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HomeMy WebLinkAbout10-21-08 (3)t. t ~ - -- - - - - - - ~. . ~ ~ 15D56041147 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 Box.2aosol 2 1 0 8 0 1 9 6 Harrisburg, PA 17128-061)1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02 04 2008 06 02 1922 Decedent's Last Name Suffix Decedent's First Name MI MOSKO RITA (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 X 1. Original Return ~~ 2. Supplemental Return -'I 3. Remainder Return (date of death `-" prior to 12-13-82) r - 4. Limited Estate L~ qa, Future Interest Compromise d f f 5. Federal Estate Tax Return Re wired ~ 4 ( ate o death after 12-12-82) 1-- v J~ 1^ g Decedent Died Testate ~ (Attach Copy of Will) a ~ Decedent Maintained a Living Trust (Attach Copy of Trust) O 8. Total Number of Safe De posit BOXES J 9. Litigation Proceeds Receroed ~~ 1 p, Spousal Poverty Credit (date of death f ~, t 1. Election to tax under Sec. 9113 A between 12-31-91 and 1.1-95) ~___: ( ) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARCI S. MILLER 717 540 4332 Firm Name (If Applicable) v H A Z E N ELDER LAW REGISTEfVILLS U~ ONLY; ~ _ c"~ First line of address ` ~ , ,= f __t 2 0 0 0 L I NGLE STOWN ROAD :-. Second line of address ~ = i ;~ SUITE 2 0 2 T' --- ,.~ =-I .. D747E FILED tv City or Post Office State ZIP Code HARRISBURG PA 17110 Correspondent's a-mail address: 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. DeGaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGN~4TURE OF PERSON RE.S~PO-NS_IBlLE_FOR FILING RETURN DATE /,/1J ~/~L/ .~ic~1~U Karen Stasko Q ,~- / 7, c~00 8 ADDRESS 3603 We mouth Drive, Mechanicsbur , PA 17050 SIGNA OF PREPA OTHER T AN REPRESENTATIVE DATE /~/ ~~ Marci S. Miller , „ / , ~ /~, n 2000 Linglestown Road, Harrisburg, PA 17110 Side 1 L 15056041147 15056041147 ~~ ,t~ ~ 15056042148 REV-1500 EX Decedent's Name: iZ i t a iui O S k O 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) ~ 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) ....................................................................... 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/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. 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 2 6 3, 7 2 9 6 3 16. 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 0 0 0 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 170,000.00 102,804.80 2,201.64 30,095.26 305,101,70 32,029.99 9,342.08 41,372.07 263,729.63 263,729.63 0.00 11,867.83 0.00 0.00 11,867.83 Side 2 15056042148 15056042148 J ~' REV-1500 EX Page 3 File Number 21-08-0196 Decedent's Complete Address: DECEDENTS NAM Rita Mosko STREET ADDRESS Messiah Village Mt. Allen Dr. -------_ CITY STATE ZIP Cumberland PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty 10,000.00 526.32 Total Credits (A + B + C) (1) 11,867.83 l2) 10,526.32 (3) (4) (5) 1, 341.51 (5A) (56> 1, 3 41.51 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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 :.................................................................................. x b. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest; or .................................................................................................................. ^ ^x d. receive the promise for life of either payments, benefits or care? ............................................................ ^ 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?......... ^ 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. 