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HomeMy WebLinkAbout11-13-09-", REV-1500 ~ cos-D5) PA Department of Revenue Bureau of Individual Taxes Po Box zsosol Hanisbum, PA 17128-0601 ~~ 15056051058 OFFICIAL USE ONLY Countv Code Year File Number INHERITANCE TAX RETURN _ 21 ~ ( 09 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Soaal Security Number Date of Death ____ 043-16-9921 ______ 07/14/2009 Decedent's Last Name Suffix _. Casey ........ . ................. ........................................................... . .......... s (If Applicable) Enter Surviving Spouse's Information Below Date of Birth 4/24/1912 Decedent's First Name j MI Janet E _. __. _ - x Spouse's Last Name Suffix Spouse's First Name MI _~ ; ~ ~ ~ ~ r ' ( ' :. ... ............... ................................ ........ .___............ ....._.._......_...........,. ~_............. ..............1 ~._._.._..._.~..._._.._..._.._~__~..,..,..._._.,......_._...... .___._._.. ~__._.._.. ., ......... Spouse's Social Security Number ~~"" THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1'. Original Retum t~,7 2. Supplemental Retum © 3. Remainder Retum (date of death prior to 12-13-82) Cy 4. Limited Estate Q 4a. Future Interest Compromise (date of p 5. Federal Estate Tax Retum Required death after 12-12-82) G7 8. Decedent Died Testate C~7 7. Decedent Maintained a Living Trust ._,.__ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) CM? 9. Litigation Proceeds Received C~ 10. Spousal Poverty Credit (date of death C} 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 T0: Name Daytime Telephone Number _ , ;John M. Eakin __.__..._._._...~... ._ , w_ . ._.~ ~.. _..__.._ _. (717) 766-3172 Firm Name (If Applicable ................_....._.............. _.. .. __ ___ . ~ _....__._......_............................................................._...........,.;,................. REGISTr~QIF WILLS U9~NLY ............' ~.v r't ~" i ..... Ftrst line of address. ... _., .._. ............., ~ j ~`_' ~ ~ rJ ~74-s y ~C ~ c ~ ~ .~ w 3 Market Square Building l ~ :tn~ - - w r~' ; ~~t _x~ _... Second hne of address ~ ..__.______._ _...____~______..___.._~.__..._._..~.~. _.. _. ~~...__ .._.__-___..__.__...__..,_..._ C~' ~ C.~? ~ ..x C, ~ ' ~ ma itV -"="+ r' f~r-t ' i.._.__-__~.._..._._._..m....____~_...~.....~._.....~., .~....._~ _.__..____..._..._._ - y t City or Post Office State ZIP Code TE FILED -- •~--••- ~.~ ---- ~ Mechanicsburg f ........................... PA 17055 i. _..__._____._--.___~____~___._._._.._.V.V._,~ Correspondent's e-mail address: Under penalties of perjury, l declare that 1 have examined this return, induding 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 prepairer has any knowledge. OF 951 W. Trindle SIGNATURE OF PRE PA 17055 DATE ADDRESS ~ Market Square 8uil Ing, Mechanicsburg, PA 17055 PLEASE U8E ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~~ 15056052059 REV-1500 EX Decedent's Name. Janet E Casey Decedent's Social Security Number ..................................................................................................................._......... 043-16-9921 ---- __ RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. ! ~My 149,000.00 2. Stocks and`Bonds(Schedule B) ....................................... 2. 7,975.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. f 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. ' ~ 5. Cash, Bank Deposits ~ Miscellaneous Personas Property (Schedule E) ........ 5. 668,829.10 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 30,005.67 7. Inter-Vvos Transfers 8 Miscellaneous Non-Probate Property {Schedule G) ©Separate 8iliing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 855,8Q9.77 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ..................... 9. ~ 84,465.54 ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. ~_____ 9,354.39 11. Total Deductions (total Lines 9 & 10) ................................... 11. ~ 93,819.93 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ! 761,989.84 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which a"~`"~"v"' an election to tax has not been made (Schedule J) ........................ 13. 10,000.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 751,989.84 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or ._ . ~ . _ _ __ _ _ transfers under Sec. 9116 ,..........~....,......_ ..........................................................................................................................._............, ,.. _...._._ _...~... . __..~ _.._ . ..._ _..... _..._ ., ...__ _. (ax1.2) X .0_ 15. 