HomeMy WebLinkAbout05-18-091505607121
REV-1500 EX (06-05) OFFIGIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 2 0 0 6 0 0 5 1 0
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 4 0 1 0 5 1 0 1 0 4 2 2 2 0 0 6 0 2 0 3 1 9 2 0
Decedent's Last Name Suffix Decedent's First Narc~e MI
K i r s s i n V i r g i n i a W
(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
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
6. Decedent Died Testate ~ 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)
(.UKKtSF'UNUtN I - 1 FIIJ Jtl.11UIV MUJI Ct I.VIVIYLCI CU. HLL l•URRCJrUI\VCIY~.c f11`IU l~vl`1rIVGi~ i i nL inn ~~r~ v~~m.+~ ~v~. v~~vv~.. r+r...,,.~.. ~.-.+ ~..•
Name Daytime Telephone Number
W i l l i a m J P e t e r s
E s q
~,>
`_'. __
Firm Name (If Applicable) REGISTER O~ WIC S USE ONLY
i -~
t _...
First line of address `-~
2 9 3 1 N o r t h F r o n t S t r e e t j ~_ ~~ :'~'
Second line of address °-
City or Post Office
State
ZIP Code LJ
DATE FILED
H a r r i s b u r g P A 1 7 1 1 D
Correspondent's e-maress: Wjp~pWlegaLCOm
Under penalties of perj 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 plete. ration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE N LE FOR FILING RETURN DATE
ADDRESS
Jon Kirssin, 510 Nurser Drive S• Mechanicsbur PA 17055
SIGN U E OF PREPARER OT THAN REPRESENTATIVE DATE
r
ADDRESS
William J• Peters 2931 N• Front St• Harrisburg PA 17110
PLEASE USE ORIGINAL FORM ONLY
1505607121
Side 1
],505607121 ~ ci;
~7'~
~J
1505607221
REV-1500 EX Decedent's Social Security Number
Decedent's Name V 1I^glnla W• Kirssin 1 4 0 1 0 5 1 0 1
RECAPITULATION
1.
......................................
Real estate (Schedule A)
..
1 •
9 6 3 5• 8 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.
1 0 8 ~ 2 • 9 3
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... .. 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 2 0 1 4 . 8 3
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ..... .. 7.
8. Total Gross Assets (total Lines 1-7) ....................... ... 8. 2 2 4 8 3 5 7
9 4 6 2 5 • 0 9
9. Funeral Expenses & Administrative Costs (Schedule H) .
7 8 9 6 2 2
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10.
11. Total Deductions (total Lines 9 & 10) 11. 1 2 5 2 1 3 ],
12. Net Value of Estate (Line 8 minus Line 11) 12. 9 9 6 2 . 2 6
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 2 6 0 0 0 D
an election to tax has not been made (Schedule J) .. ..... ....... .. 13. .
7 3 6 2 2 6
14. Net Value Subject to Tax (Line 12 minus Line 13) 14. ,
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
0
0 0
15
0.
0
0
(a)(1.2) x .o .
16. Amount of Line 14 taxable
7 3 6
2
2 6
3
3
1.
3
0
at lineal rate X .045 16.
17. Amount of Line 14 taxable 0 0 0 0 0 0
at sibling rate X .12 17
18. Amount of Line 14 taxable
0
0 0
0.
0
0
at collateral rate X .15 1 g
3 3 1. 3 0
19. Tax Due .................................. ..... ....... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505607221 1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
20 06 00510
DECEDENT'S NAME
Virginia W. Kirssin
STREET ADDRESS
100 Claremont Drive
__ __
CITY
Carlisle
_- -_ ___
STATE ZIP
PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest 59.23
E. Penalty
Total Interest/Penalty (D + E) (3) 59.23
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. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 390.53
A. Enter the interest on the tax due, (5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (56) 390.53
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; .............................. X
c. retain a reversionary interest; or .............................................................................................. ^
d. receive the promise for life of either payments, benefits or care? ...................................................... ^ 0
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? .................................................................................................. ^ 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 sunriving 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)]. 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.
31.30
0.00
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Virginia W Kirssin 20 06 00510
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Wachovia Securities 9,635.81
Account No. 4782-9257
TOTAL (Also enter on line 2, Recapitulation) I S 9,635.81
(If more space is needed, insert additional sheets of the same size)
' REV- i 508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Virginia W Kirssin 20 06 00510
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Wachovia Bank NA 2,755.93
Account No. 1000322992028
2. Gen Worth Ins. Co. 8,077.00
long term care policy funds for care of decedent prior to time of death
TOTAL (Also enter on line !i, Recapitulation) I $ 10,832.93
(If more space is needed, insert additional sheets of the same size)
REV-7509 EX +~(6-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Virginia W Kirssin 20 06 00510
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Jon D. Kirssin
B
c
JOINTLY-OWNED PROPERTY:
510 Nursery Drive South
Mechanicsburg, PA 17055
son
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET °/ OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A. Members First Federal Credit Union 4,029.65 50. 2,014.83
Account No. 6980
TOTAL (Also enter on line 6, Recapitulation) I $ 2,014.83
(If more space is needed, insert additional sheets of the same size)
` REV-'Y511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Virginia W Kirssin 20 06 00510
Debts of decedent must be reported on Schedule t.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Aver Memorial Home and Cremation Service, Inc. 998.00
4100 Jonestown Road, Harrisburg, Pennsylvania
2. Nino's Bistro (after service meal) 956.00
B
2.
