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Home My WebLink About07-14-08 (2)J 15056041147 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box.2soso~ INHERITANCE TAX RETURN Harrisburg, PA 1712b-0601 RESIDENT DECEDENT 2 1 0 8 0 2 1 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 207 02 23 2008 02 24 1920 Decedent's Last Name Suffix Decedent's First Name MI RICHTER III WILLIAM (If Applicable) Enter Surviving Spouse's Information Below H Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW l^ ! 1. Original Retum ~ ~ 4. Limited Estate LX ~ g. Decedent Died Testate (Attach Copy or Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return L i qa. Future Interest Compromise (date of death after 12-12-82) r--, ~- ~ 7. Decedent Maintained a Living Trust (Anech copy or rrust> r j 1 p. Spousal Poverty Credit (date of death --, between 12-31-91 and 1-1.95) -~~ ~~•~~~~ ~ - ~ nro ~~~ t wtv MUST BE COMPLE Name DAWID J. LENQX Firm Name (If Applicable) THE WILEY GROUP, pC First line of address 130 W. CHURCH STREET Second line of address City or Post Office DILLSBURG State ZIP Code PA 17019 3. Remainder Retum (date of death prior to 12-13-82) S. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes ~ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) 1ENTIAL TAX INFORMATION SHOULD BE DIRE Daytime Telephone Number 717 432 9666 REGISTER OF1t$~S USE O~Y ='~ _ ~_;f cT~ ; r r_ 1 ::" ~ C t -. -~ t-~ r , : d . ' DAT~ ILED s * _ ~cr'+ ~ Correspondent's e-mail address: Under penalties of perjury, I deGare 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. Declafalion of preparer other than the personal representative is based on all information of which preparer has any knowledge. r itvrct'vt•1'tKbON RESPOlyS18 F R F~ING RETUR s William H. Richter IV 81ron Gate~ourt, Mechanics David J. Lenox DATE 130 W. Church Stfeet, Dillsburg, PA 17019 t t Side 1 15056041147 15056041147 J ~ 15056042148 REV-1500 EX Decedent's Social Security Number ~eceaent~s Name: W i I l i a m H R i c h t e r l l l __ _ __ 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 8 Miscellaneous Personal Property (Schedule E) ............ .... 5. 6. Jointly Owned Property (Schedule F) L~ Separate Billing Requested ......... .... 6. nter- ivos Transfers & Miscellaneous N on-Probate Property (Schedule G ~~ Separate Billing Requested ......... .... 7, 8. Total Gross Assets (total Lines 1-7) ................................................................... .... g. 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/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. 10,133.61 10, 133. 61 1, ____- _ 153. __ 72 8, 122. 92 9, 276. 64 856. 97 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, of transfers under Sec. 9116 (a)(1.2) X .00 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 8 5 6 9 7 1 s. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 () _ fl ~ 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 856.97 0,00 38.56 0.00 0.00 38.56 Side 2 15D56042148 15056042148 REV-1500 EX Page 3 File Number 21-08-0211 Decedent's Complete Address: William H Richter III STREET ADDRESS - _ - - - _ - _ _ - - --_.-- 325 Wesley Drive clrY zlP STATE ~ Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty -------------...-- 0.00 Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. q. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) 38.56 (2) 0.00 (3) (4) (5) 38.56 (5A) (5B) 3 8.5 6 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 :.................................................................................. `~ _; ~x ~__. re ain t e ri ht to desi Hate who shall use the roe transferred or its income :.................................... I , 9 9 P P rtY -_ c. retain a reversions interest; or ............... x rY~ ............................................................................................ ... 'x d. receive the promise for life of either payments, benefits or care? .............................................................. j x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... __ ix~ 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 beneficia desi nation? .......................................................................................... ~ i X_I ry 9 ............................ I__. ~ 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)]. 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. 1 ~~'~~.t T~~ ~-nx~: ~~~tczn~tertt OF WILLIAM H. RICHTER, III BE IT REMEMBERED, that. ', WILLIAM H. RICHTER, III, ;: mind, memcry and understanding, do make, publish ar.d dcciare this as and for my Last Will and Testame..t, hereby rev ok.~nq and making null anti ~aoid any and all W_li= and Testamen*_~; and writings in the nature thereof made by me at any t_me heretofore. ITEM 1: I direct that all my lust debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: AlI the rest, residue and remai-:der cf my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my children, PAMELA A. KIRKPATRICK and WILLIAM H. RICHTER, IV, in equal shares, per stirpes. ITEM 3: I direct my hereinafter named Executor to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my estate or the transfer of any property passing hereunder cr ctherwise passing by reason cf my demise, may be subject and to char:~e such taxes against my residuary estate, it being my intention. WITNESS: l / WILLIAM H. RICHTER, III -1- :C~a ~ none Of thP_ aFCrEF `~a-;O CaX.e~, e_tne'." feder.__ G?" `=1 ~. „_. ar.y .~rcperty re^.:~ ~. ~ .; F. d~~ - - ~ ~- - .`~`~ c-r__ _ ~_,. ~., . , ur:c:F: he previsions c' ~.r y state er `ecc: ~ -~ law r.o~„ -•- rr r.e-~~eafter E-nac* e ~ t - _ . _ , . ~.., _.. - c -. -~~tres:E?d ;~~: E~~ -. ~___ rc-- _ ._ c_ ~ , _ - _. ,-- transferred er to whom any benefit accrues. ITEM 4: I appoint my son, WILLIAM H. RICHTER, IV, ,_,: Executor of this my Last 69111 and Testament. Sho~:ld my ;,, predecease me, fail to oualify, cease to act or renounce probate, I then appoint my daughter, PAMELA A. KIRKPATRICK, as Executrix of this my Last Will and Testament. ITEM 5: I direct that my Executor or his successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand anrJ seal ~~J this ~.~ day of _ 1 ('J~7j~~J 2002. ~i~l~ (S EP. L ) WILLIAM H. RICHTER, III -2- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF YORK We, WILLIAM H. RICHTER, III, JAN M. WILEY, ESQUIRE ar..a SHERRY A. FITZKEE, the Testator ar.c she w;t;;e;~,.~s respectively, whose names are signed tc the attached cr fcreconc instrument, being first duly sworn, do herE~by declare to the undersigned authority that the Testator signed and executed the instrument as his Last Wi1i and Testament and that he had signed willingly (or will~ncly directed another to sign for him}, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed this Last Will and Testament as witness and that to the best of their knowledge the Testator was at the time eighteen (18) years of age or older, of sound mind and under r,o constraint or undue influence. WILLIAM H. RICHTER, III Sworn to and subscribed ~ before me this !~~ day of LJ 2002. 1 .C.GC-r '~ ~ ~~~ / NOTARY PUBLIC MY COMMIS.S_Lnnt ~_..--,~;~-I-,BLS-~--- IJOtanalSeal S. Dawn Glatllel!er, Notary Public Dillsburg 6oro, York County nmmission Expires May 17, 2005 Perrin.;,>~:,o~ S'J!