HomeMy WebLinkAbout09-02-08 (2)REV-1500 Ex + (500)
COMMONWEALTH OF
~
REV 15 0 0 OFFICIAL USE ONLY
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1- 0 8 0 0 3 8 7
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
z CROWLEY M. CHRISTINE a/k/a CROWLEY MARY C.
W
~ DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
U 02/08/2008 06/10/1921
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
n/a - -
w
F 0 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82)
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~ a ~
~ 4. Limited Estate
~ 4a. Future Interest Compromise (date of death alter tz-IZ-e2)
~ 5. Federal Estate Tax Retum Required
~ a m ~ 6. Decedent Died Testate (Attach copy orwiq ~ 7. Decedent Maintained a Living Trust (Attacn cnpy of trust) ~ 8. Total Number of Safe Deposit Boxes
a
a
~ 9. Litigation Proceeds Received
~ 1 O. SpOUSaI POVerty Crodlt (date of death between 12-31-91 and 1-1-95)
~ 11. Election to tax under Sec. 9113(A) (Attach sch o)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AN D CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
F
w NAME COMPLETE MAILING ADDR ESS
°z Richard M. Mohler Attorne 14 S. Main Street
y FIRM NAME (If Applicable)
~ n/a Lewistown, PA 17044
p TELEPHONE NUMBER
717 248-5462
OFFI USE ONLY
1. Real Estate (Schedule A) (1) :
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2. Stocks and Bonds Schedule B (2)
116 698.5 ~_.
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3. Closely Held Corporation, Partnership or Sole-P roprietorship (3) r
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4. Mortgages & Notes Receivable (Schedule D)
(4) ~ J
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5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 16,198.79 .
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(Schedule E) fV
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O 6. Jointly Owned Property (Schedule F) (6) W
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F' ~ Separate Billing Requested ~
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~ ~ Inler_\/ivne Troncferc R AAiccollanannc Nnn_Pmhata Prnnerty rn _ 122,273.05
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11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(Schedule G orL)
8. Total Gross Assets (total Lines 1-7) (g) 255,170.37
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 31,227.73
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
14. Net Value Subject to Tax (Line 12 minus line 13)
(11) 31,227.73
(12) 223,942.64
(13) 0.00
(14) 223,942.64
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z 15. Amount of Line 14 taxable at the spousal tax
~ rate, or transfers under Sec. 9116 (a)(1.2) X (15)
t--
~ 16. Amount of Line 14 taxable at lineal rate X (16)
~ 57,147.74 6,857.73
d 17. Amount of Line 14 taxable at sibling rate X .12 (17)
~ 18. Amount of Line 14 taxable at collateral rate 166, 794.89 X .15 (18) 25,019.23
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X 19. Tax Due (19) 31,876.96
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20. QX • • ~ • •
1
> BE SURE TO'ANSWER ALL QUESTIONS ON REVERSE-SIDE AND,REGHECK MATH ` < <
aecederlt's Complete Address:
STREET ADDRESS
Golden Living Center West Shore Health & Rehab
STATE PA ZIP 17011
clrv Camp Hill
Tax Payments and Credits:
~. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 32.000.00
C. Discount 1.684.16
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(1) 31,876.96
Total Credits (A +B +C) (2)
Total InteresUPenalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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.
A. Enter the interest on the tax due.
(3)
684.16
(4) 1,807.20
(5)
(5A)
0.00
B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (56)
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
b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ ^X
c. retain a reversionary interest; or ...................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ............................................................. ^ ^X
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 "intrust 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? ....................................................................................................... ^X ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
0.00
Under penalties of pery'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 Uue, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PER ON RESPONSIBLE F FILIN RETURN DATE
ADDRESS 3680 U. S. Highway 5~2 orth ~
Lewistown PA 17044 ~~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
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 3%
[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 0% p2 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 childtwenty-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 0% [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 4.5%, 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 12% [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.
