HomeMy WebLinkAbout03-01-10 (3)15056051058
REV-1500 Fx (OB-05) oFFICULL UsE ONLY
PA Depertrnerd of Revenue
Bateau of individual Taxes County Code Year Ftle Number
Po Box 211oeo1 INHERITANCE TAX RETURN _ -
lisldebiag, PA n128-0801 RESIDENT DECEDENT ~' v ~ I p~ (~ SS
Social Security Number Date of D~th
162-22-3564 12/23/2009
_ _. _ .
Decedent's Last Name -_ .3uflix _
Heckman Jr
(If Appllrable) E~sr Survhring Spouse's loforrriatbrt Below
Spouse's Last Name Suffix
Spouse's Social Security Number -
_ . _
FILL IN APPROPRIATE OVALS BELOW
C>~ 1. Original Retum
Date of BMh
02/11/1929
___
Decedent's Flrst Name
John
MI
O
Spouse's First Name
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
O 2. Supplemental Retum O 3. Remainder Retum (date of death
prior to 12-13-82)
O 4. Limited Estate G7 4a. Future Interest Compromise (date of p 5. Federal Estate Tax Retum Required
death e(ter 12-12-82)
Old B. Decedent Died Testate
of ~I
(A S O 7. DeoedeM Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
PY
) (Attach Copy of Trust)
t'~ 9. Litigation Proceeds Received O 10. Spousal Poverty Credll (date of death c~ 11. Election b tax under Sec. 9113(A)
between 1231-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THB SEl:TION MUBT BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTW
TAX INFORMATpN SHaILD DE DIRECTE
Name .
D T0:
Daytlme Telephone Number
_._
John R. Heckman
__ _- _
(717) 766-6143
Flrrn Name (If Applicable) ___
_
---
_
__ __
__. , ,. .. __.. _ ---._ ___ _ ~_.
._ ..
_ i REGISTER OF WILLS USE ONLY
First line of address ~ o t :`,~~
5024 Kylock Rd ~O
p~
a i
r
~;
second line of address c
n
t n~n
~ m ."~
1 r.~j J
; ~ +";
~~
r~
_ _ ^~
Gty or Poat Offlos
- State ZIP Code„ ~'1FlieD ~
Mechanicsburg
PA 17055 b ~' ~ ~ ~
-
_ _._ - . __ ,
_ tT
CorresporWertt's e-mail address: lheck5024(~comcast.net
Under peneMbs of perjury, I dsdare that I have axanrined this realm, fndudkp aooarparrying sdredWas end starorrrents, and b the beet of my knowledge and bslbf,
a fs true. wnact and complete. Dsdrntion of praparer odrer Than the peraorral rs
rpantalive i
b
d
p s
ase
on ae intorrnatbn nt which preparer has an y knowledg e.
S RE f~ ERSON SIBL FOR FILING RETURN DA E
~ ~~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE
DATE
ADDRESS
PLEASE t!Q! ORIOINIAL fF01lM ONLY
1 505605 1 058 Side 1
15056051058
15056052059
REV 1500 EX
Deoeaenrs Narrre: John
RECAPITULATION
O Heckman
Decedent's Social Security Number
162-22-3564
1.
Real estate (Schedule A) ........................................ _.
..... 1.
___ __
0.00
2. Sfodcs and Bonds (Schedule B) .................................. ..... 2.' 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00
4. Mortgages & Notes Receivable (Schedule D) ........................ ..... 4. ' 0.00
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ... ..... 5. 124,425.98
8. Jointly Owned Property (Sdredule F) C7 Separate Billing Requested .. ..... 8. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property _.._ .. __._..._. _ _..___._._ __.. _.... _ . _
(Schedule G) O Separate Billing Requested... ..... 7. 0.00
8. TAI Grass Asssts (total Lines 1-7) ............................... ..... 8. 124,425.98
9.
Funeral Expenses & Administratlve Costs (Schedule H) ................ .~__
..... 9.
______ . _w._ _ ______..____.___~...w..._______.__ _
7,237.81
_ . _ .. _____
10.
Debts of Decedent, Mortgage Liabilitles, & Liens (Schedule I) ...........
..... 10. __.... _ _
7,828.72
11. Tofal Dsductlons (total Unes 9 & 10) .............................. ..... 11. 15,066.53
12. Nst Valw of Eshb (Line 8 minus Line 11) ......................... ..... 12. 109,359.45
13. Charitable and Governmental Bequests/Sec 9113 Treats for which __ __ __...._ ._. ~..._ __... ~... _ _ _
an election to tax has not been made (Schedule J) ................... ..... 13.
