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Home My WebLink About02-15-08 (3) ....J 15056051047 REV-1500 EX (06-05) PA Department of Revenue *' Bureau of Individual Taxes PO BOX 280601 PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT County Code Year File Number 2 1 0 7 00947 Date of Birth 207 3 4 6 6 O. 9 100 5 200 7 050 219 1 2 Decedent's Last Name Suffix Decedent's First Name MI L A R SON P H Y L LIS A (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 XX 1. Original Return 2. Supplemental Return 4. Limited Estate c:) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required Xx.? 4a. Future Interest Compromise (date of death after 12-12-82) _,_.~ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) i=) 10. Spousal Poverty Credit (date of death C~) 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) '_~'N,~H'm,",__".~~^,~'~^'_'_'>.'~_.'.__~'_'_~_'_~.'."~_.-~^..,.'._W~~~'^__________~_~___~~_'_M~'_Y_'____,w__~_.~_'~____"~__"'^"_~~~~~~_~'_"_V~_'_'___~^'m~...___.._,.,-~M~~__",.__,_~__..,___",_.__~.~",^ CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received ...0_ 8. Total Number of Safe Deposit Boxes K E I THO. B R E N N E MAN Firm Name (If Appiicable) E S QUI R E 717 6978528 S N E L B A K E R & B R E N N E MAN First line of address 4 4 W EST M A INS T R E E T Second line of address ~~~:-, City or Post Office State ZI P Code .:::;0 M E C H A N I C S BUR G P A 1 7 055 \..C Correspondent's e-mail address: _m,_w.v.'_.",~_~?N_~~W~~"~''^~_,_~~~~.__~',~~~_'~.~'~~__~y=_~,~,w"~,W.'~'~~~__,,,~.~'~,"^,.'N~~_~'_'__'~'~'m,^'~_~_~__,~____'^.~'_W,'~"_"_V'_^_'~'A_'_._,W^W'^~~.,~.,~,__W.'~..~',~, U~d~~;"p~nalties of perJury, I declare that I have examined this return, inciuding schedules and statements, and to the best of my and belief, it IS true, correct and complete. Declaration of preparer other than the personal is based on all information of which has ::::;:;E~;;E~P~~~__... .,.,~",.~,~~_c:~.~or ,...,.......".....i{....~.!~~~,~..~..... ""..'", .~ZQ ~,~9~l<::.;!.::~,c!.g~__J:2!:J..Y.~,,!.,JI.9..U i SJ!,1,1.IK~",P~A"JIUJL.~~._.,~,.._.,~m~~"m,',._,m,__m, "-""""""'''',Z ... .",. :;::~~:,::~::~::~~~I~:",,"""'w"'m'"~'''_''_._m_m''''m"""",m,",..,.~"_,.m,:~~:~i~_~~ 44 W. Main Street! Mech~I!w~,c:::'..l:J,~:.~,""~~".,~?Q~2,"'."~_""~,..,,m_" HwN"'~.',>,v<~""N^"~"_"w~_.,,_"'''..<m~~uA_''_m.~_''@~'^''_Nh'mmN'~,"'- 'PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ~ -.J 15056051047 REV-1500 EX (06-05) PA Oepartment of Revenue . Bureau of Individual Taxes PO BOX 280601 'H~'W Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT County Code Year File Number 2 1 o 7 00947 Date of Birth 207 3 4 6 609 100 5 200 7 050 219 1 2 Decedent's Last Name Suffix Decedent's First Name MI L A R SON P H Y L LIS A (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 XX'" 1. Original Return c:::::> 2. Supplemental Return c:::::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required X'~ C) 4a. Future Interest Compromise (date of death after 12-12-82) c:::::> 7. Decedent Maintained a living Trust (Attach Copy of Trust) c:::::> 10. Spousal Poverty Credit (date of death c:::::> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) -~-~~~",,,,,,'~ CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. litigation Proceeds Received .1)_ 8. Total Number of Safe Deposit Boxes 4. limited Estate c:::::> K E I THO. B R E N N E MAN Firm Name (If Applicable) E S QUI R E 717 6978528 S N E L B A K E R & B R E N N E MAN First line of address 4 4 W EST M A INS T R E E T Second line of address City or Post Office State ZIP Code M E C H A N I C S BUR G P A 1 705 5 Correspondent's e-mail address: "",,,,_wu.",, """'wWCW__^ Under penalties of perjury, I declare that I have examined this return, including accompanying scheduies and statements, and to the best of my knowledge and belief, i::~_t,-~,:.~rrect an~;:,~:.:::: Declaration of pre parer other than the personal representa(j~~~~~~.ed on all inform~~~~..~f Whi~_h...~:.~!?~arer ~~~~~~~~:::i~dge DATE .~::..~~ ~:~~:!::.... SIGNATURE O~ON RESPONSIBLE ~=-- ..A-r~.~.,. .. ___~....___...._..._~...__.~Ex~c~~~__ ADDRESS _~Qrive. lIarrisbu~PA 1]110 SIG R RER OTHER THAN REPRESENTATIVE ""'~""'A"'_W_wc,c~__~'''.''"''''''-''=__'''''~~_~'~,,~w~~~,._,"..,_~,~_A_ ADDRESS 44...~.: Ma~~_tr::et ,~ecJ.:~?~_~~.!>urg~__.~A 170~.?".....~."