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HomeMy WebLinkAbout04-05-10 (2)15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Hamsburg, PA n12a-osol RESIDENT DECEDENT ~ 1 ©'`~' ~ ` ~°J~~ 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth DecedenCs Last Name Suffix Decedents Fi~rs/t Name MpI ~~'F~'~ L ~ ~ S"fl N /V R (If Applicable) Enter Surviving Spouse's Information Below Sp~wo~~use's Last Name Suffix Spouse's First Name MI t•V~~ Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-1~-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) berNeen 12-31-91 and 1-1-95) (Attach Sch. b) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIOIN SHOULD BE DIRECTED T0: Name Daytime Telephone) Number C N.~',~Z L FS ~ `S N / .E'[. ,hS ! ~ / 7 17 ~,b~to ~RD 9 _ .w- __~ Firm Name (If Applicable) l11 ~ /4 First line of address ~2 CL ~NSF~ ~2O~.D Se~c[ond line of address ~V City or Post Office State ZIP Code ~'~ '-7 i_ .,_i ~.; r`r~ C~7 c ,.~ -~-; ti~ r-rz Q ~~ 1h~C N/!-N! c sBu RG ~/~ i ~o ss~~ 3:5 Correspondent's a-mail address: ~' eSIJ/~~~s 3 l~G WMCQS~~ ~eL Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best 0f my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI ~NAIUBE OF PERSON,R~~NSIBLE~OR FILING RETURN DATE ,. .. ,..~ ~ --,--~~_ v ~ 330 / o ADDRESS 'gg~Q 7; K~'/tZL/ lS85 W L/S,egK.t~iJ/ .~o.~D /YIE ilrl/lC5~3~I!~2l F>/1 /70SS' SIGNATUR PREP ER OJ71ER TH RE~IVE DA E ~ 3 30%0 ADDRESS CH/~/QLES ~, lE,~j)f ~' t'o LO~lSEQY /1Dil~f3 /~7E ~N/CSE36!/E'1~. ~/I /yOSS" PLEASE USE ORIGINAL FORM ONLY Side 1 15056D51047 15056051047 J~ ~ ~ 15056052048 REV-1500 EX nn Decedent~'/s Social Security Number ["~ _ Decedent's Name: TD)"~I~ YS. XE7p(.IA~ ~ ~ "1' o~ ~ $ ~ S J RECAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. . ~ Q 2. Stocks and Bonds (Schedule B) .................................... ... 2. . Q 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. . O ~ 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. . ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 3 'T 6 D ~ . 3 3 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. '~// T 7 S ~] 9 D 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 3 I 3 S 9, a 3 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 3 s ~, q . & 3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. al 3 6 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 3 ~ ~p a ~ ~ 7 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 3 S , l!7 I ~ ~ 7 ~o 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. , ~ 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ~ ~ 6 ~ O ~ ~ 6 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{~ ~ (~ D 15. ~' a 16. Amount of Line 14 taxable at lineal rate X .045 , ~ ~ 16. O O 17. Amount of Line 14 taxable p 7 at sibling rate X .12 3 ~ ~ ! ~ ~ 17 / ~ 8 .Z,,. ~ q 18. Amount of Line 14 taxable at collateral rate X .15 ~ ~ 18. ~ ~ 19. TAX DUE ....................................................... ..19. ~ oC O oZ . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 15056052048 15056052048 REV-0508 E% q(497) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY //~~/~/ ~~ j~ ~ rlLt NUMBER !~ /V a /- o q 5y3 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. Sov~'~/6AI ,Q~NX : /J2oa I~7arket ~¢Cet. # o92y~ Gi~B 737 s$ /~, 3i6, s~{ ~. Necr, inf; J5 do.d oa .1.~ir~ No./ ~ ~SCC l~Q/Kgfioh ~arq a7~LiGf?14~~. 3, ~N~ /~~N,~; CtictK,'n~ ~~e t ~ Soo ~y2 S9y2 S, ID/{~C ~i¢N~' ~ Ch GG~iity ~G't,~. ~ Sl ~ D l O 9 ~ ~5 ~~0/1-iAt. olaria~) USCG va/uah opt mar a~u e~eea> ~- ~e~wnd D>7 aMbwlct,r-.cc bill 7. Re~•-d on 131ue Shield ~ol icy. ~. O/d Son -~}K.nk Value (( ~~ q- o ~d 7-/ / */N~'o Nom' : ~CeA~i~ lied ih P~/~~I ~)~ ~~S bo'al~~ ~etu~r ti2r~--rt a~rte~ D~P2f~ ff~am, ~ hems/ SS' and -R ~ }tt ~t71,o~ G~ ~l~y ~urn;slted by ~rerwfar. n 10 . ~G~,-d o a ~~ S vna,) Tn c.. -~..~c,~ , Y"a . ~t. a'~ ~e~/~u~.Q !/. j?a(~wrid e~ 1~ona~ S,,t~, =}-axes, U. S. "jrtusvN~ 9.89 ~S, moa. G7 ./O ~g~ 37 9. sS ~~6.~6 ¢~{ 30.9,2 Z ~r0 ~`s b.o~ 9 3.00 ~I, zyy,oo TOTAL (Also enter on line 5, Recapitulation) I $ 3 ~, (a O /. 3 3 (If more space is needed, insert additional sheels of the same size) ~;~=Sovereign MA1 MB3 02-10 Court Ordered Processing/Decedent P.O. Box 841005 Boston, MA 02284 s E 5 5 6 a` 3 s Y E t ti r g .~ 5 s` m z• F i 2' 3 ~Y August 31, 2009 ~~~ / ~'~" Attn: Charles E. Shields, III Attorney-at-Law 6 Clouser Road Mechanicsburg, PA 17055 RE: John R. Kerlin Date of Death: May 28, 2009 Dear Charles E. Shields, III: Per your request, enclosed please find account information as of the date of death for the above-named decedent. For your information, accrued interest in not included in the date of death balance. Please feel free to contact me if I can be of any further assistance Very truly yours, t~-~ icole Job COP Specialist III Decedent Department (617) 533-1364 Sovereign Bank ESTATE OF John R. Kerlin SOCIAL SECURITY #: 204-26-8155 DATE OF DEATH: May 28, 2009 Account #: 0924088737 Type: Money Market Open date: 4/3/2009 In the name of: John R Kerlin (Barry T Kerlin POA) Date of Death Balance: $18,316.54 Int.(YTD) from 1 /1 /2009 to 5/4/2009 $16.54 Accrued interest to date of death: $9.89 Other Info: Account closed on 07/31/09. Page 1 of 1 2009 8:21AM PNC BANK 412-705-2]47 t~~vc LBAD~ THE WAY September 28, 2009 Charles E Shields IlI Esq 6 Clouser Rd Mechanicsburg, PA 17055 RE: .Name: John R Kerlin SSN: 204-26-8155 DOD: OS-28-2009 Dear Mr. Shields: No, 9]33 P. 2 In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Checl~ng Account Account # 5006425942 Established: 04-02-2009 JOHN R KERLIN DOD balance: $5,000.67 + 0.10 accrued interest interest paid O1-O1-2009 thru OS 28-2009 $0.67 YTD Account # 5140109895 Established: 02-01-1970 JOHN R KERLIN DOD balance: $9,379.55 non interest bearing Please note that this office provides date of death balances for deposit accounts (IltAs, CDs, Checking and Savings). We do not prncess any fiaancisl transactions or provide statements. if you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC I Page 1 of 1 REY-1510 EX • )t8T) SCHEDULE G INTER-VIVOS TRANSFERS ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT - ESTATE OF ~~F~L/N' ~.