HomeMy WebLinkAbout10-10-0815056041147
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO 60X.280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 8 0 0 6 8
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
486 28 1046 O1 15 2008 07 18 1923
Decedent's Last Name Suffix Decedent's First Name MI
MATTINGLY MONA J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
^ 4. Limited Estate
I~ 6 Decedent Died Testate
L ^ I(Attach Copy of Will)
^ 9. Litigation Proceeds Received
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
^ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
~ Decedent Maintained a Living Trust 8. Total Number of Safe De osit Boxes
(Attach Copy of Trust) P
^ 1 ~' between P2 31 81 anditt(datges; f death ~ 11, Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
FOREST N MYERS 717 532 9046
r,:,
Firm Name (If Applicable)
LAW OFFICE FOREST N MYERS
First line of address
137 PARK PLACE WEST
Second line of address
City or Post Office
SHIPPENSBURG
State ZIP Code
REGIST ~fj WILLS ONLY. -
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Q7ZTE FILED c.Fi
PA 17257-9212
Correspondent'se-mail address: fnmyers@embargmail.com
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 o parer other than the personal representative is based on all information of which preparer has any knowledge.
~~.~~...TUf~ PERSON RESPOI~3IB FORS INB RETURN ~ DATE
ADDRESS
Denise A LUCK
6719 Massaponax Church Rd, Spotsylvania, VA 22551
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
'~~~ ,~, Forest N Myers ~o , ,~ _ v ~
ADDRESS
137 Park Place UVest, Shippensburg, PA 17257-9212
Side 1
15056041147 15056041147 J
15056042148
REV-1500 EX
Decedent's Social Security Number
oecedenc's name: M o n a J M A T T I N G L Y 4 8 6 2 8 1 0 4 6
RECAPITULATION
1. Real Estate (Schedule A) .......................................................................................... 1.
2. Stocks and Bands (Schedule B) ............................................................................... 2. 2 9 0, 8 5 4 7 9
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages 8~ Notes Receivable (Schedule D) .......................................................... 4.
5. Cash, Bank De osits & Miscellaneous Personal Pro e
p p rtY (Schedule E) ................
5. 2 8 , 6 1 1 5 9
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ............. 7.
8. Total Gross Assets (total Lines 1-7) ....................................................................... g, 3 1 9, 4 6 6 3 8
9. Funeral Expenses & Administrative Costs (Schedule H) ........................................ . 9. 3 9 , 3 0 5.13
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 6 6 0 6 2
11. Total Deductions (total Lines 9 & 10) .................................................................... .. 11 • 3 9 , 9 6 5 . 7 5
12• Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12, 2 7 9 , 5 0 0 6 3
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. 2 7 9 , 5 0 0 6 3
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 .o0 0 0 0 15. 0 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 2 7 9, 5 0 0. 6 3 16. 12 , 5 7 7. 5 3
17. Amount of Line 14 taxable
at sibling rate :K .12 0 0 0 17• 0 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18• 0. 0 0
19. Tax Due .................................................................................................................... • 19. 1 2, 5 7 7 5 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
15056042148 15056042148 J
REV-1500 EX Page 3
rlennrlnn+~c f_mm~loto DI't['ICP_CC_
File Number 21-08-0068
DECEDENT'S NAME
Mona J MATTINGLY
STREET ADDRESS
210 Big Spring Rd
CITY STATE ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
g, Prior Payment:>
C. Discount
10,000.00
0.00
Total Credits (A + B + C)
(1) 12,577.53
(2) 10,000.00
3. InterestiPenalty if applicable
p, Interest
E. Penalty
Total lnterest/Penalty (D + E) (3)
4, If Line 2 is greater than Line 1 + tine 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5) 2, 577.53
q. Enter the interest on the tax due. (5A)
g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. {56} 2 ~ cJ 7 7 , ~J 3
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? .............................................................. ^
If death occurred after December 12, 1982, did decedent transfer property within one year of death without
2
.
receiving adequate consideration? ....................................................................................................................... ^ 0
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? ......................................................................................................................
