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Home My WebLink About09-06-07 .... ---.J 1.50.56041147 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 21 07 0016 Date of Birth 204039256 12102006 10271920 Decedent's Last Name Suffix Decedent's First Name MI SHENK DOROTHY L (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 X 1. Original Return 4. Limited Estate D [J [J D 4a. Future Interest Compromise (date of death after 12-12-82) 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required X 6. Decedent Died Testate (Attach Copy of Will) 7. ~riaecdhe2to~:~/i-ir~~~) a Living Trust 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10 Spousal Poverty Cred,t (date of death . between 12-31-91 and 1-1-95) D 11.Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MICHAEL L. BANGS 7177307310 Firm Name (If Applicable) REGISTER.IDF WILLS U~~ONL Y First line of address .-') ( ./) , ,', u 429 SOUTH 18TH STREET c' Second line of address r-.:-) City or Post Office State ZIP Code 17011 DATE-FILED CAMP HILL cr, PA Correspondent's e-mail address: Under penalties of perjury, I declare that.1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, It IS true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAJl'!'~ OF PERSON R~SP9rSIBLE FOR FILING RETURN DATE t (..Vt<b'-O---<:.)~L--i'" 4----. Michael G. Shenk C; /0 't /0 7 ADDRESS (~ Michael L. Bangs 429 South 18th Street, Camp Hill, PA 17011 Side 1 L 15056041147 1505b041147 -.J , , PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Shenk, Dorothy L. 21-07-0016 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete, Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge, Signature #2 ~,-k; .p.C~~/ Name Address1 Address2 City, State, Zip Date ,~ Nancy S, Cantone ~O S'f'IZINL:" /<.JJOLL JJR(V~ ~f} egtS.J7iu K(~ r:-i 1'7111 q-1/- 01 --.J 15056042148 REV-1500 EX Decedent's Name Dorothy L. Shenk 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) Separate Billing Requested" 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C 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)" 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)""""" 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 ~ 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 2,942.09 0.00 588.42 19. Tax Due 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 15. 16. 17. 18. 19. Decedent's Social Security Number 204039256 1. 2. 159.60 3. 4. 5. 25,470.66 6. 7. 8. 25,630.26 ---- 18,991.99 3,107.76 22,099.75 3,530.51 9. 10. 11. 14. 3,530.51 0.00 132.39 0.00 88.26 220.65 D 15056042148 --.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Dorothy L. Shenk - -- --------------- STREET ADDRESS 603 Manor Road File Number 21-07-0016 CITY STATE fZjpU Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B Prior Payments C. Discount (1) 220.65 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 0.00 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) 220.65 220.65 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: 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 No [J [J D D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ......................................... 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. 39116 (a) (1.1) (i)]. F or 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. 39116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 39116 (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 PS. 39116 1.2) [72 P.S. 39116 (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. 