HomeMy WebLinkAbout05-01-08 (2)
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue '*
~~~~~~=~uaITaxes INHERITANCE TAX RETURN
Harrisburg, PA 17128-D601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
2 1 0 8
File Number
o 0 2 5 9
Date of Birth
161341410
022 7 2 008
042 6 1 9 3 6
Decedent's Last Name
Suffix
Decedent's First Name
BEE C HER
DONALD
MI
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
[:&J 1. Original Return
D 4. Limited Estate
[:&J 6. Decedent Died Testate
(Attach Copy of Will)
D 9. Litigation Proceeds Received
o 2. Supplemental Return D 3. Remainder Return (date of death
prior to 12-13-82)
o 4a. Future Interest Compromise (date of D 5. Federal Estate Tax Return Required
death after 12-12-82)
o 7. Decedent Maintained a Living Trust 0
(Attach Copy of Trust)
o 10. Spousal Poverty Credit (date of death 0 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
8. Total Number of Safe Deposit Boxes
I V 0
V
o T T 0
I I I
ES QUI RE
717 243 334
City or Post Office
State ZIP Code
-0
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nf"n
no
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"-1)
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Firm Name (If Applicable)
MARTSON
LAW OFFI CES
First line of address
1 0 E A S T
Second line of address
H I G H S T R E E T
CAR LIS L E
P A
17013
Correspondent's e-mail address:
Under penalties of pe~ury, 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 OF PERSON RESPO 51 LE F R Fill
. ..
CARLISLE
NEWVILLE
CARLISLE
PLEASE USE ORIGINAL FORM ONLY
PA 17013
Side 1
L
15056041125
15056041125
-..Ie;
--l
15056042126
REV.1500 EX
Decedent's Name: DONALD R. BEECHER
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) 0 Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous N.2!l;Probate Property
(Schedule G) U 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/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) . . . . . . . . . . . . . . . . . . 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.O _
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
o . 0 0
15.
5 2 9 8
. 8 9
16.
o . 0 0
17.
o . 0 0
18.
19. Tax Due
. . . . " .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056042126
Decedent's Social Security Number
161341410
2804.85
45365.63
2000.00
6 0
7
7 O. 4 8
78.79
9 . 8 0
7
8 8. 5 9
5 2 9 8
1 . 8 9
5 2 9 8
1 . 8 9
o . 0 0
238
4 . 9
o . 0 0
o . 0 0
2384.
9
o
15056042126
....J
, REV-1500 EX Page 3
. Decedent's Complete Address:
File Number
21 08 00259
DECEDENT'S NAME
DONALD R. BEECHER
STREET ADDRESS
8 Beecher Drive
CITY I STATE I ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due (Page 2 Une 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
2,384.19
119.21
Total Credits (A + B + C) (2)
119.21
3. InteresVPenalty if applicable
D. Interest
E. Penalty
T otallnteresVPenalty ( 0 + E ) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
0.00
2,264.98
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
B. Enter the total of Une 5 + SA. This is the BALANCE DUE.
(SA)
(5B)
2,264.98
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; ...................................................................... 0 (&J
b. retain the right to designate who shall use the property transferred or its income; ............................... 0 (&J
c. retain a reversionary interest; or ................................................................................................ 0 (&J
d. receive the promise for life of either payments, benefits or care? ....................................................... 0 (&J
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... I&J 0
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 [RJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................................. ........................................... .......... 0 [RJ
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. 99116 (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 retum 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 P.S. 99116(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.
REV-1003 EX... (6-98)
*
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATEOF
DONALD R. BEECHER
FILE NUMBER
21 08 00259
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
22 shares Cumberland Valley Cooperative Association@ $10.00/share
VALUE AT DATE
OF DEATH
220.00
2.
34 shares, Prudential (744320102) @ $76.025/share
2,584.85
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,804.85
REV-1508 EX + (6-98)
..
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DONALD R. BEECHER
FILE NUMBER
21 08 00259
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
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
12,048.97
M&T Checking #754250
2.
Adams County National Bank dba Fanners National Bank Checking #2163578
27,906.37
3.
Patient Access Network Foundation, assistance benefit
3,309.29
4.
U.S. Treasury, stimulus payment
300.00
5.
Donegal Insurance, premium refund on vehicle insurance
301.00
1997 Mercury Villager Minivan, actual sale price
1,500.00
TOTAL (Also enter on line 5. Recapitulation) $
(It more space is needed, insert additional sheets of the same size)
45,365.63
REV:1'510 EX + (6-98)
..
