HomeMy WebLinkAbout04-07-10 (3)1 1505607121
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 2 1 1 0 0 0 7 7
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 3 1 0 4 7 3 3 0 1 0 7 2 0 1 0 0 6 1 7 1 9 2 0
Decedent's Last Name Suffix Decedent's First Name MI
R A F F E N S P E R G E R E L E A N O R L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 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 CONFIDENTIAL TAX INFORMATION 5F10ULD BE DIKtG I tU I U:
Name Daytime Telephone Number
J A N L B R O W N 7 1 7 5 4 1 5 5 5 0
Firm Name (If Applicable)
J A N L B R O W N & A S S O C
First line of address
8 4 5 S I R T H O M A S C T S T E 1 2
Second line of address
City or Post Office
H A R R I S B U R G
State
P A
ZIP Code
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REGISTE
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Correspondent's a-mail address: BRENDAJLB _VERIZON.NET
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Under penalties of pery'ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of 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 N URE OF PERSON R SPONSIB FOR FILING RETURN DATE
~}-~i~.n~ ~ `~~~~[ ~ 4 / 6 / 2 010
110 FAIRVIEW DR HARRISBURG PA 17112
SIGNATURE OF P ER THAN REPRESENTATIVE DATE
__ 4/6/2010
845 SI~`-~MAS CT STE 12 HARRISBURG PA 17109
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505607121 1505607121
J
REV-1500 EX
1505607221
Decedent's Name: ELEANOR L • RAFFENSPERr;ER
Decedent's Social Security Number
2 0 3 1 0 4 7 3 3
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. •
9 5 4 5 7 . 1 8
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5.
6. Jointly Owned Properly (Schedule F) ^ Separate Billing Requested ....... 6. 3 0 7 3 5. 0 2
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested .......
7. 6 1 6 8 7 3. 3 9
8. Total Gross Assets (total Lines 1-7) ........................... 8. 7 4 3 0 6 5. 5 9
9. Funeral Ex enses & Administrative Costs Schedule H
P ( ) ................ 9. 1 9 0 8 6 . 3 8
10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I
9 g ( ) ............ 10. 1 0 1 8 . 4 0
11. Total Deductions (total Lines 9 & 10) ........................... 11. 2 0 1 0 4 • ? 8
12. Net Value of Estate (Line 8 minus Line 11) ......................... 12• 7 2 2 9 6 0 . 8 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. 7 2 2 9 6 0 . 8 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 0. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 7 2 2 9 6 0. 8 1 16. 3 2 5 3 3. 2 4
17. Amount of Line 14 taxable 0 0 0 0 0 0
at sibling rate X .12 17, •
18. Amount of Line 14 taxable
0
0
0
0
0
0
at collateral rate X .15 . 1 g, .
3 2 5 3 3. 2 4
19. Tax Due ............ .......................... ... ....... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L 1505607221
Side 2
0
1505607221
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 10 0077
DECEDENTS NAME
ELEANOR L. RAFFENSPERGER
STREET ADDRESS
770 Po lar Church Road
East Pennsboro Township
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
~• Tax Due (Page 2 Line 19) (1) 32,533.24
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount 1,626.66
Total Credits (A + B + C) (2) 1,626.66
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
6. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
0.00
(5) 30,906.58
(5A)
(56) 30,906.58
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 : ...................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^ ^X
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... Q ^
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q
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)].
For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-0ne 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)].
0.00
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-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ELEANOR L. RAFFENSPERGER
FILE NUMBER
21 10 0077
--
Indudethe proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T Bank Checking 61207446 8,197.42
2 M&T Bank Savings 15004222002682 1,000.12
3 M&T Bank CD 31003913944590 8,892.57
4 M&T Securities AZD-415941 20,102.82
Cash balance
5 PNC Bank Checking 5004894008 9,822.53
6 PNC Bank Money Market 5004414473 38,781.38
7 Residuary Trust UWO Carl Raffensperger 0.14
Ck 101 dtd 1 /14/10 payable to Estate of Eleanor L Raffensperger for 2009 interest
8 Carl T Raffensperger Trust 758.00
Ck 1011 dtd 1 /14/10 payable to Estate of Eleanor L Raffensperger for 12/09 interest
9 Residuary Trust UWO Carl Raffensperger 223.99
Ck 1038 dtd 1 /14/10 payable to Estate of Eleanor L Raffensperger for 12/09 interest
10 HARP LTC refund; Check 0028579495 dtd 1 /11 /10 107.50
11 HARP cancellation refund; Check 0028666420 dtd 2/3/10 21.05
12 Capital Blue Cross refund 342.67
13 Comcast subscriber refund; Check 0003832573 dtd 2/3/10 34.11
14 Golden Living Center refund 875.88
15 MetLife nursing home benefit; Check 000635202 dtd 1/4/10 3,906.00
16 United States Treasury; 2009 1040 overpayment refund 1,502.00
TOTAL (Also enter on line 5, Recapitulation) a 95,457.18
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-15001nheritance Tax Return Resident Decedent
ELEANOR L. RAFFENSPERGER