3.
4
5.
6.
7.
8.
9.
10
11
ADMINISTRATIVE COSTS:
Personal Represenlative's Commissions
Name of Personal Representative (s)
Street Address
City State _
Year(s) Commission Paid:
Attorney Fees William J. Peters, Esquire
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Zip
130.00
Tax Return Preparers Fees Leon Walter, CPA - 2006 Tax Return
304 Sharon Drive, New Cumberland, PA 17070
Payment -Department of Revenue - 2006 tax
Sentinel -Advertising cost
Cumberland Law Journal -Advertising cost
Photocopies
Postage
788.00
24.00
144.29
75.00
2.00
7.80
TOTAL (Also enter on line 9, Recapitulation) I $ 4,625.09
Zip
1,500.00
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Virginia W Kirssin 20 06 00510
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Claremont Nursing and Rehabilitation Center 5,347.00
1000 Claremont Road, Carlisle, Pennsylvania
Fees for care 4/1/2006 to 4/22/2006
2. Mobile X-ray Imagae 72.00
3. (Reimbursement to Public School Employees' Retirement System for paymenl: I 2,477.22
received after time of death
TOTAL (Also enter on line 10, Recapitulation) I $ 7,896
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
~r~,.~.,~~ ~n~ u~~~~~~ 20 06 00510
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees) OF ESTATE
[ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1 Kirk Kirssin (grandson) Lineal 1/10
3903 Top Flite Lane
Mason, Ohio 45040
2. Keith Kirssin (grandson) Lineal 1/10
293 Lucinda Lane
Ruckersville, Virginia 22968
3. Jon D. Kirssin (son) Lineal 1 / 5
510 Nursery Drive South
Mechanicsburg, Pennsylvania 17055
4. Jeffrey L. Kirssin (son) Lineal 1 / 5
6831 Loyet Road
Collinsville, Illinois 62234
5. Lee C. Sutton (grandaughter) Lineal 1 / 10
1686 Massachusetts Avenue, Rear
Cambridge, Massachusetts 02138
6. Jay H. Kirssin (son) Lineal 1 / 5
727 Slate Street
Lemoyne, Pennsylvania 17043
7. David W. Sutton (grandson) Lineal 1 / 10
2556 Warren Avenue N.
Seattle, WA 98109
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
~-. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE
B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 Dickinson College -Bluegrass on the Green 100.00
2. Cleve J. Fredrickson Library 2,500.00
100 N. 19th Street, Camp Hill, PA
TOTAL OF PART tl -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COb'ER SHEET $ 2 600.00
(If more space is needed, insert additional sheets of the same size)
.'
LAST WILL AND TESTAMENT
OF`
VIRGINIA W. KIRSSIN
I, VIRGINIA W. KIRSSIN, of the Township of
Hampden, County of Cumberl.ands Commonwealth of Pennsylvania,
being of full age and of sound and disposing mind and. memory and
not under any restraint, do hereby make, acknowledge, publish and
declare this to be my Last Will and. Testament, he-r_eby revoking
any and. all Wills and Codicils heretofore made: by me.
ITEI~I I - T hereby direct that, pursuant. to the
Pennsylvania Uniform Anatomical Gift Act or any similar law of
any jurisdiction of_ which I may die a resident and in accordance
with. the Unifarm Donor Card which I ].nave el~ecuted, any needed
argans or. parts of my body may be used. far purposes of
transpl.antatian, ther.-apy or other medical purpases. After. the
x~em~ava.?. of arty such organs or parts, I directs that r:~y body be
cremated.
r / '
~~~~~-~-~~~V (sEAL )
_ ~~~~-
,'
ITEM II - I direr..t that my jus~_ debts, funera7_ a.nd
burial expenses and the expenses of any last illness, claims for
whicl'i are presented in th.e manner. ar~d within t:he time prov~sded by
law, be paid out of the assets of my esf~ate or.. the income
therefrom, as soon after my death. as may be practicable. I
further hereby direct that a1.1 estate, inheritance, succession.
and transfer taxes imposed by the United. States or any state,
territory„ or possession which shall. became payable by reason of
my death, sha11_ be paid from the residue of my estate. It shall
not be necessary to file any claims therefore, nor to have them
a1.lawed by any court.
