HomeMy WebLinkAbout04-14-11 15056101D1
REV-1504 Ex ~a~-1o,
PA Department of Revenue pennsyLVania OFFICIAL USE ONLY
Bureau of Indwiduat Taxes
PO BOX 280601 OEPARTNENTOFREVENUE County Code Year File Number
INHERITANGE TAX RETURN
J
~~ ~~
~
Harrisbur , PA 17128-0601 RESIDENT DECEDENT
1 ~ ~ '~.'~
~,,,~'
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
717-10-7215 ' 01/23/2011 ' 05/21/1917
Decedent's Last Name Suffix Decedent's First Name MI
Reed __ ' Sr. 'Charles ~
{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
C~ 1. Original Return p 2. Supplemental Return O 3. Remainder Return (d:ate of death
O 4. Limited Estate O prior to 12-13-82)
4a. Future Interest Comprarnise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O
(Attach Co
of Will) 7. Decedent Maintained a Living Trust _____ 8. Total Number of Safe Deposit Boxes
py (Attach Copy of Trust)
O 9. Litigation Proceeds Received Q 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 TO;
Name..... Daytime Telephone Number
William C. Kollas (717) 731-1600
First line of address
Kollas & Kennedy
Second line of address
1104 Fernwood Avenue
city or Post office
Camp Hill
State ZIP Code
PA 17011
REGISTER OF WILLS IJSE ONLY
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Correspondent's a-mail address: J ~;~ei ~ l~v ~~tis Crn~ ~CeNn ~~~ ~,.,\
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my k:nawledge and belief,
it is true, correct and complete. Declaration of prep er other than the personal representative is based on all information of which preparer has any knowledge.
GN ERSO, N~E~OtySjB E F ILIN`d'R~~Fj(~1 DATE=
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SIGNATU OF PREPARER OTHER THAN REPRESENTATIVE
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PLEASE USE ORIGINAL FORM ONLY -"-
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Side 1
],505610101 1,5056103,D1
J
REV-1500 EX
Decedent's Name:
1,50561,0],05
Decedent's Social ~~ecurity Number
717-10-7215
RECAPITULATION -
1. Real Estate (Schedule A) .......................................... ... 1. 159,625.00
2. Stocks and Bonds {Schedule B) .................................... ... 2. ' 0.00
3. Closely Held Corporation, Partnership or Sale-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 Ej.... ... 5. 50,990.94
6. Jointly Owned Property (Schedule F} O Separate Billing Requested .... ... 6. ' 0.00
7. Inter-Vivos Transfers & MisceNaneous Non-Probate Property
(Schedule G) O Separate Billing Requested..... ... 7. 0.00
8. Total Gross Assets (total Lines 1 through 7) ............ . ..... . . . . .... . . . 8. ' 210,615.94
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9.
15,254.27
10. Debts of decedent, Mortgage Liabilities, and Liens (Schedule I) ............ .. 10. 6,881.50
11. Total Deductions (total Lines 9 and 10) ........ . ........ .
.............
.. 11. 22,135.77
12. Net Value of Estate (Line 8 minus Line 11 } ............................ .. 12. 188,480.17
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. 188,480.17
----
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable
at lineal rate X .0 45 8,481.61 1g, 8,481.61
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. 8,481.61
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
15056101,05 15O561O1D5
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Charles John Reed, Sr.
__ _ _ __
STREET ADDRESS
410 North Second Street
__ _ __ _.
_.._
CITY
Wormleysburg
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
_..___
B. Discount
0.00
446.39
File Number
STATE
PA
ZII'
17043
(1)
Total Credits (A + B) (2)
3. Interest
4. ff Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3)
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 WILLS, AGENT.
8,481.61
446.39
0.00
8,035.22
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 :.......................................................................................... ^ a
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? ................................... ...,..,......,... , ^ 0
..............
2. If death occurred after Dec. 12, 19$2, did decedent transfer property within one year of death
without receiving adequate cansideration? ...................................................................................
3. Did decedent own an "in trust 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? .....................................
.................................................................................. ^ a
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-1502 EX+ (11-08)
,,,,. ,
aq.;. ~~ x... Pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
t~ i a i t vF FILE NUMBER
Charles John Reed, Sr. 21-11-012Ei
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is iointly-Owned with rieht of curvivn~ehGn ~.,..~+ tie a:~.,i..__~ __ ~_~_~..~_ .
•~ ~~~~~~ ~r~~~ ~~ iiccucu, niacin auw~wndl 5f1@eLS Oi Lne same slZe.
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
tJIAIt OF
Charles John Reed, Sr.
