The URL can be used to link to this page

Home My WebLink About03-20-09--~ REV-1500 1505607120 PA Department of Revenue EX (06-05) OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box.2sosoi INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 8 0 5 0 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 193 48 4562 04 11 2008 08 24 1907 Decedent's Last Name Suffix Decedent's First Name WELLS MI GOLDA I (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 ^ 3. Remainder Return (date of death ^ 4. Limited Estate ^ prior to 12-13-82) qa Future Interest Compromise (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required g, Decedent Died Testate (Attach Copy of Will) ^ 7 Decedent Maintained a Living Trust (Attach Copy of Trust) O 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 p Spousal Poverty Credit (date of death between 12-31-91 and 1-1 Election to t ^ 11 95 . - ) ax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL Name TAX INFORMATION SHOULD BE DIRECTED TO: JOHN M . GARB E R , ESQU IRE Daytime Telephone Number 717 848 2385 Firm Name (If Applicable) r-3 GARB E R & GARB E R REGISTER OS USE A~ F~LY First line of address , ~ } ~ ~ ~ 40 SOUTH DUKE STREET ~`_'~`-~~ sL v, - o - Second line of address `^ ~ =r ~`? v ~ ~, ~~ City or Post Office DAT~FILED ~ YORK State ZIP Code PA 17401 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, cor,ect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE Doris Frank , ~~./9-e 9 JJ ~ / c/o 40 ke Street, York, PA 17401 OTHER THAN REPRESENTATIVE John M. Garber, Esquire 40 South Duke Street, York, PA 17401 Side 1 1505607120 DATE - 19 ~D 1505607120 J 1505607220 REV-1500 EX Decedenes Name: G O I d 8 ~. W e ~ ~ s Decedent's Social Security Number RECAPITULATION 193 48 4562 1 . Real Estate (Schedule A) ......................... ............................................................... .. 1. 2 . Stocks and Bonds (Schedule B) ............................................................................. .. 2. 2 0, 5 5 8. 8 5 3 . Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)......... . 3. 4. Mortgages & Notes Receivable (Schedule D) ..... .................................................... . 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... . 5. 1 1 9 , 9 5 7 . 7 6 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) .............. ................................ ......................... $. 14 0 , 516.61 9. Funeral Expenses & Administrative Costs (Schedule H) ................ ......................... 9. 1 8 , 1 6 2 . $ 5 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 2 , 9 2 5 . 8 3 11. Total Deductions (total Lines 9 8 10) ......... ............................................................. 11. 21,088.68 12. Net Value of Estate (Line 8 minus Line 11) .... 13. ..................... . ................................... Charitable and Governmental Bequests/Sec 9113 Trusts for which 12. 119 , 4 2 7. 9 3 an election to tax has not been made (Schedule J) . ................................................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE .. 14• 1 1 9 , 4 2 7 . 9 3 15. Amount of Line 14 taxable RATES at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 0. 0 0 15• O 0 0 16. Amount of Line 14 taxable . 17. at lineal rate X .045 Amount of Line 14 taxable 0. 0 0 16. 0. 0 0 at sibling rate X .12 0 0 0 17. 18. Amount of Line 14 taxable . 0 . 0 0 at collateral rate x .15 1 1 9, 4 2 7. 9 3 18. 17 , 914.19 19. Tax Due ...................................... ................................ ......... 19 ...................................... . 17 , 914.19 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. L 1505607220 Side 2 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: Golda I. Wells EET ADDRESS 210 Big Spring Road File Number 21-08-0509 CITY Newville STATE ZIP PA 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 17,914.19 A. Spousal Poverty Credit B. Prior Payments 17 238.16 C. Discount 710.53 3. Interest/Penalty if applicable Total Credits (A + g + C) (2) 1 7, 948.69 D. Interest 34.50 E. Penalty Total Interest/Penalty (D + E) (3) 34.50 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 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~.~0 f n A Make Check Payable to: REGISTER OF WILLS, AGENT z ... .~ - ~> :;~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :............................................................................... Yes No b. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest; or .................................................................................................................. 