HomeMy WebLinkAbout06-12-08 (2):15056051058
REV-1500 EX (OEi-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes Y ' County Code Year File Number
Po Box 28osot INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 -~ RESIDENT DECEDENT 21 0$ 0368
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
'March 27, 2008 February 25, 1908 ',
.Decedent's Last Name Suffix Decedent's First Name MI
Garman Ernest_
B
__ __ ___ _
(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 Return 3. Remainder Return (date of death
prior to 12-13-82)
„ 4. Limited Estate ~~"'°~ 4a. Future Interest Compromise (date of a,-,. 5. Federal Estate Tax Return Required
death after 12-12-82)
;l• 6. Decedent Died Testate ~„"„;e 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ ~~ 10. Spousal Poverty Credit (date of death .,:,_ 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
:Andrew C. Sheely, Esquire
. ' 717-697-7050
.Firm Name (If Applicable) _ _ __ _ _ _ __ . _ r.~
__ ......._ _-_..... __.. .._ ._ .. ... _... _... I REGISTER OF>;?4p.LS USE ON~ `7
.Andrew C. Sheely, Attorney at Law ~ ~-~~ ~ -r i~~~t
First line of address i
~ ~ _~,7
~ ~ :_
' ; j
127 South Market Street I _~? , ~
,_ 1- ~,~ _ r
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Second line of address j ~ ~ ~?(~ -p ~ r-;~
_ I
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P
O
Box 95 `
='~-- L7
.
.
__ 1 ~J
_ _ ~.: .: f ~'l
City or Post Office State...... ZIP Code _ _ ?.. _ _DATE~LED _ _ ~
'Mechanicsburg _ _ _ _ _
_ PA ' 17055 +.I
Correspondent's a-mail address: andreWC.Sheely@verlZOn.net
Under penalties of perjury, 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 P SQN SP NS BL R FILING RET~ ~P iia~a
Ahf)RFSC
Michael E. Garman, Executor, 95 Haldeman Avenue, New Cumberland, PA 17070
SIGNA E OF P EPAR OTF~ HA PRESENTATIVE HATE
p nRCCc
Andrew C. Sheely, Esquire, 127 arket St., P.O. Box 95, Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051058 15056051058
15056052059
REV-1500 EX
Decedent's Social Security Number
Decedent's Name Garman, Ernest B.
w.~ . ~ ~ _ _ _ _ ~.~.~ . _... w... e ...... _ . e ,
RECAPITULATION
1. Real estate (Schedule A) ........................................... .. 1.'
118,454.10
2. Stocks and Bonds (Schedule B) ..................................... .. 2.'
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. S`S
4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4.
5. Cash, Bank De osits & Miscellaneous Personal Pro ert Schedule E
P P Y( ) ...... 5. '
.. 113,982.41
6. Jointly Owned Property (Schedule F) ~ ~"~ Separate Billing Requested ..... .. 6. 45,445.26'
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~~:. Separate Billing Requested..... ... 7. `:
8. Total Gross Assets (total Lines 1-7) ................................. ... 8. '; 277,881.67
9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ' 12,022.06
10.
9 9 ( ) .............
Debts of Decedent, Mort a e Liabilities, & Liens Schedule I 10,
... 195.97
11. Total Deductions (total Lines 9 & 10) ................................ ... 11. "~ 12,218.03
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. 265,663.64
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ..~,.. ~ ^~,...~..
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers unc+~~ sec. 9116
00
500
0.00
(a)(1.2) x .o. . 15.
16. Amount of Line 14 +~~~ble
at lineal rate X .045 _.....
260,163.64.
16.
11, 707.37
17. Amount of Line 14 taxable
at sibling rate X .12 I
., _ 17•
_.
18. Amount of Line 14 taxable 000.00'
5 750.00"
at collateral rate X .15
_ ,
_ _ 18.
..
. 12,457.37.
.....
19. TAX DUE ..................
...........................
..19. ._
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
~J~ ~
15056052059
Side 2
15056052059
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Ernest B. Garman
STREET ADDRESS - --
1509 Brandt Avenue
0~ 0368 '
DECEDENT'S SOCIAL SECURITY NUMBER
178-05-1368
CITY ~ STATE
New Cumberland zIP
- PA 17070
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1) 12,457.37
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 11,834.53
C. Discount 622.85
3. Interest/Penalty if applicable Total Credits (A + B + C) (2) 12,457.37
D. Interest -
E. Penalty --
4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT.tal Interest/Penalty (D + E) (3)
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. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00
Make Check Payable fo: 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 :.......................................................................................... ^
b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ 0
c. retain a reversionary interest; or .......................................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ..................................................