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with rislht of survivorship must by dicr_~nswrl ~., c,.tisa„~e r
FILE NUMBER
21-11-0126
~~~ ~~~~~~ ~Na~~ ~~ ~~~~~~~, ~~~~C~~ auaiuonai snee[s of the same size)
REV-1511 EX+ (10-09)
~~~~ ~~~ Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Charles John Reed, Sr. 21-11-0126
Decedent's debts must be reported on Schedule I.
ITEM -
NUMBER DESCRIPTION AMOUNT
A• FUNERAL EXPENSES: -
1' Musselman's Funeral Home
2 Rolling Green Cemetery
3 Pealer's Flowers
4 Pizza Grille, Camp Hill--repast
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
6,969.57
1,395.00
222.00
701.00
0.00
City __
Year(s) Commission Paid:
State ZIP
2• Attorney Fees: 1,000.00
3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00
Claimant Merline F. Wolf
Street Address 410 North Second Street
city _Wormleysburq state F'A zIP 17043
Relationship of Claimant to Decedent Daughter
4• Probate Fees: 617.50
5• Accountant Fees:
o.oo
6. Tax Return Preparer Fees:
0.00
~~ Home Insurance Premium
200.00
8 Real Estate Taxes
649.20
TOTAL (Also enter on Line 9, Recapitulation) I $ 15,254.27
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
ca i A i c ur FILE NUMBER
Charles John Reed, Sr. 21-11-012b
Report debts incurred by the decedent prior to death that remained unpaid ar rhp dwto ~f danr6 ,....~..a,......___:_~..___~ ___,._,
•~ ~~~~~~ ~Na~~ ~~ iiCCUCU~ niser~ aoaitionai sneers or the same size.
REV-1513 EX+ (01-10)
i pennsylvania SCHEDULE J
DEPARTMENT pF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
C~IAIC Vt:
Charles John Reed, Sr.
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1 • Merline F. Wolf, 410 N. Second Street, Wormfeysburg, PA 17043
FILE NUMBER:
21-11-0126
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Daughter
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
100%
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I ~
If more space is needed, use additional sheets of paper of the same size.
~ Pennsylvania
DEPARTMENT OF REVENUE
Bureau of Individual Taxes
PO BOX 280603
Harrisburg, PA i~128-0603
REALTY TRANSFER TAX
STATEMENT OF VALUE
See reverse for instructions.
_ RECORDER'S USE ONLY
___
State Tax Paid
Book Number
Page Number
Date Recorded
Complete each section and file in duplicate with Recorder of Deeds when (1) the full value/consideration is not set forth in the deed, (2) the
deed is without consideration or by gift, or (3) a tax exemption is claimed. A Statement of Value is not required if thE~ transfer is wholly exempt
from tax based on family relationship or public utility easement. If more space is needed, attach additional sheets.
A. CORRESPONDENT -All inquiries may be directed to the following person:
Name
Telephone Number:
James W. Kollas, Esq. (717) 731-1 Ei00
Mailing Address City State ZIP Code
1104 Fernwood Avenue, Suite 104 Cam Hill PA 17011
B. TRANSFER DATA C. Date of Acceutance of Der~,me~nt
~~a~~wi ~~~~~essor~s)
Merline F. Wolf, Executrix for Estate of Charles J. Reed, Sr.
Mailing Address
410 N. 2nd Street
City State ZIP Code
Wormleysburg PA 17043
D. REAL ESTATE LOCATION
Street Address
410 N. 2nd Street
Grantee(s)/Lessee(s)
Merline F. Wolf
Mailing Address
410 N. 2nd Street
City
Wormleysburg
City, Township, Borough
Wormleysburg
State ZIP Code
PA 17043
County School District Tax Parcel Number
Cumberland West Shore School District 47-19-1588-067 _
E. VALUATION DATA -WAS TRANSACTION PART OF AN ASSIGNMENT OR RELOCATION?
1. Actual Cash Consideration 2. Other Consideration 3. Total Consideration
___.._
1.00 -}- 0.00 __ _ 1.00
_ _...
4. County Assessed Value - _
5. Common Level Ratio Factor
6. Fair Market Value
104, 300.00 _ X 1.25 - 130 37
F. EXEMPTION DATA
- 5.00
la. Amount of Exemption Claimed lb. Percentage of Grantor's Interest in Real Estate ic. Percentage of Grantor's Interest Conveyed
130, 375.00 100% 100%
Check Appropriate Box Below for Exemption Claimed.
® Will or intestate succession. Charles J. Reed, Sr. 20'11-00126
(Name of Decedent) (Estate File Number)
^ Transfer to a trust. (Attach complete copy of trust agreement identifying all beneficiaries.)
^ Transfer from a trust. Date of transfer into the trust
If trust was amended attach a copy of original and amended- trust.
^ Transfer between principal and agent/straw party. (Attach complete copy of agency/straw pansy agreement.)
