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Home My WebLink About05-29-07 (2) 1SDSbDS1D47 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 Date of Birth ~~ Suffix Decedent's First Name [[[] INHERITANCE TAX RETURN RESIDENT DECEDENT MI G Suffix [[[] MI D THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Fill IN APPROPRIATE OVALS BELOW 4Ii:> 1. Original Retum c::> 4. limited Estate 4IIt> c::> 2. Supplemental Retum c=:::> c::> L 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a living Trust (Attach a Copy of Trust) 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 SHAll BE DIRECTED TO: Name Daytime Telephone Number ~~ 6. Decedent Died Testate (Attach Copy of Will) 9. litigation Proceeds Received c::> c::> c::> c::> 8. Total Number of SOB's ~ REGISTEROf~lllS USED. lY ,.:--) , ] ....-' '-I DATE filED ~ ~ tpandrews@pa. net DATE ~~7-Z>7 Side 1 L 1SDSbDS1D47 1SDSbDS1D47 ~ J ~ 1SDSbDS2D46 REV-1500 EX Decedenfs Name: RECAPITULATION Elizabeth D Kirk 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) 0 Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested 8. Total Gross Assets total Lines 1-7 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Sub'ect to Tax Line 12 minus Line 13 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 _ $0.00 16. Amount of Line 14 taxable at lineal rate x .045 $1,455,251.40 17. Amount of Line 14 taxable at sibling rate x .12 $0.00 18 Amount of Line 14 taxable at collateral rate x .15 $15,000.00 19 TAX DUE 20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L Side 2 1SDSbDS2D46 1.1 $975,000.00 I 2.1 $458,882.341 3.1 $0.00 I 4.1 $0.00 I 5.1 $68,263.861 6.1 $47,683.631 7.1 $104,250.31 I 8. $1,654,080.14 9.1 $181,573.20 I 101 $2,255.541 11.1 $183,828.741 12.1 $1,470,251.40 I 13.1 $0.00 I 14. $1,470,251.40 15 $0.00 16 $65,486.31 17 $0.00 18 $2,250.00 191 $67,736.31 I c:::> 1SDSbDS2D46 J REV-1500 EX Page 3 File Number Decedent's Complete Address: Decedent's Name Elizabeth D Kirk STREET ADDRESS 123 South West St CITY Carlisle Tax Payments and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discounts 3. Interest/Penalty if applicable D. Interest E. Penalty 4. Totallnterest/PentaRy (D+E) If Une 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A, This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (3) (4) (5) (5A) (5B) 21-06-0815 $0.00 $15,104.73 $15,104.73 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: b. retain the right to designate who shall use the property transerred or ns income: c. retain a reversionary interest: or d. retain the promise for life of enher payments or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust fo(' or payable upon death bank account or secumy at his or her death? 4. Did decedent own an Individual Retirement Account, annuny, or other non-probate property which contains a beneficiary disignation? D D D D W D W w w w W D W 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. 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 3% [72P.S. Sec. 9116(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 0% (72 P.S. Sec. 9116(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 retum 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 deseased 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 0% [72 P.S. Sec. 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) [72 P.S. Sec.9116(a)(1). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. Sec.9116(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. SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Elizabeth D. Kirk 21-06-00815 All real estate owned solely or as a tenant in common should be reported at fair market value with is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to sell, both having reasonable knowledge of the relevant facts. Property jointly-owned with Right of Survivorship must be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH ITEM NUMBER 155 - 157 W. Louther St., Carlisle, PA 17013 Deed reference: 20 P 196 Sold in arms length transaction; settlement 11/29/2006 [settlement sheet attached] Price: $185,000 $185,000.00 2 271 W. South St., Carlisle, PA 17013 Deed reference: 17 Q 79 Sold in arms length transaction; settlement 1/30/07 [settlement sheet attached] Price: $240,000 $240,000.00 3 123 South West St., Carlisle, PA 17013 Deed reference: 22 U 431 Yet unsold 7,840 sq. ft. parcel, with 5000 sq. ft. house w 2 apartments Tax parcel: 04-21-0320-159 2006 tax assessment: $296,560; common level ration 1.14 adjusted tax assessment: $338,078 $550,000.00 Total (also enter on Line I, Recap) $975,000.00 A. &ettlemant Statement U.S. Department of Housing and Uman Development B. TVD8 of Loan OMB ADDroval No. 2502-0265 (emlres 9130120061 FINAL 1. DFHA 2. DFmHA 3. DCanv. Unlns. .1 6. Ale Number I 7. Loan Number I 8. Mortgage Insurance Case Number 4. nVA 5. nConv. Ins. FN2007.105JBL C. Note: ~~~~~~,=::-"':-~~~=--~s':...