HomeMy WebLinkAbout03-12-09C 15[]5607120
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes ~ County Code Year File Number
Po Box.zsoso~ INHERITANCE TAX RETURN 2 1 0 8 1 2 4 3
Harrisburg, PA 17128-0601 ~ RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
202 36 5629 06 26 2008 10 14 1946
Decedent's Last Name
MILLHOUSE
(If Applicable) Enter Surviving Spouse's Information Below
Suffix Decedent's First Name
JANET
Spouse's Last Name Suffix Spouse's First Name
MILLHOUSE, SR. WENDELL
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
4. Limited Estate
X ' 6 Decedent Died Testate
- - (Attach Copy of Will)
2. Supplemental Return
4a. Future Interest Compromise
(date of death after 12-12-82)
j ~ Decedent iVlaintained a Living Trust
U~ (Attach Copy of Trust)
3. Remainder Return (date of death
prior to 12-13-82)
'~ 5. Federal Estate Tax Return Required
MI
M
MI
E
8. Total Number of Safe Deposit Boxes
I 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
i __ between 12-31-91 and i-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
JERRY A. WEIGLE ESQUIRE 717 532 7388
Firm Name (If Applicable)
WEIGLE & ASSOCIATES, P.C.
First line of address
126 EAST KING STREET
Second line of address
City or Post Office State ZIP Code
SHIPPENSBURG PA 17257
Correspondent's a-mail address:
`~ ~F
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
It is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNA,T,UR~ OF PERS RES ONSIBLE FOR7F.I,LI~NG RET R DATE
~~~ ~ ~ ~~~!D/~ i Wendell E. Millhouse Sr. ~ - 7~'-- ~~
626 Wal~xGt~Bottom Road, Shippenst~urg, P/J~ 17257
SIGNP.TUR F P P R 0 ER AN REPRE NT I DATE __
~ J rry A. Weigle Esquire `2 - 2 7-~''
ADDRESS
126 East King Street, Shippensburg, P 17257
Side 1
~„ 155627120 151756i7712~
1505607220
REV-1500 EX
Decedent's Social Security Number
oecedert'sName. Janet M. Miilhouse 2 0 2 3 6 5 6 2 9
RECAPITULATION
1. Peal 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 6 , 8 1 5 3 9
(Schedule G) ~ Separate Billing Requested ......... .... 7,
8. Total Gross Assets (total Lines 1-7) .............................___..........................._.. .... 8. 6, 8 1 5 3 9
- - 9,876.01
9. Funeral Expenses & Administrative Costs (Schedule H) .................................. .... 9.
1,167.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......................... ....... 10.
11,043.01
11. Total Deductions (total Lines 9 & 10) .............................._............................__ .... 11.
-4,227.62
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 Vatue Subject to Tax (tine 12 minus Line 13) .............
................................
. 14. -4,227.62
-
__ ~
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICAB LE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
0 0 0
15. 0 0 0
(a)(1.2) X .00
16. Amount of Line 14 taxable 0 0 0 16. 0 0 0
at lineal rate X .045
17. Amount of Line 14 taxable
0 0 0
17. 0 0 0
at sibling rate X .12
18. Amount of Line 14 taxable
0 0 0
18. 0 0 0
at collateral rate X .15
19 0.00
19. Tax Due ............................................................................. ................................
.
..
20. FILL IN THE OVAL 1F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
15Q56Q722Q 150567220
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-08-1243
DECEDENT'S NAME
Janet M. Millhouse ___
---------- --
STREET ADDRESS
626 Walnut Bottom Road
.CITY STATE 'ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 0.00
Total Credits (A + B + C) (2) 0.0 0
3. InterestlPena!ty if applicable
p. Interest
E. Penalty
Total Interest/Penatty (D + E) (3)
4. If Line 2 is greater than tine 1 + Line 3, enter the difference. This is theOVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund _ l - --
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) 0.0 0
A,. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (56) Q , ~ 0
Make Check Payable to: REGISTER OF WILLS, AGE,'VT
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 :................................ _ ~ ~~ x
c. retain a reversionary interest; or ..............................._............................._............................._................ 'J ~X
--
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? ................................................................................................................. ~ x
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... j l xl
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)j. The statutedoes 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.
