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HomeMy WebLinkAbout01-23-07 ~ 15056051047 REV.1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number Date of Birth Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW .. 1. Original Return c:::> 2. Supplemental Return c:::::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::::> 4. Limited Estate c:::> - c:::::> 4a. Future Interest Compromise (date of death after 12-12-82) c:::::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::::> 10. Spousal Poverty Credit (date of death c:::::> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes c:::::> f') . I G.) -'0 1") rv Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSO ' ESPONSIBLE J;OR FI!-ING,RET N DATE n ~. '- ( .' __ I -tJ 7 ADDRESS 10 - t "'--L_n,...r .nr., t""lJ...., .. .r,..",.... 1""I.r"'."'I I""lll._~___ . - ~ I Side 1 --.J 15056052048 REV-1500 EX Decedent's Name: RECAPITULATION 1. Real estate (Schedule A). 2. Stocks and Bonds (Schedule B) . . . .......................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . ... ....... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c:::> Separate Billing Requested . . . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::> Separate Billing Requested.. . . 7. 8. Total Gross Assets (total Lines 1-7). . . 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)X.0_ . 15. 16. Amount of Line 14 taxable at lineal rate X .0fl5 I. .. ~.'$Hil.<.:ko 16. 17.. Amount of Line 14 taxable at sibling rate X.12 . 17. 18. Amount of Line 14 taxable at collateral rate X .15 . 18. 19. TAX DUE. . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 Decedent's Social Security Number I /0 Cf, <t D).f J.I 1. 8. 9 c:::> 15056052048 ---l REV-150o EX PafJl'l 3 File Number Decedent's Complete Address: DECEDENT'S NAME ----- r-::'Pl- 1" rL - ----J3r--11~u...G P_- ---. STREETADDR~ /) , -- --'Tde--WDW5unA-'T{i~P-'1'W11_ ~dJf- --- L15.8l1.w --- $..o_M___ C. A.M f>' CITY S1 E ZIP (1 D \l Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) ~I ~/L1J. , .."'" ____ ______ __~),_"'v__ ------7-b-tf5. 00 - --- J-l-]. <:[3 Total Credits ( A + B + C ) (2) ~{)/~. ~ 3 3. Interest/Penalty if applicable D. Interest E. Penalty ---- -- - U_ Total Interest/Penally ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. , 5 tlt!J D.fJO I 510. H. q B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 IJ?"" b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [id' c. retain a reversionary interest; or...................................................................................................................... 0 [Ja- d. receive the promise for life of either payments, benefits or care?..................................................................... 0 g-- 2. If death occurred after December 12,1982, did decedent transfer property within one year of death . without receiving adequate consideration? .......................................................................................................... rn 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [B" 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [W 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 PS. S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 PS. s9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. S9116(1.2) [72 PS. s9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. s9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV.150B EX + 12.B71 . SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or Type FILE NUMBER COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ 0 l"f~ JLJv\\l-LE.~ (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule Fl ~/-f~ - Db} 9 ITEM NUMBER J. M f\\...VERI\J dl tI ~:3. " l l+t " '-< I' DESCRIPTION VALUE AT DATE OF DEATH feDf:,R.Al,-9WlIl1bS. ' K t=f DI30oUQ3 II It It #- ~lILfI:S'-ob II tl II -.,J. ,~71y.\5-{/ , ~ II i if 7 J '1-' 5 - tJ r;' u 141,?-\ 7 b ,b~ J.. <'i 03 I b1 I HI a..$'1' t{ ~ II J/ II -/fl.J{ CO If o'bW;b~3 Be.A)c r \( UU<. \ tS.s r\jt.e.. SHAfW A.;{) Jf\ lot t:.S f{d..LERJ{~~;1J qD~cr' Df D pe:.Neo '7 ~ ll-~ b Tvc..t<6TT (aU.Lrl T [(:.) l F, f'l,j\ \- ft::-N&iVI\J fl\.