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HomeMy WebLinkAbout06-22-09 EV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 15056051058 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN ' 21 09 ..., 0544...__. _____. _ RESIDENT DECEDENT Date of Birth April 4, 1926 .............................................................................. Decedent's First Name MI Josephine !P ' Spouse's First Name MI 'Harold 'A THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 209 20-297s ~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 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) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number :Andrew C. Sheely, Esquire 717-697-7050 _ Firm Name (If Applicable) _ _ __ ~r~ REGISTER O~"IfjfILLS USE OIq+C1f Andrew C. Sheely, Attorney at Law ~ - j ~ ~ ~ _._ ~ ^ ~~. E ! First line of address <") ~ ~, ~' 127 South Market Street ~ ,`~~, i'U ; r `; ,~~i Second line of address P O Box 95 ~' ~ ~ - ~„ -~" ~- . . _ ~ D ~I~~~ " ~ City or Post Office State ZIP Code -• -~• ••- - -- • - -~• -• • • - ~' ' ..... ... ............~ ....... Mechanicsburg PA f ..._._.._ . , .......... ~ :17055 4 ~ t Correspondent's a-mail address: andrewc.sheely@verizon.net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN URE OF PERSON SPONSIBLE FOR FILING RETURN PeTc AITIr)RFRR Harold A. Kerste er, 307 East Gree Street, Shiremanstown, PA 17011 SIGNAT OF PRE R R ESENTATIVE n .. ~~ d~ FCC Andrew C. Sheely, Esquire, 127 South Market Street, P.O Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: KerSt~tteY' ~ Josephine P. 210-18-9588 RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 1,732.66 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested....... 7 15,253.34 8. Total Gross Assets (total Lines 1-7) .................................... 8. 16,986.00 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9. < 8,123.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. ; 8,123.00 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 8, 863.00 ; 8,863.00 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unc+~~ cec. 9116 _. __ _ _ (a)(1.2) x .00 8,863.00 15. 0.00 16. ... Amount of Line 14 +~~~ble .. . ,. at lineal rate X .0 16. 17. ........ Amount of Line 14 taxable _ '' at sibling rate X .12 '; ; 1 ~ 18. Amount of Line 14 taxable at collateral rate X .15 _.... 18. 0 00 19. TAX DUE .............. ......................................... 19 _ ~ __ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-15o0 EX Page a ~.w„~M ....:~ _.~,.~..~..~.....,.,...~.,,..,.,W.Y.,...,,. _,... -~ 21 f~09 0544 's Com late Address: ~~xr ~..~ ... Decedent p DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Josephine P. Kerstetter _ 21 -18-9~a STREET ADDRESS 307 East Green Street _.. _.- _ _ _ _ - _ __._.... - - - - ---- - -- --.... STATE CITY PA Shiremanstown 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. InterestlPenalty if applicable D. Interest _ E. Penalty _ Total InterestlPenalty { D + E) (3} 4. if Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Flit in oval 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. (6} A. Enter the interest on the tax due. {sA} B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB} ZIP 17011 o.oo 0.00 0.00 Make Check Payable to: R~EGISTFR OF WILLS, AGFNT .~ ''..5 ;. ,~ 1~ .y~oL'. ~~A.. .P .fix. "' ~ .» .. ... P, _. .. .. .. .. .. .. .<. ,w" .... ,. PLEASE ANSWER THE FOLLCIWING 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; ar ...................................................................,...................,.................... .............. d. receive the promise for life of either payments, benefits or care? ........................................................ .............. If death occurred after December 12,1982, did decedent transfer property within one year of death 2 . without receiving adequate consideration? ................................................................................................ " .............. ^ ^ or payable upon death bank account or security at his or her death? 3. Did decedent own an "in trust for .............. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .......................................................................................................... .............. a ^ IF THE ANSVYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ,. ~ ` ~: . ..... .. ..... a .. x . ., ck =or dates of death on or a€ker July 1, 1994 and before January 1,1995, the tax rate imposed an the net value of transfers to or fpr the use of fihe surviving spouse s three (3) percent [72 P.S. §9116 (a} (1.1 } (i}}. =or 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 (d) 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 fling a tax return are stilt applicable evert if the surviving spouse is the only beneficiary. ~or dates of death on or after July 1, 2@@@: "he 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 idoptive parent, or a stepparent of the child is zero (@} percent [72 P.S. §9116(a}(1.2)}. 'he talc 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 2 P.S. §9116(1.2} [72 P.S. §9116(a)(1 }]. 'he tax rate imposed an the net value of transfers to or far the use of the decedent's siblings is twelve (12} percent j72 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 deceden#, whether by blood or adoption. REV-1508 EX+ (6-:~9} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX NETURN RESIpEN'f DECECiENT SCHEDULE E CASH, BANK DEPC>SITS, & MISC. PERSONAL PRQPERTY ESTATE OF ~ RT Josephine P. Kerstetter FILE NUMBER 21-09-0544 Include the proceeds of litigation and the date the proceeds were received by the estate. All oragerty iotntly-owned with right of survivorship must be disclosed on Schedule F. Historical Quotes: Charting Tools for Looking Up a Security's Exact Closing Price - BigCharts 6/ 16/09 12:57 PM Mora Enter Keywarc!(s) :;~:~a~c~l~i 's.~. ~r~Sto~~~; -- #`r~+vr b"y~tiA'lK~B~+'0-dir r., w»....~,,,-«.,.~,...,,,...,.«. M . ~~ f i„ ,,. ', ..:.., d. ,,.i...aiL4 .., ~:.. :... k~tt~ ~ltAk>~ti~ t?itlYfetl ~~lt~Mtttlil4` I M#~tt~+k~f~ a llbalfOttlMaat ~11lItliR 171~1~'~, ~,M~'I!#PIN~'~~t1i ~ ' ~1 ~~1~1Ld~li This Historical Quotes tool allows you to look up a security's exact closing price. Simply type in the symbol and a historical date #o view a quo#e and mini chart `:1 for that security. ~~., ~~,~ t~nicer Symbol:-~-~-mm- : Bnter Daite: os~ /2o/zoo9 ~~~ ..• .pru t~.'~':•°.?rttic~f I"'i63.ikt'tt.:r:i Irii ~:.?s;er : 42.95 .ti, 4~? ~ 6 i 1~,. 46~.3ES tact .., i :Y'=. ~tir~~~i Nc~ Splif~ -M~ntl-~ f.:)aily {;;li`~<:arX ~s ~'r~t.frl~n~i~~i ~'-ir~~zr}~:ii ir~r Sponsored Links Trader Makes $4 Billion Wiz Kid Stock & Option Trader Makes $4 Billion Trading Stock Options! .vw~n~ 'Jirtual nvestinrJi;lcab corn 4.59% Fixed Mortgage Refi Refi Your Mortgage Now with DPR®! As Featured on CNNMoney & Forbes. r?tlltBPrir nuRc,fin~urce. rr~+n Solar Stock Pick - EVSO Solar Power Your Portfolio. Green Energy Stock Investment w~.n^x Es~nlu?i~n.`5nlar c:um Obama Urges Refinance $180,000 Refinance $939/mo. See Rates - No Credit Check Req.. vw•r: A4ortcJanr;i~ratc•:sr.:xpt'rt~ ~nm Scottrade: 37 Trades, Get 100 Commission- TD AMERlTRADE. 30-oey Guarantee. Fast Executions Free Trades, Trade free far 30 days. Click Here. ti~S 16pSr.