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HomeMy WebLinkAbout10-03-2005 Register of Wills of Cumberland County PETITION FOR PROBATE and GRANT OF LETTERS Estateof :td.JI\ ~tJ-W 10l\ltJ.. No. .2/. e,s . (I "; '7S:- also known as To: , Deceased. Social Security No. \11" 113'" ~ Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, and the execu~ named in the last will of the above decedent, dated . . 7/t:t.E", 2006'"" and codicil( s) dated (state relevant circumstances, e.g. ren~on, death of executor, etc.) Decedent was domiciled at death in -'t',....'",..."'. ~ r'l1 jQ~-1~ Pennsylvania, with h last family or principal residence at 30~ \\(.vrtf~~ .Ap4-"& ~(I.+~/-P'" l7ol~ (list street, number and municipality) Decedent, then ~ years of age, died 8 / /:2.. , 20~, at ~ ~ ~ Except as follows, decedent did not marry, ~as not divorced and did not have a child born or adopted afte execution of the will offered for probate; was not the victim ofa killing and was never adjudicated incompete : Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value ofreal estate in Pennsylvania situated as follows: $ $ $ $ Couhty, o t:J WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) present d herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b. .c.t.a.) thereon. ~;/?'1~)) ') {' '1 ( ) Co .) ) ... ~) .j Register of Wills of Cumberland County OATH OF PERSONAL REPRESENTATIVE , .- COMMONWEAL TH OF PENNSYL VANIA } SS: COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief ofpetitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate ac~cord' t~ law. ~ Sworn to or a. ffrrmed an~~ubscribed {~ /) ) Be~~~~i~,~ , 20 day of en QQ' ::l '" 2" .... ;l. ~ ,-.~GncCc,-- ~~t"\"'"\ \~o.o hClI.~ ~A~. c..\.\..'f~:-.. Register . 'J ~\~ No.02I-()S0~7S" Estate of T]:)" Nobw-< \-\> Ton ..", , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW C Q.tc.."~ "- 3 20 O~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s), dated '7 . c;;J. 5 . <). C0..5. ' described therein be admitted to Pr(~te, file~ ofrecord as the last will of ...IDJ>.. ~()bc....,~\,- \D"~... , ; and Letters are hereby granted to l-ttotpJ;::). 'fJ-{1t.A:) Automation Fee,....,.,...."..... Bond............................. .... Total FEES Probate, Letters, Etc. ............. $ Will............................ ..... $ Renunciation... . . . . . . . . . . . . . . . . . . . . $ Short Certificates ( ).. . .. . .. .. .. $ JCP.. .. . ....... . . ... .. . .. . .. . . . . . . ... $ $ $ $ 20 05 Jik.m:h ~(1Lrt,,, l ,,^Jl 'L'M1f'~" ~_~\- Register of Wills ~. t. ~ :JO - (1(:) 15.c:o . Attorney (Sup. Ct. LD. No.) Iv'GO 10.00 5.c'o Address Filed 10 G lr ' <.0 ~ Phone \ I 11""'1' /(I\ !!'I' . . ". . " I' 's correctl' copied from an original certificate of death dul)'. filed with This is to certify that the mformatlon he~ilf~~nf(~~warded ~) the State Vital Records Office for permanent hlll1g. Local Registrar. The original certificate WARNING: It is illegal to duplicate this copy by photostat or photograph.,,~~ me as No. ~ Local Registrar .,.- .~"',. ....n~;(\ Fee for this certificale. $6.00 ;' P 11948581 ~l HIOS, :4JAIIY..2J87 I I I COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH . TYPE/PAINT IN PERMANENT IIUCK 'HI( Wr.ME OF QECEDENT tFLta M~. Las) 1. :r,~o... Noba..n tl.^. STAlE FlU: .\lU"'8EA sex SOCIAL SE~UAITY NUMBER 2. tc.Y>u..k... J. /q3 - 78 - 0'1-7 AGE lLa. 8itthCIaV) UNOEFI1 YEAR MonchI 0.,.. BlRTHPl.ACf: lC;tv MId Stalaar rarWQJ\ COUf\[I>j1 .. COUNTY OF OEArH Lfl v... City,: o Ul '" ::l '" -< :; J-< J ~ o -- 1'2. ..l./Xl ~ CWlMe Of rapt&lory AI'''. $hod( Of heilll I&u.. J ~ ~ ,.P '0 Z [ OUE mtOR AS A COOiSEOUENCE Of): o "'tl \-1 WERE Al1lOPSY FINDINGS MANNER OF DeATH --...su PRlOft 10 COOlPI.ET1OH 0# CAUSE X 0 0# CERH'7 -... - - 0 p-- 0 ...0 - 0 Could noI M dMMftiMd 0 DATE OF INJURV (MooCh. Day, ""J TIMe OF INJURY INJURY A.f WORK? OESCRI8E.."" RY OCCUAREO. YM 0 NoD ... PlACE OF INJURY..\I home, twm....... fK'fDrY. 0" ~e4C.I~1 ... 28D. no JOlI. CERTIPIIIIIOKk only 00lIt oCUlT.,..,1MQ IIHYIIClAH (Phy$ClW1 ~ cauMd. 0NIh when ~ phytlClan has pronowv:ad deiI#l at'CJ ~ '*" 231 To"'__of.,~. dUChOGCUrrM........CMIM(.)andlNllfVletUaUled......... _........... _................ -MEDICAl. EXAMaNIERJCORONEA On tbI baeI. of .xamlN'lon andJ<<lnv..llo-Uon. in my opinion. dum OCClUfed at 1M time. d.... and place. and ou. to Ih. cau..(.) and m.nner.. wta1ed................................................. ...... ............................. .... . .... 31a. AEGISTR,\A'S SIGNATURE AND NUM8ER 8-~~dI- .... ~ Z Ul o Ul :rl o ... o ~ -< Z .~AHD CElUurYlHGl'HYStClAN (PI'lytCIM bOCtI ;JfonounclnQ~ and~ IOcaAII oIOU1hI To N b..-oI My kno........ dMIIOCCunM allN..... dat.. and~..and due... the c:auM(a) .....manrMI'.. ~., .... ........ Last Will And Testament Of J~ N't)8,0:-I'\ ItA - \ "DN"-'t \ . I I, \~ ~.\2,~~\\\.A \DML\.\ (name), of LUfv\...&~\......t:\\,\ ( county), V e f'-\ ~ S '--\ Lv ~ '\-\ '<=\ ( state), revoke my former Wills and Codicils and publi h and declare this to be my Last Will and Testament. ARTICLE I MARRIAGE & CHILDREN I am divorced from IE' {V\. \ \-\ F\\"-\-i\ ~\V,c:..:ol4 R )01-\..u.. \ (name of ex-spoust). I am not married. I have the following child(ren): Name: --.::J ~--V\-\- ~ \ ?c.\-\ ,^l\A-e.~ Born on 09 - \ '6 - ~ -b--.. I Name: \V\~\;<<-SDR.l b \l \...\"-'1 \~u.;~ Born on C 5 - Of ~ 'l{.: - 1 ! Name: Born on I ! ,.) I I ARTICLE IT FUNERAL & BURIAL EXPENSES I authorize the Executor of my Will to pay such sums as the Executor deems proper fo my funeral, cremation or burial and interment, including the disposition of the ashes or the acquisition of any burial site and the erection and engraving of monuments and markers, regardless of any limitation fixed by statute or rule of court and without order of any court. ARTICLE ill PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, testamentary expenses and expenses oflast illness be first p I. d out of and charged to the capital of my general estate. t All taxes (including income taxes and inheritance taxes) and any interest and penalties thereon owed because of my death shall be paid out of the residue of my estate. The Executo shall create, out of the residue, a separate fund for the purpose of paying any inheritance taxes in the amount necessary to pay said inheritance taxes. The payment of the taxes shall be made regardless of whether the taxes are owed on property passing under this Will or any codicil hereto, outside of this Will, in connection with any insurance on my life or any gift or benefit I given or conferred by me either during my lifetime or by survivorship. The payment ofthe taxqs shall be made regardless of whether the taxes are owed by my estate or by any beneficiary. Th~ Executor shall not seek reimbursement from any beneficiary for the payment of the taxes. Initials: \ ~ '\ Testator ~.i/~ ~ Witness Page 1 of I () ECS Witn r',) u , I . This direction shall not extend to or include any such taxes that may be payable by a ! purchaser or transferee in connection with any property transferred to or acquired by such I purchaser or transferee upon or after my death pursuant to any agreement with respect to suchl property. ARTICLE m DISPOSmON OF PROPERTY Specific Bequests I direct that the following specific bequests be made from my estate. \ 1'\ ~ \..--..Dn$ I Q \C-OI"I ~ \ , t:t-'\..C.. b\....G shall be distributed to ~\'i7C ~\..LtvU~>~ A~O (\.A..~t<:...le. If this beneficiary does not survive me, this bequ st shall be distributed with my residuary estate. ~ ~~ I-=t-"\ "" I shall be distributed to \'-Jvf\\Z,.:.-4i:>'R..-I...G 1~sevt:\ \'::....,Y'ct-jq:Jfthis beneficiary does not survive me, this bequ st shall be distribute with my residuary estate. 6q \ i\ ~~\.C, ~ 'f:-\,G\--\~, \".=h....(:;. shall be distributed to ~f0~\-\:- ~\-Qc.r'\:0...~i6r::\ If this beneficiary does not survive me, this bequ st shall be distributed with my residuary estate. Primary Residence All my interest in my primary residence or homestead, if any, shall b distributed to my child(ren) A. LL (\. ^ '-4-.. ~Ds"EY\~ (name(s)). Ifmore th one child is named, then the distribution shall be in equal shares per stirpes. Residuary Estate I direct that my residuary estate, including any real property and personal property, be distributed, bequeathed and given to my child(ren) -~ \i\ \:.--\ \='~\.A~ e A;; ~"a "'^-.~ ~<".>RLG f\.(f u. 