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HomeMy WebLinkAbout05-31-07 (2) -l 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY 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 . County Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 6 File Number 01069 Date of Birth 194527676 11112006 03231962 Decedent's Last Name Suffix Decedent's First Name HUHBERSTON DEBORA MI J (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 0 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82) 0 4. Limited Estate 0 4a. Future Interest Compromise 0 5. Federal Estate Tax Return Required (date of death after 12-12-82) [K] 6. Decedent Died Testate 0 7. Decedent Maintained a Livin9 Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 0 9. Litigation Proceeds Received 0 10 Spousal Poverty Credit (date of death 0 11.Election to tax under Sec. 9113(A) . between 12-31-91 and 1-1-95) (Attach Sch. 0) ~ORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number HUBERT X. GILROY 7172433341 '-i Firm Name (If Applicable) HARTSON LAW OFFICES REGISTER OF 't'VI~~S US~_~NL Y c. ') First line of address 10 EAST HIGH STREET , , Second line of address >,j I ,~- ,) DATE FILED c~ j'-,; City or Post Office CARLISLE State PA ZIP Code 17013 Correspondent's e-mail address:hgilroy@martsonlaw.com Under penalties of perjury, I declare that I have examined this retum, 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 F PERSON RESPONSIBLE FOR FILING RETURN ATE Thomas A. Ballots ADDRESS Hubert X. Gilroy reet, Carlisle, PA 17013 Side 1 L 15056041147 15056041147 -l J --.J 15056042148 REV-1500 EX Decedent's Name: Debora J. Humberston Decedent's Social Security Number 194527676 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)................ 6. Jointly Owned Property (Schedule F) D Separate Billing Requested............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D 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 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, of transfers under Sec. 9116 (a)(1.2) X ~ 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 1"'4"iiiXiible at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 0.00 15. 0.00 16. 9,387.77 17. 0.00 18. 19. Tax Due.................... ............ ........... ........... .................................. ............................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 11,131.24 5. 16,516.64 27,647.88 15,267.14 2,992.97 18,260.11 9,387.77 9,387.77 0.00 0.00 1,126.53 0.00 1,126.53 D 15056042148 --.J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-06-01069 DECEDENT'S NAME Debora J. Humberston STREET ADDRESS 82-A Linda Drive CITY I STATE IZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 1,126.53 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. (3) (4) (5) (5A) (5B) 1,126.53 1,126.53 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS No o ~ o ~ o ~ o ~ o ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~ 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. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.................................................................................. b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or.................................................................................................................. d. receive the promise for life of either payments, benefits or care?.............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................... .................................. ................. ........... ........... ........................... Yes 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, 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 decedent's siblings is twelve (12) percent [72 P.S. ~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. Rev.1503 EX+ (6-98) . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Humberston, Debora J. FILE NUMBER 21-06-01069 ESTATE OF All property jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 Merrill Lynch Account #2AR-28R51 - Investment 9.280.98 account 2 U.S. Savings Bonds - Seven (7) Series EE, $50 face, 1.850.26 issued TOTAL (Also enter on Line 2, Recapitulation) 11.131.24 (If more space is needed. additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+ (6-98) *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Humberston, Debora J. FILE NUMBER 21-06-01069 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Commerce Bank, Certificate of Deposit #1400449 VALUE AT DATE OF DEATH 6.143.38 2 Commerce Bank, Checking Account 666.28 3 Commerce Bank, Savings Account #626816300 4.781.55 4 Refund 62.46 5 Refund 94.92 6 Tangible personal property - Household goods, appraised value 1.715.00 7 Tangible personal property -1993 Mercedes 190E 1.800.00 8 Merrill Lynch Account #2AR-28R52 - Individual Retirement Account, payable to Estate 1.253.05 TOTAL (Also enter on line 5, Recapitulation) 16.516.64 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV.1151 EX+ (12-99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Humberston, Debora J. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-06-01069 ESTATE OF ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 12,603.65 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees Martson Law Offices 1,900.00 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 144.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 619.49 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 15,267.14 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-98) *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Humberston, Debora J. FILE NUMBER 21-06-01069 ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Valley Memorial Gardens - Grave plot and opening 2.540.00 2 Krapf & Hughes Funeral Home - Funeral and burial expenses 9,481.96 3 Thomas Ballots - Reimbursement for funeral clothing for decedent 131.69 4 Thomas Ballots - Reimbursement for funeral reception 450.00 Subtotal 12.603.65 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-98) . SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Humberston, Debora J. FILE NUMBER 21-06-01069 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Acme Storage - Storage unit for personal property required to be removed from rental property 217.00 2 Martson Law Offices - Advanced for stock valuation reports 6.20 3 Martson Law Offices - Advanced for Short Certificates 12.00 4 Martson Law Offices - Advanced for Sentinel, advertising Letters 144.29 5 Martson Law Offices - Advanced for Cumberland Law Journal, advertising Letters 75.00 6 Martson Law Offices - Advanced for filing fee, Inheritance Tax 15.00 7 Martson Law Offices - Reserved for miscellaneous filing fees and expenses 150.00 Subtotal 619.49 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Humberston, Debora J. FILE NUMBER 21-06-01069 ESTATE OF Include unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Bronstein Jeffries PA - Account payable VALUE AT DATE OF DEATH 27.50 2 Carlisle Digestive Disease Associates L TO - Account payable 31.23 3 Carlisle Endoscopy Center Ltd - Account payable 86.63 4 Carlisle Regional Medical Center, Acct. 5009982 - Account payable 952.00 5 Carlisle Regional Medical Center, Acct 7636328 - Account payable 1,143.07 6 Cingular Wireless - Account payable 324.30 7 Cumberland Pathology - Account payable 28.79 8 Cumberland Valley Endo Center - Account payable 193.95 9 Direct TV - Account Davable 50.06 10 Geico Indemnity Company - Account payable, premium 7.13 11 Kinetic Imaging Inc., Acct 5009982 - Account payable 33.62 12 Kinetic Imaging Inc., Acct 7636328 - Account payable 26.41 13 Lanc HMA Phys Mgmt Cent Pen - Account payable 27.50 14 Lehigh Anesthesia Assoc - Account payable 18.96 15 Moffitt Heart & Vascular Group - Account payable 14.32 16 Philip D. Carey, M.D. - Account payable 27.50 TOTAL (Also enter on Line 10, Recapitulation) 2,992.97 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV.1513 EX+ (9-00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Humberston, Debora J. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal aistributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee/sl FILE NUMBER 21-06-01069 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) ESTATE OF I. 1 Thomas A. Ballots 16 Quarry Hill Road Newville, PA 17241 Brother Entire residue 9,387.77 Total 9,387.77 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule J (Rev. 6-98) FEB-16-2001 23:58 COMMERCE WIRE-RCH 7177956128 P.02 March 13, 2007 Commerce l:8ank Martson Law Offices 10 E High St carlisle PA 17013 RE: Estate of: Oebora J Humberston social Security #: 194-52~7696 Date of Death: November 11, 2006 Dear Sirs: In reference to the letter regarding the above mentioned Estate, we would like to inform you of the