HomeMy WebLinkAbout05-30-06
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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
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
:L I 010
o 01 14--
Date of Birth
a 0 q '3 0 '5 7 .~ .<6'
Decedent's Last Name
01 31 ;)..00 Co
Suffix
03ao }~ 13
Decedent's First Name
MI
(Ylf.. () J I e.(
(f\r $
tLe. \ ~t1
.T
(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 Retum
<=>
2. Supplemental Return
<=>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
<=>
4. Limited Estate
o
<=>
<=> 4a. Future Interest Compromise (date of
death after 12-12-82)
<=> 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
<=> 10. Spousal Poverty Credit (date of death <=> 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
iL
8. Total Number of Safe Deposit Boxes
...
~ e \J t rl 'I
Firm Name (If Applicable)
D ea.. f\
(goer q~7 ~ro<{7
REGISTEIHJ:F WILLS USE @.Y
..- CY'"
, 0 ~ A..( I lLn + r (.,
Second line of address
..
A 1/ Vn .IJ....-e...
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C)
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j f-Tl
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"11
First line of address
(-)
:*~
-...
~
City or Post Office
So fO<l ( S
State
ZIP Code
DATE~ILED
CJ1
Po 1 1\4-
tJ3"
o <l a.q, <.I
Correspondent's e-mail address: ~ O'()~
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. Declaretion of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN OAT
~3 aoe
N:S ogCj.l/4
ADDRESS . +
ItJ3 Af./4~i'- A~Y)u.e. ~~S PO)f}
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051047
15056051047
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1SDS6DS2D48
REV-1500 EX
Decedent's Name:
RECAPITULATION
1. Real estate (Schedule A). ............................................ 1.
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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
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 Govemmental 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.
Decedent's Social Security Number
dO Y> 30 5 '7 ;\ f
20 0 0 0 . 0 ~
(J .
o
o.
.1 5 q o.a 0
l1 .
o
2 I 5q 0.0 0
to .(0 (0 LJ.l 0
7 a o.(e 3
/ I 3~5.33
TO.. ~o </. fq 1
o.
'0 ~ 0 tf. ~ 7
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_
16. Amount of Line 14 taxable
at lineal rate X.O.!:lS
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
10;lD
o.
tf..(P7
o
d
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
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1SDS6DS2D48
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3ISCf.al
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1SDS6DS2D48
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENTS NAME
Helt'r1 cr. ~cI U--r
STREET ADDRESS J.J..<
- uu_u ---1.JJo~ \N. -~~---~u--Sb.
File Number
CITY
'€..-
ZIP J70 ) '5
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CrednslPayments
A. Spousal Poverty Credn
B. Prior Payments
C. Discount
(1)
$ 3) I set. d., \
3.
InterestlPenalty if applicable
D. Interest
E. Penalty
o
Total Credits ( A + B + C ) (2)
4.
~-_.~~. TotallnterestIPenalty ( 0 + E)
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.
(3)
(4)
(5)
(SA)
(5B)
o
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
1f' ~ I S9 . J J
I
o
o
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE 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 ~
b. retain the right to designate who shall use the property transferred or ns income; ............................................ 0 l8J
c. retain a reversionary interest or.......................................................................................................................... 0 gj
d. receive the promise for life of enher payments, benefits or care? ...................................................................... 0 ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 l&I
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 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 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1 t 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. 99116 (a) (1.1) (ii)l. The statute does not exemDt 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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-1502 EX+ (6-9W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
/-If If-0 0. mend w
All real property owned solely or as a tenant In common must be reported at fair martlet value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is jolntly-owned with right of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Deceden t '5 reslcl(()c~ at tD 00
IN. LOlJ-+~ $}-.
fIgO) 000
TOTAL (Also enter on line 1, Recapitulation) $ ?O, 000 ,a (]I
(If more space Is needed, insert additional sheets of the same size)
REV-150B EX+ (6-9B) .-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VAlUE AT DATE
OF DEATH
J
&f)~ QeCO-Atrl- IfQO . (] C)
I+-en, S r~ Jlcu.S/c)10 lcl Solo{ 1-0 a~dielr1eu- - I} 4-30. o(J
vaLLu cy:pro ~~ ~;f)(; St I~
a
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
/S9o
REV-1511 EX+ (12-99*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Debts of decedent mUlt be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
1.
V)W\lI-Y'O:)) Io~\) Co.Sh-t ~ <e~J
-ex.~~S
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
N~
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _Zip
Year(s) Commission Paid:
2.
Attorney Fees
NOne..
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Nore.....
Street Address
City
State _Zip
Relationship of Claimant to Decedent
4.
Probate Fees
N CIne-
Ndy)Q.....
5.