't \bu.J R (name()). If more than one child is named, then the distribution shall be in equal shares per stirpes. If non of the named child(ren) or their descendants, survive me, I direct that my residuary estate be distributed in equal shares per stirpes to: If any such beneficiary does not survive me, my residuary estate shall be distributed to my heirs-at-Iaw, eir identities and respective shares to be determined under the laws of the State of then in effect, as if I had died intestate at the time fixe for distribution un r this provision. Except as may be specifically otherwise provided herein or directed otherwise by law, i any person should become entitled to any share in my estate before attaining the age of majorit or while under any other disability, I authorize the Executor to nevertheless make any distribution for any such person directly to the beneficiary or to a parent, guardian, conservato , committee of such person, trustee of such person, person with whom the beneficiary resides at Initials: } ~-\ estator ~~m~ fls Witness page2of~ the time of the distribution or to any other person the Executor may consider to be a proper recipient thereof Receipt of any such distribution shall be a sufficient discharge to the Executo . ARTICLE V TRUST FOR MINOR CHILDREN If at the time of my death, any of my child(ren) are under the age of \6 y s, those children shall be deemed and referred to as "minor child(ren)" for purposes of this Will d the Trust created thereby. I direct the Executor to transfer all assets that have passed under thi Will to any minor child(ren) to the Trustee named in this Will, to invest and to hold in trust, as a private trust, (herein referred to as "Trust" or "Trust assets") for the benefit of my child(ren). 1. The Trust assets shall be retained, held, managed, invested, administered and distributed by the Trustee, under the provisions of this Will, in order to provide for the care, health, support, maintenance and education of any minor child(ren). The share of the proceeds of any life insurance policy on my life, any pension plan, contract or other policy passing to any minor children shall be held in trust by the Trustee and treated as part of the Trust assets. In Trustee's discretion, the Trust assets may be converted into cash or other instruments in order to make the administration of the Trust easier. 2. The Trustee shall pay any minor child(ren) or their descendants such sums fr m the income or principal of the Trust as the Trustee deems appropriate for their maintenance, support, health and education (including college and professional education) until such time as each child is no longer a minor as defined herein. If deem d necessary by the Trustee, such amounts paid to my child(ren) need not be equal among my children, but should be based on the individual need(s) of my child(ren) and on the availability of assets in the trust. Any such payments shall not be deducted from or charged to the child(ren)'s share ofthe final distribution at the termination of the trust. If during any year that the Trust is in effect any portion of the income from the trust is no paid to or applied for the benefit of the child(ren) such portion shall be added to the principal. 3. As each minor child reaches the age of years, the Trust will termin e as to that child alone and the Trustee shall give that child his or her share of the Trust, including any share of undistributed income. When my youngest child reaches the age years, this Trust will terminate and the Trustee shall give that child any remaining income and principal of the Trust. Ifany of my child(ren) should die before receiving the whole of his or her share under the Trust created by this Will, then such share or the amount thereof then remaining shall be divided among the descendants of such child in equal shares per stirpes. The Trustee shall administer such shares for any descendants under the age of years as directed by this Will for any of y minor children. If any of my child(ren) should die before receiving the whole of his or her share under the Trust created by this Will, and if such child leaves no descendants I surviving him or her, then such share or the amount thereof then remaining shall be I divided among any of my other children, who shall be living at the time of the death of I such child, in equal shares per stirpes. Initials: ~~"\ estOtor w CiN-uS Witness 2:S Page 3 of ---1.!2- I ARTICLE vm NOMINATION OF EXECUTOR I appoint \1\\\ L\P 'Th. "'\ Gv--.