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. ', ~' Rev1502 EX+ (g.98) SCHEDULE A REAL ESTATE COAMAONWEALTH OF PENNSYLVANW INHERRANCE TAx RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mosko, Rita 21-08-0196 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is definetl as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy ar sell, both having reasonable knowledge of the relevant facts. Real property which Is jolntlyowned with Aght or survivorship must be disclosed on schedule F. tlr more space Is neeaeD, aDDltlonal pages Df the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) .~ .' Rev-1603 EX+(g.88) COAMdONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT scHe~u~e s STOCKS & BONDS ESTATE OF FILE NUMBER Mosko, Rita 21-08-0196 All property jolntlyowned with rlgM of survivorship must be dlscloaed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 (14) United States Savings Bonds -Series EE - $1,000 12,756.80 each; issued October, 1993 2 (6) United States Savings Bonds -Series EE - $5,000 36,444.00 each; issued April, 1991 3 (9) United States Savings Bonds -Series EE - $5,000 53,604.00 each; issued January, 1992 TOTAL (Also enter on Line 2, Recapitulation) I 102,804.80 (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-1608 EX+ (8-98) COMdONWEALTH OF PENNSriVAN1A INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Mosko, Rita FILE NUMBER 21-08-0196 Indude the proceeds of litigation and the date the proceetls were received by the estate. Ali Pr'oPertY loi~Y-0wned with the Aght of survivorship must be dlselosed on schedule F. ITEM NUMBER DESCRIPTION 1 Credit for -county/town taxes paid in advance of real estate closing (7/18108 - 12/31/08); see attached settlement statement line #406 2 Credit for -school taxes paid in advance of teat estate closing (7118/98 -10/1108); see attached settlement statement line #407 3 Credit for -sewer paid in advance of real estate closing (7118/08 -10/1/08); see attached settlement statement line #409 4 Credit for -Homeowners Association dues paid in advance of real estate closing; see attached settlement statement line #410 5 Northern Trust -Rite Aid pension payment for month of death 6 Refund -East Pennsboro Twsp. - seweNtrash 7 Refund from Foremost Insurance Co. -homeowner's premium refund 8 Refund - UGI Utilities VALUE AT DATE OF DEATH 204.68 1,556.11 95.83 18.06 12.94 115.00 188.50 10.52 TOTAL (Also enter on Line 5, Recapitulation) I 2,201.64 (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-1609 EX+(6-88) COMMONWEALTH OF PENNSriVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Mosko, Rita 21-08-0196 Karen Stasko B. C. 3603 Weymouth Dr. Daughter Mechanicsburg, PA 17050 JOINTLY OWNED PROPERTY: DESCRIPTION OF ITEM LETTER DATE PROPERTY NUMBER FOR JOINT TENANT MADE JOINT INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR DATE OF DEATH VALUE OF ASSET % OF DECD'S DATE OF DEATH VALUE OF DE ' JOINTLY-HELD REAL ESTATE. INTEREST CEDENT S INTEREST 1 A 3/22/2000 AmeriChoice Federal Credit Union - 18,874.08 50.000% 9 437 04 Checking Account #32040-13 , . 2 A 4/27/2000 AmeriChoice Federal Credit Union - 0.15 50.000% 0 08 Money Market Account #32040-18 . 3 A 4/27/2000 AmeriChoice Federal Credit Union - 41,280.91 50.000% 20 640 46 Money Market Account #32040-19 - , . Opened from Money Market Account #32040-18 4 A 3/22/2000 AmeriChoice Federal Credit Union - 35.35 50.000% 17 68 Savings Account #32040-01 . TOTAL (Also enter on Line 6, Recapitulation) I 30,095 26 (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 F (Rev. 6-98) it an asset was made )olnt wlthln one year of the decedent's date of death, it must be repoRed on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT .~ .' REV-1167 EX+ (12.89) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Mosko, Rita FILE NUMBER 21-08-0196 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: Neill Funeral Home AMOUNT 2,446.00 B. ADMINISTRATIVE COSTS: 1. 