HomeMy WebLinkAbout10-08-10 1505610101
REV-1500 Ex ~°1.1°'
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes ~""p~~`~' County Code Year File Number
INHERITANCE TAX RETURN
PO BOX28o6oi ' ~ ~ ~ ~ '
_ _ Harrisburg, PA 1'7128-D6 oi RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Socaa! :=acurity Number Date of Death MMDDYYW Date of Birth MMDDYYW
2.02-20-1624 01 /09/2010 03/22/1927
Decedent's Last Name Suffix Decedent's First Name MI
Hartman Mae E
(!f 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
~ 1. Original Return O 2. Supplemental Return O 3. Remainder Retum (date of death
prior to 12-13-82)
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)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE C OMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTE~TO:
Name Daytime Telephot78jNumber =-,
Anthony J. Nestico, Esq (717) 533-54(~ ~ o r'
r-?Tv~ _~_, r
~
REGISTER~OFt
USE ONLY ~~
First line of address 7 ..
~ ;, ? ~-~ ~~
,_
-R
Nestico
Druby & Hildabrand, P . C . - - ~-~ =- "-7
,
Second line of address `' tV ~~ r~
,
tL~
840 E. Chocolate Ave.
City or Post Office State ZIP Code DATE FILED
Hershey PA 17033
Correspondent's a-mail address:
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. D laration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU P OI~SIBLE FOR FILING RETURN DATE
840 East Chocolate Avenue, Hershey, PA 17033
SI NATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
83 Honeysuckle Drive, Mechanicsburg, PA 17050
PLEASE USE ORIGINAL FORM ONLY
Side 1
15D5610101 1505610101 J
REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
202-20-1624
RECAPITULATION
1. Real Estate (Schedule A) ........................................... .. L 0.00
2. Stocks and Bonds (Schedule B) ..................................... .. 2. 0.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00
4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. ' 14,913.91
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...... .. 7. 316,492.88
8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 331,406.79
9. Funeral Expenses and Administrative Costs (Schedule H) ............. ...... 9. ' 8,269.89
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........ ...... 10. 0.00
11. Total Deductions (total Lines 9 and 10) ........................... ...... 11. 8,269.89
12. Net Value of Estate (Line 8 minus Line 11) ........................ ...... 12. 323,136.90
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) .................. ...... 13. 0.00
14. Net Value Subject to Tax (Line 12 minus Line 13) .................. ...... 14. ' 323,136.90
TAX CALCULATION -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_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 45 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE .................................................... .....19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610105 1505610105
1505610105
14,541.16
14,541.16
O
REV-1500 EX Page 3
Decedent's Complete Address:
2,152.82
DECEDENT'S NAME
Mae E. Hartman
STREET ADDRESS
801 N. Hanover Street
CITY
Carlisle STATE ': ZIP
PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
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
5
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
File Number
(1)
Total Credits (A + B) (2)
(3)
(4)
(5)
14,541.16
2,152.82
0.00
12,388.34
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 :.................................................................................... ...... ^ x^
b. retain the right to designate who shall use the property transferred or its income :...................................... ...... ^ Q
c. retain a reversionary interest; or .................................................................................................................... ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ ^x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................................................................................................ ...... ^ x^
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ........ ...... ^ x^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? .................................................................................................................. ...... ^ 0
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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i}].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 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 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 12 percent [72 P.S. §9116(a)(1.3}]. A sibling 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 FILE NUMBER
Mae E. Hartman 2010-00123
Include the 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.
