HomeMy WebLinkAbout04-24-0815056051058
REV-1500 EX (06-05)
PA Department of Revenue OFFICUIL USE ONLY
Bureau of Individual Taxes
PO 80X 280601 County Code Year File Number
INHERITANCE TAX RETURN
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PA 17128
0601 _~~
RESIDENT DECEDENT ~ ( ~ U
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ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
165-16-0152 02!08/2008 09/07/1920
Decedent's Last Name Suffix Decedent's First Name MI
Startzel Leon R
(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 2. Supplemental Retum 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Retum Required
death after 12-12-82)
• 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received 10. Spousal Poverty Credk (date of death 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 CONFlDENTUU. TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephorte Number
Thomas C Miele (717) 255-6810
Firm Name (If Applicable) c~-~'
REGISTER OF LS USE ONL`~
a
First line of address ~. t
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4084 Caissons Court ~ fV
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Second line of address
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City or Post Office State ZIP Code DATtK~ILEO _
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Enola PA 17025 ~
correspondent's e-mail address: tmlele05 CCDCOmcaSt.net
Under penalties of perjury, I declare that I have examined this return, including acoomparrying sdtedules 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 arty knowledge.
SIGNAT E F PERSON ~E~SPO, IB E FOR F LING RETURN DATE
ADDRESS
SIGNA URE OF PREPARER OTHER THAN REPRESENTATIVE ATE
nuurctss ~
`fG'.3 t/ C-~-.~-SSo-~-s ~ ~- ~.~2'~~,¢ ~i~. /7015`
PLEASE
15056051058
Side 1
15056051058
REV-1500 EX
15056052059
Le0t1 R Stattzel
'
Decedent
s Name:
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 8~ Notes Receivable (Schedule D) ........................... .. 4.
5. Cash, Bank Deposits t3< Miscellaneous Personal Property (Schedule E) ...... .. 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers li< Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested...... .. 7.
8. Total Gross Assets (total Lines 1-7) .................................. .. 8.
9. Funeral Expenses 8 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, or
transfers under Sec. 9116
(a)(1.2) X .0 15.
16. Amount of Line 14 taxable
at lineal rate x .0 45 9,978.60 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE .........................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
Decedent's Social Security Number
165-16-0152
0.00
0.00
0.00
0.00
8,890.00
8,600.50
17,490.50
7,100.00
411.90
7,511.90
9,978.60
9,978.60
449.02
449.02
15056052059
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER
Leon R Startzel _ _ 165-16-0152
--- __
- - --- -- -
STREETADDRESS
208 Senate Ave APT 219
CITY STATE ZIP
Camp Hill ~ PA 1 17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 449.02
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 23.63
Total Credits (A+ B + C) (2) 23.63
3. InteresUPenalty 'rf applicable
D. Interest
E. Penalty
-- Total InteresUPenalty (D + E) (3)
4. ff 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 differerxe. This is the TAX DUE. (5) 425.39
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 425.39
Make Check Payable to: REG/STER 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 :.......................................................................................... ^
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 Wst for" or payal~ 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 benefiaary designation? ....................................... ^
.................................................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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
(/2 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 disdasure of assets and
filing a tax return are still applicable even if the surviving spouse is the only benefiaary.
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) pen~nt [f2 P.S. §9116(a)(1.3)]. Asibling 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)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Leon R Startzel
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.
pf more space is needed, insert additional sheets of the same sae)
~ REV-1509 EX+ (g-g8)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Leon R Startzel
If an asset was made joint within one year of the decedents data of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Nancy R Miele
4084 Caissons Court
Enola, PA 17025
Daughter
B
C.
JOINTLY-OWNED 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 °h OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. Commerce Bank, Acct# 0536617392 1,837.00 50 919.00
%' ~~3
2 A ga.jg}/r;~ Postmark Credit Union Acct# 1382-10 12,960.00 50 6,480.00
~~~~~ ~
Postmark Credit Union Acct# 1382-00 176.00 50 88.00
Postmark Credit Union Acct# 1382-09 2,277.00 50 1,113.50
TOTAL (Also enter on line 6, Recapitulation) I S 8,600.50
(If more space is needed, insert additional sheets of the same size)
Commerce
.Bank
0184021NY1N00005738
L ROBERT STARTZEL
NANCY R MIELE
SUSQUEHANNA VIEW
208 SENATE AVE APT 219
CAMP HILL PA 17011
Commerce BanktHarrisburg N.A.
