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Home My WebLink About04-08-09 15056051058 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 eox 2sosol 21 08 0861 Hartisburc.PA17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 08/21 /2008 Decedent's Last Name GOBLE (If Applicable) Enter Surviving .Spouse's Information Below Spouse's Last Name _ _ .. Spouse's Social Security Number Date of Birth 05/03/1936 _.. _ Suffix Decedent's First Name MI 'NICHOLAS ' L Suffix Spouse's First Name MI _ _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~. 2. Supplemental Retum ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of ~W°? 5. Federal Estate Tax Return Required death after 12-12-82) sl:: 6. Decedent Died Testate w 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~'~ ;. 10. Spousal Poverty Credit (date of death ~.,~ 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 __ _ __ - Lisa Marie Coyne N (717) 737-04~ ~ .- = _ , _ ;,r --- Firm Name (If Applicable) I REGISTER C~j LS USE fY ~ ; ~ ~ ` ~ ~ te ' COYNE & COYNE, P.C. 7 r - ' = _ : ~ -rrn I ;,~:r ~ ~~ ~ ~ ' First line of address _ , L ~ , _ 3901 Market Street ,, ; ~ ~{~ ~ :Y , _ ~, ; Second line of address _ _ _ ~ C~ :: D ..-- - . { City or Post Office State ZIP Code DATE FILED - ---- - __,_ ,.. _.. _______. _.... Camp Hill _ -_ PA :17011-4 _ _ _ __ 227 _ Correspondent's a-mail address: Ilsa@COyneandCOyne.COm Under penalties of perjury, I deGare 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. FOR FILING RETURN A. Placido, 1001 Oak Street, Hood River, OR 97031 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS Lisa Marie Coyne, 3901 Market Street, Camp Hill, PA 17011-4227 PLEASE USE ORIGINAL FORM ONLY I___ 1 505605 1 058 Side 1 15056051058 y REV-1500 EX Decedent's Social Security Number NICHOLAS L GOBLE ~ __ ~~ oecedent's Name: , ~ __..~....~. .____.._Y~ N _.d.__.._.~~. RECAPITULATION .. _. ... 1. Real estate (Schedule A) . .......................................... .. L ' 175,000.00 2. Stocks and Bonds (Schedule B) 2. ' 164,090.75 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. ' 43,449.79 6. Jointly Owned Property (Schedule F) J Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ` 7 ' 390 53 216 "":- Separate Billing Requested..... (Schedule G) . ; ... , 8. Total Gross Assets (total Lines 1-7) ................................. ~ ... 8. ! 598,931.07 ': ~ 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 58,120.48 '. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ', 25,696.48 i 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 83,816.96 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ', 515,114.11 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. ', 515,114.11 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or . _._ . . _ ... _. transfers under Sec. 9116 ', _____. ..,_...._.... _~ _.__~. _, __. ,, ~,. w_ 16. ._.__.._ w.,,.,, ~ Amount of Line 14 taxable at lineal rate x .0 45 515,114 11 i 1B• 23,180.13 . .e, 17. ~....~....._. . __.~ ._..~..~ __. _~..~.µ,,..., , . __..~~ ..~ . Amount of Line 14 taxable .. _~._. ,~.._~ _ _... ~_. _.. ~~......~._ ... _ ._ at sibling rate X .12 _..~,... , ......_ ,.,.._.v. 17• ~..., ...... ~._.. .____..._ ...,.,. ......... .......... 18. Amount of Line 14 taxable at collateral rate X .15 ! 18. ' 23,180.13 ', 19. TAX DUE ....................................................... .. 19. 15056052059 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 ~~ 15056052059 REV-1500 EX Page 3 rlororipn+'c (_mm~lF-+p L\cidreSS' Pile Number _~_ ....~.~.___...._~..T m 21 08 ` "0861 --- DECEDENTS NAME ~ DECEDENT'S SOCIAL SECURITY NUMBER NICHOLAS L GOBLE 303-38-2261 STREET ADDRESS 42 Ridgeway Drive CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total InterestlPenalty (D + E } 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval 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. (3) (4) (5) (5A) (56) Make Check Payable to: REGISTER OF WILLS, AGENT 23,180.13 0.00 0.00 23,180.13 23,180.13 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? ........................................................................................................................ 