(If more space is needed, insert additional sheets of the same size)
i?EI-1~1Q EX+ OS-`J?i
~ Pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mae E. Hartman 2010-00123
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 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
i. Ameriprise Financial -Client # 1516 90179 00, Group ID # 0448 60021 001 76,889.86 100 76,889.8E
2 Mass Mutual -Account # ODY 16325940 157,168.56 100 157,168.5E
3 American Equity -Account # 331593 24,728.81 100 24,728.81
4 American Equity -Account # 308190 32,753.93 100 32,753.9c
5 American OM -Account # RAR0004057 24,951.72 100 24,951.7
TOTAL (Also enter on Line 7, Recapitulation) $ ~ 316,492.88
If more space is needed, use additional sheets of paper of the same size.
j i~ pennsylvania SCHEDULE H
~ DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Mae E. Hartman 2010-00123
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES;
I' Golden Living Center (assisted living facility) 1,335.00
2. Church of God Home (assisted living facility) 3,746.48
3. Myers Funeral Home 400.00
B.
1.
2.
3.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State _ __ ZIP
Attorney Fees: Nestico, Druby & Hildabrand, P,C.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
4.
5,
6.
7.
s.
City State
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Continuing Care Rx
Envelopes and Postage
ZIP
2,344.70
420.50
4.62
18.59
TOTAL (Also enter on Line 9, Recapitulation) I $ 8 , 2 6 9 , 8 9
if mnra cnarP is naariari ncP arlAihinnal choatc of nanor of tho camo eioo
SAN-14-2010 10:33 NESTICO~ DRUEsY xILDAERAND 717 533 5717 F.001i006
From:GES AUTOMATION TECHNOL''"v INC To:5335717 01~''l2010 09:43 #DE1 P. 001/006
LAST WILL AND TESTAMENT
(Pour-Over Will)
OF
MAE E. HARTMAN
IDENTITY
I, MAE E. HARTMAN, residing in the County of Cumberland, Commonwealth of Pennsylvania,
being of sound mind and memory, and not acting under duress or undue influence of any person
whomsoever, hereby declaze this to be my Last Will and Testament, and I do hereby revoke all other former
Wills and Codicils to Wills heretofore made by me. My Social Security Number is 202-20-1624.
All reference made herein to "spouse or my spouse" refers to the person to whom I am currently
married, namely, ALFRED W. HARTMAN. By the ensuing provisions of this Will, it is my intention to
dispose of my interest in our property; I do not intend to dispose of anything belonging to my husband or to
put him to any election.
I have the following children: LAVANCE FRANK HARTMAN, Deceased.
DEBTS, TAXES AND ADMINISTRATION EXPENSES
I nave provided for the payment of all my debts, expenses of administration of property wherever
situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other
than any tax on ageneration-skipping transfer that is not a liability of my Estate (including interest and
penalties; if any) that become due by reason of my death, under THE ALFRED W. I-iARTMAN AND MAE
E. HARTMAN REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"),
or if my spouse predeceases me, under the Survivor's Trust created by the said Revocable Trust. If the
Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items
from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In the
alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary
to pay alI or part of these items, plus claims, pecuniary legacies, and family allowances by court order.
PERSONAL AND HOUSEHOLD EFFECTS
It is my intent that all my personal and household effects were transferred to the Revocable Trust
as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership
or disposition ofthese assets, it is my desire that such assets pour into the Revocable Trust, signed by me this
date in accordance with the provisions of the section titled "Residue of Estate."
POUR-OVER WILLS ~.•~ ~77
Page 1 (Testator/Testatrix)
JAN-14-2010 10:33 NESTIC4~ DRUBY HILDABRAND 717 533 5717 F'.003.'006
From:GES AUTOMATION TECHNOL''"~ INC To: 5335717 01~`'l2010 09:44 #021 P. 002/006
RESIDUE OF ESTATE
I give, devise and bequeath all the rest, residue and remainder of my property of every kind and
description (including lapsed legacies and devices), wherever situated and whether acquired before or after
the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the
execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus
of the above described Trust and shall hold, administer and distribute said property in accordance with the
provisions of the said Trust, including any amendments thereto made before my death.
If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a
court of competent,jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said
Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and
remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their
substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested
and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date
of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any,
hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will.
EXECUTOR
I hereby nominate and appoint ALFRED W. HARTMAN as my Independent Executor of this, my
Last Will and Testament, to serve without bond.
In the event the first named Executor shall predecease me or is unable or unwilling to act as my
Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint FRANK X.
APONTE to serve without bond as my Independent Executor.
In the event the second named Executor shall predecease me or is unable or unwilling to act as my
Executor for any reasons whatsoever, then and in #hat cvent, I hereby nominate and appoint ARMANDO G.
HARTMAN to serve without bond as my Independent Executor.
In the event the third named Executor shall predecease me or is unable or unwilling to act as my
Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint VANESSA A.
HARTMAN to serve without bond as my Independent Executor.
Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this my
Will, such words and respective pronouns shall be held and taken to include both the singular and the plural,
the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and
to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall
possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally
named herein.
EXECUTOR POWERS
By way of Illustration and not of limitation and in addition to any inherent, implied or statutory
powers granted to executors generally, my Executor is specifically authorized and empowered with respect
to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate
POUR-OVER WILLS ~9 ~°
Page 2 (Testator/Testatrix)
JAN-14-2010 10:33 NESTICO, DRUBY HILDABRAND
Fr-om:GES AUTOMATION TECHNOI`"'~ INC To:5335717
717 533 5717 P. f]03f006
01 '' '!2010 09:44 #021 P. 003J006
between principal and income, assign, bon: ow, buy, care for, collect, compromise claims, contract with
respect to, continue any business ofmine, convert, deal with, dispose of, enter into, exchange, hold, improve,
incorporate any business ofmine, invest, lease, manage, mortgage, grant and exercise options with respect
to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of
partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers
in the management of my Estate which any individual could exercise in the management of similar property
owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and
deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry
out the purpose of this my Will, without being limited in any way by the specific grants or power made, and
without the necessity of a court order.
My Executor shall have absolute discretion, but shall not be required, to make adjustments in the
rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences
of any tax decision or election, or of any investment or administrative decision, that my Executor believes
has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others.
In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have discretion
to select the valuation date and to determine whether any or all of the allowable administration expenses in
my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions and shall have
the discretion to file a joint income tax return with my spouse.
SPECIFIC OMISSIONS
I have intentionally omitted any and all persons anC entities from this, my Last Will and Testament,
except those persons and entities specifically named herein. if any person or entity shall challenge any term
or condition of this Will, or ofthe Living Trust to which I have made reference in the sections "Household
and Personal Effects" and "Residue of Estate," then, to that person or entity, I give and bequeath the sum of
only one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that
person or interest may have in my Estate or the Living Trust and its Estate.
SIMULTANEOUS DEATH
If my spouse and I should die under circumstances such that the order of our deaths cannot be
determined, then it shall be conclusively presumed for the purpose of this Will that my spouse survived me.
If any other Beneficiary should not survive me for sixty (60} days, then it shall be conclusively
presumed for the purpose of this my Will that said Beneficiary predeceased me.
'mot a.-~ ~ ~ ~~ ~/~vv~.d~v~
MAE E. I-iARTMAN
Testatrix
POUR-OVER WILLS ~ ~ ~_
Page 3 (Testator/Testatrix)
JAN-14--2010 10:33 NESTIGO, DRUSY HILDABkAND
From:GES AUTOMATION TECHNOI"`'Y INC To:5335717
717 533 5717 P.OG4/G06
01 " 112010 09:45 #021 P. 0041006
This instrument consists of 5 typewritten pages, including the Attestation Clause, Self-Proving
Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at the bottom of each
of the receding pages. This instrument is being signed by me on this ~_ day of
_~JnuSt OOI.
ATTESTATION CLAUSE
The Testatrix whose name appears above declared to us, the undersigned, that the foregoing
instrument was her Last Will and Testament, and she requested us to act as witnesses to such instrument and
to her signature thereon. The Testatrix thereupon signed such instrument in our presence. At the Testatrix's
request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence
of the Testatrix. The undersigned hereby declare, in the presence of each of us, that we believe the Testatrix
to be of sound and disposing mind and memory.