~ M.E'N" &. 13DI bLf TOTAL (Also enter on line 5, Recapitulation) $ ~ I bO (Attach additional BY," X 11" sheets if more space is needed.) REV.1509 EX+ 112.881 , ~ ~.q::r'l.Jrl. ~~~ SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE~ ......... _\J (). 0 tJJ . t:: ~ 'l/l- L~R- Joint tenant(s): J FILE NUMBER ~I- /Jh- 6 b L1 ~- .. ADDRESS -no ~ 1/ "t- p,e \\)6 LEW1~~t;P~ i{nJ7?3q ~ J b ;;;;~lXJ A~ f DAD 0eW-I;(<5v l LL{; J ~I J 9;<-(bD RELATIONSHIP TO DECEDENT NAME A. SrH\~otJ t")i)Q{f;I/ P A. iA6 HTE 1<- B. J t\~60 L M,U-E-{Z 0R G~rJ C. Jointly-owned property: 1. DATE MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE DECO'S DOLLAR VALUE OF OF ASSET % INT. DECEDENT'S INTEREST ITEM NUMBE A-t 'IN6~ i 1./, !> V 33 J../ /15 ~ ( AtE F tp f:flli L ~ ifl.\6..s b3/Y,17 33!JJ 9-ilbt~J ~I TOTAL (Also enter on line 6, Recapitulation) (If more space is needed insert additional sheets of same size) s ~ \ ~ \ . \~ REV-1510 EX. (1-97) SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF E. () t T \--\ 84 r\,l L..LE;~ FILE NUMBER ~ -Df:,.~b lq ~ This schedule must be ccmpleted and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes_ ITEM NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. ~ Mt~~ rE I T Pit A~~~"- No ~ 1 i I.f \ S" - 't 5"' MADe. JDi A1/ 'D'-b- D5 W(It'i SHt\'P-i)N-rz<;-~e-T~~) AND Jf\N.c,S MIL.L.G~ JR hlv) . ~ El\ee-P-S I Yr- FfDf;AA i- 6R-wrr- lINi /)/ ACL't>~rv f' tUe. ~71 L{ J 5"- ~ MA.06I..Jl>lN'T it>- b-D~ ilhnl St{APC~ lOq,ry ~%I-/l ~I' A Nfj) ~MCj, Nl/,.LER JfZ L);.) ALLSiA-rf: Llff JNSU({'AlJcE t'o' - IttRttiAScO /D--L--,ob. - AA.I/V~l[j 'fJ '/~f. AMD.uJl If j)D;,~O') ~ - .-- fA 10 OrJ Of.IrrH Dr PtLtD~I'vT 10 5 H A ~ c)t) ~, 'IV (l,<.EIf (pA.'-i(.rCl ~~ ) ~ N D Jf\t.tt: ~ t M I u.. eft rJ P- (E,c V ,~ %OF DATE OF DEATH DECD'S VALUE OF ASSET INTEREST EXCLUSION TAXABLE VALUE 9-9,610 I L5 :35lJf~( 10' I SJ.J, ilf TOTAL (Also enter on line 7, Recapitulation) $ 1(.,.5 Slfb.'1.) (If more space is needed, insert additional sheets of the same size) 3 5J, D'3 ~ IS- I Do I::.Mo 35 04- ~. cl Ie. t /)D ct () () IDI15~3.,L~ ~ o Ou ESTATE OF ITEM NUMBER A. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS C.D \",b{ 13 . 1"'\ H- \.. €. R Debts of decedent must be reported on Schedule I. DESCRIPTION 1. FUNERAL EX~Et:iSES: Li "" ~ t,\ t;. rEA. bP,b rJUifp 1. B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 2. Name 01 Personal Representative(s) Social Security Number(s)/EIN Number 01 Personal Representative(s) Street Address City State ~ Zip Year(s) Commission Paid: Attorney Fees 3. Family Exemption: (II decedent's address is not the same as claimant's, attach explanation) 4. Claimant Street Address City State ~ Zip Relationship 01 Claimant to Decedent 5. Accountant's Fees Probate Fees 7. 6. Tax Return Preparer's Fees ~ q. 1 e. II "OOlniH\lAJ,.. D5AnJ ~etOl-~ 1U..'ftS1N G; '\1EIt\ T ^fAc MeOL<:A.s.. 1- p\#.Ne/1'"\ Co "f\\(J Hu",,- F t ICe C;;. A/'1.61..\ l-ANG& c~ ~T IJ~JC,'\1' LfS tit:. '" ~ G'~p FILE NUMBER ~1""6~ -~l'l AMOUNT -,S1. h.3 O../JO I tit's ti) . O~{)t) ~.c~O bSas. 4 b Sit,O] 3 " , t..-f 61... 1.. V' TOTAL (Also enter on line 9, Recapitulation) $ ~'(ltJIA.If'P 0)) (II more space is needed, insert additional sheets 01 the same size) If; x,\.hg L r f\ I'L 1:3 It-t 17 Ib 17. rr{ '4 J.-o ~. i-~, ") 3. ~ '-t . .~ 'l.~ . ()L. - ~7. ~). j. ,. EO~T~ se ~ sO l\.L..[ (C~rVTlt0\A.EO ) H 6. M.LLL~(<. ~I- 6b-Db['f C.HE.c..K.S SeIOl...C Fc>~ .f:.6~Te. NIA:R.7\/UG Hb"""~ /1 u...o v---trJ t 'f.qS- Jb~I.17 ~lt. 1.;3 Q.. 'f .5 =l 1.11:. ~1-~.57 "5~ crt ~fJO ,oU bY, lJ :l. 31.17 31 I l '-f 1{6.s J II H It II I. .1 f}$SOGIATE:'D C~~IDWJ(;t61S ftt ~ S(c'Ii\.r.>!j Rctt-A& W f3:,!Jr S1tt>~ e.,v..$ OAu~D s, ~A.{?JOI~N , t..-fl1- tu Nf'Vo-R.., R\-(. HAs S~( , I\T1$ q u.A.A)r~11. IMA6lfJ G .- ~61~H.i fJ~f\$ltJ ~ HOfi\.G S cu:H.e fJ~{.). f7 IV r.:. Ii Ott HliL1 5f\ 12. \ r- t/o':1PI11\L StSel~kE: ~ _ S~(lJ7lrJa - AOl>~,lGt jS.5iATD ~~e,e'lt\.,fWO LGGI\L. (2cCOf-D ADJJ~'nss ~7flTB ~€bV:f~(.t ~ f HI Il..L-S "{,lC flUfityl-UWcl1^"J. ~ t I k II RCS~t:.