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HomeMy WebLinkAbout09-03-10 (2) Ex (o,-to) 1505610143 J R!V-1500 . ; A Department of Revenue pennsyhrania OFFICIAL USE ONLY ureaw Of individual Taxes DEP~R7IAENT Or REVENUE ounty ode Vsar Flb W11tN~r Box.2soso~ INHERITANCE TAX RETURN 21' 10 0 0 3 0 8 rrisburg, PA 17128-0601 RESIDENT DECEDENT ENTETER RECEDE iNFORMATiON BELOW Social Security N mt~er Date of Death Date of Birth 188 05 3770 03 03 2010 08 26 192011, DeoedenYs Last me Suffix Decedent's First Name III MI BENDER JANE ~ I (If Applicable) En r Surviving Spouse's IrNarmatiorl Below Spouse's Last Na e Suffix Spouse's First Name M) Spouse's Social S rlty Number THi3 RETURN MUST BE FILED IN DU UGATE WITH THE REGISTER OF W LS FILL IN APPROPR TE OVALS BELOW I ® 1. Original R m ^ 2. Supplemental Return [) 3. Re~ne)nder Return (date of death pri to 12-13-82) ^ 4. Limited tB ^ qa, Futuro Interest Compromise ^ 5. Federal Estate Tax Return Required ath aRer 12.12-52) (date a d e 0 ~ ® e DeGdent Testate (Attach Copy y~rl) ^ ~, Decedent Maintained a Living Trust _ __ 8. TO ai Number of Safe Deposit Boxes (Attach Copy Of Trusq I, ^ 9. Litigation P Received ^ 10. batuVVV ~R31 ~1C~ ~•date~or dean, ^ 1 t . E ' n to tax under Sec. 9113(A) Sch. O) CCIFtRE8PONDENT THE 8F.CTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFiDENTWL TAX OR#AATION IlsNOULD BE DIRECTED TO: Name Daytl Tsiephone!Number DEBRA R PALLET 717 737 1300 ~a 4' REG TE 4L3 USF,~NLY,:-;. :1~, . `:: ,~ ~ r"r! ~ - ~ ~ ~ -, r First floe of add ~ ~ -t,7 ; ' r ~ 24 NORT 32ND STREET r , I ~~~ ~ Second Ilrre Of add , ~ ~ . ~ ` I _ ,_ _ ~ Y-, ~ ,~ DATE FILED City or Post Offl~ State Zip Code CAMP HIL PA 17011 comespQnde<tt's,-mall adarss; wa i letd e b ~a o 1. co m Under panaldas of , I dar~ar~s Sf~t 1 have examined this retlarn, Includinngo atxxxnpanying scfiedules and atatsmer>is, and the beat ofrr)y k and belief, k is hue, correct and . Oaclaration of preperer other than ;the personal rpresentative is based on-ail information of preparer h8a any k ge. SIGMA E PERS SIaLE F FIL N R TURN DA ~~ ~ (,~ ~ Suzanne K. Hitt-orn $~ ~ ADDRE 5613 Moreland urt, Mechani¢~burg, PA 17055 SIGNATURE OF PREPARE OTiiER THAN REPRESEMTATIVE ~ DATE r_~.__ u ..t ._.. Debra K Wallet I 1~..~r 19 4~ls 24 North 32nd Street, Camp Hill, PA 17011 15t~5610143 Sids 1 15056110143 J J 1505610243 EV-1900 EX Decepent's Social Security Number oeoeaem~. Na,x: BENDER, JANE I. 1818 O S 3 7? 0 1. Real Este (Schedule A) .......................................................................................... 1. ~, i 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely He Corporation, Partnership orSole-Proprietorship (Schedule C).......... 3. ~I 4. Mortgages Notes Receivable (Schedule D) .......................................................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. i 7 2 , 3 2 9 • 9 7 6. Jointy Property (Schedule ~ ^ Separate Billing Requested ............. 8. 7. Inter-Vnros ransfers 8 Miscellaneous Non-Probate Property (Schedule ) ^ Separate Billing Requested ............. 7. s. Total G Assets (total Lines 1-7) ....................:.................................................. 8. 7 2, 3 2 9. 9 7 9. Funeral Haas 8 Administrative Costs (Schedule H) ......................................... 9. 10. Debts of nt, Mortgage Liabilities, 8 Liens (Schedule 1) ................................ 10. 11. Total Dedu one (total Lines 9 810) ...................................................................... 11. 12. Net Value Estate (Line 8 minus Line 11) ............................................................. 12. 13. Charitable a d Govemmentel BequeststSec 9113 Trusts for which an ebction t tax has not been made (Schedule J) ................................................. 13. 14. Net Value S bject to Tax (Line 12 minus Line 13) ................................................. 14. TAX COMPUTA ON -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Li 14 taxable at the spou I tax rate, or transfers u r Sec. 9116 (a)(1.2) X . 15. 16. Amount of Li e 14 taxable at lineal rate .045 5 0, 8 4 7. 0 3 16. 17. Amount of Li e 14 taxable at sibling ra X ,12 17. 18. Amount of Li e 14 taxable at collateral to x .15 2, 8 2 4. 8 3 1S• 19. Tax Due ....... ........................................................................................................... .. 19. 20. FILL IN THE ~VAL IF YOU ARE RECUESTING A REFUND OF AN OVERPAYMENT. 