HomeMy WebLinkAbout11-02-07J 15056051047
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes ~
PO BOX 280601 INHERITANCE TAX RETURN
T
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Harrisburg, PA 17128-0601 RESIDENT D ECEDEN
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
`~
Decedent's Lasl Name, Suffix Drr~- 1rnCs Fi~~ t IJame MI
/ ~)~~) r} K ~ ~ ~~ ~ l ~-
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix, Spou~r ~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
~f 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
C) 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Firm Name Uf Applicable)
First line of address
~) i
Second line of address
City or Post Office
l~~ i~ ~~1~ lU~ % ~ y L ~ T y
ZIP C'~ 1'
REGISTER OF WILLS USE ONLY
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DATE FILE ~
Stale ,uc e
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Correspondent's a-mail address: ~~~-~ I~~ ®~~~ ` ~-~'~
Under penalties of perjury, I declare that I have examined this r n, 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 O~~RS9W'~ES'~IJSIB NG RETURN pUATE ~ ~ '
ADDRESS
Side 1
15056051047 15056051047
v\
ADDRESS
47 SOUTH MAIN ST. PO BOX 210 MAHANOY CITY PA 17948
PLEASE USE ORIGINAL FORM ONLY
J
15056052048
REV-1500 EX
Decedent's Social SecuriQty Number
Decedent's Name: MARGARET L . STEVER / ~O `3 ~ (O f ~ J
RECAPITULATION
1. Real estate (Schedule A) ........................................... .. 1. •
2. Stocks and Bonds (Schedule B) ..................................... .. 2. •
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. •
4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. •
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. ~ ~ ~ ~ ~ ~ (~
6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. ~ '~ ~ ~ • ~~
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.....
... 7.
8.
Total Gross Assets (total Lines 1-7) .................................
... 8. //
1 (o C
0 ~ q
~ 0
9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ~ ~ ~ ~ 9 .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ~~ T ~ J`
1'I. Total Deductions (total Lines 9 & 10) ................................ ... 11. ~ 7 3 ~ J`
1:?. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. - ~ ~ ~~ ~ ~'~
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
14. an election to tax has not been made (Schedule J) .....
Net Value Subject to Tax (Line 12 minus Line 13) ..... .................
................. .. 13.
.. 14.
~ ~ ~ ~~ ~ . p
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
1:5. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable n
Q
~
16
~ . ~ O
at lineal rate X .0 _ .
C! .
17. Amount of Line 14 taxable
12 n ~n
~ C' (
/
17 ,~}
~ • ~ (/
at sibling rate X . - .
18. Amount of Line 14 taxable ~~
•(1 C
(•, 18 ~ • ~~
at collateral rate X .15 •
19. TAX DUE ............................... ..... .................. ..19. ;G .fJ
2'.0. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
O
Side 2
15056052048 15056052048 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
MARGARET L. STEVER
STREET ADDRESS
5269 EAST TRINDLE ROADS APARTMENT 2
CITY !STATE - 'ZIP
HUNTINGTON PA 17050
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) Q, c.~'~
2. Credits/Payrnents
A. Spousal Poverty Credit _
B. Prior Payments
----_ -
C. Discount
Total Credits (A + g + C) (2) Q. QQ
3. InterestlPenalty if applicable
D. Interest
E. Penalty
----
Total InterestlPenalty (D + E) (3) . QCi
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4) ~. ~; C
5. If Line 1 + Liine 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Q • Q~
A. Enter the interest on the tax due. (5A) ~- ~i
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5g) ~ , QQ
Make Check Payable to: REGISTER OF WILLS, AGENT
r~ ~~'~-
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 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? .............................................................................................................. ^^
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? ........................................................................................................................ ^ X^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 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)]. Asibling isdefined, 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 + (~;-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Margaret L. Stever
