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HomeMy WebLinkAbout02-09-1115D561D143 REV-1500 Ex (01_,0, OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 Harrisburg, PA 17128-0601 RESIDENT DECEDENT Year File Number 10 0688 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 163 05 5509 06 05 2010 Decedent's Last Name Suffix SCOULER (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW L (~, 1, Original Return r-- 4. Limited Estate ~-.J ~~ 6 Decedent Died Testate (Attach Copy of Will) Date of Birth O1 30 1915 Decedent's First Name MI JAMES F Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS C~ 2. Supplemental Return ~~ 4a. Future Interest Compromise II (date of death after 12-12-82) L _ J ~• Atta ch Copy of Trust)a Living Trust ~ g, Litigation Proceeds Received ~ j 10• between12~31 ~J1 and~tl(datge5~f death r ~ 3 Remainder Return (date of death L- ~ prior to 12-13-82) ~ ~ 5. Federal Estate Tax Return Required g. Total Number of Safe Deposit Boxes (~~ 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 TO: Name Daytime Telephone Number MICHAEL L BANGS 717 730 7310 First line of address 429 SOUTH 18TH STREET Second line of address City or Post Office CAMP HILL Correspondent's a-mail address: State ZIP Code PA 17011 r-.:~ REGISTER OF 1lVDLLS USE ON~'>( t~ ~~ f r~r;7 - p 1~ fir; r ~i_..~t l~ I ~~~ ~1~ f `\ _. ~ -:~. C ..~ ,Ja ~-~ .. -~ ....,. DAT „ It~D ~-~ ~,: , -A- E`T ,~'.i i... ~:.i C-,- ...a .1 1, _. ~`...~ ~ _ 1~ - _t ~.) ~,.•'~ ~'~ 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~~,-.~ Cam,--~..~?~-e~t~ ~~,_ Jane Elizabeth Day .• /-~~~~i, AD 728 Granada Drive, Boca Raton, FL 33432 IGNATURE OF PREPARER QTHER T R ESENTATIVE , / DATE ~/~~ ,~ ~" ,~ ~' / Michael L. Banas ~ ~~' / ~~ >~ ADDRESS 429 South 18th Street, Camp Hill, PA 17011 _ Side 1 15D561D143 15D561D143 „~,~ •.~l'~' J 150561D243 REV-1500 EX Decedent's Social Security Nurnber Decedent's Name: SCOUIer, James F. 163 0 5 5 5 0 9 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 & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 317 , 0 61.4 8 6. Jointly Owned Property (Schedule F) [] Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8 Miscellaneous I~q Probate Property S h d l G S 92 14 9 85 ( c e u e ) , __ J eparate Billing Requested............ 7, . r 8. Total Gross Assets (total Lines 1-7) ..................................................................... g, 4 O 9 , 211.3 3 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... 9. ------- 8,776.96 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 2 , 2 97.67 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 11 , 0 7 4 . 6 3 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 3 98 ,13 6 . 7 0 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. 3 98 ,13 6. 7 0 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 .00 1 5. (~ . 0 0 16. Amount of Line 14 taxable 3 9 $ 13 6 . 7 0 at lineal rate X .045 . 16. 17 , 916.15 17. Amount of Line 14 taxable at sibling rate X .12 ~• ~ ~ 17. ®. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. ~' . 0 0 19. Tax Due .................................................................................................................. 19. 17 , 916.15 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 150561243 J Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Scowler, James F. 21-10-0688 include the proceeds of litigation and the date the proceeds were received by the estate. Ali property jointly-owned with the right of survivorship must be disclosed on schedule F. Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) (If more space is needed, additional pages of the same size) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBAT PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER - - Scouler, James F. 21-10-0688 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TRANSFERSATTACHTA COPY OF T{~E DEIED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °r° OF DECD'S INTEREST EXCLUSION ~{F APPLICABt_E) TAXABLE ~,/ALUE 1 MetLife Investors USA Insurance Company -Contract 92,149.85 92,149.85 9200638851 TOTAL (Also enter on Line 7, Recapitulation) I 92,149.85 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (10-06) ,. COM IKONERITANCE~TFp,P~ RETURN ANIA RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COST; ESTATE OF FILE NUMBER Scowler, James F. 21-10-0688 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Michael L, Bangs 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. I Probate Fees 2,950.39 4,000.00 473.50 5. Accountant's Fees 800.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs 553.07 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 8,776.96 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Scouter, James F. 21-10-0688 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex eR rases 1 Parthemore Funeral Home 2,950.39 H-A 2,950.39 other Administrative Gosts 2 Cumberland Law Journal -estate advertising 75.00 3 Jane Day -Reimbursement to Jane Day for travel expenses needed to probate will and open 333.01 estate. The executrix resides in Florida. 4 The Sentinel -estate advertising 145.06 H-B7 553.07 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Scowler, James F. 21-10-0688 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) (If more space is needed, additional pages of the same size) REV-1513 EX+ (11-08) ,. COMMNHEgITANCE TALC RET~IRN ANIA RESSIDENT DEt~,EDEN SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Scouter, James F. ~ 21-10-06 88 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUN T OF ESTATE NUMBER PERSONfSI RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Jane Elizabeth Day Daughter one-half 199,068.35 728 Granada Drive Boca Raton, FL 33432 2 Susan M. Phillips Daughter one-half 199,068.35 12320 Mulberry Court Lakeridge, VA 22192 Total 398,136.70 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 15 00 cover sheet, as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J {Rev. 11-08) 1' 1 S~ L 1...1 l` ti MetLife P.a. ~ ~ ors Des Manes !A X0366 MetLi~e October 18,, 2010 PNC Investments Todd Perry 4242 Carlisle Pike Camp HiN, PA 17011 RE: METLIFE i.VVEST~RS US~- IN~UR~t~i~CE C~t~PA~Y Gt~iVTR~-GT X200538851 OVVIrfER JAMES F SCt3ULER Dear Mr Perry: Thank you for your recent irtqui~ regarding the date of death value of the above referenced annuity. As of ,tune 5, ~OtQ, the contract solos was ~S1,t~.8S. If you have any questions, ptease con~ct Maur representative ar calf our Customer Service Center at 1-8D0-2~5-9~4~8 Monday tttr~ouglt Fric~y aefaraen 8:30 am. anr! 5:3~ p.m., ET. Sincerely, y i r Lr ; i. ~ 1 n/ i. J. z 1 a/ ,~ nl. ~ Tanya Hvpp Sr. Annuity Representative - Pct Issue Processing MetLifie Annuity Operations and Services Page 1 of 1 Bangs Law From: Phyllis Harmon [pharmon@letorttrust.com] Sent: Wednesday, June 23, 2010 3:44 PM To: mikebangs@verizon.net Subject: James Scouler Hi Mike: Just wanted to contact you with some information for the James Scoul::r Estate. I spoke with Jane Day, Jim Scouler's daughter and told her I would make contact with you. LeTort is trustee fcr Mr. Scouler (revocable trust distributes to Jane and Susan) copy attached. The balance is approximately $224,000. I have attached date of death values. I will be on vacation from 6/28 thru 7/6. Hope you had a nice vacation! Phyllis J. Harmon, CFPC~ LeTort Trust 3130 Morningside Drive Camp Hill, PA 1.7011 (717) 761-7626 - (717) 761-7842 fax This message (including any attachments) contains confidential information intended for a specific individual and purpose, and is protected by law. If you are not the intended recipient, you should delete this message and are hereby notified that any disclosure, copying, or distribution ,af this message, or the taking of any action based on it is prohibited. 