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Home My WebLink About12-07-10 (5)1505610101 REV-1500 Ex `°'_1°' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY oEPAAT~E~T of RE~EN~E County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN / j PO BOX 280601 ~ ! ~ ~ /'~ ~ / t Harrisburg, PA 1y128-o6oi RESIDENT DECEDENT ( (!~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 160-16-9871 09/10/2010 06/12/1917 Decedent's Last Name Suffix Decedent's First Name MI BAUM VIRGINIA H (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 ~ 1. Original Return O 2. Supplemental Return O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) Q 3. Remainder Return I;date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required ~ _ 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Nurnber J ROBERT BAUM (301) 807-6501 First line of address 174 SPRINGHOUSE LANE Second line of address City or Post Office SPRING GROVE State ZIP Code PA 17362-8695 REGISTER WILLS VISE (Y ~~ ~ _. r ~~ ~ J "~ `~ _k_ ~-~ ~-..? ~ z ,< r...~_.~ t f_, _ y-~ '~,~ ~ .. cv ~~=,-~ _. _r , - ._. ~ . . C3ATE LED ~•- _ Correspondent's a-mail address: , ~ t~ a K •"'l ~ m G O ~'-'1 G •e ~~• h C .~ ',k l? F ~; _ ,. ~ +'~T_~,~ a ~_`a -;~ 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 prep r other the personal represe tative is based on all information of which preparer has arty knowledge. SIGNATURE OF PERSON RESPONSIBLE F ILING,F~ N DATA ADDRESS ~ 174 PRINGHOUSE LA PRIN GROVE PA 17362-8695 SIG AT U~ Pr>~EPARER T T EPRESENTATIV DATE AD E 6805 LAUREL SUMMIT DRIVE, HANOVER PA 17331 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 J REV-1500 EX decedent's -vame: VIRGINIA H. BAUM Decedent's Social Security Number 160-16-9871 RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 0.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 664,934.30 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. 39,879.12 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. 37,900.00 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 742,713.42 9. Funeral Expenses and Administrative Costs (Schedule H} ............ ....... 9. 5,315.70 10. Debts of Decedent, Martgage Liabilities, and Liens (Schedule I) ....... ....... 10. 11,704.50 11. Total Deductions (total Lines 9 and 10) .......................... ....... 11. 17,020.20 12. Net Value of Estate (Line 8 minus Line 11) ....................... ....... 12. 725,693.22 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. 725,693.22 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 45 725,693.22 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 1 g. 19. TAX DUE ....................................................... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610105 1505610105 32,656.19 32,656.19 O 1505610105 REV-1500 EX Page 3 File Number Decedent's Complete Address: VIRGINIA H BAUM STREET ADDRESS C/O J ROBERT BAUM 174 SPRINGHOUSE LANE CITY STATE ZIP SPRING GROVE PA 17362-8695 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 32,656.19 2. Credits/Payments --- A. Prior Payments B. Discount 1.,632.81 1,632.81 Total Credits (A + B) (2) ___ 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) 31,023.38 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 :................................................................................... ....... ^ b. retain the right to designate who shall use the property transferred or its income : ..................