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Mem ers First Fe era Cre tt Umon - C ec tng Account 358.11
2. Members First Federal Credit Union -Savings Account 2,494.55
3. 2004 Pontiac Grand Am 7,500.00
4. Pension Check 816.29
5. Social Security Check for November 2006 1,462.00
6. Return of Security Deposit by Landlord 485.00
7. 2006 Income Tax Refund 349.00
8. VA Burial 100.00
9. Refund from PA Turnpike for Easy Pass 44.20
10. Health Insurance Refund 9.01
11. Double Day Refund 1.80
12. Miscellaneous Refunds 219.82
13. Timeshare in Outdoor World 500.00
TOTAL (Also enter on line 5, Recapitulation) I $ 14,339.78
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
ESTATE OF
FILE
Margaret L. Stever
Han asset was made joint within one year of the decedent's date of death, H must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A. Amy Jo Headley
JOINTLY-0WNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY•HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
i. A. Pre 1 yr Members First Federal Credit Union 5,000.00 50. 2,500.00
Certificate of Deposit
ADDRESS
TIONSHIP TO DECEDENT
Mechanicsburg PA17055
TOTAL (Also enter on line 6, Recapitulation) I $ 2,500.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + ('12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF FILE NUMBER
Margaret L. Stever
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezzi Funeral Home 4,544.15
2. Rolling Green Cemetery -Side Walk Vase for Mausoleum 460.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Michael R. Stever
Social Security Number(s)/EIN Number of Personal Representative(s) 177-50-0642
2.
3.
4.
5.
6.
~.
8.
9.
10.
11.
12.
13.
street address 35 East Main Street
c;ty Ringtown state PA
Year(s) Commission Paid:
Attorney Fees Thomas K. Noonan, Esquire
Fatuity Exemption: (If decedents address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State _
Relationship of Claimant to Decedent
Probate Fees Register of Wills Cumberland County
Accountant's Fees Galetz Accounting Service
Tax Return Preparer's Fees
Cumberland Law Journal -Publication of Estate Notice
The Sentinel -Publication of Estate Notice
Patriot News -Advertising for Sale of Vehicle
Attorney James Bach -Fee Owed
Travel Expense for Executor
Travel Expense for Amy Joe Headley
Travel Expense for Brian Stever
58.00
35.00
75.00
122.51
185.00
250.00
500.00
100.00
100.00
TOTAL (Also enter on line 9, Recapitulation) I $ 11,929.66
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Z;p 17967
3,000.00
2,500.00
Zip
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
SCHEDULE i
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT ~
ESTATE OF FILE NUMBER
Margaret L. Stever
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Bank of America 8,863.38
2. Balance of Car Loan 7,861.50
3. Harvard Collection Services for MCI 17.24
4. National Rehab 183.85
5. Publishers Clearing House 14.83
6. The Danbury Mint 65.40
7. Lifeline 37.00
8. Pet Care Insurance Agency LTD 65.90
9. Verizon Wireless 116.67
10. Discover Card 86.77
11. Estate Information Services for Discover Financial Services 917.00
12. The CBE Group for Direct TV 33.05
13. CBCS for PP&L Electric 363.57
14. Bill Me Later 117.95
15. Philips & Cohen Associates for Citibank 839.58
TOTAL (Also enter on line 10, Recapitulation) I $ 25,435.95
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-09)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Mar are t L.. Stever
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Michael R. Stever Lineal
35 East Main Street
Ringtown, PA 17976
2. Brian D. Stever Lineal
208 South 16th Street
Camp Hill, PA 17011
3. Amy Jo Headley Lineal
905 Williams Grove Road
Mechanicsburg, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COMMONWEALTH OF PENNSYLVANIA 1
COUNTY OF CUMBERLAND f SS File
COUNTY, PENNSYLVANIA
Personal Representative(s) of the Estate of Margaret Stever
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
I verify that the statements made in this Inven- ~~~~
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of
18 Pa.C.S. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name) Thomas K. Noonan, Esquire (Supreme Court I.D. No.) 21617
(Address) PO Box 210, Mahanoy City, PA 17948
(Telephone) (570) 773-3870
DATE OF DEATH LAST RESIDENCE DECEDENT'S SOC. SEC. NO.
