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Home My WebLink About02-21-07 -1 15056041114 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 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT ). I Ot 0 dlo C) Date of Birth Suffix 05011922 Decedent's First Name MI 184-12-3770 Decedent's Last Name 03012006 WERT (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix MARY E 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 m 1. Original Retum D 4. limited Estate m D 6. Decedent Died Testate . (Attach Copy of Will) 9. Litigation Proceeds Received 0 2. Supplemental Retum 0 3. Remainder Retum (date of death prior to 12-13-82) CJ 4a. Future Interest Compromise (date of CJ 5. Federal Estate Tax Retum Required death after 12-12-82) 0 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) CJ 10. Spousal Poverty Credit (date of death CJ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECnON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: 5 SOUTH HANOVER STREET Second line of address Daytime Telephone Number (") 717-243-5~ :.=:::O REGISTER OF .25>r- -7 fT1 ~~o5~ jQo ) ~.-J 11 ,:)C :0 :::D-l J;.~ -0 :z: ~ if: ;3 ::'J f\~ C-.:J ~~ - -q ~:~ Name ROBERT M. FREY Firm Name (If Applicable) FREY AND TILEY First line of address ,"'--", -._/ "lj City or Post Office State ZIP Code DATE FILED CARLISLE PA 17013 Correspondenfs &omail 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 aU infonnation of which preparer has any knowledae. SIG}I/'TU~ OF PERSON~PONSIBLE FOR FILING RETURN DATE ac.1lI~ -J'. 1i -" ADDRESS 53 BLOSERVILLE ROAD, CARLISLE PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ~.~-~ ADDRESS ~ 5 SOUTH HANOVER STREET, CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041114 15056041114 -1 -.J 15056042115 REV-1500 EX DecedenfsName: MARY EWERT RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested. . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) DSeparate Billing Requested. . . . . . . . 8. Total Gross Assets (total Lines 1-7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184-12-3770 Decedent's Social Security Number 1. NONE 2. NONE 3. NONE 4. NONE 5. 6. NONE 7. 8. 9. 7365.00 242272.00 249637.00 3573.00 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/See 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.O ~ 16. Amount of Line 14 taxable at lineal rate X .0 ~ 17. Amount of Line 14 taxable at sibling rate X . 12 18. Amount of Line 14 taxable at collateral rate X . 15 236668.00 16. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505b'042115 15. 17. 18. 15056042115 9396.00 12969.00 236668.00 0.00 236668.00 0.00 10650.00 0.00 0.00 10650.00 m -.J REV-1500EX Page 3 184-12-3770 Decedent's Comolete Address: DECEDENT'S NAME Mary E. Wert STREET ADDRESS File Number 21-06-0260 1254 HOLLY PIKE CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 10650.00 540.23 10264.36 Total Credits (A + 8 + C) (2) 10804.59 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAVMENT. 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) A. Enter the interest on the tax due. (5A) 0.00 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 154.59 0.00 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Ves a. retain the use or income ofthe property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . .. D c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . " D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ij 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 P .S. ~9116 (a) (1.1) (i)l. 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. ~9116 (a) (1.1) (ii)). The statute does not exemot 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 P .S. ~9116(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. ~9116(1.2) [72 P.S. ~9116(a}(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3}J. 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. No o o o o o o 217 REV-1508 EX+ (6-98) COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary EWert SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-06-0260 Include the proceeds of litigation and the date the proceeds were received by the estate. All Drooertv lolntlv-owned with r1aht of survlvorshlD must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 M& T Bank, Account #1205153 2 M& T Bank, Savings #15004200916730 3 Refund. United American Insurance Company Premium. Policy #007800536 4 Social Security for February 2006 5 Household Contents VALUE AT DATE OF DEATH 1,190 4,458 245 1.072 400 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 7.365 / r! M&fBank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone(888)S02-4349 Fax (302) 934-2955 April 3,2006 Frey & Tiley Attorneys At Law 5 South Hanover Street Carlisle, Pennsylvania 17013 Re: Estate of: Marv EWert Social Securitv: 184-12-3770 Date of Death: March 01.2006 Dear Sir or Madam: Per your inquiry dated March 28, 2006, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: Ownership (Names oj) Checlcing Account 1205153 lester'S WertSr. 