0 ^ 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 p2 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GOBLE,1vICHOLAS L. 21 - 2008 - 0861 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 42 Ridgeway Drive, Mechanicsburg, Cumberland County, Pennsylvania 175,000.00 See Attached Settlement Sheet TOTAL (Also enter on Line 1, Recapitulation) ~ 175,000.00 A u.s, oErAmraatr of Irousuua ulo vnsN+oeveLOrNaar SETTLEMENT STATEMENT ac Land Associates, Inc. 3912 Market Street Camp Hill, PA 17011 (717) 763-1450 cur w ~ B. TYPE OF LOAN 1. FHA 2. FMHA 4. ^ VA 3. ^ CONV. INS. 6. ESCROW FILE NUMBER: 00915502-001 MAZ 7. LOAN NUMBER: e. MORTGAGE INSURANCE CASE NUMBER:- C. NOTE: This form is famished fo give you a statement of acfua! settlement costs. Amounts paid fa and by the se@lemenf agent are shown. Ikms marked YP.O. C.)" were paid outside the closing; They are shown here for informational purposes and are not included in the totals. D. NAME OF BORROWER: ~ BDnnle L. Conrad ADDRESS OF BORROWER: 4129 MOUntaln VI2W RDad MechanicsburD PA 17050 E. NAME OF SELLER: EState Of NICt101aS L. Goble ADDRESS OF SELLER: F. NAME OF LENDER: Unlted States Department Ot AprICUltUfe ADDRESS OF (ENDER: 401 E. LOUther Street #304 Carlisle, PA 17013 G. PROPERTY LOCATION: 42 RldgeWay DnVe Mechanicsburg, PA 17050 Cumberland County 38-23-0571-305 Parcel #38-23-0571-305 H: SETTLEMENT AGENT: Abstract Land ASSOCIateS, Inc. PLACE OF SETTLEMENT: 3912 Market Street, Camp Hill, PA 17011 I. SETTLEMENT DATE anRnnns PRORATION DATE: 3/26/2009 DISBURSEMENT DATE: J. SUMMARY OF BORROWER'S TRANSACTION K SUMMARY OF SELLER'S TRANSACTION 101. Contred Saks Price 175,000.00 401. Contract Sales Price ~ 175,000.00 102. Personal Property 402. Personal Property 103. Settlement charges to Borrower (line 1400) 4,261.72 403. 104. 404. 105. 405. ___ __ _ .-_ __ _ _._ _.. _-.. -_ .... ~.......-. w,~,,,~T""cuTC cno mc~~C CGIn GV CCI I FR IN GnVANrF' 108. V JCi /Town Taxes .. 406. C /Town Taxes 107. Count Taxes 03126/09 to 12!31!09 408.96 407. County Taxes 03/26/09 to 12/31/09 408.96 108. Assessments 408. Assessments 109. School Tax 03126/09 to 06/30/09 368.35 409. School Tax 03/26/09 to 06/30!09 368.35 110. H/O Fees 03/26/09 to 12/31/09 153.42 410. H!O Fees 03!26/09 to 12/31/09 153.42 111. 411. 112. 412. 113. 413. 114. 414. 115. 415. 120.. GROSS AMOUNT DUE FROM BORROWER: 160,212.45 420. GROSS AMOUNT DUE TO SELLER: 175,930.73 201. Deposit or earnest money 1,000.00 501. F~ccess deposit (sae instrudions 202. Principal amount of new loan(s) 175,000:00 502. Settlement charges to Seller (line 1400) 12,216.92 203. Existing loan(s) taken subjed to 503. Existing loan(s) taken sub'ed to 2pq, 504. Payoff of first mortgage loan 205. 505. Payoff of second mortgage loan 206. Cumberland County AHTF Grant 4,450.00 506. 207. 507. 208. 508. 209. 509. 210. Clty/Town Taxes 510. C' /Town Taxes 211. County Taxes .511. Coun Taxes 212 Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER: 180,450.00 520. TOTAL REDUCTIONS IN AMOUNT DUE SELLER:. 12,276.92 301. Gross amount due from Borrower (line 120) 180,212.45 601. Gross amount due to Seller (line 4201 175,930.73 302. Less amount paid by/for Borrower (line 220) 180,450.00 602. Less redudion in amountdue Seller (line 5201 12,216.92 303. CASH (^ FROM) ( ® TO) BORROWER: 237.55 803. CASH (-^ FROM) (®TO) SELLER: 163,713:81 3. IYICONV. UNINS. -rwrc t - R W FI •BASED~ON PRICES 175,000.00 ~ 5.0,00 Ye= $8,750.00 ,r OF COMMISSION (LINE 700) AS FOLLOWS: PAID FROM BORROWER'S FUNDS AT SETTLEMENT PAID FROM SELLER'S 4,400.00 to M.C. Walker Realty FUNDS AT SETTLEMENT 4,350.00 to Exit Platinum Plus Realty .Commission paid at settlement 8,750.00 Transaction Fee to Walker Really/Exit - 195.00 125.00 d1. Loan Origination Fee d02. Loan Discount Fee 803. Appraisal Fee to Unhed States Deparbent of AgriwRure 325.00 604. Credit Report 605. Lenders Inspection Fee 806. MoRgage Insurance Application Fee 807. Assumption Fee BOB. Tax Service Fee to United States Department of Agncutture 119.00 609. Initial Escrow Deposft to United States Department of Agriculture 524.66 810. 611. 901. Interest From to @ $ Iday % (days) 902. Mortgage Insurance Premium far Month(s) to 903. Hazard Insurance Premium for 1 Years(s) to State Farm (411.00) 904. 905. 