._ _.....__ . 0.00
_._. ._. _m
14.
Nst Valw Su6Hct fA Tax (Line 12 minus Line 13) ...................
..... 14. ____ .. __
109,358.45
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at fhe spousal tax rate, or
trarus<ersunderSec.9118 __ _._.._ _. _. _ _._
18. Amount of Line 14 taxable ~`" ""° °"__ _ _ ~_.._._.___ _..._.___...._....._ a __._....___,_____ ~.~ ~,., _._ _ . .
at lineal rate X .0 45 109,359.45 ' 16, 4,921.17
17. Amount of Line l4 taxable '._~~~`~"~""`-"~-_.. .___._.___.._._...._ . __~.._...,..__. _.._.,.......
at sibling rate X .12 17.
18. Amount of Line 14 taxable _ ,...._.... _ __ _.. _ .
at collateral rate X .15 18.
19. TAX DUE ..................................................... ....19.: 4,921.17
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 Comalete Address:
--~ ,
~ ~~~
s_ ____ .__._.~_ ,
DECEDENT'S SOCIAL SECURITY NUMBER
John O Heckman
162-22-3564
STREEfADDRFSS
20 North 12th St.
CITY
Lemoyne STATE ZIP
PA 17043
Tax Payments and CIredH~:
1. Tax Due (Page 2 Line 19) (1) 4
921
17
2. CreditslPayrnenis ,
.
A. Spousal PoveAy Credit
B. Prior Payments
C. Discount 246.00
3. Total Credits (A + g + C) (2)
InteresflPenalty if applicable 246.00
D. Interest
E. Penalty
4. Total InterestlPenaAy (D + E) (3)
If Line 2 is greater then Line 1 + Use 3, enter the difference. This is the OVERPAYMENT. 0.00
FNI In oval on Page 2, lJrre 20 to squat a refund. (q)
5. If Line 1 + Line 3 is greater than Line 2, enter the differarxe. This is the TAX DUE (5) 4,675.17
A. Enter the interest on the tax due. (~)
B. Enter the total of Line 5 + 5A, This is the BALANCE DUE (56) 4,675.17
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 incortle of the properly transterred :...................................................................... ^
....................
b. retain the right to daignale who sheu use the properly transferred or Its Irlcorrle : ............................................ ^
c. a reversionary interat; ar .......................................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^
2. ff death ocarred alter December 12,1982. did decedent transfer properly within one year of death
without receiving adequate consideretion? .............................................................................................................. ^
3. Did decedent own an in tnrst for" ar payable upon death bank account or security at his or her death? .............. ^
4. Did decederd own an Individual Retirement Account. annuity, or other nonyxobate propeAy whidi
contains a beneficiary designation? ........................................................................................................................ ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FEE R AS PART OF THE RETURN
- --
ordates of death on or after ,grly 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the tie of the surviving spouse
is three (3) percent p2 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) peroertt
[72 P.S. §8116 (a) (1.1) (ii)]. The statute does not ezemot a transfer to a surviving spouse fiom tax, and the statutory requirements for disdoslrre of assets and
filing a tax return are still applicable evenrf the surviving spouse is the only beneficiary.
For dates of death on a otter 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 fhe use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [l2 P.S. §9116(a)(1.2)].
The tax rate imposed on tits net vakre of transfers to or for the use of the decedent's lineal beneficiaries is fcur 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 tits net value of transfers ip or for the use of the decedents siblings is twelve (12) pero~t (/2 P.S. §9116(aK1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common witir the decedent, whetiter by blood or adoption.
REV-1508 EX+ (8-88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
scNEOU~ E
CASH, BANK DEPOSRS, 8~ MISC.
PERSONAL PROPERTY
es rAr t yr FILE NUMBER
John O Heckman jr 2009-01208
Include the proceeds d litigation and the daps tiie proceeds were received by Ule escape.
