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15056041046
REV-1500 EX (05-04) ~ USf ONi'r
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Dept. 280601 -7
Hamsburg, PA 17128-0601 ~ RESIDENT DECEDENT ~ ~ ~~ ~ ~~ 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
~ ~~ 3d 7-~3 C, o ~ dg Zo a g a b ~ ~ i ~a ~
Decedent's Last Name Suffix Decedent's First Name MI
C ~1 Q ~ S T .~ ~ S .~ ~ ~ ~ T ~! fL y n1 L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
Firm Name (If Applicable)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. 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
~,AQy M, F"~ S SE c. ~o~ gy.? ~a~~
First line of address
15 $ i 3
Second line of address
City or Post Office
State
Svc
Sr
ZIP Code
~.
REGIS _a OOF WILLS USk~ONLY "'
T~ n rv `
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-_ ~.-~ r.., ~
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'DATE FILED GJ - s l
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Correspondent's a-mail address:
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
URIC
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041046 15056041046
Q (~ c~ o K
Under penalties of perjury, I declare that I have examined this return, including acwmpanying 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 oreoarer has anv knowledge.
15056042047
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: - _ ~ ~ ~Jr . ~ .~.~.. '~ ~-
RECAPITULATION
1. Real estate (Schedule A) . ........................................... . 1. Q C . Q ~
2. Stocks and Bonds (Schedule B) ...................................... . 2. d d • 0 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. , , ~ V s a
4. Mortgages & Notes Receivable (Schedule D) .. ..... ......... .. . 4. ~i d .` ~ t1
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . 5.. 4 2 3 7 . ~ S
6. Jointly Owned Property (Schedule F) C Separate Billing Requested ...... . 6. 6 d ~Q rJ
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested....... . 7. O e «,O C .
8. Total Gross Assets (total Lines 1-7) ................................... . 8. Qf
O Z 3 ~ ~' ~ ~~
9. Funeral Expenses & Administrative Costs (Schedule H) .................... . 9. ~ Z„ ~ ~ , ~~ ~j
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... . 10. ~ O, ~ v
11. Total Deductions (total Lines 9 & 10) .................................. . 11. C~ Z (~ t~ 3
12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. ~ ~a ~ • 3 d~
13. Charitable and Governmental BequestslSec 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. ""
5'3 .
'a~
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
s'
16. Amount of Line 14 taxable
at lineal rate X .0 _ • 16.
17. Amount of Line 14 taxable
at sibling rate X .12 • 17.
18. Amount of Line 14 taxable
at collateral rate X .15 • 1g, ,.
19. TAX DUE ........................................................ .19. Q ~ « d ~
20. FILL IN THE OVAL fF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
15056042047 15056042047
~• ~ ,
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
DECEDENT'S NAME C
}~ -T.-"i~y ~~J _ L • _ ~~R1 ~ST~ 5 ~1 ~_ _ Moir ~vcicl~,Ur 1~I °'h ~
STREETADDRES~
- __ - -- ~ o_o o ---c,,2 ~ , ---l~,o ,__
CITY __
C AtQL15 t.~ STATj1~ ZIP' ~~ 1 3_88as
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit _____ _., __ _____ _ __ _ _ _ -
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
(1) ~, dc~
Total Credits (A + B + C) (2)
O" ab
E. Penalty
-- - - - - -- - Total Interest/Penalty (D + E) (3)
d
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. d
~ •
Fill in oval on Page 2, Line 20 to request a refund. (4) Q , p ~
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~, 00
A. Enter the interest on the tax due. (5A) ~ Q c~
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ ~,
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 :......................................................................................... . ^
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? ............................................................................................................. . ^ [~
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.
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.