1001 Hazard Insurance montlu ~ a per monln 10D2~ Mortgage Insurance months ~ s per month 1003. City Property Taxes months ~ S per month 1004. County Property Taxes months ~ 5 per month 1005. Annual Assessments months ~ s per month 1006. months ~ s per month 1007 months ~ $ per month 1008. rtanths ~ E per monN 1101. Settlement or closing fee 1102. Abstract or title search 1103. TRIe examination 1104. Title insurance binder 1105. Document preparation to Coyne and Coyne 200.00 1106. Notary fees to Settlement/ClericelMotary Fees 25.00 1107. Attorney's Fees (Indudes above hems numbers: ) 1108. Title Insurance to Abstract Land Associates, Inc. 944.06 (Indudes above Rems numbers: ) 1109. Lenders covers e $ 175,000.00 1110_ Owner's coverage $ 175,000.00 1111. Ends. 100, 300, 8.1, pud to Abstract Land Associates, Inc. 200.00 1112. Insured Closing Letter to Old Republic National Title Ins. Co. 35.00 1113. Ovemipht Fees to Abstract Land Associates, Inc. 30.00 1201, Recording Fees: Deed $ 48.50 MoRgage $ 56.50 Release $ 107.00 1202. Cit /Coun tax/stamps Deed $ 1,750.00 Mort a e $ 1,750.00 1203. State taxlstam s Deed $ 1,750.00 Mort a e $ 1,750.00 1204. Record Second Mortgage to Recorder of Deeds 27.00 1205. 1301. Survey 1302. Pestlnspection 1303. Taz Cert Fee to Abstract Land Associates, Inc. 10.00 1304. 2009 County/Twp Taxes to Debra B. Wiest 533.11 1305. Home Warranty to American Home Shield 395.00 1306. Final Sewer 1/6-3126/09 to Silver Spring Twp. Authority 73.13 1307. "See attached for breakdown (340.00) 380.68 1400. TOTAL SETTLEMENT CHARGES (Enter on doe 103,Sectlon J -and - doe 502, Sectbn IQ 4,281.72 12,216.92 haw ooreludy reviewed the HUD-1 Settlement Statement and to the beat of my knoxkAge end txlkr, It Is a true and accurate statement d al receiple and diabunemenla made on my tcmum o e In th's trensecdon. I further oeNfy that I h e reosived a mpy of the HUD-1 Setlkment Statement to ie L, o ad fate Nicholas L. Goble t Bonoveere Sellers the HV0.1 Settlement Staterrront whk:h I have pr Is e tr and amurete amount d mie transadlon. I have ®usetl a wid cause me tuntls to be disbursed in emordanre with this ant ~ - ,( D ~/a c,, /c~9 Settlement Agent Defe ibstre Lantl Associates, Inc. NARNING: It Is a crkne b knowingly make false statements to the United States on this ar any simlar form. Ponaldes upon eonvk:tlon r-an Indude a floe and hnpriaonment For Betels ex: rbk 18 U.S. Code Sectlon 1001 and Sedan 1010. ~ 00915502-001 MAZ DETAILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES Buyer Seller Amount Amount ,ty 8 County TaxlStamps ity TaxlStamps: Deed $1,750.00 Total as shown on HUD page 2 Line #1202 1,750.00 Buyer Seller Amount Amount 03. State TaxlStamps State Tax/Stamps: Deed $1,750.00 Total as shown on HUD page 2 Line #1203 1,750.00 UD 1307 DETAILED BREAKDOWN OF ADDITIONAL SETTLEMENT CHARGES Description P'd'~' 308. H/O Assn Fees to Evergreen 309. Fire Door Installation to Pat Carol 310. Home/Pest Inspections to National Property Inspections (340.00) Total as shown on HUD page 2 Line #1307 Sefier Amount 200.00 , 180.68 380.68 a COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER GOBLE, NICHOLAS L. 21 - 2008 - 0861 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH NUMBER 1 3129 shares Century Financial Corp 14.32 44,807.28 2 200 shares of PNC Bank 70.53 14,106.00 3 100 shares of Pepsico 69.62 6,962.00 4 100 shares of Hewlett-Packard 45.68 4,568.00 5 100 shares of IBM ~ 125.22 12,522.00 6 300 shares of GM 29.74 8,922.00 7 500 shazes of Texas Instruments 26.40 13,200.00 8 200 shares of Johnson & Johnson 71.70 14,340.00 9 100 shares of 3M 73.60 7,360.00 10 200 shazes of Honeywell Int. 51.36 10,272.00 11 200 shares of Gannett Company 19.31 3,862.00 12 100 shazes of Wal-Mart 59.25 5,925.00 13 2957.802 shares of Ameriprise Mutual Fund 4.15 12,274.88 14 1197.492 share of Ameriprise Mutual Fund 4.15 4,969.59 TOTAL (Also enter on line 2, Recapitulation) 164,090.75 'OLIO STATEMENT As of 08(12/2008 Nicholas I.. Goble Acct n 3D8343507 42 Ridgeway Drive Mechanicsburg, PA 17050 Trade Unit Cast Current Current Unrealized Svmbol Description Date Quantity Cost Basis Price Value Gain (Loss) °1° G1L Cffsh CASH Cash 2,908.92 2,908.92 Equity-Selected List Banks-Major Regional PNC PNC Financial Services Groug 03/17(2008 200. 61.60 12,320.00 70530 14,106.00 1,786.D0 14.5% Beverages-Non Alcoholic PEP Pepsico Incorporated 03/17/20D8 100 69.15 6,915.00 69.620 6,962.00 47.00 0.7% Computers-Iinrdware HPQ Hewlett-Pockard Inc. 03/I7I2008 100 46.42 4,642.00 45.b8D 4,568.00 (74.D0) -L6% IBM Intl. Business Machines 03(17/2008 100 1 I5.55 11,555.00 12.5.220 )?,522.00 967.00 8.4% J 6,197.00 17,090.00 893.00 ~ 5.5% Diversified-Industrials GE General Electric Campony 03/17!2008 300 34.33 10,299.00 29.740 8,9?2.00 {I,377.00} -13.4% EIectronics-Semiconductors TXN Texas lnstruments Inc. 03/17/2008 500 28.68 14,340.00 26.400 13,200.00 (I,I40.OD} -7.9% Iienlth Care-Diversificsi JNJ Johnson & Johnson 03/l 7/2008 200 64.04 12,808.OD 71.700 14,34D.00 1,532.00 12.D% Manufacturing-Diversified MMM 3M Company 03/17/2008 100 7851 7,851.00 73.600 7,360.00 (491.DD} -63% HON Honeywell Intl, Inc. 03!17/2008 20D 55.22 11,044.00 51360 10,272.00 (772.00} -7.0% 18,895.00 17,632.00 (1,263.00} -6.7% Pu trlish in g-Newspapers GCI Gannett Companylnc. 