HomeMy WebLinkAbout01-07-1015056051058
REV-1500 EXcob-o5) OFFICW. U8E ONLY
PA Departrrrent of Revenue
Bureau of Individual Taxes Code Year Fle Number
Po BOx 260601 INHERITANCE TAX RETURN j~~ oo / A
Hanisbug, PA 17t2s-osot RESIDENT DECEDENT (J /
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Dade of Birth
12/24/2007 02/07/1927
Decedents Last Name Suffix Decedent's First Name MI
GEIBEL BETTY
V
(If Applicable) Err~er Surviving Spouse's Inforrrratlon Bebw ,
Spouse's Last ~~ 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
'>~ 1. Original Retum ~°`;;~> 2. Supplemental Retum :.T.`, 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate _.._ 4a. Future Interest Compromise (date of , :... 5. Federal Estate Tax Retum Required
death after 12-12-82)
x7C 6. Decedent Died Testate ~" ""~ 7. Decedent Maintained a Living Trust 0 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 CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Da me Tel
Yb ephone Number
GAIL G NORRIS (678) 640-4889
Finn Name (If Appligble) ~
~S
. ,
REGISTER OF{MItI.LS USE ON~ ~
-~-.~
~~ 'Caw I (' 7 -7
First fine of address ~ ; ; .`~ ~_ :~.-
-
,:~)
545 WATBORO HILL DRIVE --~~ ' ~ ~~~
~) r~
` -
Second line of address ~
~ -,a
' ~
~__. S
7 -.~.~ ~
rr-~ rri
City or Pmt Office State ZIP Code _ DAt'~FILED _ _.~ L ~ ~_~
ALPHARETTA .tr
GA 30004 ";]
Correspondent's a-mail address: GGNCPA@EARTHLINK.NET
under penames or pequry, ~ sedan; that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief,
it ~ true, correct and complete. Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge.
SIGNATURE OF PEF3$~ON R~ SIBLE FOR FILING RETURN DATE
545 WATBORO HILL DRIVE, ALPHARETTA, GA 30004
SIGNATURE OF PREPARER ~ 'LAaG~L~i~~~.l~~ l.. / ~ DATE ~~ /~
ADDRESS ~/ ~ `~
545 WATBORO HILL DRIVE, ALPHARETTA, GA 30004
PLEASE USE OfRIt31NAL FORM ONLY
Side 1
15056051058 15056051058
15056051058
REV-1 SOOocc~os~ ~~.Y
rllrswelatBrridrwlT^tes ~I~ERITANCE TAX RIETtlRN ......_...
_ ~ nr~oeot RESIDENT DECEDENT
ii~ ~ ~ ,
SociN 9ettaily Ntarrber Date d Death Dale of ~
~ 12/2412007 02/071'[ 927
Deoeder>t's Last Mama suehc ,~. ~~ , ~
t3EIBEL .. BETTY . V .
(If AppYaibla) Ether >3111rtlrtlg Spouse's lerfon^eMlow Bebw
Spouse's last Nerve Su18x Spouse's ~ Mama .. MI
Spots sods sectuily Mlsstber
. _ . TI88 RETURN MU6T BE FB.ED ~ DUPL.[CATE YN?H fl~iE
- REGISTER OF HALLS
~.IN ATE ovwLS seLaw
fs- 1.OrlDkrel Rehrro ~ .: -: 2. Supptemerrtal Return C.:3 3. Rwrterinder Return (date of death
prbr to 12-13.82)
~'~:..• 4. Limited Eetate +_•-- : 4e. Future Interest Compromise (date of t'.:'a 6. Federal Estate Tlet Retum Required
dear edter 12-12-82)
~.r'• @. Decederd Died Testate ...: _ 7. Deoadant MahttsNted a L.IWnp Trust d 8. Total Number of Sate Deposit Boxes
(Atladr (`,ppy of WIN) (Attach Copy d Trust)
C. ~:~ 8. LbfgaNrxl Proceeds Received c::.::~ 10. Spousal Pohl Credt (dale of death ... ; 11. Electiorr 1Cr tax under Sec. 9113(A)
betvreen 1231.81 and 1-1-95) (~libsah Bch. O)
C - TMB 3>:CTIOq MINT Bt: t~l'LETED. ALL CNDEgCE AitD CONFDHIT1Ai. TAiI MM'ORIUTiON StIQULD 8E DIRFCiED TO:
Name Telept!or!er. Wurr~ .
GAIL G. NORRIS (678) 640-4$89
FUrm Pleme+(If AppNceble) _-----.._-.__...
.. ~ RE(iiS'fER OF WILLS U8E ONLY [
~ Nbe of address
545 WATBORO HIU. DRIVE
.. .. _ ...
Second Nrte of address
qty ar Post Otflre _ - • • 8teta • -•Z1P Code
AI.PHARETTA ~ ~ GA 30004
DATE FILED
Cortsaportdelrrs • addresa+ ~svr~t~.rt+~rlrR t n~Irtl~.IVa t
t panstres o1 psrJrry,1 dsdsre trod 1 haw eaosrnined thls rettnq eooonrpooyirrg edradulas and to Nre best of my IrraMsdps end bsNet.
h b true, ooaect and complete. Dealeraron oI pr~eptrer oMrsr Mrsn its psrea+sl repreeerMNlve M on a of viAdch prepsrer tm any Iprowledge.