^ Transfers to the commonwealth, the U.S. and Instrumentalities by gift, dedication, condemnation or in lieu of con-
demnation. (If condemnation or in lieu of condemnation, attach copy of resolution.)
^ Transfer from mortgagor to a holder of a mortgage in default. (Attach copy of mortgage and note/assignment.)
^ Corrective or confirmatory deed. (Attach complete copy of the deed to be corrected or confirmed.)
^ Statutory corporate consolidation, merger or division. (Attach copy of articles.)
^ Other (Please explain exemption claimed.)
n er Pena ties of law, I declare that I have examined this statement, including accompanying information, and to
the best of my knowledge and belief, it is true, correct and complete.
Signature of CorrQ pondent or Responsible Party -
Date
.~~~~~
AILURE TO COMPLETE THIS FORM PROPERLY OR ATTACH REQUESTED DOCUMENTATION MAY RESULT IN
THE RECORDER'S REFUSAL TO RECORD THE DEED.
. _ BEM'-~r33 EX ;o4-lal
~ Pennsylvania REALTY TRANSFER TAX -~ ~ ---- --RECOROER~s usE orv~Y
State Tax Paid
DEPARTMENT OF REVENUE STATEMENT O~ VA~u~ BOOk Number
Bureau of Individual Taxes _
PO BOX 280603 Page Number
Harrisburg, PA 1'7128-0603 See reverse for instructions. Date Recorded
Complete each section and file in duplicate with Recorder of Deeds when (1) the full value/consideration is not set forth in the deed, (2) the
deed is without consideration or by gift, or (3) a tax exemption is claimed. A Statement of Value is not required if they transfer is wholly exempt
from tax based on family relationship or public utility easement. If more space is needed, attach additional sheets.
A. CORRESPONDENT -All inquiries may be directed to the followin person•
Name
Telephone Nurriber:
James W. Kollas, Esq. - (717) 731-1600_
Mailing Address City State ZIP Code
1104 Fernwood Avenue, Suite 104 Cam Hill PA 17011
B. TRANSFER DATA C. Date of Acce tance of Document
Grantor(s)/Lessor(s) Grantee(s)/Lessee(s)
Merline_F. Wolf, Executrix for Estate of Charles J. Reed, Sr. Merline F. Wolf
Mailing Address
410 N. 2nd Street
City
wormleysburg
State ZIP Code
PA 17043
Mailing Address
410 N. 2nd Street
City. _
Wormlevsbura
State ZIP Code
PA 17043
D. REAL ESTATE LOCATION
Street Address
N. Third Street
County
Cumberland
E. VALUATION DATA -WAS TR
1. Actual Cash Consideration
1.00
4. County Assessed Value
23,400.00
F. EXEMPTION DATA
City, Township, Borough
_ Wormleysburg
- _.
School District _ _ - _ __ __- _ _. --
Tax Parcel Number
West Shore School District 47-19-1588-082N _
NSACTION PART OF AN ASSIGNMENT OR RELOCATION? ^ y
2. Other Consideration 3. Total Consideration
-~- 0.00 = 1.00
5. Common Level Ratio Factor 6. Fair Market Value
X 1.25 = 29,250.00
la. r+iiiuurn or exemption ciaimea lb. Percentage of Grantor's Interest in Real Estate 1c. Percentage of Grantor's Interest Conveyed
29,250.00 100% 100%
C eck Appropriate Box Below for Exemption Claimed.
® Will or intestate succession. Charles J. Reed, Sr. 2011-00126
-_ _ __ _
(Name of Decedent)
(Estate File Number)
^ Transfer to a trust. (Attach complete copy of trust agreement identifying all beneficiaries.)
^ Transfer from a trust. Date of transfer into the trust
If trust was amended attach a copy of original and amended trust.
^ Transfer between principal and agent/straw party. (Attach complete copy of agency/straw party agreement.)
^ Transfers to the commonwealth, the U.S. and instrumentalities by gift, dedication, condemnation or in lieu of con-
demnation. (If condemnation or in lieu of condemnation, attach copy of resolution.)
^ Transfer from mortgagor to a holder of a mortgage in default. (Attach copy of mortgage and mote/assignment.)
^ Corrective or confirmatory deed. (Attach complete copy of the deed to be corrected or confirmed.)
^ Statutory corporate consolidation, merger or division. (Attach copy of articles.)
^ Other (Please explain exemption claimed.)
_. __
n er Pena ties of law, I declare that I have examined this statement, including accompanying information, and to
the best of my knowledge and belief, it is true, correct and complete.