03/!7/2008 200 29.24 5,848.00 19.310 3,862.00 (1,986.00} -34.0% Retail-General Merchandise WMT Wal-iviart Stores Inc. 03/17/2008 100 49.95 4,995.00 59.250 5,925.00 930.00 18.6% 102,6I7.00 102,039.00 (578.00) -0.6% 105,525.92 104,94792 (57$.DO} -D.S% _ f _. First S10CE Itn~estment riduisors, Inr. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER GOBLE, NICHOLAS L. 21 - 2008 - 0861 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Sovereign Bank 5,052.92 Checking Acct. No. 0351080465 (Owned w/Wife who prededeased Decedent) 2 Sovereign Bank 6,381.95 Checking Acct. No. 1681727811 (Owned w/Wife who predeceased Decedent) 3 First State Investments 2,908.92 Cash Holdings 4 Citizens Bank 14,553.00 5 Misc Personalty 6,353.00 6 2004 Lincoln Towncar --- Sale price 8,200.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 43,449.79 _.. - ~, ;, ~ `' ~.~.- X ~ ~..r-~-- ~ ~ - _ :~ 4~- ~. ,~- ~ ~ ~ ~ . - ~_ ~ ~ ~ ~ . -, ~. CY, Y ~G CLAUDE C. IdIIOLFE & ASSOCIATES AUCTIOi~iEERS & APPRAISERS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET CAMP HILL, PA 17011 717-737-0734 August 25, 2008 Appraisal for the Estate of Nicholas L. Goble 42 Ridgeway Drive, Mechanicsburg, PA 17050 ENTRY Single drawer stand 24.00 Oval mirror 10.00 Pair of rush seated chairs -1 broken 25.00 Small table lamp 2.00 Luggage 2.00 Hoover upright vacuum cleaner 8.00 8X-20 X Smm Sonoma binoculars 20.00 Misc. pictures 15.00 Painted writing desk w/3 drawers 75.00 5' Wooden step ladder 10.00 Artificial plant & planter 8.00 Buffet 60.00 86 Pieces of misc. sterling silver flatware 600.00 Noritake partial service for 12 dinnerware 75.00 Misc. knick-knacks on buffet 15.00 Misc. linens 8.00 Misc. contents of entry 20.00 LIVING ROOM Reproduction marble top stand w/drawer -Lyre motif 75.00 Misc. books 10.00 Sony TV & stand 75.00 Sony DVD player 40.00 Misc. VHS tapes 20.00 CLAUDE C. WOLFE & ASSOCIATES AUCTIONEERS & APPRAISERS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET CAMP HILL, PA 17011 717-737-0734 Goble appraisal Page 2 of 6 LIVING ROOM -continued Green recliner -worn 10.00 Artificial Ficus tree 30.00 Rounded container with children's building blocks 15.00 Artificial plants 8.00 Rocking chair with ottoman -fair condition 25.00 4 Wooden TV trays 20.00 2 Round end tables -35.00 Floor lamp 15.00 Trash basket 2.00 Tan colored recliner & matching recliner sofa -soiled 135.00 Portable TV 10.00 2 Table lamps 10.00 Tlarge wall mirror 45.00 Magazine basket 5.00 Drop leaftable -marked 150.00 Ionic Pro electric air purifier 10.00 Step stool 5.00 Pair of reproduction brass candleholders 10.00 Misc. contents of living room - 25.00 DINING AREA Table & 6 chairs -fair condition 75.00 KITCHEN Hotpoint refrigerator 60.00 Green bowl 20.00 Brown bowl 10.00 Misc. glassware 10.00 Utensils 2.00 CLAUDE C. WOLFE & ASSOCIATES AUCTIONEERS & APPRAISERS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET CAMP HILL, PA 17011 717-737-0734 Goble appraisal Page 3 of 6 KITCHEN -continued 0o are Telephone 8.00 5 Frankoma decorator plates 30.00 Cutlery 3.00 Small yellow lamp 2.00 Broiler -poor condition 1.00 Artificial plants 2.00 Misc. everyday dishes 10.00 Mr. Coffee coffee maker 5.00 Flatware 5.00 Toaster 7.00 Oriental style teapot -cracked 5.00 Pair of "TK" Czech candlesticks -broken & chipped 2.00 T&V decorator plate 5.00 Ironstone teapot & sugazs -crazed 30.00 Decorator plate w/pink flowers 5.00 Misc. contents of kitchen 25.00 LAUNDRY GE washer 60.00 GE dryer 3 5.00 B&D electric iron 2.00 Misc. contents of closet 20.00 BATH Trash can 1.00 Misc. contents of bath 5.00 CLAUDE C. WOLFE & ASSOCIATES AUCTIONEERS & APPRAISERS FAMILY OiG7VED SINCE 1910 2009 LINCOLN STREET CAMP HILL, PA 17011 717-737-0734 Goble appraisal Page 4 of 6 MASTER BEDROOM -CLOSET Misc. toys Misc. pictures Misc. linens Shoe rack 3-Piece Stanley bedroom suite Round nightstand 2-Drawer nightstand Table lamp Alarm clock Portable TV -old VCR 5-Drawer chest Clothes hamper Misc. bed linens Trash can 2 Straight chairs Computer desk Old computer w/printer Desk lamp Trash basket 2-Drawer file cabinet Slant front desk Antique trunk Table lamp Telephone a MASTER BEDROOM SECOND BEDROOM 5.00 10.00 3.00 1.00 85.00 8.00 15.00 2.00 1.00 2.00 10.00 35.00 1.00 7.00 