OF PERSON ItEaPONSNBLL PiOR tgLMdl3 DATE
~ ~ .:X
ADDfaE8s y ~- ~ .
P O BOX 1277 CAMP HIUT.IP~AI 17001 '' ~~ ~~
t31QNATt1~ OF ~~/. ..~~~., ~~i~ /•4/.2~/nC
PLBAde t!S! OW6iNAL FbRM ONLY
8fde 1
15056051.058 15056051058
J 15056052059
REV-1500 EX
Deoederrt's Social Security Number
Decedent's Name: BETTY V GEIBEL
RECAPITULATION
1. Real estate (Schedule A) ............................................. 1.
2. Stacks and Bonds (Schedule B) ....................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ............................. 4.
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5.
6. Jointly Owned Property (Schedule F) .~.~ Separate Billing Requested ....... 6.
7. Inter-V'wos Transfers ~ Miscellaneous Non-Probate Properly
(Schedule G) ~:~ Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1-7) .................................... 8.
9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9.
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule 1) ................ 10.
11. Total Deductions (total Lines 9 & 10) ................................... 11.
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12.
13. Charihable 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.
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 45 348,722.31 18.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18_
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
234,900.00
22,620.51
131,611.00
389,131.51
30,176.12
10,233.08
40,409.20
348,722.31
348,722.31
15,692.50
15,692.50
~~
15056052059 Side 2
15056052059
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER
BETTY V GEIBEL
STREET ADDRESS
BETTY V GEIGEL
809 MANDY LANE
CITY STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments 10,570.50
C. Discount
3. InteresUPenaity if applicable
D. Interest
E. Penalty
1,076.96
1,000.00
Total Credits (A+ g + C) (2)
Total InterestlPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
rill th oval on Page 2, Line ZO to request a refund. (4)
5. ff 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
(1)
15,692.50
10, 570.50
2,076.96
7,198.96
7,198.96
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 Properly 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 deoedeM 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 benefiaary designation? ........................................................................................................................ ~ ^
IF THE ANSVYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
172 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot 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 benefidary.
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.
REV-1502 EX+ (11-08)
' Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
BETTY V. GEIBEL 2008-00190
Ail real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of surr'nrorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1' I PERSONAL RESIDENCE~09 MANDY LANE, CAMP HILL, PA 17011 ~ 234,900.00
TOTAL (Also enter on Line 1, Recapitulation.) I $ 234,900.00
If more space is needed, insert additional sheets of the same size.
REV-1508 EX+ (8-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCEIEpuLE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
BETTY V. GEIBEL 2008-00190
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property joitlUy-owned with right of survivorship must be disdosed on Schedule F.
(rt more space is needed, Insert additional sheets of the same size)
REV-1510 EX+ (08-09)
~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
BETTY V. GEIBEL 2008-00190
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is ves.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, TFIE[R RHATIDNSHIP TD DECEDENT AND
THE DATE of TRANSFta. ATTACN A CDPY of rNE DEED FDR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPUCAaIE~
TAXABLE
VALUE
I• MONY VARIABLE ANNUITY CONTRACT #2VA0030764
18,250,00 100 0.00 19,250.0(
2 MONY VARIABLE ANNUITY CONTRACT #2VA0030765
112,361.00 100 0.00 112,361.0(
TOTAL (Also enter on Line 7, Recapitulation) # I 131,611.00
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (12-39)
C.ONMAONWEALTH OF PENNSYLVANIA
INFIERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEp1~LE N
FUNERAL EXPENSES ~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
BETTY V. GEIBEL 2008-00190
Dsbte of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMpU~
A. FUNERAL EXPENSES:
t' MYERS-HARNER FUNERAL HOME, INC. INVOICE DTD 01/02/2008 6,780.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)IEIN Number of Personal RepreseMative(s)
Street Address
City State
Year(s) Commission Paid:
2. Altomey Fees
3. Family Exemption: (If decederrPs address is rat the same as daimant's, attach explanation)
Claimant
Street Address
City State
Relationship of Claimant to Decedent
4. Probate Fees
5. Accantant's Fees
6. Tax Ream Preparer's Fees
7. 2008 CUMBERLAND COUNTY PROPERTY TAXES
8 STATE TAX STAMP (PAID ATCLOSING}-SEE SETTLEMENT STMT
s REAL ESTATE COMMISSIONS (PAID ATCLOSING}-SEE SETTLEMENT STMT
to MISC ADMIN EXPENSES (PAID AT CLOSING~SEE SETTLEMENT STMT
» TRAVEL EXPENSE REIMBURSEMENT FOR GAIL G. NORRIS (CO-EXECUTOR)
Tip
2,259.00
Zip
404.00
1,000.00
1, 000.00
2,607.89
2, 349.00
13,209.00
187.00
380.23
TOTAL (Also enter on line 9, Recapitulation) I ; 30,176.12
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (12-08)
~ ; Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILMES 8c LIENS
ESTATE OF FILE NUMBER
BETTY V. GEIBEL 2008-00190
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, induding unreimbursed medical exuerules.
lr more space is neetletl, insert additional sheets of the same size.
