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Home My WebLink About12-15-091505607120 REV-1500 PA Department of Revenue ~ (~5) OFFICIAL USE ONLY n ear ie m Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 17128-osol RESIDENT DECEDENT 2 1 0 9 10 0 5 Social Security Number Date of Death Date of Birth 201166557 09302009 01041926 Decedtartl's Last Name Suffix Decedent's First Name MI MCCLINTOCR MARY H (If Appikable) 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 1MTH THE REGISTER OF WILLS FILL IN APPROPRWTE OVALS BELOW ® t. Original Retum p 2. Supplemental Retum ~ 3. Remainder Retum (date of death prior to 12-13-82) ~ 4. Limited Estate 0 qa. Future Interest Compromise ~ 5. Federal Estate Tax Retum Required (dale of death aRer 12-12-82) ® g, Decedent Died Testate ~ 7. Decedent Maintained a uang rn,st 0 e. Total Number of Safe Deposit Boxes (Aaaa, copy or win) (Attach copy a rnrsq 0 9. Litigation Proceeds Received ~ 10. Spousal Poverty Crernt (date of death t 1 _ Election to tax under Sec. 9113(A) between 1231.91 and 1-t-95) ~ (Attach Sch. O) ame Daytkrte Telephone Number DALE F SHIIGHART, JR. ESQIIIRE 7172414311 Firm Name (If Applipble) First Iirw of address 10 1PEST HIGH STREET Second Tine of address City or Post 011ice CARLISLE State ZIP Code PA 17013 ~~~ ~. '7.'t .. ) C`~ c <:~ : v r _, t ,~ - °::~ ~, z~ ,~ ,5 ? .7°-s `rt sri c',-a ~y Cortespondertt's e-mail address: lJrtdsr pertaltles of perjury. I declare that I have examirted tfda rettxry indudinnpp aocompertyktp. schedules and sfalerrrertts, and to the best it is true, correct and complete. Declaratlort of preparor other than the personal repreaerMatlve is based on atl IMorrrtation of wttiGt ~ and belief, _ preparttr has any knowledge. Diane K. Herman 430 Capitol Hili Road, Dillsburg, PA 17019 10 West High Street~.C~rlfsle, PA 17013 Dale F Shughart, Jr. Esquire ~ Side 1 L 1505607120 --RE,UISTE.R OH WILL/CLhRK oI~ oRPx~uvs cxr REGISTER OF WILLS USE ONLY rV PLEASF. NOTE: DUE TO AN I:LEC'IRONIC C"1 ~' ` i~fALFUNCTION WITH TIMECLOCK - THF. C'q C"7 . CLOCK DATE ON TI-IIS DOCU:~fEN'I' IS 12 ~ k:7 T a HOURS BEHIND Tf IE ACTUAI.'I'IME. '-.~ ~ rte- . t~ ` ern r. I ~; ~ rt1 E..~ .r-, ,-. 1505607120 ~Z REV-1500 EX 1505607220 oeceae~rs rye: M C C L I N T O C K, MARY B. 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. 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ............. 6. 7. Inter-Vvos Transfers & Miscellaneous Non-Probate Properly (Schedule G) ~ Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ....................................................................... g, Decedent's Social Security Number 201166557 6,388.72 6,388.72 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 1 1 , 0 0 1 . 2 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) ................................ 10. 1 0 1 , 2 18.5 6 11. Total Deductions (total Lines 9& 10) ...................................................................... 11. 1 1 2, 2 1 9. 8 3 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12, - 1 0 5 , 8 3 1 . 1 1 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, - 1 0 5 , 8 3 1 . 1 1 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxabte at collateral rate X .15 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505607220 0.00 1505607220 J REV-1500 EX Page 3 File Number 21 - 09 - 1005 Decedent's Complete Address: McClintock, Mary B. Sarah A. Todd Memorial Home 1000 West Orange Street Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) {1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InterestlPenalty if applicable p_ 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. (4) Check box 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) -0.00 0.00- 0.00 0.00 Q.Q~ 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 :.................................................................................. x b. retain the right to designate who shall use the property transferred or its income :.................................... x c. retain