12/24/2006 5269 E. Trindle Rd., Apt. #2, Huntington, PA 17050 163-36-9070
FIGURES MUST BE TOTALED
1. Members First Federal Credit Union Checking Account
2. Members First Federal Credit Union Savings Account
3.2004 Pontiac Grand Am
4. Pension check
5. Social Security check for November 2006
6. Retum of security deposit by landlord
7. 2006 income tax refund
8. VA burial
9.Refund from PA Turnpike for Easy Pass
10. Health insurance refund
11. Double Day refund
12. Miscellaneous refunds
13. Timeshare in Outdoor World
(Attach additional sheets as needed)
358.11
2,494.55
7,500.00
816.29
1,462.00
485.00
349.00
100.00
44.20
9.01
1.80
219.82
500.00
TOTAL: I 14,339.78
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. ,~ 3301(b))
Form RW-09 rev. 10.13.06
THE LAW
of:
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JAMES M. BACH
~~tto~ey-At-La w
352 S. Sporting Hi11~ Road
Mechanicsburg, PA 17050
737-2033
LAST WILL AND TESTAMENT
FOR
~~~ar~rL. srEV~R
Last Will And Testament Of
MARGARET L. STEVER
I, MARGARET L. STEVER, of the TOWNSHIP OF HAMPDEN, COUNTY
OF CUMBERLAND, COMMONWEALTH of PENNSYLVANIA, being in good
bodily health and of sound and disposing mind and memory, and not acting under
duress, menace, fraud, or undue influence of any person whomsoever, merely calling to
mind the frailty of human life, and being desirous of disposing my worldly goods while I
have the strength and capacity so to clo, I do make, publish and declare this my Alm
WILL AND TESTAMEIV`f. I hereby revoke, cancel and annul all my former Wills
and Testaments, including codices thereto, by me at any time made, and declare this
alone to be myLAST WILL AND TESTAMENT.
AS TO SUCH ESTATE TT HAS PLEASED GOD TO ENTRUST ME WITH IN
THIS LIFETIIViE, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:
ITEM 1. I direct that my Executor hereinafter named, pay and discharge all of my
just debts, funeral and testamentary expenses.
ITEM 2• I order and direct that I be buried in a lot, which I own situate at the
Rolling Green Cemetery, Came Hill, Pennsylvania.
ITEM 3. All the rest, residue and remainder of my entire estate, wheresoever
situate, and whatsoever it may consist of, I give, devise and bequeath,
absohrtely, and in fee, to my dearly beloved children, MICHAEL R
STEVER, BRIAN D. STEVER and AMY JO HEADLEY, share and
share alrlse, per stirpes.
M 4 I nominate and appoint my dearly beloved soq MICHAEL R
STEVER, as Executor of this my Last Wr11. Should the Executor
named herein fail to qualify or cease to act as Executor, then I appoint
AMY JO HEADLEY, as Executrix.
ITEM 5. I order and direct that myPersonal Representative(s) named herein use
the legal services of JAMES M. BACH, as Attomeyfor myEstate.
,~~~Cc~ ~ s.~~4:r>
GARET L. STEVER
1
I direct that mypersonal representatives, as well as their successors
shall not be required to give bond for the faithful performance of
their duties in airy jurisdiction,
l~'EM 7• I direct that all estate, succession, legacy, inheritance or other transfer
taxes, however designated that shall become payable by reason of my
death in aspect of all property comprising my gross estate for tax
purposes, whether or not such properly passes under this LAST
WILL, shall be paid by my Executor out of my residuary estate.
II'EM g. I grant to my personal representatives herein named, in addition to,
but not in limitation of those powers vested by law, to be exercised
without prior application to or approval of any court, the power and
authority to retain indefinitely nay property, to invest and reirrvest
arty assets or the proceeds derived from the sale of assets, akhough
said investments may not be of the character prescribed by law, to
sell, corrvey, assign, transfer and encumber anyproperry, to pay,
settle or compromise all claims, to make distribution or divisions in
cash or in kind, and in general to exercise all powers in the
management of arty property hereunder which any individual could
exercise in the management of similar properly owned in her own
right, and to execute and deliver any and all instruments and to do all
acts, which maybe deemed necessary and proper.