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ 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" or payable-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 oi` 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-1503 EX+ (6-98) SCNEDVLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER VIRGINIA H BAUM 2.1-10-0961 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) REV-1508 EX+ (6-98) SCHEDVLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONA! PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER VIRGINIA H BAUM 21-10-0961 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. METRO BANK 50 PLUS CHECKING ACCOUNT # 32085961 INCLUDING ACCRUED INTEREST 19,649.17 2. METRO BANK PERSONAL MONEY MARKET ACCT # 536247950 INCLUDING ACCRUED INTEREST 7,183.78 3. THRIVENT FINANCIAL - REFUND OF LONG TERM CARE PREMIUM 2,210.00 4. BAUM TRUST FBO DECEDENT -RESIDUAL BALANCE 1,286.17 5. ESTIMATED OVERPAYMENT OF 2010 FEDERAL INDIVIDUAL INCOME TAX 9,300.00 6. ESTIMATED OVERPAYMENT OF 2010 PA INDIVIDUAL INCOME TAX 250.00 TOTAL (Also enter on line 5, Recapitulation) ~ ~ 39,879.12 (If more space is needed, insert additional sheets of the same size) RFV-1510 EX+ ;Oa-C9j ~ enns lvania SCHEDULE G P Y DEPARTMENT OF REuENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT -- ESTATE OF FILE NUMBER VIRGINIA H BAUM 21-10-09fi1 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 1. CASH GIFTS TO 4 CHILDREN WITHIN ONE YEAR OF DEATH 49,900.00 I 12,000.00 37,900.OC TOTAL (Also enter on Line 7, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 37,900.00 RCV-1511 EX+ (10-0~; ~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER VIRGINIA H BAUM 21-10-0961 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' MEMORIAL SERVICE EXPENSE FOR MINISTER, PIANIST AND VOCALIST 375.00 2. MEMORIAL SERVICE FLOWERS 381.55 3. MEMORIAL SERVICE LUNCHEON 680.42 a. AUER CREMATION SERVICES 80.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City __ _ _ _ _ _ _ _ _ _ __ _ _ State _ _ ZIP __ Year(s) Commission Paid: 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 Retum Preparer Fees: ~• RESERVE FOR ADDITIONAL PROBATE FEES s. PATRIOT NEWS -ESTATE NOTICE 9. PATRIOT NEWS -OBITUARY ~o. UPS REGARDING INVESTMENT ACCOUNT ~ ~ . CUMBERLAND COUNTY BAR ASSOCIATION JOURNAL TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 523.50 2,000.00 500.00 194.73 470.72 34.78 75.00 5,315.70 REV 151.2 EX+ li2-GS) Ir Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER VIRGINIA H BAUM 21-10-0961 __ 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) ~ pennsylvania DEPARTMENT OF RE`JENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF: FILE NUMBER: VIRGINIA H. BAUM 21-10-0961 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) ()F ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1• JAMES A. BAUM SON 25% OF RESIDUE 490 LANGDALE COURT, KING OF PRUSSIA, PA 19406 2 DIANE M. KERLY DAUGHTER 25% OF RESIDUE 1241 FOX HILL ROAD, STATE COLLEGE, PA 16803 3 DEBORAH M. LONG DAUGHTER 25% OF RESIDUE 5430 RIVENDALE BOULEVARD, MECHANICSBURG, PA 17050 4 J. ROBERT BAUM SON 25% OF RESIDUE 174 SPRINGHOUSE LANE, SPRING GROVE, PA 