The URL can be used to link to this page

Home My WebLink About10-25-07 ...J 15[]5b[]41147 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 0486 Date of Birth 184167071 05042007 10021921 Decedent's Last Name Suffix Decedent's First Name MI TAPPAN ELIZABETH E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIA TE OVALS BELOW L~ 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS -~l 4. Limited Estate D D 2. Supplemental Return D D 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) !xi 6. Decedent Died Testate (Attach Copy of Will) n 7 Decedent Maintained a Living Trust ~! . (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received D 10 Spousal Poverty Credit (date of death . between 12-31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) ~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number M I C HAE L L. BAN G S 7 1 7 7 3 O:~ 3 1 0 ' '.' Firm Name (If Applicable) ., -"..';' .} '-'.., REGISTER OF WILI,.S Us"EONL Y First line of address r\) 429 SOUTH 18TH STREET Second line of address ('.' ) City or Post Office CAMP HILL State PA ZIP Code 17011 DATE FILED cr, that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, laration of preparer other than the personal representative is based on all information of which preparer has any knowledge. LE FOR FI G RETURN DATE Donald L. Tappan Michael L. Bangs Ii 429 South 18th Street, Camp Hill, PA 17011 L Side 1 15[]Sb041147 15056041147 --l -.J 15056042148 REV-1500 EX Decedents Name: Elizabeth E. Tappan Decedent's Social Security Number 184167071 RECAPITULA nON 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) D Separate Billing Requested.............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 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/Sec 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~ 0.00 15. 16. Amount of Line 14 taxable at lineal rate X .045 17. Amount of Line 14iai<able at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 140,802.49 0.00 0.00 16. 17. 18. 19. Tax Due.............................. .... ............................... ................ ............. ....................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L Side 2 15[]5b[]42148 159,047.95 159,047.95 14,684.68 3,560.78 18,245.46 140,802.49 140,802.49 0.00 6,336.11 0.00 0.00 6,336.11 o 15[]5b[]42148 --1 REV-1500 EX Page 3 Decedent's Complete Address: FileNumber 21-07-0486 DECEDENT'S NAME Elizabeth E. Tappan STREET ADDRESS Outlook Point Nursing Home 153 Logan Road CITY I STATE /ZIP Dil/sburg PA 17019 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 6,336.11 (1 ) 5,907.23 310.91 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 6,218.14 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. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) 117.97 (5A) (58) 117.97 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 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 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. ~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-1508 EX+ (6-98) ~ ~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYlVANIA iNHERITANCE TAX RETlRN RESIDENT DECEDENT ESTATE OF Tappan, Elizabeth E. IFILE NUMBER I 21-07-0486 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 PNC Bank - Checking Account VALUE AT DATE OF DEATH 133.202.18 2 PNC Bank - Certificate of Deposit 25,789.26 3 State Employees Retirement System - Final payment from retirement 56.51 TOTAL (Also enter on Line 5, Recapitulation) 159,047.95 (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 Tappan, Elizabeth E. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-07 -0486 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 6,335.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Donald L. Tappan Social Security Number(s) I EIN Number of Personal Representative(s): Street Address 205 Runson Road City Camp Hill State PA Zip 17011 - Year(s) Commission paid 3,500.00 2. Attorney's Fees Michael L. Bangs 3,500.00 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 340.00 5. Accountant's Fees 750.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 259.68 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 14,684.68 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 RE1URN RESIDENT DECEDENT ESTATE OF Tappan, Elizabeth E. FILE NUMBER 21-07 -0486 ITEM NUMBER DESCRIPTION 1 Dr. Rev. Norman C. Marks AMOUNT 500.00 2 Funeral luncheon 500.00 3 John Sullivan Funeral Home 5.335.00 Subtotal 6.335.00 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 ESTATE OF Tappan, Elizabeth E. FILE NUMBER 21-07 -0486 ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal - Estate Advertising 75.00 2 Gift certificate for aid STUMP 50.00 3 The Sentinel - Estate Advertising 134.68 Subtotal 259.68 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 ESTATE OF Tappan, Elizabeth E. FilE NUMBER 21-07 -0486 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 10 11 12 1 Cheryl Hoke - Round the clock health care services provided to decedent that remained unpaid at the time of death. 