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Home My WebLink About08-05-05 (2) Thi" i~; to certify that the information here given is cOITectly copied from an original certificate of death duly filed with mc as Loul Registrar. Thc original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. P 1 ~":i d C' (\ [" ..:~ '_A .L "...' '-<...1 No, liu..~. ~~~~~~ Local Registrar Fcc for this certificate. $6.00 JUl D"CJ :'Iff r-....,) S 0 20crm ~ '~l -0 ~Cl :; ~:>j )c) . ~::.J .~: <:~ I,) ;.~-:J " C, ':1-1 -n 'c"'5 rn j') C"") ',1 :--.:,,. -::Ek\i\{\.j5' , S\tc&('%'. \\l,\t~ ~\e 7 -~\l'~ lcf-~~. c-:: G") ! - N .l:"" H105.143Ruv.2JS7 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECDRDS . CERTIFICATE OF DEATH (PElPRINT IN ,RMANENT LACK INK NAME OF DECEDENT (ArS!, Middle, Last) Albert C. Seifert ,. ST.c:n:F'U:NlJMBI"R SOCIAL SeCURITY NUMBER ,.177 ......24 _6892 AOE(LastBirlhday} UNDER 1 YEAR Months Days tlJATHPlACe (Cily and Slataorfore;l;inCounlryl ddonsburg,PA g'~)D 5. 74 Yrs . COUNTY OF DEIQ'H DECEDENT'S USUAL OCCUPATION (~;':ok~i~~rld=u~'~r~)l 11.. Supt. MAAITALSWUS.Mamed Never Married, Widowed, Divorced {Specifyl 1~arried RACE. Am.ncan Indian. 81al:k. White, ell:. (Specify) ,White SURVIVING SPOUSE (1Iwila.glvemaidenneme) ,Q\ Cumberland lb. ..... 17b.Coun r.llmberland 17d.~ :h:;=71i~I~:OLM~chanicsburq MOEH~R~ NAM~e' ~t:'~~U 'S'ITn ". INFORMANT'S MAILING ADDRESS (SI'MI. CityfTown, Stale, Zip Code) _.107 Orchard st. Mechanicsbur PA17055 PLACE OF DISPOSITION. Name 01 Cemetery, Crematory LOCATION - CttylTown, State. Zip Co<le or Otn&r'Plaoe J1,ollinger Crematory Mtl"Holly Springs, PA17065 NAME AND ADDRESS OF FACILITY . ingerFH&CrematoryMt.HollySprlngs,PA17065 .-I1~1bom LIceNSE NUMBER D,a:rE SIGNED (Monm.Oay.Yea'l ,... TlMEOFDEp;fH DATE PRONOUNCED DEAD (Monlt1. Day. Year) 7:45.,1\ ,. July 23,2005 :t3b. 23<:. 'WAS CAse REFERREDTO MEDICAL EXAMINERICOAONER? .../i1 Jt'1..Jf ",0 ... 27. PART I: Ent"!M diMta.H~, Injurlll~ O/'complk:l'll~M whl"h elIUMd thll doll'llh. Orl not ',"'B,IM modB 01 dying. ~u!:h,,~ !:..rdi,,!: 0' ""'pl'Alory B'......l. ~hodc 0' heArt fBllurtl Ll3t only one elIuSfl on !te!:n line ... . -'n;n - ih)~LV~ {fWlfdrY11A-- . DUETO(ORASAC SEOUENCEOF}: I \: d. I ApproxlmA'tl \ lnl..",,,-Ibe",,"n IOMEllenddHtl'l , i PAATII: other~lgnlli<:"-ntcorKlitlon8conlrlbutlngtodeath.but not"'sullinginlh..undArf~ngellu""giVllninPAFlTI DUE 10 (OR AS A CONSEOUENCE OF): DUE TO (OR AS ACONSEQUENCE OF}: WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPl..ETION OF CAUSE QFDE1IJt-I? MANNER OF DEATH DArE OF INJURY (Month. Day,YIlar) TIME OF INJURY OESCRI8E HOW INJURY OCCURREO.,.,;_ Yf!l~ 0 No 0 Ne!u....1 [g A<::ddent 0 SuKllde 0 Homicide 0 P..ndinglnvestlgallon 0 CouldnOlbedelermirMd 0 .28&. Db. 2"9. CERTIFIER (Check o"ly one) .CERTlFYINO PHYSlctAH (Physic,an certilying CiluSil 01 delllh wll"" a'1Oth... physil;ian has p'onounCed dgath and completed It am 23) To th.. Hill. of my knowledge. de,lh oceur1'tld due 10 the ~un(sl,nd....IlM1'''~. . " z w ~ @ ~ W . ~ . PRONOUNCING AND CERTIfYING PHYSICIAN (Phy8lCian bo!h PTonnur'CO'og dIlalh and "","ilytng 10 i'".ilIJ!;e nl o-Ih) To lhe DH1 of my knowleclge, de.lh oceurrecI.llhe urn" dlII,'nd pc.ce. end dlHl to thtI elIuM(e' end mllnMr ullllted.... "MEDtCAL. EXAMINER/CORONER On tIM bollia ot ..Imlnlltlon Ind/or Invl8tlptloh, In my opinion, dllllh oceUITfId III ttMt lime, dill, Ind placll, end dUll ta IhIt ~BII(e' Ind