~ proW~ JoMMyownad vdtlr right of survlvorsMp must bs dbcbsad on SchaduN F.
un~neo I ------__--- VALUE AT I]ATE
1 Pa State Err~loyees Credit Union account 8248 (IRA Account)
2 PA State Employees Credit Union account 8248 (Certificate Account)
3 PA State Employees Credit Union account 8248 (Checking Account)
4 Teamsters Local 778 Retirentertt Pay
5 Fumishingsl iwo room retirement home Essex house Lemoyne
6 Household goods/dothinglMisc
TOTAL (Also enter on line 5, Recapitulation) ;
(If more space is needed, insert additional sheets of the same size)
19, 718.22
100,539.76
2,644.00
524.00
750.00
250.00
124,425.98
REV-1511 EX+ (10-09)
~ Pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RET4RN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
John O Heckman jr. 2009-01208
Deudant'a debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' US Military Uniform for burial
400.35
2 Patriot News obituary notice 388.96
s Women of Zion church, funeral luncheon 700.00
a Zion Lutheran church sexton services 100.00
5 Pastor Weaver, and Pastor Houdc 200.00
s Pamelas ibwers, funeral service 235.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
4,800.00
Name(s) of Personal Representative(s) John R. Heckman
street Address 5024 Kvlock Rd.
City Mechanicsburg _ state PA ZIp 17055
Year(s) Commission Paid: 2010
Z• Attorney Fees: 0.00
3• Family Exemption: (If decedent's address is not the same as daimant's, attach explanation.) 0.00
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: 363.50
5• Accountant Fees:
0.00
6• lax Return Preparer Fees:
50.00
7.
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL (Also enter on Line 9, Recapitulation) # 7,237.81
IF more space is needed, use addmonal sheets of paper of the same size
REV-1512 EX+ (12-OS)
Pennsylvania
DEPARTMENT OF REVENUE
lNHERITANCE TAX RETURN
RESIDENT DECEDENT
OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES 8t LIENS
FILE NUMBER
John O Heckman jr. 2009-0128
Report debts Incurred by the decedent prior to loth that remained unoahl at the dace of nearh_ In~~~i.... ~.....~...ti..se.....r~__~ ________
.~ n~VIG illOK ~~ ~REAtlD, mser[ aoDiuonai sneers Dr me same size.
REV-1513 EX+ (11-08)
Pennsylvania SCHEDULE 7
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
estate OF FILE NUMBER
John O Heckman jr 2009-01208
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Truste(e) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1.
2
3
4
5
6
John R Heckman 5024 Kylodk Rd Mechanicstwlg PA 17055
JoArln Powanda 342 East Walnut SL Shillington PA ! q b o7
Jamie Ridkent>ach 6827 Heister Valley Rd Richfield PA 1 ~ ~ S+o
Jill Hamel 91 Pepper Ave Enda PA 17025
Janine Howe 206 Longview Dr. Smithfield NC. ~ ys 7 ~
Jody Bose 12504 Old Chapel Rd. Glen Dale MD ~ 0 7 (0 9
son
daughter
daughter
daughter
daughter
daughter
ENTER DOLLAR AMOUNTS FOR DISTRIBUT10N5 SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER BECKON 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1
1/6
116
1/6
1/6
1/6
1 /6
TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
If more space is needed, Insert additional sheets of the same size.
LAS? RILL IID T=S?~'t
OF
N
JOB O. g ~ ~''
JR. ~ o ~., : ~ ~
C7 t'7 .7
I, JOBN O. HgCKYIUT, JR., Social 3eeurity Number 104= S6 s ofd r?
the state o! Pennsylvania, declare that this is my LAST ~:..
TESTAI~NT and I revoke all other wills and codicils previ' y mslte ~~i~
,~- `Y)
FIRST: I appoint my Wife, c3BRALDINB A. 88CKW111, as any Personal.
Representative concerning this Will. IS she is unable or fails to
serve, I then appoint my son, JOHN R. HSCKYAN, o! Yechaniasburg, '
Pennsylvania, to serve as my personal 8epresentative.
a. I request that my Peraonal Representative be permitted to
serve without bond or surety thereon and without the intervention of
any court, except as required by law. I direct that my Peraonal
Representative act in unsupervised administration so as to administer
my estate with a minimum of court supervision. If it becomes necessary
to have ancillary administration of ay estate in any ~urisdiation where
my Personal 8epresentative is unable or does not. desire to qualify as
ancillary legal representative, I appoint as such ancillary legal
representative such individual or corporation as my Personal
Repr.eaentative shall designate, in writing.
b. I direct my Personal Representative to pay the expenses
of my last 111neas, the expense: of a funeral appropriate to my stption
in life and custom of living (including a suitable monument or marker
for. my grave), and written charitable pledges which I have made. I
grant my Personal Bepresen•tative the power to extend or renew any dQbt
for such time as my Peraonal Representative sha13 diem appropriate.
c. All estate, inheritanoe, succession and other death taxes
with respect to all property passing under this my Will shall be paid
from and borne by the prineipal.of my residuary estate,•without regard
to reimbursement, as if such taxes ware administration expenses. i(y
Peraonal Representative .may pay such taxes at any time deemed
advisable,. whether or not then due and payable.
d. Icy Personal Representative is requested to settle my
estate as soon after my death as may be practicable,- and to pay or
deliver every legacy or bequest to my benelieiaries without waiting any
time that may be believed to be customary in probate matters.