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 .15 751,989.84 .... . ': 18. ' 112,798.47 19. TAX DUE ..................:............................... . ..... 19.E 112,798 47 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Fii,~..~.grt!I~..._.. 21 09 0693 ~~~ DECEDENTS NAME ~ DECEDENTS SOCIAL SECURITf NUMBER Janet E Casey 043-16-9921 STREETADDRESS 951 W. Trlndle Road CITE' STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1} 112,798.47 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 110,000.00 C. Discount 5,789.30 Total Credits (A + B + C) (2) 115,789.30 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. Fill in oval on Page 2, Une 20 to request a refund. (4) 2,990.83 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 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 QUEST{ONS 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 Dust 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)j. 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 survnring spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)j. 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)j. 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)j. 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(~)(1.3)j. 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. REV-1502 EX+ (i1-08) pennsytvania DEPARTMENT OF REVENUE 1NHERIrANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Janet E. Casey 21-09-0693 All real property owned solely or as a tenant in common must be reported at fair market value. Fafr market value is deftned 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 that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the sedlement sheet if the property has been sold. ITEM. Indude a copy of the deed showfig decedent's interest ff owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DFSCRIPTION _.... ,.:,.:.r 1• ;201 W. Coover Street, Mechanicsburg, PA 17055, appraised value 7h4f07 ~ 149,000.00 see attached appraisal If more space is needed, insert addiftanai sheets of the same size. cenbatl'ern M6~s~s, krc. p1~ ts7-4soo Uniform Resift~l Auoraisal Report D6I Wl1Ml/CDM~ e d Ods to k lo, the lend ~ '~an•~corab 'and to d the rtnrket value d the su Addnas 201 W. C R ME HANICSB R Stab PA Code 17 5 Harrower. Owner d Ri Record M D L DB A Asseaser't pucd • "~ Taz Yeir R.E. TaxeO Ntme E R Referarce A Cenau: Tact b Owner Tenant Vacant S Acaessmarb HOA month Fee Leasehold Odrer dncrtde Aaa T Purchase Trarnactlon ReMrrance Tnnsactlon . Olbr dexxfbe P N L PRNA Addnas b the aub otterd f saN a hu M been dfered to sob in the 1weM mordhs b tla eifectlw dab d tlds s sal? Yu No R dsb aource a used df a and dab a . I ^ did ^ dW nd antlyn 1M cartract to sale fa 1M tub~ect purchue truuactlan. E~lahr 1M ntuMi d the analysb d the cartrect fa ssb a why 1M analysis waa apt ortned. Cartract Rice WA Dab d Contract A b the steer tlu owner d. ordl Yes No Dad Space a b there any 1lnancW aui=brrct (loan charyts, saN corrcaaloru, Sift a downpaymart uibtanu, etc.) b M paid by my party on behaq d the borrower? Yea No r Yea the bW doAar amoraad and deacdbe the Morns b M WA Form 1004 - "WInTOTAI' appnbal sollNnre by a b mode. Inc. -1-S00-AIAMODE Freddls Mac Faun TO March 2005 Pape 1 of 8 Fannb Mae Form 1004 March 2005 Uniform Re~l~l Appraisal Report Flle# wcoovER2o1 ye oNadd for :sb fn~ b e han 78 to 78 Theta ue 4 ales h the wttllh • •1weM. nal5 hs h ah itan i 15000 0 to S 169500 FEATURE UBJECT COMP •1 COMP SALE # 2 COMPARABLE SALE Addnas 201 W. COOVER IC 8TREET 805 S YORK STT t~.T •• P 108 E MAPLEWOOO AVE 1 210 W MARBLE STREET M I R PA 7 ip $cb s>b r~rice sale Pdc LW. Aron Dap Sourr:e s yedflca8pr Saace a VALUE IIDJUSTAIFIJTS RPtION Iles ~ a R D DESCRIPTION 1so 00o S1A0 NT/ E + - strrwM .4 mi s 7 Jt. AS ME D DESCRIPTION s 1sa fVT PT + - 12 mibs S a .ft MT R ENT D DESCRIPTION s 158 eoo /A E / EPT. + • sbrwrd SalaaflroncYq Carcasbns CASH NONE KN N CONVENTIONA NONE KN CASH N NE KNOWN DatadS 1 7 / 2 Tl4 locs8on A A V 8 P EE IM L FEE 1M E IMP SPoe ybv Des Ou d Construc8orr Acdtal Corrdidorr A Above Grade R VE E Tod Bdrma. Belha T Y BTR N AV Tod Bdmu. BAa 8 AVE T A 7 Y B N AV ToW Bdrma. BAu 8 A 1. T A E Y S R TH AVd Tod Bdnm. Beau 8 ~~ +2 +2 1 + Grow Ara s .ft 14 a .ft +3 121 t .ft +S 1 .ft + 2 Basenrert b Ad:1Md F Rcoms Below Grade ULL BMST I H FULL BMST N NI HED FULL BMST N I H O FULL BMST Rnrelorul RAC3E N N -4 N Hlbiad Itara N + I EP -3 N N N N N N E N N N N Ntt Adpated Sale Pdu d + Net Adj. 9.8 -% Oroaa .11.5 % -6 S 144 300 + Net Adj 2.8 -% Gtou 17A % ~ i 150 800 + Net Adj. 5.5 - % Gross 12.7 % i 150100 I did did nd raaroh d rt sab a