HomeMy WebLinkAbout09-10-10' 1505607121
REV-1500 EX (OS-05)
OFFICIAL USE ONLY
PA Department of Revenue
County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po sox 28oso1 2 1, 1, 0 0 0 9 0 6
Harrisburg, PA 17128-OS01 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 9 1, 2 8 7 9 6 0 8 2 4 2 0 1 0 0 7 1 9 ], 9 2 4
Decedent's Last Name Suffix Decedent's First Name MI
S H E A F F E R F L E T A D
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
S H E A F F E R W I L L I A M H
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Rei:urn (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 s. 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)
Name Daytime Telephone Number
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City or Post Office
C A R L I S L E
Correspondent's a-mail address: a~ M A R T S O N L A W• C O M
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
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.
SIG T RE P~R~j~f RE PONSI FOR FILING RETURN DATE ~~1U
` ///~~ ~!
ADDRESS
3 ALLIANCE DRI APT 302 CARLISLE PA 1,7013
SIGN URE F P ~ PAR OTHE AN REPRESENTATIVE D,AT~ /
o
ADD ESS ,
10 EAST HIGH ST EET CARLLSLE_ PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056071,21, 15056071,21
State ZIP Code
P A 1 7 0 L 3
J
f~mW
1505607221
REV-1500 EX
Decedent's Social Security Number
~ecedent'slVame: FLETA D SHEAFFER 2 0 9 1 2 8 7 9 6
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1. •
2. Stocks and Bonds (Schedule B) .................................. 2. 1 5 9 ~g 9 8 • 1 4
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. •
4. Mortgages & Notes Receivable (Schedule D) ........................ 4. •
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. •
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ....... 7.
8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 5 9 f5 9 8 • 1 4
9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 6 _~ 4 1 . 5 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. •
11. Total Deductions (total Lines 9 & 10) ........................... 11. 6 =~ 4 1 . 5 0
12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 1 5 3 ~i 5 6 . 6 4
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, 1 5 3 ~~ 5 6 . 6 4
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 .o0 1 5 3 5 5 6 6 4 15.
16. Amount of Line 14 taxable
at lineal rate X .0 0 0 0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18
19. Tax Due ............ ........................... .. ...... .19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505607221 1505607221
0. 0 0
0. 0 0
0. 0 0
0. 0 0
0. 0 0
J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 10 00906
DECEDENT'S NAME
FLETA D. SHEAFFER
STREET ADDRESS -
770 S HANOVER STREET
CITY STATE Zlp
CARLISLE PA 17013
Tax Payments and Credits:
1 ~ Tax Due (Page 2 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.00
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. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00
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 : ...................................................................... ^ 0
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^ 0
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^
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 "in trust 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-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)). Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
FT .F.TA i~_ SHEAFFER 21 10 00906
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Merrill Lynch Investment Account No. 872-49591 (see attached valuation) 159,898.14
TOTAL (Also enter on line 2, Recapitulation) I $ 159,898.14
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FLETA D. SHEAFFER 21 10 00906
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A.
1. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State Zip
Year(s) Commission Paid:
2 Attorney Fees Martson Law Offices (estimated) 2,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00
Claimant William H. Sheaffer
Street Address 3 Alliance Drive Apt. 302
City Carlisle State PA zip 17013
Relationship of Claimant to Decedent Spouse
4. Probate Fees 326.50
5 Accountant's Fees
6. Tax Return Preparer's Fees
7. Register of Wills, filing fee, inheritance tax return 1.5.00
TOTAL (Also enter on line 9, Recapitulation) I :6 6,341.50
(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
FLETA D. SHEAFFER 21 10 00906
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. William H. Sheaffer Spousal 153,_556.64
3 Alliance Drive, Apt 302
Carlisle, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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)
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}~ \FILES\DATAFILE\WILLS16106-w codicil
CODICIL
I, FLETA D. SHEAFFER, of South Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and
declare this to be a Codicil to my Last Will and Testament dated October 15, 1997.
1.
Paragraph C of Item Five of my Last Will and Testament is hereby deleted and replaced with
the following:
C. Upon the death of my said husband, WILLIAM H. SHEAFFI~R, my
Trustees shall distribute the remaining principal and interest, in equal shares, unto my
daughters, VICKI L. STEEDLE and LINDA M. BURNS, absolutely.