Decedent's Name
Page 1
21 10 0077
File Number
Schedule E -Cash, Bank Deposits, & Misc. Personal Property
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
17 PA Department of Revenue; 2009 PA-40 overpayment refund 889.00
SUBTOTAL SCHEDULE E 889.00
GRAND TOTAL SCHEDULE E ~ 95,457.18
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
ELEANOR L. RAFFENSPERGER
FILE NUMBER
21 10 0077
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Todd W Lehman
I s Jon V Lehman
I C Louise L Hesse
667 W 161 St Apt 3H son
New York NY 10032
735 State St son
Lancaster PA 17603
110 Fairview Dr daughter
Harrisburg PA 17112
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTERESI
1. A. 2006 M&T Bank Money Market 15004219140271; 18,312.28 50. 9,156.14
originally established in M&T Securities 428050
2 B 2006 M&T Bank Money Market 15004219140289; 33,438.27 50. 16,719.14
originally established in M&T Securities 428076
3 C 2006 M&T Bank Money Market 15004219140263 9,719.48 50. 4,859.74
originally established in M&T Securities 426344
TOTAL (Also enter on line 6, Recapitulation) I S 30,735.02
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
ELEANOR L. RAFFENSPERGER 21 10 0077
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.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY of THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1. Gift on 12/26/09 from Eleanor L Raffensperger to 13,000.00 100. 3,000.00 10,000.00
Todd W Lehman, son
2 Gift on 12/26/09 from Eleanor L Raffensperger to 13,000.00 100. 3,000.00 10,000.00
Jon V Lehman, son
3 Gift on 12/26/09 from Eleanor L Raffensperger to 13,000.00 100. 3,000.00 10,000.00
Louise L Hesse, daughter
4 M&T Securities IRA AZR-062771; Todd W Lehman, 57,405.85 100. 57,405.85
Jon V Lehman and Louise L Hesse, children, beneficiaries
5 Transamerica Nonqualified Annuity 02CBT090956; 126,012.36 100. 126,012.36
Todd W Lehman, John V Lehman and
Louise L Hesse, children, beneficiaries
6 Residuary Trust UWO Carl T Raffensperger 403,455.18 100. 403,455.18
DOD value $409,529.18 less exp of $6,074 = $403,455.18
Note: Schedule O election was not made in the
Estate of Carl T Raffensperger (File 21-06-0682).
Dececent, spouse of Cart T Raffensperger, was primary
beneficiary of this Trust. The remaindermen beneficiaries are:
75% - Fred C Raffensperger & Amy R Meade, Carl's children
25% - Todd W Lehman, Jon V Lehman &
Louise L Hesse, Eleanor's children
TOTAL (Also enter on line 7 Recapitulation) I ~ 616,873.39
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
ELEANOR L. RAFFENSPERGER 21 10 0077
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hoover Funeral Homes & Crematory Inc 3,281.00
2 Memorial program 25.31
3 Isaac's; memorial luncheon 500.00
4 Memorial/marker inscription 200.00
B.
2.
3.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Louise L Hesse
Street Address 110 Fairview Drive
city Harrisburg State PA
Year(s) Commission Paid: 2010
Attorney l=ees Jan L Brown & Associates
Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Zip 17112
5,962.00
6,792.00
4.
5.
6.
7.
8
9
10
11
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Acxountant's l=ees Parks & Company; final 1040 and 1041 prep
Tax Return Preparers Fees Denk & Associates PC; 2009 income tax prep
Cumberland Law Journal; legal advertising
The Patriot-News; legal advertising
Parking fee
Postage
Cleanup/disposal fee
339.50
500.00
395.00
75.00
300.41
4.00
12.16
700.00
TOTAL (Also enter on line 9, Recapitulation) S 19.086.38
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ELEANOR L. RAFFENSPERGER
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 10 0077
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Amber Long Weyant; caregiver 250.00
2 Edward E LaMarque MD 76.17
3 Golden Living Center 78,83
4 Jan L Brown & Associates; invoice dated 1/6/10 100.00
5 PharMerica 140.32
6 Verizon 15.58
7 West Shore EMS -BLS; dos 12/23/09 177.50
8 United States Treasury; federal withholding tax 150.00
9 PA Department of Revenue; state withholding tax 30.00
TOTAL (Also enter on line 10, Recapitulation) I ~ 1,018.40
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
ELEANO R L. RAFFENSPERGER 21 10 0077
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
j TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Todd W Lehman, son Lineal
667 W 161 St Apt 3H, New York, NY 10032 Sch F & G
1 /3 residue
2 Jon V Lehman, son Lineal
735 State St, Lancaster, PA 17603 Sch F & G
1 /3 residue
3 Louise L Hesse, daughter Lineal
110 Fairview Dr, Harrisburg, PA 17112 Sch F & G
1 /3 residue
4 Fred C Raffensperger, son of Carl & stepson of Eleanor Lineal
17 Peverell St Apt 3, Dorchester, MA 02125 Sch G
5 Amy R Mead, son of Carl & stepson of Eleanor Lineal
467 Atlantic St, East Northport, NY 11731 Sch G
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
jj. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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
ELEANOR L. RAFFENSPERGER
I, ELEANOR L. RAFFENSPERGER, now domiciled in Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament. I revoke all other wills and codicils
that I may have previously made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after my
death.