--•7• ~~~~• ~ vi i c~Nt~i ~VClll Ur rcesponsioie Narty Date
`f /
rH1LUKC i v cvMPLETE THIS FORM PROPERLY OR ATTACH REQUESTED DOCUMENTATION NNAY RESULT IN
THE RECORDER'S REFUSAL TO RECORD THE DEED.
LAST WILL AND TESTAMENT
OF
CHARLES J. REED, SR
I, CHARLES J. REED, SR, of 410 N. 2°d Street, Wormleysl;~ti :r;~, C~ c l ~f.rland
County, Pennsylvania, do make and declare this to be my last Will and Testament, 1~.~~;r~,.b ~ ~ puking
all prior Wills and Codicils.
FIRST: I direct that all my debts and funeral expenses be paid as see Sri rt lf'te ~ ~ ~ death
as maybe practicable. I further direct that all estate, inheritance, transfer, legacy, or : u.c~~ e: ~ ~ ~ t<~xes
which maybe assessed to my estate, or any part of my estate, whether passing undo ~,I• ,ira y a, l , shall
be paid out of my residuary estate as an expense of administration and without apI ~c,~r1:i o: ~: i ~ r.~;,
SECOND: I give all the rest and residue of my estate to my your-~;~~ c,,,„1::I ~ ~~ a E;:~~te:r,
MERLINS F. WOLF, 1130 Oyster Mill Road, Camp Hill, Cumberland County,l"~c~rrri~s , a ~ r.~.,a. I
am fully cognizant that I have four children: CHARLES JON REED, RICHARD L. ~~,.1:? 1;I , °~,~ ~~.Ry
J. ST. ONGE and MERLINS F. WOLF and love my four children equally, but b ec;~?~.c rs .: ~ i their
different stations in life and their needs, I bequeath my entire estate to my your ~~;c; ~~~t !, ~ ~ c; ;krter,
MERLINS F. WOLF.
THIRD: Without limiting the powers conferred by statute or by gen~~l a:! r~.cl~ ,~ :~~ ' aw,
my Executrix is specifically authorized and empowered:
1 of 4
~ -fir i.
~ 6 ~4,i~~
(a) To invest any funds of my estate in any corporate shares, bonds, notes,
or other securities or property, real or personal, including any common or commingled funds
maintained by my Executrix. This is to reflect my intention to give the broadest investment powers
and discretion to my Executrix;
(b) To sell or otherwise dispose of any property, real or personal, at any
time forming a part of my estate, for cash or upon credit, in such a way and on such terms as my
Executrix may deem best;
(c) To manage, operate, repair, improve, mortgage, and lease :for any term
any real estate at any time held;
(d) To make distribution in cash or in kind upon any division c-f my estate;
and
(e) In general, to exercise all powers in the management cif my estate
which any individual could exercise in the management of similar property in her own r7ght, and to
do all acts which my Executrix deems necessary or proper to carry out the purposes of this will.
FOURTH: I appoint my daughter, MERLINE F. WOLF,1130 Oyster Mill Road,
Camp Hill, Cumberland County, Pennsylvania Executrix of this Will. No Executrix acting
hereunder shall be required to post bond or enter surety in any jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand this ~l __ day of
YY1A.r~.{-~ ,aoos.
CHARLES J. REED, SR.
2 of 4
SIGNED, PUBLISHED and DECLARED by the above, CHARLES J. REED, SR, as
and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and
in the presence of each other, have hereunto subscribed our names as witnesses:
/ ~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
_5~~ ~ l 7~ l 1
i S ~~C~,~la,~s y ~.y-v£
SS:
I, CHARLES J. REED, SR., Testator, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I have signed
and executed the instrument of 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.
Sworn to and acknowledged before me by CHARLES J. REED, SR, the Testator,
this ~- ~'-`~' day of rnA Yf _.~'l , 2005 .
CHARLES J. REED, SR
NOTARIAL SE L ~
CAROLE A ROSE
Notmy Public
Notary Public TWSP OF LOWER ALLEN
~ CUMBERLAND COUNTY
M Commission E res OCt 21, 2007 ~
3 of 4
G ~, ~~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
~ ~
We, Ll S ~ I `~.~ and ! ,C'/~~~'~ ~~ the
witnesses whose names are signed to the attached instrument, being duly qualified accor. ding to law,
do depose and say that we were present and saw the Testator, CHARLES J. REED, SR., sign and
execute the instrument of his Last Will and Testament; 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.
Swo and subscribed to before me by ~ 5~4- ~ o C,k_ and
,,:
~J,P o ~ witnesses, this d^~ day of ~ ~- ;1-~ 2005.
~~~ /
fitness Witness
NOTARIAL SEAL
CAROLE A ROSE
Notory Public
TWSP OF LOWER ALLEN
• CUMBERLAND COUNTY
otary Public Commission Ex Tres Oct 21, 2007
4 of 4