39116 (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 Shenk, Dorothy L. FILE NUMBER 21-07 -0016 ESTATE OF All property jointly-owned with right of survivorship mus1 be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 30 shares of U.S. Gold Stock - 30 shares of stock 5.32 159.60 TOTAL (Also enter on Line 2, Recapitulation) 159.60 (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 ESTATE OF Shenk, Dorothy L. FILE NUMBER 21-07 -0016 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with the right of survivorship mus1 be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Automobile -1995 Cadillac Seville sedan (see paperwork attached) VALUE AT DATE OF DEATH 2.400.00 2 Christian Baker - Refund of unearned renters insurance 144.20 3 Civil Service Annuity 543.00 4 M& T Bank - Account No. 77676726 2,290.21 5 M& T Bank - Account No. 15004207043031 566.57 6 M& T Bank - Account No. 15004213068388 5.15 7 Refund from Mutual Benefit Insurance - Refund of unearned automobile insurance premium 119.20 8 Refund from West Shore Pathology Assoc. 22.00 9 Refund of 2006 IRS income tax 534.00 10 Shenk Athletic Equipment - (paycheck) 361.06 11 Wachovia - Certificate of Deposit 5,986.02 12 Wachovia - IRA distribution 709.12 13 U. S. Office of Personnel Management - Annuity CSA 2 617664 0 1.000.00 14 Wachovia - IRA 10,790.13 TOTAL (Also enter on Line 5, Recapitulation) 25.470.66 (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 ESTATE OF Shenk, Dorothy L. FILE NUMBER 21-07 -0016 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 12,481.48 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees Michael L. Bangs 5,500.00 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 122.00 5. Accountant's Fees 600.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 288.51 TOTAL (Also enter on line 9, Recapitulation) 18,991.99 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 COMMONVVEAL TH OF PENNSYlVfJJ'JIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shenk, Dorothy L. FILE NUMBER 21-07 -0016 ITEM NUMBER DESCRIPTION AMOUNT 1 Cantone's Restaurant - funeral luncheon 1.662.05 2 Judith Shenk - funeral luncheon 354.03 3 Parthemore Funeral Home 10.306.60 4 Rt 15 Beverage Express - beverages for funeral luncheon 158.80 Subtotal 12.481.48 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) REV 1513 EX+ (9-00) ,~ ~~ SCHEDULE J BEN EFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 21-07 -0016 NUMBER Shenk, Dorothy L. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List TrusteeCsl SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. See attached schedule Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) 0.00 SCHEDULE .. BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Dorothy L. Shenk 204-03-9256 12/10/2006 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Kristin Dyan Shenk Granddaughter one-tenth 763 2nd Avenue Apt. 10 New York, NY 10017 2 Michael G. Shenk Son one-fifth 4 Spartan Circle Camp Hill, PA 17011 3 Nancy Shenk Daughter one-fifth 6230 Spring Knoll Drive Harrisburg, PA 17111 4 Owen P. Shenk Son one-fifth 729 Wheatland Road Lewisberry, PA 17339 5 Robert Clayton Shenk III Grandson one-tenth 369 N. 27th Street Camp Hill, PA 17011 6 Richard J. Yost Foster child one-fifth 110 Camp Hill Drive Clarks Summit, PA 18411 Total 1 Frank R. Baker 146 Springhouse Lane Spring Grove, P A 17362 Phone: 717/ 225-5450 Fax: 717/225-0494 e-mail: frankr.baker@comcast.net January 22, 2007 The following is the value of Dorothy Shenk's stock holdings at the time of her death on December 10, 2006: Equities Stock Symbol High Low Average Shares Value U. S Gold UXG 5.59 5.15 5.32 30 $ 159.60 You will need to provide the following documents to open an Estate account at The Investment Center: 1. Signed Cash Account Agreement 2. Affadavit of Domicile 3. Short Certificate that is not more than 60 days old 4. Death Certificate You will need a signed Stock Power, as well as, the above documents, excluding the Cash Account Agreement for each stock security in order to sell them. I have enclosed a Cash Account Agreement. I will call you to get additional information to open the Estate account, such as date of birth ~f Executor, Tax ID of estate, and other personal information about the Executor. If you have any questions, please call me. Sir-.cerely, \'\,. ~tr{~c[CR~~(1v Frank R Baker Fax Transmission 1/30/2007 11: 54: At1 PAGE 1/002 Fax E;errer - __ ~'JII"'" -~ <<!'