~~=::"~:"-' I TitleExpcess Settlement System convtclIan,*,~':"':d:ollno .J~For_ _: _'s U. s. Codt _"\'M,ni _1010. Printed 0112912007 at 14:04 KLL D. NAME OF BORROWER: Restoration Heritage Homes LP ADDRESS: E. NAME OF SELLER: Estate of Elizabeth 0: Kirk ADDRESS: F. NAME OF LENDER: Cash ADDRESS: G. PROPERTY ADDRESS: 271 west South Street, Carlisle, PA 17013 . Borounh of Carlisle H. SETTlEMENT AGENT: Abstract Company of Central PA, Inc., Telephone: 717.243-6222 Fax: 717.243.6486 PLACE OF SETTLEMENT: 26 West Hlnh ~ Carlisle PA 17013 I. SETTLEMENT DATE: 01l3Ol2OO7 J. 'OFB ~TRANSACTION: K. SUMMARY of SELLER'S TRANSACTIoN: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contraclsalesorice 240 000.00 401. Contract sales nrirA 240 000.00 102. Personal Pmn..rtv 402. Personal Prooertv 103. Setttement ch- to borrower lline 1400\ 2.!llI'3.50 403. 104. 404. 105. 405. Adiustments for ilema naid bv seller in advance Adiustments for items paid bv seller in advance 108. School Taxes 011301071006l3OI07 1241.19 408. School Taxes 011301071006130107 1241.19 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 244..144.69 420. GROSS AMOUNT DUE TO SELLER 241241.19 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. ~ or earnest money 5 000.00 501. Exooss l1Annoit lsee Instructions! 202. PrlnclMl amount 01 ~ loans 502. Settlement ch- 10 seller (Hne 1400\ 14618.13 203. Exislinn IoanIs\ taken subiect to 503. Existlna 1oan151 taken suhiArJ 10 204. 504. PavoII 01 Arst LInrlnMA Loan 205. 505. 206. 506. 207. 507. 208. 508. 209. 509. Adlustments for Items unnald bv seller Adlustments for Items unoald bv seller 211. Countv taxes 011011071001130107 97.64 511. Countvtaxes 011011071001130107 97.64 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 5 097.64 520. TOTAL REDUCTION AMOUNT DUE SELLER 14.715.n 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower nine 120\ 244.144.69 601. Gross amount due 10 seller IIine 4201 241 241.19 302. Less amounts--;;;;k\ bvlfor borrower Iline 220\ 5097.64 602. Less reduction amount due seller Illne 520\ 14715.n 303. CASH FROM BORROWER 239.047.05 603. CASH TO SELLER 226 525.42 SUBSTITUTE FORM 1099 SELLER STATEMENT: Tho -.notion ccnIolnod _ II impollonllox irIomlotion ond II bolng ~ \0 1l1o _ RfrMnuo SlHVice. W you ore requAd \0 Illo 0 roI\.m, ~~.::. ~ e~::;:t ~lhiI_ II roquAd \0 bo IOpartod ond 1l1o IRS __... Rha nat-. roportod. Tho Conlr8d _ Prlco dotat>odon = =~:;.,::r.::: ~ ;.:.~.r= =:"b ';~~19. _or Exdlongoo/ PmclpoI RHldonco. lor "'i goin, - _Incorno lox rolLm; Ior__ =.=~~,,;=~~.<r.~~::u..-~o/~~""'J:~J::"~.:'.~~~~~~_ion 11N: SELLER(S) SIGNATURE(St. SELLER(S) NEW MAft.'NG ADDRESS: - , ...l',,"" .. '_~~.;:'_ r.~ .,~ . '" " l' S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: FN2007.1 05 FINAL PAGE 2 SETTLEMENT STATEMENT TIIIeExDress SeUlement SYStem Printed 0112912007 at 14:04 KLL L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SAlESlBROKER'S COMMISSION based on price $240 OOO.OO@ 5.000 = 12 000.00 BORROWER'S SELLER'S Division 01 commission lline 700\ as follows: FUNDS AT FUNDS AT 701. S 12 000.00 to ERA NRT Inc. SETTLEMENT SETTLEMENT 702. $ to 703. Commission oak! at SeltIement 12.000.00 704. Transaclioo Fee to ERA NRT.lnc. 165.00 165.00 BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Orioinatlon Fee % 802. Loan Discount % 803. Aooraisal Fee 804. CredIt- 805. Lender's Insoection Fee 806. icatIon Fee 807. Assumolion Fee 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @$ . ldav 902. Mort"""" Insurance PremIum for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo.@$ lmo 1002. Uartaaoe Insurance mo. lmo 1003. City ProoerIv Tax mo. Imo 1004. Countv ProoerIv Tax mo. 102.41 Imo 1005. School Taxes mo. 248.38 Imo 1009. Aaareaale AnalYSis Adiustment 1100. TITLE CHARGES 1101. Settlernent or cIoslno fee 1102. Abstract or tIUe search 1103. Hie examination to Abstract ComDany of Central PA. Inc. 200.00 1104. Tille insurooce binder 1105. Document Preoaration to Taylor P. Andrews, Esa. POC 1106. Notarv Fees 1107. AttnrT1P.V'sfees to Saldls Flower & LindsaY 100.00 !includes above ttems No: \ 1108. Tille Insurance to POC !includes above ttem' No: \ 1109. Lender's PoIlcv 1110. Owner's PoIIcv 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordino Fees Deed $ 38.50 ..'^"'~_. . Release $ 38.50 1202. CilvlCounlv taxlstamllll Deed $2 400.00 ..~_. 2 400.00 1203. State Taxis''''"'''' Deed $2 400.00 . Mortaaoe S 2 400.00 1204. 1205. 1300, ADDITIONAL SETTLEMENT CHARGES 1301. Final WaterlSewer #04435 to Borouah of Carlisle 53.13 1302. Pest Insoecllon 1303. 1304. 1305. 1306. . 1307. 1308. 1400. TOTAL SE~ENT CHARG&g ~on lines 103 Secllon J and 502 Seclion Kl 2 903.50 14618.13 ~ '/ 1/. / ?CERTlFlCAT1ONOFeUYERANDSELLER ~~.?T) lho HUD-l IfldlD lho ~ ond belief. Ilia_ ond lICCUIllIe __ "'1I18<8IplI1fld _ made on my ac:<:cultorbyma ~trtI.~a~"'.!