06 P 01/1 )1J4 MaryE Wert. 1. 'JYpe of Account Account Number Opening Date 03/22/94 Closed C!/30106 Balance 011 Date of Death $1,190.34 $ 0.00 Accrued I~' Total ------------ $1,190.34 2. 1yPe of Account Account Number Savings Account Ownership (Names oj) 015004200916730 lester'S WertSr. .f:::.t.d) ;/111 q~ MaryE Wert. Opening Date 01/10183 Closed03/30106 Balance on Date of Death $4,457.54 $ 0.58 Accrued Interest $4,458.12 Total __ 82013848 united american=;,!u~ce company 3700 SOUTH STONEBRIDGE DRIVE . POST OFFICE BOX 8080 . MCKINNEY, TEXAS 75070 1 oJ,k --' ~T/~-- y~\Iv\ /wrL ~~ Date 03/16/2006 Estate of Mary EWert 1254 Holly Pk Carlisle PA 17013 Policy 007800536 Check No 375904 Dear Sir or Madam: We are concerned to learn of the death of our Insured. Attached is the refund of monies paid beyond the date of death for policy number 007800536. ~)j~y(,'l { Sincerely, Ann Braswell, Vice President Policy Service 'J (r / ~ s:-- k.e- f 0 7 2,~ Detach This Portion At Dotted Line Before Depositing Check 62DU lr".\~lrtturbJtBtm1rmmDItr~1 P 006,576,801 ~ 03 03 06 75 PHILADELPHIa,. PA ~ 2051 95640884 28045300 S1 2 1...111..1111.1..1.11..11..111111111.11.111..111.11.1. .1111111 MARY EWERT 84 1254 HOLLY PIKE CARLISLE PA 17013.4240 . .,. " . ". ....; I .,., 0. ;! aD 0. C; III 20 5 ~ 5 III Check No. 2051 95640884 P SOC SEC FOR FEB $***1072*00 \: 1:000000 5 ~Sl: q 5 b ~DSa ~ q III 0 '10 310 b .to' . .... .' '.' .'~.,:. 217 REV-1510 EX+ (6-98) COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Mary EWert FILE NUMBER 21- 06- 0260 DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF API'UCAIU) VALUE 1. Real Estate, 1254 Holly Pike, South Middleton Township 150,000 100.00% 150,000 2. Sammons Securities Account #29-49-6530, Open End Mutual 32,230 100.00% 32,230 3. Sammons Securities Account #29-49-6530, Closed End Mutual 60,042 100.00% 60,042 TOTAL (Also enter on line 7 RecaDitulation) 9; 242 272 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET Is yes. (If more space is needed, insert additional sheets of the same size) STONE MILL FINANCIAL SERVICES' Securities. Insurance. Living Trusts. Estate Planning 298 South Progress Avenue, Harrisburg PA 17109, (717) 545-5515 - (866) 763-9810 - Fax (717) 545-5701 Email: ghuff@sammonsrep.com Robert M Frey Frey and Tiley 5 S. Hanover Street Carlisle, PA 17013 Dear Attorney Frey: Anna M Smith bas requested the date of death value for the account that she has held jointly with her mother, Mary E. Wert. The Sammons Securities account number is 2949-6530 and is entitled "MaIy E. Wert and Anna M. Smith TTEES; Wert Family Trost DID 10/0312000. Here are the values: $ 9,640.80 Bank Deposit Sweep Option (Money Fond) $ 6,122.80 Oakinark International Fund $ 9,400.59 0akmaIk Equity and Income Fund $16,706.76 Vanguard Short Corporate Bond Fund $14,145.00 Aberdeen Asia Pacific Income Fund $26,740.00 John Hancock Investors Trust $ 9,516.00 Nuveen Senior Income Fund The total value was $ 92,271.95 SiDceleIy, 1/ / j); s&dlrvr Securities offered through Sammons Securities Company, LLC Member NASD and SIPC i 5 I ".::~ l"~'~~''''' , ":~:i;:.'t[;;1'~~Rt ,. ~f~~ ~ioo. IF TAXES ARE IN ESCROW. FORWARD TO MORTGAGE CO $1.00 FEE FOR ADDITIONAl RECBPTS TAXPAYER COPY Bm No: PAYMU: TO: Control No: 040 - 0035n ~SUs~ ~ Values 33 550 DI!SC: JUDY A. CAMPBELL., TAX COLLECTOR 6 HOPE DRIVE; PO BOX 300 . BOIUNG SPRINGS, PA 17007 ASSESS.NO - 400035n MAP NO: 40-24-0752-002 1254 HOLLY PIKE ACRES 1.910 DEED 00237/01111 LAND APPROX. 2 ACRES .. R88ldentIaI Building. RESIDENTIAL TAX AMOUNT DUE--> OF Rates COtJN'1'Y R B. Rates COtJN'1'Y LIB .00219700 73.71 .00018000 6.04 .00219700 187.18 .00018000 15.34 260.89 21.38 Ratu PIRB PROTC .00016000 5.37 .00016000 13.63 2 t. PAID TAX WERT FAMILY TRUST PAYEFI. 1254 HOLLY PIKE CARUSLE PA 17013 \ 8073 310112006 ~ 10 t 286.98. 10 t 23.52.. . lOt 20.90 $331.40 7/0172006 APR 2 H 2006 JUDY ACAMPSELL 121131200I. TAX COLLECT!IEE REVERSE SIDE OF.LL FOR A BREAKDOWN OF YOUR COUNTY TAX DOLLARS- OI'FICE HOURS: MON 10AM-6:30PM (717)258-6517 TUES & WED 10AM-S:3OPM CLSO WKS OF JULY 24-31106 & 11120-12/4106 CLOSEDHOUDAYS Retum Bill with Payment. For a Receipt, Enclose Self Addressed Stamped Envelope. '):'. -:a 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Mary EWert FILE NUMBER 21-06-0260 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman-Roth Funeral Home, Funeral Services 417 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions I Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 2,791 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 79 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Checks cleared after the date of death 271 8. Register of Wills, Filing Fee 15 TOTAL (Also enter on line 9 RecaDitulation) $ 3573 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN I SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Mary