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•
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHRESIDENTDECEDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
k~T~ ~, N ~. C~s~~~
Indude 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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~-
loo ~>E : ~FI~- -1JTTC1ur~ ~ Tt ~A-
~ ~J ~'~ta I- c.~,s.r~
c~~M$ A6z:~~~ cDM:Y, oEP~•
~.liLF.4u o~ t • ~4sJ C'~ ~ L. ~C~~ i ..v .1s
~x ~ ~ ~ R~~~~ ,~~~av ~-
~~ ~A ~ ~ ! i-1 ~ ~TA t~ d et t' ~ ~A r~ A m o~ c~ ~
~61~aL a ~ ~`~~ o~ ~~ $235 ~~-,
j r~ ~ ~~ hw • ~E~ 1n 5 - ~ ~ •J ~ ~.~ ~a t ~ ~ ICS
~-~ti-fit' c'T2. ~~~- ~ ~ C A 3-!.!_S A L A ~o
t
~' a his TE ~q'i ~IQa~ 1v s W i u .A n1fl ~~C Fi ~
A L. ~ Ts2 c,F -1'€ S ~ ~ c~no,J ~
TOTAL (Also enter on line 5, Recapitulation) I S $23 a . orb'
(If more space is needed, insert additional sheets of the same size)
.,
t
Consolidated Statement
01 1010030547056 752 30 0 19 _
Electronic Delivery
~~
~n~~~~u~~~~n~~ni~~n~u~r~~~
KATHRYN L CHRISTENSEN
GARY M FISSEL POA pB
15813 BRETON BROOK DRIVE
HUNTERSVILLE NC 28078
10/31 /2008 thru 11 /26/2008
Summary of Accounts
Checking & Savings
Account number Account 8alance As of Interest Maturity
rate date
1010030547056 CROWN CLASSIC BKG 7,453.58 11/26
257410099562257 IRA 120 MONTHS 785.47 11/27 2.47 % 3/14/2018
Total _ =8,239.05
WACHOVIA BANK, N.A. , HARRISBURG MALL page 1 of 3
F
COMMONWEALTH OF PENNSYLVAN{A
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8488
HARRISBURG, PA 17105-8486
December 18, 2008
GARY M FISSEL
15813 BRETON BROOK STREET
HUNTERSVILLE NC 28078
Re: KATHRYN CHRISTENSEN
CIS #: 120190169
SSN: 225-32-7236
Date of Death: 01/08/2008
Dear Mr Fissel:
This is to acknowledge receipt of payment in the amount of $7,666.02
regarding the above-referenced estate. This reflects payment up to the value
of the estate. If any additional funds become available, please contact me.
Your remittaace in this matter is appreciated.
Sincerely,
~'
Angela S. Bonner
Claims Investigation Agent
717-705-9701
717-772-6553 FAX
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i
~6, /
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-,,`ti,, ~~ Angela S. Bonner
ti~ ~ Claims Investigation Agent
Commonwealth of Pennsylvania
Bureau of Financial Operations
Division of Third Party Liability
Estate Recovery Program
P.O. Box 8486
Harrisburg, PA. 17105-8486
December 11, 2008
Re: Kathryn Christensen
CIS #: 120190169
SSN: 225-32-7236
Date of Death: O1 /08/2008
Letter Dated: 08/08/2008
Deaz Ms. Bonner:
Enclosed you will find a Money Order issued by Wachovia Bank in the amount of
$7666.02. Per our conversation 12/10/08 this is the final amount due to the State of
Pennsylvania to close Kaythryn's account.
I have included a copy of Wachovia's Close Confirmation. This was the only asset in
Kathryn's estate.
Thank You:
,~
Gary M. Fissel (POA)
15813 Breton Brook St.
Huntersville, NC. 28078
`J ~
E
y,,;,
GARY M FISSEL
15813 BOETON BROOK STREET
HUNTERSVILLE NC 28078
COMMONWEALTH OF PENNSYLVANIA
' ~ DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
August 8, 2008
Re: KATHRYN CHRISTEN5EN
CIS #: 120190169
SSN: 225-32-7236
Date of Death: 01,08/2008
Dear Mr Fissel:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $22,674.68 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $22,593.73, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $80.95, is to
be entered as a priority Class 6 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
sad a current appraisal, if available.
Sincerely,
Angela S. Bonner
Claims Investigation Agent
717-705-9701
?17-772-6553 FAX
Enclosure
Addendum: I received correspondence from Attorney Allen D. Smith. In his
letter, the attorney indicates that he is not involved is the matters
relative to settling this case. Please provide new attorney information, or
REV-1511 EX+;12-99)
~~ SCI~IEDULE N
~.