tranabr Ns d the sub and arabb cabs. M research did dM rat tnrod sales a tranafen d the s fa 8u tlvee an to 8Mt eifectlve date d this ptp s N 1N Hearth did did sot mal cabs transfers d 1M sabs for 8w e b tlw dap d ssN d the c arabb:ab. Dap Sorwa a E M D N N 8w neAp d 1M research and d the sab a treater d tlN and sales addtloral cabs on 3 . ~ SUBJECT COMPARABLE SALE #1 COMPARABLE SALE #2 COMPARABLE SALE #3 DatedPlior ramfer P 1 N 2- F1ke d Prbr rerafer P R AB Dap s 1BIedM Dab d Datr a of sab a tarsier d the~erb and - cabs N 1 HI R CT OMPARA S d SaNs i I al I '* b the K 1 n ma a as a all ktdcebd Valve Sala i 149000 trdlated Yelw . Sa1ee h i Coet dwe i Inoonre N dove = • lhb spprabal b made "u b", subject to carpNtbn Per pbra and spscMbatloru an Mw Oub d a hypolMtlcal condltlon tlat tlu Improrenents haw ban cantpleY4 ^ subject b tw toloNMrp nptMs a altsntloM an 8w barb d e hypoUwtlctl eardgorr tlad tlw rpaks a aBeatlaa haw been , a [] :object b tlM Ins hued an iM u tlat 1M caf~tlon a dos not s11ea8on a Based on a eompleb vbuai Nu~~ of Ure inbrbr and exbrbr anu of the e , deBrred scope of wok, etabemeM of eaumptlone and BmIWq aorrditlone, add appNeers oertllbWon, my (our) optdor- d the market value, uflrwd,' 'c18-e nsl propeAp that le iM eubJeot of tlde npott b f 149000 u d 7-14-07 whkh b 1M deb of Ins and the effeclNe dab d fhb a nbd froddb Mac Form 70 Much 2005 Page 2 of B Fannte Mae Form 1004 March 2005 Fam 1001- "NNnTOTAI' sDDrda# wflware by a b mode, Inc. -1.800-ALAMODE X Uniform Re. ~ ~ A raisal Ra ort Fne~r vvcoovERZO1 ENDMENT TO SC IS TO EVALUATE TH P S °13J T TH ST 1 L I E D F I PRAT ~ O M NAN P N R I M NTS F I DENT. THE INTENDED U E TRA SA BJE T A ISA RE R F RM D THE IN N F E DI THE REPLA E ENT 13 R ME LE b N AGE N Y. THE IN M APP N E U I T A SI L MIL L P R Prorlde Mamudlon for the lender cBeM to the bebw cost and aleulitlars. fa tre d aBs tnlte a d c land tabs a atlbr metlads to slb tnilue ESTB~UITED REPRODUCTION OR ' REPLACEMENT COST NEW OPNION OF SRE YALUE ..._...._..........__. Sarctdcostdata HAL FT VA TI N ........._...... RVI DWEWN6 S .R ....._...._...__... ,,.._,,,,,,, .j inm cat servke A Eilectlw dsb d cost dah .R, Carmrarb an Cat ana caknrlatlons etc. .._........ Gan S .R. _ _ _ Tohl EsBmate d Cat-New Lase kal Wnedond l9dern al Cat d ' ......................._... _ ._ • ~ ~ 'Aa-Is' Vabe d Sib ....................... . . .............. _ . ... ........................ lxtlrmYd Econaric LMe UO and VA . Esttonbd Marlat Rent X Bross Rent M Years WDICATED VALUE BX COSTAPPROACH ...._._....._.._. N/A N/A .._.....__... 'j krdicated Valua b Nucme ch d Yrcome su to merltet not and ORM k the in control d 1M Haneowners' Assodatlon 0 ? Yes No Udt s DehcMd Attached Pmride tlr Ydanna0ar to PUDs ONLY the Baer b In contra d 1M HOA and tl» au b an albched awe untL Neme d Tod numMr d ToW number d uNb ToW numbs d unit sold ToW amber d uNb nded Total rwrnbet d adb to ssM Wh source s Wa iM cnsbd Ou cenvenlon d s Ndo a PUD? Yu No M Ya dab d eonverabn . Does Mo cerdain uNb? Yes No Dda Soaa An tlM uYb camton and naeatlon fadBles T Ye: No k No describe iM status d com etlon. An Ow common elemads lased to a 6 tlM Homeowner:' Assodatlar7 Yea No K Yes describe tlM roMal terms and o Dsscdbe common element and reaeatlonal hcNtla. , keddie Mac Form 70 March 2005 Pape 3 of 8 Fannie Mae Form 1004 March 2005 fvnn 1004 -'NMTOTAL' aDDnissl:dlwan by a W mode, Inc. -1.800-AIAMODE REV 1 ti03 EX+ (8-98) COMMONWEALTH OF PENNSYLVANW INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Janet E. Casey 21-09-0693 All property )ointlyr-owned with rlyht of survivorship must be disclos~d'on Schedule F. VALUE AT DATE (If more space is needed, insert additbnal sheets of the same size) REV 1608 EX+ (&98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Janet E. Casey 21-09-0693 Indude the proceeds of Iitlgation and the date the proceeds were received by the estate. AU property jolntty-0wned wkh fight of survivorship must be disdosed on Schedule F. ITEM VALUEAT DATE 1. ~ ~ :Citizens Bank CD# 6244376191 Principal $50,000.00, Interest Rate 3.45%, Issue Date 81212006 : 5 0, 056.71 ' ~ Maturity Date 8/2/2010 2.~ 'Citizens Bank-CD# 6251642476 ~^ Principal $100,000.00, Interest~Rate 2.72°k, Issue~Date 6/11/2009 ~ 100,231.00 Maturity Date 6/11/2014 3. ,, m...,,~.wa.....~. -,,,~ ~ ,~ p ;Members Fkst Federal Credit Union CD# 57451-42 Princi al $100,000.00 Issue Date 9/11/2007 100,143.53 ,. Maturity Date 8/14/08, see attached 4.' `Members First Federal Credit Union Savings Aa;ount # 57451-00, see attached 65,639.50 5 Omega Bank CD# 173-0047755 Principal $100,000.00, Interest Rate 4355%, see attached 100,124.66 6. ~ Soverign Bank CD#1685426502 Principal $50,000.00, Interest Rate 3.25%, Issue Date 7/28/2008 50,128.07 ........ ~ ,..._..,,..,.........r.. ,.. ... Maiurity Date 7/28/2009 7. ~ Metro Bank CD#802444 Principal $180,000.00 180,210.00 8. Citizens Bank Account #6422 22,295.63 W N D ~3 v ~~ ~ ~' .. ~~, • ~~ ~~ ~~ ~4 ~3 ~~ ~' ~ ~ g m ~~~~ ~~~~~g = ~ z ~ ~ ~ Z ~ ~ ~ _~ °. ~ o~ ~. ~ a ~ ~ ~ ~ ~.~~ ~~ O z ~ ~ m ~' v vii ~c6~~ ~'; ~1 $. y 0 ' ~ r-~~ ~~~~~~ z .~~ ? ~ ~~ ~~~m~m s~ Z ~, ~~~' o .. ~~ ~~~~~~ ~ ~ m ~i ~ `~~ ~~~~ o ~ ~ ~.,~ ~ ~ ~s~ c~oa~3~°c~ a~ ~~~~~ ~~~~~ C ~ 3 c ~. ~ tti Z ~ ~ ~ ~ ~ ~ ~v ~i ~ ~ n _ ~,~, ~, ~a~~ ~ g g~~~ ~~~~~ ~ -. ~~ ~.~ ~v ~ w cep n ~ ~~~~; m ~~ ~ o 0 ~~' ~_.°~ sue` ~~~ $ ~ ~~° ° ~ y o ~ ~• rt t~ n ~~ ~ ~~~ 4 $ Q ~ ~ ~~ M m t ~ ~. D ~, g ~~ 5 ~~~~ ~, ~~ g oqi r c~ a m 3 v a~ ~ "~ Z m Z n n ~~'~ ~ ~' ~O ~ g ~ z ~ ~ o ~~ ~'~ ~~~~ ~ ~ ~ ~ c C ~~~ ~~ ~am~ ~ ~ ~ ~ ~ ~ ~ ~ ~ `° s, ~ o ,°,; m K ~~ ~~ d ~~~ o z o m • 8 3 r. ~ ~ a a ~ vii ~ ~ ~ .n0. ~ ~ O ~ RZ~ 1 ~ ~_ ~ ~/ ~ ~~ ~~~ ~~ o Q~ 8"° n ~ as ~~ a ~' ~ ~ Z -~i t'F` C7 C ~ fl' ~ p ~ ~ LD ~ s~ ~o~, ~~ No H ~ m N ~ =dam ~~ ~ ~ ~~, ~ ~ ~ ~~~ ~~ g~m'~ ~~ ~ ~- ~ o o _ ~ ~ .. ~p'- _. G~'t V1 .a 'V iY p 'Q~ N C O CSC ~ n _ v ~ ~ G ti iD ~' ~ a~~ ~ p ~ ~ ca 3 m r3 '$ ~• ~ ~ '0 ~ "ft ~-~D m ~ ~.~ ~ ~ c~n d ~ j ~ _ °' ~~ ~~~~ v - ~' QQ 3 ~ n v o ~ ~. H A ~. _ s. :Jt ~ ~~~~ 5000 Louise Drive ~ CERTIFICATE ' Mechanicsburg, PA 17055 APPLICATION AND R~CEIP~ . ~ ~~~,, (80083-2328 \ 1/QVe hereby apply for a Members 1" Certificate in the amount and term listed below. Maturity Date: 03/14/2010 Please ~~ Account #: .0000057451 Member Name: JANET 1C CASEY SSN: Oda-16-9921 Street: 951 W Triadlo Rd g~Ad~sy; City: Msahaniasburg State: PA Zip Code: 17055-4080 ~. girst• MI• Suffix• 1 Street:. .... . .. ... .._ . ,,Ci _ .. ~ _ . ,.State• . Zl 4de' _ Extra Address: Date Of Birth: --/--/---- SSN• - - ~; First: MI• Suffix• 2 S~ Ci State: Zi Code: Extra Address• ~ Date OfBirth• -- --/---- SSN: - - I.ast: ~ First• MI• Suffvc• 3 Street; Ci State: Zi Code: Extra Address: DateOf$irth• -- --/---- SSN• - - Irast: First: MI• Suffix: 4 Streer+ ~ C' ~ State: Zi Code: Extra Address: Date OfBirth• ~-/--/---- ~ SSN• - - ^ Deposit Amount: ~ ® Transfer Amount $ 100 , 000.00 From Account: 0000057451 Share ID: 41 - 12 MONTH CERT !''~7!ilT1Ri!`eTli! nRTAii 4 Certificate Type Minimum Amount Original Deposit Amount Annual Percents e'Yield Dividend Rate Shs 19 N~rra cats 500.00 100 000.00 4.11d$ 4.030 42 Dividends Payment Method: By: sy ctioak To: Account Number: Shan ID: l~'~'" r Member's Signature: Date: 08/14/2008 This is to certify that the above named person(s) is (are) the owner(s) of a Certificate account at Members 1" Federal Credit The Certificate is in accordance with the terms of the Membership and Account Agreement and the Credit Union's current T~ Savings Rate and Fee Schedule which shall accompany the receipt of deposit for this Certificate and is incorporated by this refe MEMBERS 1'~ FEDBRAL (:R~1T i1NION SAVINGS ACCOUNT: Account Number/Suffix 57451-00 Date Account Established 09/17/1964 __ Prinapal Balance at Date of baathi ~ $65,627.81 Accrued Interest to Date of Death $11.69 Total Principal and Accrued Interest $65,639.50 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 57451-42 Date Account Established 08/14/2008* Principal Balance at Date of Death $100,000.00 Accrued Interest to Date of Death $143.53 Total Principal and Accrued Interest $100,143.53 Name ofi Joint Owner None *Rollover from certificate 57451-41, originally established 09/11/2007. M BERS 1~ FEDERAL. CREDIT UNION ~- ~,- 1~...__ Danielle A. Kline Insurance Services Specialist August 5, 2009 Estate of: JANET E. CASEY Date of Death: 07/14!2009 Social Security Number: 043-16-9921 5000 Louise Drive P.Q Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwxPe r~iberslst.org Omega Bank N. A. Rectipt for , Number 173-0047755 CERTIFICATE OF DEPOSIT NON-NEGOTIABLE NON-TRANSFERABLE This certificate is subject to ell applicable existing and future rules and ngutations of this Bank. ~ PAYABLB 1'O asuTror+nm ear Tyra rx wo Tar JANET $ ~Ey 3ELF F Y 043-16-9921 TYPE OF CERTIFICATE 201 W COOPER ST Automatic Renewai MECHANICSBURG, PA 17055-6411 ' PHONE # H 717-647-1379 W 1'SE SUM OF One hundred thousand and zx / 100 DOLLARS S 100,000.00 PROD TYPE DEP TYPB 1099 OFFR CD BRANCH ACCT CLASS ISSUE DATE 7756 Ol I 798 225 03 04/04/2005 1NT PAYMENT FRBQ DISFOSI'1'tON OF II11'ERBSr PAYMENT RENBW INFO Monthly 04 Mall 2 3 0 000 MATURITY DATE INT RATE FUNDS SOURCE 04/048010 4.SSYo Check Drawn on Other 07 • r H RBPRBSENTATIVE