~Oy~ ~, FILE NUMBER a!~ O ~^S ~3 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIRRELATIONSMPTODECEDENTANDTHE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE - ATTACH A COPY OF THE DEED FOR REAL ESTATE . JMBER VALUE OF ASSET INTERESQT FAPPLICASLE 1. U . S. Si4Y//IIGS BbN~$ ~ p0./~ ?v ~~i 7S7 q~ /DD/p _0 .. ~~~ 7$7. 9~ iB~2~S'Y /«1/i/~ L3ro lycr (`sew liQ/aafo~ ara~ .S~~et af~arl~c~J TOTAL (Also enter on line 7, Recapitulation) ($ ~, 'J $ 7. 9 ~ !If mnro snara is naarlarl incarf arirlitinnal chaafc of tha lama ci~al Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 05/2009 7/28/09 5:13 PM 3":~t~E prmc~ Tr~t~l Value T~-tal ~nt~r~~t ~~'~ 1r~t~~-~~~: $731.25 $4,757.90 $4,026.65 $4.24 Bonds: 1-39 of 39 ~erg;~E # 5erle ~Q6311237776E E 'Q6311237777E E (Q6311231379E E +Q6055714905E E ~~Q6047837386E E Q6023878067E E Q6039874308E E Q6007043698E E Q6209572886E E Q6169936129E E Q6155565473E; E Q6155562289E; E Q6151220640E E Q6150075292E E Q6047834160E E Q6264460251E E Q6162093592E E Q6264453219E E Q6263787079E E ~Q6254722541E' E Q6254335474E' E Q6237714993E E Q6162080467E E Q6162076830E E Q6156020492E E Q6142781640E E Q6301733820E E Q6301070600E E Q6291817330E E Q6246565787E' E Q6246547537E, E Q6244787077E E Q6232534502E E Q6292321682E E Q6271031419E E Q6271017785E E s l~er~am Issue N C1a'~C' AC $25 01/1979 X25'01/1979 $25:12/19.78 $25 11/1975 $25.10/1975 $25.08/1975 $25 08/1975 $25°.05/1975 $25 10/1977 $25.04/1977- $25:02/1977 $25.01/1977 $25..01/1977, $25.12/1976 $25 11/1975' $25.06/1978 __ $25:03/1977 _$25:05/1978` $25 05/1978: $25 04/1978' $25 04/1978' $25 02/1978. $25 03/1977 $25 03/1977 $25 02/1977 $25 12/1976 $25.12/1978 $25 12/1978 $25:11/1978 $25 04/1978 ' $25 03/1978 $25 03/1978 $25.01/1978 $25'10/1978 $25 07/1978 $25 07/1978 ~xt E~nal CC'Uc~l ~IaltWrit~( 01/2009 01/2009 ' 12/Z008 11/2005 10/2005 08/2005. 08/2005 05/2005 1o/zoo7 04/2007 :02/2007 01/2007 01/2007 12/2006 11/2005 06/2008 03/2007 05/2008 05/2008 ; :04/2008; 04/2008 02/2008' 03/2007 .03/2007: 02/2007 12/2006 12/2008 12/2008 11/2008 04/2008 03/2008. 03/2008. 01/2008 10/2008 07/2008 07/2008.: Issue F~riee ~r~tc~f~~.~t: Ynleresl ~a~e - ~~l~ae ~~~~~ $18.75 $89.53 $108.28 MA $18.75 $89.53 $108.28 MA $18.75 $89.52 $108.27 MA $18.75 $115.71 $134.46 MA $18.75 $114.40 $133.15 MA $18.75 $114.40 $133.15 MA $18.75 $114.40 $133.15 MA $18.75 $114.08 $132.83 MA $18.75 $120.92 $139.67 MA $18.75. $119.29 $138.04 MA $18.75.. $119.29 $138.04 MA $18.75,,. $119.29 $138.04 MA $18.75 $119.29 $138.04 MA $18.75 $119.29 $138.04 MA $18.75 $115.71. $134.46 MA $18.75_ $88.19. $106.94 MA $18.75 ' $119.29. $138.04 MA $18.75; $87.92 $106.67' MA $18.75 * $87.92: $106.67 MA $18.75,'_. $89.79 $108.54 MA $18.75:. $89.79 $108.54 MA $18.75. $109.70 $128.45 MA ,$18.75 $119.29 $138.04 MA $18.75 $119.29 $13.8.04 MA $18.75 $119.29 $138.04 MA $18.75 $119.29 $138 .04 MA $18.75 $89.52 _ $108.27 MA $18.75 $89.52 $108.27 