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?...... ................... .. ^ 0 ................................................ 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? ................ ^ ^ ........ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. y - ,. '~ . a~ ~. +~ For dates of death on or after Jul 1 1994 and before January 1, 1995, the tax rate imposed on tthe net value ` ~ ~ ^y surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)], of transfers to or for the use of the 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)]. sibling is definedounder Sectiont9102 as an Individual whothas at least one patient in aolmmon ~hlthe(decedent,nwhetheSby blood(or adoption. Rev-1603 EX+ (B•98) ,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT wlMtC Vr' Wells, Golda I. LE NUMBER 21_nR_n~no All property Joinllyowned with right of survivorship must be disclossd on Schedule F. ITEM CUSIP NUMBER NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 DWS Scudder Deutsche Bank Group - GNMA Fund 15.02 Class S Account Number 502197909; Fund Number: 20,558.85 2393 TOTAL (Also enter on Line 2, Recapitulation) I 20 558 85 (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) SCHEDULE B STOCKS & BONDS Rsv1608 EX+ (6-88) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Wells, Golda I. FILE NUMBER 21-08-0509 Include the proceeds of litigation and the date the proceeds were received by the estate. All propsrty jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1 Cash - In Decedent's Wallet OF DEATH 3.24 2 First Commonwealth Bank -Account Number 2440-000-9486710 Interest Payment (Check Number 710246) 27.95 3 First Commonwealth Bank -Account Number 0100-200-0000650 Interest Payment (Check Number 711425) 37.91 4 First Commonwealth Bank -Account Number 0100-200-0000649 Interest Payment (Check Number 711424) 39.82 5 First Commonwealth Bank -Official Check Number 1559673, Dated April 7 2008 , 14,267.41 6 First Commonwealth Bank -Certificate of Deposit Account Number 0100-200-0000152 12,591.96 7 First Commonwealth Bank -Certificate of Deposit Account Number 0100-200-0000152 -Accrued Interest 7.71 8 First Commonwealth Bank -Certificate of Deposit Account Number 0100-200-0000649 12,914.55 9 First Commonwealth Bank -Certificate of Deposit Account Number 0100-200-0000649 -Accrued Interest 5.14 10 First Commonwealth Bank -Certificate of Deposit Account Number 0100-200-0000650 12,298.22 11 First Commonwealth Bank -Certificate of Deposit Account Number 0100-200-0000650 -Accrued Interest 4.90 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recapitulation) 119,957.76 Copyright (c) 2002 form software only The La kner Groupnlnc.ed, additional pages otthe same size) Form PA-1500 Schedule E (Rev. 6-98) Rev1 g0g EX+ (g.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued wlMl G Vr' Wells, Golda I. ILE NUMBER 21-08-0509 ITEM NUMBER DESCRIPTION VALUE AT DATE 12 First Commonwealth Bank -Certificate of Deposit Account Number OF DEATH 2440-000-9486710 10,000.00 13 First Commonwealth Bank -Certificate of Deposit Account Number 2440-000-9486710 -Accrued Interest 8.12 14 Marion Center Bank -Checking Account Number 404210637 24,173.03 15 Marion Center Bank -Checking Account Number 404210637 -Accrued Interest 0.99 16 Marion Center Bank -Certificate of Deposit Account Number 14588 32,000.00 17 Marion Center Bank -Certificate of Deposit Account Number 14588 -Accrued Inter t es 3.51 18 Pennsylvania Department of Revenue -Income Tax Overpayment for the 2007 T ax Year; Credited to Estimated Account; Date Processed: October 6, 2008 39.00 19 Highmark -Refund of Unearned Premium (Check Number 0216650) 234.30 20 Penn Treaty Network America Insurance Company -Long Term Care Insuance Benefit Payment; Dates of S i 1,000.00 erv ce: March 1, 2008 through March 31, 2008; Claim Number: H2O007511; Policy Number: H2O0075 (Check Number 836019) 21 United States Treasury - 2008 Economic Stiumuls Payment (Check Numbe r 230935994352) 300.00 TOTAL (Also enter on Line 5, Recapitulation) 119,957.76 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1161 EX+ (12-89) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ~~+..