a reversionary interest; or .................................................................................................................. x d. receive the promise for fife of either payments, benefds or care? .............................................................. x 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 "intrust for" or payable upon death bank account or security at his or her death?......... ^ ^x 4. Did decedent own an Individual Retlrement Account, annuity, or other non-probate properly 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 th or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0}percent ]72 P.S. §9116 (a} (1.1 } (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero {0) percent [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116 1.2) (72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3}]. A sibling is defined under Section 9102, as an individual who has at feast one parent in common with the decedent, whether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. CONNAONNIEALTN OF PENNSn.vAN1A PERSONAL PROPERTY INHERRANCE TAX RETURN RFSbENT DEC~ENi ESTATE OF McClintock, Mary B. 21 - 09 -1005 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 Ise disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 M & T Bank, checking account 9830137726 Principal 4, 325.87 Interest .18 2 M ~ T Bank, checking account 9849246641 Principal 2,062.67 Interest -0- 4, 326.05 2,062.67 I TOTAL (Also enter on Line 5, Recapitulation) ~ 6,388.72 CHmIJLE H caa~noNwEn~Trl of ~NSnv~ww r INHERR'ANCE TA7C RETURN ~~~~~ ~5 RESIDENT DECEDENT 1 ESTATE OF McClintock, Mary B. 21 - 09 - 1005 Debts of decedent must be reported on Schedule 1. I M NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Hoffman-Roth Funeral Home, funeral bill 9,632.49 2 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Diane K. Herman 270.78 Social Security Number(s) / EIN Number of Personal Representative(s): street Address 430 Capitol Hill Road City Dillsburg State PA Zip 17019 Year(s) Commission paid 2010 2. Attorney's Fees Dale F. Shughart, Jr., Esquire 1,000.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Gaimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 75.00 5. Accountants Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Register of Wills, Short Cert~cates 8.00 TOTAL (Also enter on line 9, Recapitulation) 11,001.27 CO~MAONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN Schedule H w,,~..,.~Fi~r~,~,,w~a,,lw6^q~e~nses & Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE carwoNwEn~TNOFaENNSrwnNw LIABILITIES & LIENS K~FiERRMiCETAX RETLRN ~ RESIDBdT DEC®ENT ESTATE OF McClintock, Mary B. FILE NUMBER 21 - 09 - 1005 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Todd Home, nursing care check #499, written before death, clearing after death 1,063.26 2 ~ PA Department of Public Welfare, Medical Assistance reimbursement ~ 100,155.30 I TOTAL (Also enter on Line 10, Recapitulation) ~ 101,218.56 REV-1513 EX+ (8-00) COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER McClintock, Mary B. 21 - 09 -1005 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Na ust Trustee(s) SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) I~ TAXABLE DISTRIBUTIONS[indude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Diane K. Herman Daughter one-quarter 430 Capitol Hill Road Dillsburg, PA 17019 2 Donald L. McClintock Son one-quarter 19A Burgners Mill Road Carlisle, PA 17015 3 Douglas A. McClintock Son one-quarter 19B Burgners Mill Road Carlisle, PA 17015 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropriate, on Rev 1500 cover sheet II~ NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX+ (9-00) COMMOMNEALTH of PENNSriVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES continued ESTATE OF McClintock, Mary B. I FlLE NUMBER 21 - 09 -1005 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT DoNdllstTrustsa(a) SHARE OF ESTATE (Words) AMOUNT OF ESTATE ($$$) I~ TAXABLE DISTRIBUTIONS [ndude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 4 Duane E. McClintock Son one-quarter 93 Beagle Club Road Carlisle, PA 17013 Page 2 of Schedule J 00 0 04319M NN I17 3640 MARY B MCCLINTOCK 2168 NEWVILLE RD CARLISLE PA 17015 INTEREST PAID YEAR TO DATE 2.28 HIGH STREET-CARLISLE A ~`f`n11 SIT nlluu.e~.. ~ • :' C: ::: ~ ~ .~~. ~, •::.v 1I r : 1 ran 1 -:. : ,.. ..;.Skt'JI~IC~.;.,:: .. . . :, .. < .: ::i .:c :..:<:~tHEIt~:k~DOr1'.YOei~>;:::: . .. > ~HEfi P'.k~b:.. :. :> ;:. :.... .: ... ,~B~~fAC'l'~t11~ :...; :: RR. .::; ,INT~kE~S~`:PB : :.;.,~ALi-1!I~E . ; NO. AMOUNT NO. AMOUNT NO. AMOUNT . : 4,271.16 3 1, .97 3 ,12 .22 0 0.00 0.18 4,303.09 w nn nllu~ ~ ^ 1 / '~v 1 1 1 1 1 ;: SATE ;:: _ ,. ~ItANSAC~~ON:1fES~1~~P~~ON z., ~ ::. P4~& &~• .. R .&.0 ~ ER::A~..~'~~OIiS• ~ EGK±S $:.Q;HER ,.>:., ` ~'IItACTTOIVS ..: /! LY .........,.BALANCE is 09-05-0 BE6IlMIIN6 BALANCE !4,271.16 09-17-0 DEPOSIT 114.67 4,385.83 09-22-0 CHECK NUMBER 0498 09-30-0 CHECK NUMBER 0500 12.7 4,373.13 47.26 4,325.87 10-01-0 US TREASURY 312 CIVIL SERV 248.30 10-01-0 CHECK NUMBER 0499 10-02-0 US TREASURY 303 SOC SEC 792 00 1,063. ~ 3,510.91 10-05-0 INTEREST PAYMENT . 4,302.91 0.18 4,303.09 ENDING BALANCE 54,303.09 <:...::<:•;::~ <;::;;:> :::. ......:..>NHS:>:Pa4~:;StE1~!!~R~.::...:.;< .. ., :. .................................. 498 09-22-09 12.70 499 10-01-09 1,063.26 500 04-30-09 47.26 ANNUAL PERCENTAGE YIELD EARNED = 0.04 YOU COULD NIN COOL PRIZES .LUST FOR USING YOUR M&T CHECK CARD! THE MORE YW USE IT, THE MORE CHANCES YOU HAVE TO NIN. JUST PUSH "CREDIT° AT STORES OR SHOP ONLINE. FANTASTIC, HUH? THE MiT FANTASTIC PLASTIC SNEEPSTAKES VISIT NNN.MTB.COM/FANTASTICPLASTIC TO LEARN MORE AND FOR OFFICIAL RULES. LAOSA (6/0~ ~ Y1 ,~;G4z` as ~< r 00 0 06128M NN 017 15565 MARY B MCCLINTOCK 2168 NEWVILLE RD CARLISLE PA 17015 r _. _ _ fr s ______ ..__ ~---_.._. __ _. _. _ ____. ______... _._. CARLISLE HEST Af'f`(111A1T CI{MMADV BEGINNING BALANCE DEPOSITS 8 OTHER ADDITLONS CHECKS PAID OTHER SUBTRACTIONS CURRE INTEREST PH EKING BALANCE NO. AMOUNT NQ. AMWNT N0. ANOUNT 1,972.67 1 90.00 0 0.00 _ 0 D.00 0.00 2,062.67 ACf'(llilJT A('TT\lTTV POSTING DATE TRANSACTION DESCRIPTION DEPOSITS,INTERE5T 5 OTHER ADDITIONS CHECKS 8 OTHER SVBTRACTIONS DAILY BALANCE 08-22-09 BEGINNING BALANCE 51,972.b7 09-01-0 US TRfASURY 220 VA BENEFIT 90.D0 2,062.67 ENDING BALANCE 52,062.67 YOU COULD MIN COOL PRIZES JUST FOR USING YOUR MGT CHECK CARD* THE MORE YOU USE IT, THE MORE CHANCES YOU HAVE TO MIN. JUST PUSH `'CREDIT" AT STORES OR SHOP ONLINE. FANTASTIC, HUH? THE MGT FANTASTIC PLASTIC SMEEPSTAKES VISIT MMM.MTB.COM/FANTASTICPLASTIC TO LEARN MORE AND FOR OFFICIAL RULES. Page: 1 Document Name: untitled STFD 1 THE TRANSACTION STMT FORMAT 09/10/26 15.17.13 STMT CO 96 OP EBRN MS 50861 LAST PAGE OF TRANSACTIONS ACTION COID PROD CODE DDA ACCT 9830137726 SHORT NAME MCCLINTOC K MARY B CURR CODE PAGE 3 SEARCH FROM 109/08/20 THRU 109/10/26 ACTN POST EFFECTIVE CHECK NUMBER TRAM AMOUNT D/C BALANCE TRACE ID DESCRIPTION 10/26 .09 C 3,262.88 I-GEN109102600 000001 INTEREST PAYMENT 10/26 299431995 3,262.88 D .00 MQWBKP99 CLOSEOUT PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM gate: 10/26/2009 Time: 3:17:54 PM Page: 1 Document Name: untitled STFD 1 THE TRANSACTION STMT FORMAT 09/10/26 15.17.25 STMT CO 96 OP EBRN MS 50852 ACTION COMPLETE ACTION COID PROD CODE DDA ACCT 9 830137726 SHORT NAME MCCLINTOCK MARY B CURR CODE PAGE 2 SEARCH FROM 109/08/20 THRU 109/10/26 ACTN POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION * 09/22 0498 12.70 D 4,373.13 8004260890 CHECK NUMBER 0498 * 09/30 0500 47.26 D 4,325.87 8006886873 CHECK NUMBER 0500 * 10/Ol 248.30 C 4,574.17 009271007109572 US TREASURY 312 CIVIL SERV * 10/Ol 0499 1,063.26 D 3,510.91 8007353725 CHECK NUMBER 0499 * 10/02 792.00 C 4,302.91 _. 