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 Hazen Elder Law 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 10,500.00 4. Probate Fees Cumberland County Register of Wills 365.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 18,718.99 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 32 029.99 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) ,~ ,' Rw•1602 EX+ (8-98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS c wERR~i~NCe ~ ETURN~w continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Mosko, Rita 21-08-0196 ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberl d L J an aw ournal -Estate Notice 75.00 2 Debbie Lupold, Treasurer -real estate tax final payment for 2007/2008 441.05 3 East Pennsboro Twp. -sewer - 4/08 - 6/08 115.00 4 East Pennsboro Twp. -sewer - 7108 - 9/08 115.00 5 Foremost Insurance Co. -Homeowner's insurance -March 2008 146.75 6 Foremost Insurance Co. -Homeowner's insurance -April 2008 146.75 7 Foremost Insurance Co. -Homeowners insurance -May 2008 146.75 8 Foremost Insurance Co. -Homeowners insurance -June 2008 146.75 9 Foremost Insurance Co. -Homeowners insurance July 2008 146.75 10 Handyside Plumbing -repairs to ice maker; needed for sale of residence 112.73 11 House Doctors -drywall repair needed for sale of residence 900.00 12 John Songster -painting repair needed for sale of residence 100.00 13 Lauren Stasko -cleaning of residence prior to sale 60.00 14 Pennsylvania American Water -March 2008 12.00 15 Pennsylvania American Water -April 2008 24.05 16 Pennsylvania American Water -May 2008 12.92 17 Pennsylvania American Water -June 2008 20.94 Copyright (c) 2002 form,software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) ,~ • Rev-1602 EX+ (8.88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Mosko, Rlta 21-08-0196 ITEM NUMBER DESCRIPTION AMOUNT 18 Pennsylvania American Water -July 2008 21.08 19 PPL Electric -March 2008 24.00 20 PPL Electric - Apri12008 21.02 21 PPL Electric -May 2008 17.62 22 PPL Electric -June 2008 20.80 23 PPL Electric -July 2008 23.90 24 Real Estate closing costs for the sale of real estate - as per line #520 of attached 15 295 35 Settlement Statement . . 25 Sherwood Court Homeowners Assoc. -March 2008 40.00 26 Sherwood Court Homeowners Assoc. -April 2008 40.00 27 Sherwood Court Homeowners Assoc. -May 2008 40.00 28 Sherwood Court Homeowners Assoc. -June 2008 40.00 29 The Sentinel -estate legal notice 182.56 30 UGI -March/April 2008 170.25 31 UGI -May 2008 24.17 32 UGI -June 2008 35.80 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) ,~ ' Rev-1612 EXa (8-88) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS CO~A~AONWEALTH OF PENNSYLVANUI INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mosko, Rita 21-08-0196 Include unreimbureed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 2007 federal income tax 204.00 2 2007 PA income tax 52.00 3 Alert Pharmacy Services, Inc. -medical expense 134.17 4 Foremost Insurance Co. -Homeowner's insurance 146.75 5 Hoty Spirit Hospital -medical expense 25.76 6 Messiah Village -final nursing home bill 8,515.27 7 Pennsylvania American Water 12.00 8 PPL Electric 52.98 9 Sherwood Court Homeowners Assoc . 80.00 10 UGI 119.15 TOTAL (Also enter on Line 10, Recapitulation) I 9 342.08 (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~au ex+(e•oo) I SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mosko, Rita NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ TAXABLE DISTRIBUTIONS [include outright sppousal distributions and transfe under Sec. ~116(a)(1.2)] Marian Garletts 84 Sailor's Cove Deltaville, VA 23043 Karen Stasko 3603 Weymouth Dr. Mechanicsburg, PA 17050 FILE NUMBER 21-08-0196 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) Do Not flat Trustee(s) Daughter one-half residue Daughter one-half residue