............................................................ ^ ^X
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ^ n
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)j. The statute does not exemg 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)j.
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)j.
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 is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
21 ..
~?EV-1503 ErX+ (6-d38)
`'.. '~
.. SCHEDULE B
Ct)MMONWEALTH OP PENNSYLVANIA STOCKS & BONDS
lNHERITANCL== TAX RETURN
RESIDENT DECEDENT
ESTATE !7F FILE NUMBER
Ernest B. Garman 21-0$-0368
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(It more space is needed, insert additional sheets of the same size)
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f~EV-1508 ~X+ (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ernest B. Garman 21-OJ-0368
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 DESCRIPTION VALUE AT DATE
OF DEATH
1. 1997 Lincoln Continental, fair condition $3,250.00
2. PNC Bank CD account # 31600323388 - at date of death 20,135.63
3. PNC Bank CD account #31900218481 - at date of death 20,639.47
4. PNC Bank CD account #31900220555 - at date of death 24, 980.16
5. PNC Bank CD account #31600254419 - at date of death 25,161.43
6. PNC Bank checking account #5140022546 - at date of death 19,815.72
113,982.41
TOTAL (Also enter on line 5, Recapitulation) $
~_ (If more space is needed, insert additional sheets of the same size)
. a.er~`.~~~~--~ R~#ureE tt tags ~# f~~~~. e .
2177745204
01:17:47 p.m. 04-15-2008
B PNC Facsimile
1 /2
Phone:
Date: t~-/~ _ U
From: ~
Phone:
Re: ~ _ ~ i
v Fa::
Page Including Cover:
Fax:
This facsimile may contain privileged and confidential information intended only for the use of the addressee(s) named
above. if tfie reader of this message is not the intended recipiengs) or the employee or agent responsible for delivering
the message to the intended recipirnt(s), please note that any dissemination, distribution or copying of this
communication is strictly prohibited Anyone who receives this communication in error should notify us immediately
by telephone and destroy the message in its entirety.
The P~IC Ftrwdal Servka Grwp
www.pnc.com
7177745204 01:17:59 p.m 04-15-2008 2/2
i _ .
Name Ernest B Getman (Deceased)
SS# 178-OS-1368
DOD 03-27-2008
ACCQUNT NUMBER * X}ATE OF DEATH BALANCE + ACCRUED INTEREST
Cda # 31000233277 $ 10,700.04 + $ 5.37
Cda # 31600323388 $ 20,072.21 + $ 63.42
Gda # 31900218481 $ 20,639.47 + $ p.00
Cda#'31900220555 $24,931.45 + $ 49.16
Cda # 31600254419 $ 25,106.20 + $ 55.23
Dda # 5140022546 $19,810,77 + $ 4.95
Sv8 # 5003172468 $ 80,Obb.'~8 + $ 118,39
If you've selected the balances to be sent to the `= Branch " they will only be sent to the
regttestor vla Lotus Notes.
FiEV-1509 lrXi- (6-9f3j
COMMONWEALTH OF PENNSYLVANIA
INFiE-RITANCE TAX RETURN
RESIDENT DECEDENT
scN~ou~E F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Ernest B. Garman 21-0~-0368
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 ADDRESS RELATIONSHIP TO DECEDENT
A• Michael E. Garman 95 Haldeman Avenue, New Cumberland, PA 17070 Son
B.
C.
JOINTLY-OWNED PROPERTY:
ITEM
NUMAER 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 DEAThI
VALUE OF ASSET °o OF
D[CD'S
INTEREST UATF OF DEATH
VALUE OF
DECEDENTS IMEREST
1. A. 0~'f-2i-2oo3 PNC Bank - CD account #31000233277 $10,705.37 50% $5,352.68
2. A. S-2y-lees PNC Bank money market account #5003172468 $80,185.17 50% $40,092.58
TOTAL (Also enter on line 6, Recapitulation) I $ 45,445.26
(If more space is needed, insert additional sheets of the same size)
EV-151? EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Ernest B. Garman 21-0~ 0368
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
~~ Parthemore Funeral Home $8,856.37
2. Flowers $ 328.60
3. Funeral services/luncheon $813.56
4.
B.
1
2.
