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Home My WebLink About10-22-10b T ~ f ~ 1505610101 REV-1500 Ex ~°,_1°' ~' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania o~PARrM~~,o~w~~~N~~ County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6oi ~ ~ ~~ ~ ~~ ~ ~ HarrisburS, PA 1'7128-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYWY 097-12-8905 10/07/2009 04/02/1923 Decedent's Last Name Suffix Decedent's First Name MI '~ Ka ~ z o~clS~'K I -~-'~ ~~U~C (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 m 1. Original Return O 2. Supplemental Return O 3. Remainder Return (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) O 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 COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Sandra A. Cronin (717) 385-8667 ~~..~ First line of address 18 Cumberland Estates Second line of address City or Post Office Mechanicsburg Correspondent's a-mail address: sacronin@comcast.net 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 ATURE OF PERSON PO IBLE FOR FILING RETURN DATE ~, lJ 10/22/10 18 Cumberland Estates Dr., Mechanicsburg, PA 17050 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS State ZIP Code PA 17050 c ~ __ _ ~- REGISTER ~F LS USE C~Y °) _ "~ '. ..._ _ _ i _~ f_~ A ._ r ;- _, -.. _, -- ~ .__. ~ ~ ~. ~;i DATE FILED PLEASE USE ORIGINAL FORM ONLY L 150561011 Side 1 1505610101 J v~ J 1505610105 REV-1500 EX Decedent's Social Security NumbE~r Decedent's Name: FeliX Kozlowski 097-12-8905 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 and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property {Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 30,399.14 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 30,399.14 9. Funeral Expenses and Administrative Costs (Schedule H) ........... ........ 9. 8,606.27 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... ........ 10. 63..19 11. Total Deductions (total Lines 9 and 10) ......................... ........ 11. 8,669.46 12. Net Value of Estate (Line 8 minus Line 11) ..................... ......... 12. 21,729.68 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. 21,729.68 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 21,729.68. 16. 977.$4 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. 977.$4 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 15056101,05 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Felix Kozlowski STREET ADDRESS 18 Cumberland Estates __ CITY .STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 977.84 2. Credits/Payments A. Prior Payments ___ __ _ 997.90 B. Discount Total Credits (A + B } (2) 977.90 3. Interest (3) _ 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WELLS, 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 : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .............. ^ 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 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)). 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-i5o9 EX+ (oi->.o) ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: Felix Kozlowski 2110-0199 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Sandra A. Cronin 18 Cumberland Estates Dr., Mechanicsburg, PA 17050 Daughter B. C JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE )DINT 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 DECEDENT'S INTEREST DATE OF DEATH VALUE: OF DECEDENT'S INTEREST 1 A . . 03/01/99 Members1st FCU savings and checking account# 182035 60,798.28 .5 30,399.14 TOTAL (Also enter on Line 6, Recapitulation) I $ 30,399.14 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) r Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Felix Kozlowski 2110-0199 Decedent's debts must be reported on Schedule I, ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; I' Myers Funeral Home -funeral expenses 7,626.00 Gate of Heaven Cemetary -interment 600.00 Marinak & Glossner, DDS -denture repair 138.50 Koste Villa -funeral breakfast 166.77 B, ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) _ _-_ _ - _____ Street Address City _ State - - -- ZIP - - Year(s) Commission Paid: 75.00 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City _ - - -_- _- -- - - -- --- - - - -- --_ _ -State __ -_ ZIP -_-- -- - Relationship of Claimant to Decedent 4• Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7, TOTAL (Also enter on Line 9, Recapitulation) I $ 8,606.27 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Felix Kozlowski 2110-0199 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) r pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Felix Kozlowski 2110-0199 _ 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• Sandra A. Cronin, 18 Cumberland Estates, Mechanicsburg, PA 17050 Daughter 7243.23 Paul Kozlowski, 34 Crownview Terrace, Hamburg, NY 14075 Son 7243.23 Michael P. Kozlowski, 489 Mapleview, Cheektowaga, NY 14225 Son 7243.23 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 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, use additional sheets of paper of the same size, J T REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2010- 00199 PA No . 21-- 10- 0199 Estate Of: FELIX KOZLOWSKI (First, Middle, fast) Late Of : SlL VER SPRING TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No : 097-12-8905 WHEREAS, on the 31st day of March 2 010 instruments dated June 9th 2000 July 7th 2000 were admitted to probate as the Iasi will and codicil of FEL/X KOZLOWSK/ (First, Midd/e, Last/ late of S/L VER SPRING TOWNSHIP, CUMBERLAND County, who died on the 7th day of October 2 0 09 and, WHEREAS, a true copy of the wi 11 &codi ci 1 as probated i s annexed here to THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 1.1 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, .hereby certify that I have this day granted Letters TESTAMENTARY to: SANDRA A CRONIN who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of which fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE, CA RL lSL E, PENNS YL VAN/A . IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 3~st day of March 2070. ~, Register o rlls j //` ~ / ,~ Deputy * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ~~rst ill xn~ ~e~st~ment OF FELIX KOZLOWSKI 'I, FELIX KOZLOWSKI, of Hampden Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Wi:tl and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in her opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not own a burial plot or a grave marker at thE~ time of my death, I authorize my personal representative, in hex- sole discretion, to purchase a burial plot and to erect a suitab~lE~ grave marker at my grave, and to expend sums from my estate ~c~r~ c ~~ ~--> this purpose . `;~ ~- ,- ~ -'~ _. :~ P :,_ ( _ t._._ Cs.~l r _, - . ,. _ j C ' ~ ~~ ~~ ~I-~1 ~~~ ; ~ "_ PAGE 1 OF 6 .; ~} Cyr LAST WILL AND TESTAMENT OF FELIX KOZLOWSKI SECOND I give, devise and bequeath the rest, residue and remainder of my estate, together with all insurance proceeds thereon of whatsoever nature and wheresoever situate to my beloved spouse, ROSE M. KOZLOWSKI, providing that she survives me by thirty (30) days: THIRD Should my spouse, ROSE M. KaZLOWSKI, predecease me or die on or before the thirtieth (30th) day following my death, then I give, devise and bequeath the rest, residue and remainder of my estate together with all insurance proceeds thereon of whatsoever nature and wheresoever situate in equal shares to my children, SANDRA A. CRONIN, PAUL KOZLOWSKI, and MICHAEL KOZLOWSKI, who survive me by thirty ( 3 0 ) days . In the event my son, PAUL KOZLOWSKI , predeceasE~s me or dies on or before the thirtieth (30th) day following my~ death, then the share of my estate that was to pass to him shall be distributed equally between my surviving children who survive me by thirty {30) days, per stirpes. In the event either SANDRA A. CRONIN or MICHAEL KOZLOWSKI predeceases me or dies on or before th.e thirtieth (30th) day following my death, then SANDRA A. CRONIN'S~ or MICHAEL KOZLOWSKI'S share shall be distributed equally to his or her children, respectively. It is further my desire that m~y personal representative, after consultation with any heir or heirs of mine who survive me, and in her own discretion, choose such PAGE 2 OF 6 LAST WILL AND TESTAMENT OF FELIK KOZLOWSKI articles from my tangible personal property {exclusive of ~~ash, stock certificates, bonds, and all other tangible evidences of intangible personal property) as she believes will be useful to such heir or heirs or desirable for him or her or them to have, either from a sentimental point of view or otherwise, and to f deliver such articles to such heir or heirs or among such heirs in egla.al or unequal shares as determined by the further exercise of her discretion, provided no other heir objects to the distribution. All tangible personal property not so distributed is t.o be sold, either publicly or privately, by my personal representative, adding the proceeds of such sale or sales to my residuary estate and tc~ be disposed of in equal shares among my surviving heirs after payment of my estate debts, taking into account the tangible personal property otherwise provided to them. r FOURTH I grant my personal representative the following powers in addition to and not in limitation of such powers as my personal representative shall hold by law: (a) To retain all property received including the stock of any corporate fiduciary acting hereunder, provided such property remains productive. {b) To join in any corporation, partnership, recapitaliza- tion, merger, reorganization or voting trust plan; to delegate authority with respect thereto; to deposit investments under PAGE 3 OF 6 LAST WILL AND TESTAMENT OF FELIX KOZLOWSKI agreements and pay assessments; and generally to exercise all rights of investors, including but not limited to, the voting of shares. (c) To manage, operate, repair, improve, mortgage or lease on any `terms any real estate held or owned by my estate. '(d) To operate any business that I may own at my death. (e) To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of diversification or any other statute or general rule of law in her absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investment:~ do not unnecessarily prevent the prompt settlement of my estate. (f) To sell or otherwise dispose of any property, real or personal, tangible or intangible, at any time forming a part of my estate in any manner and on such terms and conditions as my' personal representative shall see fit in her absolute di:~cretion. (g) To borrow money for the payment of taxes or for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as security. (h) To compromise claims without court approval including, but not limited to, any controversies with the United States of America or the Commonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under. this my Last Will and Testament. PAGE 4 OF 6 LAST WILL AND TESTAMENT OF FELIX KOZLOWSKI (i) To distribute in cash or in kind upon any division or distribution of my estate. (j ) To undertake any and all acts deemed necessary and proper by my personal representative for the proper, advantageous and prompt management of the settlement of my estate. .(k) In general, to exercise all powers in the management of my e M ate which any individual could exercise in the management of similar property owned in his own right, upon such germs and conditions as to her may seem best and to execute and deliver all instruments and to do all acts which she deems necessary or proper to carry out the purposes of this, my Last Will and Testament. FIFTH No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any1 beneficiary have the power in any manner to charge or encu~.mber hi.s or her interest either in income or principal, nor s~lall the interest of any beneficiary be liable or subject in any manner while in the possession of my personal representative for the liability of such beneficiary. PAGE 5 OF 6 I• LAST WILL AND TESTAMENT OF FELIX KOZLOWSKI SIXTH I nominate, constitute and appoint my spouse, ROSE M. KOZLOWSKI, as personal representative of this my Last Will and Testament. In the event my spouse is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoevE=_r, then I nomihate, constitute and appoint my daughter, SANDRA A. CRONIN, as personal representative of this my Last Will and Testament. I direct that my personal representative shall not be required to give or post bond for the faithful performance of her duties in this or any other jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand to thi:~ my Last Will and Testament this 9th day of June, 2000. WITNESS: } ~~ ~ x `-. . "'L/ vim"' r E FELIX` KO L I .~ PAGE 6 OF 6 LAST WILL AND TESTAMENT OF FELIX KOZLOWSKI ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA SS. T COUNTY OF CUMBERLAND I, FELIX KOZLOWSKI, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I ;signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. i ,: j ! FELIX KO LOW' I Sworn or affirmed and acknowledged before me by FELIX KOZLOWSKI, the Testator, this 9th day of June, 2000. .~-.... s .,~ J ~,. NOTAR PUBLIC NOTARIAL SEAL HEIFN E RASMUSSEAt, Nosy Public May Canm~lot~ExplC r~Aug. 2 i~ LAST WILL AND TESTAMENT OF FELIX KOZLOWSKI AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND WE, and ~ ! C...L..~'l~1~l~C- ~. ~t•~ _, the Witnesses whose names are attached to the foregoing document, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Last Will and Testament as witnessed and that to the best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed and subscribed before me by ,i ~.. ~.ir and i this 9th day of June, 2000. :~ vI~TOTARY ~BLIC NC?TARIAL SEAL HELEN E. RASMUSSEN, Notary Pt~6ilc camp Hill Borough, Cumberland Courtly My Commission ExpUes Aua. 2, 2003 LAST WILL .AND TESTAMENT OF FELIX KOZLOWSKI ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBER~,AND I, FELIX ROZLOWSKI, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed a:nd executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and volunta~.ry act for the purposes therein expressed. ;~ FELIX KO LOW I Sworn or affirmed and acknowledged before me by FELIX KOZLOWSKI, the Testator, this 9th day of June, 2000. .,--T -.. J J _ ..~ NOTAR PUBLIC NOTARIAL SEAS. HE1Fi~i E RASM3J~5SEN, Nosy Pt~biic M~Comm3~~.siExpi~r~ug. 22 ?!03 Y F~~.,? ~~ ~ CODICIL TO THE LAST WILL AND TESTAMENT ~~~ :~ ' ~~ ~ e, r :~ R _, r. ~_~ ...~-- , , FELIX KOZLOWSKI '-:-; `' ~~ ~~~' `~~ _ :~ 'i3 (~ - -' C.a3 ' I, FELIX KOZLOWSKI, of Hampden Township, Cumberland County, t Pennsylvania, the within named Testator, do hereby make arld publish this, Codicil to my Last Will and Testament, dated June 9, 2000, hereby revoking and making void all previous Codicils heretofore made by me. I hereby modify the said Last Will and Testament as follows: ITEM I: The second sentence of Paragraph THIRD is deleted and replaced with the following: In the event my son, PAUL KOZLOWSKI, predeceases mE~ or dies on or before the thirtieth (30th} day following my death, then the share of my estate that was to pas: to him shall be distributed equally between KEANU KOZLOWSKI and MITCHELL KOZLOWSKI. The remainder of Paragraph THIRD, as set forth in said Last Will and Testament, continues to be in effect. In all other respects, I confirm and ratify my aforesaid Last Will and Testament. 1 PAGE 1 OF 2 CODICIL TO THE LAST WILL AND TESTAMENT OF FELIX KOZLOWSKI IN WITNESS WHEREOF, I have hereunto set my hanc~ to this Codicil of my Last Will and Testament this 7th day of July, 2000. WITNESS: 1r'd FELIX KOZLOW I PAGE 2 OF 2 CODICIL TO THE LAST WILL AND TESTAMENT OF FELIX KOZLOWSKI ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA : • SS. COUNTY OF CDMBERLAI~D - I, FELIX KOZLOWSKI, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as the Codicil to my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. ~ r ~ FELIX KOZ OW Sworn or affirmed and acknowledged before me by FELIX KOZLOWSKI, the Testator, this 7th day of July, 2000. ~- `NOTARY I C NOTARIAL SEAL Pt~ic HELEN E. HASMI~SSEN, Nosy Camp Hill Barougfi, Cumberland County My Commission Expires Aug. 2, 2003 .- CODICIL TO THE LAST WILL AND TESTAMENT OF FELIX KOZLOWSKI AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA • SS • COUNTY OF CUMBERLAND WE, ~ and ~3~T~'ll~lt'~_ ~ , ~~?~-~'~,. , the witnesses whose names are attached to the foregoing documents, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as the Codicil to his Last Will and Testament; that rie signed willingly and that he executed it as his free and voluntaz~y act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Codicil as witnessed and that to the best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. t ~~_~l ~, o-:z, , Sworn or affirmed and subscribed before me by `c' ~~ _ ~~~ and r~ this 7t:h day of July, 2000. N NOTARIAL SEAL NELEN E RASMU;SSBV. ~Y Public Camp HiN Borough, Cumberla~ui County My Comrnlssion Expka~ Aug. 2,_ 2003