1 0243 Side 2 15,270.90 562.38 15,833.28 56,496.69 2,824.83 53,671.86 2,288.12 423.72 2,711.84 ail 15056 0243 _ ~_ _ REV-1500 EX Pag 3 Decedent's C mpiete Address: File Number 21 - 10 - 00308 Benda , Jane I. STREET ADDRE S 2100 a nt Creek Blvd. CITY Mecha i - - csburg STA_~E ----- PA ZIP --- 17050 Tax Payments nd Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payme is A. Prior Pa is B. Discount (1) 2,711.84 2,200.00 115.79 Total 3. interest 4. If Line 2 is Brea r than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Ct~k box on Page 2 Line 20 to roquest a refund 5. If Line 1 + Line is greater than Line 2, enter the difference. This is the TAX DUE. Make Check Payable to: REGISTER OF WILLS, PLEASE A 1. Dk E t c c 2. If c rec 3. Dk 4. Dk c~i IF THE AN3titfER TI For dates of death on spouse is 3 percent p For dates of death on a~sse~ a~9 fllin8 a) tax For dates of death on ~ • The tax rate imposed adoptive parent, or a •~PS §9116 1p2j[; • The tax rate imposed sibling is defined and +B) (2) 2,315.79 (3) 0.00 (4) (5> 396.05 THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TF~E APPROiPRIATE BLOCKS decedent make a transfer and: ~ Yes No retain the ~ of income of the property transfe ~~ transferred or its income :................................... ^ ' retain the ' ht to des' Hate who shall use the ro x retain a reversionary iMerost; or ................................................................................................................. receive the promise for life of either payments, benefits or care? ........................... .................................. x bath occurred after December 12, 1982, did decedent transfer property within one year of death without living adequate consideration? ...................................................................................................................... r-~ ~xJ decedent own an •in trust for" or payable upon death bank account or security at his or er death?,......... [] ~x j decedent own an Individual Retirement Account, annuity, or other non-probate property ich lains a benefxtiary designation? ..................................................................................................................... ~~ Lx ~ ANY OF THE ABOVE QUE8TION3 IS YES, YOU MU8T ,COMPLETE SCHEDULE G A D FILE IT Ali PART OF THE RETURN. >r after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or far the use of the surviving ! P.S. §9116 (a} (1.1) (i)]. '1 x after January 1, 1995, the tax rate imposed on the net value of transfers to or for the u of the surviving spouse is 0 percent ii)]. The statute does not ex~m~t a transfer to a surviving apou~ from tax, and the slat cry requiromeMs for disclosure of ~m are still applicable even if the surviving spouse is the only beneficiary. afterJuy 1, 2000: n the net value of transfers from a deceased child 21 are of age or younger at death apparent of the child is 0 percxnt [72 P.S. §9116 (a) (1.2)]. n the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 P.S. §9116 (a) (1)]. n the net value of transfers to or for the use of the decedent's siblings is 12 percent 2 Section 9102, as an individual who has at least one parent in common with the derredE or for the use of a natural parent, an except as noted in t,Swfiether by blood~oAadoption. ~~~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL Pi~OPERTY FINE NUMBER ESTATE OF Bende , Jane f. 21 -10 - oo3p8 Include the proceeds of itigation and the date the proceeds were received by the estate. AH property j rrtly-owr~d with the rtyht of survivorship must bs isclosed ~ schedule F. ITEM NUMBER DESCRIPTION ~~ VALUE A7 DATE OF DEATH 1 Sovereign Bank Checking Account #431129851 ~ 2,692:81 2 Sovereign Bank Money Market Account #57417450 ~ ~,I 44,718.81 3 ~I Citizens B nk Checking Account #610080-194-2 2,292.76 4 Citizens B nk Money Market Account#610102-180-8 ~~ 200.59 5 Citizens nk CD #6253-741705 5,192.83 6 Citizens B nk CD#6140-907020 ~I i 14,000.00 7 Refund fro The Bridges at Bent Creek ~ 3,232.37 TOTAL (Also eater on Line S, Recapitu~atlan) ~ 72,325.97 9C~DULF H FL~ERAL E~BJ~ES & AL~IIINSTRATIVE C05T5 ESTATE OF Bender, Jane I. ~ { ~ 21 - 10 - 00308 _`___ Debts of decedent must be reported on Schedule 1. _ __,__ _ ------- - 'r--- ITEM ~' AMOUNT NUMBER FUNERAL XrENSES: DESCRIPTION _-- - A. 1 Snyder F neral Home ---~---- - _- - - ~ -_- _- - 9,545.40 I 2 Reverend Martin 80.00 3 Reverend Davis I'I ~ 50.00 