Signed by us on the same day and year as this Last Will and Testament was signed by the Testatrix.
WITNESSES:
l~~~~ /~~z~°2r-2L~
J~~~~ ~~~Jc ~ ~~.
(Printed Name of Witness)
~1
° ~ ~
~
n n ~,,,
. . ~
~-
rx ~ S ~ .
(Printed Name ofV~itness)
ADDRESSES:
5 G.~c~~c .La~.~
/1~~., Pte.
POUR-OVER WILLS '~'t'1
Page 4 (TestatodTestatrix)
JAN-14-010 10:33 NESTICO~ DRU3Y HILDAERAND
From:GES AUTDMATIDN TECHNOI''"~ INC To:5335717
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SELF-PROVING CLAUSE
717 533 5717 P.005i006
01~~'/2010 09:46 #021 P. 005/006
BE~ORE ME, the undersigned authority, on this day personally appeared MAE E. HARTMAN,
p~,,,~ ~,li,~~~ and ~~,ra,4 ~j,:.~l , known to me to be the
Testatrix and the wifiesses, respectively, whose names are subscribed to the foregoing instrument in their
respective capacities, and all of them being by me duly sworn, MAE E. HARTMAN, Testatrix, declared to
me and to the Wifiesses, in my presence, thatthe instrument is her Will and that she had willingly made and
executed it as her free act and deed for the purposes therein expressed; and the Witnesses, each on his or her
oath, stated to me in the presence and hearing of the Testatrix, that the Testatrix had declared to them that
the instrument is her Will and that she executed the same as such and wanted each of them to sign it as a
witness; and upon their oaths, each witness stated further that he did the same as a witness in the presence
of the Testatrix, and at her request and that she was at that time eighteen (18) years of age or over and was
of sound mind, and that each of the witnesses was then at least fourteen { 14) years of age.
~'
MAE E. HARTMAN
Testatrix
~~~~5 ~~~~ L. ~~ r
(Printed Name of Witness)
Witn ss
~ Cz~ , ~.o , Yl s ~°
(Printed Name of fitness)
SUBSCRI$ED AND ACKNOWLEDGED before me by MAE E. HARTMAN, Testatrix, and
subscribed and sworn to before me by f~ and ~,~~ ,
witnesses, this the --_[~ day of ~ V , 2C7 (~ .
N y P 'c, Commonwealth of Pennsylvania
JEFF~,,~Q~DES
Commissioner of Deeds
Commonwealth of Pennsylvania
My Commission expires Nov 17, 2003
POUR-OVER WILLS ~~~
Page 5 (TestatodTestatrix)
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
IN RE: ESTATE OF
MAE E. HARTMAN,
DECEASED
RENUNCIATION
NO.
I, Frank X. Aponte, in my relationship as grandson of the above Decedent, hereby
renounce the right to serve as First Successor Trustee of the Alfred W. Hartman and Mae E.
Hartman IZerocable Living Trust Agreement dated August 9, 2001. I respectfully request that
Armando G. Hartman, the Decedent's grandson, named Second Successor Trustee under the
Alfred W. Hartman and Mae E. Hartman Revocable Living Trust Agreement dated August 9,
2001, serve as First Successor Trustee.
,,
tt'l~ v~ ~ i~G'~L
Date
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, -.,
Frank X. Aponte
~ _; -~' ~'~ ~-•
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N
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF C~~ber~~-c~% .
On this, the ~~ day of h h. ~ ~ n ~ 2010, before me a Notary
Public in and for said County and State~ersigned officer, personally appeazed Frank X.
Aponte, known to me (or satisfactorily proven) to be the person whose name is described to the
within instrument, and acknowledged that he executed the same for the purpose therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
c;oMiuor~lwE~.ni of ~lsnv~w~
Nora~uu~s~+t.
gT1Y ~ OLASSER N ublic
31LVER SPIAgO TiOWNSHfP aUMB~ COlJHiY
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