REV-1513 EX+ (11-08)
~ ~~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE ~
BENEFICIARIES
ESTATE OF FILE NUMBER
BETTY V. GEIBEL ~nnsa.nn~on
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
f1b Not list Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. GAIL G. NORRIS 545 WATBORO HILL DR. ALPHARETTA, GA 30004 DAUGHTER 68.87%
2 GREG GEIBEL PO BOX 1277 CAMP HILL PA 17001 SON 31.13%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE.
II NON TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. #
Ir more space is neeaea, insert additional sheets of the same size.
A. OMB N0.2502-0265 1
B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1'~FHA 2.QFmHA 3. QCONV. UNINS. 4. QVA S.OX CONV. INS.
SETTLEMENT STATEMENT s. ~180UMBER: 7. LOAN NUMBER:
0278319843.
8. MORTGAGE INS CASE NUMBER:
4.875/F11056.65
C. NOTE: This /orm is hnrrished to gAre you a statement of actual settlement costs. Amounts aid ro end b the settlement e
/Gems marked 7POC)" gyre paid outside Hre dosi the are shown here for informational u y Dent are shown.
~' Y p rpoaes and am not inducted in fhe totals.
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: ~ F. NAME AND ADDRESSS OP LENDER:
Nathan P. Havens and Estate of Betty V. Geaibel
Heidi Havens SUNTRUST MORTGAGE INC.
809 Mandy Lane 901 SEMMES AVENUE
Camp Hill, PA 17011 RICHMOND, VA 23224
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 68-0510988
809 Mandy lane Community Land Transfer, LLC I. SETTLEMENT DATE:
Camp Hill, PA 17011
Cumberland County, Pennsylvania PLACE OF SETTLEMENT MeY 1, 2009
2331 Market Street
~'~
~~
Q/~
C
a
~~
Camp Hiil, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: K SUMMARY OF SELLER'S TRANSACTION
101. Contract Sales Price 400. GROSS AMOUNT DUE TO SELLER:
102. Personal Pro 234 900.00 401. Contrail Saks Price
103. Settlement Cha to Borrower Line 1400
~' Personal Pro 234 ~•~
104. 8.467.25 403.
105. 4~•
Lsbrterds For tlerrts Paid 8 Seller in advance 405.
'
106. C /Town Taxes
to A
ustments For hems Paid 8 Soler in advance
107. Coun Taxes 051D1/09 to 01/01/10
108. School Taxes 05!01/09 t
355.06 406. C' /Town Taxes ~
407. Cou Taxes
05101!09 to 01/01/10
o 07/01N9
109• Saver 05/01/09 to 07/01/09
311.47
408. School Taxes 05f01/09 to 07/01/09 35,5.06
311
47
110. 92.94 409• Sewer 05/01/09 to 07/01/09 .
111
410. 92.94
112. 411.
412.
120. GROSS AMOUNT DUE FROM BORROWER
244,126.72 420. GROSS AMOUNT DUE TD SELLER
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 235,659.47
201. it or earnest mo S~• REDUCTIONS IN AMOUNT DUE TO SELLER:
202• Pried I Amount of New Loans 2,500.00 501. F~coess De ft Instructions ~
203. loans taken sub'eil to 199,665.00 502. Setement Cha to Seller Line 1400
18
967
97
204. 503. loans taken su ' to '
'
205. 504• Payoff of first Mortgage
206. 505. Pa ff of second Mott a
207. 5~•
208. 507• De disD. as roceeds
209. Seller Assist 508.
A 'usbnerrfs For Items U 8 Seller 3 710.00 509. Seller Assist 3
710
00
210. /Town Taxes
to A bsbnents For Items Un id 8 Seger ,
.
211. Coun Taxes t 510. C /Town Taxes ~
o
212. School Taxes to 511. Coun Taxes
to
213. 512. School Taxes to
214. 513.
215. 514.
216. 515.
217. 516.
218 517. Jud meet Pa ff to Resu nf/Cflibank/512107014771 7
130.96
219. 518. Inheritance Tax Reaf Estate to Cumberland Cou ,
10,570.50
519.
220. TOTAL PAID BY/FOR BORROWER
I 205,875.00 520. TOTAL REDUCTION AMOUNT DUE SELLER
300. CASH AT SETTLEMENT FROMfTO BORROWER: 40,379.43
301. Gross Amount Due From Borrower Line 120 600. CASH AT SETTLEM T TOfFROM SELLER:
302. Less Amount Paid B /For Borrower (Line 220)
( 244,126.72 601. Gross Amount Due Tp Soler Line 420 235
659
47
205,875.00 602. Less ReducOons Due Seller (Line 520)
( ,
.
4
303. CASH (X FROM) ( TO) BORROWER
38,251.72
603. CASH (X TO) ( FROM) SELLER 0,379.4
The uruiwrainnnrl 1.e.ew.. ..r._~_._-'-- _ 195,280.04
- - --_- ^•r• °• ° ~^^~•r ~+ wpy yr pages IiLZ of this statement & any attachments referred to herein.