009272007965188 US TREASURY 303 SOC SEC * 10/05 .18 C 4,303.09 I-GEN109100500011581 INTEREST PAYMENT 10/19 10/01/09 248.30 D 4,054.79 EACHBPN REVERSE DIRECT DEPOSIT 10/19 10/02/09 792.00 D 3,262.79 EACHBPN REVERSE DIRECT DEPOSIT PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM Date: 10/26/2009 Time: 3:18:01 PM Page: 1 Document Name: untitled STFD 1 THE TRANSACTION STMT FORMAT 09/10/26 15.17.25 STMT CO 96 OP EBRN MS 50852 ACTION COMPLETE ACTION COID PROD CODE DDA ACCT 9 830137726 SHORT NAME MCC LINTOCK MARY B CURR CODE PAGE 2 SEARCH FROM 109 /08/20 THRU 109/10/26 ACTN POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION * 09/22 0498 12.70 D 4,373.13 8004260890 CHECK NUMBER 0498 * 09/30 0500 47.26 D 4,325.87 8006886873 CHECK NUMBER 0500 * 10/01 248.30 C 4,574.17 009271007109572 US TREASURY 312 CIVIL SERV * 10/01 0499 1,063.26 D 3,510.91 8007353725 CHECK NUMBER 0499 * 10/02 792.00 C 4,30 2.91 _- 009272007965188 US TREASURY 303 SOC SEC . * 10/05 .18 C 4,303.09 I-GEN109100500011581 INTEREST PAYMENT 10/19 10/01/09 248.30 D 4,054.79 EACHBPN REVERSE DIRECT DEPOSIT 10/19 10/02/09 792.00 D 3,262.79 EACHBPN REVERSE DIRECT DEPOSIT PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM 11-CUTO -STSM Date: 10/26/2009 Time: 3:18:01 PM LAST WILL AND TESTAMENT OF MARY B. MCCLINTOCK I, Mary B. McClintock, of West Pennsboro Township, Cumberland County, Pennsylvania, declare this to be my last Will and- T-es~ament aad- rear-ake all Wilds-- aad Codicils--pr-evously-made by me. ITEM I: I direct that my legally enforceable debts and funeral expenses, together with the expenses of the administration of my estate, including any state, federal or other death taxes payable because of my death, shall be paid from my residuary estate as soon as practicable after my decease, as a, part of the expense of the administration of my estate. ITEM II: I bequeath all of my clothing, personal effects, furniture, furnishings, household goods, and 'other tangible personal property of like nature (excluding cash on hand, any motor vehicles I may own at my death and tangible evidences of intangible property),-together-with any policies-of insurance applicable thereto, including any prepaid premiums, unto my son, Douglas A. McClintock, provided he shall survive me by thirty (30) -days. ITEM III: I devise and bequeath the rest, residue and remainder of my estate of every nature and wherever situate in equal shares unto my four (4) children, Donald L. McClintock, Duane E. McClintock, Douglas A. McClintock and Diane K. Herman, provided, however, that the share of any of my said children who shall predecease me or die on or before the thirtieth day following my death shall be distributed to his or her issue, per stirpes, living on the thirty-first day following my death and in defaui-t of such then living issue, such share shall-be added t~ the shares for my then living children and the issue, per stirpes, of my then deceased children. ITEM IV: I appoint my daughter, Diane K. Herman, Executrix of this my last Will and Testament. Should my said daughter fail to qualify or cease to act as Executrix, I appoint my son, Donald L. McClintock, Executor of this my last Will and Testament. ITEM V: I direct that my personal representative, as well as her successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal, __ . _. this ~ day of August, 2000. [ sEAL Ma cClintock The preceding instrument, consisting of two (2) typewritten pages, each identified by the signature of the Testatrix, was on the date thereof, signed, published and declared by Mary B. McClintock, the Testatrix therein named, as and for her last Will, in the presence of us, who, ~t her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, Mary B. McClintock, Dale F. Shughart, Jr, and John J. Baranski, Jr., the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of. age or older, of sound mind and under no constraint or undue influence. w~ness ____.___ Subscribed, sworn to and acknowledged before me by Mary B. McClintock, the Testatrix, and subscribed and sworn to before me by Dale F. Shughart, Jr., and John J. Baranski, Jr., witnesses, this 3p ~- day of August, 2000. - __i Notary P is w oH~ ~~'~;~w+o ~ O0 oarwas ocros~ f, o Q Testatrix