- Fl L':;' (?e;u..zr\SEr p.. Jl'O{l tUfrJ S c. v r -r S;;; f\. Ru..q.\ - 'f "7 /J J~K) 1 37,():' 7.!;ji/> C) 1.5,cJD is /) (j ;}...5D~ 00 '/iT^l-' ,~.~rq -r .1>f11('6 I r A ,REV-1513,EX+ (9-00. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF EOl' NUMBER I FILE NUMBER -0 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 5-' rH~~DN --r;;c.k' E,r 'll[b Sl= '17- ~. J A-I"\Gg ~,MlL..L..t:1<- J fZ.. 11 b THOlLSAtJO At P e: {CoA. 0 6tLL-2(lS III L~C . ~_ - I ~~b 0 1. OActf, L-rrf fZ 5?.v AMOUNT OR SHARE OF ESTATE 5D'Z --- 50 ~ - ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) MALVERN FEDERAL SAVINGS BANK SINCE 1887 42 E. Lancaster Avenue, P.O. Box 485, Paoli, Pennsylvania 19301-0485 (610) 644-9400 FAX (610) 251-9276 www.malvemfederal.com August 5, 2006 Robert E. Myers Attorney at Law 100 York Rd New Cumberland, Pa 17070 RE: Edith Bond Miller, deceased Mrs Miller had the following accounts at Malvern Federal Savings Bank. Savings #010130486 opened as a joint account with James Miller Sr. on 6-6-97. This account was changed to a joint account with Sharon Tocket and James Miller on 2-1-99. The date of death balance was $14.54. Checking # 013001193 opened on 1-30-87 as a joint account with James Sr. It was changes to an indivual account on 4-2-99. The date of death balance was $141.21. CD # 016676336 opened on 5-7-02 as a joint account with James Miller, Jr. and Sharon Tocket. The date of death balance wa~ $6,348.87. IRA CD # 016656263 opened as a retirement account on 8-11-86. The beneficia1ts are James Miller, Jr. and Sharon Tocket. The date of death balance was $9,059.01. All the balances include interest to date of death. All the accounts are now closed. There are no other accounts at this bank foe Edith Bond Miller. Mary McCarty, Customer Service Paoli MALVERN (610) 647-7944 1 (Xl W. King Street BERWYN (610) 251-9585 650 Lancaster Avenue LOAN SERVICING (610) 695-3682 P.o. Box 556 Berwyn, PA 19312-0556 EXTON (610) 363-1700 Routes 30 & 100 COVENTRY (610) 469-6201 Routes 23 & I {)() LlONVILLE (610) 594-6400 Rt. #113 & w. Devon Dr. REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint O,,'mer CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner MONEY MANAGEMENT ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Estate of: EDITH B. MILLER Date of Death: 06/06/2006 Social Security Number: 169-18-0374 ~lm MEMBERS 1st FEDERAL CREDIT UNION 271415 -00 09/13/2005 $76.41 $.24 $76.65 None 271415 -11 09/13/2005 $2,803.59 $.08 $2,803.67 None 271415 -05 09/16/2005 $14,283.92 $5.50 $14,289.42 None 271415 -45 1 0/06/2005 $35,000.00 $30.15 $35,030.15 Sharon E. Tocket James E. Miller Jr. 271415 -46 10/06/2005 $35,000.00 $42.96 005,042.96 Sharon E. Tocket James E. Miller Jr ~;.l/I.oi}.Ab 1dMBER~ 1ST F~E~L CREDIT UNION ?'/tl(t( t2' a:f::J o nise A. Wolfe Insurance Services Su rvisor August 9, 2006 5000 Louise Drive. Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1st.org WILL of Edith B Miller . I, Edith B Miller, of Chester County, Pennsylvania, declare that this is my will. I revoke all prior wills and codicils. ARTICLE ONE. DECLARATIONS CONCERNING FAMILY AND PROPERTY 1.1 Family. I am not married. My children are James E Miller, Jr. born 5/2/1947 and Sharon E Tocket born 9/28/1951. I intentionally leave nothing to anyone else claiming to be a child of mine regardless of the validity of their claim. 1.2 P.rsona~ Wishes. It is my desire that my executor follow any written directions left with this will regarding memorial services. My remains shall be buried and under no circumstances shall my remains be embalmed. ARTICLE TWO GIFTS OF PROPERTY 2.1 Tanq1b~e Personal Property. I give my Wedding rings and general jewelry to Sharon Tocket. I give my Garnet/diamond ring to Ada Miller. I direct my executor to distribute the balance of my tangible personal property to my child James E. Miller, Jr. and my child Sharon E. Tocket in equal shares. If any of the beneficiaries do not survive me for 30 days then their share shall lapse. I may also leave a non-testamentary letter addressed to the executor requesting that certain of my personal possessions