Borrower ~~'
Seller
Na P. av ns ~ Es /ej~ Del
U~/l~ ~`l
Heidi Havens
:.„.
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ % 13,209.00 PaoFNOw PaoFxora
Divisron of Commission line 700 as Follows: aoreROwEas seuEas
701. $ 6,629.50 to ERA-NRT, INC. FUNDS AT FUNDS AT
702. $ 6,579.50 to THE HOMESTEAD GROUP, INC. sErn.EwENr sErnEMENr
IN
~.~«~~ rec u.oauu ~
802. Loan Discount °6 to central PA Mort a e, LLC
to 1,697.15
803. Appraisal Fee to Brian Raines Appraiser POC:8350
00
804. Credit Report
805. Lender's Inspection Fee to CREDCO
to : 11.05
806. Mort a e Ins. .Fee to
807. Assumption Fee to
808. Mortgage Broker Fee to Central PA Mortgage, LLC C:B2745
39
809. Administrative Fee
810. JV Processing Fee to Central PA Mortgage LLC
to SUNTRUST MORTGAGE INC .
P : CPA M 500
00 600.00
811. Tax Service Fee
812. LOL Fbod Cert.
813. OF Fbod Cert.
814. .
to Valutree Real Estate Service
to First American Flood
to First American Flood . 83 ~
6 ~
2 ~
815.
816.
817.
818.
819.
820.
90n_ ITFYC RFM IIDen cv 1 Cunre rn e~ n. u............__
(00.180 /00.1BD/12)
St
MEMBERS 1St
FEDERAL CREDIT UNION
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanicsburg, PA 17055
www.membsrslst.org
Main SwRchboard: (717) 697-1161 or (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283.4372
TDD: (717) 697-5312 or (800) 283-2328 ext. 5312
TeisBranch: (717) 795-6049 or (800) 237-7288
BETTY V GEIBEL
GREGORY J GEIBEL
C/O GREGORY GEIBEL
809 MANDY LANE
CAMP HILL PA 17011-1536
Statement of Accounts
Dec 25, 2007 thru Jan 24, 2008
Account Number: 206337
Account Balances at a Glance:
Checking: o . 00
Savings: 14, 459.72
Certificates: o . 00
Loans: o . 00
Money Management: o . 00
Page: 1 of 2
Members 1st has partnered with CO-OP Network to put an additional 25,000 ~``
surcharge free ATMs at your fingertips.
See the enclosed insert for more details. ~,. "~~''
„~ y.-,~ - ~ ~ l,,
X , Y
CHECKING ACCOUNTS
11 -CHECKING
Dec 25 .Balance Fanivard r+aaltlons Subtractions Balance
Dec 26 Withdrawal"Debit Card 1,11.5.51
12/24 425802001'906201 HAMPDEN TOWNS 431 ' 85- X3.66
Dec 31
Jan 05 HIP- SEWER 717
Deposit Swipe 5 Rebate 0.05
VNRhdrawal Debit Card-
683.71
01/04 00221350001PRA1 WORLD CUP SKI 1.00- 682.71
Jan 06 CYCLE MECHAN
Withdrawal Debit Card
Jan 07
Jan O7 01/05 554172100.100007 USAA P&C PREMIUM 800- 531.- 8
Deposit Transfer from Share 00 1,673.95
Check 000311 Tracer 0001215534 558.16- 124.55
1,798.50
Jan 24 Ending Balance 1,798.50- 0.00
2002 Divide»ds Paid 0.59 0.00
Check #
000311 CHECK SUMMARY
Amount Date Check #
1,798.50 Jan 07
Amount
Date
SAVINGS: ACCOUNTS
00 - REGULAR SAVINGS
Date Transaction Descri lion
Dec 25
Ba/ante Forward Additions. Subtractions Balance
Dec 31 Deposit Dividend 1.000°!0 5,003_.00
Annva/ Percentage Y/e/d Earned 1.000% from 12/01/2007 through 12/31/2007 5. 15 5,010.15
Jan 02
Jan 03 Deposit by Check
.Deposit by Check .~0
I~(~
13,010.15
Jan 07 Withdrawal Transfer To Share 11 ~
8'~~' ~ 21,510.15
Jan 15 Withdrawal by Check 1,673.95- 19,836.20
CERT. CHECK j 5.371.48- 14,464.72
Jan 15
J
2 Withdrawal
~5
an
4 E»ding Balance 5.00-
,a(~ -1 14,459.72
14,459.72
- - - Continued on following page - - -
~~~
C~%La~
An AXA Financial Company
~~ r~ ~
January 22, 2008
Gail Norris
545 Watboro Hill Dr
Alpharetta, GA 30004
IIitQNY Life Insurance Company of America
P.O. Box 4720
Syracuse, New York 13221
(315) 477-3000
p.~.i~~ _
~ ~ ~~
~ ~ ~ `.~ ~ ~.~' ~ Rte:' ~ "~' ~ ~"
kpg
..s f ~it.~ U ~ LA ~ "~ A~ ~ b ~ '~ &J
• .? ~; ~ ~F ~ " ., $ S e~ ) ~,',?::';tai'
Re: Contract - 2VAC1030764 & 2VA0030765 (~ ~ r,i ~ ~ -~ t ~~;~~, ~
Annuitant -Betty Geibel
Dear Mrs. Geibel: ~ ,~
r~~3 <5 ,a
On behalf of MONY Life Insurance Company of America, please accept my heartfelt
condolences on the loss of your mother.