menner..llll1ted.................................................................................................. 31e. REGISTRAR'S SIGNATURE AND NUMBER ~\la,\I()1 ". eX I - 6 S- - 66 II REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS Charles E. Shields , TTT eaaieil ~ a subscribing witness to the will presented herewith, (-etleft) being duly qualified according to law, depose(s) and say(s) that he wa S present and saw Albert C. Seifert the testat n r , sign the same and that he signed as a witness at the request of testat..---O-r-- in hi s presence and (ill tb.e flrestlftee af E8Eh-8tli,~in.~: presence of the other subscribing witness(es)), ~ E. ~"7iI Sworn to or affirmed and subscribed before Charles E. Shields, I I I me this q'f.-J'L day of 6 Clouser Rd. (Name) A t 2005 Mechanicsburg, PA 17055 uqus (Address) Register NOTARIAL SEAL BECKY M.1CNISa.Y, NCItIIy PublIc Mect_~ 8oro, ClInbel1Ind Co. MyQ),...:_'Ol. &rliIw "111, 2008 (Name) (Address) ~iJ2f!;-!)(' L /1, lA-/~ 8/1/65 REGISTER 1fi' WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS 1"",...) = ) t""), (~) a subscriber hereto, (eaeaj being duly qualified according to law, depose(s)liWi say(s~hat she is familiar with the signature of Albert c. se:!JJ!!rtc~) , eedierl-, '-1 .;:- will M. Annan Seifert ':J ;.-'\ ~ -) , . .~S [-'J ~.) ~?3 ~ ~~~ ';=) l-n testat~ of (one of the subscribing witnesses to) the that she .) Albert C. Seifert knowledge and belief. 1 ~ ~ 'A~7: ~Prr./. 107 Orchard S~Nam~ Mechanicsburg, PA 17055 (Address) to the best of npr (Name) (Address) ~J-O)- 0091 .... .. ,.. LAST WILL AND TESTAMENT OF ALBERT C. SEIFERT I, ALBERT C. SEIFERT, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently he done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to my beloved wife, M. ANNAN SEIFERT, to her own use and benefit absolutely. 3. In the event my said wife, M. Annan Seifert, should predecease me or die at about the same time I do, such as in an accident or disaster common to both of us, I hereby direct that my estate be divided and distributed as follows: A Eight and one-third (8 1/3%) per cent to my son, CHRIS A. SEIFERT, absolutely. In the event he predeceases me, this share shall go to his two (2) sons, in trust, as provided for below. B. Eight and one-third (8 1/3%) per cent to my daughter, M. ANNAN HOLLINGER, Trustee, in trust, for the benefit of my grandson, DAVID SEIFERT, upon the terms and conditions set forth more fully herein below. C. Eight and one-third (8 1/3%) per cent to my daughter, M. ANNAN HOLLINGER, Trustee, in trust, for the benefit of my grandson, DANIEL SEIFERT, upon the terms and conditions set forth more fully herein below. D. Twenty-five (25%) per cent to my daughter, M. ANNAN HOLLINGER, absolutely. In the event she predeceases me, her share shall be divided in equal shares, ver cavita, amongst my grandchildren who survive me. Any such shares payable to the said DAVID and/or _'1" C'l . DANIEL SBjJFERT, shall be in trust as provided for above and below herein. '""_ E.. Twenty-five (25%) per cent to my daughter, KIERNA BLACK, absolutely. In the o' r: ~venf~he ~eceases me, her share shall go to her children who survive me, in equal shares. , ,. (_t') c..-J; ;;::'c:F. 'cTwenty-five (25%) per cent to my daughter, TARA JANKOUSKAS, absolutely. LC-:,~ '-."" ( ; In the::e;,ent she predeceases me, her share shall go to her children who survive me, in equal shares. ~~.