ITEM III - I hereby exercise al. 1. powers of
appointment which I array have at the time of my death ~..n favor of
my Executor, and al.l property subject to all such powers of
appointment sha11 be included. in niy estate and be governed by the
provisions of th~..s Will.
ITEM IV - I give, devise and bequeath, tree
Witnesses:
_.._.. ~ _~.-y//° ~c _ (SEAL
~~ f°,.~-
~~' -
U
Page 2. of 7
.'
residue of my estate, bath real ar.d personal, of every kind and
nature whatsoever anal wheresoever situated, which I awn or have
the might to dispose of or appoint at the time of_ my death, to my
children, JEFFREY L. KIRSSIN, JA1' Ii. KIRSSIN and JON D. KIRSSIN,
and to my grandchildren, LEE SUTTON, DAVID SUTTON, KIRK KIRSSIN
and KEITH KIRSSIN as follows: i~ty Estate shall. be divided into
fl..ve equal. shares with each of my children, JEFFREY L. KIRSSIN,
JAS' H. KIRSSIN and JON D. KIRSSIN, shall receive one equal share
each.. The fourth share shall be divided equally between my
grandchildren, LEE SU'1"TON and DAVID SUTTON, and held i:r. separate
guardianships by my son, JON D. KIRSSIN, as guardian of such
estate shares until said LEE SUTTON acid DAVID SUT~'ON shall. each.
reach the age of twenty-five (25~ years acid at the time that each
said grandchild shal_1 reach the age of twenty-f~_ve (25) his/her
share shalrE~ be paid directly to said gr.an.dch~Ll.d.. The fifth. and
remaining share shall be divided equally between my
grandchildren, KIRK KIRSSIN and KEITH KIRSSIN, and held in
separate guardianships by my son, JON D. KIRSSIN, as
Witnesses:
~~
~_ `L _ ~ ~ _~_ ~-S EAL
--~''~ ~~
~ ~~~_ ".
Page 3 of 7
guardian of such estate shares until said KIRK KIRSSIN and KEI'T'H
KIRSSIiv' shall. each reach the age of t.vaenty-five X25} years and at
the time that each said. grand.chil.d srial.l. reach the age of
twenty--five X25) his/her share shall be paid directly to said
grandchi.l d ,
?n the event that any of my children do not
survive me or Live for a period af. thi.rty (30~ days after the
date of my death, their share of my estate shall be given to and
divided equally between their children, natural or adopted, then
living. If said grandchildren of mine are under the age of
twenty-five (25~ at the time of my death, then. any share that may
be givers t.o them vaill be paid and held in a separate guardianship
by my son, JON D. KIRSSIN, as guardian for such. estate shares
until said grandchild shall reach the age of twenty--f~_ve (25)
years. In the event my son, JON D. KIRSSIN, far any reason u.s
unable or refuses to act as guardian for the estate of said
grandchildren, then, in t:he alternative, I appoint my son,
Witnesses: ~/
____ ~,A~' . °~ .~'~' ( SEAL ~
1
~ ~
Page 4 of 7
~a
JEFFRFI' L,. KI:RSSIN, as the guardian of said. estate shares for
said grandchildren. If. any of my children do not survive me or
li..ve for thirty (3d) days after the date of my death, and not be
survived by children, then their share shall be distributed. to my
then surviving children and grandchildren in the manner provided
above
ITEM V ~ No interest in income or principal of my
estate shall be subject to attachment, levy or seizure by any
creditor, spouse, assignee or trustee or receiver. ira bankruptcy
pf any beneficiary of my estate prior to the beneficiary's actua]_
receipt. thereof. My Executor shall pay over the net income and
princi_pa1 to the benefica..aries herein designated as their
interest may appear,. without regard to any attempted anticipation
(except as may be specifically provided lzerei.n), pledge or
assignment by any beneficiary of my estate and without. regard to
any claim hereto or. attempted levy, attachment, se.~.ztzre or other
process against said beneficiary.
Witnesses:
f
_~/~ . ~
~ f SELL)
Page 5 of 7
.~
ITEM VI -- I make, nominate and appoint
my san, JON B® KIRSSIN, Executor of this my I-~ast C~i.11 and
Testament, with full power and authos~ity to do any and all things
necessary for the complete administration of my Estate. In the
event that my son, JON D. KIRSSIN, shall refuse or for any reason
whatsoever, fail. to qualify as such. Executor6 and having accepted
he shall , for an~r reason , fay. l to complete tree same , then I ,
makeF nominate and appoint, my son, JEFFREY L. KIRSSIN, t.a be the
Executor of this my Last Will and Testament..