4 Willow Va ley (funeral refreshments) 331.00 ~I ~i I 1B. ADMINIS TIVE COSTS: ~, Personal R resentative's Commissions Name of Pe onat Representative(s) Street Add ss City State Zip Year(s) C mission paid 2. Attorney's F Debra K. Waiiet, Esq. ~ 5,000.00 3, Family Fie " n: (If decedent's address is not the same as claimant's, attach explanation) '! Claima Street dress City State Zip Relatio hip of Claimant to Decedent 4. Probate Fee ~ 234.50 5. Accountant's ees II 6. Tax Return P pacer's Fees ~, 7. Other Admini five Costs ' 1 Postage, ph tocopies, mileage, etc. ', 30.00 I I TOTAL (Also enter on Ilse 9, Recapitulation) ~ 15,27Q.90 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS HESIpB~1T OBG ENT ~- ------- i--- -- FINE NUMBER-- . ESTATE OF Benda , Jane L _ 2~~10 ._00308.__ __ _. __ ____ _ ______ Report debts incurred b the decedent prior to death that remained unpaid at the date of death, includin~ unreimbursed medical expenses. ITEM NUMBER 1 Alert 2 West EMS DESCRIPTION AMOUNT 202.47 359.91 TOTAL (Also enter on Line 1Q Recapit lation) 562.38 REV-161 EX~ (11-0t) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT __ ESTATE Of Bender, Jane I. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ TAXABLE DISTRIBUTIONS (include outright s usal f ers distributions and trans under Sec. X118 (a) (1.2)] 1 Suzanne K. Hilborn 5613 Moreland Court Mechanicsburg, PA 17055 2 Julie Garcia 141 Main Street New Providence, PA 17560 RELATIONSHIP TO DECEDENT Do Not Ust Teusbgs) Daughter Goddaughter 1 FlLE NUMBE 21 -10 -_00308 SHARE OF EST TE AMOUNT OF ESTATE (Words) ~ ($$$) 90% of Estate 5% of resid Estate Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as approp NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Pearl Street United Methodist Church 133 Pearl Street, Lancaster, PA 17603 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER 2,824.83 2,824.83 2004Willa/Bender, Jane I. Will rev.09-07-04 LAST WILL AND TESTAMENT OF JANE I. BENDER I, JANE I. BENDER, of the City of Lancaster, Lancaster, and Commonwealth of Pennsylvania, do h publish and declare the following to be my Last F Testament, hereby revoking any and all Wills and heretofore made by me. ounty of eby make, 1 and dicils ITEM I PAYMENT OF DEATS TAREB ~ I direct that all estate, transfer, successio , inheritance, legacy, and similar taxes, together w'th interest and penalties in respect thereof, if any, upon or ith respect to any property required to be included in my gros estate under the provisions of any tax law and whether or not p ssing under this Will or any codicil hereto, and upon or with expect to any person with respect to any such property, shall be paid out of my Residuary Estate, and that there shall be no ap ortionment of any such taxes, interest, or penalties. ITEM II I give certain items of my tangible personal set forth on a separate list bearing my signature y as at its end, ~. ~... which list I have placed with this Last Will and T those persons named upon such list provided that i such person survives me. To the extent that my di because of the death of any person named, the desi tangible personal property, together with all of m personal property not specifically mentioned in my become part of my Residuary Estate as hereinafter no list bearing my signature is found with this Item shall be of no effect. I give, devise and bequeath all of the and remainder of my estate, both real and persona wheresoever situate (my "Residuary Estate") to my H. BENDER, provided he survives me by thirty (30) ITEM IV In the event that my spouse MAHLON H. BENDER or fails to survive me by thirty (30) days, I giv bequeath my Residuary Estate as follows: (A) Ninety percent (90$) thereof to my daug HILBORN provided she survives me by thirty (30) d predeceases me or does not survive me by thirty t, to each case lapse ~ nested tangible list, shall of fined . I f 1, then this st, residue and se MAHLON ys. me devise and SIIZANNE R. and if she days, then -2- in equal shares to her children BELLY D. ANDERSON and CHRISTI L. NEIPMAN or to their issue per stirpes; (B) Five percent (5$) thereof to the PEARL STREET ONITED METHODIST CHIIRCH, located at 133 Pearl Street, Lancaster, Pennsylvania 17603; and, II, (C) Five percent (5$) thereof to my goddaug ter JIILIE GARCIA, provided she survives me by thirty (30) d s, and if she predeceases me or does not survive me by thirty (30) days, then her share of my Residuary