-HUD-l S-. :.;.: f/Vv ., Y i/ " ~.~ The HUD-1 Settlement StMemenI which I hIwe prepared II . true and ea::tnIIe IICCXU1t of this bWlsadion. I h8ve CMlMd or wUI C8UM Ihe f1n:II to be diIbl.nied In KCOI'dlI'lce with this statement. ~ ~)~ 1-10-07 Cpnestoga Title Insurance Co. 123 East KiI;lg Street, Lancaster PA 17602 Phone 1-800-732-3555 In Lancaster 299-4805 FAX 717-295-7155 Settlement Statement u.s. Departinent of Labo. end Urban DeYl\!lIpment OMB Nil 2502..()265 A. HUD.1 UNIFORM SETTLEMENT STATEMENT B. TypeofLlI8n 1. [)FHA 2. [)FmHA 3. [IConY.Unlns. 6. File Number. 17. Lllan Number. 18. Mortgage Insurance Case Number. 4. [)VA 5. [ ] Cllnv. Ins. C. NOTE: This rorm fumishes a staternant of settlement costs. Amouts paid to and by the settlement agent are shown. ttems marked "(p.o.c)" were paid outside the closing; they are shown ror Inrormatlonal purposes and are not Included in the totals. D. Name & Address of Borrower. E. Name, Address and TIN of Seller: F. Name & Address of Lender. Lynn G. Brenneman, III Fstale of Elizabeth D. Kirk, Yyonne E. Kirk, Exec. nla Diane L. Brenneman 7100 Old York Road 12035 Lake Newport Road Philadelphia, PA 19126 Reston, VA 20194-2741 TIN of Seller. 120-708-3892 G. Property Location: Piace of Settlement: H. SellIement Agent: 155-157 West Louther Street 44 West Main Street Borough of Carlisle, Cumberland County Mechanlcsburg, Pennsylvania 17055 Keilh O. Brenneman Pennsylvania- Phone: (717) 697-8528; FAX: (717) 697-7681 Date of Settlement: INov. 29, 2006 J. SummarY of Borrower's Transaction K. Summary of Seller's Transacttlln 100. Gross Amllunt Due from B!IITClwe. 400. G.!ISS Amllunt Due t!I Selle. 101. Contract sales price $185,000.00 401. Contract sales prlce $185,000.00 102. Personal property 402. Personal proDerty 103. Borrower's settlement chaF\les (line 1400) $3,382.25 403 104. Mortgage Payoff 404 105 405 Adjustments for Items paid by sella. In advanca Adjustments for llems paid by salle. In advance 106. Cilyllown taxes to 406. Cilyllown taxes to 107. Cty./Bor. Taxes 11/29106 to 12/31/06 $67.17 407. Cty./Bor. Taxe=s 11/29/06 to 12/31106 $67.17 108. Assessments to 408. Assessments to 109. School Taxes 11/29/06 to 06130107 $1,056.47 409. School Taxes 11/29/06 to 06130107 $1,056.47 110 410 111 411 112 412 113 413 120. Gross Am!IUnt Due Fr!Im Bllrrowe. $189,505.89 420. GrlI8S Amllunt Dua tll Selle. $186,123.64 200. Amounts Paid bv or In Behall of Bllrrower 500. Reductions In Amount Due to Seller 201. DePIISiIs or earnest money $5,000.00 501. Excess deposil (see Instructions) 202. Principal amount of new loan(s): 502. Settlement charges to seller (line 1400) $14,147.40 203 503. Existlnp Ioan(s) taken subiecl to 204 504. Payoff of first morlgage 205 505. Payoff of second mortgage 206 . . 506 $0.00 207 507 208 508 209 509 Adjustments feI. llems unpaid by selle. Adlustmants feI. Items unpaid bv selle. 210. Cilyllown texes to 510. Cltyllown texes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213 to 513 to 214. Proratlonofrents-ll/29,lll3O $90.34 514. Proration of rents-l1/29, 11/30 $90.34 215. (3 apartment unils) 515. (3 aparlrnent unKs) 216 516 217 517. Transfer of securily deposils to Brenneman $980.00 218 519. ($435, $545) 220. Total Paid By/for Borrowe. $5,090.34 520. Total Reducttlln of Amount Due to Selle. $15,217.74 300. Cash at SeWement Fromlto Borrowe. 600. Cash at Settlement ToIfr!Im Selle. 301. Gross amount due from borrower (line 120) $189,505.89 601. Gross amount due to seller (line 420) $186,123.64 302. Less amounts paid bylfor borrower (line 220) $5,090.34 602. Less reductions In amount due selle. (line 520) $15,217.74 303. Cash [X) from r ) to Borrower $184,415.55 603. Cash [X] to [ ) from Seller $170,905.90 Substitute Form 1099 Selle. Statement The inrormatlon In Blocks E, G, H, I & line 401 (or if line 401 is aSlerisked, line 403 and 404) is Imporlant tax Inrormatlon and Is being fumished to the Internal Revenue Service. If you are required to file a return, a sanction will be Imposed on you if this Kem Is required to be reported and the IRS delermlnes that K has not been reported. If this real estate is your principal residence, file FORM 2119, Sale or Exchange of Principal Residence, ror any gain, with you. income tax retum; ror lither transactions, complete the applicable parts of Form 4797, Form 6252 and/or Schedule 0 (Form 1040). You are required to provide the Selllement Agent (named above) wilh your taxpayer identification number. If you do not provide the Settlement Agant with your taxpayer identification number, you may be subject to cjvil or criminal penalties Imposed by law. Under penailles of pe~ury, I certify that the number shown on this statement is my correct taxpayer identification number. Seller Seller .... .~ ~' .J... . 0." " '. " L., SlIUlement Charges 700. Total SalesIBroker's Commission: (based on price) 185,000 iIll 6% Paid from Paid from Division of Commission (line 7001 as follows: Borrower's Seller's Funds at 701. 