1.00 15.00 40.00 45.00 2.00 1.00 20.00 65.00 65.00 2.00 5.00 CLAUDE C. ~I(OCFE & ASSOCIATES AUCTIONEERS & APPRAISERS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET CAMP HILL, PA 17011 717-737-0734 Goble appraisal Page 5 of 6 SECOND BEDROOM -continued Sentry safe 10.00 Artificial flower & basket 2..00 Misc. office supplies 10.00 Misc. pictures 10.00 Misc. contents of bedroom GARAGE Misc. pictures AM/FM/Cassette player Misc. hand tools Misc. garden tools Ironing board Cooler chest Walker -health aid Shop vac Golf clubs & bag -Cobra Golf clubs & bag -Misc. 20.00 5.00 5.00 20.00 8.00 1.00 2.00 1.00 12.00 80.00 55.00 2004 Lincoln Town Car -Signature Series, 50,899 miles very good condition 11,500.00 PATIO Weber gas grill(not propane) 75.00 Misc. patio furniture 65.00 Ct.A~UDE C. WOLFE & ASSOCIATES AUCTIONEERS & APPRAISERS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET CAMP HILL, PA 17011 717-737-0734 Goble appraisal Page 6 of 6 APPRAISAL TOTAL $ 14,553.00 This Fair Market value appraisal is true and correct to the best of my ability as an auctioneer and appraiser with 35 years experience. Member: Certified Appraisers Guild of America CLAUDE C. WOLFS & ASSOCIATES W. K. "Dusty" Chapman, CAGA • SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF ~ FILE NUMBER GOBLE, NICHOLAS L. 21 - 2008 - 0861 ~ nis scneaule musr oe com te><ea ana mea ~r >cne answer ro an or uesuons ~ ><nrou n 4 on a e ~ is es. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF NUMBER Include the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET DECD'S EXCLUSION IF APPLICABLE TAXABLE VALUE Attach a copy of the deed for read estate. INTEREST ( ) 1 Ameriprise Financial IRA 42,919.84 42,919.84 2 Charles Schwab IRA i I i i 173,470.69 173,470.69 TOTAL (Also enter on line 7, Recapitulation) 216,390.53 The Personal Advisors of Ameriprise Financial September 10, 2008 Lisa Marie Coyne Coyne & Coyne, P.C. 3901 Market Street Camp Hill, PA 17011 ~ ~-~~~~, n. ~~~~; ~` - . Dear Ms, Coyne: ... We have received notification o 1`IICH~LAS L GOBLE's death. e deceased's name appears on the follo~ accounts. Account values as of 0 /2008 are listed below. At the nd of this letter, you will fmd a list of beneficiaries shown in our initial review e accounts Account Information Mutual Funds Account. Number 01151212682 9 002 02151212682 8 002 Annuities -Post 1985 Account Number 93107800626 5 004 Mutual Funds Account Number 01151212682 9 002 02151212682 8 002 Annuities -Post 1985 Account Number 93107800626 5 004 Ownership Individual - TOD Individual - TOD Ownership IRA -beneficiary designated Total Value # of shares $12,296.09 2,957.802 $4,978.18 1;197.492 Total Value _ $42,919.84 ! j ~A' Asset Value Per Share $4.15 4.15 The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts maybe subject to market fluctuation as governed by each product. Please note that the values indicated for any Life Insurance products with the insured deceased reflect the gross death benefit at date of death and not the cash value. Values indicated for Life Insurance products with only the owner deceased reflect the cash value as of the date of death. Values for any proprietary mutual funds include accrued dividends as applicable. Values provided for brokerage products are manually calculated, and should be used as estimates only. The prices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a service to its clients. Actual values used in preparation of tax returns or for planning purposes should be verified by your legal and accounting advisors. David W. Kidd, CFP®, CFS Ameriprise Fnancial Services, Inc. Financial Advisor Suite 604 CERTIFlED FINANCIAL PLANNERTM West Shore Office Center practitioner 214 Senate Avenue Camp Hill, PA 17011 Tel; 717.761.3300 Fax: 717.761.3686 Toll Free:_866.600.1177 davi d.x ki d~dC2a m pf. co m An Ameriprise associated franchise. Ameriprise Financial Services, Inc. offers financial advisory services, investments, insurance and annuity products. RiverSource91A products are offered by afFliates of Ameriprise Fnancial Services, Inc., Member NASD and SIPC. O ~ x -a N O N O 00 O ~ C"7 ~ ~ v ~ ~ y ~ c _BA ~~ o ~ m n _ f N 7 ~ ~ O ~~. Q n •~ N ~r o ~ ~ n ~ f a N a ~o oa ~ O ~ s m N N N 6 j N c~ Q ~- a O O ~~ ~~. ~r m ~ ~ ~ 0 m o o ~~~y (n N N rT~~r¢¢1T1 C1 O N [fir Q4 ~ D N N ~, n cNO X ° u~=p w a~ 0 ~. ~. m o ~ v ~ rn vat, a n @ rt ~ ~ m~ c "~F-r ~ ~ m N N n '_"`''~'~ w ~ ~ N o ~ ~ o v ~' ° ro c°n II` `` ~r w o m ~ o~ ~q a c.b~ (D ~ ° ~ c~C o cc~~FF~~ .o o m ~ o -° m ~ 3 m ~* tra CD N N N C) 0 7 CD j ~ ~ O (p rb 97 ~ ~ rS n m m ~'' O7 Oq C] p ors o ~ 3v ~~ ~ ~ cn ~n.