17362 5 NICOLE SEIFERT, TROY SNYDER, ERICH BAUM, ROBIN NAISMITH 4 GRANDCHILDREN $5,000 SPECIFIC BEQUEST EACH ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S 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. Vanguard -Accounts & Activities https:/Jpersonal,vanguard.catt~/us/TPView?TpvPrtAnc=1 ~~ Accounts ~ activity ~ P-R,twspaee Total Vanguard Assets $245,426.31 C Do«nbadaansactia'is ~ Compan3 to year-end balances > Create a pr+efemed acoouM view Q Hide zero balance holdings ~ Find balance by date Vanguard Investments Expand name and address inforrrration Portfolio of Virginia H. Baum Virginia H. Baum-individual Account Buy ~ SeH ~ Transaction History ~ Cost Basis Price as of 09/i0/2ot0 .._.. Name Fund & Accounk Shares Price ~ Change Value Vanguard Prime Morrey Market Fund ~t~tar~sr 0030-09888333331 2,285.840 $1.00 - $2,265.84 Vanguarti lnl9ermediate-Term Treasury Fund Admiral Shares 0535-099fi8333331 20 678.911 $11 76 -$0.02 $243,160.47 Subtotal $245,426.31 Virginia H. Baum Portfolio Total $245,426.31 ; Outside fnvestmerrts Outside klvestments atiotivs yoc+ b view your non-Vangceni investments from the Vanguard Aaoounts & ilctivity page_ team more about this service, ® i895-2010 'Tt~e Vanguard Group, hc. AO rigtris reserved. Vanguard Marketing Corp., Dtstrtb. Terms & ao+W'ii;ons a~ use { Seasity Career {amain prospectus { C~ar~eers {Mobile servkes (H Feedback { Et~anced Support 1 oft 9!i 1J2OiO 6:3'7 AM Portfolio -Wells Fargo Advisors, LLC hops:/Iwachseconl ine.wachovia.corn/NASApp/e BrokeragelEBroker... €~ ~ Ga~a~e CashlCash Alternatives Descriestion .~ Bank DepositlMoney Market Fund Total CashlCash Alternatives Stocks Symbol f Trade Date1 Quantiri Descrieytfon ~ ` SYm6ot ------._w ~_ ;Trade Date1 ._.~_._.___.__---._. Qusrrti ~_. _ .~ Common Stock _.. __ ___ ALLIED (#2iSH BKS SPONSRD At6 ~ 09/16/1981 4,584.000 FAIRPOMT COMMUNICATIONS ~ FRCMQ ~ 09/22/1987 7.000 FRONTIER COMMN~ATEONS FTR 09/22/1987 96.000 (SHARES RUSSELL 1000 GR IWF E 11112f2004 `: 520.000 MONEYGRAM INTL INC MGE ~._. 08122/1996 ~ 3 400.000 PPL CORPORATION :PPL ~ 12/0611984 2,620.000 __.._.__~ ~ _.._.T ~ L ._ __._._ ...__..~._._.~ UGl CORP NEW ~K UGI 01/07/1985 ~ 1,320.000 VERIZON COMMUNICATIONS ^ VZ 09/22/1987 400.000 VIAD CORPORATION • _ ~ ^^ ~ Wi~ 08/22/1996 ~ V_ 100.000 -_--._._w._._.,__.__.. _.__________..._..___ Total Stocks _._______.. ------__.__.. ; 1 ,..__. Mutual Funds s Ct~anae Market T°~ ~s Tc Price ..._._,_...._...._.._..__ fn Price .___-__._~__~...__._.t Value .._. ____,._ ,. Clean e~ t 3 ... _ ___.__ ___. $5,338.26 _._ __.._._~._.._.,_,.._._. 55,338.26 Change Market T~ `s T~ Price fn Price Value Chanae~ ~ $2.090 ~ a 0.140: $9,580.56: $641.76 $o.ozs o.ooo $a.ts ` $o.oo $7.720 a 0.060 $741.12 $5.76 $49.320 F x 0.230 ~ $25,646.40 $119.60 $2.010 T (0.040) ~ $804.00 ': {$16.00} $27240 ' a 0.120: $71,368.80 $314.40 $28.540 : 0.390: $37,672.80 $514.80 $30.820 T (0.020) $12,328.00 ($8.00} ,`•. $15.140 t ,~ 0.270 ~ $1,514.00 ~ $27.00 $159,655.86: $1,599.32 Chance ~ Market Toda~t's S T< Description a Symbol ;Trade Date1 ~ Q_ uantity Price in PricelYieki ' Value Chan e1 t `Open End Mutua! Funds ~. ^... _ GAPETAL MCOME BLDR CL A _ CAIBX peel {~ + 362.544 _ . _ _ _.______________...____ _ __ ._ __._._ CAPITAL ENCOME BLDR CL A ._. ____.