Total I Enter dollar amounts for distributions shown above on lines 5 through 18, as appropriate, on Rev 1500 cover sheet III NON-TAXABLE DISTRIBUTIONS: T A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT I BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 0 00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) Calculated Value of Your Paper Savings Bond(s) .' Calculated Value of Your Paper Savings Bond(s) Bonds: 1-3 of 3 Page 1 of 1 NA EE $5,000 01/1992 07/2008 01/2022 NA EE $1,000 10/1993 04/2008 10/2023 $2,500.00 $3,456.00 4.00% $5,956.00 NA EE $5,000 04/1991 04/2008 04/2021 $500.00 $411.20 3.75% $911.20 $2,500.00 $3,574.00 4.00°6 $6,074.00 Totals for 3 Bonds 5 500.00 7 441.20 NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earnin interest cif/c4~Z ~ k S,aS'b = s3, X04 ~~b~ i~~~5~~.~~ ~ 0 1 t4~'3 t4x 9'tt.20 = ~ ~ ~a~ 4 = 36, 444- `~~. ~_~_ _~,. ~ O~ ~ ~o~(. ~a http://www.treasurydirect.gov/BC/SBCPrice 2/8/2008 Calculator Results for Redemption Date 02/2008 w 1 e ~ ~ ~ _ ~__ ~ _ ~F ~, ~~`~ ~~~...~~,;~~~ SERIES ~~ _. _ pyy~~g b ,~ .r ~~' ~A ~.~,~i! 1D ~ i{~1`fR£37 GE A$£S 30 VE`.4 R5 ~. Y ~~-- ) il ,• _ -, +'a_ x ~~ _~jjROM 1S5UEVAT4tE z 1 - .. '~ :, ~ ~£ F ~~ 1143 `;ate ~ ~,#`~ ~ ~ z { ~ ~ T ,+ .~ ~: C~F3g~ 4D~~J 7~. r c ~~ .u~u~ a ___._. ~ ,. ___ - __ u ~ ~ ~ ~ ~ ~jC `_ _ ~ -- - - ' '~~~~~~+w^^~ "~°~ ~?~,~ ~1VTERC4T CE:~SES 30 YE.4A5 "~~ ~~ ~ Js.~t.FRDtw lSS UE ~ArE n • ~- ,,~ , ~ _ I (~ I ~ ~.3 ~r~ y. ~ ~ ~~ b-a „x ~' ~a cam. '. a, R ~ -a..~ f'p ~ ~ '~ ~ ~ fi~ F" ",.' i ..~tZ~'4 4~ ..... i p ~t ~ .ems ~ ~: _ ~ `'"'i'4F'~7wFrP i n s ~ , ~ ~~~a~ ~ ~`~ x _~; ~. p ~# x ._._._ y: .~ ~ ~ ~ ~~~ _.....~,....~_.._ ~ ~~~ ~ b_, ,. ~--.-, ~-mo~s - _ ~, - . . y ~.,,t~c ~ ~ 3'~d ~1. ~~~~'il#i1~~6.~r,~js~yy}r~~,~~((. _~_~»p~_-,--~.Y Y C. _ _j~wi~ {~-~'} C ~ c- ~'~' ~£ ~~~ ~~E.I~~~yyi. 6~ 7~} S9 i~ ~1.'ILJ~ ~ ^ r ~NTE REST LEASES 30 vEAR$ ., ~ '.~~~ 3. 't ~~~.~ gROM ISSi~E DATE ' ri 11 {{ ry1~ L ~ L 7 7 . .. ~ !ter ~ ~ 1y ~ ~~ ~ Q ' tt ~~ 3 ~ l 1~!! !!^^ tp~ ~~,ff ty it ~~~5^'rt ~ ~`3~-~ t~-~yyrr y ~ --L~ ~~ ~5908Q~9.'~~ ~;:z t ~ - ~.0£~009000'~~.p ~ y - ~,..F~..« t 600 5 9 :080 3 9 4,r^ ~, „ :. . ,~ . .~, 1 ap f? s+l~ ~.} / 1 Y ~- tN 1 t ~ C 1 / c ~,,. ~. -»~_ ~ 1 ,. ~ - .. ~ _ ,, ~ .. a 2 }~ ire 6' Sfl T~rtRS ' ~~.9UE 4hTE y ~~~~ <~ <' ,~ ~' _ ~~~': ~,. 33~~`~ i~ ~. ~° ti F ~. ~ e a z ~,r ~= s c ..., ~ _y ~. _._--~v...c N ) .~-.R >.~.. ~. r~ ~ i ~ .a _ ~ . , . .~'u _. SERIES EE INTEREST CEASES 30 YEAP.S FkOM f55VE GAT E - ~~ ) L`~~ e 3 g '3 r" a ;; a r _ ~£ ~:~a;~ ~~ ~~ ~ ~ ., M5908039~EE 1.0000 9000 21. ','' ~'-- ~~ o? -•-~ 900 5 9080 3 9 7~i• ' ... .._-..~ <,.~3'ZY.c,S'.A3;1R.yrSYdrlCyL(3..tii~-.u<.,, ..., ~rn bkf~iuiStw.uux!3'v.,:~v 59x~r;S+zKi;~~:uaW~a ..sb::.>:~ z~~c;~..,sau r., ........ " ~i ^z~,,n'S~'#4Frv as H" h~~ ~ -':mxr a~-ac•~- z ~ E I f Tl"~-'p"~ ~7s-n~- mss.`, c~_. _ ,,~ ~ ~ ~~'I~ ~` ~ ~1a1+~'~ ~`' • ~ +1 _ ~~` . 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Wr~N....~...~ 4.4 ~ ~' a +aa,e.. ..- ~. i~ _.. ;• rt.~~ .. .... d~~t us .,. ... w~T'~ ~ ~ ~~ ~~ .'d a ~ 6i 5 y 48 .. _ r Y a a : .: 4 ` t , ,.~lsy -sa l\~~ c""'~G~".. ~ °/ r ~ r ~~.a*r ~ esx,.: r~ ~ ~~~ ~`~ R ` ; ~~~liy~~ l_~t9~~111' ~~f ~~~°t~~~ \~~J ~~# I. ~~i~\ ..\ ~ T SERIIJS EE ., .:N r ~~ :, ~ `~ t)'\~ x;I;Cf ii `~t11) t),E!>rar ~1-1:''. .. , __.,1 ` ~~-~ INTEREST CEASES 30 vE qRS ' £ly" <~ _~ FROM ISSUE DgTE ~~-d CITY ~ .'*d~-~-r~r ?=~ ~3~~?3 ., { ~~~~~ ~r~~,~,~ ~~ ~~~ ~ ~~T,~~ 3.~#~3 ~~~~~ ''~ ~.f=~'~ ~ P --- MS9080401EE x:00009000?x:07 ~ 2005908040 L~~' :. __ ~.~~.,;A~.._. ! f j f// I ,u y.~ - 'f ~,. ~~ .f c~~a~;. x r~~~;,t~ ~~W~~a x,ar~~~r~.~a~ ~~.~ ~~- ?~FJ~ St1~i C T?Y C r ~1T~az, ~~ 335? 3 SERIES EE INTEREST CEASES 30 'FEARS FROn< ISSUE 04 TE a~ 1 ~~_~ ~~Tr2~! I~;~~A 2:~iano 3,,~$~ ~~T ##2~~f~c 3.933 _ ' o.