_mm_~m" PLEASE USE ORIGINAL FORM ONLY DATE ILl / e ~..m_~..~.~m....~..m."...m.m.2p+..~..~." Side 1 L 15056051047 15056051047 -.J ..-J 15056052048 REV-1500 EX Decedent's Name: Phyllis A. Larson RECAPITULATION 1. Real estate (Schedule A). 2. Stocks and Bonds (Schedule B) . . . . . . . . 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) c;::) 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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 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) . . . . . . . . . 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . ...12. .....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, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O 45- 6 3,2 5 8 . 0 6 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 19. TAX DUE.. . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 Decedent's Social Security Number 207346609 1. 2. 163,415'20 . 6. 1,917.65 7. 1 5,0 2 2 . 5 8 8 7,0 5 2 . 2 1 1 0 2,0 7 4 . 7 9 6 3,2 58.06 __~_~_!.~.__2~_m.~.. 2,846.61 18. 2,8 4 6 . 6 1 15056052048 ---I REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Phyllis A. Larson ---------" -- STREET ADDRESS 100 Mt. Allen Drive File Number 21-07-00947 CITY STATE Mechanicsburg PA , ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) $2,846.61 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. $2,846.61 B Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (SA) (5B) A. Enter the interest on the tax due. $2.846.61 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: Yes No a. retain the use or income of the property transferred; .......................................................................................... D [XI ~: ;:::;~ :h~e~;~~i~~:~s;~t:~~:;~~. .s.h.a~~. ~~~. t~~. ~r~~~~. ~.~~.~.~f~~~~~ .~r. it~ .i.n.c.~.~~.;.::::: :::::::::::::::::::::: ::::::: :::::::::: B ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ~ D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (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. S9116 (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. 99116(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 S9116(1.2) [72 P.S. 99116(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. 99116( 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS Phyllis A. Larson All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21-07-00947 ITEM NUMBER 1. VALUE AT DATE OF DEATH DESCRIPTION Smith Barney individual account No. 724-03502, consisting of the following stock: Stock Symbol EMC GE ORCL TRMB ABALX AEPGX AGTHX Shares 250 165 250 175 1211.911 649.852 2045.375 Price/Share $20.97 $41.87 $22.18 $40.36 $20.44 $55.77 $37.96 Total: Value $5,242.50 $6,908.55 $5,545.00 $7,063.00 $24,771.46 $36,242.25 $77,642.44 $163,415.20 TOTAL (Also enter on line 2. Recapitulation) $ 163,415.20 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Phyllis A. Larson FILE NUMBER 21-07-00947 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ~ Bruce A. Larson ADDRESS RELATIONSHIP TO DECEDENT 4705 Rock Ledge Drive Harrisburg, PA 17110 Son B. Karen L. Mohler 335 West Main Street Mechanicsburg, PA 17055 Daughter C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND 8ANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A, 9/28/7 M&T Bank checking account No. $5,758.71 33.3% $1,917.65 B. 54383374 TOTAL (Also enter on line 6, Recapitulation) $ 1,917.65 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Phyllis A. LArson FILE NUMBER 21-07-00947 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1. Prudential Life Insurance, Policy No. 4,200.00 100% 100% 78524, payable to Bruce A. Larson and Karen L. Mohle , children of Decedent on October 5, 2007 (date of death) TAXABLE VALUE -0- 2. Mass Mutual Financial Group Life Insurance 7,326.66 Policy No. 43657, payable to Bruce A. Larson and Karen L. Mohler, children of Decedent on October 5, 2007 (date of death) 100% 100% -0- 3. Mass Mutual Financial Group Life Insurance 2,415.74 Policy No. 1464935 and No. 4358408, payable to Bruce A. Larson and Karen L. Mohler, children of Decedent on October 5, 2007 (date of death) 100% 100% -0- TOTAL (Also enter on line 7 Recapitulation) $ -0- (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PhylliS A. Larson FILE NUMBER 21-07-00947 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Myers Funeral Home - funeral services $8,813.00 2. Camp Hill Methodist Church - funeral luncheon 150.00 B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) waived --~---------------- ---- - Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees to Snel baker & Brenneman, P. C. 