+~ ~ yr Wells, Golda I. FILE---- 21-n1;_nsna ueots of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: See continuation schedule(s) attached AMOUNT 3,311.30 B• ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Doris Frank Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 2551 Berkshire Lane city Dover State PA zip 17315 Year(s) Commission paid 2009 6,620.66 2. Attorney's Fees Garber 8 Garber 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 '- 7,370.66 4• Probate Fees 70.00 5. Accountant's Fees 6• Tax Return Preparer's Fees ~• Other Administrative Costs See continuation schedule(s) attached 790.23 TOTAL (Also enter on line 9, Recapitulation) 18,162.85 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 Wells, Golda I. LE NUMBER 21-08-0509 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Bauer Family Funeral Homes -Professional Services, Facilities and Equipment, Automotive Equipment, Merchandise, and Cash Advances for Decedent's Funeral 2,986.30 Services 2 Country Junction Restaurant -Luncheon Following Decedent's Funeral Services 325.00 H-A Subtotal 3,311.30 Other Administrative Costs 3 Clerk of the Orphans' Court -Filing Fees to File Waiver Executed by Each Beneficiary 70.00 4 Garber 8 Garber -Reimbursement for Costs Advanced (Copies, Courier Fees, Postage) 41.58 5 Postmaster -Postage (First Class/Certified/Return Receipt) 5.32 6 Postmaster -Postage (First Class/Certified/Return Receipt) 10.81 7 Register of Wills -Short Certificate (1 @ $4.00 Each) 4.00 8 Register of Wills -Additional Fee for Letters Testamentary 240.00 9 Register of Wills -Filings Fees to File Inventory and REV-1500, Inheritance Tax Return, Resident Decedent 30.00 10 Smith Bertocchi Arbaugh 8 Hall PC -Preparation of Decedent's 2008 Federal and State Income Tax Returns 115.00 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 Wells, Golda I. ILE NUMBER 21-08-0509 ITEM NUMBER DESCRIPTION AMOUNT 11 The Cumberland Law Journal -Legal Advertising (May 16, 2008; May 23, 2008; May 75.00 30, 2008) 12 The Sentinal -Legal Advertising (May 31, 2008; June 7, 2008; June 14, 2008) 198.52 H-B7 Subtotal 790.23 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1612 EX* (6.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT C CST ~~~ w SCFIEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-08-0509 ~~~~~~ yr Wells, Golda I. Includs unrelmbursed msdieal sxpsnses. ITEM NUMBER DESCRIPTION 1 Continuing Care Rx #001 -Decedent's Liability for Pharmaceuticals Decedent Received March 10, 2008 through March 31, 2008; Account Number: 100026330 2 Continuing Care Rx #001 -Decedent's Liability for Pharmaceuticals Decedent Received April 3, 2008 through April 11, 2008; Account Number: 100026330 3 Green Ridge Village -Room, Board, and Supplies Decedent Received; Account Number: 61242GRV; Statement Date: April 30, 2008 4 Pennsylvania Department of Revenue -Application of Overpayment for the 2007 Tax Year to Decedent's Income Tax Liability for the 2008 Tax Year VALUE AT DATE OF DEATH 45.92 7.00 2,833.91 39.00 TOTAL (Also enter on Line 10, Recapitulation) I 2 925 83 (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•1613 EXt (8.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCFIEDULE J BENEFICIARIES CCTA TL- /1r~ Wells, Golda I. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. 1 2 3 4 5 II. FILE NUMBER 21-08-0509 RELATIONSHIP TO SHARE OF ESTATE AMOU DECEDENT Do Not List Trustaa(sl (Words) NT OF ESTATE ($$$) under Sec. 9116(a)(1.2)] Bonnie Lee and Thomas Austin None 951 Linden Road $10,000.00 Eighty Four, PA 15330 Bequest James and Georgann Bell None 116 Crandon Circle $20,000.00 Beaver, PA 15009 Bequest James E. and Becky Bell None 2495 Dutch Ridge Road $10,000.00 Beaver, PA 15009 Bequest Thomas and Nancy Bell None 100 Eric Drive $10,000.00 Beaver, PA 15009 Bequest Thomas Brown None 404 South Center Avenue $10,000.00 Somerset, PA 15501 Bequest See continuation schedule attached Continuation Enter dollar amounts for distributions shown above on lines 15 throu h 18, as a 9 NON-TAXABLE DISTRIBUTIONS: Total ppropriate, on Rev 1500 cover sheet A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See continuation schedule(s) attached 0.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 C(~VFR cuGGT ~~ ~ •• ~-~ -~~~ ~~~~~~ a~nware onry I ne Lackner Group, Inc. -- ~ v.vv Form PA-1500 Schedule J (Rev. 6-98) GESTATE OF: Golda I. Wells 04/11/2008 193-48-4562 Item Name and Address of Person(s) Number Receiving Property 6 Annette Drake 85 Jenny Drive Zanesville, OH 43701 7 Doris Frank 2551 Berkshire Lane Dover, PA 17315 8 Jeff Frank 1995 Jug Road Dover, PA 17315 9 Edith McQuilkin 137 North Marshall Street Lancaster, PA 17602 10 Philip McQuilkin 137 North Marshall Street Lancaster, PA 17602 11 Mary Beth and Larry Slagel 2405 Alder Way York, PA 17402 12 Iva Stahl R. D. 1 Rochester Mills, PA 15771 13 Michael and Sherry Williams 20 Blrch Glen Ripley, WV 25271 SCHEDULE J The BENEFICIARIES (Part I, Taxable Distributions) Relationship None Cousin Cousin None None Cousin None None 1 Share of Estate (Words) $10,000.00 Bequest $20,000.00 Bequest $10,000.00 Bequest $20,000.00 Bequest $10,000.00 Bequest $10,000.00 Bequest $30,000.00 Bequest $20,000.00 Bequest Amount of Estate ($$$) SCHEDULE J-11B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS continued ESTATE OF Wells, Golda I. ITEM NUMBER DESCRIPTION 1 Glade Run United Presbyterian Church FILE NUMBER 21-08-0509 AMOUNT 0.00 Subtotal I 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J-IIB (Rev. 6-98) LAST WILL AND TESTAMENT I, GOLDA I. WELLS, of the Borough of Dayton, County of Armstrong and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, in manner and form following, hereby revoking any Will or Codicils heretofore made by me. FIRST: I direct that all my just debts, funeral expenses, and costs of administration of my estate, be fully paid and satisfied, as soon as may be convenient after my decease. SECOND: I give and bequeath the sum of $10,000.00 to my husband's niece, Bonnie Lee Austin, and Thomas Austin, her husband of 95 Linden Road, Eighty-four, PA 15330. THIRD: I give and bequeath the sum of $10,000.00 to my husband's nephew, Thomas Brown, and Matilda Brown, his wife, 404 South Center Ave., Somerset, PA 15501. FOURTH: I give and bequeath the sum of $30,000.00 to my husband's nephew's wife, Iva Stahl, R.D. #1, Rochester Mills, PA 15771. FIFTH: I give and bequeath the sum of $10,000.00 to Annette, granddaughter of Ray Goss, R.D. #1, Roseville, OH 43777. SIXTH: I give and bequeath the sum of $20,000.00 to my cousin's wife, Edith McQuilkin, 137 N. Marshall St., Lancaster, PA 17602. SEVENTH: I give and bequeath the sum of $10,000.00 to Philip McQuilkin, son of Alex McQuilkin, 137 N. Marshall St., Lancaster, FA 17602. EIGHTH: I give and bequeath the sum of $10,000.00 to my cousin, Mary Beth Slagel, and Larry Slagel, her husband, 2405 Alder Way, York, PA 17402. NINTH: I give and bequeath the sum of $20,000.00 to my friends, Michael Williams and Sherry Williams, his wife, Box 85, Ripley, WV 25271. TENTH: I give and bequeath the sum of $20,000.00 to my friends, James Bell and Georgann Bell, his wife, 116 Crandon Circle, Beaver, PA 15009. ELEVENTH: I give and bequeath the sum of $10,000.00 to Thomas Bell, son of James Bell, and Nancy Bell, his wife, Eric Drive, Beaver, PA 15009. TWELFTH: I give and bequeath the sum of $10,000.00 to James E. Bell, son of James Bell, and Becky Bell, his wife, 2495 Dutch Ridge Rd., Beaver, PA 15009. THIRTEENTH: I give and bequeath the sum of $20,000.00 to Doris Frank and Thomas Frank, her husband, 2551 Berkshire Lane, Dover, PA 17315. FOURTEENTH: I give and bequeath the sum of $10,000.00 to Jeff Frank, 1995 Jug Road, Dover, PA 17315. FIFTEENTH: I give, devise and bequeath all of the residue and remainder of my estate of whatsoever kind and wheresoever situate unto the Glade Run United Presbyterian Church, R.D. #1, Dayton, PA 16222. I do hereby make, constitute and appoint Doris Frank to be my executrix of this, my Last Will and Testament and further direct that no bond shall be required in connection with the settlement of my estate. IN WITNESS WHEREOF, I, GOLDA I. WELLS, the testatrix above named, have hereunto subscribed my name and affixed my seal this 23rd day of April, in the year of our Lord, two thousand four. '1/AL} Golda I. Wells Signed, sealed, published and declared by the above named GOLDA I. WELLS as and for her last Will and Testament in the presence of us, who have hereunto subscribed our names as witnesses thereunto in the presence of said testatrix and of each other. COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF ARMSTRONG ~ We, GOLDA I. WELLS, PAULA R. FLANDERS AND LEE J. CALARIE, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and Testament, and that she signed willingly and expressed her free and voluntary act for the purposes therein set forth, and that each of the witnesses, in the presence of and hearing of the testatrix herein, signed the Will as witnesses and to the best of their knowledge, the testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. ~._.__-~Golda I. Wells Lee ,~. Calarie Subscribed, sworn to and acknowledged before me by GOLDA I. WELLS, testatrix, and subscribed and sworn before me by PAULA R. FLANDERS AND LEE J. CALARIE, witnesses, this 23rd day of April, 2004. Notary Public My commission expires: COMMONWEALTH OF_ p~Syj,V~A 1Votarial Sea! Mary Ellen O'Hare, Notary public Kittanning Boro, Armstrong County My Commrssion Expires Dec. I6, 2QK>