~S..ic~sCf..ur ~`~ ~~ ~~~ M59080402EE x:00009000 7x:0 ? ~ 300 5 908040 2~~' x, •.. , ~°'~^'~- ''.•+1..?+Q.a~.vkw~Sa'8:..d5iL~~-. .dYf.N,4a'bYu`l'.S17G'ialuli:u'>~tc ~rtnn..i A a9it, --- --- -- -- -- ----- ~~y_s i ~ ~ ~~ ~ - - -~~t~;~~~~~~~5~~~~tJf~~;t~~~~r~i ,SE~~IE~ ~2~~ _ ~~~ ~~~ ~~b4~ ~ ~~~ It ~f1L '] l~~]i/t~~~~r 12lTCR PSI MCVFA ESC ATE AR$ ~v t}I 7 14 X361 ,;', * °, i4 ~9~3 , ~. I8.1~ PE`38i,~ ~~~ ~~~ .~~,Y~3 NC7 ~.l~.~'. '~ ,~~ , -~~~~~ = ~ SU~~I CI~`Y ~FN~~-f ~~ 3~~~3 ~ Bl~tt~xN.~k~l~~?i ?~ j ." . ~n _~ d ~ n ~,~, ~ " ~- _•_ C ~! v ! -~ ~w> <> ti a ~,, F y 1~ - ' t ~~ ~, 033-22x8194 04 199.1 ELzta. Mosko s .,.. 1810 Pebble Beach B:ivd, `;,~i. ~' ` "' ~ ' Sun City Center Fl. 33573 #~'~ ~~ ~y ¢~~ Or Carl ~1oskQ - -~. ~~M. . i ~ ~ - fe " < _. °_;. ~n~~©~ 4©00 ?x:08 ~ ~, __-,.. -- s . ~ ru v~ .~e a = t ~ ~ ._ _.~__ ~~ > ~ ,~ : ~~ ~~ ,_~, ~_ ~,~. 033-22-819 ~ 0~4 i~9~~ f,~„~ f:~ Rita Mosko :~~~ ~~~ ' _ s L810 Pebble .Beach $~~,vd; I3, .. . dun ,City Center E'l. 33533 ~,~6~~ ,~Ew~y~y}}s ~._. ,_ - ~ ~ ,~rr 6~ "IS3 ~ ~ r i~ul' ~~' ~~~, r ~~ Cari ~hiosk~ fi..-~..: ~ ~, ,~ ~ ~~,. ~~j, ~, ~. ~ ,., ., „ _,~ ~ ,, ,y ~ _ . ;, - -- - - ~~ ~ f~ ~a ~s~~,,, ~,e~.___..~F~z s: _ _.. 033-22-8194 04 1991 Rita Plosko 1810 Pebble Breach Blvd. N. Sun Cit,- Center, Fl. 33573 .. _, ,. r;~: Or Carl Mosko ~'= } ;.{. + 4 ., ~.~. ~~ .~ V1~25084EE :00009000 ?I:oB 000 ~ ~ 25084~~' _..._ z~v<~..u ~.;:ti~:aw-a ~';.rzt~•~W ~..._.:...~..:tetra zzx+s„hy, _ - .~ek2~ti:A6L!.'6.¢~'il~»4:k~.,.c~:;,~~.'.ti~~k4i.~+.:ai'LSip~U:hYz~2ti~T6XAk2fi*ilSa'•'Sk~siS~K',~~u.. ~ :.. ~~ f 1 4 0' 41 '~ ~ ~Y,., ls~.~~ ~T "~"~~ ~~ ~k'J*1~'6a ~t :7P : _ .. ~:~~R~...,,. ~ ..,t, unwu:~:,s..~. .s~.c:.~.__s ri.«...~., a..t6,xd:.+s.. ~,~~~~6b ~~''$~~,,....\~ ~fa~ ~` . `4 i ~~IV1,!I ~l~I3(d ~`~i~l,~,,-~~d~'f~~(sl'I6_,~~~`~! 033-22-8194 04 1991 "~ Rita Mosko 1810 Pebble Beach Blvd. N. Sun City Center, Fl. 33573 "' ~~. Or Carl Mosko ~ ~~ _ ,~ -'~--~ ~~=- V1~25085EE (:00009000 ?I:08 ~' 000 L 7 2 508 5~~' ~_ ~~~ 3 ae ~ ~ ~ a -~ ,~ ~" - .: ~ ~, .~ vim' '"=' `~ k ~ • ~ '~` ' ~ ~,•: S~R~~~ I #I`4tI~ I~I9f~)~,[~,~~x~0\~I~}!(~3(t?'Ca~6.s#I~~ia ;a 033-22-8194 04 1991 s, ~ ~~~"' -'~~ Rita Mosko ~ _ 1810 Pebble Beach Blvd. N. Sun City Center, F1. 33573 .. ; Y rya ~~ Or Carl Mosko `'-^` '~, ~: = _ a ~, . (:00009000 ?~:OB a~ 000 Z ? 2 508 6~~' ;.. ,, ~. . ,~~ ~. ~, ~. ~. ~ • _ .'_. , _. ......: se . c .IC,e ...u.,... ,.,.,,..,i'si[/~ ~ _`> ~ ~ ,c ~ .. ~ _S ~ j ~ i~l~ i ~ ~OwZ~~~~~i< ~~ ~~-~ Zti`'eCC.~^ 1~, _ ~ c e 1 ti sii r' d ii ni ~@C~~ . ~~V! _ _ i~.E.Y. ~~~a~~ft «., y ^y • ~- SERII1~ 1'~ x ~,_-. - - ~.,~-j. ka~li i.~.4+e4' INTEREST CEASE) SI` Yc AF.. ~" FROM i55UE i?AT'E ~ ~ ~` a :w - ' `M, M r.,.: f~ V2'+65~185EE R.'i` 4"8.l , , .ti;~..:.';. r~sa,laiti,.•ayr.~yO+: 5:0000 9000 71:08 --~ 0000 2 4 6 5 78 5++' . :: ..<~.:,[te3.`b9.?.is<. .:te%2tGtiiU;:k$+~.o!xS~2~~;.~i'~A`iY+iaau~YUFYn..+taww.irl ,~, - .uav}J- r s,~c x }~ .iSuy2a4fo~n`tirou-..Xa vtv:, ~T-- *`d, y'1 i .. ; ~~"'.' x .t _ 4a: e? ,„ ~,, ~ ~;.;'r_~ I,. -,~~ F ~ 1 ..~f ,.,, z R .r g s A ?? ~;.~ K Cl 5:0.00,09000 75:08 ?a~~9~~3 JAN ~3 2992 :. Mpg, Y3~Z4b5736~r ~. - V2465~86EE 1000 246 5 786++' w.~k~~ n cctis+iaa ,~ ~sr~ctwxs, y ...: ,aY~~ ari a .~ .~ a I - .., _ _ '.., i;~ Y, .. -.. ....- -. I ~f`i.l;i i ~~°,i #''~~,~1+~'~i~iJl,~ fir2't ~~.°~~~i ~~i?Ihi .~ yy p ,~ y SERIES EE ~~-~`^ ~ t)z=ai <'Y,1;~ii~a ia~f.r„~ 15 ~; INTEREST GEASEJ 30 vE\ 5 ~` FROM fSSI'E CA TE. pp~~ `` ~~++yy~ ~2 29~? ~'..~ LA~i,~ ~LaJ n~i ~> 23I(3 P=i~~L~ [i~A~#i ~LV~ N~~TN F.Rsg3.' SJ;'V CITY G~~1TER~ i"~ 33'573 ~IR~#INGHA~! J~-~i ~p3~~~2w99~ o Ti~'JTJ P 3. '?~ =:I TA 'faSK~7 1~0~24~i57~37~~ t-^ ``~ ~` ` V2465~8~EE 5:00009000 75:08 y ~ 2000 246 5 78 7u^ 'aE~v'~KilfkZiaA3ii .:.-:,-.;,.. i t<sf'~75.