information that we have researched and found. Type: Checking I ~ <- Account #: 535574476 Date Opened: 10/29/03 primary Owner: Debora J Humberston Date of Death Balance: $666.28 Accrued Interest: $0.00 Principal Balance: $666.28 Type: Savings :L~ 3 Account #: 626816300 Date Opened: 03/10/06 primary Owner: Debo~a J Humberston Date of Death Balance: $4,781.55 Accrued Interest: $0.09 principal Balance: 4,781.46 Type: Time Deposit :L~ Account #: 1400449 Date opened: 03/10/06 Primary Owner: Debora J Humberston Date of Death Balance: $6,143.38 Accrued Interest: $1.98 principal Balance: $6,141.40 If there are any questions or additional information that is needed, please feel free to contact me at (717) 412-6134. Commerce Bank / Harrisburg, N.A. PO Box 4999 3801 Paxton Street Harrisburg, PA 17111-0999 commercepc.corY'l 3:..1-1. J::. TOTRL P.02 ...... ARGYLE T.'OCU",ON' 04/09/2007 ARGYLE SOLUTIONS, INC 2604 LONG PRAIRIE RD, STE 300, FLOWER MOUND TX 75022-3904 (888) 368-9835 Account#:5009982 Reference #: 6403802 Patient Name: DEBORA J HUMBERSTON Date of Service: 11/11/2006 Dear DEBORA J HUMBERSTON: Your account from CARLISLE REGIONAL MEDICAL CENTER has been turned over to ARGYLE Solutions, Inc., a licensed collection agency, to pursue for payment. Our records indicate that your balance of $952.00 is outstanding for services rendered at CARLISLE REGIONAL MEDICAL CENTER on 11/11/2006. To prevent any further collection activity, please mail your check or money order to our office today. For immediate resolution you may call our office at (888) 368-9835 and use our check by phone service or to charge your balance to MasterCard, VISA, American Express, or Discover. This communication is from a debt collector and is an attempt to collect a debt. Any information obtained will be used for that purpose. Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any portion thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days from receiving this notice, this office will obtain verification of the debt or obtain a copy of the judgment and mail you a copy of such judgment or verification. If you request this office in writing within 30 days after receiving this notice, this office will provide you with the name and address of the original creditor, if different from the current creditor. You can now pay your bill on-line at www.paymvbill.com. Enter 1248079 as your UserlD-Access Code and 6403802 as your password. PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION RETURN SERVICE REQUESTED RE: CARLISLE REGIONAL MEDICAL CENTER HMA858 ID NUMBER: 6403802 ACCOUNT NO: 5009982 BALANCE DUE: $952.00 AMOUNT ENCLOSED: $ PO BOX 2190 ASHLAND VA 23005-5190 III1II1IIIIIIII . 11 . 2 , I 5 e " 9 ... . FOR PROPER CREDIT TO YOUR ACCOUNT RETURN THIS STUB IN lHE ENCLOSED ENVELOPE WllH YOUR CHECK OR MONEY ORDER. BE SURE lHAT OUR NAME AND ADDRESS APPEARS IN lHE WINDOW. 417/S0/HSB/04l09/2007 o Change of address: Print New Address on Back 10254 11111111111111111111111111111111111 *6403802* DEBORA J HUMBERSTON 16 QUARRY HILL RD NEWVILLE PA 17241-9403 50 ARGYLE SOLUTIONS. INC. PO BOX 270929 FLOWER MOUND TX 75027-0929 11...1.1.1.11.....1.11...111...1.1....1.11.1....1.11.1..1..1.1 SCtl. -L,...L ~ Y. 52 6403802 6 ... ARGYLE ......'O_unON' 03/30/2007 ARGYLE SOLUTIONS, INC 2604 LONG PRAIRIE RD, STE 300, FLOWER MOUND TX 75022-3904 (888) 368-9835 Account#:7636328 Reference #: 6357607 Patient Name: DEBORA J HUMBERSTON I SECOND NOTICE I Dear DEBORA J HUMBERSTON: We have not received payment or information from you on how you are going to settle your account with CARLISLE REGIONAL MEDICAL CENTER. Our records indicate that you still owe $1,143.07 for services rendered. Please contact our office today at (888) 368-9835. In today's economy, maintaining a positive credit profile is very important. If we do not have satisfaction of this debt within fifteen (15) days we may be reporting this debt to one of the national credit bureaus. To prevent this derogatory information from being reported to the credit bureaus you must contact our office at (888) 368-9835 and make arrangements for payment of this debt. For immediate resolution you may call our office and use our check by phone service or charge your balance to MasterCard, VISA, American Express, or Discover. This communication is from a debt collector and is an attempt to collect a debt. Any information obtained will be used for that purpose. You can now pay your bill on-line at www.paymybill.com. Enter 1248079 as your UserlD-Access Code and 6357607 as your password. PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION PO BOX 2190 ASHLAND VA ~19O RE: CARLISLE REGIONAL MEDICAL CENTER HMA858 10 NUMBER: 6357607 ACCOUNT NO: 7636328 BALANCE DUE: $1,143.07 AMOUNT ENCLOSED: $ RETURN SERVICE REQUESTED III1IIIIIIIII . , I 2 7 2 9 6 2 9 " . FOR PROPER CREDIT TO YOUR ACCOUNT RETURN THIS STUB IN THE ENCLOSED ENVELOPE WITH YOUR CHECK OR MONEY ORDER. BE SURE THAT OUR NAME AND ADDRESS APPEARS IN THE WINDOW. 