P.O BOX 4999
Harrisburg, Pennsylvania 17111-0999
1-888-937-0004
We're here 7 days a week, 24 hours a day at 1-888-937-0004.
Statement Balance. as of 01!08108
Plus 1 Deposits and Other Credits
Less 2 Checks and Other Debits
Statement Balance as of 02/08108
Transactions By Date
Date Description
01/16!08 CKCD DEBIT 01/14 RITE AID
STORE #11CAMP HILL PA
01!18108 CKCD DEBIT 01116 PERKINS
#2390 0912LEMOYNE PA
02/ORl4R INTEREST PAYMENT
Interest Summary
Beginning Interest Rate
Number of Days in this Statement Period
Interest Earned this Statement Period
Annual Percentage Yield Earned this Statement Period (APY)
Interest Paid Year to Date
012 Cycle
NrITC• ecc ccvcocc c~nc cno uwnnnrw.,r ~ur.~.r.uwr~..u
50 PLUS CHECKING 0536617392
- sts~5.z7
$0.23
$38.91
_$1,836.59
Debit Credit Balance
$11.31 $1,863.96
$27.60 $1,836.36
$0.23 51,836.59.
0.15°/a
31
$0.23
0.15°l0
$0.47
Page 1 of 1
~ ~ ~ PO STMARK
C R E D I T U N I O N
• 2630 Linglestown Road, Harrisburg, PA 17110-3666
LEON R STARTZEL
NANCY R MIELE
208 SENATE AVE
APT 219
CAMP HILL PA 1 701 1-2341
SUFFIX:00 REGULAR SHARE ACCT
Trans Date Description
Member Statement
Account Number
Social Security Number
Statement Period
Page 1 of 2
1382
Confidential
02/01/08-02/29/08
Refer your family members to
join POSTMARK Credit Union. We'll pay
you $7.50 and they will earn 7.50% on their savings!
For more information about this great offer watch
for the postcard we are sending to you.
Summary -All Accounts
Beginning Ending
T1~ Balance Balance
SUFFIX:00 REGULAR SHARE ACCT $175.71 $175.81
SUFFIX:09 INVESTORS CHOICE $2,227.48 $2,279.29
SUFFIX:10 CHECKING $11,272.68 $11,867.01
Withdrawal Deposit Balance
02/01/08 Beginning Balance
02/29/08 DIVIDEND
02/29/08 Ending Balance
Y-T-D DIVIDENDS: .28
ANNUAL PERCENTAGE YIELD 0.7526%
ANNUAL PERCENTAGE YIELD EARNED 0.7187%
175.71
0.10 175.81
175.81
SUFFIX:09 INVESTORS CHOICE
Trans Date Description Withdrawal Deposit Balance
02/01/08 Beginning Balance 2,227.48
02/01 /08 DIRECT DEPOSIT 50.00 2,277.48
USTREASURY 312 -CIVIL SERV
02/29/08 DIVIDEND 1.81 2,279.29
G2/29/08 Ending Baiance 2,279.29
Y-T-D DIVIDENDS: 4.62
ANNUAL PERCENTAGE YIELD 1.0046%
ANNUAL PERCENTAGE YIELD EARNED 1.0049%
SUFFIX:10 CHECKING
Trans Date Description
Withdrawal Deposit Balance
02/01/08 Beginning Balance
02/01 /OS DIRECT DEPOSIT
USTREASURY 312 -CIVIL SERV
02/01 /08 DEPOSIT ALLOCATION
USTREASURY 312 -CIVIL SERV
02/01 /OS DIRECT DEPOSIT
USTREASURY 303 -SOC SEC
02/04/08 VERIZON -PaymentREC
(Continued on next page)
11,272.68
1,630.34 12,903.02
50.00 12, 853.02
191.00 13,044.02
34.56 13,009.46
" ~ ~ O STMARK
. '~ P
~ C R E D I T U N I O N
2630 Linglestown Road, Harrisburg, PA 17110-3666
Member Statement
Account Number
Social Security Number
Statement Period
Page 2 of 2
1382
Confidential
02/01/08-02/29/08
SUFFIX:10 CHECKING
Trans Date Description Withdrawal Deposit Balance
(Continued]
REG-E TRANSACTION
02/05/08 CUNA MUTUAL -ADi3~D PREM 21.00 12,988.46
REG-E TRANSACTION
02/07/08 CM INS. SOC. JOI -CMIS LIFE 10.53 12,977.93
REG-E TRANSACTION
02/07/08 CM INS. SOC. JOI -CMIS LIFE 17.93 12,960.00
REG-E TRANSACTION
02/20/08 CHECK # 5014 ID 001 1031943 430.00 12,530.00
02/21 /08 CHECK # 5012 ID 001206481 1 50.00 12,480.00
02/22/08 CHECK # 5011 ID 0020006874 113.35 12,366.65
02/22/08 CHECK # 5013 ID 0012074828 211.65 12,155.00
02/22/08 POINT OF SALE TRANS REG-E TRANSACTION 5 287.99 1 1,867.01