11,100.00toERA-NRT,lnc. Funds at 702 Settlement Sel\lement 703. Commission paid at Settlement 11,100.00 704. Transaction Fee to ERA-NRT, Inc. ~. 165.00 165.00 800. Items Payable In ConnecUon with Loan 801. Loan Origination Fee , 802. Loan Discount 803. Appraisal Fee 804. CredK Report to 805. Lender's Inspection Fee 806. Mortgage Insurance Application Fee 807. Flood Certlflcatlon Fee to 808. Tax Service Fee to 809. Documem Preparation Fee 810. Plan Rev1ewto 811. Assumption Fee to 812 813 814 900. Items Required by Lender to Be Paid In Advance 901. Interest from to @ per day 0.00 902. Mortgage Insurance Premium for . 903. Hazard Insurance Premium for 904 905 1000. Reserves Deposited with Lender 1001. Hazard Insurance months @ oer month 0.00 1002. Mortoage Insurance months @ per month 0.00 1003. cny property taxes months @ per month 0.00 1004. County property taxes months IIll per month 0.00 1005. Annual assessments months @ per month 0.00 1006. School taxes months @ per month 0.00 1007 1008 1009. Aggreoate AccountillQ Adlustmenl 1100. TIUe Charges 1101. Selllementlcloslno fee 1102. AbstractllKIe fee 1103. TItJe examination 1104. Tnle insurance binder 1105. Document preparation 1106. Notarv fees 1107 Attorney's fees to (includes above Kem numbers 1108. Title insurance to KeKh O. Brenneman, Agent, Conestoaa Title Insurance Companv 1,283.75 (Includes above Kem numbers 1101-1105) 1109. Lender's coveraoa: 1110 Owner's coverage: $185,000.00 1111. Insured Closing Letter 1112. Endorsements 1113 1200. Government Recordlna and Transfer Charges 1201. Recording Fees: Deed: $38.50 Mortgaae: MIL Stip: 38.50 1202. City/county taxlstamps Deed: $1,850.00 Mortgage: 1,850.00 1203. Slate tax/stamps Deed: $1,850.00 Mortgaae: 1,850.00 1204 1205 1206 1300. Additional SeWement Chames 1301. Survey 1302. Pest Inspection to PerrY Pest Control Co. 45.00 1303. Borough of Carlisle - water/sewer 10 December 28, 2006 103.84 1304. PerrY Pest Control Co. -treatment 928.56 1305 1306 1307 1308 1400. Total SeWement Charoes (This number transfers to Lines 103 & 502 Above) 3,382.25 14,147.40 Certlflcatlon I have carefully reviewed the HUD-l Settlement Statement and to the best of my knowledge and belief, K is a true and accurate statemenl of all reciepts and disbursements made on my account or by me In this transaction. I further certify that I have recelvad a copy of the HUD-l Settlement Statement ~~~-=.--=:~ := Diane L. Brenneman By To the best of my knowledge the HUD-1 Selllement Statement which I have prepared Is true and accurate account of the funds which were received and have been or will be disbursed by the undersigned as part of the selllement of this transaction. 171~ ~llffhOif" WARNING: It is a crlme to knowingly make false statements to the UnKed States an this or any other similar form. PenaRles upon conviction can include a fine and Imprisonment For details see: Tnle 18 U.S. Code Section 1001 and Section 1010. Seller ~"...i "l .,.... '. SCHEDULE B STOCKS AND BONDS ESTATE OF FILE NUMBER Elizabeth D. Kirk 21-06-00815 ITEM NUMBER All property jointly-owned with Right of Survivorship must be disclosed on Schedule F DESCRIPTION V ALUE AT DATE OF DEATH 409 shares ofpepsico @ 64.39 per $26,335.51 2 177.1681 shares of Colgate Palmolive@ 61.16 per $10,835.60 3 1,012.28 shares of Lucent Tech @ 2.25 $2,277.63 4 79 shares of Lucent Teck@2.25 [in certificate form] $177.75 5 5,879.57 shares of Vanguard @ 55.17 $324,375.88 6 544 shares of Carlisle Companies @ 83.3 $45,315.20 7 89.843912 shares of AT&T@31.36 $2,817.51 8 156 shares of Com cast Corp. @ 35 $5,460.00 9 14.3479 shares ofNCR @ 34.39 $493.42 10 100 shares of Avaya stock @ $10.38 $1,038.00 9 89 shares of Photo me de x @$1.39 $123.71 10 Van Kampen 434.489 units @13.39 $5,817.81 11 DW Scudder 1518.380 shares @22.27 $33,814.32 TOTAL (also on line 2, Recapitulation) $458,882.34 SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF FILE NUMBER Elizabeth D. Kirk 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 DESCRIPTION VALUE AT DATE OF DEATH 21-06-00815 ITEM NUMBER Citizens Select Prime money market account $2,114.82 2 Multiple coins sold to Delaware Valley Rare Coin Co [purchase order attached] $14,718.72 3 Personal Property sold at public sale on May II & 12,2007 by Carl E. Ocker sale sheets are available for inspection. $32,497.50 4 Personal Property sold at sale by Alderfer Auction Company on 3/22/07 $4,370.00 5 Personal Property sold at sale by Alderfer Auction Company on 5/24/07 $2,335.00 6 Personal Property remaining with Alderfer Auction Company for future sale $9,300.00 7 Personal Property retained by Yvonne E. Kirk as per will $770.00 8 Rent due at date of death but collected after date of death $600.00 9 Personal federal income tax refund for 2006 $1,130.00 10 Personal state income tax refund for 2006 $346.00 11 coins from SDB [not sold to Delaware Valley Rare Coin Co nor at public sale] $81.82 TOTAL (also on line 5, Recapitulation) $68,263.86 '\ I / ~ DELAWARE VALLEY /1\ DELAWARE VALLEY RARE COIN CO., INC. 2835 West Chester Pike. Broomall, PA 19008 (610) 356-3555 · (800) 345-8188 . FAX (610) 325-0468 PURCHASE ORDER y~ )../07 DATE: " NAME: 4/ 2~$e. rl ,.:(;/J'~/ kY4 '?