\ , ("Executor") as the Executor of this my Will. If such person or entity cannot, does not or is unable to serve or continue to serve as Executor for any reason, I appoint l'-\ \ ~ , , to be the Executor of this my Will in the place and stead of the first aforementioned Executor. References to "Executor" in this my Will shall include each Executor, Executrix, and Personal Representatives of my Will, my estate or any portion thereof who may be acting as such from time to time whether original or substituted and whether one or more. To the extent permitted by law, the Executor shall have the right to administer my es ate without adjudication, order or direction of the court having jurisdiction over my estate, u ing "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. No bond, security or surety shall be required of any Executor serving hereunder. ARTICLE IX POWERS OF EXECUTOR & TRUSTEE In addition to the existing authority of the Executor with regards to the Will and of an} Trustee with regards to the administration of any Trust created by this Will, and in addition to other powers and authority granted by law or necessary or appropriate for proper administrati< n of my estate and the Trust, the Executor and the Trustee shall have the right and power to: I. Lease, sell, grant options, partition, exchange, mortgage, or otherwise encumber or dispose of all or part of any real or personal property that may be include< in my estate in such manner and for such purposes, for such prices, and upon such tern s, credits and conditions as may be deemed advisable, without order of court and without notice to anyone. I also give to the Executor or Trustee power to execute and deliver such deeds, mortgages, leases or other instruments and documents as may be necessary to effect such a sale, mortgage, lease or other disposition. The power of sale herein is discretionary and not mandatory. 2. Take charge of any real property as part of the probate administration of my estate for such period as the Executor or Trustee shall determine; collect any income therefrom; and pay the taxes and expenses thereof, including the cost of keeping such property in adequate condition and repair, in the manner and to the extent that the Executor or Trustee shall deem advisable. 3. To accept surrenders of leases and tenancies, to expend money in repairs, alterations, rebuilding and improvements and generally to manage any such property. The Executor or Trustee shall also have the right to renew and keep renewed any mortgage or mortgages upon any real estate forming part of my estate or any part thereof, to borrow Initials: \ \'\ '\ Testator ~~~ {JfrfIJ &u:b Witness f-f~ Witness Page 5 of (0 I I , I money on any such real estate upon the security of any mortgage or mortgages and to way off any mortgage or mortgages which may be in existence at any time forming part of ~y estate. I 4. Make any division of my real or personal estate or set aside or pay any share or interest therein either wholly or in part in the assets forming my estate at the time of m' death or at the time of such division, setting aside or payment, and I expressly will and declare that the Executor or Trustee shall in their absolute discretion fix the value of m estate or any part thereof for the purpose of making any such division, setting aside or payment and the decision of the Executor or Trustee shall be final and binding upon all persons concerned, notwithstanding any fluctuation in market value and notwithstandit1(g that one or more of the Executor or Trustee may be beneficially interested in the property or any part thereof so valued. 