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DONALD R. BEECHER
FILE NUMBER
21 08 00259
This schedule must be completed and filed n 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 INCLUOE THe NAME OF THE TRANSFEREE. THEIR RElATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF APPUCASlE) VALUE
1. 12/25/07, $5,000 cash gift to Ernest R. Beecher, son 5,000.00 100. 3,000.00 2,000.00
2. 12/25/07, $5,000 cash gift to Donald R. Beecher, Jr., son 5,000.00 100. 3,000.00 2,000.00
3. 12/25/07, $5,000 cash gift to James B. Beecher, son 5,000.00 100. 3,000.00 2,000.00
4. 12/25/07, $5,000 cash gift to Joseph A. Beecher, son 5,000.00 100. 3,000.00 2,000.00
5. 12/25/07, $5,000 cash gift to Lauri A. Nailor, daughter 5,000.00 100. 3,000.00 2,000.00
6. 12/25/07, $5,000 cash gift to Ellen D. Carey, daughter 5,000.00 100. 3,000.00 2,000.00
TOTAL (Also enter on line 7 Recapitulation) $ 12,000.00
(If more space is needed. insert additional sheets of the same size)
. REV~1'511 EX + (12-99)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DONALD R. BEECHER
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 08 00259
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Auer Memorial Home, funeral expenses, balance 205.74
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) 0.00
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Martson Law Offices (estimated) 3,200.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs. attach explanation) 3,500.00
Claimant Lauri A. Nailor
Street Address 8 Beecher Drive
City Carlisle State P A Zip 17015
Relationship of Claimant to Decedent Dau~hter
4. Probate Fees Register of Wills 140.00
5. Accountanfs Fees
6. Tax Return Prepare(s Fees
7. Register of Wills, filing fee, Inheritance Tax Return 15.00
8. Stock valuation report 1.55
9. Checkbook charges 16.50
10. Reserved for additional probate and filing fees 100.00
TOTAL (Also enter on line 9, Recapitulation) $ 7,178.79
(If more space is needed, insert additional sheets of the same size)
. . REV-1512 EX + (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DONALD R. BEECHER
FILE NUMBER
21 08 00259
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursecJ medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1. Mable Stitt, tax collector, personal tax due 1/1/08
9.80
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
9.80
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 Outri~ht spousal distributions, and transfers under
Sec. 9116 (a (1.2)]
1. Ernest R. Beecher Lineal 8,830.32
10 Beecher Drive
Carlisle, P A 17015
2. Donald R. Beecher, Jr. Lineal 8,830.32
93 Fish Hatchery Road
Newville, P A 17241
3. James B. Beecher Lineal 8,830.32
21 Beecher Drive
Carlisle, P A 17015
4. Joseph A. Beecher Lineal 8,830.31
116 Old State Road
Gardners, P A 17324
5. Lauri A. Nailor Lineal 8,830.31
8 Beecher Drive
Carlisle, P A 17015
6. Ellen D. Carey Lineal 8,830.31
12 Beecher Drive
Carlisle, P A 17015
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
.
RIiV-'~13EX+(.
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DONALD R. BEECHER
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 08 00259
(If more space is needed, insert additional sheets of the same size)
PI M8UBank
499 Mitchell Street, Millsboro, DE 19966
December 27, 2007
Martson, Deardorff, Otto, Gilroy & Faller
10 East High Street
Carlisle, PA 17013
RE: Estate 01 Donald Beecher
Date of Death: February 27, 2008
Social Security Number: 161-34-1410
Dear Ms. Myers:
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.... .. .. . .. .. .... .. .... 754250
Ownership (Names of).............. Donald Beecher, Viola Beecher
Opening Date...........................l1j01j68 (account closed 03j07 j08)
Balance on Date of Death......... .$12,048.97
Accnled Interest
$
0.00
Total........ ........................... ....$12,048.97
The above named decedent did not have a safe deposit box.
* If upon reviewing the information above, you believe there are additional accounts not
referenced, please provide us with an account number andj or the name of any possible
joint account holder. For any additional information on the above accounts, including
ownership and any changes, closures andj or reimbursement of funds, please contact
our High Street Carlisle branch at 1 West High Street, Carlisle, PA 17013, or # 717-240-
4536.
Sincerely,
/
i '/- - I ", l ld l )!.L ('PC Ie
l____! .. c L . t ; \X../ /;
Charlene Warrington, Records Management
1-888-502-4349
Schedule "E-1"
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Schedule HE_2"
LAST WILL AND TESTAMENT
OF
DONALD R BEECHER
I, Donald R Beecher, of Carlisle, Pennsylvania, revoke my former Wills and Codicils and declare
this to be my Last Will and Testament.
ARTICLE I
IDENTIFICATION OF FAMILY
The names of my children are Ernest R Beecher, Donald R Beecher Jr, James B Beecher, Joseph
A Beecher, Lauri A Nailor (Beecher), and Ellen D Carey (Beecher). All references in this Will
to "my children" are references to the above-named children.
ARTICLE II
PAYMENT OF DEBTS AND EXPENSES
I direct that my just debts, funeral expenses and expenses of last illness be first paid from my
estate.
ARTICLE III
DISPOSITION OF PROPERTY
Residuary Estate. I direct that my residuary estate be distributed to my children in equal shares.
If a child of mine does not survive me, such deceased child's share shall be distributed in equal
shares to the children of such deceased child who survive me, by right of representation. If a
child of mine does not survive me and has no children who survive me, such deceased child's
share shall be distributed in equal shares to my other children, if any, or to their respective
children by right of representation. If no child of mine survives me, and if none of my deceased
children are survived by children, my residuary estate shall be distributed to Great Grandchildren,
Carlisle, Newville, Newburg, Pennsylvania. If such beneficiary does not survive me, my
residuary estate shall be distributed to the following beneticiaries in the percentages as shown:
0.00% -
If this person does not survive me, this share shall be
distributed proportionately to the other distributee(s) listed under this provision.