Estate shall be added tO share of my Residuary Estate set forth at Item IV (A) above. '~ ITEM O If any property held hereunder or under any shall be distributable or payable to a minor or under a legal incapacity, my Personal Representa fiduciary's discretion, may: (A) Transfer and pay over-all or any such p such minor, (ii) a guardian of the property of su other person under a legal incapacity wherever ap requiring ancillary guardianship, (iii) a parent having the care or custody of such minor or other 1 hereto r person in such y to ( i ) minor or inted without person on under a legal incapacity without requiring such parent or ~erson to qualify as guardian in any jurisdiction, or (iv) a custodian for such minor under the applicable version of the Unijform Transfers to Minors Act (with authority to maintain such cus~odial account until the maximum age of the beneficiary permitted by law); or, -3- (B) Set aside all or any such property, title to which shall have vested absolutely in such minor or othelr person under a legal incapacity, in a separate fund and hold tY~le same until such minor shall become of age or sooner die or such other person under a legal incapacity shall have such incapacity removed or shall sooner die. During such period my Personal Representative may at any time or from time to ti le pay over all or any portion of such fund as provided in Sub-se tion (A) hereof, or invest and reinvest the same and pay or~ apply to or for the use of such minor or other person under allegal incapacity all or so much of the principal thereo and net income therefrom (including accumulated income), e~nd accumulate and add to principal any net income not so paid orll applied, as my Personal Representative may in such fiduciary's sole discretion determine, irrespective of any other sdurce of income or resources of such minor or other person under ~ legal incapacity. My Personal Representative holding such fund required to give bond or security or to render periodic accounts and shall be entitled to such fund were a separate trust. If any such property shall be tangible pers my Personal Representative shall have no duty to same into productive property, and the expenses o~ the the safekeeping thereof, including but not limited toinsurance, shall be a proper charge against the income and principal of the other property held for such minor or other person under a legal incapacity pursuant to this Item or pursuant to ar~y other -4- I shall not be ation as if 1 property, provision of this Will. I specifically empower my Personal Representative to retain any item of tangible personal property which my Personal Representative may deem to have ',family heritage or sentimental value to my beneficiaries delivery to my beneficiaries. (C) The receipt of the person to whom any for later incipal or income shall be transferred and paid over pursuant to any of the above provisions shall completely discharge my Pe~sonal Representative from all liability with respect toany assets so transferred and paid over, and my Personal Repre have no obligation to see to the use or applicat payment or to make inquiry with respect to any o or income of such minor or other person under a prior to making any such payment. ITEM VI tative shall of any such r resources al incapacity My Personal Representative shall have with respect to any and all property, real and personal, whether prin~ipal or income and whether owned by me at the time of my death o thereafter received from any source whatsoever, the followin powers, authorities, and discretions without limitation b their specification: (A) To retain any such property without regard to the proportion such property or similar property held may bear to the entire amount held, and whether or not the safe is of the class in which fiduciaries are authorized by law cbr any rule of court to invest funds; -5- (B) To sell any such property upon such terms and conditions as may be deemed proper, at either public or private sale, either on credit for such period of time as Imay be deemed proper or for cash and with or without security, and the purchaser of such property shall have no obligation to see to the use or application of the proceeds of sale; too exchange, lease, sublease, mortgage, pledge, or otherwise encumber any such property upon such terms and conditions as ma~i be deemed advisable; to grant options for any of the foregq'ing and to make any