6/28/2010 p F- 0 Q 1-- W J ~ ~ U o N ~ ~ o ti ti W °o a -~ N is N ai ss Z c Z v ~ v Q n Q ~ In 00 O O 00 ~ O tt N O N M ~ ~ O M CU N (O I` '~ N C? t0 C'7 ~ LO L (p to d0 t1') ~ ti O ~ O ~ ' ~ N ~ ~ ~ (O N CO N M f` O N E ' d ~ ~ f~- N O M ~ ~ N N tf ) N O M (~ Q M A O ti) ~ O ~ M N ~ 1n !,f) O p N .c- r r r r ~- M N ~ M r ~- O N p N 0 c~ d X 0 0 t.f) Q O M ~' N ~ O O O ~ O i~ N CD M ~ 00 N M 0 0 0 ~ j O ~ 00 N N O O O O ' ti ' O ' N N O CO N t0 N ~ I~ 00 N ~f d d ti N O M 'cfi ~- N N ~ N O 00 ~ d M A O In to O ~- M N ~['~ tf') ~n 0 Y (`~ ~ ~- r ~ ~ r M N ~ M `- ~ ~ N ~ N 0 cn d ~ ~ O to O O O d' N ~ d' ~ ~ ~ O O O 1~- O ~ O N M N I` N CU CO O {~ O O 00 O O •- ~ 1~ O N •- ~ CO N CO N N 1~ O N V 1'~ N O M 'd' ~- M N ~ N O o0 ~ d M ~ O ~ to O ~-- M N ~S7 ~n ~n 0 i N ~- r r- r ~ r M N ~ M c- ~ ~ N ~ N 0 v m ~ ~ o o ~n o o ~ ~ o o ~n p O ~ M O O ~ 0 0 ~ ~t 0 0 00 O U N ' ~ O O M ' ' N N 00 C'7 ~ O O O O M • 1~ ,I ~ ~r O rn CU rn O o ~ rn 00 rn ~ c~ ~ o I M O O O rn M c~i ~t rn ~ ~ ai o r= ~- ~ co ~ N N .- <- .- ~ M N r' M ~ N L O O O O O O O O O O O O ~ 0 0 0 0 0 0 In I~ c'~ O r- O ~. M 0 0 0 0 0 CO l` ~ O 00 O y c- 0 0 0 0 0 I`~ 00 lL~ O t!7 O L N 0 0 0 0 0 CO N r- O tip 0 ~ I~ O O O O O to OO N O ~ O ~ N 'd' M O A O O O tS') O ~ O O O ~ M O N O ~ M M O ~ - N ~ ~- ~- ~ ~ r r H o o N r- M ~ ~ r' U ~ U ~ ~ U U M ~- U ~t ~n cn Z ~ ~ ~ ~i o ~ N ~ U Z o N ~ U ~ _ W N '~ ~ p ~ ~ Z ~ ,~ ~ ~- ao ~ N ~ o ~ -- - a _ \ ~ ~ ~ ~ o ~ ~ ~ = o ~ ~' W ~ O Z ~ ~ ~ J -' O O W ~- ~ I_ ~ w Q o ~ w 0 0 0 cn ~ W W p Z ~ p U U U ~ p ~ D ~ ~ ~ W cn ~ ¢ U C~ ~ ~ a a a. a > ~ t7 '..i . / 'e,i I' h ! '. i % I ~ I r Ibl ~- Ifl 4 ~ ~,'~,I { ~ ~' { i ~ i ',~ ~ ~ F -i f -P1tiIC LEADIl10 TH£ WAY September 2t~, ? ~ 1 Q Michael L fangs A1tQt`ney at Law 429 South 1 ~`~ St Gawp Bill, FA 1701.1 ~tE: Name: James F Scczulex SSN: 1b~-05-~50t~ T~QI]: 06-45-~{l I Q Dear I~fz~. B~n~s: ~'~~, `113 r, In response to your request far Date oI~ Death ~DQD) balances €or the cost©me~r noted abr~ve, our rec~r~~ ~l-ew the following: ~ . Ghe+c~ng Arcouat Account # ~ 14(NaS~ I U~ Estab~ish~: OI -01-1978 JA1~S F SCt~UL~R DC?D balance: ~ 2,318.fJ7 -~- a.00 ~.c~c~ %~t~rest YIIV~9'~IQ~It'Y ~~C~lUE~I~ The deced~~t tnairltain+~d l:i~uestment AGGQUnt # ~ I7~722 I . Fir f.+er information, you ~ia~y call tie ~rokersge D-ePaxta~,er~t at l -$00-~~~-111. Flame nc~x~ that thus office pr+o~vides date cf death balances far ~3e~osit account. C~t~s,'s, ~h+ecking anrd Savings. ~e do not process an~r financial transactions ox pr+a~ide statement. Tfyou need assistaiace with any of these items, plea.~e call 1-~~8 ~'~~-BA~{l~ (1-'~~8-7~i~-265'} ter stop t~y~rour ]cacal F~~ Bank branch office. SIIlGe~~~~, National Finanei~ Services i~enfie2~ 1'NG .dank, N.A. Member FRIG Page I of I F~.~t transmatt~.l SI~IZOIf~ 1Z : 2Z : i(1 PM PAGE ~~~ Wach©via Ban]: L3alancc Ccmfirmation Services P 4 Rax 40Q28 Roanoke. VA 24022 August ~, ZQ 10 BANGS LAW OFFICE ** R~f~: [L~:3I?0032 SITB7ECT: ~7erifir,~~n ~ C.anflrmaticm of Aocaanx~It arld Bata..gtc~e Iui'crr~riatian provided for: Cugtamer: JAIVIES F SCQU"LLD. {5.~1~# I~ -55tds) Date ~' Deatb: June 5, 201Q DeuO~nt ACCO~ri~t Information Account d4catt L~uteofl~cat~: Avena~'fJa~ance L'~ .Maturity [rrt+aast Aid Y1T) ~}atG '1'yec Numher 13alar~oe ffiened Date RaM Int~:rrRd Itfer~xt Paid (_lta~} C'-III:C'KIN(~ :'^(k':~XX~"7~'1~5t~3 '$90,193.32 it7112!`2CItI~ ~I7.4:Z 533095 '1~:~.'2tlI~ I.EGAL'I'i'I7~: JAh~II?,S F.[2ANKLIN SCUUI:F12 JANT S 13AY 1"C)A CIASIN(U I3ALANC:E: $9U21.8.52 Page 1 of ~ ~.~~..i No Sa('c I~otit Box found For- trustcxner. * Date of death balance does rot include saxued interest. 1~l~fCli3r1:L ~: ~~~~~~ • V date of death sreaeuire crn a vieekeuecl or a hsaiiday, ~at~ of death balance einsi ns?t ittaluale anry taa~esac~%exss that ewary maRie diving tF-at t~eme ixiriocl m Lliana Mcf}uirc Servicenter 1lssoeiate lYhnne: (54t?)