- ~ - ----- PA(i8 1
~- _ OF FOUR PAQE3 c~A•S. ~ ~~_ - (/~~~'"' -
~._~~_
e. I have aeroed in the Armed Foraea o1 the United States.
Therefore, I direst my personal $epresentative to consult with a Legal
Assistance Attorney at the nearest military installation and with the
Department of Veterans Aitairs and the Social Security Administration
to ascertain it there are any benefits to which my family members are
entitled by virtue of my military service.
t. I may leave a letter of intent with the executed copy of
this A1111 for the purpose of giving guidane• to my Personal
Repreaentative concerning the distribution or sale of certain items o!
my property: I request, but do not require, that my Personal
Repreaentative honor my wishes therein expressed.
SECO$D: I give, devise and bequeath, absolutely and forever, all
of my estate and property of which I may be seized or possessed, or to
which I may be entitled, at the time of my death, wherever aftuated or
of whatever nature, be it real, personal, or mixed, to ~- spite,
flEBALDIITE A. $ECKYA)i, as her sole and absolute property it she shall
survive me.
T$IBD: In the event that my pile, ~BALDIIIE A. $ECKMA1i shall not
survive me, I Sive, devise and bequeath, absolutely and forever, all of
ny estate and property of which I may be seized or poasesaed,.or to
which I may be entitled, at the time of rq- death, wherever situated or
of whatever nature , be it real , personal , or mixed, to ~JOAITN POMIA1pDA,
JO811 8. $ECKYAIT, JAYIB L.BICKE$HAC$, JILL L- $A$ZBL, JAYIYB A.. HEAVEB,
JODY 3. $BCKYA1t, and to-any child or children that may be born to or
adopted by me, in shares of auhatantially equal values to be divided as
they may agree.
a. It any of my children shall not survive me, than the
share o! that deceased child shall go to the descendants of that child,
who are to tak• per atirpea and not per capita. Ii any of my children.
shall not survive me and shall not be survived by any descendants, then
the share of that deceased child shall be distributed to my surviving
children and, the descendants of any of ma- other children who lair to
survive me, in the manner set forth above.
b. Ii they are unable to agree, the division among my
children and the descendants of any of myr children who fail to survive
me shall b• made by ~Y Personal Representative, in that per:on'a sole
and absolute discretion. I empower my Personal 8epr.esentative to sell
any or all of such property, it such property is not diatribut~d in
kind hereunder, and to distribute the proceeds among mar said children
in substantially equal shares. Any determination of myr Personal
Representative as to what should pass or be sold under this paragraph
and to whom it should peas or be delivered or at what price it should
be sold shall be eonelusive.
- - ~~ --- PAQE 2
-__-~'' OF FOUR PA(iH8 . A~_ ~..~~ ---~~-
FOT78TH: 8xaept as otherwise provided in this 11111 , I have
intentionally failed to provide for any other relatives or other
persona, whether claiming to be an heir of mine or not. Insotaa" as I
have failed to provide in this 11111 for any of ~W issue now living or
later born or adopted, such failure is intentional and not occasioned
by accident or mistake.
FIFTH: llny beneficiary who fails to survive until one hundred
twenty (120) hours after my death shall be deemed to have predeceased
me, and the gift to that beneficiary shall be disposed of aaaordingly.
SIXTH: Definitions:
a. The term 'ebildren' as used in this Mill includes adopted
and afterborn persons. The term 'children" as used in this will shall
also include step-children, the natural born or adopted children of a
person's spouse. d relationship by or through legal adoption shall b®
treated the same as a relationship by or through blood for purpose of
succession to property under this Will.
b. The term 'descendants' as used in this Will means the
immediate and resote lawful, lineal descendants by blood or adoption of
the person referred to adso are in being at the time they must be
ascertained in order to give effect to the reference to them.
c. The term 'issue' as used in this Will means all persons
who are descended from the person referred to either by legitimate
birth to or legal adoption by.Lhat person, or any of that deaaendant's
legitimately born or legally adopted descendants.
d. The term 'Personal Representative' ae used in this Will
means Executor, Executrix, Independent Executor, or any other title of
like import which is used to deaarlbe such a fiduciary.
e. The term 'per stirpea' as used in this Will means that
whenever a distribution is to be made to the deaeendanta of any person,
the property to be distributed shall be divided into se many =hares as
there are (1) living children of the person, and (2) deaaaaed children,
who left deaeendanta who are then living, of the person. Sash living
child (ii any) shall take one share and the share of each deceased
child shall be divided among his then living deaeendanta in the same
manner.