Article II
All inheritance, estate, and succession taxes (including interest and penalties thereon, but not
including any generation skipping tax) payable by reason of my death shall be paid out of and be
charged generally against the principal of my residuary estate without reimbursement from any
person. This provision is not a waiver of any right which my Executor has to claim reimbursement
for any such taxes which become payable as the result of any property over which I have the power
of appointment.
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Article III
I give, devise and bequeath in accordance with any memorandum which I have either
handwritten or signed, located with my will or with my valuable papers and found within 30 days of
the probate of my will. Gifts may only be to persons who survive me or to organizations which exist
at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath IN EQUAL SHARES to my children, LOUISE L. HESSE, of
Dauphin County, Pennsylvania, TODD W. LEHMAN, of New York City, New York, and JON V.
LEHMAN, of Lancaster County, Pennsylvania.
If any of my beneficiaries predecease me or fail to survive me by thirty (30) days, I give,
devise and bequeath his or her share to his or her natural issue (not to include stepchildren) who
survive me, per stirpes, or if he or she has no natural issue, the share(s) are to be added equally to the
other shares.
Article V
Except as otherwise provided in this Will, I have intentionally failed to provide for any
other persons or relatives, whether claiming to be an heir and/or relative of mine or not. Insofar
as I have failed to provide in this Will for any of my relatives, and/or issue now living or later
born or adopted, such failure is intentional and not occasioned by accident or mistake.
Article VI
If any person or entity other than me singularly or in conjunction with any other person or
entity directly or indirectly contests in any court the validity of this Will, including any
amendments or codicils thereto, then the right of that person or entity to take any interest in my
estate shall cease, and that person or entity shall be deemed to have predeceased me.
Article VII
I nominate, constitute, and appoint my daughter, LOUISE L. HESSE as Executrix of my
Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason
whatsoever of my Executrix, I nominate, constitute and appoint my son, TODD W. LEHMAN as
successor Executor of my Last. Will and Testament. In the event of the renunciation, death, or
inability to act, for any reason whatsoever of TODD W. LEHMAN, I nominate, constitute and
appoint my son, JON V. LEHMAN, successor Executor of my Last Will and Testament. I direct
that my Executrix or successor Executors be permitted to serve without bond and in addition to those
powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares
and to file any qualified disclaimer I could have filed if living. My Executrix or successor Executors
shall receive reasonable compensation for services rendered to my estate.
Article VIII
In addition to the powers conferred by law, I authorize my Executrix and successor
Executors, in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate or
personal property except that which I specifically bequeath herein,
-3-
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which I am engaged in, or have an
interest in at time of my death, and
(j) to receive reasonable compensation in accordance with their standard schedule o~f fees in
effect while their services are performed.
IN WITNESS WHEREOF, I, ELEANOR L. RAFFENSPERGER, hereby set my hand to
this my Last Will and Testament, on ~ 2006.
-~
r.
ELEANOR L. RAFF SPE GE
In our presence, the above-named ELEANOR L. RAFFENSPERGER signed this and
declared this to be her Last Will and Testament and now at her request, in her presence, and in the
presence of each other, we sign as witnesses.
Name
/c:~,~ ,~ S~.
Address
845 Sir Thomas Court, Suite 12, Harrisburg, PA 17109
845 Sir Thomas Court, Suite 12, Harrisburg, PA 17109
-$-
I, ELEANOR L. RAFFENSPERGER, Testatrix, who signed the foregoing instrument,
having been duly qualified according to law, acknowledge that I signed and executed this instrument
as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein
expressed.
Sworn to or affirmed and
acknowledged before me by
ELEANOR . RAFFENSPERGER, the Testatrix
on `x 3 2006.
,~
ota Public
coMMONwEA~n+ OF PENrsnrANU-
NOTARIAL SEAL
JACQtIELfNE A. KELIX NOTARY PUBL~
LOYYER PAXTON TYVP., DAUPHIN COUNIY
MY COMMISSION EXPIRES DEC.17, 2007
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ELEANOR L. RAF SP R
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
bY~1'
and i.v ~t, ~C-:` ~ sc~~C ,
witnesses, on ~ -a .~ , 2006.
of Public
COMMONMIEALTH OF PENNSYIYANUI
NOTARIAL SEAL.
1ACQUEUNE A. KElll~ NOTARY PUBLlC
IDWER PAXTON TWP., DAUPHIN COUNTY
MY COMMISSION EXPIRES DEC. 11, 1007
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Witness
L~2.C~ ~ • L"~ Sly
fitness
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