~~ ~ 7r1 ct y 3 ~ ~ N C ~ ~• r- to m- 0 o r- n3 o H ~~ ~ ~ ~ ~. n O O J (n 7 (D N a N H fD ~ O 1-h 04 0 m _° G fl- o < ~„ m w a c O ~ .~ .G? C ~ (~ ~ ~ m rt N ~. o O ~ ~ v ~ Hc~z v y ~vco ~ ~ H C'] O ~i W 0~ ~ :h ~ O Ai O ~ G (D ~ ~ o~~ z w u , ~o t-~ cn ~ ~ ~ ~ w r- rn O ~ C C] t'' H O I-5 d ~q (p C]xC1 H ~rt~ t-' ~p~ ~ E Cam] t'' A~ W G O Ai rt ~' LTJ F--~ I--' (D W t-t ~' 77 G7 • • • . • _ .. ct (D .. ' rp .. a+ Co ~ r ~ C] t~ -~ 0 0 0 O w ~scn ~ ~~~~ H .L . O F-+ 1--' 7., J l0 N N i~ O \ \ \. N N N C7 61 000 C lD O O O ~ ~ ~ ~ ~-3 ro 0 n r-r H, O ~- N 0 ;_] O rr m trr cn w .~, N F--+ v w .a N v to f'~' ¢1 lD rt z ~-o ~ ~ ° O I O' rt M (D .. ri y 'Y]O"O ~H ~-'- M lD Cl C] (D Cl] O O H (~ Ai ~ ~ C7 G rt rt C/~ r< (D .. F'• t~ wct O wtn ~N•rn~t~1 N !D N OU] p OG] ~ • • lD ~o O ~ v a CA ~ H rt r-' t-' ~rn~'coC~] ® i ~~ ® ^ \:J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATNE COSTS ESTATE OF FILE NUMBER GOBLE,1\TICHOLAS L. 21 - 2008 - 0861 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: 1. Myers-Harnish 7,269.00 2. Reception 1,490.46 3. , Honorarium 200.00 B. ~ ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. 3. 4. Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Coyne & Coyne, P.C. 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 Probate Fees Register of Wills 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Postage 2 Cumberland Law Journal-- Legal Advertisement 20,000.00 500.00 88.00 75.00 Total of Continuation Schedule(s) 28,498.02 TOTAL (Also enter on line 9, Recapitulation) 58,120.48 CC Schedule' H COMMONWEALTH OF PENNSYLVANIA ru~ -T~"^- INHERITANCE TAX RETURN ~~~-~ ~~ ~l~n~ RESIDENT DECEDENT ESTATE OF GOBLE, NICHOLAS L. FILE NUMBER 21 - 2008 - 0861 3 Patriot News-- Legal Advertisement 127.38 4 Filing Fee--Inheritance Tax Return 15.00 5 Additional Death Certificates 50.00 6 Cleaning Supplies 350.00 7 Travel, Food, Lodging and Transporation for Executrix 3,000.00 8 Toll Calls for Executrix 300.00 9 Stock Broker Commissions 500.00 10 Rey Woof-- Real Estate Appraisal 300.00 11 Dusty Chapman-- Personalty Appraisal 250.00 12 Pat's Home & Garden Services-- Repairs and Painting of House for Sale 1,580.00 13 Real Estate Taxes 1,400.48 14 Homeowners Association Fee 200.00 15 Legal Advertisement for Sale of Home and Vehicle 259.25 16 Chem-Dry Carpet Cleaning 316.40 17 First State Fee-- Brokerage 619.92 18 Walker Realty 8,875.00 19 Closing Costs 2,961.24 20 Eastwood Lawn Services 250.00 21 ~ Silver Spring Sewer Authority 260.00 22 Scotts Lawn Service 186.71 23 Terminex ~ 46.64 24 I Peerless Insurance (Home & Auto) 1,050.00 25 Bank Charges and Checks 100.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GOBLE, NICHOLAS L. 26 ~ Reserves 27 ~~ Carey & Assiciates -- Tax Returns Schedule H Funeral E~er~es & ~'Y11rVe ~;06~5 (~OnbnUeCl FILE NUMBER 21 - 2008 - 0861 5,000.00 500.00 Page 3 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER GOBLE, NICHOLAS L. 21 - 2008 - 0861 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Soverign Bank-- Car Loan (Lincoln Towncar) 12,734.00 2 IRS 3,000.00 3 Coyne & Coyne, P.C.-- Margaret Goble Estate Fees 5,000.00 4 Patriot News 81.02 5 Extra Probate Fees and expenses for Wife's Estate 39.00 6 Uncleared Checks 1,400.00 7 PSERS-- Refund of Overpayment 1,919.46 8 Coyne & Coyne, P.C.-- Estate Planning for Nick Goble. 350.00 9 Verizon 164.00 10 PP&L 250.00 11 UGI 500.00 12 HealthSouth 9.00 13 Comcast 160.00 14 United Water 90.00 TOTAL (Also enter on Line 10, Recapitulation) ~ 25,696.48 REV-1513 EX+ (g-0O) a ~ a ~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERI B E N E F I CIARI E S TANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GOBLE, NICHOLAS L. FILE NUMBER 21 - 2008 - 0861 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE OF ESTATE I~ TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Michaella A. Placido Daughter 1/3 of Residual Estate 2 '. Mark Goble Son 1/3 of Residual Estate 3 Nicholas T. Goble i Son 1/3 of Residual Estate i I i Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria te, on Rev 1500 cover she t III 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 SHEE ~t F f: ~1 ~lL_J' ~L Y V ~~ 1 .fill V JLJ' ~~~~1 ~l._L V" JLJLl1 9 ~~ ~~~~1 .11~ ~o. ~LJi ~~~~11 W W ~~ W ~a O U z v I, NICHOLAS L. GOBLE, of the Township of Silver Spring, County of Cumberland, ~mmonwealth of Pennsylvania, declare this to be my Last Will and revoke any Will or' Codicil previously made by me. ITEM 1: Upon my demise, I direct that my body be buried at Fort Indiantown Gap National Cemetery, Annville, Lebanon County, Pennsylvania.