Rev-1510 EX+ (6-98)
~. SCl~lEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMtAONWEAtTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Millhouse, Janet M. 21-08-1243
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 D CRIPTION F PROPER
INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST ( EXCLUSION
IF APPLICABLE) TAXABLE
VALUE
1 Prudential Bank and Trust -IRA pension 6,815.39 100.000 0.00 6,815.39
account. Beneficiary -decedent's estate
TOTAL (Also enter on Line 7, Recapitulation) I 6,815.39
(If more space is needed, additional pages or the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+(12.99)
COMMONWEALTH OF PENNSYLVANIA
INHER4TANCE TAX RETURN
RESIDENT DECEDENT
S~HEDI~LE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF ~ F1LE NUMBER
Millhouse, Janet M. 21-08-1243
Debts of decedent must be reported on Schedule I.
lTEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached
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 Weigle 8~ Associates, P.C.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Wendell E. Millhouse, Sr.
Street Address 626 Walnut Bottom Road
city Shippensburg state PA zip 17257
Relationship of Claimant to Decedent SpOUSe
a. ~ Probate Fees Register of Wills, Cumberland County
5,352.26
750.00
3,500.00
79.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 194.75
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 9,876.01
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H {Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF (FILE NUMBER
Millhouse, Janet M. I 21-08-1243
ITEM
NUMBER DESCRIPTION
Funeral Expenses
1 Fogelsanger-Bricker Funeral Home
Other Administrative Costs
2 Cumberland Law Journal -advertising Letters Testamentary
3 News Chronicle -advertising Letters Testamentary
4 Register of Wilis, Cumberland County -filing PA Inheritance Tax Return
H-A Subtotal
H-67 Subtotal
AMOUNT
5,352.26
5,352.26
75.00
104.75
15.00
194.75
Copyright (c) 2042 form software on'y The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev1512 EX+(8.98)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF (FILE NUMBER
Millhouse, Janet M. I 21-08-1243
Include unreimbursed medical expenses.
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form FA-1500 Schedule I (Rev. 6-98)
REV-1513 EX+ (g-00) y,
SCHEDULE ~!
COM N~ERTANCETAXRET~RNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Millhouse, Janet M. 21-08-1243
NAME AND ADDRESS OF RELATIONSHIP TO
SHARE OF ESTATE
AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List Trustee(s)
I~ TAXABLE DISTRIBUTIONS [include.outright spousal
and transfers
dlstributlons
,
under Sec. 9116{a)(1.2)]
1. Wendell E. Millhouse Sr. Spouse
626 Walnut Bottom Road
Shippensburg, PA 17257
Not relevant as estate is insolven .
Total
Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r sheet
II. NON-TAXABLE DISTRIBUTIONS'
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 U.UU
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule) (Rev. 6-98)
II _ I
} E =_n -.L ~,~s ~ ~ ..,~.;~-, =s~ 2/10/2009 0 2 5 5 4 0 ~ ~
?80 T RU~i3'JLL STREET, HO5T
~~,-T-o~n. cT osio3 z~ 6,838.97 ~
i
Six Thousand Eight Hundred Thirty Eight Dollars And Ninety Seven Cents' ~'~_"'_~ =,'s`.J
i=~~Y TO I FIE O~ie`~E~-' OF ESTATE OF JANET M MILLHOUSE
CLOSE ACCT 20113114
11'0 2 5 5 14 011' ~:0 L L 9 7 5 2 2 b~: L00000 3 211'
~ L~rude~~-~~1 `~'.-..~~-`&EP'S OHE~,~C
_ ~RS~®~~~r c~PY
'~~~~ -~ _..__ rug
SIGNATURE
025540
Date: 2/10/2009
Amount: $6,838.97
Written Amount: Six Thousand Eight Hundred Thirty Eight Dollars And Ninety Seven Cents
Pay to: ESTATE OF JANET M MILLHOUSE
Memo: CLOSE ACCT 20113114
WEIGLE & ASSOCIATES P.C
126 EAST KING ST
SHIPPENSBURG PA 17257
~,,
- - -
Prudential Bank & Trust, F.S.B.
PO BOX 5310, SCRANTON, PA 18505-5310
Tel 888 244-6295
JANET M MILLHOUSE
626 WALNUT BOTTOM RD
SHIPPENSBURG PA 17257
PAGE: 1
ACCOUNT: 20113114 12/31/2008
104
----------------------------------------
Effective October 1, 2008, the annual fee on statement savings IRA
accounts was significantly lowered. The new annual fee schedule is $25
for account balances less than $10,000 and no fee for account balances
$10,000 or more.