JACK WILLIAMS TIRE CO CAMP HILL PA US
02/29/08 Ending Balance 11,867.01
Checking Account Summary
Checks-The asterick (*) indicates a break in the check sequence
No. Amount No. Amount No. Amount No. Amount
5011 113.35 5012 50.00 5013 211.65 5014 430.00
Total: 805.00
Summary of Year-to-Date Dividends
2008 2007
REPORTABLE DIVIDENDS CREDITED 4.90 29.79
NON-REPORTABLE DIVIDENDS CREDITED .00 .00
TOTAL DIVIDENDS CREDITED 4.90 29.79
REPORTABLE DIVIDENDS OF $10 OR MORE ARE REPORTED TO THE IRS AS INTEREST INCOME FOR THE YEAR.
Summary FOr 2008 Total YTD Total YTD
Reporting SS# YTD Dividends IRA Dividends Other Dividends Withholding Forfeitures
# # #-# #-0l 52 4.90 .00 4.90 .00 .00
EV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDI~LE H
FUNERAL EXPENSES 8r
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Leon R Startzel
' l~bts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
1 ~ Myers Funeral Home, Inc. Mechanicsburg, PA 17055. Professional Services, Facilities, Opening Grave
Casket, Grave Liner.
z Church Services, Flowers, Funeral Refreshments, Clothing.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name or Personal Representative(s) Nancy R Miele
Social Security Number(s)lEIN Number of Personal Representative(s)
Street Address 4084 CiaiSSOn$ COUrt
City Enola .state PA zip 17025
Year(s) Commission Paid:
2. Attorney Fees
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
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
5, 590.00
1,260.00
250.00
7,100.00
REV-1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Leon R Startzel
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expemes.
Qf 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 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Leon R Startrel
Report debts incurred by the decedent prior to death which mmalned unpaid as of the date of death, including unreimbursed medical expenses.
(If mare space is needed, insert additional sheets of the same size)
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REV-1513 EX+ (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE tJF FILE NUMBER
Leon R Startzel
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
t TAXABLE DISTRIBUTIONS [indude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
~ Nancy R Miele, 4084 Caissons Court, Enola, PA 17025 Daughter 4,922.30
2 Winifred Leib, 209 West High Street, Hummlestown, PA 17036 Step-Daughter 4,922.30
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
tl 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S
(If more space is needed, insert additional sheets of the same size)
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ice --
• ~ t JAMES M. BACH ~~~
Attorney at Law
352 S. Sporting Hill Rd., Mechanicsburg, PA 17050, Tel: (717) 737-2033
THE LAW OFFICE
of:
JAMES M. BACH
Attorney-At-Law
352 S. Sporting Hill Road
Mechanicsburg, PA 17050
737-2033
LAST WILL AND TESTAMENT
FOR
a
LEOleT R. STAR7C~LL
Last Will And Testament Of
LEON R. STARTZEL
I, LEON R. STARTZEL, of the BOROUGH OF MECHANICSBURG,
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 do, I do make, publish and declare this my LAST
WILL AND TESTAMENT. I hereby revoke, cancel and annul all my former Wills and
Testaments, including codicils thereto, by me at any time made, and declare this alone to be
my LAST WILL AND TESTAMENT.
