiology. DO NOT ABBREVIATE. Enter Only one cause on a line. Add additional lines If necessary. i Onset to Death
IMMEDIATE CAUSE - sa.
I
(Final disease or condition Due to(or as•consequence of):
resulting In death) 7 / L" /
Sequentially list conditions, Du co(or as a Consequence of): -
if any,leading to the cause ,
I lsted on line a. Enter the . C.
UNDERLYING CAUSE Due to(or as a consequence of);
M (disease or InJury that
¢ Initiated the events resulting d. 1
F In death)LAST. Due to(or as a consequence
2..---1.- Enter other I nifi i but not resulting In the underlying cause given In Part I. �2-.X__
Was an autopsy pe Kor+bpd?
Q Yes C
V ¢r¢autopsyflndings available
complete the cause ofyeash7
' Q Yes Q'T
29.If Fe 30.Dltl Tobacco USE Co ntribut¢to Death? 31.Ma Death
Not pregnant within past year Q Ve Q Probably Natural Q Homicide
Q Pregnant at time of death Q'N p Unknown Accident
O Not pregnant,but pregnant within 42 days of death Q Q Pending Investigation
i- Q Not pregnant,but pregnant 43 days to 1 year before death 32.Date of Injury Mo/Da /Vr 5 Q Suicide Q Could not be determined
j ry( y )(Spell Month)
Q Unknown If pregnant within the past year 33.Time of Injury
34.Place of Injury(e.g.home;construction site;farm;school) 35.Location of injury(Street and Number,City,County,State,Zip Code)
C '
44
1
36.Injury at Work 137.If Transportation Injury,Specify: 38.Describe How Injury Occurred:
QYes Q Driver/Operator Q Pedestrian
Q No Q Passenger Q Other(Specify)
39a.C -physician,certified nurse practitioner,medical examiner/coroner(Check only one):
Eff Ce Klfying only-To the best of my knowledge,death occurred due to<he ea uses)end manner stated.
O Pronouncing&Certifying-To the best of my knowledge,death occurred at the time,date,and piece,and due to the cause($)and manner stated.
Q Medical Ezaminer/Coroner-On[h Is of examination entl es[Igatlon,In my opinion,death occurred at the ti m ,date,and place,and due to the�cfa�use(s)and manner stated.
Signature of ce Klfier: /� Title of Certifier: / License Number:/�l `G1��/V
39b.Name, ddress and Zip Code of n Completing Cause of Dea[ (Item 26 39c Date Signed(Mo/Day/Yr)
i /'%� i -C-
;2
�y 40.Registrar's District Number l 41.Regisira is Sig 42.Registrar F e Data(Mo/Oay/Vr)
1_2
c 43.Amendments
_O
c 105143
Dispo5l[IOn Permit No. 1079116
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-^ G'� C:)LAST WILL ANT) TESTAMENT ra v 0D C,-) 7
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OF cn
12EGINA C. CIIONUSKIF,
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1, REGINA C. CIIONUSKIE, now of Camp Hill, Cumberland County, 1�Penns ania,
being of sound and disposing mind, do hereby make, publish, and declare this to be my Last Will
and Testament; hereby revoking and making null and void all prior Wills and Codicils made by
me at any time heretofore.
ITEM I. I direct that all my legally valid debts, funeral and administrative expenses,
and debts incurred or payable because of illy death; shall be paid by riny Executor, hereinafter
named, Froin my residuary estate as soon after my death as practicable. All death taxes;
including federal, state, and other death taxes, with respect to the property forming my gross
estate for tax purposes, whether or not passing under this Will, including any interest or penalty
innposed thereon, shall be considered an expense of administration of nn), estate, without
apportionrnent or right of reimbursement, except for negligence or fault on the part of my
Executor. Taxes on future interests may be prepaid.
ITEM II. 1 give and bequeath certain items of tangible personal property that are
solely owned by i;ne at the time of my death and that are identified in any separate x riting
directing distribution thereof after lily death which is dated and is signed by inc at the end thereof,
to those persons designated in such separate writing who survive me. If any item of tangible
Page -I-
personal property is identified in more than one separate writing, I direct that, unless stated to the
contrary, the separate writing bearing the last date shall govern the disposition of such item.
ITEM III. I make the following specific bequests:
A. I bequeath the sum of One Thousand Dollars ($1,000.00) to THE CHURCH OF
THE GOOD SHEPARD, in Camp Hill, Pennsylvania, or its successors in
interest, for its general purposes, given in memory of Joseph and Regina
Chonuskie.
B. I bequeath the sum of One Thousand Dollars ($1,000.00) to my friend,
BARBARA PARSELLS, now of Camp Hill, Pennsylvania, if she survives me by
thirty(30) days. If she should not so survive me, then this bequest shall lapse into
the residue of my estate under Item V.