- j(r f1? < IDENTIFICATION: v , ADDRESS: 7/~ o-/d y~ k ~ / fi',~ /f4 v /r/~& PURCHASED B;f CASH CHECK TRADE AGAINST INVOICE # o CHECK THIS BOX IF PURCHASE WILL ;/tf frl{ ~rf( REQUIRE FORM 1099B .. - QUANTITY DESCRIPTION PRICE AMOUNT U.S. 90% COIN U.S. 40% COIN, W.T.N. . ~, ~;; /' c"1 ;?;",z;e .-.J.' ~if /V7rJ. ,- C~ f'i1r '-W ~ < y c; 31 it 2i c ~~" Ib J.~ 1702L~ + 3 ,.- 1ft." 7 "'-..,{. qjt (1-- lf1 '12093 i- II i '17 p -{ 7 "it' .- l '- 28<000' 1" '-I f71 't -g.L.V ~). - 32 c , ' '3 .... ('1" 'V ~ V,i!!JC ly /' , 1 ' .... 1 2 c r&-/f"1J y. .-C-~ 3t1 "" 5 0 c. 33 c. .$"-.- I ?7~ ''-{ C.- '0 ~~.. 24 8 tf- /rlJ' ~ /'k ",if fD' ~. 1 5 75 ) ';' l r1;y ''{ if"" /...-5 IS' 'Jj 6:3 ," 'J (; ~ (qt 7 jJj'i;f ~ Y ~ -CD b'3 - I, (", .- C).,vC j;4-s '!. ,L{ IfB - (, /& /1'7/ .9 J '/7 t-- I( t/ ~ ,...- /6 \5 ~ 3430'72 + 1 4 :::75GOO )02 TOTAL ' 'z. 1 ' 718"'7~: ~'O IL( -?/J" ~ ", , i ------------ -- " -{\\ , ~ 'fA./ 4 t ~ BILL OF SALE? .' . . . ARTY, IN CONSIDERATION OF $ VAUUE RECEIVED DO HEREBY SELL & ASSIGN LISTED ON THIS BILL TO DELAWARE,VALLEY RARE CGIN CO" INe. AND WARRANT THAT ro DISPOSE OF SAME. I FURTHER WA~ANT THAT I 31:1 \.- .r.:::. EFEND MY RIGHT & TITLE TO . ~, ,GAINST ALL OTHER CLAIMS. t' )' V>4"' (./..,).:1- y;/<' 4 N \ .. SOCIAL SECURITY # (IF'APPLICABLE) Mu~ _ ....1", / / SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Elizabeth D. Kirk 21-06-00815 if an asset was made joint within one year of the decedent's death, it must be reported on Schedule G Surviving Joint Tenant (s): NAME ADDRESS RELATIONSHIP TO DECEDENT A B Yvonne E. Kirk W. Wright Kirk, Jr. 7100 Old York Rd., Philadelphia, PA 19126 319 S. Albany St., Ithaca, NY 14850 daughter son Jointly-owned propertY: ITEM NUMBER LETTER FOR DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF TOTAL VALUE OF DECD'S % INT. DOLLAR VALUE OF DECEDENT'S JOINT TENANT INSTITUTION AND BANK ACCOUNT NUMBER OR ASSET INTEREST SIMILAR IDENTIFYING NUMBER. A 11 ACH DEED FOR JOINTLY-HELD REAL ESTATE 1 A&B Pre 2005 T. Rowe Price Mutual Fund $74,428.22 33% $24,561.31 2 A&B Pre 2005 1400 shares PP&L @ 34.01 $47,614.00 33% $15,712.62 3 A Pre 2005 M&T cking acct: 477757 $14,819.40 50% $7,409.70 TOTAL (also on line 6, Recapitulation) $47,683.63 SCHEDULE G TRANSFERS ESTATE OF FILE NUMBER Elizabeth D. Kirk 21-06-00815 ITEM DESCRIPTION OF PROPERTY TOTAL VALUE DECD.% EXCLUSION TAXABLE INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT NUMBER AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. OF ASSET INT (if applicable) VALUE I 1 Annuity w American Investors Life Insurance Co $20,010.01 100.0% 0.0% $20,010.01 Policy # 338762 I 2 Annuity w American Investors Life Insurance Co $76,613.80 100.0% 0.0% $76,613.80 Policy # 388812 I Beneficiaries [transferees] of both annuities are Yvonne E. Kirk and W. Wright Kirk, Jr daugher and son of decedent. I 3 Gifts to W. Wright Kirk, Jr. after 9/07/2005: $16,253.00 50.0% $3,000 $5,126.50 W. Wright Kirk, Jr. is Decedent's son. paid from joint account with Yvonne E. Kirk I 4 Gifts to Yvonne E. Kirk after 9/07/2005 $11,000.00 50.0% $3,000 $2,500.00 total $11,000 from joint account with Yvonne E. Kirk. This schedule to be completed and filed if the answer of the question on the reverse of the cover is yes. TOTAL (also on line 7, Recapitulation) $104,250.31 AmerUs Annuity Group Co. 555 South Kansas Ave Topeka, KS 66603 1-8oo-ANNUITY November 16,2006 .AMERUS Annuity Group Taylor Andrews 78 W. Pompfer St. Carlisle, PA 17013 Re: American Investors Life Insurance Company Policy Number - 388812 Annuitant - Elizabeth Kirk (Deceased) Dear Taylor: We were sorry to learn of the death of Elizabeth Kirk and ofter our deepest sympathy to her family and friends. Please read the enclosed General Instructions for Completion of Annuity Death Claim Form. These instructions list the documents required to process the claim on Policy #388812. Our records indicate the beneficiary designation is W. Wright Kirk, Jr. and Yvonne Kirk. The Death Benefit provided by this policy is the Accumulated Value (approximately $76,613.80 as of today's date) applied under a fixed period equal to five years or longer. We have enclosed an illustration of a five-year payout with monthly benefits for your review. Annual, semi-annual and quarterly payouts may also be chosen. We will be pleased to provide illustrations of alternative payout options for your review. In lieu of the Accumulated Value under a fixed period, the Beneficiary