SIQNAT(JRE reNDAR1~ 7'RRMQ_ rR[11a[cYrlt]NAr_. Oi+~?ts AND CHANGES IN INITIAL CER7'IP`ICATE OF DEPOSIT TERMS UPON RENEWAL: For infomration as to yow interest rata, annual percentage yield, special promotional offers, maturity date and other pertinent infom~ation of the certificate you have purchased or have wthorized for subsequent renewal with a revision and/or change in the original or prior teen, refer to the "Certificate of Deposit Disclosure" which will be delivered or mailed to you st that time. ~ncrr OWN>fRSAIP T7i;R1-i~ AN14"L~ONDITI'ONS: ~ 1:t't3»s certificate l issued to Iwo p3y~os, aberiitTCdte ivill'be'iit;ld'by them as joint tenants with n'~hC aurrivorship, and shall be payable to either of them or the survivor. Each payee shall be the agent for the other to receive. interest, to give or receive any notice, and to take any action affecting this certificate or rights hereunder, including but not limittd to receiving and receipting the proceeds thereof. By opening this account you herebyagree to keep yow funds an deporit with the above identified bank until the due date specified above and for the full maturity any subsequent renewal. Any withdrawal made prior to the maturity of this contract may bt made only with the bank's consent and with a substanpal pena]ty. T certificate is not negotiablo, not subject to check, and may not be assigned without acceptance of such assignment by the bank. The bank specif cally reserves the ro nfLse to accept or acknowledge any assignment thereof. Deporit Accounts will be governed by and interpreted in accordance with federal law and the laws of Commonwealth of Peansyhanis. Deposit Accounts are accepted by bank in the Comrranwealth of Pennsylvania. If there is a lawsuit, depositor agrees upon bare) request to submit to the jurisdiction of the courts of Centre County, Commonwealth of Pennsylvania. The bank has the right to mature this certificate upon notice attachment, levy or right of setoff exercised under Pennsylvania or fode'al law. This cwti8cate is payable with interest to the registered holder(s) hereof in current upon proper rtaipt and acknowledgement. Unless presented for redemption within the ten day grace period following any maturity date or you provide written, e-rnaii, or verbal recorded telephone instwrcdon to change the original term or product offered; your certificate, including accumulated interest, if compounded, w renew automatically for an additional period equal to its original term at the then pnvaiting bank interest rate offered for a like term certificate and product. ljgi such renewal env saettal interest rate adiuatment option or aromotional offer attached to the initial term shall havaexaired. Accumulated interest, if applicable, mil be added to tha principal at tech renewal dato and as such will be subject to penalty if withdrawn before the next maturity date. Compounded rote; earnings, however, credited W this account during the immediate prior term maybe withdrawn without penalty at any time before the next maturity date of the cerl Bank will pay no interest on yow deposit aRer its maturity date unless your deposit is automatically renewed. If bank nnaws yow certificate, you will receive wri confirrtution and bank will pay you interest from the prior maturity date to the new maturity data at the then prevailing interost raft. The rate of interest payable hereunder upon renewal and ail othtr terms and conditions am subject to change by bank's regulations and/or to comply with applicable banking laws and reguladc The bank rnservea the right to redeem this certificate upon notice at say maturity date. This receipt need not be presented to redeem or change the certificste at ma OPTIONS AT MATURITY: You may take any of the following actions within 10 days after the maturity date of yow doposit: (1.) Withdraw your deposit; (2.) Transfer the deposit to a new or existing account; (3.) If yow deposit is sutornadcally renewable, you do not have to take any action. BALANCE COMPUTATION METftOD: Bank uses the daily balance method to calculate the interest on yow account. This method applies a daily periodic rate to the principal in the account each day. F.ARr.y WITHDRAWAi• P)lrNAi 1'Y: See yow Certifioate of Deposit Disclosure for Early Withdraw) Penalties that may apply. • BY my/ow signature(s) below, Uwe certify acceptance of the Terms and Conditions, Early WiUrdrawal Ptnalty and the accriracY b 'llii!"'OP=>~tl8liti"dlf'd8'~lCined in this Certificate of'DBpdlit i-~tt. - .' " . .. g 9 CER77FICATION: Under penalty of perjury, Lwe•certity (1) that the number shows oa this form is my torrent tazpayer tdeufititat[oa anmli~r (TDB and (2) that I am not subject to baclwp withholding either betawe I have sot been aottAed that I am subject to backup wihoholdiag as a result of a failure i report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. I uaderatand that the tax ideatitleation anmber that I am certityinQ at this time wW be used for tar reporting purposes. IInatructioas: Stoke out Item camber 2 is the certiIIcation If you have been notitted that you are sub jest to backup withholding and yon have not received s notice from the Internal Revenue Service that batknp wiUrholding has terminated. If thl account is exempt from backup withholding; you should check the spate below. 7'he Internal Revenue Service does not require your consent to say provision of the document other than the certificadoas required to avoid backup withholding. "BJCF.TdP'I'" TRI W-8 Signed >~~ ~~ . ' ~ W-8 Signed Depositofs si;nalme W~8 Signed Depositols ai`aadire TRI Change 1D PA 13277304 (Pj2] ~Cp- Signature tq follow Name Added DATE s overeign Bank Certificate of Deposit Receipt Addition to Principal /Withdrawal from Principal Transactions ONLY This receipt is issued to: JANET E CASEY 951 W TRINDLE RD MECHANICSBURG PA 17055 The account evidenced:by Phis receipt is sub,~ect:to:and further: explaaned.in:the tcr3ns and. -- eenditions-as' coded itr-the -depdsit~a~tftit agret~ent' anz~th~~ertifi~a't~ zi~d~ioslt disclosure. Princ_ final D ; llar Amount Balance before Addition/Withdrawal $50,000.00 Addition to Principal $0.00 OR Withdrawal from Principal $0.00 Penalty Amount $0.00 'not during grace period. New Certificate of Deposit Amount $50,000.00 Account Details Account Number: 1685426502 IRA Account: ^ Yes®No Date Opened: 07/28/2008 Term: T2 .MUS . Maturity Datei ~ b~~8~~0~' ,. .. <~ Interest Rate: 3.25 Annual Percentage Yield: 3.30 Interest Disbursement: CHECK Interest Payment Frequency: MONTf II.,Y . This account is not negotiable and not transferable. F.ffecave ivta02 Thank you for opening your Commerce Bank Account! Please retain this. information for your records: Dater a C Pr Interest Rate: ~0'0~% ETR~ BANK ^ Checking --~~J 7a. _ dytlaile M. Gsr Se~c• Reprose[-tarive 5~ Simp•~^ F•rry Road -. .__ _ _. , ~gS ._. ~.....- ._ _..._.- .. ~ Simp•o^ F~stotna M•chenksburo' PA17~` _-----_ 717-786-68~ Fax: 7a~~com Certificate -Term a ~ Yh ~ ~ jynau..l7~~e8~r"y"' Account # ~0 a ~ ~ ~ ~~~acunty Date: ~ 4 q / ~ Tiered Rates Balance Interest Rate APY To: Commerce . ~ Q~~'~ America's Most Conven~nt Bank• Y 1-888-93T-0004 ealano.~ otl~r ~ ~ fhrouyh e~oo PM on that ewr,.., da . Pwk to the pruuNNor„ of the unx~om~i Co ~cyo~w oar w;aaaW' for k""Ndl•ts wkhdrwa~. chadc. Y PP~abls won •Cr•~wnt 3~ 1S PM # loipgygg ~ ~~F2444 Netr Tim pePVBlt Deposit $i$fl,DDp..~p ~'~~ I84 StIiPSON fERRY~ ~ ~, , J etc» B .. s.~aroeac ~~~ , ~~ .~ ~ ~ . ~` $R 2$ REV 1509 EX+ (8.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F • JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER Janet E. Casey 21-09-0693 Han asset was made !Dint within one year of the decedents data of death, it mu:t be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME I ADDRESS I RELATIONSHIP TO DEGEDENT C. JOINTLY-OIAMED PROPERTY: LETTER OATS DESCRIPTION OF PROPERTY % OF DATE or DEATH RBJ FOR .IONT MADE NCLUDE NAME OF FIN/WCW. NS7ITUTION AND BANK ACCOUNT NUMBER OR SIMILAR OAIE OF DEATH DECD'S VN.UE OF NUMBER TENANT JONT a~Ni1FY1N0 NUMBER ATTACH DEED FOR JOWTLY-HELD REAL ESTATE. VALUE OF ASSET NTEREST DECEDENTS INTEREST 1• A. 01~4J0q Susquehanna Bank CD#48152724, Pnncipal $100,000 00 100 018 90 1 1/3 ~~ 30 005 67 _ .. _.... _ ... , i ; , . Interest Rate 3.45%, issue date 1!24!04, maturity date 111212014 -_- _ ... ~ ~ i ...G. a , ...... .~ ~.. _...____..... ..... ...._.__;___ _ _ __ .,..._:- ....._.~ ........... .... ....._..~.... .~ .. ~ ~::muxs 111: 'l I 4 ~' ... ._. .. .._ ~ ...... ...... .... ..... i ~ ~ ..,. . . . ......_... ,..._. ....__..._..._... _. ...... ...... .: ........ _....-. _.........._-' ~ :.."M~... ~ ...~..... .:.. vex ~: _..4 . ~.... _~ ... - . .. . ._.. ! ~ ~. ._. ...... ...__.. .......... i , f I i : _ E I . ................... ..... ._ ......_....... ~..... ....... ........................... .. ......... . ............ _.......... .. _...... _._ ....................._..,...., i . l.ii:in:.!