ITEM IV. I bequeath all my household and personal effects,jewelry, automobiles,
and all other tangible personalty of like nature that are solely owned by me at the time of my
death, and that are not named in any list prepared pursuant to Item II hereof, to my niece,
KAREN J. NORRELL, now of Idaho Falls, Idaho. Any item that my said niece does not want
shall be sold by my Executor, either at public auction or private sale and such proceeds shall pass
as part of my residuary estate under Item V.
ITEM V. I give, devise and bequeath all of the residue of my estate, whether real,
personal, or mixed, and wherever situate, to my niece, KAREN J. NORRELL, if she survives
Page -2-
me by thirty (30) days. If she does not so survive me. then I make such bequest to JAMES P.
NORR1,11 , now of Irvin, Idaho (or to his estate if he has predeceased me).
ITEM V1. The interest of beneficiaries hereunder shall not be subject to anticipation
or to voluntary or involuntary alienation.
ITEM V11. I hereby appoint RONALD M. KATZMAN to serve as executor- (the
"Executor"), of this, my Last Will and Testament. In the event of his refusal or inability to so
serve, I then grant to him the right and power, exercisable in his exclusive discretion, to
nominate and appoint, whether in advance while competent, or at the time of a renunciation or
resignation, a successor person or persons to serve as such Executor, which nomination shall be
honored as if I had made such an appointment in this Will.
ITEM VIII. I direct that Illy Executor shall not be required to -live bond or post any
other security for the faithful performance of duties in any jurisdiction.
ITEM IX. Any person Nvho shall have died at the same time as me, or in a common
disaster with me, or under such circumstances that it is difficult or impossible to determine ,rho
died first, shall be deemed to have predeceased me.
ITFIM X. My Executor shall have the following powers in addition to those invested
by law and by other provisions of my \VIH applicable to all property, whether principal or
income, exercisable Without Court approval, and effective until distribution of all property:
Page -3-
i
A. "leo retain any investments I may have at my death so long as my Executor may
deem it advisable to my Estate so to do.
13. To vary investments, when deemed desirable by my Executor, and to invest in
such bonds, common trust funds, stocks, notes, real estate mortgages, or other
securities or in such other property, real or personal, as my Executor deems Nvise,
without being restricted to so-called "legal investments".
C. In order to effect a division of the principal of my Estate or for any other purpose;
including any final distribution, my Executor is authorized to make; said divisions
or distributions of the personalty and realty partly or wholly in kind. If such
division or distribution is made in kind, said assets are required to be divided or
distributed at their respective values on tate date or dates of their division or
distribution.
D. To sell either at public or private sale and upon such terms and conditions as my
] xccutor may deem advantageous to my Estate, any or all real or personal estate
or interests therein owned by my Estate severally or in conjunction with other
persons or acquired after my death by my Executor, and to consummate said sale
or sales by sufficient deeds or other instruments to the purchaser or purchasers,
conveying a fee simple title, free and clear of all trust and without obligation or
liability of the purchaser or purchasers to see to the application of the purchase
money or to make inquiry into the validity of said sale or sales; also, to make;
execute, acknoN7,7ledge, and deliver any and al l deeds, assignments, options, or
Page -4-
other writings which may be necessary or desirable, in carrying out any of the
powers conferred upon my Executor in this paragraph or elsewhere in my Will.
1;. To mortgage real estate, and to make leases of real estate for any period of time as
my Executor may deem reasonable.
1'. To borrow money from any party to pay indebtedness of mine or of my Lstate,
expenses of administration, or inheritance, legacy, estate, or other taxes.
G. To pay all costs, taxes, expenses, and charges in connection with the
administration of my Estate. My Executor shall pay expenses of my last illness
and funeral expenses.
11. To vote any shares of stock which form a part of my Estate, and to otherwise
exercise all the powers incident to the ownership 01'such stock.
1. To compromise claims and to abandon any property which, in my Executor's
opinion, is of little or no value.
IN WITNESS «VIIEI2EO , I have hereunto set my hand mid seal to this my Last Will
and Testament, consisting of five (5) type\vritten pages, this _0 day of 2010.
REGINA C. CIIGNUSKIE
Page -5-
We, the undersigned, hereby certify that the foregoing Will was signed, scaled; published
and declared by the above-named I estatrix, RIsGIAIA C. CIIONUSKIE', as and for her Last Will
and Testament; in the presence of us, who at her request and in her presence and in the presence
of each other, have hereunto set our hands and seals the day and year above written, and we
certify that at the time of the execution thereof, the said Testatrix was of sound and disposing
mind and memory.
residing at � r� /s�'
residing at
COMMONWEAL'I'I-I OF PENNSYLVANIA
A'
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COUN'T'Y OF
Subscribed, sworn to and acknowledged before me by the Testa ix; REINA
CI10NEJSICII., aril s ibsc ibcd and sworn to before me by
and _—y� -- —, witnesses; this $' day of _ 0D10.