120.00 2 Choice Critical Care 35.00 3 Debbie Sierra - Round the clock health care services provided to decedent that remained unpaid at the time of death. 285.00 4 Debbie Sierra - Round the clock health care services provided to decedent that ---_=__..1 ..___:... _4 "1-_ .&:__ _~ ...__..... 100.00 5 Jennifer Galloway - Round the clock health care services provided to decedent that remained unpaid at the time of death. 210.00 6 Joan lamb - Round the clock health care services provided to decedent that remained unpaid at the time of death. 45.00 7 Kristi lanFranca - Round the clock health care services provided to decedent that remained unpaid at the time of death. 600.00 8 Kristi lanFranca - Round the clock health care services provided to decedent that remained unpaid at the time of death. 100.00 9 Michelle Yeagy - Round the clock health care services provided to decedent that remained unpaid at the time of death. 112.50 Miscellaneous - Supplies for Hospice/services provided to decedent from 3/31/07 through 5/4/07 261.25 Outlook Pointe - Final bill 326.00 PA American Water Company 26.03 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 3,560.78 (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 J (Rev. 6-98) Rev-1512 EX+ (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Tappan, Elizabeth E. FILE NUMBER 21-07-0486 ITEM NUMBER 13 DESCRIPTION PA American Water Company - final bill VALUE AT DATE OF DEATH 45.65 14 Pinnacle Health Medical Services 71.21 15 Sammy Doll - Round the clock health care services provided to decedent that remained unpaid at the time of death. 127.50 16 Tara Baughman - Round the clock health care services provided to decedent that remained unpaid at the time of death. 720.00 17 Tara Baughman - Round the clock health care services provided to decedent that remained unpaid at the time of death. 100.00 18 Terry 0011- Round the clock health care services provided to decedent that remained unpaid at the time of death. 75.00 19 UGI 200.64 TOTAL (Also enter on Line 10, Recapitulation) 3.560.78 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9..00\ .~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE .. BENEFICIARIES ESTATE OF NUMBER Tappan, Elizabeth E. 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(s) FILE NUMBER 21-07 -0486 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. 1 Cheryl H. Givler 945 S. 29th Street Camp Hill, PA 17011 Daughter One-half 2 Donald L. Tappan 205 Runson Road Camp Hill, PA 17011 Son One-half 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 Copyright (c) 2002 form software only The Lackner Group, Inc. TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Form PA-1500 Schedule J (Rev. 6-98) JLL-17-2007 17:14 PNCBANK 412 768 3458 P.01/01 ~ PNCBAN< July 17,2007 Michael L. Bangs Attorney at Law 429 South 18th Street Camp Hill. PA 17011 RE: Estate of Eli2:abeth E. Tappan. ~ SSN: 184-16-1071 DOD: 51412007 Dear Mr. Bangs: In response to your request for Date of Death balances for the customer noted above, our records show the following: Certificate of Deposit Account #31100292376 Established 05109/1995 ELIZABETH E TAPPAN DOD balance: $25,789.26 + $832.53 accrued interest Interest Paid 11112007 - 5/4/2007 - $0.00 Checking Ac:eoUDt Account #5140113907 Establisbed 0411112005 ELIZABETH E TAPPAN DONALD L TAPPAN DOD balance: S133,202.18 + $3.,64 accrued interest Interest Paid 1/112007 - 514/2001 - $72.43 Please note that this offrce only provides date of death balances for deposit accounts (IRAs, CDs, Checldng and Savings accoWlts). We do .ot proeas _, tmaaeial tra.sacdoaa Or provide statemeDts. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNe Bank branch office. Sincerely, ~ UlLlJ1>- Rachelle Wells 1-800-762-1775 P7-PFSC-04-F 500 first Ave. Pittsburgh PA 15219 Member FDIC TnT,..... n n... , ~ Cl ~. ~ -~ \') '\ ,~~ ,k "1 ~ ~:; \~ ~ " . , .~ ,~ ~~ v \J ~ , -"'.~ _.'._ "'. .... ... e'"",." ., " ,.,... ~, ~." -~"." ..-..~~~,,..t.-.~~.,,.~~,...,,,,,,,,,,.....~__,............",,,,~,-~,.',,,,_ ~,,:c~-:'''':'':-'';'''~7.'-'~ C'::'--:~=~ 6)fJI1 !/ WfphdA Y5. ~/affi/ I, ELIZABETH E. TAPPAN, of314 College Hill Road, Enola, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, 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 II. I give and bequeath all of my household goods, automobiles, jewelry, and all other articles of household and personal use, equipment and ornament, together with all insurance thereon and relating thereto, in equal shares to my children, CHERYL H. GIVLER and DONALD L. TAPPAN, provided they survive my death by thirty (30) days. Should CHERYL H. GIVLER predecease me or be deceased on the thirty-first day after my death, her share shall go to her issue per stirpes, Should DONALD L. T APP AN predecease me or be deceased on the thirty-first day after my death, his share shall go to my' daughter-in-law, LINDA J. TAPPAN. ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate in equal shares to my children, CHERYL H. GIVLER and DONALD L. TAPPAN, provided they survive my death by thirty (30) days. Should CHERYL H. GIVLER predecease me or be deceased on the thirty-first day after my death, her share shall go to her issue per stirpes. Should DONALD L. T APP AN 1 ~ \) ~ ""'), 1 ~ '\;) '~ '~ .... ~ ~ predecease me or be deceased on the thirty-first day after my death, his share shall go to my daughter-in-law, LINDA J. TAPPAN. ITEM IV. Should any of my issue entitled to a share of my estate not have attained the age of twenty-five (25) years at the time for distribution to him or her, I devise and bequeath the share of such issue to my hereinafter named trustee, IN SEP ARA TE TRUSTS, to hold, manage, invest, and re-invest, the shares so received, and the accumulation of income thereon, and to use and apply from time to time such portion of income and principal thereof as my trustee thinks proper for the comfortable support, maintenance, health, welfare, and education of the issue or to make payment for such purposes, without further responsibility, directly to such issue, or directly to any person taking care of such issue. Any principal or income not so applied shall be distributed to such issue when he or she attains the age of twenty-five (25) years, or ifhe or she dies prior thereto, to his or her personal representative. ITEM V. I appoint my son DONALD L. TAPPAN trustee of the trust or trusts created by this my last will. Should Donald L. Tappan predecease me or otherwise fail to qualify or cease to serve as Trustee, I appoint my daughter-in-law LINDA J. TAPPAN trustee of the trust or trusts created by this my last will. In addition to the other powers and authorities granted to my trustee by Pennsylvania Law and by the preceding. paragraph of this my last will, I hereby give my trustee the following special powers and authorities: A. To retain any or all of the assets of my estate, real or personal (including any stock or securities of any corporate fiduciaries), without any regard to any principle of diversification, risk, or productivity; 2 ~ \l '" ~.. ~ rr) ) k 0) ~ I , .I ~ 'i } B. To invest and re-invest in all forms of property without restriction to investments authorized for Pennsylvania Fiduciaries, as my trustee deems proper, without regard to any principle of diversification, risk or productivity; C. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my trustee deems proper and in the best interest of the beneficiary or beneficiaries of said trusts; D. To allocate receipts and expenses to principal or income or partly to each as my trustee from time to time deems proper in its sole discretion; E. To compromise any claim or controversy; F. To exercise any option, right, or privilege granted in insurance policies or in any other investments; G. My trustee may accumulate the income from this trust during the term thereof but may, from time to time, distribute from current income or from accumulated income or from principal such amounts as my trustee, in its sole discretion, deems advisable for the education, welfare, and comfort of the trust beneficiary , ITEM VI. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. 3 ~ " ~' ~ \ ~ \~ '1 "1 ... ." ,~' \ ITEM VII. I appoint my son DONALD L. T APP AN executor of this my last will. Should my son predecease me or otherwise fail to qualify or cease to serve as executor of this my last will, I appoint my daughter CHERYL H. GIVLER executrix of this my last will. ITEM VIII. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly. to each as my personal representatives deem proper in their sole discretion. ITEM IX. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. 4 IN WITNESS WHEREOF, I have hereunto set my hand this 97'1f' day of /}?7.d:A'~ ,2004. 7;> _" r.:-7 ~,-tl//~ (;;. J~~.--;--<___ ELIZ 'BETH E. T APP AN / 5 r ' f [ r. The preceding instrument, consisting of this and FIVE (5) other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by ELIZABETH E. T APP AN, 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 as witnesses hereto. v,' r [: ~ t ~ F k f! ! t, i l , I ~' ~ 6 i" f" ~' I ~ , . il ,'j 'I ;J ,'.1 "11 '~ i,j " ;1 ~ '1 1 \ ;','j );,.;; .,~ '4 . , COMMONWEALTH OF PENNSYLVANIA ) ( SS: ) COUNTY OF CUMBERLAND The undersigned, being the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~~~ ~//~' ELIZA: ETH E. T APP AN . Sworn or affirmed to and acknowledged before me by the testatril' 'pam~4 above this ,r, day Of, /71 all et) ,2004. / j .ll/ide'! aZld': () ~Publi / NOTARIAL SEAL j WENDY S. CHESBRO, Notary PublIc Lower AIen Twp., Cumberland County .., CommI8Slon Expir1I May 10,2007 COMMONWEALTH OF PENNSYLVANIA ) ( SS: ) WE~Ll) L.~AAJ and H,~~l !_4I'Jl1 ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last will; that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight ofthe testatrix signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and under no constraint or undue influenc COUNTY OF CUMBERLAND Sworn or affirmed to and acknowledged ~r,e;ye jhis aJ~~day of L!Jd:~J(]j ,2004. /JuJ ~O NOTARiAl SEAl WENDY S. CHESBRO. Notnr! PubIle Lower Allen Twp., Cum~ County My CommIssIor1 ExpIres May 10, 2007 7