3.
4.
5.
6.
~.
s.
9.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Michael E. Garman, EXeCUtOr
Social Security Number(s)/EIN Number of Personal Representative(s)
street Address 95 Haldeman Avenue
city New Cumberland _ state FA .Zip 17070
Year(s) Commission Paid:
Attorney Fees
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
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Misc. postage and registered mail costs
Filing Fees for Inheritance tax return
Reserves for first and final accounting, advertising and other Estate administration activities
$1, 025.00
$ 360.00
$ 23.53
$ 15.00
600.00
TOTAL (Also enter on line 9, Recapitulation) I $ 12,022.06
(If more space is needed, insert additional sheets of the same size)
Parthemore Funeral Home & Cremation Servic s, Inc.
p,p. Box 431
1303 Bridge Street
New Cumberland, PA 17070-0431
(717) 774-7721
Mr. Michael E. Garman
95 Haldeman Avenue
New Cumberland, PA 17070
Fos the service of Emest B. Garman
TRANSACTION
DATE
03/27/2008 Balance forward
Due 04/27/2008.
INV #1438
03/28/2008
04/01/2008 .
PMT #373. Michael Garman
04/08/2008 PMT #001. Estate
Statement
AMOUNT DUE
50.00
AMOUNT
8,856.37
-877.00
-7,979.37
~~~
1-30 DAYS PAST 31-~ DDUE PAST 61-90 DDAUE PAST O PA T DUE
CURRENT DUE
0.00 0.00
0.00 0.00
0.00
Please don't hesitate to call our office if we may be of assistance.
AMOUNT ENC.
BALANCE
0.00
8,856.37
7,979.37
0.00
AMOUNT
you.
DATE REFERENCE ITEM
,131/08 000047590 ARRANGEMENT, GENERAL
Occasion:. Sympathy
ERNEST GARMAN
f/31/08 000047591 FUNERAL ARRANGEMENT, CASKET
SPRAY
Occasion: Sympathy
ERNEST GARMAN
$20.00 ~ $0.00 ~ $1.20
$21.20 ~ $21.20
$290.00 ~ $0.00 ~ $17.40 I ~ $307.40 I $307.40
ACCOUNT NUMBER CURRENT 30+ DAYS 60+ DAYS 90+ DAYS 120+ DAYS TOTAL DUE
000000 1 1 1 1 $328.60 $0.00 $0.00 $0.00 $ .00 $328.60
_ -- - - .-_
.. _ _ - _ ,~.c Olds 7ewsc ~leslot ~ 'hre. ~ (71 ~ 774-1260
I
page 1 of
~~ . _
1
MAY SPECIAL -BASKET OF AFRICAN VIOLETS - $25.00 - CASH &~, ~~ ,.
DELIVERY EXTRA '
VISIT US AT OUR WEBSITE -www.oldetowneflorist.com µ~ .
}~ r
R^
REV-1512 EX.+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCI~IEDt~LE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FSTOTF f)F
Ernest B. Garman
FII F NIIMRFR
21-OQj-0368
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX~ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ernest B. Garman
NUMBER
1
1
2
3
4
5
6
II
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Mari Jo Garman, 508 Harding St., New Cumberland, PA 17070
Abigail C. Garman, 95 Haldeman Ave.,New Cumberland, PA 17070
Kathryn J. Garman, 12 Fisher Ave., Pittsburgh, PA 17070
Kelli A. Recher, 508 Harding St., New Cumberland, PA 17070
Frances Gruber, 700 Elkwood Drive, New Cumberland, PA 17070
Michael E. Garman, 95 Haldeman Ave.,New Cumberland, PA 17070
FILE NUMBER
21-0$-0368
RELATIONSHIP TO DECEDENT ( AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
great granddaughter
granddaughter
granddaughter
granddaughter
friend
son
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
St. Theresa's Parish, 1300 Bridge Street, New Cumberland, PA 17070
$ 500.00
$10,000.00
$10.000.00
$10,000.00
$10,000.00
$5,000.00
Rest, residue
&remainder
- ---
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 500.00
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
ERNEST B. GARMAN
I, ERNEST B. GARMAN, now of 1509 Brandt Avenue, New Cumberland,
Cumberland, County, Pennsylvania, i~o~o, declare this to be my last Will and Testament
and revoke any Will or Codicil previously made by me.