2010.
J14
Notary Public
(SEAL)
195 I S3.1
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Jennifer L.Bortz,Notary Public
City of Harrisburg,Dauphin County
My commission Expires May 30,2013
Member,Pennsylvania Association of Notaries
Page -6-
Y
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FIRST CODICIL
TO THE WILL OF o rn m
REGINA C. CHONUSKIE :2C-> cd -Tj
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I, REGINA C. CHONUSKIE, now of Camp Hill, Cumberland County, Pennsylva-rsia,;=
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being of sound and disposing mind, do hereby make,publish, and declare this to be a Fitt -ri
Codicil to my Last Will and Testament, dated September 8, 2010 (my "Will").
I hereby amend the following sections as follows:
ITEM VII. Delete ITEM VII and insert the following:
"I hereby appoint BARBARA L. PARSELLS to serve as executor(the
"Executor"), of this, my Last Will and Testament. In the event of her refusal or inability to so
serve, I then grant to her the right and power, exercisable in her exclusive discretion, to nominate
and appoint, whether in advance while competent, or at the time of a renunciation or resignation,
RONALD M. KATZMAN to serve as such Executor, which nomination shall be honored as if I
had made such appointment in this Will."
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this First Codicil to
my Last Will and Testament, consisting of one (1) typewritten page, this day of
January, 2012.
r A C. CHONUSKIE
1
100581576;vl}
We, the undersigned, hereby certify that the foregoing First Codicil was signed, sealed,
published, and declared by the above-named Testator, REGINA C. CHONUSKIE, as and for a
codicil to his Last Will and Testament, dated January 24, 2012, in the presence of us, who at his
request and in his presence and in the presence of each other, have hereunto set our hands and
seals the day and year above written, and we certify that at the time of the execution thereof, the
said Testator was of sound and disposing mind and memory.
4 presiding at
ding at J
2
{00581576;v1}
COMMONWEALTH OF PENNSYLVANIA
. SS..
COUNTY OF CUMBERLAND
We, the Testator, and Ronald M. Katzman, and & L �,M , the
witnesses, respectively, whose names are signed to the foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the Testator signed and executed the
foregoing instrument as a First Codicil to his Last Will and Testament, that he had signed
willingly, that he executed it as his free and voluntary act for the purposes therein expressed, that
each of the witnesses, in the presence and hearing of the Testator, signed the First Codicil as
witness, and that to the best of his/her knowledge the Testator was at that time eighteen years of
age or older, of sound mind, and under no constraint or undue influence.
J GINA C. CHONUSKIE
Witness _
-Witness
Subscribed, sworn to and acknowledged before me by the Testator, REGINA C. CHONNU KIE,
and subscribed andsworn to beforl me by Ronald M. Katzman and ,
witnesses, this day of -4 AAm 52012.
'r ill
—1, V
o 7r ublic
( AL)
COMMONWEALTH OF PENNSY
Notarial Seal
,Jsn„ir+or L.Boltz,Notary Public
city 0i`4arrisburg,Dauphin County
m dommltaslon Expiras May 30,2013
ph1b0P, ennsylvanla Abstaiwat1d, 0f Notaries
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3
{00581576;vII
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
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Estate of Regina C. Chonuskie ' I
t-- --� ,,�, Dt¢easR c-.)
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Ronald M. Katzman (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 his / her presence and in the presence of each other.
Z��W 4&�k/
(Signature) (Signature)
Ronald M. Katzman
4250 Crums Mill Road
P.O. Box 6991
(Street Address) (Street Address)
Harrisburg, PA 17112
(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 e this c��7� day
of of
Deputy for Register of Wills ary Illic
Cos
rysionn Expires:
(Signature and seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's commission.)
COMMONWEALTH OF PENNSYLVANIA.
Notarial Seal
Jennifer L. Boltz, Notary Public
Lower Paxton Twp.;Dauphin County
My Commission Expires May 30,2017
MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES
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.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc.
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Regina C. Chonuskie Deceased
Sherry Waple
(each) a subscribing witriess:to ->
(Print Name/s) L:
the ® Will ❑ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s)and,.: ,=► �� M
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o
say(s) that she/he/they was/were present and saw the above Testator/Testatrix sign the sarW
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 his/her presence and in the presence of each other.
(Signature) (Signa ore) Sher Waple
(Street Address) (Street Address)
/Z 7LT
(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 bet re me this �q day
of of `a Q/
Deputy for Register of Wills &tAry Public
My Commission Expires:
(Signature and seal of Notary or other official qqualified to
admin(star oaths. Show dale of expiration of Noterys commission.)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
John S. Davidson,Notary Public
Derry Twp.,Dauphin County
My Commission Expires May 3,2017
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.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc.