HomeMy WebLinkAbout03-11-101505bD7121
~' REV-1500 EX (06-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po sox 2aosol INHERITANCE TAX RETURN
Harrisbum PA 17128-0601 RESIDENT DECEDENT '~- ~ I O ~~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 8 8 2 0 5 6 9 9 1 0 2 9 2 0 0 9 1 2 0 5 1 9 2 b
Decedent's Last Name Suffix Decedent's First Name MI
W A K E F I E L D M A R Y J A N E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL INAPPROPRIATE OVALS BELOW
Q 1. Original Return
4. Limited Estate
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
{Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND GONFNEN f IAL I AX INFURMAI IUN SHUULU tlt UIKtG I tU I U:
Name Daytime Telephone Number
G R E G O R Y R R E E D 7 1 7 2 3 8 0 4 3 4
Firm Name (If Applicable)
First line of address
3 1 2 0 P A R K V I E W
Second line of address
City or Post Office
H A R R I S B U R G
Correspondent's a-mail address: LAWOFFICE~EPIX.NET
State ZIP Code
P A 1 7 1 1 1
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REGISTER OF 4.L3 USE ON
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Under penalties of perjury, I declare that I have examined this return, including. accompanying schedules and statements, and to the best of my knowledge and belief,
tt is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SI ~TURE OF,p~SON R PONSIBLE R FILING RETURN DATE
~.!?o ~1,~.~. ~u/Ja~~~rpv'-pry-- 3/i~/~o~o
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 15D5b07121
L A N E
~~.
J
1505607221
REV-1500 EX
Decedent's Social Security Number
oecedent'sName: MARY JANE WAKEFIELD 1 8 8 2 0 5 6 9 9
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 & Notes Receivable (Schedule D) ........................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 4 5 2 7 • 4 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
h
l
S
d
G
~] 2 9 0 0 5 0
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)
Separate Billing Requested ....... 7. .
8. Total Gross Assets (total Lines 1-7) ........................... 8. 7 4 2 7. 9 0
9. Funeral Ex enses 8 Administrative Costs Schedule H
P ( ) ........... 9.
..... 1 6 6 6. 5 0
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ....... ..... 10. 1 0 4 7 1 1 • 7 1
11. Total Deductions (total Lines 9& 10) ...................... ..... 11. 1 0 6 3 7 8. 2 1
12. Net Value of Estate (Line 8 minus Line 11) .................... ..... 12. - 9 8 9 5 0 . 3 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. 9 8 9 5 0. 3 1
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)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 1 g.
19. Tax Due ............................................ ....19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505607221 1505607221
REV-7500 EX, Page 3
Decedent's Complete Address:
File Number
0 ~
DECEDENT'S NAME
MARY JANE WAKEFIELD
STREET ADDRESS
CITY STATE ZIP
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty 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.
Fiil in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (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 QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred : ...................................................................... ^ ^
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^
c. retain a reversionary interest; 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 trust for" or payable upon death bank account or security at his or her death? ......... ^ ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^ ^
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 surviving spouse is zero (0) percent
p2 P.S. §9116 (a) (1.1) (ii)J. The statute does not exemat a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are stil- applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption,
1
REV-1508 E,X + (B-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RES DENTEDECEDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
MARY JANE WAKEFIELD 0 0
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properly jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. IRS Refund (not yet received) 500.00
2. Members 1st Federal Credit Union 245.91
Checking Account
3. Members 1st Federal Credit Union 719.49
Savings Account
4. Guardian Elder Care in Carlisle (refunded to Agent) 3,019.00
5. CRX Railroad (refund) 10.00
6. MetLife -husband's pension plan (widow's benefit) 33.00
7. Stainless steel old-English ring initialed "R", 0.00
referred to in ITEM THIRD of Decedent's Last Will & Testament,
never found or located.
TOTAL (Also enter on line 5, Recapitulation) S 4 527.40
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE G
INTER•VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
FILE
MARY JANE WAKEFIELD 0 0
This schedule must be completed and filed 'rf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORRFALESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF DECD'S
INTEREST
EXCLUSION
(IFAPPLICABLE)
TAXABLE
VALUE
1. Prudential common stock -issued over the years to Decedent 2,900.50 2,900.50
in lieu of dividend. Received by son at her death because he
was beneficiary of very small life insurance policy that was
liquidated prior to her death to pay nursing home bill. This
was not a probate asset.
(see documentation attached hereto and marked Exhibit "1")
TOTAL (Also enter on line 7 Recapitulation) ~ ~ 2 900 50
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARY JANE WAKEF{ELD 0 0
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Funeral (pre-paid) $8,000
B. ADMINISTRATIVE COSTS:
1. Personal Representakive's Commissions
Name of Personal Representative {s) Cheryl D. Musselman
Street Address
City State Zip
Year(s) Commission Paid:
2 Attorney Fees Gregory R. Reed
3, Family Exemption: (If decedent's address is not the same as claimants, attach explanation)
Claimant NOT APPLICABLE
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills
5 Acxountanrs Fees
6, Tax Return Preparers Fees
7, Income tax preparation -Crystal U. Hackett, CPA
750.00
i
750.00
76.50
90.00
TOTAL (Also enter on line 9, Recapitulation) ~ S ~
(If more space is needed, insert additional sheets of the same size)
REV-1512 la(* (12-03J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & DENS
ESTATE OF hlLt NUMI3tK
MARY JANE WAKEFIELD 0 0
Report debts incurred by the decedent priorto death which remained unpaid as of the date of death, including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Commonwealth of Pennsylvania, Department of Public Welfare 104,711.71
(see copy of letter attached hereto and marked Exhibit"2")
TOTAL (Also enter on line 10, Recapitulation) I S 1
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (i1-08)
pennsylvania SCHEDULE ]
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. Cheryl D. Musselman, 706 Front Street, Enola, PA 17025 Daughter 50% of residue
2. Donald D. Wakefield, 866 Flook Road, Jersey Shore, PA 17740 Son 50% of residue
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
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.
hiblt 1
Ex
Prudential
IMPORTANT TAX RETURN DOCUMENT ENCLOSED
001632
IIII'Illll'IIIIIIIIIrIJrIIIIIIIIrLlnlllllllllll'1111'1""ll'I
Recipient
DONALD D WAKEFIELD
866 FLOOK RD
JERSEY SHORE PA 17740
Holder Account Number
00030982029 I N D
T
SSNfrIN Certified Yes
Symbol PRU
Ct:sip 744320102
ODICS0007.SAL.C.REG.D.L.CI5.051749 2731/001632/00163211
Prudential Financial, Inc. -Sale Advice 12010 Tax Form 1099-B
Corrected (if checked} Copy B -For Recipient
Form 1099-B -Proceeds from Broker and Barter Exchange Transactions 2010
This is important taz information and is being famished to the Internal Reverale Service. If you are required fp file a return, a negligence
penalty or other sanction may be imposed on you'rf this income is taxable and the IRS detennines that it has not been reported.
DONALD D WAKEFIELD
Recipient 866 FLOOK RD
JERSEY SHORE PA 17740
Account Number 0030982029
Recipient's ID no. 183440462
Payers FederallD No. 43-1912740
OMB No. 1545-0715
Deoanment of the Treasury -Internal Revenue Serv ce
ta- Date of Sale '~ p Stocks, Gross Proceeds
or Exchange CUSIP No. I Bonds, etc. ($) Reported to IRS Payer's Derails
11 Jan 2010 744320102 2,915.91 Yes COMPUTERSHARE
P.O. BOX 43010
FEDERAL INCOME '
- --De4er~tier~- ----Nerve-af Is~;oar - ---- ---- --- --- - .Tt2r~sackon .. _ _-- ._ . _.. -- ---
T~v ItITLI LIGI fl /[1
0.00 PRUDENTIAL FINANCIAL INC Sale - 001
NOTE: Computershare will report the amount in Box 2 to the IRS. The difference between the gross proceeds amount in Box 2 and the net proceeds
you received represents any fees, charges, or withholding taxes you may have paid.
Form 1099-B (fceep for your recorast
Summary This advice is a result of the sale of Plan andlor Direct Registration shares.
Trade ' ShareslUnits Price Per Gross Amount Deduction I Deduction Net Amount
~ Transaction Description I Sold I SharelUnit $ I of Sales $) I Amount $)
DatelTime i {) ( ( Type of Sale ($)
01111!201014:01 Sale 55.000000 53.016557 2,915.91 15.40 Transaction Fee 2,900.51
Computershare Trust Company, NA., as agent, upon written request, will provide the name of the executing broker dealer associated with the transaction(s), end within a reasonable amount of time will disclose the source
and amount of wmpensaGon received from third parties in connection wIN the transac0on(s), i(any. If trade time is not included above, it may be available upon written request.
~'
71 UTX
~,omputershare
Computershare Trust Company, N.A-
PO Box 43033
Providence, Rhode Island 02940-3033
Within USA, US territories 6 Canada 800 305 9404
Outside USA, US territories b Canada 732 512 3781
v~v11w. computersha re.com/investor
PRU 'I"
`~~~~~ ~~-~~~~ OOHX2E{FT) PLFASECASHNEPOSITTHISCHECKPROMPTLY.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DIVISION Of THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
February 22, 2010
GREGORY R REED ESQUIRE
3120 PARKVIEW LANE
HARRISBURG PA 17111
Re: Mary Wakefield
CIS #: 580197303
SSN: ###-##-5699
Date of Death: 1OJ29/2009
Dear Attorney Reed:
Please be advised that the Department of Public Welfare maintains a
claim in the amount of $104,711.71 against the above-mentioned estate. This
claim is for restitution of medical assistance granted on behalf of the
decedent for which the Probate Estate is now responsible to reimburse the
Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as
amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's
itemized statement of claim.
A portion of this medical expense, namely $37,769.97, was incurred
during the last six months of the decedent's life; therefore, it is a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $66,941.74, is
to be entered as a priority Class 5.1 claim against the estate.
Please acknowledge receipt of this letter and advise whether the
Commonwealth's claim is admitted and when payment may be expected. If the
estate accounting is complete, please provide a copy. If the estate contains
real estate, please provide copies of the deed, the latest tax assessment,
and a current appraisal, if available.
S' cerely,
aren H. Peterson
Claims Investigation Agent
717-772-6615
717-772-6553 FAX
Enclosure
LAST WILL AND TESTAMENT OF MARY JANE WAKEFIELD
KNOW ALL MEN BY THESE PRESENTS, That I, MARY JANE WAKEFIELD,
of the Borough of West Fairview, County of Dauphin and State of
Pennsylvania, do make, publish and declare this instrument to be
my Last Will and Testament, hereby revoking and making void any
and all former Wills by me at any time heretofore made.
FIRST - I direct the Executor or Executrix hereof to pay all
my just debts, funeral expenses and costs of administration as
soon as conveniently may be done after my death. I further
direct the Executor or Executrix hereof to pay all inheritance,
estate, transfer and succession taxes which may be levied or
assessed upon any property which is included as part of my gross
estate for the purpose of any such tax.
SECOND - I give, devise and bequeath all the rest, residue
and remainder of my estate, both real and personal, to my
husband, RAYMOND L. WAKEFIELD.
THIRD - If my said husband fails to survive me, then I give
and bequeath my husband's stainless steel old-English ring,
initialed "R", to my granddaughter, REBEKAH WALTZ.
FOURTH - If my said husband fails to survive me, then I
give, devise and bequeath all the rest, residue and remainder of
my Estate, both real and personal, as follows:
(a) Fifty (50$) percent thereof to my daughter,
CHERYL D. MUSSELMAN, or if she fails to
survive me, to her issue per stirpes; and
,,
'. `;
r,
(b) Fifty (50%) percent thereof to my son,
DONALD D. WAKEFIELD, or if he fails to
survive me, to his issue per stirpes.
FIFTH - I appoint my said husband, RAYMOND L. WAKEFIELD, to
be the Executor of this, my Last Will and Testament. In the
event of the death, resignation, renunciation or inability to act
of my said husband, then I appoint my said son, DONALD D.
WAKEFIELD, Executor hereof. In the event of the death,
resignation, renunciation or inability to act of my said husband
and my said son, then I appoint my said daughter, CHERYL D.
MUSSELMAN, Executrix hereof. I do hereby give to the Executor or
Executrix hereof full power, discretion and authority at any time
or times to sell, at private or public sale, mortgage, lease,
pledge, exchange or otherwise deal with or dispose of the
property comprising my estate upon such terms as deemed best, to
settle and compound any and all claims in favor of or against my
estate as deemed best and, for any of the foregoing purposes, to
make, execute and delivery any and all deeds, mortgages,
contracts, leases, bills of sale or other instruments necessary
or desirable therefor.
LASTLY - I direct that no fiduciary appointed by this, my
Last Will and Testament, shall be required to give Bond and that
if, notwithstanding this direction, any Bond is required by any
law, statute or rule of court, no Surety shall be required
thereon. ~ ,
~/
IN WITNESS WHEREOF, I have set my hand and seal to this, my
Last Will and Testament, consisting of three (3) pages on the
margin of which (except this page) I have affixed my initials
this ~'" day of :~/t"2~`r~~1~rt~^ A. D. 2002.
,~ j~/ ~:(. ~~ ` •;• ~ ~~ /1~" c:r~,j~-rte t.C~ (SEAL )
Signed, sealed, published and declared by MARY JANE
WAKEFIELD, the above named Testatrix, as and for her Last Will
and Testament, in the presence of us and each of us, who at her
request, and in her presence, and in the presence of each other,
have hereunto subscribed our names as attesting witnesses.
~f Jam,'' ; ..-
,~' .,-
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s ~.ry•ti
ACKNOWLEDGMENT
STATE OF PENNSYLVANIA
COUNTY OF DAUPHIN
:ss
I, MARY JANE WAKEFIELD, 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 instrument as my Last Will; and that I signed
it willingly and as my free and voluntary act for the purposes
therein expressed.
Sworn to or affirmed and acknowledged before me by MARY
JANE WAKEFIELD, the testatrix, this ~~ day of November, 2002.
~', ~ ,.
L1: ,.
MARY ,' E WAKEFIELD -
Testatrix
Notary Publ'c
NOTARIAL SEAL
CARA J. VJENGER, Notary Public
City of Harrisburg, Dauphin County
My Commission Expires Feb. 24, 2003
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
:ss
We, Gregory R. Reed and Susan F. Reed, the witnesses whose
names are signed to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we were
present and saw the testatrix sign and execute the instrument as
her Last Will; that the testatrix signed willingly and executed
it as her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and
sight of the testatrix signed the will as a witness; and that to
the best of our knowledge the testatrix was at that time 18 or
more years of age, of sound mind and under no constraint or
undue influence.
Sworn to or affirmed and subscribed to before me by
Gregory R. Reed and Susan F. Reed, witnesses, this lst day of
November 2002.
~:~
Witness
Witness
G ~
/ ~
Notary Publi
NOTARIAL SEAL
CARA J. WENGER, Notary Public
City of Harrisburg, Dauphin County
My Commission Expires Feb. 24, 2003