may elect to receive a lump sum payment of (approximately $70,408.08 as of today's date) which is the larger of the Cash Surrender Value or the total Premiums paid under this policy less any Withdrawals. . The death benefit will be paid with interest from the date of death to the date of payment or other settlement at the same rate that the Company would have credited if the Annuitant had not died. The credited rate is currently 3.00 percent. If you should have any questions or need illustrations of alternative payment options, please do not hesitate to contact our Customer Service Department at 1-888-ANNUITY (1-888-266-8489). Sincerely, ~4{~ Katrina M. Teske Claims Specialist Enclosures ... AAaRvs,,-, AMERUS Life 1-888-252-5530 (CUSTOMER SERVICE) AMERICAN INVESTORS LIFE INDIANAPOLIS LIFE ...AAaRVS,,- 1-888- 266-8489 (CUSTOMER SERVICE) 1-888-266-8489 (CUSTOMER SERVICE) AMERICAN INVESTORS LIFE INSURANCE CO., INC. November 16, 2006 SPECIAL DEATH BENEFIT PROVISION (5 YEARS) Kirk Policy Number 388812 Account Value $76,613.80 Payment $1,339.98 PER MONTH $~69.99 (Per Beneficiary) First Payment 11/16/2006 Last Payment 10/16/2011 Total Payments $80,398.52 Principal . $50,000.00 Exclusion Ratio 62.19% Interest Rate 2.00% This illustration will expire on: November 26, 2006 AMERICAN INVESTORS LIFE INSURANCE CO., INC. November 16, 2006 SPECIAL DEATH BENEFIT PROVISION (5 YEARS) Kirk Policy Number 338762 Account Value $20,010.01 Payment $349.98 PER MONTH $174.99 (Per Beneficiary) First Payment 11/16/2006 Last Payment 10/16/2011 Total Payments $20,998.50 Principal $14,626.17 Exclusion Ratio 69.65% Interest Rate 2.00% This illustration will expire on: November 26, 2006 SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF Elizabeth D. Kirk FILE NUMBER 21-06-00815 ITEM NUMBER A. 1 2 B. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Debts of decedent must be reported on Schedule I. DESCRIPTION Funeral Expenses: Auer Memorial Home and Cremation Services Memorial expenses Administrative Costs: Personal Representive Commissions Name of Personal Representative(s) Yvonne E. Kirk Social Security Number of Personal Representative: 174-46-6034 Street Address: 7100 Old York Rd. City: Philadelphia State: P A Zip: 19126 Year(s) commissions paid: 2007 Attorney fees to Andrews & Johnson Family Exemption not claimed Claimant Street: City: State & Zip Relationship of Claimant to Decedent: Probate Fees to Register of Wills Tax Return Preparer's Fees to Patricia Rosendale, CPA Realtor fees - sale of 155 - 157 W. Louther St., Carlisle Transfer Tax - sale of 155 - 157 W. Louther St., Carlisle Pest Control treatment for sale of 155 - 157 W. Louther St. Carlisle Realtor fees - sale of271 W. South St., Carlisle Transfer Tax - sale of271 W. South St., Carlisle Realtor fees - sale of 123 S. West St., Carlisle Tansfer Tax - sale of 123 S. West St., Carlisle Auctioneer's fee to Carl Ocker's Auction services + auctioneer's expenses Alderfer Moving and Storage - moving and storing until sale of personalty Alderfer Auction Company - sales commission from 3/22/07 sale Alderfer Auction Company - sales commission from 5/24/07 sale Alderfer Auction Company - sales commission on items yet unsold [15%] Legal advertising Appraisal of select personal property [some retained by Yvonne Kirk] Tim Williams - labor to prepare properties for sale Penoco's Asbestes Abatement - prepare property for sale Yvonne Kirk - reimburse for supplies to prepare for public sale Yvonne Kirk - mileage for multiple trips from Philadelphia to Carlisle [.445 per mil Yvonne Kirk - tolls for mutiple trips from Phildadelphia to Carlisle AMOUNT $291.00 $617.39 $45,000.00 $45,000.00 $1,245.00 $800.00 $11,265.00 $1,850.00 $928.56 $12,165.00 $2,400.00 $33,000.00 $5,500.00 $6,997.75 $1,010.08 $992.75 $513.75 $1,395.00 $226.55 $180.00 $3,674.44 $2,932.00 $762.73 $2,024.79 $182.00 25 26 27 28 29 30 31 32 Yvonne Kirk for postage Yvonne Kirk for trash bags [municipal bags] Milton Stackfield - trash removal after public sale Yvonne Kirk reimbursement for office services - Kinko's etc Traveler's Indemnity - casualty insurance on decedent's home & possessions $54.05 $119.00 $250.00 $71.36 $125.00 TOTAL (also on line 9, Recapitulation) $181,573.20 SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Elizabeth D. Kirk 21-06-00815 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 2 3 4 5 6 7 Blue Cross Penn Rehab Associates Tim Williams - for labor on properties Robert Myers - security deposit Lowes Jill Oaks - security deposit Susan Fron - security deposit $115.00 $33.20 $643.50 $177.05 $626.79 $125.00 $535.00 TOTAL (also on line 10, Recapitulation) $2,255.54 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Elizabeth D. Kirk 21-06-00815 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributioos, and transfeTS under Sec. 9116(aXI.2)] 1 Merritt C. Kirk, Jr. , 