I will be assisting you personally throughout the claim process and have enclosed the forms and a
list of documents we will need to expedite processing of the claim. Please be assured I am here to
help if you need assistance in completing the forms or if you have any questions throughout the
claim process. i ~~.j .; ~ ~~''~ - 1 ~~~ "~
Daughter, Gail JNon-is, if living, if not, Son, Gregory Geibel, is the be eficiary listed on these
contracts. The approximate amount payable orr 2VAQ(f3Q76¢ is $19,250.08, noinei of which is
taxable and 2V~14Q307b5 is $112,361.32, none of which is taxable,. and the options available are
listed below. You may want to consult with a tax advisor to determine which option is best for
you:
1. Electing an Installment or Life Option can spread the taxable amount out. To obtain
election forms or for more information about these payment options, please call toll free at 1-
800-326-6744. Please note: If a Settlement Option is elected, it must be elected within 30
days of the date we received due proof of death-(the Death Certificate).
2. Itmnediafe Payment Option:
• Proceeds are immediately made available by means of an interest-bearing checking account.
Please submit the following forms and documents to my attention at MONY Life Insurance
Company of America, PO Box 4720, Mail Drop 32-52, Syracuse, NY 13221.
• The enclosed Request for Payment of Benefits form #03552.
• Certified copy of the Annuitant's Death Certificate.
• The original Contract, if available.
• The enclosed Federal Income Tax Statement of Elections form #11363.
35424 (9/2004) Gat. #134228 (9(04)
__
LV /11 IL n JVI IV I•, , V1 ~•If111u aV aw~Ia la aJal~.,L W.
PLEASE SEND BOTH COPES OF BILI. WlSASE FOR RECEIPT
PAYABLE
TO'
MARIE HUBER, TREASURER
230 S SPORTING HILL ROAD
MECHANICSBURG, PA 17050
oESC: ASSESS.NO -10004087
MAP NO: 10-19-1596-012
809 MANDY LANE
ACRES .340 DEED 0023U 00421
CHESTNUT HILLS
LOT 5A
Residential Building
RESIDENTIAL
rAx
PAYER
GEIBEL, GERALD J ~ BETTY V TO T~
809 MANDY LANE CIA~A eURE/1U POR ~I.fECt10N ~~ F1I.II~i ~ w u~1 AQAWWST
CAMP HILL PA 17011 YOUR '
"SEE REYF.RSE 81DE OF BILL FOR A BREAIIXtOWN OF YOUR COUW7'1f TAX DOL1J1R6
Z o~~ 687
oFflcE MARCH 8 APRIL: MON & TUES 9-4:30
Nouns: WED & THURS 9-12 ~ ~ST 8"I
MAY 8~ JUNE: MON,WED,THURS 9-12
CLOSED FRIDAYS '(717)737-4822* ~oT~-C~
_ ~~ Retum Bill with Payment. For a Receipt , Encbse Self Addressed Stamped Envebpe.
HOLD OOCIiMENT UP TO THE LIGHT TO VIEW 7RI~G w~7cauar .. ~ ~ ~ I ~
a ..
1202212945
WACxov~
4702459
m
Y
8 Pay To The ~~*Marie Huber Treasurer*~~
_. Order Of
~ *TWO THOUSAND FIFTY DOLLARS AND 08 CENTS
Wachovia Bank. National Association
Gail Norris
Remitter
u^ 1 20 2 2 i 294 511' I: 26 i L 700 2 51:50 799000008~'T~7n'
28tt
4702459
3.202212944
wACxovrA 12!19/2008
Y
~a Pay To The ~**fharie Huber, Treasurer*~*
-_- Order Of d+ ® $ 5 S 7.81
~ `p
~' FIVE HUNDRED FIFTY SEVEN DOLLARS AND 81 CENTS
Wactrovia Bank, Natrona( Association Dollars
~~h
Gail Norris : ~~M
Back.
Remitter -~-- ~- _ - ~
_-----__-` Authoriz .Signature --
- - - _ -
r auvnavvu ~ wr ~ ~, ~,
~' ""• ~' ~ - w-~' sane a~sos msrrt or NAtI N IEstab Ta~css Bili Date: 3/011
Assessed Land Improvement Mineral Total
Values 40 000 151 720 0 191 720
Rates V 0 neon+t Fen Pw-
.00228500 .00228500 2 ; -t
COUNTY R 8 91.40 346.68 429.32 438.08 481
Rates .ooDlaoao .00018000 2 }
COUNTY LIB 7.20 27.31 33.82 34.51 37
OF
Rates .00018000 .00018000 2 } 1
MANIC. R 8 7.20 27.31 33.82 34.51 37
TAX AMOUNT DUE -> i~s.so ilso~.~o ~
_! Bated Oa ~' Ztt~s 3 Ol 2008 5 Ol 2008 7 01 2
i! Daid Oa os >!-oloro 4 30 2008 6 30 2008
lF NO'T P111D ®1f i?!1 7fM6
121191200$
~z,OSO.oa
Dollars
s..,»ey
t OeaBa m
~..