lease or sublease, including any oil, gasj, or mineral lease, for such period of time and to include therein any covenants or options for renewal as may be deemed proper without regard to the duration of any trust and without ap~roval of any court; ', (C) To invest and reinvest and to acquire byj exchange property of any character foreign or domestic, or~iinterests or participations therein, including by way of illustration but not of limitation real property, mortgages, bonds, notes, debentures, certificates of deposit, capital, common and preferred stocks, and shares or interests in investment trusts, mutual funds or common trust funds, without regard to the. proportion any such property or similar property Meld may bear to the entire amount held and whether or not the Same is of the class in which fiduciaries are authorized by .law q'r any rule of court to invest funds; to contribute to the capital of any limited partnership and to become a limited partner therein; (D) To borrow at any time and from time to dime from any person or corporation (including any fiduciary actling hereunder) -6- for such periods of time and upon such terms and conditions as may be deemed proper, such sums of money as may b~ deemed necessary or advisable, and to secure such loans ~y the pledge or hypothecation of any property held hereunder, end the decision with respect thereto shall be conclusive on all persons interested hereunder; no person making such loan shall be bound to inquire into the necessity, expediency, or pro~riety thereof or to see to the application of the sums loaned; (E) To hold any personal property in any st~te; to register and hold any property of any kind, wheth~r real or personal, at any time held hereunder in the name ~f a nominee or nominees; and to take and keep any stocks, .bonds or other securities unregistered or in such condition as t pass by delivery; (F) To make or refrain from making election permitted under any applicable income, estate, or inheritan a tax law without regard to the effect of any such election on the interest of any beneficiary of my estate and, if ny such election shall be made, to apportion, or refrain rom apportioning, any benefits thereof among the reap ctive interests of the beneficiaries of my estate, all ~n such manner as shall be deemed appropriate; (G) To employ investment counsel, accountants, depositaries, custodians, brokers, attorneys, andiagents, irrespective of whether any person so employed sh~ll be a fiduciary hereunder or a firm or corporation in w~ich a fiduciary hereunder shall have an interest, and t~ pay them the usual compensation for their services out of the principal or -7- income of the property held hereunder, in addition to and without diminution of or charging the same against the commissions or compensation of any fiduciary hereunder; and any fiduciary who shall be a partner in any such firm ;shall nevertheless be entitled to receive his or her sh~re as partner of the compensation paid to such firm; I (H) In distributing any property held hereu der, to transfer and pay over the same in kind (at market value unless otherwise directed herein) or in cash or partly i~ kind and partly in cash, and as to any property transferre and paid over in kind to so use any distribution to be composed of cash, property, or undivided fractional interests diffe ent from any other distribution and to determine the property o be transferred and paid over to any persons; (Y) To file joint income tax returns with m spouse, to consent to treat any gifts made by my spouse at a y time prior to my death as having been made one-half (1/2) by me for the purposes of any gift tax law, and to file gift to returns in connection with such gifts; (J) To allocate to income all cash dividend or other cash distributions, whether ordinary or extraordinary, received from any source, including without limitation by the specification thereof, all dividends or distributions in cash r~ceived from any mining or other wasting asset corporations orreal estate corporations, partnerships, investment trusts or ether real estate interests, or business trusts at any time field hereunder (notwithstanding such cash dividends or distribut~.ons may have been extraordinary or designated or described by the disburser -8- thereof to be in whole or in part a return of capital or a distribution from depletion or depreciation reser~tes) without setting apart any