2.
In all other respects, I ratify and affirm my said Last Will and Testament dated October 15,
1997.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~'~` da of
Y
2001.
~_(SEAL)
Fleta D. Sheaffer
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for a Codicil to her Last Will and Testament dated October 15, 1997, in the presence of us, who at
her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said
Testatrix and of each other.
t/ / ~~ t,. ~
Page 1 of 2 Pages
.: f
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
We, Fleta D. Sheaffer, Ail k ~., . n ~r1IL ~ rV6~~. and / l r~iP~c~4 `~, c'4 lm.P~d nJ ,
the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and
executed the instrument as a Codicil to her last Will dated October 15, 1997, and that the Testatrix
has signed willingly, and that the Testatrix executed it as her free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed
the Codicil as a witness and that to the best of his/her knowledge the Testatrix was at that time
eighteen years of age or older, of sound mind and under no constraint or undue influence.
Testatrix
~~ /`J
rtness
_~ ,'~
~.
'~ (f ~~ ,
Wit ess f/
Subscribed, sworn to and acknowledged before me by Fleta D. Sheaffer, the Testatrix, and
subscribed and sworn to before me by ~Y1 ,Q-~ ,~~. ,~~E, y~ n1 Gr-~~2 and
/'72,~~,,,q C~,~7'r~y ,the witnesses, this ~~'`~ day of ~-- r , 2001.
~~
Notary Public
NQTARtAL SEAL Pubic
CORRINE L. MYERS, Nao+n~+dCax-
Cariisle- Bono, Cumberl
Commission Expires Ma 27Y , 2 --3
Page 2 of 2 Pages
F \F'ILES\DATAFILE\WILLS\6106-W.WIL
LAST WILL AND TESTAMENT
I, FLETA D. SHEA.FFER, of South Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and
declare this to be my Last Will and Testament, hereby revoking any and all former Wills or
Codicils by me made.
ITEM ONE
I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance
taxes shall be paid to the extent possible from the assets held or passing under ITEM FIVE hereof
as soon as practicable after my decease and as part of the administration of my estate.
ITEM TWO
In the event my husband, WILLIAM H. SHEAFFER, shall predecease or fail to survive
me by thirty (30) days, then I give such items of personalty as are itemized in .a certain list
attached hereto to the persons named thereon, which list is signed and dated by rrie at the end
thereof.
ITEM THREE
If my said husband, WILLIAM H. SHEA.FFER, is living thirty (30) days after my death,
then I give, devise and bequeath all of my estate, both real and personal property, unto my said
husband, WILLIAM H. SHEA.FFER, absolutely. If my said husband does not so survive me, then
I give, devise and bequeath all of my estate, both real and personal property, unto my Trustees to
be held or distributed by such Trustees under ITEM FIVE, C., hereof.
ITEM FOUR
In the event my said husband, WILLIAM H. SHEA.FFER, shall disclaim all or~ any portion
of any devise or bequest made to my said husband under the foregoing ITEM THREE, then the
amount otherwise payable shall be held by my Trustee(s) under ITEM FIVE hereof. F'or purposes
of the Trust established under ITEM FNE hereof, my said husband shall not be deemed to have
predeceased me by virtue of my said husband's exercise of the right to disclaim set forth herein.
ITEM FIVE
RESIDUARY AND DISCLAIMER TRUST
My Trustee(s) shall hold the assets received under ITEMS THREE and FOUE~ hereof, if
F.D.S.
Page 1 of 7 Pages
any, for the following purposes:
A. My Trustee(s) shall pay the net income, at least quarter-annually, t:o my husband,
WILLIAM H. SHEAFFER, for life. In addition, my Trustee(s) in their sole discretion, may invade
the principal of the Trust for the proper and adequate support of my said husband, WILLIAM H.
SHEAFFER.
B. My Trustee(s) shall further pay to my said husband, WILLIAM H. SHEAFFER,
annually, such sum from the principal of the Trust as my said husband may request in writing,
provided, however, that said sum may not exceed the greater of Five Thousand Dollars ($5,000.00)
or five percent (5%) of the aggregate value, at the time of said request, of the principal of the Trust
hereunder.