~ . .. , 4. The tenns and conditions of the trusts to be established for my two (2) grandsons aforenamed are as follows: A Each trust shall be separately maintained and administered. B. The income from each Trust Estate, as well as so much of the principal as is needed according to the discretion of the Trustee, shall be used and expended for the college education, or other such formal education, such as any internship, apprenticeship, residence, clerkship or the like of the trust beneficiary. The decision of my Trustee as to the sort or type of education acceptable and to the completion thereof shall be absolute and fina1. C. The payments authorized herein may be made by my said Trustee directly to the beneficiary if he is, in the sole opinion of my Trustee, of such age and ability to handle properly the funds so paid to him, or may be made by my Trustee directly to any institution or other service provider entitled to such payment by reason of services rendered or to be rendered to the beneficiary . D. To pay the accumulated income and principal then remaining in the Trustee's hands to the beneficiary when he has attained the age of twenty-five (25) years. E. I direct that the interests of the beneficiary in the Trust hereby created, whether in the principal or income thereof, shall be free from liability to attachment or other legal process issued at the instance of any creditor or assignee of the beneficiary, and I direct that no payment shall be made by way of anticipation of sums which may thereafter accrue to any beneficiary. F. In the event the beneficiary of a trust hereby created predeceases me or dies during the term of such trust, his share shall go to his surviving children, in equal shares. In the event he is not survived by children, his share shall go to his brother, in trust, provided his brother has survived him. In the event that he is not survived by his brother, then his share shall be divided and distributed in equal shares, per cavita, amongst my then surviving grandchildren. G. In the event the aforenamed Trustee is unable or unwilling to serve or to continue to serve for any reason, then I appoint my daughter, KIERNA BLACK, as first successor Trustee. In the event she is unable or unwilling to serve for any reason, then I appoint my daughter, TARA JANKOUSKAS, as second successor Trustee. I further direct that my Trustee need not file a bond for her faithful performance in this or any other jurisdiction. 5. I nominate, constitute and appoint my wife, M. ANNAN SEIFERT, to be the Executrix of this my Last Will and Testament. In the event that she S.hnoouu"ld~ red=eceasc me or for any reason be ~C.~ 2 " .. <C;:'",~ . .. ~ unwilling or unable to act a~ such Executrix, I nominate, constitute and appoint my daughter, M. ANNAN HOLLINGER, to be Executrix in her place and stead. In the event that she is unable or unwilling to serve in such capacity, I appoint my daughter, KIERNA BLACK, to be Executrix in her place and stead. In the event that she is unable or unwilling to serve in such capacity, I appoint my daughter, TARA JANKOUSKAS, to be Executrix in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /o/t... day of fY..ct~ , AD. 2000. ~o...T: C ---Kr:-4~ ALBERT c. SEIFER1' (SEAL) Signed, sealed, published and declared by the above-named ALBERT C. SEIFERT, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence, and in the presence of each other, have hereunto subscribed our ames as witnesses. 3