EWert 21-06-0260 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Commonwealth of Pennsylvania, Department of Public Welfare, Claim 2. Sarah H. Todd Home, Medical 7,563 1,181 295 57 300 3. Judy A. Campbell, Tax Collector, 2006 County and Township Taxes 4. Gates, Halbruner & Hatch, P.C., Miscellaneous 5. Diversified Appraisal Services TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9,396 217 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF M EW SCHEDULE J BENEFICIARIES arv ert - RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(sl OF ESTATE I. TAXABLE DISTRIBUTIONS pndude outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] 1lester S. Wert, Jr. Son 25% of residue of estate 53 Bloserville Road, Carlisle PA 17013 2 Anna Mary Smith Daughter 25% of residue of estate 482 Petersburg Road, Carlisle PA 17013 3. Craig A. Wert Son 25% of residue of estate 1254 Holly Pike, Carlisle PA 17013 4. Joan Elizabeth Wert Daughter 25% of residue of estate 105 S. Orange Street, Carlisle PA 17013 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ FILE NUMBER 21 06-0260 (If more space is needed, insert additional sheets of the same size) - LAST WILL AND TESTAMENT OF MARY E. WERT I, MARY E.'~mRT, of South Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last will and Testament, in manner and form following: 1. I hereby expressly revoke all wills and Codicils heretofore made by me. 2. I hereby direct my Executor to pay all my just debts, funeral and administrative expenses out of my estate, as soon as practicable after my death. 3. Should ~y husband, Lester S. Wert, survive' me for a period of thirty days following my death, I devise and bequeath the remainder of ~ estate to Lester S. Wert. 4. Should my husband, Lester S. Wert, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the remainder of my estate to my issue living on the thirty-first day following my death, per stirpes. 5. I nominate and appoint Farmers Trust Company, Carlisle, Pennsylvania, Trustee of the share of any beneficiary who may be under the age of twenty-one years. The income and/or principal of said trust may be accumulated or expended for the maintenance, education and support of such beneficiary as my Trustee in its sole discretion 'may determine: and my Trustee, .in the expenditure of income and/or principal for such purposes, may, at its discre- tion, apply the same directly without the intervention of a guardian or pay the same to any person having the care or control of said beneficiary or with whom the beneficiary resides, without duty on. the part of the Trustee to supervise or inquire into the application of the funds by any person to whom any payment is so made. The balance of such income and/or principal shall be paid to such beneficiary upon reaching the age of twenty-one years, or to such beneficiary's estate in the event of death prior thereto. - 1 - 6. I nominate and appoint my husband, Lester S. Wert, as Executor of this my Last Will and Testament; and as substitute Executors I nominate and appoint my children, Lester S. Wert, Jr., Anna Mary Smith, Craig A. Wert and Joan Elizabeth Wert. 7. I direct that my personal representative and Trustee, as well as their successors, shall not be required to file bond or security in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal -fA this /q - day of Augus.t, 1982. 111 . ~ 'W~ Ma~ E. Wert (SEAL) WITNESS: ~IJ~ f?,/~ IW~ COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND I, Mary E. Wert, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law', do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein express.ed. Sworn or affirmed to ~d acknowledged before me, by Mary E. Wert, Testatrix, this I 'f~ day of August, 1982. ~s~C W.u;C C) ()..., I ~J f J4 -e,,:tP. NOTARY PUBUC J.Ai'Jlc:r:: E. l-lEP.T7.:LfR, . PA . I I r n"y Carlisle, r"r:~'-:-":': C~~I ...nll I 27 1983 I,A" co''''mission E"pires January , '/II "" - 2 - _ 0'. __.... ____0- '''_.' "'_"~".~""'"''''~_"__''''''''''''''' ,......,,:.:-JI."...:-,., :.--::' ..,.."';>....-."..~~ .." ............. ' 0:>0..-.. . 1\ COMMONliEALTH OF PENNSYLVANIA SSe COUNTY OF CUMBERLAND We, Tom H. Bietsch and Roger M. Morgenthal, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix, Mary E. Wert, sign and execute the instrument as. her Last will~ that she signed willingly and that she executed it as her free and voluntary act for the" pur- poses thereinexpressed~ that each of us in th~ hearing and sight of the Testatrix signed the Will as witnesses; and th~t to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue inf~uence. " . Sworn or affirmed to and subscribed to before me by Tom H. B1etsch and Roger M. Morgenthal, witnesses, this I a~ day of August, 1982. I - . ~bl~ Witness ~IkJlJ1~ W ness ~ I).,.,,&J I~~ , JAN!CE E. HFRTZLER, NOTARY PU~lIC C\}.{\Derkl'1d r:ounty Corlisle, PA fAy COIT\mi!isb., l:>:oires Janllary V, 1983 - 3 -