C. Upon the death of my said husband, WILLIAM H. SHEAFFER, my Trustees shall
distribute the principal and any undistributed income, as follows:
1. The sum of Fifly Thousand Dollars ($50,000.00) shall be paid to MT. ZION
UNITED METHODIST CHURCH, 420 Park Drive, Calrisle, Pennsylvania;
2. The remaining principal and interest shall be distributed to my daughters,
VICKI L. STEEDLE and LINDA M. BURNS, in equal shares, absolutely.
ITEM SIX
POWERS OF EXECUTOR AND TRUSTEE
In addition to the powers conferred by case law, by statute, and by other provisions hereof,
my Executor and Trustee and their successors, shall have the following discretionary powers
applicable to all property held by them which powers shall be effective without order of any court
and shall exist until final distribution:
A. To retain any property of any nature received by them for whatever period they shall
deem advisable;
B. To invest and reinvest all or any part of said property in such stocks, bonds, common
trust funds, securities, accounts, certificates of deposit (including, but not limited to, stocks, bonds,
common trust funds, securities, accounts or certificates of deposit of the Trustee) or other property,
real or personal, as in their discretion they shall deem proper, without regard to statutes limiting the
property which a fiduciary may purchase;
~- i
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Kea . ~-
F.D.S.
Page 2 of 7 Pages
C. To sell, transfer, exchange or otherwise dispose of, any part of said property, for cash
or on terms, publicly or privately, or to lease, even for a term exceeding five (5) years or the duration
of any trust herein, without liability on the purchasers or lessees to see to the application of the
proceeds, and to give options for these purchases without the obligation to repudiate; them in favor
of a higher offer;
D. To execute and deliver any deeds, leases, assignments or other instrtunents as may
be necessary to carry out the provisions of any trust hereunder;
E. To borrow money, including the right to borrow money from any bank and to
mortgage or pledge any asset of the estate as security;
F. To assume continuance of the status of any beneficiary with regard to death, marriage,
divorce, illness, incapacity and the like in the absence of information deemed reliable without
liability for disbursements made on such assumption;
G. To pay from the trust, or the income therefrom, all debts or claims against my estate,
or any taxes or similar charges on my estate;
H. To make any distribution hereunder either in kind or in money, or partially in kind
and partially in money. Distribution in kind shall be made at the market value of the property
distributed, and my Trustee(s), in their absolute discretion, may cause the share distributed to any
distributee to be composed of property similar to or different from that distributed to any other
distributee;
I. To exercise any subscription right in connection with any security held hereunder,
to consent to or participate in any recapitalization, reorganization, consolidation or merger of any
corporation, company or association, the securities of which may be held hereunder, to delegate
authority with respect thereto, to deposit investments under agreements, to pay assessments, and
generally to exercise all rights of investors;
J. To invest in endowment, insurance or annuity policies on the lives of beneficiaries
of any trust hereunder;
K. To continue in any partnership, joint venture, joint ownership or other business
enterprise of which I am a part at the time of my death;
L. To compromise claims;
~-> r~
F.D.S.
Page 3 of 7 Pages
M. To continue for whatever period of time as they shall deem necessary any ownership
as a tenant in common or as a partner, in real estate or other property and to act as I could have done
had I been living;
N. To lend money to my estate or to any trust created hereunder or to purchase from the
estate or from any trust created hereunder, at the market value thereof at the time of~purchase, any
securities or other property tendered to them by my estate or any trust created hereunder at any time
and from time to time within a period of nine (9) months after my death;
O. In the event that any amounts are payable hereunder or under any trust created
hereunder to a minor, or to a person otherwise under legal disability, or to a person not adjudicated
to be an incapacitated person, but who, by reason of illness or mental or physical disability is, in the
opinion of fiduciary(ies) hereunder, unable to properly administer such amounts, such amounts may
be paid by the fiduciary(ies) hereunder in his, her or their sole discretion in any of the following
ways as he, she or they may deem best:
1. Directly to such beneficiary;
2. To a legally appointed guardian of such beneficiary for the benefit of such
beneficiary;
3. To a person having custody of such beneficiary for the benefit of such
beneficiary;
4. By the fiduciary(ies) hereunder using such amounts directly to the benefit of
such beneficiary.