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CROWLEY. M. CHRISTINE. a/k/a CROWLEY. MARY C. 21 08 00387
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Citigroup Global Markets, Inc., Smith Barney Division, Account No. 204-00016-18 554 25,293.27
consisting of the following:
(1) 2,000 shs. Tiers Principal Protected Minimum Return Trust Certificates
Nasdaq-100 Index 2003-12 at $11.25 per share, Cusip No. G88653-86-3
($22,500.00);
(2) Bank Deposit Program ($2,793.27)
2. Wachovia Bank, N. A., Trust Account No. 1519192827 under Agreement dated 90,939.82
4/29/1992, consisting of the following investments:
(1) 5,000 shs. Wachovia PT Money Market, Cusip No. 9979981006 5,000.00
(2) 6461.173 shs. Evergreen Short Term Diversified Income Fund
(Fund #459) at $5.85 per share, Cusip No. 299908202 37,797.86
Accrued dividend to date of death 44.29
(3) 866.449 Evergreen Select High Yield Bond Fund (Fund #532)
at $8.63 per share, Cusip No. 299908798 7,477.45
Accrued dividend to date of death 13.58
(4) 458.299 shs. Evergreen International Bond Fund Class I
(Fund #460) at $11.59 per share, Cusip No. 299908830 5,311.69
(5) 322.261 shs. Evergreen Strategic Growth Fund Class I (Fund
#440) at $29.45 per share, Cusip No. 299909408 9,526.04
(6) 232.783 shs. Evergreen Growth Fund Class I (Fund #703)
at $14.03 per share, Cusip No. 300237252 3,265.95
(7) 178.304 Harbor Small Cap Value Fund Insured Class at
$18.56 per share, Cusip No. 411511843 3,309.32
(8) 382.472 shs. T. Rowe Price Equity Income Fund Equity
Income Fund at $26.10 per share, Cusip No. 779547108 9,982.52
(9) 664.623 shs. Evergreen International Equity Fund Class I
(Fund #252), at $9.40 per share, Cusip No. 299924704 6,247.46
(10) 2963.65 shs. Wachovia PT Money Market at $1.00 per share,
Cusip No. 997981006 2,963.65
3. 16 shs. Supervalu, Inc., Common Stock at $29.09 per share, Cusip No. 465.44
013104104
TOTAL (Also enter on line 2, Recapitulation) ~ S
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, 8~ MISC.
PERSONAL PROPERTY
FILE NUMBER
rROWLEY. M. CHRISTINE. a/ /a CROWLEY. MARY C. 21 08 0087
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Wachovia Crown Classic Checking Account No. 1010084798275 12,853.13
2. Albertson's, Inc., per share merger cash entitlement to owners of Albertson's 1,831.50
Common Stock at $20.35 in cash per share for 90 shares (Merger completed
on 6/2/2006, but Decedent never converted shares of Albertson's Common Stock)
3. SuperValu, proceeds from liquidation of fractional share of 0.38 share of 11.24
SuperValu, Inc., Common Stock as a result of merger with Albertson's
4. Albertson's, Inc., payment of accrued dividends on unexchanged shares 21,82
5. United States Treasury, government Stimulus Payment 300.00
6. MetLife Pension Co., pension payments dated 2/28/2008 ($590.50) and 3/31/2008 1,181.00
($590.50) as beneficiary of Neill Crowley's pension from Wyeth
TOTAL (Also enter on line 5, Recapitulation) ~ $
198.
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
FILE NUMBER
CROWLEY. M. CHRISTINE. a/k/a CROWLEY. MARY C. 21 08 00387
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.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IFAPPLICABLE)
TAXABLE
VALUE
1. Sun Life Assurance Co. of Canada Non-Qualified Annuity 122,273.05 100. 122,273.05
Contract No. 0200777790-01 issued August 17, 1998;
M. Christine Crowley, Annuitant and Owner, payable to
Joanne Lyons, Susan Morefield, Mary Ruth Houtz, and
Ronald Swartz as designated beneficiaries, surrender
value at date of death
TOTAL (Also enter on line 7 Recapitulation) I $ 122,273.05
(If more space is needed, insert additional sheets of the same size)
REV-1511 Ex + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
CROWLEY M CHRISTINE a/k/a CROWLEY MARY C 21 08 OO~R7
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Rex Funeral Home, funeral expenses 2,861.17
B. ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Name of Personal Representative (s) Howard Houtz
Social Security Number(s)/EIN Number of Personal Representative(s)
street Address 3680 U. S. Highway 522 North
city Lewistown state PA Z;p 17044
Year(s) Commission Paid:
2, Attorney Fees Richard M. Mohler
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant n/a
Street Address
City
Relationship of Claimant to Decedent
State Zip
4• I Probate Fees
5. I Acxountant's Fees
6. ~ Tax Return Preparers Fees
6, 316.00
6, 736.00
7.
8. Wachovia Bank, N.A., processing fee to fiduciary in connection with liquidation
of trust account 500.00
9. Golden Ventures-West Shore, payment of balance for room and board at nursing
home 12,762.37
10. The Juniata Valley Bank, wire transfer charges for four transactions 40.00
11. Cumberland Law Journal, publishing Estate Notice 75.00
12. PA Department of Revenue, payment of 2007 State Individual Income Tax 280.00
13. David S. Baboian, CPA, preparation of 2007 Federal and State Individual Income
Tax Returns 199.00
14. Citigroup Global Markets, Inc.,, commission ($100.00) and transaction fees ($5.15)
on sale of 2,000 shs. Tiers Principal Protected Minimum Return Trust Certificates 105.15
ota orwar ed from page 1 to Schedule H 1 353.0,4
TOTAL (Also enter on line 9, Recapitulation) $ 31,227.73
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
CROWLEY, M. CHRISTINE, a/k/a CROWLEY, MARY C. 21 08 00387
Decedent's Name Page 1 File Number
Schedule H -Funeral Expenses 8~ Administrative Costs - 67.