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 met 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 ind'+vidual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1503 EX+ (6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX F2ETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
MATTINGLY, Mona J 21-08-0068
All property jointly-owned with right of sunrlvorshlp must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
F M Trust; Revocable Trust Acct
1 032511107 324 shares of Anadarko Petroleum Corp -Common 63.075 20,436.30
2 256219106 172.049 shares of Dodge & Cox Stock Fund -Common 130.7800103 22,500.57
3 315920686 475.312 shares of Fidelity Advisor Series Vlll - Divr Intl 20.7099968 9,843.71
Institutional
4 37362TAZ3 20,000 shares of Georgian Bank Atlanta GA .99986 19,997.20
Accrued dividend on Item 4 through date of death 962.00
$ 399874106 772.197 shares of Growth Fund American Inc - 32.2899985 24,934.24
Common
g 411511306 172.538 shares of Harbor Fund -Intl Fund 66.5400086 11,480.68
Institutional
7 411511306 2.527 shares of Harbor Fund -Intl Fund Institutional 66.5413534 168.15
8 922031307 1,057.198 shares of Vanguard Fixed Income Securities 10.5000009 11,100.58
Fund - GNMA Inv
9 02639ENCA $45,000 American General Finance Corp 101.4502 45,652.59
Accrued interest on Item 9 through date of death 300.00
10 12557WQD6 $30,000 Citi Group Inc Internotes Book 94.6501 28,395.03
Accrued interest on Item 10 through date of death 656.25
Total of Continuation Schedule See attached page
TOTAL (Also enter on Line 2, Recapitulation) 290,854.79
(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 B (Rev. 6-98)
Rev-1503 EX+ (6-98)
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MATTINGLY, Mona J 21-08-0068
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
11 31331SYE7 $30,000 Federal Farm Credit Banks Cons System 100.03127 30,009.38
Accrued interest on Item 11 through date of death 195.83
12 3133XER27 $25,000 Federal Home Loan Banks 100.15624 25,039.06
Accrued interest on Item 12 through date of death 535.69
I
13 34539CPN6 $20,000 Ford Motor Co Conn Offer Bd 92.4321 18,486.42
Accrued interest on Item 13 through date of death 61.11
14 s5oosaCHS $20,000 New York Telephone Co 99 19,800.00
Accrued interest on Item 14 through date of death 300.00
TOTAL (Also enter on Line 2, Recapitulation) 290,854.79
Copyright (c) 2002 form sofM~are only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-150e EX+ (6-98)
SCHEDULE E
~ CASH, BANK DEPOSITS, 8t MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
MATTINGLY, Mona J 21-08-0068
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Northwest Mutual -guaranteed payment as of 01/08/2008 before date of death 126.99
2 Carlisle Regional Med Center -Refund for overpayment 118.44
3 Commonwealth of Pennsylvania -Refund 448.00
4 Commonwealth of Pennsylvania -Tax refund 840.00
5 F&M Trust -Checking account 609.19
6 F8~M Trust MM Account -Money Market (@ Trust Dept.); beginning balance as of 12,132.08
date of death
7 Greenridge Village -Refund 4,531.92
8 Greenridge Village -Refund of overpayment 197.05
9 Health Management Associates -Refund of overpayment 104.56
10 Mutual of Omaha -Refund of premium 20.32
11 Rexam -Benefits for January 823.01
12 Rexam -Refund of overpayment 60.03
13 Diamond ring - in platinum setting (approx. 1.02 carats per attached appraisal) 8,600.00
TOTAL (Also enter on Line 5, Recapitulation) I 28,611.59
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form softuvare only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1151 EX+(12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8r
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
MATTINGLY, Mona J 21-08-0068
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
15,221.33
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
2. Attorney's Fees 11 810.79
r
See continuation schedule(s) attached
3. Family Exernption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
Ciry State Zip
Relationship of Claimant to Decedent
4. Probate Fees 436.00
See cantinuation schedule(s) attached
5. Accountant's Fees
6. Tax Return IPreparer's Fees
7. Other Administrative Costs 11,837.01
See cantinuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 39,305.13
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev1502 EX+ (8.98)
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
MATTINGLY, Mona J 21-OS-0068
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+(6-98)
SCHEDULE H-B2
ATTORNEY'S FEES
continued
COMMONWEALTH OF PEINNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
MATTINGLY, Mona J 21-08-0068
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B2 (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-B4
,, PROBATE FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
MATTINGLY, Mona J 21-08-0068
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-64 (Rev. 6-98)
Rev-1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
ESTATE OF (FILE NUMBER
MATTINGLY, Mona J 21-08-0068
ITEM
NUMBER
DESCRIPTION
AMOUNT
1 Cumberland County Legal Journal -Estate Advertisement 75.00