5. Sell, call in and convert into money any part of my estate not consisting of money at such time or times, in such manner and upon such terms, and either for cash ( r credit or for part cash and part credit as they may in their absolute discretion decide up )n, or to postpone such conversion of my estate or any part or parts thereof for such lengtl of time as they may think best. Make any division or distribution of my residuary estate in money or in other property or partly in both upon the basis of fair market value and cat se any share to be composed of money, property or undivided :fractional share in property 6. Retain any of my investments or assets in the form existing at the date of my death at Executor's or Trustee's absolute discretion without responsibility for loss to tt e intent that investments or assets so retained shall be deemed to be authorized investmer ts for all purposes of my Will. No reversionary or future interest shall be sold prior to falling into possession and no such interest not actually producing income shall be treat ed as producing income. 7. Permit any beneficiaries of my estate to use any tangible personal property 0 real property, without paying any rent, without giving any bond or security and withou liability for any loss or damage. The Executor or Trustee shall not be liable or responsible for any injury to, consumption of or loss of any such property so used. 8. Make or refrain :from making, in Executor's or Trustee's absolute discretion, any elections, determinations, and designations permitted by any statute or regulation enacted by the federal government of the United States of America, by the legislature 0 government of any state, or by any other legislative or governmental body of any other country, state or territory, and such exercise of discretion by the Executor shall be conclusive and binding upon all the beneficiaries hereof The Executor or Trustee shall not be liable to any person, whether beneficiary or otherwise, by reason of any loss, claim, tax or other cost experienced by any such person or by my estate resulting :from any election, determination, designation or exercise of discretion, entered into by the Executor or Trustee in good faith, 9. Windup, dissolve, settle or continue any partnership or business in which I may have an interest at the time of my death. Initials: 11'-\ \' Testator ~~E::S Page 6 of 10 II 10. Compromise, settle, waive or pay any claim or claims at any time owing by my estate or which my estate may have against others for such consideration or no consideration and upon such terms and conditions as the Executor or Trustee may de advisable and to refer to arbitration all such claims if the Executor or Trustee deem s advisable. 11. Pay all necessary and reasonable expenses and costs incurred in connectio with administering my estate, including but not limited to attorney, accountant, agent, broker and other professional fees. The Executor or Trustee shall be fully protected in exercising any discretion granted to them in my Will and shall not be liable to the beneficiaries or their heirs or personal representatives by reason of the exercise of such discretion. The Executor or Trustee shall exercise the powers, authority and discretion granted herein in what Executor or Trustee dee s to be the best interest, whether monetary or otherwise, of the beneficiaries, whether or not suc exercise may have the effect of conferring an advantage on anyone or more of the beneficiarie or would otherwise, but for the foregoing, be considered as being other than an impartial exe ise of their duties hereunder or as not being maintenance of an even-hand among the beneficiaries and all such exercise of their powers, authority and discretion shall be binding upon all of the beneficiaries and shall not be subject to any question or review, by any person, official, authority, court or tribunal whatsoever or whomsoever. ARTICLE X MISCELLANEOUS PROVISIONS The provisions in this Will for the distribution of my estate shall be supplemented by the following: 1. Paragraph Titles and Gender. The titles given to the paragraphs of this Wil are inserted for reference purposes only and are not to be considered as forming a part this Will in interpreting its provisions. Throughout this Will the use of any gender shal be deemed to include all genders, and the use of the singular the plural, and vice versa. and any pronouns shall be taken to refer to the person or persons intended regardless 0 gender or number The terms "child" and "descendant" shall include an adopted person and such adopted person's descendants, if, but only if, the adopted person is not more than twelve years of age on the date of the court order granting such adoption. 2. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, Each beneficiary shall be deemed not to have survived me unless the beneficiary is living on the thirtieth day after the date of my dea h. 3. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of y estate, and my estate shall indemnify such natural person from any and all claims or Initials: ;:;;-\ \""ll' Testator GIl^e.ss & .. ~ ~ Witness {LS Witness Page 7 of 10 I 4. If at any time prior to the termination of the Trust created under this Will or when the trust is ended, none of the intended beneficiaries of the trust is living, the Trustee shall distribute the property to whomever and in the same proportions as, my Executor would have been required to distribute it had I died intestate, unmarried, and a resident of the state of at such time and owning such property. 5. The interest of any beneficiary in the Trust shall not be subject to any assignment, anticipation, creditor's claim, seizure, attachment or other manner of legal process. this provision shall not be deemed to be a limitation upon the right of any beneficiary to renounce, in whole or in part, any provisions of the trust for the benefit 0.... such beneficiary, or upon any power of appointment herein granted. As to any interest 'n the trust renounced by a beneficiary, the trust shall be construed as though such beneficiary predeceased me if the beneficiary's renunciation occurred within nine months following the date of my death and the beneficiary has not accepted any of the benefits so renounced. The Trustee may withhold the distribution of any income or principal to an' beneficiaries under the Trust if Trustee, in Trustee's own opinion and judgment, feels tl at the 'proceeds' may be subject to any type of seizure or other legal proceeding. ARTICLE VI TRUSTEE I appoint ~ \~ , as the Trustee under this Will. IJ such person or entity cannot, does not or is unable to serve or continue to serve as Trustee for any reason, I appoint , , to be the Trustee under th s Will in the place and stead ofthe first aforementioned Executor. No bond, security or surety st all be required of any Trustee serving hereunder. The Trustee shall provide an accounting to the beneficiaries under the Trust once a year. If a beneficiary is a minor or has a disability, the Trustee may provide such accounting to that beneficiary's Guardian, Conservator or Trustee. ARTICLE VII GUARDIAN Ifit becomes necessary to appoint a Guardian for any of my minor child(ren) under the age of eighteen years, I appoint E (l.... \ ~ A~o \L \.C..M A:.i4) ~ ~ v \ S as the Guardian ( f my minor child(ren). If such person cannot, does not or is unable to serve or continue to serve as Guardian for any reason, I appoint \'\ \ r\. , as the GuardilllIl of my minor child(ren) in the place and stead of the first aforementioned Guardian. It is my wish that before the expiration of _ days from the date of my death the appointed Guardian apply to have custody of such child(ren) and act as the guardian of the property of such child pursuant 10 the provisions of applicable law. Initials: \ ""-\ \ Testator w ~ws Witness tcS Witness Page 4 of 10 I expenses in connection with or arising out of that fiduciary's good faith actions or non- actions as the fiduciary, except for such actions or non-actions which constitute fraudulent conduct or bad faith. 4. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. 5. Matrimonial Rights. No gift, or the income therefrom, under this Will shall I e assigned or anticipated, or fall into any community of property, partnership or other fo m of sharing or division of property which may exist between any beneficiary and his or her spouse, and every gift together with the income therefrom shall remain the separate property of a beneficiary hereunder, free from all matrimonial rights or controls by his ( r her spouse. 