ITEM
NUMBER
DESCRIPTION
AMOUNT
15. MetLife, return of pension payment dated 3/31/2008 590.50
16. The Sentinel (Carlisle, PA), publishing Estate Notice 150.64
17. Richard M. Mohler, reimbursement for filing fee for Petition for Probate and
Short Certificates 335.00
18. PA Department of Revenue, payment of additional interest and penalty on 2007
State Individual Income Tax Return 16.30
19. Glenda Farner Strasbaugh, Register, fee for Short Certificate 4.00
20. SuperValu Shareholder Services, services charges ($15.00) and commissions
($1.60) in connection with sale of SuperValu, Inc., Common Stock 16.60
21, Glenda Farner Strasbaugh, Register, filing fees for Inventory ($15) and PA
Inheritance Tax Return ($15) 30.00
22. Glenda Farmer Strasbaugh, Register, filing fee for Proof of Publication 15.00
22. Glenda Farmer Strasbaugh, Register, filing and passing First and Final Account 180.00
23. Glenda Farmer Strasbaugh, Register, filing fee for Releases 15.00
SUBTOTAL SCHEDULE H-B7
1,353.04
REV-1513 EX + (q-nm
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
rR(1\A/I FV AA ('t-IRICTII~IF ~/I~/~ (`R(l1A/I RV ~A4RV (` ~~ no nnoo~
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 outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Joanne Lyons, now Joanne Lyons Allen Sister 20% of gross Estate and
9 Saddle Drive co-beneficiary of annuity
Belleville, PA 17004 contract
2. Ronald Schwartz, properly Ronald Swartz Nephew 5% of gross Estate and
R. R. #4, Box 1478 co-beneficiary of annuity
Mifflintown, PA 17059 contract
3. Robert Ulsh (Date of death was October 28, 2007)
4. Donald Ulsh (Date of death was December 7, 2006)
5. Cats, Pewter and Blue Boy, are both deceased
6. Susan Swartz Morefield Niece 50% of net residuary
4819 Bryan Road Estate and co-beneficiary
Mechanicsburg, PA 17050 of annuity contract
7. Mary Ruth Houtz Niece 50% of net residuary
3680 U. S. Highway 522 North Estate and co-beneficiary
Lewistown, PA 17044 of annuity contract
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 TAXIS NOT BEING MADE
1. n/a 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. n/a 0.00
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S 0.00
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
M. CHRISTINE CROWLEY
I, M. Christine Crowley, of the Township of Manheim, County of
Lancaster, and Commonwealth of Pennsylvania, hereby revoke all
Wills and Codicils, as well as all other instruments of a
testamentary nature, heretofore made by me, and do hereby make,
publish and declare this to be my Last Will and Testament.
ARTICLE 1: I direct my hereinafter named Executor to pay
all my funeral expenses and just debts for which I am legally
liable at the time of my death as soon after my decease as may be
practicable.
ARTICLE 2: I make the following bequests, provided,
however that each bequest shall lapse if the named person shall not
have survived me by thirty (30) days:
a. I give and bequeath Twenty (20~) Percent of my
gross Estate to Joanne Lyons of Lewistown, Pennsylvania.
b. I give and bequeath Five (5~) Percent of my
gross Estate to Ronald Schwartz of Mifflintown, Pennsylvania. If
Ronald Schwartz does not survive me by thirty (30) days, I direct
that this bequest be distributed to his son, Bently Schwartz.
c. I give and bequeath Five (5~) Percent of my
gross Estate to Robert Ulsh of McAlisterville, Pennsylvania.
d. I give and bequeath Ten (10~) Percent of my
gross Estate to Donald Ulsh of League City, Texas.
1
ARTICLE 3: I direct that my Executor find some person who
is willing to care for my cats, Pewter and Blue Boy during their
natural lifetime. I direct that my Executor distribute Two
Thousand Dollars ($2,000.00) from my estate to that person for the
care of my cats. This bequest shall be made outright to the person
selected by my Executor and these funds are not to be held in Trust
for the care of the cats.
ARTICLE 4: I give, devise and bequeath all the rest,
residue and remainder of my estate, including both real and
personal property, in equal shares to Susan Swartz Morefield and
Mary Ruth Houtz, or to their heirs per stirpes in the event that
one or both of them are deceased at the time of my death.