0.00 - Percent Total
ARTICLE IV
NOMINATION OF EXECUTOR
I nominate Donald R Beecher Jr, of Newville, Pennsylvania, and Lauri A. Nailor (Beecher), of
Carlisle, Pennsylvania, as Co-Executors (the "Executor"), without bond or security. If one of the
above nominees does not serve for any reason, the remaining nominee shall serve as sole
Executor without bond or security.
ARTICLE V
EXECUlOR POWERS
My Executor, in addition to other powers and authority granted by law or necessary or
appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or
otherwise encumber any real or personal property that may be included in my estate, without
order of court and without notice to anyone.
My Executor shall have the right to administer my estate using "informal", "unsupervised", or
"independent" probate or equivalent legislation designed to operate without unnecessary
intervention by the probate court.
ARTICLE VI
MISCELLANEOUS PROVISIONS
A. Para~aDh Titles and Gender. The titles given to the paragraphs of this Will are inserted for
reference purposes only and are not to be considered as fonning a part of this Will in interpreting
its provisions. All words used in this Will in any gender shall extend to and include all genders,
and any singular words shall include the plural expression, and vice versa, specifically including
"child" and "children", when the context or facts so require, and any pronouns shall be taken to
refer to the person or persons intended regardless of gender or number.
B. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent
conduct or bad faith, be liable individually to any beneficiary of my estate, and my estate shall
indemnifY such natural person from any and all claims or expenses in connection with or arising
out of that fiduciary's good faith actions or nonactions of the fiduciary, except for such actions or
nonactions which constitute fraudulent conduct or bad faith. No successor trustee shall be
obliged to inquire into or be in any way accountable for the previous administration of the trust
property .
- 2 -
c. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or
among two or more beneficiaries, the specific items of property comprising the respective shares
shall be determined by such beneficiaries if they can agree, and if not, by my Executor.
IN WITNESS WHEREOF, I have subscribed my name below, this \ ~ day of
~~\'-~\ ,c_aO&;
Testator Signature:
/' '\
7tJ1fU1/ ~ ~~A./C/
Donald R Beecher
We, the undersigned, hereby certify that the above instrument, which consists of -3- pages,
including the page(s) which contain the witness signatures, was signed in our sight and presence
by Donald R Beecher (the "Testator"), who declared this instrument to be hislher Last Will and
Testament and we, at the Testator's request and in the Testator's sight and presence, and in the
sight and presence of each other, do hereby subscribe our names as witnesses on the date shown
above.
Wi~ssSignaUue: .~I ~ ~L
Name: Leonar E Nailor
City: Carlisle
State: Pennsylvania
Witness Signature:
Name:
City:
State:
~~1,J~~lI'JC
Jocjlyn S ck - .
Newburg
Pennsylvania
Witness Signatur .
Name:
City:
State:
/'
- 3 -
PENNSYLVANIA
Self-Proving Clause
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I, Donald R Beecher, 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 as my free and voluntary act for the
purposes expressed in the instrument.
Sworn to or affirm~ 70wledged before me by Donald R Beecher, the Testator, this
~dayof" ~. , t::7~ .
Testator Signature
fJ oYZtti/ ;f' 1!e~L
Donald R Beecher
4/~:r~Y ~UIfLI ~
Official capacity of officer
commonwealth ot Penns1lvania
(Seal NEDY NotarY Public
SHIRLEY A. KEN ~ County
Penn TOWNhIp, :........ JuIf 11. 2001
My comm-aon .......-
AFFIDA VIT
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
We, Leonard E Nailor and Jocelyn S Ranck and Vincent J Gajewski 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 the
Testator's Last Will; that the Testator signed willingly and executed it as the Testator's free and
voluntary act for the purposes expressed in it; that each of us in the hearing and sight of the
Testator signed the Will as a witness; and that to the best of our knowledge the Testator was at
that time 18 or more years of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed and subscribed to before me by Leonard} Nailor and Jocelyn S Ranck and
Vincent J Gajewski, witnesses, this -I.B- day of ()t. ~ , t!.:J ~ .
/ ,
Witness Signature:
f1t/? 4r~
Name:
City:
State:
Leonard E Nailor
Carlisle
Pennsylvania
Name:
City:
State:
~ ~
//' /
( _ l r' Y! .. f1('~Z
Jocelyn S Ranck
Newburg
Pennsylvania
Witness Signature:
Witness Signature:
Narne:
City:
State:
Vincent J Gajewski
Carlisle
Pennsylvania
- 2 -
,40r~r A/At!/D
Seal and official capacity of officer
COftUl\Oh_...., cf -: ..._~.....
NOTONAL SIAL
sHIRLEY A.. KINNIDY. NotIIIY PubIc
Penn TownehIP. CUR........ County
My commllelon ~ JuIf 11, 2001
- 3 -
~