` ITEM 2: I direct that all my just debts and funeral expenses be paid as soon as practical I' after my death. ITEM 3: I direct that all taxes that .may be assessed in consequence of my death, of ', whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my Estate. ITEM 4: I give, devise and bequeath all the rest, remainder and residue of my estate of every nature and wherever situate, together with all insurance thereon, to my beloved, wife, MARGARET ANN GOBLE, provided she survives my death by thirty (30j days. ITEM 5: Should my beloved wife, MARGARET ANN GOBLE, predecease m~ or fail to survive my death by thirty (30) days, then I give, devise and bequeath all the rest, remainder and residue of my estate of every nature and wherever situate, together with all insurance thereon, in equal shares, to Page 1 of 6 my children, MICHAELLA A. PLACIDO of 1001 Oak Street, Hood River, OR 97031, MARK K. of 3413 East Pratt Street, Baltimore, MD 21224 and NICHOLAS TOBIAS GOBLE of 36 South 9`~ Street, Camp Hill, PA 17011, per capita. ITEM 6: My Executrix or her successors shall have the following powers in addition to se given by law to be exercised by her in her absolute discretion, which powers shall be applicable to all pFOperiy held by her, effective without the order of any court and until the actual distribution of all such property: a. To retain any investments at discretion including stock of any corporate fiduciary or of a holding company controlling it; b. To invest and reinvest in the executrix's discretion as permitted under Act 28 of 1999, as W ~ a w 0 ~ a v~ d a o ~- .- ~ z amended, the "Prudent Investor Act," with the specific right to-invest in stocks, bonds and real estate, including non-income producing residential real estate for the occupancy of any present income beneficiary or beneficiaries, and in such diversified, proprietary money market and mutual funds, including such mutual funds of any corporate fiduciary hereunder or those of any successor or affiliated corporation or a holding company controlling it, as my executrix deems appropriate; c. To sell, to grant options for the sale of, pr otherwise convert any real or personal property or interest therein, at public or private sale, for such prices, at such time, in such manner and upon such terms as they. may think proper, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof without liability of any purchaser to see to the application of the purchase money; d. To borrow money and to secure the repayment thereof by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the ~applicatiori thereof; e. To compromise claims by or against my estate or any trust created hereunder; Page 2 of 6 £ To allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries or trusts, in cash or in kind, or partly in each; g. To register investments in the name of a nominee or to hold the same unregistered in such that they will pass by delivery; h. To join in any recapitalization, merger, reorganization or voting trust plan affecting to deposit securities under agreement; to subscribe for stock and bond privileges; and y to exercise all rights of security holders; i. To manage, operate, repair, alter or improve real estate or. other property, and to lease real estate and other property upon such terms and for such period as my executrix deems advisable even for than five (5) years and beyond the duration of any trust; j. To deduct administration expenses upon either the federal estate tax return or fiduciary ne tax return with or without adjustment as between principal and income, as my corporate or disinterested executrix shall determine; k. To associate with tliem in the absence of a corporate fiduciary, an accountant, custodian and investment advisor, and other agents and to compensate them from principal or' income'or both, as my executrix shall determine, such compensation to be a reduction of the compensation of my executrix; ~ W 1. To associate with her at any tune, in her absolute discretion and of her choice, a corporate - ~ fiduciary which shall have the same powers as my executrix, such designation by my executrix and ~~ a acceptance by a corporate fiduciary to be iii writing; v~ m. To combine, without prior court approval, any trust herein with any other