Item I: I direct that all expenses of my last illness and funeral, including
my gravemai•lcer and perpetual care, 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, devise and bequeath to the St. Theresa's Church of New
Cumberland, Pennsylvania, or its successor, Five Hundred ($500.00) Dollars for Masses
in memory of Josephine M. Garman. Masses to be said on her birthday, November ~~n.
The money should be divided to provide ten (io) Masses over a period of ten (io) years.
Item III: I give, devise and bequeath to Frances Gruber of New
Cumberland, Cumberland County, Pennsylvania, the sum of One Thousand (.$:i.ro -~~
Dollars for her kindness and understandin for man ears. ~t"'~' a_
g YY ~- ,-~;~
V,,,.,r-,,..,
I
Item IV: I give, devise and bequeath to my great granddaughter, Mari Jo
~~i~n1
)j (~/ r of New Cumberland, Pennsylvania the sum of Ten Thousand ($io,ooo.oo)
/~l ~ !'~ Dollars to be placed in an interest bearing account to be maintained for her by her
mother for college or distribution to her after she reaches the age of majority.
Item V: I give, devise and bequeath to my granddaughters, Kelli Ann
Garman Recher, Kathryn Jo Garman and Abgail C. Garman, a trust fund for each in the
sum of Ten Thousand ($io,ooo.oo) Dollars. The funds shall be held in trust jointly by
Michael E. Garman and his wife, Frances Garman, or the survivor of the two for
educational purposes and, any remainder to be turned over to the named beneficiary on
her Twenty First (2i5t) birthday.
Item VIII: I direct that the rest, residue and remainder of my estate be
distributed to my son, Michael E. Garman, and if he fails to survive me, to my daughter-
in-law, Frances J. Garman.
Item VII: I direct that all taxes that may be assessed in consequence of my
death of whatever nature and by whatever jurisdiction imposed shall be paid from my
residuary estate as part of the expense of the administration of my estate.
Item VIII: I hereby authorize and empower my executrix or executor, named
herein, to sell any of the real or personal property which I may own at the time of my
death, as he or she shall, in his or her sole discretion, deem appropriate, for the best
interest of my estate and my beneficiaries, upon whatever terms or conditions he or she
deems to be appropriate and to execute, acknowledge, and deliver all proper writings,
deeds of conveyance and transfer thereof.
Item IX: I appoint my son, Michael E. Garman, as Exe,}cutor of this Estate, , /~
shall not be required to give bond for the faithful performance beer duties in any%'
jurisdiction. In the event that my son, Michael E. Garman, in unable or unwilling to
stand as Executor, I appoint my daughte~n-law, Frances J. Garman, as Executrix.
ERNEST B. GARMAN
The preceding instrument, consisting of this and four (4) other typewritten pages,
identified by the signature of the Testator ERNEST B. GARMAN, was on the day and
date thereof signed, published and declared by ERNEST B. GARMAN ,the Testator
herein named, as and for his Last Will, in the presence of us, who, at his request and in
his presence and in the presence of each other, have subscribed our names as witnesses
hereto.
of
G'
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
. SS.
COUNTY OF ~~~,~,'n
I, ERNEST B. GARMAN, 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; and that I
signed it willingly and as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowledged before me by ERNEST B. GARMAN,
Testator this = day of ~~ ~,1~f1.~. ° 2004'
ERNEST B. GARMAN
No ary ublic
NOTARIAL SEAL Public
MICHELE A. RENEKER, Not County
City of Hamsburg, DauptN
M Comm~ssion';cp~res March 17,2007
s
COMMONWEALTH OF PENNSYLVANIA SS.
COUNTY OF DAUPHIN '
WE, the undersigned witnesses whose names are signed o°e to d say thadt we
foregoing instrument, being duly qualified according to law, do dep
were resent and saw the Testator, sign and execute the instrumenn a~ tnesse n the
p that each subscribe g
voluntary act for the purposes therein expressed;
hearing and sight of the Testator signed the Will as a witness; and thaf soundbmind and
knowledge, the Testator was at that time i8 or more years of age, o
under no constraint or undue influence.
the undersigned witnesses,
Sworn to or affirmed and subscribed before me by
A~~~ , 2004.
this ~-day of ~~-
Witness
~ .'--- NDT~EAL public
` ~ ~' _ ~ MICHELE A. RENEKER, Notary
CiC/ of Hamsburg, Dauphin County
Witness ~ Tres March 17, 207
~~dy C~~;imia,on ExP ____-
i
Notary Public