~xxx!iilk n.... da TOTAL (Also enter on line 6, Recapitulation) $ ', 30,005.67 (N more space is needed, insert additlonal sheets of the same size) Certificate of Deposit Receipt This receipt is issaed to: rJANET E CASEY CHESTER L WOLF BEULAFI J ATKINSON 951 W TRINDLE RD ~MECHANICSBURG, PA 17055 Account Number; 3 4 815 2 7 2 4 -- IRA Number: Amount ~ 100, 000.00 Date Opened o ~, / 12 / 2 0 0 9 Term 60 Month/sl ' Maturity Date 01, / 12 /2 01 4 , --~ Interest Rate 3, 4 0 0 0 0 Annual Percentage Yield 3.45°S O1 -Susquehanna Bank ' Camp Hill Office 201 St Johns Church Road Camp Hill, PA 17011 The account evidenced by this receipt is subjec~~ to and further explained in the. temps and cotuditions contained in the accoul agreement and account disclosures. The account is Not Negotiable and Not Transferable. Only the itams checked apply. ^ Fixed Interest Rate ® Variable Interest Rate ^ Additions Permitted ® Automatically Renewable ^ Single Maturity (aot automatically renewable) ^. Callable ^ Notice Account Interest will be: ® mailed to the owner(s). ^ added to principal (compounded). ^ paid to account No, ,__ ® to be t,aid every 1 Month f,g~ of 19!14 B~Nnrr SystMn, Ma., Et Cloud, MN Form CDFtEC-BK-LAZ 8/7/2002 Ipp~ 1 of 1 f;y, . . REV 1510 EX+ (8-98) coMMONwEALTH of PENNSYI.vANw INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 6 INTER-VNOS tRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Janet E. Casey 21-09-0693 This schedule must ba 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. DESCRIPTION OF PROPERTY DATE OF DEATH 96 OF DECD'S EXCLUSION TAXABLE ITEM rrauoEntF wuE oFnfTwus~ nit raswnoes-ivTC oECeoEHr~No 1• ~Westem National Annuity FJ204223 i~ E f ..... _... _ _..... ... _....._... _ ........ ... .... ....__ b .i..:.r..ri. ~ ::..i i., i ._. t ~ gym„ i _.. ,..... (~ ~{ ~~ , ~I i (If more space is needed, insert additbnal sheets of the same size) ~+'~'~r~~~T ` ~ ~ READ YOUR POLICY CAREFULLY •L'>.1~'iGlii~.L'li r , Amcrtcan General Altnult] This pOUcy Is a legal contract between the policy owner and t M I ~-rENE~L • Insuraace Com nr the Company. l.T A~• ~ 11p~~ruxu ANNUITY Tdep4oor. tt~ The Company will provide written notice of the Initial Interest • Rate with delivery of your policy. • ~ FJ 204223 • ". • ~s• Policy Number Policy D~~ / 3 0 /19 99 • - Initiali'remiumPayment 1©0035.78 Annuity ate ANNUITANT ' FuU Name. Marna) Status, S~HpyE • ~ JANET $ Social Secu~ 31 f,~9 9 21 • ~'$~r~~l SrT COOVER ST Date of Bit~t4 / 2 4/ 3 912 Age 7 Phone No. (Hot~76971379 j MECHANICSBURG pR . ~`~'U55 Phone No. (Business) • OWNER ~ • FuIF Name Marital Status Sex , • Social5ecurity ' Address Date of Birth .~~ Age Phone No. (Home) Zip Phone No. (Business) Y i; BENEFlCIARY ~'`~- On The Life Of Annuitant; • ' Pnma},~,tff,AH ATKINSON Relations~ECE Continge~f Relationship On The Life Of Owner, If AppUcable: ' Pd~y Relationship Contingent • Relationship The flight Td Change The BeneTrc/ary is Reserved To The Owner • ANNUITY APPLIED FOR ' •• Plan: Flexible Premium Deterred Annuity. Non P~rtlcipafing • • Type of,Artnuity: Non-C~ualifie~ IAA Transfer $ Rollover $ ' (attach endorsement) Deposit Year $ , • Other Deposit Year $ • ' Will any insurance or annuity now In force be replaced or changed by the annuity applied for on application? Yes , : ~io •• . • . If yes, give company, amount, year Issued and reason. ' ~: I understand this annuity Is not federally insured. On behalf of myself and any person who may claim any' interest under this policy,, I represent that all statements set forth are full, complete and true as written and correctly recorded to the best of my knowledge. Y Any parson who knowingly and with intent to defraud any insurance company or other person files an application for insurance or a statement of claim containing any materially, false information or conceals for the purpose of misleading, information concerning any • ' fact rftttterial thereto, commits a fraudulent insurance act, which Is a crime and subjects such person to civil and criminal pertaltles. ' CHECKS NfIjS~'~SE:MAtyE PAYA•BLE'FO A1UlERt(:AN~`rEirl~RA1, QNN~IlT1f.IN5~R"A"I~I~E C011i1P'~1'ryY. ' • DO NOT fiAAKE CHECKS PAYABLE TO ~'HE AiGEN'T OR LEAVE 7HE PAYEE BLAJ;IK. `:' SignedCSBURG PA th1~0 day1~JGU5T . ~~~:. •.•.. Signature s ~ , .._._, , ..,,~ • ' Annuitant if age 18 or over X ~ l ''~ } . i : ~ t~'r ••tt' (' • • Owner if different from Annuitant X t~ ~ Jvlnt OwnerX t • , Ucensed Agent StgiiaFu~e E cAS~v • MARK TRUBE • A Sgt ~ Licensed Agent and Numb~'203_41417 ~ • • YO'fVlbn~r stet ~geC ~ ,paid for life with 10 year period certain, will be O$ ~ 5 . . • ,based on a representatiV~e~nnual premium of $2,gOQ.00. This Is based on the guaranteed'Cash values, • assuming no withdrawals and that only the guarantet3d interest rate of 3.5`Yo is paid. , FOR AQENT To the best of your ktwwledge, is this•insurance being purchased to replace or change any eztsting insurance orannuity7 Yes .