+21Aiu'i~Sixl, ,4aai~2~+sb.'ids:`a:dixv.Za<'dtaia'a~in'S•~$.vS_s;Y:< ~.-'4.... . ,. .. `.... ..,.. .... u+ 1L+.ati.,, `I iii [_ ~dt'Il^(l'//~~ ~~L~ ~''i1;t~!~^ t1i13:i:f'1. SERIES EE "~~~ ~ 5°i.~it ~l I11T;°~~~_ li?t~)I~S..,Y~f-g ~i_ iNT ERE Sr CEASES 3G YEARS FROM ISSUE GATE ~i 2992 ~A~ti ~i~S~C`~ - 2~2^ r~~ ~~k- ~~aCH ~Llli3 N~}~T~i S~,i'V i:ITY C~:i`3TL~~ F~ 33573 t'~'~•~. I ~ I'+1 ~ ~ ,~ ~t .. ~ - 1 si r r~>~ } c~ ~ .I I~, -~. ~" F ~ ~ ,.f J~ c ~ I ~,`l f i vwma ~a~' ra r ~„~ r _ _ _.-,...-.w~"~ s...,, ... "'"`.ae+.tVCf._J .^,e4:;z.~~.~..:~ w..r i~ ..c ... ~...,a..._d.~~L ~~d .u-.~_5~..~...._ _._ . i - _ ~~i ,~,~ ~ _. =~U~ ~T TY C~.~~ ~ ~~* ~{ 33?73 ~.~.=3. ~I~ti?v~;-tA" ---- J~~ ~~ I~~z _ ~~,~.. t V2~65~88EE :~ ~.. x:00009000 7:08 3000 246 5 78$ii' ~~`. ,~. ~..• =ci.:aL+4~a_uu:i,..$G~9D2?Ai6.VfVi°n~rYYt~idYr!w`1uS2PE$36,2~iitY6F'7N:'r~Y~~;S$~51~ ,6N,63AliwYaYr~~':~:a4~X.".~:r,..4bsoaxs....abi;.:w,.wxw-:urstv~~.u+5..vs, .,.~w...~ .+ww,v::u~w-~. .. F a, h~' `"'~~.- _ rs.- "~ ~ ~~~ ~!`~`~~ "'T,~~' ; A,. }t _~,~p ,~tp~l) R...+ ~- ~ti. ( 6 ! ..,r„~i~f~il~ 1hR~;IR Z*B ~ ~ ~ . a ~'~pv~ r ~v(i~~ ~:~~~•~`~;~a~^~1~~`~* ~.~~~~~~~a~ .~a. SERIES E ~a 4xp~5# I~p~~;~~~ II"1~*'`~~:D I"R~QM^ ~§t$1`~~~i.;.~.'1; INTEREST CE.4SE5 30 TEnq~. 9 ~ -~ FROM ISSJE D<'[ CI 14~ lBic~ pE~~~ 3~AGH zs~V~ NQ~TH F.~.~. aU'v CITY '',~~~T~-~L* ~~ :33573 ~i?~'~I~GNA?~ a J31~3 2.3 1t19z i~~ ~;~~L ?~CI~K~I ~_ V(3~2~b5 739E _ V2~t65~89EE x:00009000 71:08 y y 4000 246 5 789~~' 4Yi>,V'~YaQ.'~7~1 ~Qk17iL1 .~•ti: ;. :~11~.~1%Y]';'iS. ..e4 `~ikY1i •, YlYC~4Sa`uYa13'.'rJ~iS~'~Sii+i.415YuSL.'LOLXu:.kddkN/X~'.::: .:66LaltiiN\U34N~6Y~;YLUti•:llxi}v.= ~~~ fir? ~1t?~f ?ITS .;~.~K`~ I31~ ~'~:~'s~l.~ 3~ACt-~ =3d..'Jt~ t~~?~T~f ~i~ f ~~~ ~~~r~~'! ~~.. 33573 :;AFL ~~SKC7 VO~J2.4b579{3~ ,, 5000 246 5 790~~' SERIES EE INTEREST CEASES 30 YEARS FRO+A ISSVF_ DATE ~1 1~~2 ~aRa~a ~I~'~IP~ivNA~ 2'8y~~9'9 JA~t ?:3 199 ""'R~~'° V2465~90EE '~~' r 6 - ~ ~`! § hr 6 6+ x ~ E P ~$SYp f f t~\ \R '!\fd Fw>rs ~ ~ ~ o-', ` ~ - _ _ ,~ w _ ~,~.~_ .~~._..u,.' .:~3:~w~~,,...u. __ '~__..._ . w5`~~ ~ _ ~ EFR a aka :~~~.~.,,'~ r'i~Vt4 ~o~_ ~ ~~,`.- P"sus:. s .~i'~~?1 ~~ §`'$?A'! ~ ~ ~:a. ,:~Q-,,. -, g ~: - ~~ ~ ~~r ~ ~ - - ,- f ;,. ~• ~ y Lei r~. .F SE :_ rt~Q(~}d +'l~'t ~i ~'~~~~"~ s-i '~ .~ ~" ~ -.~~c'~ b... ? ~~ i p ~ - - V2~65991EE x:00009000?x:08 y 6000 2465?9 iii' '~.~>>~~ ~t ?: .~_: ~ ~, , ~ ~ GS:. , ,~ ~~~. ,~,, . .. is .~ :~ ,~ f ~ ~. ~ SF=~~ ':ITY ':~?1ET~#?• 1=L 3373 SEI~IE~ E.E INTEREST CEASES 30 YEARS j FROM ~SSIiE DATE ~3 z~~~~ ~_ yA~itt it..: > f3~ 1 ~ ~ F s': E ~. ~ ±-.~:.yy 2 ~'~'T ~~?"~ :,~-±tpg V~~2465392t'-~ ..~.~:~:'_'_ V2't65992EE __ .- (:0000 9000 ?~:OB ~ ?000 2 4 6 5 ? 9 2~-' _... ... _ .~~:ta~~ ryy_.xa~4~zya~~~~~~,~-~~tR ~~^~~~1.~~~~~ ~ SERIES EE # !!l~e~ ly~~~~`f~~~~, TF~~~ ~~~t'1~T ~i1 ~1I1Z1f 1a'w~".1S INTEREST CE.AS ES 3~ YEARS FROM t55liE DATE X33 ~Z T~~ ~1 L3~2 ~i1'~ CITY ~F_~'~R+ F~. 3373 ~I~c?~1~.;sas-?A,~ 2~~~~~'~ JA"~! Z3 1~~'~2_ J' R CA~tI ~tS~Lb V'~~Z~t6~793~E ~~-~~ '- ~-~-~ V2465~93EE x:0000 9000 ?i:08 ~ 8000 2 4 6 5 ? 9 3~i' :~ a'.~?+,ki~~3w,.ds..x~.-._,.. ~, :;.K,o ,sfi~etbra"tixSh~Y~ov~ailrixMtr.~;Ka~~%s:.~+~~°n~^'':^~~ a9a,~.i2*a~e~~m,-: _ms~~~~a~iox,:~•~$ A. OMB N0. 2502-0265 B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING 3 URBAN DEVELOPMENT 1'QFHA 2.QFmHA 3.QX CONV. UNINS. 