417/19/HSB/03/30/2007 o Change of address: Print New Address on Back 2'" 11111111111111111111111111111111111 *6357607* DEBORA J HUMBERSTON 16 QUARRY HILL RD NEWVILLE PA 17241-9403 19 ARGYLE SOLUTIONS. INC. PO BOX 270929 FLOWER MOUND TX 75027-0929 11...1.1.1.11.....1.11...111...1.1....1.11.1....1.11.1..1..1.1 SCH. .I~:r~ S 52 6357607 5 ~\ \J \..c \ ('Joel WILL I, Deborah J. Humberston, of 82 Windsor Drive, Apartment 1, Mechanicsburg, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. Item One: I direct that all my debts and funeral expenses including my gravemarker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. Item Two: Ballots. I give, devise. and bequeath my entire estate to my brother Thomas Item Three: I appoint my brother Thomas Ballots, Executor of this my last will. Item Four: All estate, inheritance, succession, and other taxes, imposed or payable by reason of my death, and interest and penalties thereon. with respect to all property comprising my gross estate for tax purposes, whether or not such property passes under this will, shall be paid out of the principal of my residuary estate, without apportionment or right of reimbursement. Item Five: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. Item Six: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executor during the full time necessary for the administration of my estate the following rights and powers to be exercised in his or her sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions as to legal investments. c. To repair. alter, improve or lease for any period of time any real or personal property and to give options for leases. D. To sell at public or private sale. for cash or credit with or without security. to exchange or to partition. to mortgage or pledge real or personal property. and to give options for leases. E. To make distribution in kind. F. To compromise claims. gS :Z Hd ~- :J3Q gOal I :0 jJ.j~;5 :=-j~~~J~~:, . "I IN WITNESS WHEREOF, I have hereunto set my hand this;l-5f'day of November, 2006. Signed ~\;c;G'd" )l~._.'~k+<' Deborah J. Humberston The preceding instrument. consisting of this and two other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein named as and for her last will, in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names. .1 ~ ~\ l\ \-t, ~ \i-a u\ 0:; !,\'r eA it \ ,J A, AliJ COMMONWEALTH OF PENNSYL VANIA ss COUNTY OF CUMBERLAND We, John H. Broujos ari"d:'i/, {J".. c. ( ;1. .r?, if' , 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 the Testatrix sign and execute the instrument as her last will; that she signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of age. of sound mind and under no constraint or und intluence.~ .- \.",,\ -J-,~. c-'-.. I I . l ~/-I/ s\Vom ~~~f.is_/' ed. }qb..eforeme this/l~t day of Novem' er, 2006.,'/" ,---,~j C{' Z ~/ ~' / N AR Y PUBLIC r ss .oNWEAL',ri \),' ':'C::l",Nf~YLVANIA Notaria! Seal I 3helly Brooks, Notarj Public ,sle Boro, Cumberland County I ')rnmission E;>';~ijr~ AU2' 5. 2009 ! .,. [.._.., ~lH1$yivJ(li3 /~ -'.~. _'~' .~tl'.,~_~'l ...)1 1'.iotaries j/ ; COMM WEAL TH OF PENNSYL VANIA COUNTY OF CUMBERLAND I, Deborah J. Humberston, whose name is signed to the attached document, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; that 1 signed it as my free and voluntary act for the purposes therein expressed. -\:.:._ ,_,~' ~"./'~: \.. ,0" ~..I. \_~...{\:,,,~,_, , Debora J. Humberston, Testatrix I , Ii. . / I / ,~ , S151~~~ttJ"IJ1~knOWledged before me thi;~'i day of November, 2006. / NOTARY PUBLIC GOtvl:\.10N.i'::ALi ri C);C"l:.:'"'-,,::di.Vh\,, / Notarial Sea! Shelly 8rool<s, Not,uy Public I Carlisle Boro, Cumberland County J' My Commission E,'\pires Aug. 5. 2009 > --~'-~""-'----~--- \1pn~~{:r p.-.:;.r: . /,L/>:',;.";::(l~l ,)f >J()ji-li';'~:.\;