2 Cynthia Tognotti -Reimbursements for funeral expenses 418.55
3 F8~M Trust -Bank fees; administration of Trust (based on account balance) 231.86
4 F8~M Trust -Bank fees; administration of Trust (based on account balance) 230.17
5 F8~M Trust -Bank fees; administration of Trust (based on account balance) 222.60
6 F8~M Trust -Bank fees; administration of Trust (based on account balance) 215.85
7 F&M Trust -Bank fees; administration of Trust (based on account balance) 218.95
8 FB~M Trust -Bank fees; administration of Trust (based on account balance) 216.81
9 F8~M Trust -Bank fees; administration of Trust (based on account balance) 211.02
10 FB~M Trust -Bank fees; valuation of assets held on date of death 20.15
11 Green Ridge Village; -living expenses 8,g72.gg
12 Postage -mailing Notices to Beneficiaries; correspondence to bank(s); transmittal 6.32
letters to advertise estate
13 Sentinel -Estate Advertisement 182.56
14 Visa -consumer credit account 5.20
15 Visa - corrlsumer credit account 708.99
Subtotal
11,837.01
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-67 (Rev. 6-98)
Rev1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF (FILE NUMBER
MATTINGLY, Mona J 21-08-0068
Include unrelmbursed medical expenses.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Carlisle HIMA Physician Mgmt -Medical services 21.49
2 Carlisle Regional Med Center -Medical services 223.00
3 Carlisle Regional Med Center -Medical services 118.44
4 Continuing Care Rx -medical services 11.20
5 Continuing Care Rx -Medical services 137.66
6 Dr. Guisvaite -Medical services 13.53
7 Dr. Guisvuite -Medical Services 34.53
8 Kinetic Imaging -Medical services 1.68
9 Masland Associates -Medical services 1.61
10 McKesson Med/Burg -Medical services 12.50
11 Newville I;,ommunity Ambulance -Medical services 84.98
TOTAL (Also enter on Line 10, Recapitulation) I 660.62
(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 I (Rev. 6-98)
REV-1513 EX+ (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
MATTINGLY, Mona J 21-08-00 68
NAME AND ADDRESS OF RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY
Do Not List Truste s (Words) ($$$}
I TAXABLE DISTRIBUTIONS [include outright spousal
f
d t
. rans
ers
distributions, an
under Sec. 9116(a)(1.2)]
Mary C HEMPHILL Daughter One-fourth 67,725.16
21 Governor's Ln share of net
Bethel, CT 06801-2707 distributable
estate
Denise A LUCK Daughter 2 carat ladies 76,325.16
6719 Massaponax Church Rd diamond ring
Spotsylvania, VA 22551 and a
one-fourth
Charles J MATTINGLY Son One-fourth 67,725.16
19 Douma Dr share of net
Newton, NJ 07860-1548 distributable
estate
Cynthia B TOGNOTTI Daughter One-fourth 67,725.16
2648 Isabelle Ave share of net
San Mateo, CA 94403-2337 distributable
estate
Total 279,500.64
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropr iate, on Rev 1500 cove r sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FO R WHICH AN ELECTION TO TAX IS NOT
BEING MACE
t3. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS UN uNt ~3 Vr ttty-i5uv wvtrc srltt I ~ v.vv
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)
LAST WILL AND TESTAMENT
I, MONA J. MATTINGLY, a resident of Greene Township, Franklin County,
Pennsylvania, being of sound mind and memory, do make, publish and declare this my
last will and testament, hereby revoking any and all wills by me heretofore made.
ITEM I. I direct my personal representative, hereinafter named, to pay my funeral
~,ew ~ur~o<:~
GLEN & GLLN
14 Ntii'I.h til tilii tiLi'c;t~.L • SuILr 3(Ili
Chambrrnbu r{;. I'.1
~~~~~~-~~,t~:,
expenses as soon after my decease as may be found convenient, and also to pay all
estatE:, inheritance, succession and other death transfer taxes, of whatever nature and
by whatever jurisdiction imposed and interest and penalties in respect thereto,
assessed against my estate or payable by reason of my death, with respect to any and
all property, life insurance and other interests comprising my estate for death tax
purposes, whether or not such property or interests pass under this will or any codicil
thereto, without reimbursement as if such taxes were administration expenses.
ITEM II. I give, devise and bequeath all my estate, real, personal and mixed, of
whatever nature and wheresoever situate, which I may own or have the right to dispose
of at the time of my decease, to my husband, HILARY B. MATTINGLY, absolutely, if he
is living at the time of my decease.
ITEM I11. In the event my husband, Hilary B. Mattingly, is not living at the time of
my decease, I give and bequeath the following:-
A. My two carat ladies diamond ring to my granddaughter, ERIN C.
MATTINGLY, if she is living.
~ ,'
_` ~~
~:
ii f, rr; .
B. All the rest, residue and remainder of my estate, real, personal and mixed, of
whatever nature and wheresoever situate, which I may own or have the right
to dispose of at the time of my decease, I give, devise and bequeath in equal
shares to my children, CHARLES J. MATTINGLY, DENISE A. LUCK, MARY
C. HEMPHILL and CYNTHIA B. TOGNOTTI, but in the event any of them has
predeceased me, then to their children who are then living.