be delivered to named individuals. Although such letter shall not be interpreted as a testamentary writing, I request that my beneficiaries and executor carry out the requests made in the letter. If a minor child is to receive personal propert~ it may be delivered to the child or their guardian or parent as the executor sees fit. 2.2 Residue of Estate. I leave the residue of my estate to my child James E. Miller, Jr. and my child Sharon E. Tocket by right of representation. - Page 1 - If my executor determines that a beneficiary's share can be retained for their benefit in a Uniform Transfers to Minor's Act (U~MA) Trust, then the executor shall distribute the beneficiary's share to the executor as custodian under the act to hold said share until the maximum age allowed by law. ARTICLE THREE.. APPOINT.MENT OF FIDUCIARIES 3.1 Executor. I nominate Sharon E. Tocket to act as my executor. If Sharon E. Tocket cannot serve then James E. Miller, Jr. is to serve as the executor of my will. No bond shall be required of any executor under this will. 3.2. Executor's Authority. In addition to any powers and elective rights conferred by statute or federal law or by other provisions of this will, I grant my executor the authority to administer my estate under any procedure for informal or unsupervised administration, or any other available procedure for avoidance of administration or reduction of its burdens. On ~U4~ II (date) this document and 20!6'at fJ~L ,,~~44""" I hereby sign (town nd sate) declare it to be my will. ~u '/~:iJPrJ Edith B Miller This document (consisting of ___ pages including this one) was signed and declared to be her will by Edith B Miller in our joint presence. At her request, in her presence, and in the presence of each other, we hereby sign as witnesses to the execution of this will, believing that she is of sound mind and under no undue influence. Each of us observed the signing of this will by Edith B Miller and each other subscribing witness and knows that each signature is the true signature of the person whose name was signed. Each of us is now more than eighteen years of age and a competent witness and resides at the address set forth after our name. We declare under penalty of perjury that the foregoing is true and correct and that this declaration was executed on ~~/;;chJor, at (date) A~~' ( town) ,/A- - Page 2 - ~l7fY,t#Ml4- ' (state) ( C~{) n it;~ ,residing at (wffn~s~~re) -r:; ~,.('~ J C-(J/\A. 0 residing at (witness signature) t: $1} / ,# Ii , (town and state) E~fj,/4 (town and state) - Page 3 - . . WILL AFFIDAVIT for the WILL of Edi'th B Miller State of a/JIVYhtM4f- . County of ~~_ I, the undersigned, and ~d- ~~ (Print name of Witness) an officer authorized to 1!r~b-' ( rint name of administer oaths, certify that Edith B Miller, Witness) the witnesses, whose names are signed to the attached or foregoing instrument and whose signatures appear below, having appeared together before me and having been first duly sworn, each then declared to me that: 1) the 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 wi~nesses signed the will upon request by 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 testator was, at that time of the signing, of the age of majority (or otherwise legally competent to make a will), of sound mind, and under no constraint or undue influence; and. 5) each witness was and is competent, and of the proper age to witness a will. f'd;:L /3. ~ Testator: Witness: ~r signature) c.. /~ . (Witness signature) ~ /~I/ Address: - Page 4 - . . . " "111~._"~~_""~"''''''''''''''''''__''',_~"",;"",,,, . . --"----l' fl W~tness: A./lU'..L..- LO/};(~ C. j. (Wi tness Address: G-"/UJ/J. #.4- . , signature) . Subscribed, sworn and acknowledged before.me, ~~4~~~h.( a Notary Public, by Edith B Miller, the testator, and by -f" ~"/LL · and ~<l . ~ the witnesses, this /? day of ~td , 2005"'. c NSYLVANIA Signed: Naarial Seal Jerrier L RalleItQ, NoIaJy PublIc TredyIfr1n Twp., 01ester Cou1Iy My CommlssIon Expires Dec. 6, 2WI Member, Pennsylvania Association Of Notaries (Official Cap - Page 5 -