AS TO SUCH ESTATE IT HAS PLEASED GOD TO ENTRUST ME WITH IN
THIS LIFETIME, I DISPOSE OF THE SAME AS FOLLOWS, VIZ:
ITEM 1. I direct that my Executrix 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
Chestnut Hill Cemetery, Mechanicsburg, PA..
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, absolutely, and
in fee, to my dearly beloved daughters, Winifred W. Leib and Nancy F.
Miele, share and share alike, per stirpes.
ITEM 4. I nominate and appoint, Winifred W. Leib and Nancy F. Miele, as Co-
~xecutrixes of this my Last Will and Testament. Should one or both Co-
Executrixes named herein fail to qualify or cease to act as Executrix, then I
appoint Thomas C. Miele as Executor in their stead.
ITEM 5. I direct that my personal representatives, as well as their successors
shall not be required to give bond for the faithful performance, of
their duties in any jurisdiction.
~ ~.
~ ~- ~ ~
LEON R. STARTZEL
ITEM 6. I direct that all estate, succession, legacy, inheritance or other transfer
taxes, however designated that shall become payable by reason of my
death in respect of all property comprising my gross estate for tax
purposes, whether or not such property passes under this LAST
WILL, shall be paid by my Co-Executrixes out of my residuary estate.
ITEM 7. 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 any property, to invest and reinvest
any assets or the proceeds derived from the sale of assets, although
said investments may not be of the character prescribed by law, to
sell, convey, assign, transfer and encumber any property, 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 any property hereunder which any individual could
exercise in the management of similar property owned in his own
right, and to execute and deliver any and all instruments and to do all
acts, which may be deemed necessary and proper.
~ ~~
LEON R. STARTZEL
END--------------------------------
2
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND
ss
I, Leon R. Startzel, the TESTATOR, 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 the instrument as my LAST WILL; that I signed it willingly; and that I signed it as my free
and voluntary act for the purpose therein expressed.
C~ ~'
LEON R. STARTZEL
Sworn t ` and acknowledged before me, by: the TESTATOR this 12''~ day of une,
2002. ~
ES M. BACH, ESQUIRE
OTARY PUBLIC
Mechanicsburg, PA 17050
My Commission Expires: 05/13/03
The preceding instrument consisting of this and three (3) other typewritten pages, identified
by the signature of the TESTATOR, was on the date thereof signed, published and declared by
LEON R. STARTZEL, the TESTATOR therein named as and for his LAST WILL AND
TESTAME T.
-~ _ ~ Residing at 352 S. Sporting Hill Road
. SCHEIDEMANN Mechanicsburg, PA 17050
r ~
Residing at 352 S. Sporting Hill Road
TERE',SA H. LAUGHEAD Mechanicsburg~PA 17050
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND
ss
We, JOHN R. SCHEIDEMANN and TERESA H. LAUGHEAD, 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 TESTATOR sign and execute the instrument as
his LAST WILL; that the TESTATOR signed it willingly and that he executed it as his free and
voluntary act for the purpose therein expressed; that each witness in the hearing and sight of the
TESTATOR signed the WILL as witnesses; and that, to the best of our knowledge, the
TESTATOR was, at the time, 18 or more years of age, of sound mind and under no constraint or
undue influence.
Sworn. to or of rmed and acknowledged before me, by: JOHN R. SCHEIDEMANN and
TERE UGHEAD, witnesses, this 12TH{ day of une, 2002.
CHEIDE TERESA H. LAU HEAD
N(3YARiAI >fEAt
iAMl6 lrl OAC-1,1~I~eyr heMr:
1lr~i~71~„ C1~iwlaMl Gwa+N
Mr C~ ~~ NIA 1 ~ ffi100
J S M. BACH, ESQUIRE
N TARY PUBLIC
Mechanicsburg, PA 17050
My Commission Expires: 05/13/03
. _ ~_
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