~!an~n.AS50C~aBen of NOlafleS 48500041046 REV-485 EX (1-07) SAFE DEPOSIT _: BOX INVENTORY PA Department of Revenue Social Security or Death Certificate Number Date of Death PLEASE USE ORIGINAL FORM ONLY 01 ~ 3 ~ c} County Code Year a ~- ~ ~ ~ zs File Number o ~ l < Decedent's Last Name , Suffi Q t C x First Name M I ~{ l C~ T ~ / ~ k. t` ~- L l C(' y~l F-f ® ADDRESS OF DECEDENT STREET. ~/~ 5 L~'t~~~'~ f'r'r!i ~ NAME AND ADDRESS OF C/ITY. ~'~t/G.i~ S~ v ST/aTF /!J/~ Z\IP CODE: ~ /~S s' PERSON REO STING THE OPENING OF T NAME ~ .._ - HE SAFE DEPOSIT BOX -- -- -- -- -- f - -- _ STREET AD DRESS ~ , L ~ -- - - ---`~c`.~ _ i'cc-~,~, itfG'~+c~'~ c __ ___ _-_ - ---- - CITY: - _.. /, ~, l/sl - _ -- - TATF ~ `7L ZIP CODE ° ~ ' _ _ .. ~ d NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSONS} PRESENT AT THE OX OPENING _ ( 7C / a. NAME: ,~ ~ RELATIONSHIP: STREET ADDRESS r---- --- - --------- ~~------ - --- - ~ - .7(~Ur~/G.4i ~ ter'-`~ -------- ~ CITY: ~.~ ~!~~cGrcr~~~sL TATS ~ ---- ZIP CODE: - - ------- b. NAME i -- - - -- - RELATIONSHIP: ~.-_ - ~ _._-~7U1 ---~ir_~ ~~ V - ~ra~ __ ~~< ~ ins -- ---- STREETADDRESS: ---- - --- -__ -~~~1____L`~Q ~~ h ~`{C Cr ~ /'~c~ --- CITY. ,~r- ~< ~lsj S TE: ZIP CODE: - _- -- c. NAME: ~ _ - - -- ---- - RELATION _~ _r~-- _ ___ i O t ~ SHIP: STREET ADDRESS: - --- CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT 80X IS LOCATED NAME: \ , i STREET DRESS: CI ~e`-E-[,~u~,. ~, ~~ ( (~ ~ STAT ZIP CODE: ~CCldt ~ C S ~uf ~~ ~ _ NAME OF PERSON MAKIN LAST RY DATE AND TIM F LAST ENTRY GJ~7f~`k~ «` f o~ DATE OF ONT T TO RENT BOX • NUMBER OF BOX 1 TITLE UNDER WHIC BOX I REGISTERED NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. NAME: STREET ADDRESS: ~~S c.Jes(Py ~l`id ~ CITY. -~,~,n// ~- STATE: ZIP CODE: /~f~~gK,CS~dr1 /1 .it ~-~~~-~ b. NAME: STREET ADDRESS: -- s za~r~~-, ~,,-r~-- CITY: STATE: ZIP CODE: /1 .I /° - v l-(LC.1~[ NAME AND TITLE OF EMPLOYEE T ING THE INVENTORY r`I ~ WAS A WILL IN THE BOX? ^ YES NO If yes, a. Date of will: b. Name and address of personal representative, if named in the will NAME: STREET ADDRESS: CITY: c. Name and address of attorney, if any NAME: STREETADDRESS: CITY: STATE: ZIP CODE: STATE: ZIP CODE: 48500041046 48500041046 REV-485 EX ~~~~ ~~~~~~~ ~~~ ~E~ V ~i~~~~~ Page of ------ {N~TRUCT{®N~ -- - - _- -- (1) Cash: Report total only. (2} Stocks: List in detail every common or preterred certificate, warrant or other rights found in box- Stocks are to be designated by ~ I name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. ~ (3} Obligations of U.S. Government: Number of items, date of issue, face value. names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation- (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch. and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: Llst and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 ITEM NO. ---- ITEM DESCRIPTION - -~ ( S ~v ~' ~~ --- I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS CORRECT AND COMPLETE TO THE BEST OF MY OWLEDGE AND BELIEF. PERSON RECEIVING COPY OF SAFE DEPOSIT BOX INVENTORY: SIGNATURE _ SIGNATUR t PRINT NAM I PRINT TITLE DATEp /~~['l67E'~vf ~(jr ~s7LS~ v/L~+C.~Og r f (((/// _ N NA E AND CHECK APPR PR ATE X BELL'' CHECK APPROPRIATE BOX: xecutor(trix) ~Administrator(Irix) ~ Estate Representative ~ Joint owner of safe deposit box NOTE: Attach additional 8'/=" x 11" sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official purposes Rev18l>8 E7(+ (8-lib) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERRANCE TA% RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Richter, William H III 21-08-0211 Include the proceeds of litigation and the date the proceeds were received by the estate. All propeRy Jointly-owned wlth the right of survivorship must be dlaclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 PNC Checking Account No. 5070075692 9,811.73 2 Refund Musselman Funeral Home 321.88 TOTAL (Also enter on Line 5, Recapitulation) I 10 133.61 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1161 EX+ (12.99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS CSIAIE OF Richter, William H III FILE NUMBER 21-AR_fl99 ~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission paid AMOUNT 514.75 2. Attorney's Fees The Wiley GrOUp, PC 350.00 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. ~ Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 145.00 7• Other Administrative Costs See continuation schedule(s) attached 143.97 TOTAL (Also enter on line 9, Recapitulation) 1,153.72 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-7602 EX+ (8.98) SCHEDULE H-A FUNERAL EXPENSES COM~AONWEALTH OF PENNSYLVANIA continued INHERITANCE TAX RETURN RESIDENT DECEDENT t5 TATE OF Richter, William H III FILE NUMBER 2~_na~", ITEM NUMBER Funeral Luncheon Red Lobster DESCRIPTION Subtotal 514.75 Copyright (c) 2002 form software only The Lackner Group, Inc. AMOUNT 514.75 Form PA-1500 Schedule H-A (Rev. 6-98) Rev1 b02 EX+ (8-98) COf+Ily10NWEALTH OF PENNSYLVANIA WHERITANCE TAX RETURN RESIDENT DECEDENT G~TATr w SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ~....-. ~ ~. yr Richter, William H III ITEM NUMBER 1 Frank Snyder 8 Sons, Engraving 2 US Post Office DESCRIPTION ILE NUMBER 21-08-0211 Subtotal AMOUNT 115.00 28.97 143.97 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1812 EX+ (8-98) SCHEDULE i DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Richter, William H III Include unreimbureetl metlical expenses. ITEM NUMBER DESCRIPTION 1 Medical Expenses and Charges at Bethany Village LE NUMBER 21-08-0211 VALUE AT DATE OF DEATH 8,122.92 TOTAL (Also enter on Line 10, Recapitulation) I 8,122 92 Copyright (c) 2002 form software only The La kner Group nleneCded addltlonal pages of the same size) Form PA-1500 Schedule I (Rev. 6-98) REV-1613 EX+ (g-ppl COMMONWEALTH OF PENNSYLVANIA SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Richter, William H III NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I, TAXABLE DISTRIBUTIONS [include outright sppot distributions, and tray under Sec. 9116(a)(1 FILE NUMBER 21-08-0211 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT Do Not List Trustees (WDfdS) ($$$) Pamela A. Kirkpatrick 706 Plum Hollow Drive Daughter 50% Residual PA 1 William H. Richter IV 8 Irongate Court Son 50% Residual College Station, TX 77845 Enter dollar amounts for distributions shown above on lines 15 throu h 18, as a ro nateTon Rev 1500 cover sheet III NON-TAXABLE DISTRIBUTIONS: g pp p 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 Copyright (c) 2002 form software only The Lackner Group, Inc. 0.00 Form PA-1500 Schedule J (Rev. 6-98) Jan M. Wiley David J. Lenox July 11, 2008 THE WILEY GROUP Attorneys at Law Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 In Re: Estate of William H. Richter, III, deceased File Number 21-08-00211 Dear Register: Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status report with regard to the above captioned estate. Also enclosed is a check in the amount of $ 38.56 representing the tax due, and a check in the amount of $30.00 representing the filing fee. Please return the recording receipts to my attention in the enclosed envelope. Thank you for your cooperation. Sincerely, n ~a ~' ~ Dawn Gla felter/Legal ssistant : ;=_ ~ f ~ ~. r~ r {_ encl - . _ -~ ~ r.. __.., cn , rn . 130 W. Church Street, Suite 101 Dillsburg, PA 17019 Phone: (717) 432-9666 (800) 682-4250 Fax: (717) 432-0426 ~~~ Y ~'u~~ 1 ,~ Y T~ i~' ~$ a ..~q~: ~ y~ B+. 1 ~~ t ', 5 '~ y~ ~. -!' 't <= s r, ' ,~~" ~, ^; ~~ ~' ..~ ~, _ -~ ~ ~,. g' ._,~ ~- ~.« >, eY"~ .. ~:; :.:. ~~wz ~< ,' .~. .~` '' ~'' ~'_ .' ~'u ~ ~": ,#~ ,.~ ''', ~F~~~~ , . ~f i-It { ~' ~. ,. ~~~~';~ ORPh~~' ~~DC~~,, N U ~ c 0 ~ "d ° d ., '~ ~ a ~, o ~ ~ a~ ~~U ~UjU o r 0 r R ~a Q~ `0 c ~.o W o M 1- r r ,~;, r,. ~~" c~,rCLF(~,' ~,,.. CUh" ~._~,