1301 Lakeview Blvd., Denton, TX 76208 nephew $5,000.00 2 Robert C. Kirk, 4288 S. 600 E., Laotto, IN 46763 nephew $5,000.00 3 Clyde Kirk, U.S. 415, Lot #58, 14880 Tamiami Trail, nephew $5,000.00 Porta Gorda, FL 33955 4 Yvonne E. Kirk, 7100 Old York Rd., Philadelphia, PA 19126 daughter 1/2 of residue 5 M&T Bank, Trustee for W. Wright Kirk, Jr. [decedent's son] FBO W. Wright Kirk, Jr. for his life son 1/2 of residue 319 S. Albany St., Ithaca, NY 14850 remainder interest to Yvonne E. Kirk, or her issue contingent remainder interest to 7 charities II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. Charitable and Governmental Bequests: TOT AL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $0 :c \". ~ '- p ~ 1 ~ <-.,J./ LAST WILL AND TEST AMENT OF ELIZABETH D. KIRK I, ELIZABETH D. KIRK, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any and all wills and codicils heretofore made by me. ITEM I: My personal representative shall pay from the residue of my estate the expenses of my last illness, funeral and burial debts du1y allowed against my estate, and all death taxes (Pennsylvania inheritance tax and federal estate tax) occasioned by my death and incurred with respect to all property taxed to my estate regardless of whether such property passes by this Will or passes outside of this Will. ITEM II: I bequeath those articles of my automobiles, personal effects, household goods, and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, as set forth in a separate memorandum which I shall place with my Will to the persons therein designated. If I shall leave no separate memorandum, or with regard to my automobiles, personal effects, household goods, and other tangible personalty of like nature (not including cash or securities) not referenced by such memorandum, I direct that my daughter, YVONNE E. KIRK, shall have the power to buy any item she wants for the appraised !::J.. ~ .. - ):: ~ l '- ~ value without the need for Court approval and all the remaining personalty shall be sold at public or private sale and the proceeds shall be distributed with the residue of my estate. ITEM III: I grant my Daughter, YVONNE E. KIRK, of Philadelphia, Pennsylvania, the option to purchase any or all of my real estate holdings (excluding all furnishings), specifically including 123 South West Street, 271 West South, and 155-157 West Louther Street in Carlisle, Pennsylvania, with each premises to be valued for purposes of such option at the appraised value as established by an appraiser who is a certified residential specialist, which appraisal shall be secured by my personal representative. Such option must be exercised by written notice thereof to my personal representative with copies to my Son, W. WRIGHT KIRK, JR., within six (6) months following my death. My Daughter shall have authority to make the purchases contemplated here without the need for Court approval. Should my Daughter, YVONNE E. KIRK, fail to exercise such option, or should she notify my personal representative in writing of her release of such option prior to its expiration, I devise my real estate as a part of my residuary estate. If my estate shall sell my real estate, I direct that my executrix shall retain the services of Mary Fitts [currently with Jack Gaughn real estate company] as the realtor to market the properties. ITEM IV: I give and bequeath the sum of five thousand ($5,000.00) dollars to each of the following of my nephews: Merritt C. Kirk, Jr., 205 Pine Tree Rd., Radnor, P A Robert C. Kirk, 5062 E. 500 S-57, Churubusco, IN Clyde Kirk, 229 Gumbush Rd., Townsend, DE 2. .~ ~ ... p t ] w ITEM V: I direct that my Executrix shall commence making payments of six hundred ($600) per month to my son, W. WRIGHT KIRK, JR. as soon as possible after my death. The monthly payments under this ITEM IV shall terminate when the Trust referenced in ITEM V, 2. is funded. The payments made under this ITEM IV shall be deducted from the share given to my son, W. WRIGHT KIRK, JR. in ITEM V. ITEM VI: I devise and bequeath the residue of my estate, of every nature and wherever situate, in two (2) equal shares, as follows: 1. One (1) share to my Daughter, YVONNE E. KIRK, of Philadelphia, Pennsylvania, or to her issue if she shall not survive me. One (1) share to my Trustee hereinafter named, IN TRUST, for the following uses and purposes: a. To pay the net income therefrom to my Son, W. WRIGHT KIRK, JR., in monthly installments. b. As much of the principal of this trust as my Trustee, in its sole discretion, deems prudent and proper for the support and assistance of my Son, W. WRIGHT KIRK, JR., shall be paid by my Trustee to my Son or on his behalf, and my Trustee shall consider the impact of a distribution of principal on my Son's eligibility for government entitlements; and I direct that my Trustee shall make no distributions of principal