ITEM IV. I nominate and appoint FARMERS AND MERCHANTS TRUST
COMPANY OF CHAMBERSBURG, Chambersburg, Pennsylvania, guardian of the
estatE: of any person under the age of 18 years and with respect to which I am
authorized to appoint a guardian and have not otherwise done so, to serve until such
persons attain the age of 18 years, and no bond shall be required of said guardian; said
guardian shall have the power to use principal as well as income from time to time for
the maintenance, education and medical care of such beneficiaries under the age of 18
years„
ITEM V. t hereby nominate and appoint my husband HILARY B. MATTINGLY,
executor of this my last will and testament, but in the event the said Hilary B. Mattingly
is not living at the time of my decease, or fails to qualify, I nominate and appoint my
daughter, DENISE A. LUCK, executrix of this my last will and testament, and direct that
no bond shall be required of said personal representative.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this last will
and testament, this 23`d day of January, A. D. 2003.
I IW (II I~II(S
i.~ Nunh N i i Sircii ni u.o Sur p.~ C~',~~<:~.- .~-,y _::"I'~~~.f%?:~L,G,lc- ~.,,~ (SEAL)
<;h^mlu•rsbur~' I'A ~` !~ Mon J. Matti ~'
SIGNED, SEALED, PUBLISHED AND DECLARED by the said Mona J. Mattingly
to be: her last will and testament in our presence, who at her request and in her
presence and in the presence of each other, we believing her to be of sound and
disposing mind and memory, have hereunto subscribed our names as witnesses.
,~
r'` ~~ ,~
t.>'"
ACKNOWLEDGMENT
Law UI'I'ia:~
(~1.f~;N & C L (;N
I-I Nur4 ~Lil Sb~i. i ~uiic 3UU
Chain bcrslnirg, 1',4
COMMONWEALTH OF PENNSYLVANIA
COUPJTY OF FRANKLIN
ss.
I, Mona J. Mattingly, the testatrix 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 Mona J. Mattingly, the
testatrix, this 23~d day of January, A. D. 2003.
.~...~ .~,,, rac~~rr~rti?~z ,r~~1~ ~~
SAT I~Y I, ~F7i+;`P71;99, Notary Public
t:Yiatr,}_ rr harr, ~Er i~~ ]ir_ C'o T'9
+i's9'7 E ~ _:~ri u, ~ F. , t, u_~ ifi~ki.._7, 200.._,9
AFFIDAVIT
~~..
Witness
Notary P blic
,.~ J1 ~'1'>~kT~~ ;~Y~.AL
.~ T t~? l i l"I 1 1. 1`dus,ai,y Public
fr:; ,,,y,,t_ i . ~,jr ,Yr,rni uy 7. 2004
~.. ,. ._.~,. ,..».~~ .~.,~..~ ....r..~,w,.~ _w,...~.,,.
Lew Ofl'iaen
GLEN c~ Gl,I+;N
II NI11'11~ M11.ilii ~Li't~.t•I. • :iiiiLi~. :lllli
Ctt~inlfo.rsbur;~. I'.1
I '7 _'ll l ~ I t5N;5
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF FRANKLIN
ss.
We, George S. Glen and Sharon L. Frank, 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 testatrix sign and execute the
instrument as her Last Will; that the testatrix signed willingly and executed it as her free
and voluntary act for the purposes therein expressed; that each subscribing witness in
the hf;aring and sight of the testatrix signed the will as a witness; and that to the best of
our knowledge the testatrix 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 George S. Glen and
Sharon L. Frank, witnesses, this 23`d day of January, A D. 2003.
i/ !'~ ,
(,r' /~
y
Witness
COPY
I, MONA J. MATTINGLY, a resident of Greene Ridge Village, Newville,
Cumberland County, Pennsylvania, do hereby declare this present writing to be a
codicil to my last will and testament dated January 23, 2003.
1. I hereby revoke Item III A. and in lieu thereof I give my two carat ladies
diamond ring to my daughter, DENISE A. LUCK.
2. I hereby ratify and confirm my said last will and testament dated January 23,
2003, in every other respect.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this codicil to
my last will and testament, this 17~h day of November, A. D. 2003.
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GLEN & GLEN
14 Nor6h Matn SLreeL • Suite 3f)f1
Chembe rsbu rg. PA
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GLEN & GLEN
14 Nnrbh Mein Strar.b • Suite 306
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1120 ~-1889
SIGNED, SEALED, PUBLISHED AND DECLARED by the said Mona J. Mattingly
to be a codicil to her last will and testament dated January 23, 2003, in our presence,
who at her request and in her presence and in the presence of each other, we believing
her toy be of sound and disposing mind and memory, have hereunto subscribed our
names as witnesses.