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. 5. Probate Fees to Register of Wills - $185; additional probate fee - $125 Accountant's Fees, miscellaneous probate fees and reserve 2,~68:88 6. T~~~~~~~~~x~sAdvertise grant of Letters: 7. a. Cumberland Law Journal: $ 75.00 b. The Sentinel: 174.58 Total: 249.58 TOTAL (Also enter on line 9, Recapitulation) $ 15,022.58 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & UENS ESTATE OF PhylliS A. Larson FILE NUMBER 21-07-00947 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Smith Barney, individual account No. 724-03502, money borrowed on margin VALUE AT DATE OF DEATH $72,238.71 2. Messiah Village, nursing home expenses: $7,302.00; $7,511.50. Total: 14,813.50 TOTAL (Also enter on line 10, Recapitulation) $ 87,052.21 (If more space is needed, insert additional sheets of the same size) REV-15B EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Phvllis A. Larson NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Bruce A. Larson 4705 Rock Ledge Drive Harrisburg, PA 17110 2. 3. Karen L. Mohler 335 West Main Street Mechanicsburg, PA 17055 Janet Mohler 335 West Main Street Mechanicsburg, PA 17055 FILE NUMBER 21-07-00947 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Son Daughton Granddaughter 1/2 Residue 1/2 Residue $30,000.00 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 $ (If more space is needed, insert additional sheets of the same size) .-1 '~---'- : ( j SNl:l fJ~\l<Ff1! Bf~F:,~~N,-r,l;\:J d: SP-\R[ LAST WILL AND TESTAMENT OF PHYLLIS A. LARSON I, PHYLLIS A. LARSON, of Hampden Township, Cumberland County, pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be paid as soon as practical after my death by my Executor or Executrix, whichever the case may be, hereinafter named. I direct that all taxes that may be assessed as a consequence of my death shall be paid from my residuary estate as part of the expenses of the administration of my estate. 2. I bequeath the sum of Thirty Thousand Dollars ($30,000,00) to my granddaughter, JANET MOHLER. 3. All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath in equal shares to my son, BRUCE A. LARSON and my daughter, KAREN L. MOHLER, absolutely. In the event my son, BRUCE A. LARSON, should predecease me, I give the share my said son would have received hereunder to my daughter, KAREN L. MOHLER. In the event my daughter, KAREN L. MOHLER, should predecease me, I give the share my said daughter would have received hereunder to my granddaughter, JANET MOHLER. I hereby nominate, constitute and appoint my son, BRUCE A. LARSON, as Executor of this my Last will and Testament, but 4. should he predecease me or fail to qualify, I nominate, constitute and appoint my daughter, KAREN L. MOHLER, as Executrix of this my Last will and Testament. I further direct that no person serving as Executor or Executrix hereunder shall be required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last will and Testament written on Two (2) pages this 20th day of April, 1998. I,.., j / I" "c/ \ ~ (/1-( II ' U. . "~. U '<'.~'-I L (SEAL) Phyllis A. Larson signed, sealed, published and declared by PHYLLIS A. LARSON, the Testatrix above named, as and for her Last will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~~ (SEAL) ~ l ~ / /"/ .''/' ..) .-// J,,;{/!cSEALJ . / L/ 1\ S~i[L!3j\..I-:F:R, GJtl':nNI'vl,\r'J ~\ Sr~\Fn' -2- COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) We, PHYLLIS A. LARSON, KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. '\ ) J). {(/I ) (/'. ..>.'.'~r' . , (, ~{,"- . - , . - 1iih;;;;;:' witness (. ,--,{. l ;' t.. )t(~ ('~-' ) /, j ,,". /-"{;/' 'I I . . Witne& j . Subscribed, sworn to and acknowledged before me by PHYLLIS A. LARSON, Testatrix, and subscribed and sworn to before me by KEITH . BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this 20th ay of April, 1998. C~~I ~ No ar Public ~ L,"'W 01 JICCS SI"!EL /J,'\J<FH [~BF r'-lt-J I-r-.l/\r! .:{ Sf',\RE Nolana' Seal Chnstlne M Whrte Notary Public Mechanlcsburg Boro CumOOtiand Cou~ I My Commission EXpires Sepf 17 200 Member Pennsylvania ASSOCIatiOn of Notaries