ARTICIE 5: I nominate, constitute and appoint Howard Houtz
and Hamilton Bank to be Co-Executors of this my Last Will and
Testament. In the event that Howard Houtz does not survive me by
thirty (30) days or is unwilling or unable to serve as Executor,
Hamilton Bank shall serve as my sole Executor.
ARTICLE 6: In addition to powers given them by law, my
Executor and his successors acting hereunder shall have the
following powers, applicable to all property held by them,
effective without Court order and until actual distribution:
a. To retain any property received by them;
b. To sell real estate for any purpose, publicly
or privately, for such prices and on such terms as they deem
proper, without liability on the purchasers to see to application
of the purchase moneys;
2
c. To compromise controversies;
d. To distribute in cash or in kind, or partly in
each, at valuations fixed by them; and
e. To invest or reinvest the principal of any said
Trust without being limited to so-called "legal investments."
ARTICLE 7: All taxes and interest and penalties payable
thereon by reason of my death with respect to property comprising
my gross taxable estate, whether or not passing under this Will,
shall be paid from the principal of my residuary estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
i
` day of ~-~~- 1995.
-,
~/E. ~~~tc , ~ ~-~ u~.c~`1 ( SEAL )
M. Christine Crowley
Signed, sealed, published and declared by the above mentioned
Testatrix, M. Christine Crowley, as and for her Last Will and
Testament, in the presence of us, who, at her request, in her
presence and in the presence of each other,. have hereunto
subscribed_ our names as witnesses.
..~' iding At ~~V' ~t
~-.,.': "° ; r %~: ~ "..¢f,% ~„~,~. Residing At ~ f .. ~ -~~'_ ;-";;
~~~
3
LAW OFFICE
RICHARD M. MOHLER
14 SOUTH MAIN STREET
LEWISTOWN, PENNSYLVANIA 17044
TELEPHONE (717) 248-5462
FAX (717) 248-4062
August 29, 2008
GLENDA FARMER STRASBAUGH
REGISTER OF WILLS
CUMBERLAND COUNTY COURTHOUSE
ONE COURTHOUSE SQUARE
CARLISLE, PA 17013-3387
Re: M. Christine Crowley Estate
Dear Ms. Strasbaugh:
Enclosed herewith please find original Inventory and
original Pennsylvania Inheritance Tax Return (with copy for the
Commonwealth) in the above Estate for filing with your office. The
extra page 1 of both the Inventory and Inheritance Tax Return are to
be clocked in and returned to my office in the enclosed stamped, self-
addressed envelope. Also enclosed is a check for $30.00 for the
filing fees.
If you have any questions regarding the enclosures or need
any additional filing fees, please do not hesitate to contact my
office. Thank you for your attention to this matter.
Very truly yours,
~~
Richard M. Mohler
RMM/pan
Enclosures
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF LANCASTER
SS:
I, M. Christine Crowley, Testatrix, who signed the foregoing
instrument, having been duly qualified according to law,
acknowledge that I signed and executed the instrument as my free
and voluntary act for the purposes there~[incontained.
~!1 • ~ .,/- `,,"" 1~.4 ~_~`~`"~ ( SEAL )
M. Christine Crowley
Sworn to or affirmed and acknowledged before me by M.
Christine Crowley, the Testatrix, this ~~~~ day of
~~~~ 19 9 5 .
y+ ,~
Not;~ry Public
r------
M Commission EX Tres: ~ NOTARIALSEAL
y P ~ i YNN R ANNF N~tar~ Piihlic
City of Lancaster, Lancaster County
COMMONWEALTH OF PENNSYLVA-At-~'~ Comm'ssion Ex Tres Jan. 8, 1998
SS:
COUNTY OF LANCASTER
We, the undersigned witnesses who signed the foregoing
instrument, being duly qualified according to law, depose and say
that we were present and saw Testatrix sign and execute the
instrument as her Will; that she signed and executed it willingly
as her free and voluntary act for the purposes therein expressed;
that each of us in her sight and hearing signed the Will as
witnesses; that Testatrix is known to each of us; and that to the
best of our knowledge and observation the Testatrix was at that
time of sound mind and under no constraint or undue influence.
_`~
EAL)
~ `~`,'~,~ 1{ ~.~C"%~"~ ~ ~ - ( SEAL )
,/
Sworn to or affirmed and subscribed to before me by
Q~e~a A-- t~M$~~4-- and :~~.~«,~` ~-? ,=~,.~~ ,-,a:~.; witnesses, this
day o f F,1,~-i~F 19 9 5 . _
-~
;~
Notary~Public
My Commission Expires : ~--- ,r, °EAL
~- LYNN R. ANNE, Notary Public
City of Lam aster. Lancaster County
I P~4v Commission Ex Tres Jan. 8, 1998
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