1VIAI~GARET L. STEVER
------------------------------------------------ -END...------------------------------...--------........
THOMAS B. NOONAN (1912-83)
THOMAS K. NOONAN
October 26, 2007
THOMAS K. NOONAN
ATTORNEY AT LAW
P. O. BOX 210
47 SOUTH MAIN STREET
MAHANOY CITY, PA 17948
TEL. 1570) 773-3870
FAX (5701773-3875
E-MAIL tknesq®ptd.net
Glenda Farner Strausbaugh
Register of Wills
Cumberland County Courthouse
:_
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1 Courthouse Square ! ~ -'
Carlisle, PA 17013-3387 ~- ~
~~~ ~~
,
Re: Estate of Margaret L. Stever J r~
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Late of Hampden Township, Cumberland County _
,
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Date of Death: 12/24/2006 ~
Date of Probate: 01/05/2007
No. 2007-00019
PA No. 21-07-0019
Dear Ms. Strausbaugh:
Enclosed for filing in the above estate are the following documents:
1. Original and one copy of the inheritance tax return.
Please contact me if you need any further information or documentation.
Sincerely,
~~,.. x z...,..
Thomas K. Noonan
TKN:mmn
Enclosures
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
OOUNTY OF CUMBERLAND
I, MARGARET L. STEVER the TESTATRIX. whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law, do hereby
aclmowledge that I signed and executed the instrument as my LAST WII.I.; that I signed a
willingly; and that I signed it as my fm and voluntary act for the purpose therein expressed.
Sworn to or affirmed and aclmowledged before me, by: the TESTATRIXthis }~ dayof ~
1~4•
~Q'h~dte.~ Dj• .,
MARGARET L. STEVER
NOTARIAL SEAL ~j
JAMES M. EACH, Notary Pub4c
Hampden Twp., Cumberland County J S M. BACH, ESQUIRE
My Commialon Explrw Ma 13, 2007 ARY PUBLIC
chanicsburg, PA 17050
My Commission Expires: OS/ ]3/07
The preceding ;~~**+~*Mnt consisting of this and two (2) other typewritten pages,
identified bythe signature of the TESTATRIX, was on the date thereof signed, published and
declared by MARGARET L. STEVER the TESTATRIX therein named as and for her I.A• TT
WILL AND TESTAMENT.
TERESAH LAUG
Residing at 352 S. Spy Hill Road
Mechanicsbure. PA 17050
Y B. D _d~~~
Residing at 352 S. Sp~g Hill Road
r~ PA 17050
OOMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND
We, TRRF SA H. L-AUGHEAD and JSJDY B. DEENY, the witnesses whose names
are signed to the attached or foregoing instrument, being duly qualified according to law, do
depose and saythat we were present and saw the TESTATRIX sign and execute the instrumcnt
as her LAST WILL; that the TESTATRIX signed it willingly and that he executed et as her free
and vohrntary act for the purpose therein expressed; that each wetness in the heating and sight of
the TESTATRIX signed the WII.L as witnesses; and that, to the best of our ]mowledge, the
TESTATRIX was, at the time, l8 or more years of age, of sound mind and under no constraint
or undue influence.
Svrorn to or affirmed and aclmowledged before me, by, TFRESA H. LAUGHEAD and U~Y
B. DEENY, witnesses, this day of Jan , ~Q44.
TERESA H LAUGHE
NOTARIAL SEAL
JAMES M. EACH, Notary public
Hampden Twp., Cumberland County
My Commission Explraa May 13, 2007
J[JDY .
J M. BACH, ESQUIRE
ARY PUBLIC
echanicsburg, PA 17050
My Commission Expires: 05/13/07