~t. I ,Job goooriunities I Cgntact Us i Foe. eck I ~ License and integrate news, custoom financial tools end data from i~w Jone~~nt Solutions.. Copyright ©2Q09 I'UlarketWatch, Inc. All rights reserved. By using this site, you agree to the, Terms of Use and Privacy Policy (updated 4/3103). ~ttp://bigcharts.marketwatch.com/historical/default asp?detect=l&symboi=pru&close_date=05%2F20%2F2009&x=40&y=20 Page 1 of 2 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~LE C INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Josephine P. Kerstetter 21-09-0544 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE) TAXABLE VALUE ~ . Member s First IRA -Account #320148 15,253.48 100% 15,253.? Transferee/Beneficiary - Harold A. Kerstetter, Spouse TOTAL (Also enter on line 7 Recapitulation) $ 15,253.34 (If more space is needed, insert additional sheets of the same size) ' ~~ Send Inquires to: 50f}0 Loulse Drlve PO Box 40 Mechanic:burg, PA 17055 www.memberslst.org Main Switchboard: (800} 283-2328 HZ Call: (717} 697-4372 or (800) 283-4372 ® TDD: (717} 697-5312 or {800) 283-2328 ext. 5312 TeleBrench: (800) 237-7288 MEMBERS 1gt FEDERAL CREDIT UNION 5183 1 AV 0,3J24 rr 5183-518+3 llllllllllllllllllllllllllllllllllllllllllllllllllllllllllllll ~ JOSEPHINE P KERSTETTER "~ HAROLD KERSTETTER ~ 307 E GREEN ST --- SHIREMANSTOWN PA 17011 Statement of Accounts Jan 25 , 2009 thru Mar 24 , 2009 Account Number: 320148 Balances at a Glance Checking : 0.00 Savings : 15, 253.34 Certificates : 0.00 Loans: 0.00 Money Management : 0.00 Swipe 5 YTD Reward : 0.00 Page : 1 of 1 Your aggregate balance as of March 1st is $15,253,34. An aggregate balance of $2,504 and having 3 products will place you in the Silver MLR level. Membership has its advantages! Your 2009 ViP pass to Carlisle Events is enclosed in this statement. ~iA-VINGS ACCOI~NTS . 00 - REt3ULA~R SAVINf3S pate. `ran Additions ~ btractlo s Balance Jsn ~5 dance Fon~-rp' S.OQ Mar 24 End~rg dance 5.00 10 -IRA Sr14VINC~S1 ~~ta ~`w~rilsacti~an ~e~a tron Add' lone ~ b Nw ce Jen Baf~nce ~vrt~r~td '15 , 3.4 J8n 31 Deposit C3ividend Tiered Fate 1~.'f6 15,238.65 ,~nn~e/ Penfage Yrald ~~rned 7. l~2pib ~m 0~/~11.~Dt~9 Through D~/.~~/2111~.9 Feb ~~ [3epos°it (~ivlClef7d T~~red` Rats x 11.6 45,3:34 AnnueJ Pert®n~g~e ~ie/d Famed 7'. Ot109s; from 02/02~JQ9 through Q2/28/2U ` ' ~ ' Mar 24 End/ng @a/anc~ ~ " r ' , 45 , ~~ . ~4 YTI~ 1~~(ARI~ ~~ ~',.~ Fr. ..,. TfJTAL iJIVII~EIdDS R~llp 00 REGUI..AR SAVINGS 0.00 x~'` 40 iRA Sr4Vl`NC3S 34.8514 ~~ ~: , ,, Total ~Pr+~vivus Ye>t II~A Cor~tri~utior-s 0.00 Toxai Curr t [' ~ ~ t 7th " '~. 0.00 Total Yaar~bIt~...i/.~~~f~ ..' ... O.OQ NI'C'E : To~ . `~ ~~ ~o~ed? ~MgRe~ i~ ~ ~;: , ..,, ~~ ~ "~ Total Year o e on~axa~~e Dividend's 24.85 C~dn't forget about our hew IlJlember Loyalty f~ewards Prc~ ram, The more p~rodl~cts ~c>fu have with us, the more benefits yau'I~receive. asl~ ~ln ~oei~te fdr di~tails t~~ visit' Dior uva~b~site at www.membarsl st.org for deteriis. EV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADiMINISTRATIVE COSTS ESTATE OF FILE NUMBER Josephine: P. Kerstetter 21-090544 Rebts of decedent must be reported on Schedul®I. ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES; ~~ Barr Funeral Home $7,684.00 B. 1 2. 3. 4. 5. 6. 7. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Harold A. Kerstetter Social Security Number{s}1EIN Number of Personal Representative(s) street Address 307 East Green Street ._ city Shiremanstown _ state PA Years} Commission Paid: Attorney Fees Famiiy Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Andress City .State Relationship of Claimant to Decedent . Probe#e Fees Accountant's Fees Tax Return Preparer's Fees Zip 17011 _ Zip TOTAL (Also enter on line 9, Recapitulation} ~ $ (If mare space is needed, insert additional sheets of the same size) __ o.oa 375.00 s4.oo 8,1zs.oo RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sqquare Carlisle, PA 17013 KERSTETTER JOSEPHINE P Estate File No.: 2009-00544 Paid By Remarks: CANJDREW SHEELY ------------------- Fee/Tax Description PETITION LTRS TEST. WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE RENLJNC IATI ON Check# 3499 Total Received.,....... Receipt Date: 6/12/2009 Receipt Time: 15:32:24 Receipt No.: 1057127 Receipt Distribution ----- Payment Amount Payee Name 20.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 4.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN 10.00 --- - -- - -- CUMBERLAND COUNTY GENERAL FUN - - -- - ___-- 64.00 64.04 REV-1513 EX+ (9-00) scN~ou~ ~ COMMONWEALTH QF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DEC#;pENi' ESTATE OF Josephine P. Kerstetter NUMBER NAME AND ADDRESS OF PERSONS} RECEIVING PROPERTY ~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2}j 1. Harold A. Kerstetter, 307 East Green Street, Shiremanstown, PA 17Q11 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Spouse FILE NUMBER 21-09-0544 AMOUNT OR SHARE OF ESTATE 100% of Rest, Residue R RPmainrlPr ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1~, AS APPROPRIATE, ON REV-1500 COVER SHEET li 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 ONLINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size} LAST 4QIL~I, AND T}~STAMENT OF J03EPHINE P. ~CEFtSTETTER I, ,rosEP~~XNE P. KFABTETTER, of the Borough of Shiremanstown, County of Cumberland, and State of Pennaylvmnira, lasing in good bodily hea~.th and of sound and di+~posing mind and memory, and not eating under duress, menace, fraud, ox undue influence of. any person whomsoever, merely calling to mind the frailty of. human life, and being desirous of dispoai.ng of mY worldly goods while X have the strength and capacity ao to do, T do ms~ke, publish and declare this my LAST WILD TESTAMENT. I hereby revok~-, cancel and annul all my former Willa and Testarna~nts, including codicils thereto, by me at any time made , and .des lar a th i s a lone to be my LAST' fh1TLL__ AND TESTAMENT. XIS Ta SUb~i ESTATE AS IT HAS PLEASED 60D TO ENTRUST ME WITH IN THIS LIFETIME, I DISPOSE OF TIE SAME AS f'OLLOt+dS, VIZ: iTEk~I i.. I direst that my Executors hereinafter .named pay and diacht~rge a11. of my just debts, funera3. and testamentary expenses. xTEM 2. All the rest, residue and remainder of my enti.r.e estate, r~heresoever situate, and whatsoever it may consist of, I give, devise, and bequeath, abeolutEly, and in fee, to my dearly beloved Husband, HAi20L0 A. KERS4TETTER. xn the event my dear],.y beloved husband, HAALILD A. KERSTETTER, dies with me in m simult~+neoua disaster or fails to survive my death by thf.rty {,~A) days, then . ~ give, devise and beq~,eat.h .my-~en.t.i.re. e~.tate, .. _ wheresoever situate, and whatsoever it may consist of, as fallowe: FiA1tULD D . KERSTETTER 45~ $ARRY L. KERBTETTE~2 45~ DAVID fi. KERSTETTER 10~ ~, ~. 3E HINE P. KE 3TETTER 1`.CF~? 3. X nominate anc~ appai.nt HAROLD D. KERSTETTER,_and HARitX L. KEI7STExTLR, as Co-Eatecutors of this my Last Will. ITEM 4. x direct that ray persona3. representatives, as well as their successors, shall not be required to give band far the faithful performance of their $utiea in any 3urisdiction. TTBM 5. T direct that all estate, succession, legacy, inheritance or other transfer tuxes, however designated that shall become payable by reason of my death in reapeot of al.t property comprising my gross estate for tax purposes, whether or not suat~ prapezty gaeaesundc~r tkais Last