to my Son or on his behalf if the effect of such distribution shall be to render him ineligible for government entitlements or government benefits that he would otherwise receive but for distributions of principal from this trust. c. This trust shall terminate at the death of my Son, W. WRIGHT KIRK, JR., and the remaining principal shall then be distributed to his issue, and ifhe shall have no issue, then to my Daughter, YVONNE E. KIRK, of Philadelphia, Pennsylvania, if she shall be surviving. If YVONNE E. KIRK shall not be then surviving, I direct that the remaining principal shall be distributed in equal shares to the following organizations in Carlisle, Pennsylvania: Safe Harbor [transitional housing in former James Wilson Hotel Building], Salvation Army, Samaritan Fellowship, American Red Cross, Allison Methodist Church, Cumberland County .:f ~ - P 3. -t ,Q ~ -- VJ Historical Society and Loaves & Fishes of Tompkins County, Inc. Should my Daughter, YVONNE E. KIRK, and my Son, W. WRIGHT KIRK, JR., both predecease me without issue, I devise and bequeath the residue of my estate, of every nature and wherever situate, in equal shares to the following organizations in Carlisle, Pennsylvania: Safe Harbor [transitional housing in former James Wilson Hotel Building], Salvation Army, Samaritan Fellowship, American Red Cross, Allison Methodist Church and Cumberland County Historical Society. ~ ..\.. ~ " p t ---0 ~ ,- -- w ITEM VII: No interest of any beneficiary under this Will, any codicil hereto, or any Trust created herein, shall be subject to anticipation or voluntary or involuntary alienation. ITEM VIII: My Executrix and Trustee, and their successors, shall have the following powers in addition to those vested in them by law, and by other provisions of my Will, applicable to all property, whether income or principal, including property held for minors, exercisable without court approval, and effective until actual distribution of all property: A. To borrow money from any person or institution, including my Executrix or Trustee, and to mortgage or pledge any or all real or personal property as my Executrix or Trustee in its sole discretion shall choose. B. To compromise any claim or controversy. c. To invest in all forms of property (including stock, common trust funds and mortgage investment funds, whether maintained by my corporate fiduciary or others) without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principal of diversification or risk. D. To retain any or all of the assets of my estate, real or personal, without regard to any principal of diversification or risk. E. To sell at public or private sale, to exchange, or to lease for any period oftime, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as they deem proper. ITEM IX: I appoint my Daughter, YVONNE E. KIRK, Executrix of this my Last Will and Testament. Should my Daughter fail to qualify or cease to act as Executrix, I appoint M&T BANK of Carlisle, Pennsylvania, as Executor of my estate. ITEM X: I appoint M&T BANK of Carlisle, Pennsylvania as Trustee of the Trust created by this Will. This appointment is subject to the power of my daughter, YVONNE E. KIRK, to replace M&T BANK with a different corporate Trustee by delivering to M&T BANK a written notice of the substitution and a written consent signed by an authorized representative of the replacement corporate Trustee. ITEM XI: I direct that my Executrix and her successors shall not be required to give bond for the faithful performance of her duties in this or any other jurisdiction. IN WITNESS WHEREOF, I, ELIZABETH D. KIRK, have hereunto set my hand and seal to this my Last Will and Testament, consisting of seven (7) printed pages, each of which bears my signature, this .:1.o-ht day of JUTle, ,2002. ~~~1d~~ V,~(\-~ Elizabeth D. Kirk, Testatrix (SEAL) Signed, sealed, published and declared by the above-named Testatrix, Elizabeth D. Kirk, as and for he t Will and Testament, in the presence of us, who, at her request, in her sight and presence and n . ht d pr sence of each other, have hereunto subscribed our names as witnes COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) WE, ELIZABETH _PoM\~~~C!)~ D. KIRK, TAYLOR P. ANDREWS, and , the Testatrix and witnesses, respectively, whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as and for her Last Will and Testament and that she signed willingly and that she executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. '\ Subscribed, sworn to and acknowledged before me by Elizabeth D. Kirk, the Testatrix, and ~cribed to and sworn or affirmed to before me by TA YLJ).R.. P. ANDREWS and C\'\4 \cL (; -:S-O~S,." witnesses, this Q() day of'.JUY\e-- 2002. NOTAAIAL SEAL SHELLY SEXTON. NOTARY PU~~~NiY CARLISLE BORO. CUM8ERlJ.NO 003 MY COMMISSION EXPIRES APRIL 28. 2 I Membar, Pennaylvanl, Maoelallon of MOW 8S (SEAL)