Accountant's Fees
6. Tax Return Preparer's Fees
7. Noy)~
1(0 ) (pCplf-. 70
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$/(\ ((J(otf.7(j
I
REV-1512 EX+ (12-()3) *'
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUTlES, & UENS
ttfJen tYluxd l ~('
Report debtllncurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
VALUE AT DATE
OF DEATH
FILE NUMBER
ESTATE OF
ITEM
NUMBER
1.
DESCRIPTION
Reav\ esh1+e-
~~$
tto &' g
~
\kk, II r~ bl \t s
LfC) · lQ 3
TOTAL (Also enter on line 10, Recapitulation) S
(If more space is needed, insert additional sheels of the same size)
REV-1513 EX+ (!HlO)
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
I. &\01\ C-\ ke \tv()
;bo (~w-l1r Rd
C~~"flt ~T Olo33 1
"l... f<u.c.h~ ) 'JdhYl) CA"<lit-o(>~ f~LJl1t') ~ll~ ~(~J - .
( a H ~ rdr" (LM\cl)'(~ ~ G-1Mi", \a ll~ ) q ("~dJu \clrt{) f)
$Q.M( odd. t't~5 oS ~Iq(\o. K.e tl~
6, ~orf~ ~Ov-n
l()~ ~U"lo.r&\~ A ue.
"S~5 PeA f1+ N~ ()~"l..c.tl\
4. b:l~ ~0lX)
~Sl~ \tJood tQ~ DeM>
~s lc.vr)tl1ro. tV:S-
--- () OR'330
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnclude outright spousal distributions. and transfers under
Sec. 9116 (e) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
~((1-..-dcA~~("
AMOUNT OR SHARE
OF ESTATE
· c2, 500
$\ 500 pex"' (.~.i1d
("l.. ) 000 .r ~o l )
q~ct~r . L)500
~ (ctrJs-.oV1
~ z.) 500
~~t ~]
ENTER DOlLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE. ON REV-l500 COVER SHEET
[c~l()u.<<i
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAl DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
o
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
C)
TOTAL OF PART 11- 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)
REV-1513 EX> (9-00) .
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
J TAXABLE DISTRIBUTIONS pnctude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
5. ko.+h)' t>(O 'AJ ~
'd.T7"L Vo..lb")~ Dr.
~ e~'11 P"'ISO lo~
<0 . ~ (i ()\-ftft €:> rOJ-Y\
~,--, "l.. \J~ l~ "\t-vJ Dc.
L~ Q'Bwt'e.'ct PA \SoCo8
"t. )+~ aovJl '"
~-" ~ "o..l~V;'-tAJ vI".
~ ~l~.("(~ l\ FA lsoto1
~. l-~~ kJ2- €AA- *-
~o 'lo N. '"l...'t'S- ~.
A r\" "t~ +c..n "A "'Z..'2. to 0 1
ct ~L\er ~
l03 A+tc-.~~(. A~
~s (/0\:04-- t\)"'J' o~c:;)..qq,
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
q(a.rdd(U.\~Kk.r
~ytt~t\(o..~~
~ rtod- ~ ('ard~(1(")
~~
AMOUNT OR SHARE
OF ESTATE
, 'l....} 50 0
1. 500
.s 500
1f 't '5oe
rt'5l~ \
05lf ) 1(JZf .lJl7)
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,ASAPPROPRIATE, 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
o
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
o
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheels of the same size)
%.AI'! W%LX. ..... "'..MIIN'I O~
HBLEN MENDLBR
,_............ . R II ~ .?4i' ""1O~'-" .' ,:". .,)0 ",_~",_",~"",',,"-~-""'''''
I, HELEN MENDLER, NOW RESIDING AT 600 W. LOUTHER STREET,
CARLISLE, PA 17013, BEING OF SOUND MIND AND UNDERSTANDING, DO MAKE,
PUBLISH AND DECLARE THE FOLLOWING TO BE MY LAST WILL AND TESTAMENT.
I REVOKE ALL WILLS AND TESTAMENTARY WRITINGS HERETOFORE MADE BY ME:
ARTICLE FIRST
A. I NOMINATE AND APPOINT MY DAUGHTER, BEVERLY, AS EXECUTOR OF
THIS ~Y LAST WILL AND TESTAMENT. IF BEVERLY PREDECEASES ME, OR SHALL
FAIL OR CEASE TO SERVE AS MY EXECUTOR, FOR ANY REASON WHATSOEVER, I
NOMINATE AND APPOINT HER HUSBAND, EDWARD L. DEAN, SR., AS HER
SUCCESSOR.
B. I DIRECT THAT NO FIDUCIARY APPOINTED PURSUANT TO THIS WILL
SHALL BE REQUIRED TO FURNISH BOND OR OTHER SECURITY IN ANY
JURISDICTION IN WHICH THEY MAY BE CALLED UPON TO ACT.