4.QVA S.QCONV. INS. SETTLEMENT STATEMENT 6. OFI~N~UMBER: 7. LOAN NUMBER: 8. MORTGAGE iNS CASE NUMBER: 0090170903 C. NOTE: This form is lumished to glue you a statement of actual settlement costs. Amounts paid to and by the settlement agent am shown. !tams marked rPOCJ- ware paid outside the closing; they are shown here for informational purposes and are not induded in the totals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: to sroa (oe-0oes.PFC~oe-0ausni H. Robert Asper and Nancy E. Asper, F. NAME AND ADDRESS OF LENDER: as Trustees for the Asper Family Trust Wells Fargo Bank, N.A. Karen Stasko, Executrix of the 111 Continental Drive, SuRe 114 20 N. 12th Street, Apt. 104 Lemoyne, PA 17043 Estate of Rka Mosko Newark, DE 19713 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 20-2339545 150 Lee Ann Court I. SETTLEMENT DATE: Enola, PA 17025 ABSTRACT AMERICA REAL ESTATE SETTLEMENT SOLUTIONS, INC. Cumberland County, Pennsylvania Juiy 18, 2008 PLACE OF SETTLEMENT 108 South State Road Marysville, PA 17053 to 120. GROSS AMOUNT DUE FROM BORROWER 177 862 48 420. GROSS AMOUNT DUE TO SELLER t00 AMOUNTS PAID BY OR IN BEHALF nF anoonwre. 171,874.68 1 to 220. TOTAL PAID BY/FOR BORROWER 300. CASH AT SETTLEMENT PROMlTO BO 126,500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 15 295 35 RROWER: 301. Gross Amount Due From Borrower Line 120 800• CASH AT SETTLEMENT T0/FROM SELLER: , . 302. Less Amount Paid /For Borrower (Line 220) 177 862.48 ( 601. Gross Amount Due To Seller Line 420 17 303. CASH (X FROM) ( 1o J BORROWER 126,500.00) 602. Less Reductbns Due Seiler Line 520 ( 1,874.68 15,295.3 The undersigned hereby acknowled i 51,362.48 603. CASH (X TOJ ( FROM) SELLER 156,579.33 ge rece pt of a completed copy of pages 182 of this statement & any attachments referred to herein. Borcower -~`ti lvj~,v H. Robertgsper, a$ atee Seller ~~h0~ ~ ~~~ /n D,(/, ~ for the Asper Family Trust Karen Stasko, Executra of the Estate of G Rka Mosko a cY E. er, as Trustee for the As r Family Trust Borrower .-~L, ~j f,,/~~, vT',~_ H. Robert Asper, as Trus ee for the per Family Trust a cY , as Trustee for the As amity Trust Seller ~Q fiJ/YL'6L/Q~,D~ `Q~Q.~,~I~A/~ Karen Stasko, Executrix of the Estate of Rita Mosko (OB-0096/0&0088/31) The undersigned hereby acknowledge receipt of a completed copy of pages 182 of this statement 8 any attachments referred to herein. ~ ., LAST WILL AND TESTAMENT OF RITA MOSKO I, RITA MOSKO, of Sun City Center, Hillsborough County, Florida, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills and Codicils heretofore made by me. ARTICLE I I direct that all of my just debt paid as soon as practicable after Representatives may in their sole domiciliary estate all or any portion administration and similar proceedings ARTICLE II s and costs of my estate be my death. My Personal discretion, pay from my of the costs of ancillary in other jurisdictions. I give and bequeath such of my tangible personal property to those persons designated in a separate writing in existence at the time of my death which is signed by me and which describes the items and the devisees with reasonable certainty. It is my intention to place that separate writing in my safe deposit box. Should more than one writing be found, the one beari~t~ a da€'e ,gin closest to the date of my death shall be deemed the_s_e~ratg writing referred to in this Article II. ----- r`~ - ,~ ~ _ ~ .~_ :~.) -=1 . . ~ ~ ., ARTICLE III I give and bequeath all of the rest, residue and remainder of my furniture, furnishings, rugs, pictures, books, silver, plates, linens, glassware, objects of art, wearing apparel, jewelry, automobiles and their accessories, and all other household goods and personal effects owned by me at the time of my death to my daughters, MARIAN GARLETTS, presently of Chester, Virginia, and KAREN STASKO, presently of Mechanicsburg, Pennsylvania, equally, share and share alike, or to the survivor of them. ARTICLE IV All the rest, residue and remainder of the property which I may own at the time of my death, real, personal and mixed, tangible and intangible, of whatsoever nature and wheresoever situate, including property of which I may have power of disposition or appointment, I give, devise and bequeath to my daughters, MARIAN GARLETTS, and KAREN STASKO, equally, share and share alike, or to their living lineal descendants, per stirpes. ARTICLE V I nominate, constitute and appoint my daughters, MARIAN GARLETTS and KAREN STASRO, or either of them, as Personal Representatives, without bond, of this my Last Will and Testament. 