Evidence of the application or payment of an amount in such a manner shall be a full and complete
discharge of the fiduciary(ies) hereunder to the extent of such payment or application. This
paragraph shall be applicable to payments of income as well as principal.
P. To employ agents, attorneys and proxies and to delegate to them such power as my
personal representative(s) and Trustee(s) consider desirable and to pay reasonable compensation for
such services as may be rendered by such agents, attorneys and proxies;
Q. To conduct an inventory of any safe deposit box necessary to the administration of
my estate.
R. To do all other acts in their judgment necessary or desirable for the proper
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F.D.S.
Page 4 of 7 Pages
management, investment and distribution of my Estate.
ITEM SEVEN
PROTECTIVE PROVISIONS
All income or principal held for the use and benefit of any trust hereunder shall not be in any
way or manner subject to anticipation, assignment, pledge, sale or transfer, nor shall any such
interest, while in the possession of my Trustee(s), be liable for or subject to the debts, contracts,
obligations, liabilities or torts of any beneficiary, or to attachments, executions or sequestrations
under process of law.
ITEM EIGHT
APPOINTMENT OF EXECUTOR AND TRUSTEE
I nominate, constitute and appoint my husband, WILLIAM H. SHEAFFER, as Executor of
my estate. In the event that my said husband shall predecease me or fail to act as Executor, then I
appoint my daughters, VICKI L. STEEDLE and LINDA M. BURNS, as Executrice;- of my estate.
I nominate, constitute and appoint my said husband, WILLIAM H. SHEAFFI;R, as Trustee
of any trust created hereunder. In the event that my said husband shall fail or be unwilling to
continue to act as Trustee, then I appoint my daughters, VICKI L. STEEDLE and LINDA M.
BURNS, as Trustees of any trust created hereunder.
ITEM NINE
WAIVER OF BOND
I direct that neither my Executor(rices) nor my Trustee(s) shall be required to file any bond
in any jurisdiction to secure the faithful performance of their duties, nor shall they be required to
obtain any order or approval of any court for the exercise of any power or discretion se-t forth in this
Will.
,,..._ i ,
IN WITNESS WHEREOF I have hereunto set my hand and seal this ,~ ,~-~ ~~°' day of
~~ ~~ ~,,~ ~-fi'~ ~., 199
~ ~:1,~__tr-4.. ~.; =~r~ _. ~ _: ~.~ -~- ~ ~ (SEAL)
Fleta D. Sheaffer ~~ ,
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
Page 5 of 7 Pages
for her Last Will and Testament, in the presence of us, who at her request, have hereiulto subscribed
our names as witnesses thereto, in the presence of the said Testatrix and of each other.
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Page 6 of 7 Pages
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
I, Fleta D. Sheaffer, Testatrix, whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed the
instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary
act for the purposes therein expressed.
~ ` !; ~,1
Fleta D. Sheaffer
_,~~_ Sworn or affirmed to and acknowledged before me by Fleta D. Sheaffer, the Testatrix, this
1 ~~ day of ~C~d~~li~c.i, 19gr
Plotarial Seal ~/
Corrine I_. h.4yers, Notary Public ,C- /~
C~.rlislo F~oro, Cumberland County
-;y Co;nmiasic~n F_r.pires ;~~iay 27, 139 Notary Public
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUNTY OF CUMBERLAND )
We, ~(.~1 ~ I 1 C~--~t.~~ ~ = y~}'~CC,r~ c~71. ~-ti~ /~.~ !~L'~'t.-~f ~ ~.. y~ ~°.-~l~`~~
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 Fleta D. Sheaffer, the Testatrix,
sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the
Testatrix executed it as her free and voluntary act for the purposes therein expressed.; that each of
us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our
knowledge the Testatrix was at that time 18 or more years of age, of sound mind ;end under no
constraint or undue influence. = 1'
!~"'~ ...
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Address ~ ~ . ~ ~-~-
;1
~~7G / ~LL , .,
Address _~d% / jn ~ ~ Q_
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Sworn or affirmed to and subscribed before me this ~ day of ~~~%~~~~t , 199'j.
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~' , ~~~f~ 1 :~; ~ r~~~~a~~y r~ arc ~ Notary Public
~ ~ .Gil i , " . t.:i~ r , .. _'.`~
Page 7 of 7 Pages