trust with „ ~ substantially similar provisions, although such other trust may have been created by separate instruments Z - and by different persons, and, if necessary to protect different future interests, to value the assets at the time of such combination and to record the proportionate interest of each separate trust in the combined Page 3 of 6 ._ . _; ... _.. _; ... _-_... _. T. fund; provided however, that no such combination shall be permitted if the effect of such combination i be (lj to violate the applicable rule against perpetuities; (2) to disqualify any interest'in one ox of such trusts for a deduction for federal estate tax purposes which would otherwise be allowable; or (3) to cause the loss of the exempt status of one or more of•such trusts from tine imposition of the generation-skipping tax; n. To exercise any stock options which they may receive; to borrow such funds from any as my executrix may deem necessary for the exercise of such options; and to pledge assets as my ix deems appropriate for this purpose; o. - No trustee shal'1 be required to qualify before, be appointed by, or, in the absence of a L ~-~. ~ `~~, C ~t .ch of trust, account to any court (and failure to account alone shall not be considered such a breach); shall trustee be required to obtain the order or approval of any court in-the exercise of any power or decision granted hereunder; p. To allocate any generation-skipping transfer tax exemption from the federal generation- skipping transfer tax to any property to which I am deemed tl~e transferor under the provisions of Section 2652(a) of the Internal Revenue Code of 1986 and its successors, including any property transferred under will and any property not in my probate estate and any property transferred by me during life as to ch no allocation was made prior to my death, to .the extent necessary to cause the inclusion .ratios '',applicable to such transfers to be zero; '~i ~ q. To disclaim any interest in property without court approval; and r. To do alI other acts and things necessary or appropriate in the management, administration and distribution of rriy estate or trust. ITEM 7: Until distributed, no gift or beneficial interest shall be subject to .anticipation or voluntary or involuntary alienation. Page4of6 ITEM 8: I appoint my wife, MARGARET ANN GOBLE, Executrix, of this my Last Will. the event my wife, MARGARET ANN GOBLE, predeceases me, fails to qualify or ceases to act as Lrix, I appoint my daughter, MICHAELLE A. PALCIDO, first alternate Executor of this my Last In the event my daughter, D~IICHAELLE A. PALCIDO, predeceases me, fails to qualify or ceases act as Executrix, I appoint my son, NICHOLAS TOBIAS GOBLE, second alternate Executor of this Last Will. ITEM 9: I direct that my personal representative or successors, shall not be required to ;ive bond for the faithful performance of her duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this 2 ay of , 2007. d NICHOLAS L. GOBLE Signed, sealed, published and declared by the above-named Testator as and for his Last Will and in our presence, who, at his request, in his presence and in the presence of each other, have Hereunto subscribed our names as attesting witnesses. ~~!~~ ~ ~~ residing at L~ ~~ ~ ;~ ~.~ p j ~~ ~ residing at nti c Z o s s- ~~ ~ Page 5 of 6 MMONWEALTH OF PENNSYLVANIA ) . ) ss: LINTY OF CUMBERLAND ) We, NICHOLAS L. GOBLE, /~ ~s,s E r•-~ . (10 ~i,_.c. ~~ and ~Ai'Tt-~ e..s Spa G-2~ 5_r ,the Testator and the witnesses respectively, whose names are signed . the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned ~rity that the Testator signed and executed the instrument as his Last Will and that he had signed ugly,, and that he executed it as his free and voluntary act for the purpose therein expressed, and that of the witnesses, in the presence and hearing of the Testator, signed the will as witness and that to best of his or her knowledge, the Testator was at the time eighteen. (18) years of older, of sound mind under no constraint or undue influence. Witness "-S Witness Subscribed, sworn and aclrnowledged before me I-~ c--.,.~ rz~ ~. Co ~ ~ ~ by NICHOLAS L. GOBLE, the Testator, and subscribed and sworn to before me by „~ c n.,e - ~ an. -.~ ~-2 and J . til,,~-~~ E;,~, S c-~ crrz.. ~-, the witnesses, this ~~~ of , 2007: Notary Public ( AL,) COMMONWEALTH OF P€NNSYLVANIA NOTARIAL SEAL HENRY F. COYNE, NOTARY PUBLIC Pa e 6 of 6 HAMPDEN TwP, CUMBERLAND COUNTY g MY COMMISSION EXPIRES JUNE il, 2008