- -- lVAcHOVIA Rl:ference ID: ] 909779 Wachovia Bank NA Balance Confirmation Services POBox 40028 Roanoke, VA 24022-7313 January 30, 2007 BANGS LAW OFFICE 429 SOUTH 18TH STREET CAMP HILL, P A 17011 SUBJECT: Verification / Confirmatj on 01" Account and Balance Infonnatio:!l provided for: Customer: DOROTH\i L SHENK (S;iN# 204-03-9256) Date of Death: December 1(,2006 ;Q!?].2!sil A'~!!!lt I~tion Account Type Account Number Date of De aU 1 Balance Average Balance'" Date Opened Manlfity Date lnteJ'~~ I Rate Accflled Interest 'lTD I,: terest P,cid Date Closed CERTIFICATE OF DEPOSIT 2474]2061047979 -....._--------~. '--_'_.'3__ $5,986.02 2/9/2000 $9Vl $26338 1/8/2007 LEGAL TIfLE: DOROTHY L SHENK IRA 257410060305] 97 ----~------------_._-~------ $10,790.13 2/9/2000 $ILI1 $468 42 1/8/2 007 LEGAL TIfLE: DOROTHY L SHENK For Beneficiary Claim Form information, please call] (800)669-2136. .. Due to system limitations. we Cln onl:' provide a twelve month aveJage IJalance on depositoJY accounts. -------------_._----~---~----- .B~~.lv!!!g CI~lit Information Account Type Account Number Dale ofDez.lh 8alam'e Cred it Lirni t Date Opened Date CIl)~ed Times Legal Tltle Late BANKLfNE ---..----------- 1-____I____r__ . 4264298558856 MBNA - Revolving credit accounts are no longer serviced by '~acJl11via B1nk. Plf,ase COlla'" MBNA aI800-477-91.31. VISA 4312437521727809 MBNA.- Rovolving credit accounts are no longer serviced by WacJlOvia B1 nk. Ple.ase cOlta"t MBNA at 800-471-913]. P.ax Transmission 1/30/2007 11: 54: Ar1 PAGE - ~~2"- --;.s..-- -=:.- ......- 'WAcHOVIA No Safe Deposit Box found for customer. "' Date of death halance does not include accrued interest 2:/ 002 Fa.x E;ermr Rc:ferenc( ID: 1909779 "'If date of death occurrs on a weekend (,r a hclidlY, dale cf death balance dce~. not include any transactions that 'Vere made during that time period. ~~ Audrey Troutt Servicenter Associate Phone: (540)563-7323 pwb; at .. ~ rm M&TBank 499 Mitchell Street, Millsboro, DE 19966 January 22, 2007 Bangs Law Office 429 South 18th Street Camp Hill, PA 17011 RE: Estate of Dorothy Shenk Date of Death: December 10, 2006 Social Security No.: 204-03-9256 Dear Mr. Bangs: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type.. .........................Checking Account Account Number....................... 77676726 Ownership (Names oj}...............Dorothy L. Shenk Opening Date.. ........ .... .............07/28/72 (account closed 01/08/07) Balance on Date ofDeath.........$2,290.21 Accrued Interest $ 0.00 Total................................... ....$2,290.21 2. Account Type.... .................... ...Savings Account Account Number................... ....15004207043031 Ownership (Names oj}.............. . Dorothy L. Sp.enk Opening Date. . .. . .. . ... . . . .. . .. . .. . .. . .05/ 19/03 (account closed 01/08/07) Balance on Date of Death....... ..$566.57 Accrued Interest $ 0.09 TotaL.... ......... ........ ................ .$566.66 . Page 2 January 22, 2007 3. Account Type........................ ...Savings Account Account Number....... ...... ....... ...15004213068388 Ownership (Names ofl...............Dorothy L. Shenk, Nancy L. Shenk Opening Date.. .........................10/27/05 (account closed 01/08/07) Balance on Date of Death........ ..$5.15 Accrued Interest $0.00 Total. . .. . .. . .. . .. . .. . . . . .. . .. . .. . .. . .. . .. .. $5. 15 The above named decedent did not have a safe deposit box. For any additional information on the above accounts, including ownership, statements and closures please contact our West Shore Plaza branch at 717-255-2271. S~cerely, ~ C~ &1+ Charlene W~gton, Records Management 1-888-502-4349 RECEIPT Mr Mike Shenk, for the estate of Dorothy L. Shenk, agrees to payment in full of $2400.00 for a used 1995 Cadillac Seville. VIN # lG6KY5294SU801569. Mr Patrick Maginnis, buyer, agrees to receive the car with 79,514 miles and in good condition. ~ ! (tA<-i-ltL Jj-y6u:~vL___ Michael ~S1enk ') . ..... -'!' , ~S~~ ~\J"~~'J Patrick Maginnis 'V'W'l~"'t"""'."""~II1I'1'!,,"~~""'.~"rw~''!i'i"'''1'I"'''-''-"'l''-''![ll'''''''''~~'''~'-"''''''''''!l'''~.'_"rP"~"""1'1"~"""'''''''''''f~,'~'F''"'''''''''''''''''''~'=1''''1I'l'I'''!f1I'I''''''''C''IJ'''''''''N''''''''''''',?"~'flIl!W'~'l,"""-,",q",,~-f""""""l~"~.''''_'M'<'''''''''',,",,,,~f'O-''''Y''''''''''''''''.'''''''-'.,., STONE. LAFAVER & STONE .:::.'::....:.:::::--:=:=::-.::. ~~::..-.::::::::..-:::::z::, ATTORNEYS AT LAW <:-------::=..:::,:;.:.:;~.:';:.;;::, 414 BRIDGE STREET NEW CUMBERLAND. PA 17070 LAST WILL AND TESTAMENT OF DOROTHY L. SHENK I, DOROTHY L. SHENK, of Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate of every nature and wherever situate as follows: A. One-fifth to my son, ROBERT C. SHENK, or to his lssue if he does not survive me. B. One-fifth to my daughter, NANCY S. CANTONE, or to her issue if she does not survive me. ~ C. One-fifth to my son, OWEN PHILIP SHENK, or to his issue if he does not survive me. D. One-fifth to my son, MICHAEL G. SHENK, or to his issue if he does not survive me. E. One-fifth to my foster son, RICHARD J. YOST, if he survives me. ITEM II: I appoint two of my children, NANCY S. CANTONE and MICHAEL G. SHENK, Executors of this my last will. ITEM IV: I appoint my Executors and their successors guardian of any property which passes, either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this ap- Page 1 of 4 ~ ", pointment of a guardian shall not supersede the right of any fiduciary ln its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction. IN WITNESS WHEREOF, I, DOROTHY L. SHENK, have hereunto set my hand and seal this },:'..l day of :/l~~ , 1996. ~ 'd7-Q,';{. ~ DOROTH L. SHENK SIGNED, SEALED, PUBLISHED and DECLARED by DOROTHY L. SHENK, the Testatrix above named, as and for her Last will and Testament, and in the presence of us, who at her request, ln her presence and in the presence of each other, have subscribed our names as witnesses. ~~.N..~ ,WZ/r4~' wi tness---/ ~ ~/rA. I tL-6-r;t~ rz 0' Address ;//'UV Address Page 2 of 4 ~ . COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND I, DOROTHY L. SHENK, the 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 this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ~~~ DORO Y L. SHENK Sworn to or affirmed to and acknowledge by DOROTHY L. SHENK, the Testatrix, this ;L~ ~ day of , 1996. (!(N4+~ LJ Y{ K:-~ Notary Pub'lic """""'-'-'-~-n.. 13, HJ09 -_.~-----.-........._- COMMONWEALTH OF PENNSYLVANIA :SS: COUNTY OF CUMBERLAND We, et~N sf.~ ~n~~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed Page 3 of 4 . , 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; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. ~~(J.~ r Witness 4~{i:'l~ ltness Sworn to or affirmed to and acknow17dged before W~ b~ and~19~: , 1996. wi tnesses, this ~3 ^1 day of NOT/\RIAL SEAL CONST'\NG::: L Ni:W r...1y Cmnmis:;ion Page 4 of 4