II^ i 20 2 2 L 2944f1' ~: 26 L L 700 2 5~: 50 799000008 7 711'
MAKE CHECKS PAYABLE TO:
Marie Huber
230 S. Sporting Hill Road
Mechanicsburg PA 17050
THIS TAX IS DUE AND PAYABLE, YOU ARE HEREBY
REQUESTED TO MAKE PAYMENT THEREOF.
GEIBEL, GERALD J 8 BETTY V
809 MANDY LANE
CAMP HILL, PA 17011
TAX PAYERS COPY ~ Kim Ti,15 PORTION FORYOUIt~ RECORD6 -- -
BILL DATE: 7/01108 MUNICIPAL CODE: Hampden Twp.
BILL NO: 353'1 PROPERTY: 809 MANDY LANE
TAXES PAYABLE TO: MAP CODE: 10-19-1596-012
TAX MILLS: 9
721
Marie Huber .
ASSESSED Vat ua• S~o~ ~~n
ah,es s ~ooo ~ Mineral (191,720 ~I
.oo
.oo
CumbeNand Valley SD D nt Faw P n
Rates .Ci097Z1
SCHOOL RJE $368.84 .009721
$1.474.87 Z%
51,863.T7 1C
ome r it
Farmstead Credit $0.00
TAX AMOUNT DUE---i 11,826.44 S1,ti63.71 52,o5o.t
M Pald tM or Before 8/15!'1008 9/15/2008 10/1512008
NO CHECKS ACCEPTED AFTER DECEMBER 15
FIRST PAYMENT I $ECONO PAYMENTr FINAL PAYMENT
WA WA( WA
A1r'1 nrcrnr urr K Paid CM Or Before If Paid CM or Before If Paid On Or Before
_~ ~_ $ Retum Bill with Payment. For a Receipt,
Tax Collector Signature Date Paid Amount Paid Enclose aself-addressed stamped envel
MAKE CHECKS PAYABLE TO: , ~ ~ ~ : I ~ ~ . ~ ~
Marie Huber RETURNT1iISPORTIONNIITHPAYMENTFORFMA,LwSTALJ.AIIENIT
230 S. Sporting Hitl Road
Mechanicsburg PA 17050 property tocatlon owner
10-19-1596-012 GEIBEL, GERALD J 8 BETTY V
RETURN SERVICE REQUESTED 809 MANDY LANE 809 MANDY LANE
CHESTNUT HILLS CAMP MILL, PA 17011
LOT 5A
BILL #: 3531 Residential Building
O FINAL INSTALLMENT ^ FINAL INSTALLMENT WITH PENALTY
MAIL TO:
CASH CHECK # AMOUNT i
Marie Huber
230 S. Sporting Hill Road
Mechanicsburg PA 17050
NO DISCOUNT
Ir Paid on or Before
10!15!08 WA
If Paid Aner
10/15/08 N/A
•. ~ .ice .+..~........ , ... ,~. ~ ~..
BRUCE BARCLAY
CHAIRMAN
GARY EICHELBERGER
VICE CHAIRMAN
JOHN BYRNE
CHIEF OPERATIONS OFFICER
EDWARD SCHORPP
SOLICITOR
RICHARD ROVEGNO TAX CLAIM BUREAU OF CUMBERLAND COUNTY
SECRETARY STEPHEN D. TILEY
One Courthouse Square, Carlisle, PA 17013-3389 ASSISTANT SOLICITOR
Printed: 1/16/08 C (717)240-b366 Receipt No.: 58800
9:30:14
Receipt Date: 1/16/2008
Control Number: 10-004087 **** RECEIPT **** page:
1
Property Description:
GEIBEL, GERALD J & BETTY V
809 MALADY LANE
CAMP HILL PA 17011
Map No: 10-19-1596-012
Tax
Year Description Face
2006 CTY-HAMPDEN TWP
2006 LIB-HAMPDEN TWP
2006 MUN-HAMPDEN TWP
2006 SCH-CUMBERLAND Vally
2006 BUREAU COSTS
2007 CTY-HAMPDEN TWP
2007 LIB-HAMPDEN TWP
2007 MUN-HAMPDEN TWP
2007 SCH-CUMBERLAND Vally
2007 BUREAU COSTS
Tendered > CHECK
Received By > JC
Paid By > GEIBEL, GERALD J & BETTY V
Remarks > 320110
CHESTNUT HILLS
LOT 5A
Residential Building
Situs Information:
809 MALADY LANE
HAMPDEN TOWNSHIP
Penalty &
Interest Costs Total
421.21 80.04
34.51 6.57
34.51 6.57
1831.69 348.05 15.00
5.66
Received For Year -0f 2006
438.08 43.81
34.51 3.45
34.51 3.45
1831.69 183.17
15.00
Received For Year Of 2007
* Continued
Total Received
501.25
41.08
41.08
2179.74
5.66
$2783.81
481.89
37.96
37.96
2014.86
15.00
$2587.67
$5371.48
Date: 01/01/2008
Greg Geibel
$09 Mandy Lane
Camp Hill, PA 17011
Mead Living Ctr West Shore 4
Meadows Living Ctr West Share
4837 East Trindle Road
Mechanicsburg, PA 17050
Resident Statement
Re: Betty Geibel
Account#: 270
Balance Due: 6,337.95
Amount Enclosed
Mead Living Ctr West Shore 4
Meadows Living Ctr West Shore
4837 East Trindle Road
Mechanicsburg, PA 17050
Date: 02/01/2008 Re: Betty Geibel
Account#: 270
Balance Due: 2,136.06
Greg Geibel
809 Mandy Lane Amount Enclosed
Camp Hill, PA 17011
Resident Statement
DATE BALANCE FORWARD
02/04/2048
12/Q1/2007 Room, Board and'Services 2,860.57
12/f?1/~047 Rocxm, Board and Services (3, 783.00)
12/01/2007 Ran, Board and t~e~ricF:s 587.05
O1/0-1/2Q~0$ Fts~m, Bootrd and. Services (2, 232.00)
01/~I/2:048 Rt~om, Board acid Services 880.57
41/16/2~U8 Past Due 45 Days 40.09
:01/21/2:008 F~~maoy Charges (9.17)'
O1/29/2fl08 Mewl Cfedit Bldg.. 4 (65.00)'
CIIRRENT MONTH Ci~A,RCES
CU~2.R$NT BALANCE I?