will, shall be paid by my Lxecutoz out of my residuary estate. xTEM 6. I grant to my personal represenkatives herein named, ire addition to, but nc~t in limitation of those powers vested by law, to bs exercised without prior application to or approval of any oauxt, the power and a~sthority to retain ilidefinitely any property, to inveeti and reinvest any assets o~- the proceeds derived from the sale o£ assets, although said investments may not be of tk~e chazacter prescribed by law, tca sell, convey, assign, transfer and encumber any property, to pay, settle ar codpromise al]. claims, to make distribution or divisions in cash ar in kind, and in general to ea~eraiee ali powers in the management of any property hereunder which any individual. cau.ld exercise in the management of similar propert~- owned in his o.wn right, end to execute a~r~ ~le~,iv~r a,ny. and al.~. - _. instruments and to do all acts which may be deemed necessazy and proper. ~' ~~ ~ w ~~ SE H E P. K RBTLTTE __.. r6a.~.~yhAM~wa.,»+~wr~r.i. ~.,. ..... ~...~ . .... ... .. :, n+Nr.i .«r r, r. >..........._...... .. ~....,.»-..... _.~._ . ~ .,.,.~. ~, r..,,.. .., ..... .~ ~ ...-. .. e~.~.,, .......,.., ......._.~... ...,..a.,...,. COMMONWk,ALTH OFD, PENNSYLVANIA ) ) 5~a C©UNTY 0~' ~t7MDERLANC) } X, JOSEPHINE P. KERSTETTER ,TESTATRIX, whose name iEy signed to the attached ar ~axegoi.ng instrument, h,~vi,ng been duly qualified according to law, da hereby aaknowlec~ge tYidt I ei.ynet] and executed the a.nstrument as ray LAST WILL; that I . signed i.t willing3.y; and that T signed a.t a's my i=iee .and. voluntary act for the purpose therein expressed. Swam or af.firmc~d to and acknowledged ~befoze rne, by JG5EP11tIVE P. KERSTETT£R _, the T~STATAIX, this ~(~~~ day of September M, 19 91. "~' ~ . ~,,. .. ~ , , r . ATTDR Y I R X30'1' PUDLI.C: NE sAME3 M, FiACH, N.tary f'upiic Mech icsbur PA CuN+Grrlar.+! County 9 + ,.....,M~! Co~mnl"~ax irea iws.~,~1r, My Gommi ss intz Expi Y. ~?S T1~e pzecadiny instrument ronsist.ing o~E this and twc~ (2) athee ~y;Pewxitten pages, identified by ti7e signattxr.e of th~± T~57'A'C`l2IX, was on the date the>~eaf: signed, pt~t~1.{shed aric] decl.a~;ed by JOSEPHINE P. ,KERSTFTTER, t»he TESTATRIX therc~ln namc~r.i as arlc3 f~~r '~r'~?~i~'1'~' r '~M.F~1T. ~~ ~ CL~t(3Y E. S RAMCl,l.I RPSi.ding at: 357. S. S~r_t.~in;iTHil.l._ttn,c. Me c I~t a ti i c s b u r~ ,_.. F'.~i ]. 7 t)'~ ~~ r KRIS. NE M. R I Residing at 352 S. 5porti.nc~-ft~S.l.l 1~0~7<~ Mech an ic~sbu.?~~.~...._?_'.~:.........~:.7t~5 A F F T D A V I '4' COMMnNtn'>rAF.Ti~ Qr 3?3aNNSYLVANXA ) } S5 c~c~c~rx ar cuMei;I~r.Ar~n ~ We . I~1.A_ i1YS„~, SPRAMEI.l,r7and CHRISTINE M. I=OR~'I y ,the ... .. w~.tne~sses . who~-c~ names are signed to the attac~e~o'r foregoing ,~ instrument', being duX,y qualSfie~1 according t;o 1aw, da depose and say that we weze present and saw TESTATRIX sig~1 and ~:~eCtai:e 1: i7r~ instrument as her 3.,AST WXI,L; that sloe signed wil.ling.ly and that. .~,l~E~ executed it ~s her free and voluntary acL• Ear the purpose thFr.ein expre.asec3; that each of. us {,n the hearing and s.ight_ of- the '1"L"STATRI7~ signed the 6JTT~L as witnesses; and that to the ?Nest: of r.>ur knowledge the x~sT~1TRIX wras at the time l8 or. rnor.e years of. ~~ge, :~.f. sound mind and under no constraia~t or undue i.nflt~encE. Sworn oar aft'ir.med to tanc3 s~tbscr i,bPd to k>FEore me r~Y GL~tDYS E~. SPRANiEI.I.I and CNRISTINE..Mv._F(1RTI.~^ "'= .- . NO'~ARIA1.8~~1L ~__ `' AT7(1i~NEY JA f9 M. l3ACl~, Pf9tarx I^tiAl4a Nay!'' Y' PUT~~,TC- -... ---..__._ M Cumbarland County Me n z. c s t~ u r g, ~ A Co~tnn~irelo» ~x irau M 1d, i9i~8 ...,,..N.,.~.» M y o mm i. ~~ s i n n is x }? i x~ :; 3