___ ~ ~X i _._ _M_..._~ € Dt~tail~ _ - 421.980 7 OPPENHE~IAR GLBL FD CL A OPPAX } Detail ~ 1,284.656 ^PRUDNTL'SCTR UTIL CL A --~ ~ ~ PRUAX L_....__~_..-_ ~ s Detail 14,022.738 TotaE Meetual Funds -y-.__._._____.. ` Fixed income ~ Descri~ian Certificates of Deposit BANK OF AMERICA CD CHARLOTTE NC ACT/365 FDIC INSURED CPN 1000% DUE01/07111 OTD 10!07/OS FC 04!07!10 BEAL BK GO LAS VEGAS NV s ACT/365 FDIC ENSURED CPN 0.250% DUEOil05l11 DTD o7rosno Fc ovoslll Total Fixed Income 'Portfolio Total- _ ~-- --- ^_^ ____, CUS1P :Trade Date1 want 06051 VJE7 09/30/2009 7,000.000 073714UN5 ~ 06!29!2010 -':, 7,000.400 _Y ___ ___ ._. .._ __ . $47.990 ~ _ ._ _._..w----,- a 0.090 ~ i -_~__ __.._. __~. $17,398.49 _... ___.,__w._._~..-.,._.._. $32.63 __._._ ;._ $47.990: .___~~_._...._. _ __ a 0.090 _.w _.__.______~.. $20,250.82: i ...._ . _.._ ._. _ _..__._._ _. $37.98 i $54.090 a 0.220 ~ $69,487.04: $282.62 $9.510 ~ 0.000 $133,356 24 ~ $0.00 $240,49259: $353.23 Es ated C°uaon Market Tc Price Ram Yalue Maturity Date1 t $100.247 ~ 1.000% ~ $7,017.29 ', 01!07!2011 $100.057 ~ 0.250% f $7,003.99 Otl05l2011 `, $14,021.28 ' 4 ' .___.______._ i_.. __,._ _._._.._.___ __.._ $419,507.99 __.._,._.._.___.__---.~- $1,952.55 -_ __..-_ . _._____.---__._s__. 2 of 3 '9/ I 1 /2010 6:33 AM Account Summary hops://online.mymetrobank.com%html/af(4GugWiwwHR012kNj~VLM... ~~ Sarvit~g ~~fra! f'ertr~sy~yanla~ 888.93'l,QptJ~4 Accoun# Summary You have no new messages. Deposit Accounts My Accounts 50 PLtj~ Cl-lECK1NG {~961~ PERS MONEY MARKET'("79501 Deposit Balances as of 9/11/2010 A~ilable Batarxe: 528,832.95 Cunet><BaFar~ce: ;28,832.95 Accoun# Display Display by Accour~ TYPe G Display by Asset/Liab~ity Account Number 32085961 535247950 Available Balance $19,649.17 $7,183.78 Current Balance 519,649.17 $7,183.78 Totals $26,832.95 $25,832.95 Tedtinicai Support 80tY20A-0541 CopyrightC¢fl09 Metro Basic Onffrle $eAlcing, Member FENC AR Rights. Reserved. -Metro Bank is a whotly owned subsidiary at Metro Bancorp. hc. and is not affiliated wirit Metro Bank Ltd, Grtaat erkain 1 of 1 ~~/ 11 /2010 6:38 AM ,~? f .~ Last Will and Testament of Virginia H. Baum I, Virginia H. Baum, of Hampden Township, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and ail former Wilis. 1. I direct my Executor hereinafter named to pay my just debts and funeral expenses as soon after my decease as conveniently may be. 2. I give and bequeath ail my household goods and tangible personal property unto my four children, J ROBERT BAUM, DIANE M. KERLY, DEBORAH M. LONG, AND JAMES A. BAUM, share and share alike, to be divided among them as they may agree. 3. I give and bequeath the sum of $5,000 each unto my four grandchildren, ROBIN NAISMITH, ERICH BAUM, NICOLE SEIFERT AND TROY SNYDER. 4. All the rest residue.;and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath unto my four children above ~ . ~- named, share and share alike, the issue of any who may predecease me to take the share of the deceased parent by representation. 5. I name consititute and appoint J. Robert Baum to be the Executor of this my will. IN WITNESS WHEREOF, I hereunto set my hand and seal this i ~~~day of /~ t c ~~ 1. e~ , 2003. ~, ~rgi H. aum Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and the presence of each other have hereunto subscribed our names as witnesses. /~