MA $18.75 $89.23 $107.98 MA $18.75 $89.79 $108.54 MA $18.75 $89.79 $108.54 MA $18.75 $89.79 $108.54 MA $18.75 $109.70 $128.45. MA $18.75' $88.22 $106.97 MA $18.75 ' $88.22 $106.97 MA $18.75 ; $88.22 $106.97 MA http:/ /www.treasu ryd irect.gov/BC/SBCPrice Page 1 of 2 Calculated Value of Your Paper Savings Bond(s) 7/28/09 5:13 PM Q6271014001E E $25 06/1978 06/2008 $18.75. $88,19 $106.94 MA Q6301067777E E $25.11/1978 11/2008 $18.75 $89.23 $107.98 MA Q5248845247E E $25 01/1975 01/2005 $18.75 $112.82 $131.57 MA Totals for 39 Bonds $731.25 $4 026.65 $4 757.90 ovoites NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty MA Matured and not earnin interest h[tp: / /www.treasurydirect.gov/BC/SBCPrIce Page 2 of 2 REV-1511 EX+ (12-99] ,~~~, SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1~ ~-t•~,RP./KLI PAC-~~t.roJ ~ M~SSG~MCtA'1S ?. ~i're`k ~u.rms {vr l~IC~nalltn ~u.nta~a! meal, ~". f sy~, l9 3. /r1 oh roe ~'wP. ~- oe~ (~ers~a/ >~r 6va~ ~ 35'. too e. I ADMINISTRATIVE COSTS; 1. Personal Representative's Commissions Name of Personal Representative(s) ~dtY hN ~ n ~'~~h ~ ~~ V~ Social Security Number(s)/EIN Number of Personal Repnresentative(s) SlreetAddress ~S$S W. L/s6a~.~ llota/ City A'1 P.Cf/QA~CS~•~ rs' State ~~ Zip ~ 70SS' Year(s) Commission Paid: 2. Attorney Fees C~1Qhl~S E. Shi,GIQ~S ri' ¢ u'j,~ /$"Q, 00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant /Vd DAe 2~i~~6~B hope Street Address City State Zip _ Relationship of Claimant to Decedent 4. p Probate Fees ~ OCig lha~ - SS ue •~ S~1or~' CPa^f~ 7~ Gn."r"G,g ~ ~~ ~ OO 5. Accountant's Fees ~Io d ~~jneSTDG~~ ~Ceoun~nt Cea~frh, fiyDO.00~ ~~j100, pQ 6. P~ 40 ~o~{o Pk 41 foil, er Tax Return Preparers Fees / > > ~. ,9-d /eft; -s 1 ~~ N.; C k>1t bcr~a,,Ka~ t_~ ~'~ l~r rta) ~'7s, DD 8', Ser- t ne I ; /9-dYBrtiSi/JQ rir CQ/`~i s ~e ~ 13 yt. ~{~J 9. / + - I Sov¢re~9a ~a~K , 1/a/ucEn o/1 ~ f a0. Qo //. F.%i~~tg /cep to ~ i S J~!" o~ Ll1i~~S " ~ ' ~/S. DD i2. ~Cds ~ es fih : /r~ia~/~:es, ~ios. E, ~S!~, C Re.~ 6krserlle~L- ' ~/8 20 ~d era./•ays. /~osfit:y~, ~.t~• r?e~t.>S . TOTAL (Also enter on line 9, Recapitulation) $ 3~ sZ 9 S3 (li more space is needed, insert additional sheets of the same size) REV•1512 EX+ X12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDt1LE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF kER, L fa~~ ~D~/N R, FILE NUMBER a.~ - 0 9- S~C3 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, includina unreimbursed mediral pYnpn~o~ u~ more space is neeaea, msen adomonal sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER K~7euN, .TDNn1 R ar-oq-sy3 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE. DISTRIBUTIONS [include outrighl spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. $ R'J2 Ry ?. /c C:-72C//l~ b roNer' qq.. /d©/~ ~ 13~NDR J. /eF?Zrr+-/, his w~~e ~ b~ /-G.