ARTICLE SECOND
I DIRECT MY EXECUTOR TO PAY: (1) ALL OF MY JUST DEBTS; (2)
THE EXPENSES OF MY LAST ILLNESS; (3) MY FUNERAL AND RELATED EXPENSES;
AND (4) THE EXPENSES RELATED TO THE ADMINISTRATION OF MY ESTATE AS
SOON AS PRACTICABLE AFTER MY DEMISE.
ARTICLE THIRD
I DIRECT THAT MY EXECUTOR SHALL PAY OUT OF MY RESIDUAL ESTATE
ALL ESTATE, INHERITANCE, SUCCESSION AND OTHER TAXES TOGETHER WITH ANY
INTEREST OR PENALTY THEREON, ASSESSED PURSUANT TO MY DEATH, IN
RESPECT TO ALL PROPERTY REQUIRED TO BE INCLUDED IN MY GROSS ESTATE
FOR ESTATE OR LIKE TAX PURPOSES.
ARTICLE FOURTH
A. I BEQUEATH TO EACH OF MY GRANDCHILDREN (KATHY BROWN, EDWARD
L. DEAN, JR., GLORIA KELLEY, BARBARA DEAN, LEE KELLEY) THEN LIVING
THE AMOUNT OF $2,500.00.
B. I BEQUEATH TO . EACH OF MY GREAT GRANDCHILDREN THEN LIVING
,. '.. ",. , . ,~ : ., '.. '.
(STEVEN BROWN, :JENN;l;'F-ER-B-ROWN, CHRI STOPHER KELLEY, RYAN KELLEY,
- . ,.-_. I
RACHEL KELLEY, JOHN-KELLEY) THEN LIVING THE AMOUNT OF $500.00.
S:"l :'Z ::d S- SAiTICLE FIFTH
,
../ __' _.' ___ ".F' .)=..1
a.-"",. ".""~"
~~~\'~7LJ..~,...~I~ ...~
~'<<"""..n'",~;"" .."""'''''''f'' . $".-,~fJ'fll .,
~ ,."""~,~,,~
A. I BEQUEATH ALL OF MY REMAINING PERSONAL EFFECTS TO MY
DAUGHTER, BEVERLY.
B. IF MY DAUGHTER BEVERLY, .PREDECEASES ME, I BEQUEATH ALL OF
MY REMAINING PERSONAL EFFECTS TO HER HUSBAND, EDWARD L. DEAN, SR.
C. I DIRECT THAT ANY EXPENSES RELATING TO THE PROTECTION OR
DISTRIBUTION OF THE ABOVE-REFERENCED ASSETS ARE TO BE PAID OUT OF MY
ESTATE AS AN EXPENSE OF GENERAL ADMINISTRATION.
ARTICLE SIXTH
THE REST, RESIDUE AND REMAINDER OF MY ESTATE, INCLUDING BUT NOT
LIMITED TO REAL PROPERTY, PERSONAL PROPERTY, AND ALL OTHER PROPERTIES
REMAINING AFTER PAYMENT OF THE DEBTS AND EXPENSES WHERESOEVER LOCATED
AND SPECIFIED IN ARTICLE SECOND HEREOF (REFERRED TO AS MY "RESIDUAL
ESTATE"), I BEQUEATH AS FOLLOWS:
A. I BEQUEATH MY RESIDUAL ESTATE TO MY DAUGHTER, BEVERLY.
B. IF MY DAUGHT~R, BEVERLY, PREDECEASES ME, I BEQUEATH MY
RESIDUAL ESTATE TO HER HUSBAND, EDWARD.
ARTICLE SEVENTH
THE INTERESTS OF ANY BENEFICIARY CREATED AND LISTED HEREUNDER
SHALL NOT BE SUBJECT TO SALE, ASSIGNMENT OR TRANSFER IN ANY MANNER,
AND SUCH INTEREST SHALL NOT BE LIABLE WHILE IN THE POSSESSION OF MY
EXECUTOR FOR THE DEBTS, CONTRACTS, OBLIGATIONS, LIABILITIES,
ENGAGEMENTS, UNDERTAKINGS OR TORTS OF ANY SUCH BENEFICIARY.