I`PEM VII - I give to my Executor, and to all.
persans succeeding ~.n said office including, Administrators with
the 6Jill annexed, full power. to compound, compr.am~.se, settle aril
adjust all claims, debts, or demands of any kind, in favar of or
against my Estate, to hold, sell., at. public ar. private sale, anal
t:o mortgage or pledge any par.~t or all of f:he assets,. real or
personal, of my Estate as he, in hi.s sole discretion, may deem
necessary or advantageous, the same t.o be at such prices and upon
Witnesses;
~-
Fage b of 7
such terms and conditions as he may determine, arad to execute,
ac~r:owledge and deliver deeds, releases and other instruments
incident anal necessary to the exec°cise of ti>uch power, and no
Order or confi.rmat.i.orr of any Court shaJ_1 be requJ_red, but. his
receipt shall be a full acquittance to any debtor of the Estate
and no person need. see to the application of i~he proceeds of any
payment made to him.
ITEM VIII _ My Executer sha11.. qualify and serve
without, the duty or obligation of fiJ_ing any bond or other
security. Any corporate fiduciary shall be entitJ_ed to
compensation for services i.n accordance `with the standard
schedule of fees in effect when the services are rendered.
III' ~aIT1VESS WHEREOF, I, set my hand anal seal. to
this my Last V7ill and Testament, consisting of this and the
preceding six (6) pages a.t the end of each page of which I have
also set my hand for greater security and better identification
this .~. ~ day of ~ ~ , 1994 .
Witnesses:
~_ y~ ,~~° (SEAL ~
1~
Page 7 of 7
(~a~~I~GN[n1EALTH OF PENNSYLVANIA
~,~ ~ S.S.
, the testatrix
and witnesses respectively whale names are signed tc the attached
cr foregoi.ng instrument, being duly qualified according to Iaw,
do depose and say that we were present and. saw testatrix sign and
execute the instrument as her Last ~7i11. and Testament; that she
signed a_t willingly and that she executed it as tier free and
voluntary act. for: the purposes therein expressed; that each of us
in the hearing and sight of the testatrix signed. the [~~i1.1 as
witnesses; and that 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 ur_due influence.
[~TITNESS
Sworn` affirmed and subscribed to
before me by Virginia 4~1. Kirssin, testatrix,
a nd~~°'o~~?~~~ ~,~~c.,,`.~~a nd
witnesses, thy. s ~.~ day
Notary Fubli.c ~~
M c ommi s s i_,.o~.__~~
TJotaria! Ssa!
Pamela J. Crum, No?ary Public
} f-{amsburg, Ua~phin Count~~
~, t~~y Com!nission Expires ping. 24,1995
`e,npn,h=~ PPnn.vlvaniaAssoCiationoiP•~OZc^+riC's
1934,.
CGAZI~~C3NWEAL~7H OI' PENNSYLVA.NIA
S.S.
CQUNTY CAF ~ ~~~~.
I, VTRGINI.A W. KIRSSl"N, testatrix whose name is
signed to the attached or foregoing instrument, having been duly
qualified according to law, do hereby acknow]'~edge that I signed
and. executed the instrument as my Last. Will anal Testaments thaf_ T
signed it wi.llinglyF and that I signed i.t as my free and
voluntary act for the purposes therein expressed.
~~ ~ ~e-~~ ~~~ a
VIRG IA W. KIRS IN
Sworn, affirmed to and
acknowledged before me, by
Virginia W. Kirssin, Testatrix,
`~~ C
this \~a~ day of ~ .a ~ ~r 1994.
~~~ _~
Notary Public
I~qy (:crnm~_ssion expires:
_~..~_..~9s
k~amela J. Cn.;~ ~ ~, t~o~~ Y Pudic
Harrisburg. C' 7uphin Counr~ `
g.24,1~ !
~.riy Con~n~issirni Expires Ru
k
~.,
fUlemb°r, Perinsyivar:,.. ~ssoc~ation of 14otadz~
WILLIAM J. PETERS
AT"1'ORNEY A"1' LAW
293 ] NOR rl - FRONT S rREE~r
HARRISBURG, PENNSYLVANIA 17110
(717) 238-7555, Extension 101
FAX (717) 238-7750
E-MAIL: wjp~~upwlc~ai com
May 15, 2009
Glenda Farner Strasbaugh
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
Re: Estate of Virginia W. Kirssin
No. 2006-00510
Our File No. 503-6
Dear Ms. Strasbaugh:
Enclosed please find an original and two copies of the Inheritance Tax Return and
appropriate schedules in the above-referenced matter. Please time-stamp a copy of the
return and return it to me in the enclosed envelope. You have already processed the
check in the amount of $390.53 representing payment of the Inheritance Tax.
If any additional information is needed, please do not hesitate to contact me.
Very truly yours,
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William J. Peters _,_
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