Effective March 2, 2009, your statement savings IRA will change from a
flat interest rate and annual percentage yield crediting structure, where
everyone gets the same rates regardless of account balance, to a four-
tiered interest rate and annual percentage yield crediting structure.
With the tiered structure, accounts with larger balances will receive
higher rates. Your account will remain a variable rate account where the
interest rate and annual percentage yield may change daily. The interest
rate and annual percentage yield paid on the entire balance in your
account will be based on the daily balance requirements as follows:
Tier 1 - less than $1,000, Tier 2 - $1,000 to $4,999.99,
Tier 3 - $5,000.00 to $9,999.99 and Tier 4 - $10,000.00 and over.
NON-PESP SAV IRA ACCOUNT 20113114
---------------
- DESCRIPTION DEBITS CREDITS DATE BALANCE
BALANCE LAST STATEMENT ............................... 12/31/07 6,769.51
INTEREST 11.51 01/31/08 6,781.02
INTEREST 8.64 02/29/08 6,789.66
INTEREST 8.66 03/31/08 6,798.32
INTEREST 8.39 04/30/08 6,806.71
INTEREST 8.68 05/31/08 6,815.39
INTEREST 8.31 06/30/08 6,823.70
INTEREST 5.80 07/31/08 6,829.50
INTEREST 5.80 08/31/08 6,835.30
INTEREST 5.62 09/30/08 6,840.92
INTEREST 5.81 10/31/08 6,846.73
INTEREST 5.63 11/30/08 6,852.36
SERVICE CHARGE 25.00 12/01/08 6,827.36
INTEREST 5.80 12/31/08 6,833.16
BALANCE THIS STATEMENT ................. .............. 12/31/08 6,833.16
TOTAL CREDITS (12) 88.65
TOTAL DEBITS (1) 25.00
*** C O N T I N U E D
_ PAGE: 2
^=' ~ - - -,-i ACCOUNT: 20/13114 12/31/2008
Prudeutial rani; & Trust, f.S.E~.
PO BOX 5310, SCRANTON, PA 18505-5310
Tel 888 244-6295
JANET M MILLHOUSE
NON-PESP SAV IRA ACCOUNT 20113114
- - - - - - - - - - I N T E R E S T - - - - - - - - - -
AVERAGE LEDGER BALANCE: 6,813.74 INTEREST EARNED: 88.65
INTEREST PAID THIS PERIOD: 88.65 DAYS IN PERIOD: 366
INTEREST PAID 2008: 88.65 ANNUAL PERCENTAGE YIELD EARNED: 1.31%
DATE RATE DATE RATE DATE......RATE DATE......RATE DATE...... RATE
...... ......
01/01 2.000Oo 02/07 1.5000% 06/30 1.000Oo
- - - ITEMIZATION OF SERVICE CHARGE PAID THIS PERIOD - - -
TOTAL CHARGE FOR SERVICE CHARGE: 25.00
LAST WILL AND TESTAiti1ED1T
I, JANET M. MILLHOUSE, of 626 Walnut Bottom Road, Shippensburg, Southampton
Township, Cumberland County, Pennsylvania, being of sound mind, memory and
disposition, do hereby make, publish and declare this my Last Will and Testament,
hereby revoking and making void all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my just debts and funeral expenses as
soon as may be convenient after my decease.
SECOND. I give, devise and bequeath all my estate, real, personal and mixed,
whatsoever and wheresoever situate, to my beloved husband, WENDELL E. MILLHOUSE, SR.,
absolutely.
THIRD. In the event my said husband should predecease me or is not living on the
sixtieth (60th) day following my death, I then give, devise and bequeath my said
estate in equal shares as follows:
A. ONE SHARE to my daughter, TONYA S. MILLHOUSE; and
B. ONE SHARE to my son, WENDELL E. MILLHOUSE, JR.
In the further event that either of my said children should predecease me or is not
living on the sixtieth (60th) day following my death, leaving issue who survive me, I
then give, devise and bequeath said deceased child's share to his or her issue, on a
per stirpes distribution basis.