~o •. • If yes, give company, amount, year issued and reason, .. • • ••> .. SBDA-96-A-PA. VYFiITE -Customer Copy LL - Home t?fftce Copy _: ' PINK - gency Copy .GOLD -Agent 538559 .•' REV-1513 EX+ (11-06) r Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE BENEFICIARIES ESTATE OF FILE NUMBER Janet E. Casey 21-09-0693 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not Litt Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under _.. _..___........... _......._......._Sec. 9116_(a)_(1.2),]_.. _ .............. ... _ .:: .:_ -: _ ...__ .. 1.' First United Methodist Church 135 W. Simpson St., Mech., PA 17055 10,000.00 2.; ... 'Beulah J. Atkinson 951 W. Trindle Road, Mechanicsburg, PA 17055 ~ !Niece ;, ~ . , ~ 1/4 of net residue 3.' 'Sarah Weidenhoft Brookdale Cypress Village, Jacksonville, FL 32224 :Niece ,.x :. ~ 1/4 of net residue 4. ; :Martha McEnany 106 Harrington Drive, Rising Sun, MD 21911 ?Niece 1/4 of net residue 5. ;Chester Wolf 5830 Lincoln Highway W., Thomasville, PA 173ti4 iNephew 1/4 of net residue ,. _..._ _ ! ._ ..... ....... ......~.._.........__ ....._........._....~......._................._ __........._. . _.. ~ , ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH _.. ..._~...._....__.......~..._..........._..... : : i 18 OF REV-1500 COVER SHEET, A ,. .~...,:::.r::., .~.. - S APPROPRIATE. II NON TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1.. _ . ` ,; 1.. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL. NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ $ If more space is needed, Insert additional sheets of the same size. ~~~~ `~i1i ~n~ `C .e~#~tt~e~tt OF JANET E. CASEY I, JANET E. CASEY, of the Borough of Mechanicsburg, County of Cumberland, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare. this my Last Will and Testament. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as•the same can conveniently be done. 2. I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof,. in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this will or otherwise. 3. I give and bequeath Ten Thousand ($10,000.00) Dollars to the First United Methodist Church of Mechanicsburg. - 1 4. I give and bequeath Sixty Thousand ($60,000.00) Dollars to my sister-in-law, CLARA CASEY SII~IIKONS. 5. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath as follows: A) One-fifth (1/5) of the residue to my niece, SARAH ALVERTA EFCEVITCH, B) One-fifth (1/5) of the residue to my niece, BE[TLAH ATRINSON, C) One-fifth (1/5) of the residue to my niece, MARTHA M. McENANY, D) One-fifth (1/5) of the residue to my niece, DOROTHY MILLER, and E) One-fifth (1/5) of the residue to my nephew, CHE6TER LEROY WOLF. 6. In the event a specific or general legatee predeceases me, his or her share shall lapse and fall into the residue for distribution to the residuary legatees who survive me. 7. Lastly, I nominate, constitute and appoint my niece, BET)I~AH ATKINSON and DONALD ATICINSON, her husband, to be Co-Executors of this my Last Will and Testament and in the event either should be - 2 - unwilling or unable, for any reason, to act as such, I then direct that the other shall serve as sole Executor. I further direct that no bond or other security be required of my personal representative to guarantee faithful performance of her or his duties. I1N WITNESS WHEREOF, I have hereunto set my hand and seal this 1.~-~~ day of December, 1995. rr ( SEAL) Jane E. Casey Signed, sealed, published and declared by the above named JANET E. CASEY as and for her Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at her request, in her presence and in the presence of each other. CO1rIIrIONWEALTH OF COUNTY OF SS I, JANET 8. CASEY, 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 same instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act and deed, for the purposes therein expressed. ~. , ts~) Sworn and subscribed to before „me this, (~_ day of ;.4es:....t_~:. _ ~._---_ _ 1995 . ,ii ~ / ~, ~rg6~t1~C1iG~k~CtY~ffi1d My Gommisiaiort Expiree~ ~ 19W - 3 COl+II~IONWEALTIi OF PENNSYLVANIA COUNTY OF SS We, the undersigned, JOAN M. EAKIN and J. ROBERT STAUFFER, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testatrix, JANET E. CASEY, sign and execute the instrument as her Last Will and Testament; that the said testatrix 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 that, to the best of our knowledge, the testatrix was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or u Sworn and subscr to before me this ~~ day of December, 1995. 1 ' ~~ ~,~ ' ,Z-` i L t.,~..~-' ~1~ - 4 -