2 r ~ ~ ARTICLE VI With respect to the estate property and in the administration of my estate, I authorize my Personal Representatives or Personal Representative, as the case may be: 1. To retain, purchase or otherwise acquire, without restriction, any stocks, bonds, notes or other securities, or any variety of real or personal property including stocks or interest in investment trusts, the holding of which they deem advisable for my estate, or trust estate, even though such property would not otherwise be of a character suitable for fiduciaries, or is unsecured, unproductive, overproductive or of a wasting nature; 2. To sell, lease, pledge, mortgage, transfer, exchange, convert or otherwise dispose of or grant options with respect to, any property at any time forming a part of my estate for such prices and upon such terms, credit and conditions as they may deem advisable; 3. To borrow money for any purpose connected with the protection, preservation or improvement of my estate, whenever in their judgment advisable and as security to property forming a part of my estate on such terms and conditions as they deem advisable; 4. In their discretion to compromise or otherwise adjust any claims or demands in favor of my estate or against my estate; 5. To make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; 3 ~ r ,. ~' 6. To execute and deliver such instruments as may be necessary to carry out any of these powers; 7. To do any other acts which they deem advisable or necessary for the proper execution or discharge of any powers or duties held by or imposed upon their whether by the terms of this Will or by applicable law. IN FATNESS WHEREOF, I, RITA MOSKO, have hereunto subscribed my name and affixed my seal, at Sun City Center, Hillsborough County, Florida, this 7th day of APRIL, 1994. ~ o,~o RITA OSRO The foregoing instrument was subscribed, sealed, published and declared by RITA MOSKO, as and for her Last Will and Testament, in the presence of us, the undersigned, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses, this 7th day of APRIL, 1994. • o f ~ '~ NAME- RACY M. WERMELSKIRCHEN ADDRESS-GIBSONTON, FLORIDA • of O . N -LORENE E. SI' IST ADDRESS-RUSKIN, FLORIDA NAME-ROBERT B. McGOWAN of ADDRESS-SUN C~ ~14 CENTER, FLORIDA 4 r • STAT13 OF FLORIDA: COUNTY OF HILLSBOROUGH: We, RITA MOSKO, TRACY M. WERMELSKIRCHEN, LORENE E. SIEGRIST, and ROBERT B. McGOWAN, the Testatrix and the witnesses, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned officer that the Testatrix, in the presence of witnesses, signed the instrument as her Last Will and Testament, and that each of the witnesses, in the presence of the Testatrix and in the presence of each other, signed the Will, and that to the best of the knowledge of each witness, the Testatrix was, at the time, eighteen (18) years or more, of sound mind, and under no constraint or undue influence. ~,~ ~~~ RITA MOSKO, Testatrix ~] r ~ ~ Y~'1.1 ~ ~Pl1lh.~1 , nc ~~_ WITNE -TRACY M. WERMELSRIRCHEN W ESS-LORENE E. SI IST WITNESS-ROBERT B. McGOWAN 5 ,~ J Subscribed. and acknowledged before me by RITA MOSKO, Testatrix, and subscribed before me by TRACY M. WERMELSKIRCHEN, LORENE E. SIEGRIST, and ROBERT B. McGOWAN, the witnesses, on the 7th day of APRIL, 1994. NOTARY UBLIC M~ Commission Expires: ,r~u^">:e~;,. TRACY M. WERMELSKIRCNF-V ~.AA. .: MY COMMISSI.OI-NyM CC/y1~9~8404 EXPIRES iTj .~ '~~ 11~W1 4, ~DJV 'M',ps F~:~~ BONDED THRU TROY FAIN INSURANCE, INC. 6