FOURTH. In the event that both my said children should predecease me or are not
living on the sixtieth (60th) day following my death, and said children should
. -~
~,' { C--
'~' - ~;~- ! ~/,~% r.i~,G/.:C G~'- (SEAL)
die without issue who survive me, I then give, devise and bequeath my estate, in four
equal shares, as follows:
A. ONE SHARE to my brother, RAY E. GORDON;
B. ONE SHARE to my brother, HAROLD W. GORDON;
C. ONE SHARE to my sister, NANCY L. MILLER; and
D. ONE SHARE to my husband's brother, ROSS E. PETERSON, JR.
FIFTH. In the event that any beneficiary of this my Last Will and Testament is
under the age of twenty-four (24) years, I then give and bequeath said beneficiary's
share to and appoint as Trustee of any property which passes under this Will or
otherwise, ORRSTOWN BANK, AS TRUSTEE, NEVERTHELESS, to invest and re-invest the same
until the said beneficiary reaches the age of twenty-four (24) years, with the
following powers in addition to those presently given by Iaw:
A. The power to expend the income towards the health, support and maintenance,
and education, including a college (both undergraduate and graduate),
trade, business or technical school education, of the said beneficiary;
B. The power to expend the principal, within the discretion of the said
Trustee, if the income is insufficient, towards the health, support and
maintenance, and education, including a college (both undergraduate and
graduate), trade, business or technical school education, of the said
beneficiary;
C. The power to sell any and all real estate, within the discretion of the
said Trustee;
D. The power and obligation to distribute the balance of principal and
interest, if any remaining, when the said beneficiary reaches the age of
twenty-four (24) years, without the necessity of a formal adjudication of
the Trustee's Account in the Court of Common Pleas of Cumberland County,
upon the receipt of a good and valid release;
I) E. The principal of the Trust and the income therefrom shall be free from the
debts, liabilities, and engagements of those beneficially interested
/ J h ,~ ,~
l .~,~ ~',~ I'~ ,~~ ''; .1'.1 ~'~ ~.~:~ .. ~ SEAL
( )
.,,,~ _
,j r ~
-2-
therein, and shall not be subject to assignment by him or her, nor to
attachment or execution under any legal, equitable or other process for the
enforcement of judgments or claims of any sort against them, either
individually or collectively.
SIXTH. I nominate, constitute and appoint my brother and his wife, RAY E. GORDON
and SARAH V. GORDON, or the survivor thereof, as the Guardians of my minor child or
children, if such be convenient to them, both financially and physically.
SEVENTH. I nominate, constitute and appoint my husband, WENDELL E. MILLHOUSE, SR.,
to be the Executor of this my Last Will and Testament; if he be unable to fulfill
the duties of Executor, I then nominate, constitute and appoint my brother, RAY E.
GORDON, to be the Executor of this my Last Will and Testament.
EIGHTH. I direct that neither my personal representatives nor Trustees shall be
required to give bond for the faithful performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I, JANET M. MILLHOUSE, have hereunto set my hand and seal to
this my Last Will and Testament, written on three pages, the first two pages signed
-~
for identification only, this ~~ day of ~'~'~'-`~ , 1991.
~,.L~ "~ r r_' -" 1 / ~~~/f !~' ,r' E,~~;L~rC,cr,~% ( SEAL )
~' ~
-3-
This instrument was by the Testatrix, JANET M. MILLHOUSE, on the date hereof,
signed, published and declared by her 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.
'~~. ~t
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
I, JANET M. MILLHOUSE, the Testatrix whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes therein expressed.
cr
Sworn or affirmed to and acknowledged
before me by JANET M. MILLHOUSE, the Testatrix,
this,'3;~a-~ day of ~~,~;~~ 1991.
r^- ~..
~:d l
Nota~iaf Seal
David P. Perkins, Notary Public
Shippensburg eoro, Cumberland Courriy
My Commission Expires Oct. 28, 1993
~.hember, Pennsylvania Association of Notaries
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
~~~ ~~ .~
We , ~,, v '~ and _ ,
the witnesses whose names are signed to the foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw JANET M.
MILLHOUSE, sign and execute the instrument as her Last Will; that she signed
willingly and that she executed it as her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testatrix signed
the will as witnesses; and that to the best of our knowledge the Testatrix was at
the time eighteen (18) or more years of age and of sound mind and under no constraint
or undue influence.
Sworn or affir ed to a subscribed
before me by ~~ • .~-~ivv~sv~
and /• '~.
witnesses, this~s day of
~ t~ 1991.
Nota~al Seal
David P. Perkins, Notary Public
Shippensburg Baro, Cumberland Courrty
~fy Commission Expires CCt. 28, 7993
Member, Pennsylvania Association of Notaries