~~Ic' ~ }~
S~.
jr r-a -_
~ r:
r 'a
~.~: ~~~
Fib
•. ~P'.r ~. ~ MI
6,337.95
(~, 411. Q0
(1,720.$9`
2,136.06
v~++11
-. i
4 t,-s41
~h
`1..'.
~ 5
F ~~.v
'~ ~; r„~-~ ~ ~ ~' ~, , ~ ~ -
. rc ;:
~ S r ~:
Mead Living Ctr West Shore 4
Meadows Living Ctr West Shore
4837 East Trindle Road
Mechanicsburg, PA 17050
Date: 12/01/2008
Greg Geibel
809 Mandy Lane
Camp Hill, PA 17011
Resident Statement
Re: Betty Geibel
Account#: 270
Balance Due: 2,357.46
Amount Enclosed
Date: 02/01/2009
Greg Geibel
809 Mandy Lane
Camp Hill, PA 17011
Mead Living Ctr West Shore 4
Meadows Living Ctr West Shore
4837 East Trindle Road
Mechanicsburg, PA 17050
Resident Statement
Re: Betty Geibel
Account#: 270
Balance Due: .00
Amount Enclosed
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SHORT CERTIFICATE
I, GLENDA EARNER STRASBAUGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 22nd day of February, Two Thousand and
Eight,
Letters TESTAMENTARY
in common. form were granted by the Register of
said County, on the
estate of BETTY V GEIBEL 1 a to of HAMPDEN TOWNSH/P
(First, Middle, Last!
in said county, deceased, to GREGORY J GEIBEL
GA/L G NORRIS
and
!rust, Miardle, Cast!
!rust, MMd/e, Cast/
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 22nd day of February
Two Thousand and Eight.
File No.
PA File No.
Date of Death
S.S. ~#
2008- 00190
21- 08- 0190
12/24/2007
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
LAST WILL AND TESTAMENT OF
BETTY V. GEIBSL
I,-BETTY V. GEIBEL, of 805-Mandy Lane, Camp ]fill; Cumberland
County, Pennsylvania, do hereby make this my .Last Will and
Testament, revoking any former Wills and Codicils made by me.
FIRST: I give my tangible personal property and a,ll insur-
ances thereon to my daughter, Gail, and to my son, Gregory, or
the survivor of them. I have complete confidence that they, or
the survivor of them, will honor any written instructions that I
may leave with regard to said tangible personal property.
SECOND: I give the rest and remainder of my estate, real,
personal and mixed, to my issue, per stirpes. I understand
clearly that if my daughter, Gail, and my son, Gregory, survive
me, they will divide this gift equally. Should one of them
predecease me without issue, the other will receive the totality.
Should either or both predecease me leaving issue, the issue will
receive the parent`s share. Should no issue survive me, I give
my entire estate, real, personal and mixed, to my heirs-at-law
under the intestate laws of the Commonwealth of Pennsylvania.
THIRD: If any individual beneficiary who would otherwise
receive an interest in my probate estate through Item SECOND is
under forty (40) years of age, I direct that his (the masculine.
to include the feminine) interest be held in trust by CCNB Bank,
N. A., 331 Bridge Street, New Cumberland, Cumberland County,
Pennsylvania, hereinafter called Trustee, until such beneficiary
reaches forty (40) years of age.
_ / h
/~-' ~ ~~
My Trustee shall apply such amounts of income and principal
as it, in its sole discretion, deems proper for the support,
education and welfare of such beneficiary, and may accumulate any
unexpended balance of income to the extent permitted by law.