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE pF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
1.
MO•~ Auq~~ T v N~klic. 11I~-n~e ~T~S442.b T.A .
n i
. ~"P ~ D fi2~ur- Q u/J.~~c iQ,tY~S ~.-~Q3yv~S Co~.t~rr~ ~q~,~C ~7 ~ Z O , o Q
L- ~OOt~~~~-c tantSc ~~~-tJsi~-T-~ pno..dQ-~~J~v.,~~c,~r~f $y~ .3S
e. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees
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
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) ~ S ~2c~y ~. J S
(If more space is needed, insert additional sheets of the same size)
ADAMS COUNTY
NATIONAL BANK
Shelh~- L. Prritz
lasist:utt Vice Prr>ident
April 6, 2007
Gary M Fissel
15813 Breton Brook Street
Huntersville, NC 28078
Re; Certificate of Deposit 172224
Dear Mr. Fissel,
Adams County National Bank has received and accepted the Individual
Irrevocable Burial Trust for Kathryn L Christensen. This Certificate
of Deposit, in the amount of $7,420.00, is payable to The Robert J.
Monahan Funeral Home, Inc.
If you have any questions, please consult with your funeral director.
ncerely,
(Shelby L P~ntz
Assistant Vice President
cc; Robert J Monahan, Sr. (Funeral Director)
I't)_Ri>s ~139.(,ctt~.bur,L'-PA i'~15 (~1~"1(i-,-I'II Fss(-I')O°-I!UU
lCl!'ll:tH 7((1. c'nNl
MONAHAN FUNERAL HOME
ROBERT J. MONAHAN
ROBERT J. MONAHAN. JR.
WILLIAM P MONAHAN
i~OMAS M. MONAHAN
February 11, 2008
Mr. Gary Fissel
15813 Breton Brook Drive
Huntersville, NC 28078
RE: Kathryn L. Christensen
Funeral Expenses not covered by burial account
Paid Death Notices: Gettysburg Times
Harrisburg Patriot
York Newspapers
Certified Copies of Death: 8 copies @ $6
Rev. Marburger's Honorarium (additional added to
the orginal $100.00)
Double Depth Grave Opening at Ever reen is
$400.00 more than standard fee of 975.00
Total
Thank You,
Try.... ~~.•~.•C
Thomas M. Monahan
125 CARLISLE STREET
G ETTVSBURG. PENNSVLVA NIA 17325-1009
717-334-2414
$ 65.00
174.35
107.00
48.00
50.00
400.00
44.35
~~ ~ Z Z}og
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
CERTIFICATE OF
GRANT OF LETTERS
No . 2008- 01170 PA No . 21- 08- 1170
Estate Of : KATHRYN LOUISE CHRISTENSEN
/First, Middle, Last)
Late Of : MIDDLESEX TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Security No: 225-32-.7236
WHEREAS, on the 24th day of November 2008 an instrument dated
March 10th 2000 was admitted to probate as the last will of
KA THRYN L OUISE CHRISTENSEN
(First, Midd/e, Last/
late of M/DDLESEX TOWNSH/P, CUMBERLAND County,
who died on the 8th day of January 2008 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
GARY M FISSEL
who has duly qualified as EXECUTOR(R/Xl
and has agreed to administer the estate according to Iaw, aII of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 24th day of November 2008.
~~.
eglste o s
eputy
* *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
-_7 '> tea
KATHRYN L. CHRISTENSEN `-,-~ =- =z~ .~- _
~- li J „ice
~Q _} ` ~.~. ..
I, KATHRYN L. CHRISTENSEN, presently residing at 382 Wyatt Road, Harr'-~l~rg, `•'•
~ ~
Dauphin County, Pennsylvania, declare this to be my Last Will and Testament, revoking all other]
Wills and Codicils previously made b~~ me.