ARTICLE EIGHTH
I GRANT MY EXECUTOR IDENTIFIED IN ARTICLE FIRST THE FOLLOWING
POWERS, WHICH SHALL BE CONSTRUED BROADLY, TO BE EXERCISED IN THE
EXECUTOR'S DISCRETION AS THE EXECUTOR DEEMS JUST AND PROPER, IN
ADDITION TO AND NOT IN LIMITATION OF THE EXECUTOR'S COMMON LAW AND
STATUTORY POWERS:
A. TO MAKE ANY DIVISION OR DISTRIBUTION OF MY ESTATE REQUIRED
BY THIS WILL, AND TO THAT END TO ALLOT SPECIFIC SECURITIES OR OTHER
PROPERTY, OR ANY UNDIVIDED INTEREST THEREIN, TO ANY PERSON, SHARE OR
PART, ALTHOUGH IT MAY DIFFER IN KIND FROM SECURITIES OR PROPERTY
ALLOTTED TO ANY OTHER PERSON, SHARE OR PART;
B. TO RETAIN OR DISPOSE OF ALL OR ANY PORTION OF MY ESTATE,
REAL OR PERSONAL, IN ANY i~NNER AND AT ANY SUCH TIME THE EXECUTOR
DEEMS SUCH DISPOSITION OR RETENTION TO BE IN THE BEST INTEREST OF THE
,.. u
~
"'I"""...,!t:!I
-._"'~",~". 'VI~:~f~,"~.:}.~~::t~'~/J?~.~:~!fiI".
",'<"i;,':._.;",c,>,/.:.,,,....:.
C. TO PAY, EXTEND, RENEW, MODIFY, SETTLE, ADJUST, COMPROMISE,
RECEIVE OR ACCEPT, WITHIN THE EXECUTOR'S DISCRETION AND UPON SUCH
EVIDENCE AS THEY MAY DEEM SUFFICIENT, ANY BENEFIT, OBLIGATION, OR
CLAIM, INCLUDING TAXES, EITHER IN FAVOR OF OR AGAINST MY ESTATE;
D. IN CASE A SPECIFIC BEQUEST BECOMES PAYABLE TO A MINOR OR TO
A PERSON WHO IS, IN THE OPINION OF THE EXECUTOR, UNABLE TO PROPERLY
ADMINISTER SUCH AMOUNTS, THEN SUCH AMOUNTS SHALL BE PAID OUT BY THE
EXECUTOR WITHIN THE EXECUTOR'S DISCRETION IN ONE OF THE FOLLOWING
WAYS, OR ANY OTHER WAY THE EXECUTOR DEEMS APPROPRIATE:
(i) TO THE LEGALLY APPOINTED GUARDIAN OR CONSERVATOR OF
SUCH BENEFICIARY;
(ii) TO SOME RELATIVE OR FRIEND HAVING REACHED THE LEGAL
AGE OF MAJORITY FOR THE CARE OR SUPPORT OF SUCH BENEFICIARY; OR
(iii) TO THE EXECUTOR FOR SUCH BENEFICIARY'S CARE OR
SUPPORT.
E. THE DECISION OF MY EXECUTOR ON THE MATTERS INCLUDED HEREIN
SHALL BE FINAL AND CONCLUSIVE ON ALL PARTIES.
IN WITNESS HEREOF, I HAVE HEREUNTO SET MY HAND AND SEAL THIS
#l
1,1- DAY OF THE MONTH OF rlEP17EMJlEI(
NINETY NINE.
, NINETEEN HUNDRED AND
1f-4Z,/IA 0J1~ ~
HELEN MENDLER
~ .~..........,. .-
SELF-PROVING AFFIDAVIT
WE, THE TESTATOR AND WITNESSES, RESPECTFULLY WHOSE NAMES ARE SIGNED
TO THE WITHIN WILL, BEING FIRST DULY SWORN, DO HEREBY DECLARE TO THE
UNDERSIGNED AUTHORITY THAT THE TESTATOR SIGNED AND EXECUTED THE
INSTRUMENT AS HER LAST WILL AND TESTAMENT, THAT HE SIGNED IT
WILLINGLY, AND THAT HE EXECUTED IT AS HIS FREE AND VOLUNTARY ACT FOR
THE PURPOSED THEREIN EXPRESSED; AND EACH WITNESS STATES THAT HE/SHE
SIGNED THE WILL AS WITNESS IN THE PRESENCE AND HEARING OF THE
TESTATOR, AND THAT TO THE BEST OF HIS/HER KNOWLEDGE THE TESTATOR WAS
AT THAT TIME OF SOUND MIND, AND UNDER NO CONSTRAINT OR UNDUE
INFLUENCE.
; JejP/11 Chtf/ll /1) bV
HELEN MENDLER, TESTATOR
.&.~
WITNESS .....--
lJu'J~ ,o~
WITNEs7-- J
Subscribed, sworn to and acknowledged before me,
HELEN MENDLER, the Testator, and sworn to and acknowledged before me
by t:'P.WAll.D .vE'MI /36,/6'AJ. ~ 'PJ3FI-N ,the witnesses, this /"t!:-
_day of .$6PI1JM16~ , 1999.
,~~~~~.
NOTARY PUP4{IC V
Notarial Seal
George L. Bowen, Jr., N~PuIIlIc
Carlisle 8oro. curi'1bel'laftd~
My CommIssion Expires June 7. 2002
Mem . nsylvania Associa ion-et- otanes