6. Severability. If any provision of this Will is declared invalid, illegal or unenforceable, any invalidity, illegality or unenforceability should affect only that provision and all other provision should remain effective. IN WITNESS WHEREOF, I have signed my name below to this Will, this ~ day ( f \ ,* ' ?oos- . at ~". I,. f i" ( city), that I declare this to be illY Last 111 and Testament, that I am oflegal age and sound mmd, that I make this under no constraint or undue influence and ask the Witnesses named below to witness my signature. Testator's Signature: ~~~, N~~[)Ib~i'-\\L-\ \OT--\.-\...\.\ (Notice to Witnesses: Three (3) adults must sign as witnesses. Each witness must read the following clause before signing. The witnesses should not receive assets under this Will.) We, the undersigned, hereby certifY and declare under penalty of perjury under the law s of the State of f'1-"I1:i'Jlv""/b- that the above instrument, which consists of ~ pages, including the page(s) which contain the witness signatures, was signed in our sight and presence by T""Iti Mb4" "-to TOY! I.t, (the "Testator"), who declared this instrumer t to be his/her Last Will and Testament and we, at the Testator's request and in the Testator's si~ ht and presence and at testator's request, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. We understand this is the Testator's Will; We believe the maker is of sound mind and memory; We believe that this Will was not procured by duress, menace, fraud or undue Initials: IN'\ Testator ~ @JAIJJS Witness &~ Witness Page 8 of /D I II I iirlluence; The maker is age 18 or older. Each of us is now age 18 or older, is a competent witness, and resides at the address set forth after his or her name. Dated: 7/J,c;/{)S ~~1~ IC1r 5UJtpfS> I .r; ~ {)(l.. /1,> Ce.-. :4.. 1 pa.- 17191 eo~tA)S;ty~ C e c e , \ L M \J.J Strf.!\'1.d. ,,~lf-f wi\sOY\ Sf. C~r l (" .st-e. 'FA ( )'7o/~ t1l:;~CAiJ- h 4i5 iA)( ~s 0Vl Sst. CAv 1 L-~ Ie fA- 1~-1 Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Witness Signature: Name: Address: City: State: Initials: ~N I estator l}:t- ~wiB Page 9 of (i) Self-Proved Will Affidavit STATE OF COUNTY OF ~"'h {"J I (/4",'i< C.; "" t.,..Q/ L~) I, the undersigned, an officer authorized to administer oaths, certify that ]:' elA ;V"hanflA Tan Vii' , the testator 1.. di+L. fro /lAc)p"tlA , and Le..'-e frc..., and , the witnesses, whose names are signed to the attached or foregoing instrument and whose signatures appear below, having appeared before me and having been first been duly sworn, each then declared to me that: 1) t e attached or foregoing instrument is the last will of the testator; 2) the testator willingly and voluntarily declared, signed, and executed the will in the presence of the witnesses; 3) the witnesses signed the will upon the request of the testator, in the presence and hearing of the testator and in the presence of each other; 4) to the best knowledge of each witness, the testat r was, at the time of signing, of the age of majority (or otherwise legally competent to make a will), of sound mind and memory, and under no constraint or undue influence; and 5) each witness was and is competent and of proper age to witness a will. \-\ l' (AO c:~ Print Name: Address: ~ C70 e I CM"ILoC{.. p~, 11()1~ ce~Qt M..fA.)STY~ Print Name: Ce.cec/~. M W stv-a.ht'l Address: ~'ff LV ~ \s em Sf-. ~/~~OI3 Print Name: 0(1' ~~ 0/ {'/. S~~ Address: 3 tf;f UJ i 1 S N\ st , <:At- n sl-e..1 "Pit f? 0' 3 Subscribed and sworn to before me by :Lot /1. .AJohc..., 6_ testator, who is personally known to me or who has produced identification, and by , L..L ft,. f( Mr I~IA is personally known to me or who has produced J.I' / VQ.r~ and by Ce ( e I l.e ,ft S~/,r, ~.J.. known to me or who has produced ~ (Witness) (Witness) Ovyver s ~nu; , the DY'ive."< L,c..e/l.c;.. as , a witness, ho L(...q'1 S c.. as identification, , a witness, who is personally L:: e"'Se as identification, and by , a witness, who is personally known t as identification, this 1- ~ day of me or who has produced D,..;",,,... ,. LI~ ,20~. L.(...e.. (<;:. '- N~~~ ~~ COMMONWi:Ai.JH OF PENNSYLVANIA NOTARIAL SEAL RODNEY E. HIGHLANDS, Notary Public Bora of Cartisle. Cumberland County My Commission ExpIres March 1, 2008 [SEAL] lor ,.(~