Without the intervention of a guardian; such amounts may be
applied directly or may be paid to the beneficiary or to the
person with whom such beneficiary resides or to the person who
has the care and control of such beneficiary. My Trustee shall
not be obliged to supervise or inquire into the application of
such amounts by such person, and the receipt of such person shall
be a complete release of my Trustee, Should the share of a
beneficiary, in the sole opinion of my Trustee, be or become too
small to warrant continuing such fund in trust, or should its
administration be or become impractical for any other reason, my
Trustee, in its sole discretion, may pay such share, absolutely,
without the intervention of a guardian, to the beneficiary, to
the person with whom such beneficiary resides, to the person who
has the care and control of such beneficiary, or may deposit such
share in the beneficiary's name in a savings account in a savings
institution of its choosing, payable to the beneficiary at
majority, which I define as twenty-one (21) years. It is my
recommendation that my Trustee consider the possibility of
distributing one-third (1/3) of the trust assets when the benefi-
ciary reaches the age of thirty (30), and one-half (1/2) of the
remaining trust assets when the beneficiary reaches the age of
thirty-five (35).
Should a beneficiary die prior to reaching the age of forty
{40) years leaving issue, his interest shall be allocated among
said issue by my Trustee and held in trust for said issue,
/ r
-2-
subject to the same trust provisions of this Will, but subject to
the additional qualification that final distribution be made to
each said issue upon his reaching the age of twenty-one (21)
years, or to his estate in the event of his death.
Should a beneficiary die after reaching the age of twenty-
one (21) years, but prior to reaching the age of forty (40)
years, leaving no issue, his interest shall be distributed as he
may specifically direct in a valid Last Will and Testament.
IInless such specific direction is made, the interest of a bene-
ficiary who dies at any age prior to reaching the age of forty
(40) years leaving no issue shall be divided among his brothers
and sisters and the issue of deceased brothers and sisters, per
stirpes, or, if none exists, among my issue, per stirpes, provided
that, any portion of such interest payable to a person who is the
beneficiary of a subsisting trust under this Will shall be added
to said trust, and be paid over to said beneficiary in accordance
with the provisions of said trust.
FOURTH: i name as my Co-Executors my daughter, Gail, and my
son, Gregory. Should either be unable or unwilling to serve, I
name as her or his replacement L. W. Brick, 802 Mandy Lane, Camp
Hill, Pennsylvania. Should he be unable or unwilling to serve, 2
name such member of the firm of Reefer, Wood, Allen & Rahal, or
its successor firm, as that firm may designate. It is my inten-
tion to have two individuals serving as Co-Executors at all
times, and if two of the individuals designated above do not
qualify and serve, I name as my Executor CCNB Bank, N.A. I
direct that my Co-Executors or Executor serve without bond in any
jurisdiction in which called upon to act.
/ t~
-3-
FIFTH: I give to any Executor, Executrix or Executors and
to any Trustee or Trustees named in this Will or any Codicil
hereto all of the powers now applicable by law to fiduciaries in
the Commonwealth of Pennsylvania and in particular, through the
Probate, Estates and Fiduciaries Cbde, as effective and as in
effect on the date hereof, during the administration and until
the completion of the distribution of my estate, and until the
termination of all trusts created hereunder and until the com-
pletion of the distribution of the assets of such trusts.
IN WITNESS WHEREOF. I~have set my hand and seal on this my
Last Will and Testament this ~ day of~~~G~~~~ 1982.
e°~c-e.(,' (SEAL )
B$TTY IB
SIGNED, SEALED, PUBLISHED, and)
DECLARED by Betty V. Geibel, )
as and for her Last Will and )
Testament, oa the day and year)
last above written, in the )
presence of us, who, at her )
request, in her presence, and )
in the presence of each other,)
all being present at the same )
time, have hereunto subscribed)
our names as witnesses: )
}- )
r M ~ 'C`~~
'7'z)n11rlG~. Q•~~ )
)
-4-
ACKNOWLEDGMENT '
COMMONWEALTH OF PENNSYLVANIA :
SS.
COUNTX OF DAUPHIN ,
I, BETTY V, GEIBEL, the Testatrix, whose name is signed to
the foregoing instrument, having been duly qualified according to
law, do hereby acknowledge that I signed and executed the instru-
ment as my Last Will and Testament; that I signed it willingly;
and that I signed it as my free and voluntary act for the purposes
therein expressed.
.aai~~_
ETTY GEIB
Sworn or affirmed to and
acknowledged before me by
Betty V. Geibel, the
Testatrix, this 3rd day
of September , 1982.
Notary 1 c
My Commission Expires:
Kat4ryc C Ho~ogv, ~ Pn66c
dr ~ Nm- t0. 1483
b+~f. FA Dgpiii Gooq
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF DAUPHIN ,
WE, GWYNNE C. RRATZER , ,
and MARCIA A. BUBAR , the witnesses whose names are
signed to the foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw the Testa-
trix sign and.execute the instrument as her Last Will and Testa-
ment; that she signed willingly and that she 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 that time eighteen (18) or more years of age, of
sound mind, and under no constraint or undue influence.
c. ;
Sworn or affirmed to and
subscribed to before me by
Lynne C. ra .pr ,
~d Marr_i a A_ B ~bak ,
this 3rd day of September ,
1982.
lvotary lic I'
My Commission Expires:
~fM- C H
~. tx ~ ~i6~