PA(IE 3 /~ _
- ----°--~------~-'~~ OF FOUB PARES l~~Bsl~_ 9.L~~_ __~~ _
SSVE11T8: In addition to any powers granted by the laws of the
state in which tbia Wl11 is probated, I hereby authorize and es~power
the iiduclariea named in thin Will, to the extent of the diaaretion
heroin granted, to sell, exchange, convey, transfer, assign, mortgage,
pledge, lease or rant the whole or any part of agr real or personal
estate, to invest, reinvest, or retain investments of may estate, to
perform all acts and to execute all documents which my fiduciaries may
deem necessary or proper in regard to my property. If any of my
liduciaries elect Lo receive compensation for services, such
compensation will be that allowed by law.
EIQHTH: It any part of this Will shall be invalid, illegal, or
inoperative for any reason, it is my intention that the remaining
parts, so far as possible and reasonable, shall be effective and fully
operative. 1[y Personal Representative may seek and obtain court
instructions for the purpose o! carrying out as nearly as may be
possible the intention o! this Will as shown by the terms hereof,
including any terms held invalid, illegal, or inoperative.
IN WITNESS WHERSOF, I have at Carlisle Barracks, Pennsylvania, this
~,_ day of jJota~.abee~ ~, 191_ set my hand and eeai to this my
LAST WILL AND TEST~I~NT, consisting of FOUR. typewritten pages, each
page bearing my handwritten signature.
~__. _ __ (SEAL)
HN O 88CKYAN, J8.
The foregoing instrument was, at Carlisle Barracks, Pennsylvania,
thds ?~ __ day of Pb~~a.laef _, 19 91 , signed, sealed. published and
declared by JOH1T 0. ~CKYiA)1. JR., the testator, to be his LAST WILL AND
TESTAI~NT in the preeenae of all o! ua at one time, and at the acme
time we, at his request'and in his presence and in the presence of each
other, have hereunto subscribed our names as attesting witnesses. and
we do ao verily believe that the said testator is of sound and
disposing mind and mfmory at the date hereof.
-- ~f'= PAQB 4
_____-- ~ OF FOUR PAaBS ~_A_~_ „~~~_
- --
Cdlipxl/gAyTg OF PEli1f37CLpAYIA
COIINTY OF CUYBB$LAliD
AC]C)TOIrL8Da100)iT
I, JO$9 O. I~HCKYAx JB., testator, whose name is aigned to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I aigned and executed the instrument
free~andavo Wuntaryhaetitorgthe purpoaeanthereiadexpreaseaigned it as my
_ _
H8 0. HECKYUI, J8. ~ ---------(SEAL)
AFFIDAVIT
~ ~ ~+3Q!~_/9ece?_~~c' ~.tu_F!~-- ~ J7.GtY~~Q__ Li ~T~'1L1tt~~' -- . and
~~L--~ ~-Lt~Sr~S___~_, the witnesses, sign, our names to this
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testator afgn and execute the
instrument sa his Lut Will; that the testator signed willingly and
executed it u his tree and voluntary set for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the testator signed the will as a witness; and that to the best of our
knowledge the testator was at that time 18 or more years of age, o!
s and mind and under no constraint or undue ialluen
+~.~JiJt...
- --------- 1Y~d.rc~8
---~~'
Hess Witness --- - ~~--___--
Wi tnesa -°
Subscribed, sworn to and acknowledged before me by JOBN O.
ICEMAN. JR the testator, and subscribed and sworn to before ~ by
~~°-~~-~~~~F~__ . ~Q~/~ Q L _ STip/t rl z~f~ _ . and
----
~~- S _~~""'"~`~~_. the witnesses, thls _zL___ day of Na,~
NOT Y POBLIC ley Commission Expires:
H~MrGMI~yPNblp
M°'"6m ~1°~'°"haNdwM.