1. The expenses of my last illness and funeral shall be paid from my estate.
2. I give, devise and bequeath my entire estate wheresoever situate and of whatsoever nature
to my son, David A. Christensen, and to my grandchildren, Jeffrey R. Fissel, Jennifer Fissel,
Katie Fissel, and Kris Fissel, share and share alike to be divided among them in as nearly equal
shares as practical.
3. I authorize any fiduciary, herein named, to exercise the following powers, in addition to
those given by law, to be exercised in their sole discretion.
A. To retain any real or personal property which may at any time form a part of my estate
as long as deemed advisable.
B. To invest in any real or personal property without restriction to legal investments.
C. To purchase investments at premiums; to charge premiums to income or principal or
partly to each. To subscribe for stocks, bonds, or other investments; to join in any plan of lease,
mortgage, merger, consolidation, reorganization, foreclosure or voting trust and to deposit
securities thereunder; and generally to exercise all the rights of security-holders of any corporation.
To vote, in person or by proxy, securities held by them and in such connection to delegate their
discretionary powers.
D. To repair, alter, improve, mortgage or lease for any period of time any real or personal
property and to give option for leases.
E. To sell at public or private sale, for cash or credit, with or without security, to exchange
or to partition real or personal property, and to give options for sales or exchanges.
F. To borrow money from any person or institution, and to mortgage or pledge any real or
personal property.
G. To carry on any business owned or controlled by me at death for whatever period of
time they shall think proper, and they shall have the power to do any and all things they deem
necessary or appropriate including the power to borrow and to pledge assets contained in my estate
security for such borrowing; and the power to close out, liquidate, or sell the business at such time
and upon such terms as to them shall seem best.
H. To compromise claims.
I. To make distribution in cash or in kind or partly in each.
J. To apply directly for the needs of any beneficiary, in case of the disability of such
beneficiary through illness or other cause, any income or principal that is payable to such
beneficiary. > ,
/~ /~
K. To exercise all power, authority and discretion given by this Will after the termination of
any trust created herein until the same is fully distributed.
4. All interests hereunder, whether principal, income or remainder, while undistributed and
in the possession of any fiduciary named herein, and even though vested or distributable, shall not
be subject to attachment, execution or sequestration for any debt, cuntract, obligation or liability of
any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or
anticipation.
5. I appoint my son, Gary M. Fissel, Guardian of any property which passes under this Will
to a minor.
6. I appoint my son, Gary M. Fissel, Executor of this my Last Will and Testament.
7. No fiduciary named shall be required to enter bond or furnish sureties in any jurisdiction.
IN WITNESS WHEREOF, I set my hand and seal this 10`'' day of March, 2000.
^~., ~y ,
I~~ trryn L.r;~hristensen
Signed, sealed, published and declared as and for the Last Will and Testament of Kathryn L.
Christensen, the Testatrix, in our presence, who in her presence and in the presence of each other,
and at her request, have hereunto set our hands and seals as subscribing witnesses hereto.
~~~ lt.-/l.<-.~' ~ JCS-~.~t ,:~t-
-~.
Residing at `E-~<_..'~ . ~~~~~;
-U_"T.
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Residing at `"~i '~. `~:
COMMONWEALTH OF PENNSYLVANIA )
)SS:
COUNTY OF DAUPHIN )
I, Kathryn L. Christensen, 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, that I signed it willingly; and that I signed it as my free
and voluntary act for the purpose therein expressed.
Sworn or affirmed to and acknowledged before me by Kathryn L. Christensen, the testatrix, this
10`~ day of March, 2000.
DANIEL K. BA1'F,P~! Notary Public
Steelton Borough, Dauphin County
My Commission Expires May 1 a, 2002
COMMONWEALTH OF PENNSYLVANIA )
)SS:
COUNTY OF DAUPHIN )
.~
athryn L. istensen
r
We, Allen D. Smith and Bonnie A. Beyer, 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 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 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 or affirmed to and subscribed to before me by Allen D. Smith and Bonnie A. Beyer,
witnesses, this 10`~ day of March, 2000
Notary
i~
Witness
NOTARI EAL
DANIEL K. BAYER, Notary Public
Steelton Borough, Dauphin County
y Commission Expires May 13, 2002 Witnes
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