portion of such cash dividends car i distributions to maintain principal intact; provided, however, that any cash dividends or distributions in connection with the winding up of the business or the liquidation of substantially all of the assets or the dissolution. of any corpo ation, partnership, trust, or other entity shall be alto ated to principal; i (K) To allocate to principal all dividends ~nd distributions payable in the stocks, bonds, or of er securities, whether of the disbursing company or another comp ny; (L) To exercise all the rights, powers, and privileges ~ herein conferred after the termination of any tru t hereunder and until the completion distribution of the prop rtv held hereunder; (M) To convey or exchange upon such terms a~d conditions as may be deemed proper any real property or interest therein held hereunder to any corporation or partnership hether general or limited, or to any real estate investment true formed or to be formed, and to receive in payment therefor sto ks, bonds, and other securities, whether or not of the same kind of such corporation or any interest in such partnership o real estate investment trust, whether or not the same as of t e class in which fiduciaries are authorized by law or any rue of court to invest funds; and, (N) To disclaim any interest in property tolwhich Y or my Estate might otherwise be entitled. -9- LASTLY APPOINTMENT OF PERSONAL REPRESENTATIVIE I appoint my spouse MAHLON H. BENDER to be my~ Personal Representative under this Will. If MAHLON H. BENDER shall for any reason fail) to qualify, or having qualified, shall cease to act as Person 1 or having qualified, shall cease to act as Personal Representative hereof, I appoint my daughter's sp I se WILLIAM B. BILBORN to be my Personal Representative in my da ghter's place. Any and all substitute or successor Personal l,, Representative hereof, I appoint my daughter SII8 R. HILBORN to be my Personal Representative in my spouse's place. If SIIZANNB R. HILBORN shall for any reason f it to qualify, Representatives or Administrators c.t.a. hereof, whether or not named herein, shall have all the powers, authoritilles, and discretions herein granted to my Personal Represen ative originally named. - I direct that no Personal Representative herein named shall be required to furnish bond or other security in a y jurisdiction where such Personal Representative ma be called upon to act. ~, IN WITNESS WHEREOF, I have hereunto set my h~nd and seal this 7th day of September, 2004. !, ~~ .S . I. BENDER -10- ~r SIGNED, SEALED, PUBLISHED, and DECLARED by the above-named person, JANE I. BENDER, on the date hereof, to be such person's Last Will and Testament, in the presence of the unidersigned, who at such person's request, in such person's presencie and in the presence of each other, have hereunto subscribed their names as attesting witnesses. residing at L~j~, ca~'~j,Ep~, ~'~~,.,..s~~xesiding at COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF LANCASTER ) I, JANE I. BENDER, whose name is signed to t foregoing instrument, having been duly qualified law, do hereby acknowledge that I signed and exec instrument as my Last Will and Testament; that I willingly; and that I signed it as my free and v for the purposes therein expressed. ~~ ~ . I. BENDER SWORN or AFFIRMED, SUBSCRIBED and ACKNOWLEDG JANE I. BENDER, this 7th day of September, 2004. ~i~~ ~ Notary Public My commission expires: i011(.T~ ~f~ r~;~6 Y~a1rY ~ ~~ attached or ording to d the geed it ntary act before me by -11- COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF LANCASTER ) We, and ' , whose names are signed to the attached or foregoins instrument, being duly qualified according to law, do depose a d say that we were present and saw JANE I. BENDER, sign and exec to the instrument as such person's Last Will and Testamen ; that such person signed willingly and executed it as such pe son's free and voluntary act for the purposes therein express d; that each of us in the hearing and sight of such person sign d the Will as witnesses; and that to the best of our knowledge uch person was at that time eighteen (18) or more years of ag of sound mind and under no constraint or undue influence. Wi tness SWORN or AFFIRMED, and SUBSCRIBED before me b1y the witnesses, this 7th day of September, 2004. r l~~~~ ~ ~~ Notarv Public My commission expires: dfi!®~i,~.4~. 7~isiY sei t~ai~:L ~~~ ~IYr lyr~i~io~~~~~ -12-