~(i3-7323 ~~ i3y :scceptmg this irtfiimutisxr, the recipient thereof reprtatn~, sad warra~tts to Wells Fargo i3an15 N.A ("lxleit+ Fargo"), that tlrt rr~ipicnt is a~}raniDed try the cuactnmrr to t~.tive latrfally th s infsxrrration. The recipient agi~ that it will rwt disclee~e, tftis in6~amatian to any third pang, an)e~ oansErc:lkd to do a4 bg ~ process„ and that it Rill Wells Fargo claw not repre~. and warrant that the infcun:ation. ix acmplet~. and accurate. The ~ further asshrooc4 `'~' ~' this infcsrnation. The rec~ric~t adarowJe~,s that rec~prc; cxlges that the irtfurnTatian may ant disclose th:: enta-e relationship 6c:iw{x n customer and Wells Farms. 'the irrfom~a[ion is sutr~oct to charge without notice to the raaipienE The recipiazt agrees to indemnify, defend, acrd hold Wells cargo harmless from and against arty claim n~tcltt~}g from the d~aclc~nre and use of the infnm~ation by the recipient nr from the bre;aeh try the recipient of anyagn~rnent, retrr~etttatiQn; csr r>rerrarrty crrrrained herein- Wachsrvia l~anlc anct 1Nachovia Bank of llelaware are divisions ~ We1k Fargo Bank, N.A. Page 2 of ~ /,/(/ ~/ ~/I?'!~ c~%~~'f~-r.G~~F/x I, JAMES F. SCOULER, of Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expense:r, including m~- gravemarker and all expenses of my last illness, and any and all taxes and assess ~nents imposed by any governmental body as a result of my death, whether on property passing under thi;> will or otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II. I give and bequeath all of my household goods, automobiles, je~Nelry, and all other articles of household and personal use, equipment and ornament, together with all insurance thereon and relating thereto, in equal shares, to those of my issue, per stirpes, as survive my death by thirty (30) days. ITEM III. I give, devise, and bequeath all the rest, residue., and remainder of Iny `' possessions and estate of every nature and wherever situate, in equ~~l shares, to those of my issrae, per stirpes, as survive my death by thirty (30) days. ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. h 1 ITEM V. I appoint my daughter JANE ELIZABETH DAY executrix of this my last will. Should she predecease me or otherwise fail to qualify or cease to serve as executrix of this my last will, I appoint my daughter SUSAN MILDRED PHILLIPS executrix of this my last will. ITEM VI. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this will., I hereby give to my personal representatives the following powers and authorities effective without court approval and until aciual distribution of ali property: to compromise any claim or controversy.; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate C~. receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM VII. I direct that my personal representatives and fiduciaries shall not be required ~= ~~'~, to give bond for the faithful performance of their duties in any jurisdiction. ~, 2 IN WITNESS WHEREOF, I have hereunto set my hand this ~ _ day of ~~G- J , 2003. 3AC S F. SCOULE~ The preceding instrument, consisting of this and THREE other typewritten pages, each identified by the signature of the testator was on the date thereof signed, published, and declared by JAMES F. SCOULER, the testator therein named, as and for his last will, in the presence of us, who at his request, in his presence, and in the presence of each other, have subscribed our COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) The undersigned, being the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing 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. f J S F. SCOULER r w~oi ~i or affirmed to and acknowledged befa.~e ~:e by the tes at ~ named ab!bve r ' . tf CONCM~NWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ( SS: WE, ~°n~~~a~6•~1`~ ~ and c~K~IY I ~~tL/ the witnesses whose names are signed to the attached or for going instrument, being duly qualified according to law, do depose anal say that we were present and saw the testator sign and execute the instrument as his last will; that he signed it willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator signed the will as witnesses; and that to the best of our knowledge, the testator was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. Notary Publcc ~-~ ~~ ~ . ~~ 5