~, SiS~r-gin-law , ~n7t"i'nt;~"es , ~ ~c'-h.alm~- ~S burg , ~/~ r 7o ss ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 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 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF JOHN R. KERLIN KNOW ALL MEN BY THESE PRESENTS, That I, JOHN R, KERLIN, of the Borough of West Fairview, County of Cumberland and State of Pennsylvania, do make, publish and dec?are 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 tree rest, residue and remainder of my Estate, real and personal, to my brother and sister-in-law, BARRY T. KERLIN and BRENDA J. KERLIN, or their survivor, and if both fail to survive me, to their issue per ~~ r stirpes. THIRD - I appoint my said brother, BARRY T, KERLIN, 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 brother, BARRY T. KERLIN, then I appoint my said sister-in- law, BRENDA J. KERLIN, to be the Executrix hereof. In the event of the death, resignation, renunciation or inability to act of my said brother, BARRY T. KERLIN and my said sister-in-law, BRENDA J. KERLIN, then I appoint all the children of my said brother and sister-in-law, BARRY T. KERLIN and BRENDA J. KERLIN, to be the Executors hereof. I do hereby give to the Executor or Executrix hereof full power, discretion and authroity 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 deliver 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) typewritten pages on the margin of which (except this page) I :have affixed my initials this ~~. day of,i~y.~~,,~~~ ~ A,n, 1989. ~ (SEAL) Signed, sealed, published and declared by JOHN R, KERLIN, the above named Testator, as and for his Last Will and Testament, in the presence of us and each of us, who at his request, and in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~~~~;, 2~ ~ / I :, {"~ ;~, ~~`_ sv ~.; ~~~ ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA s s ~. COUNTY OF ~~~Ei~l CUMBERLAND ' .: I, JOHN R. KERLIN, testator 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; that I signed it willingly; and that I signed it as my free and voluntary act for. the purposes therein expressed. ~°~ Sworn or affirmed to and acknowledged before me, by JOHN R, ~' KERLIN, the testator, this 27th day of June , 19 gg, _~ IC%v~'~` ~ '~ (SEAL ) Notarial SEaI V. ?omayne f erienbauyh, N~„ary ?ublic ~hectarncsburg E3oro, Gumberi3nd County My Gomrn~ion Expires April 5,1~J93 ~.4,~rr`~~r,.Pennsylvaniaksso~;~ti;noflVoSries , annrr-.c>r.,, COMMONWEALTH OF PENNSYLVANIA ;ss COUNTY OF CUMBERLAND Wer Nancy G. Diehl and Pauline E. Banks , 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 testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator signed the Will as witnesses; and that to the best of our knowledge the testator was ab that time 18 or more years of age, of sound mind and under no constraint or under influence. Sworn or affirmed to and subscribed to before me by, Nancy C. Diehl and Pauline E. Banks , witnesses, this 27th day of ,7une 19 gy -. !~ emu. ~ `_` Idolarial SFaI V. Roma ne i~erlenba,:oh, Notary Public I~.~11ar1iG5vuiis' LY.irU, Gurnberantl ounty 11y G~imrr,ission Expires April 5, 1993 I~Icmb2~, Fenn=_ylsania Fs/~7aiict; ei IJo;aries ~i_ 1::; {=~;~' ~:~ ~ ;'.~; f ~.., I