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1505610140
REV-1500 EX (01-10) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Hans bur28PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 2 8 2
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW
1 9 8 1 0 3 8 1 6 0 2 2 5 2 0 1 1 0 3 2 0 1 9 2 2
Suffix Decedent's First Name MI
Decedent's Last Name
H O L T R Y MARY A
(If Applicable) Enter Surviving Spouse's Information Below MI
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
^ prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required
death after 12-12-82)
t Maintained a Living Trust
d
~
8. Total Number of Safe Deposit Boxes
Q 6. Decedent Died Testate ^ en
7. Dece
^ (Attach Copy of Will)
Litigation Proceeds Received
9
^ (Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
^
haxOunder Sec. 9113(A)
11 • Att
h S
)
. between 12-31-91 and 1-1-95) c
ac
(
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
Name
ANTHONY A DAMS 71 7 5~2 32.70
H - ~ a~
~:-..~ -
First line of address
4 g WE S T
Second line of address
S U i T E 3
City or Post Office
ORANGE
S H I P P E N S B UR G
STREET
State ZIP Code
P A 1 7 2 5 7
REGISTER 0~3.]SE ONL`(
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DATE FILED
Correspondents a-mail address: htadamslaw@embargmail corn
U sdtrueecorrect andefco plete~Declahation of preparer other than the persofnal recpresent five is based on adll information of wh chhpreparerfhas any know edge,belief,
SIGyp,,TORE OF PERSON R PONSIB FOR FILING RETURN DATE
Ay ~Sfa>~ l-~i ~ L ~~~
AUUKtJJ
49 WEST ORANGE STREET, SUITE 3 SHIPPENSBURG
PLEASE USE ORIGINAL FORM ONLY
1505610140
Side 1
A 17257
1505610140
J
1505610140
REV-1500 EX (01-10) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individua- Taxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 1 1 0 2 8 2
Harrisbur PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 9 8 1 0 3 8 1 6 0 2 2 5 2 0 1 1 0 3 2 0 1 9 2 2
Decedent's Last Name
H O L T R Y
Suffix Decedent's First Name
MARY
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Return ^
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
A
MI
2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required
death after 12-12-82)
~
B
Q 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust oxes
8. Total Number of Safe Deposit
^ (Attach Copy of Will)
9. Litigation Proceeds Received
^ (Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
^
haxOj nder Sec. 9113(A)
11 • Att
h S
between 12-31-91 and 1-1-95) c
ac
CORRESPONDENT -THIS SECTION MUST BE COM PLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Daytime Telephone Number
Name
H ANTHONY A DAMS 7 1 7 5 3 2 3 2 7 0
--- ------- -
REGISTER OF WILLS USE ONLY
First line of address
4 9 WE S T
Second line of address
S U I T E 3
City or Post Office
ORANGE
S H I P P E N S B UR G
S T R E E T
State ZIP Code
P A 1 7 2 5 7
DATE FILED
Correspondent's a-mail address: htadamSlaWCa~Pmbargmafl COm
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 RESPONSI LE F NG RETURN DATE
AD~SS ~ ~ / /r ~I ~6 / S/'l t/~~ Cti- 1 7v~-Jr~7
SIGNATURE OF PREPARER OTHER THAN REPRESEN E DATE
ADDRESS
49 WEST ORANGE STREET, SUITE 3 SHIPPENSBURG PA 17257
PLEASE USE ORIGINAL FORM ONLY
1505610140
Side 1
1505610140 J
1505610140
REV-1500 EX (01-10) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Hans bur28PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 2 8 2
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 9 8 1 0 3 8 1 6 0 2 2 5 2 0 1 1 0 3 2 0 1 9 2 2
Suffix Decedent's First Name MI
Decedent's Last Name
H O L T R Y MARY A
(If Applicable) Enter Surviving Spouse's Information Below MI
Spouse's Last Name Suffix Spouse's First Name
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 ^ 2. Supplemental Return 3. Remainder Return (date of death
prior to 12-13-82)
^
4. Limited Estate
^
4a. Future Interest Compromise (date of
^ 5. Federal Estate Tax Return Required
Q
6. Decedent Died Testate
^ death after 12-12-82)
7. Decedent Maintained a Living Trust
~
8. Total Number of Safe Deposit Boxes
^ (Attach Copy of Will)
Litigation Proceeds Received
9
^ (Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
^
haxOunder Sec. 9113(A)
11 • Att
h S
)
. between 12-31-91 and 1-1-95) c
ac
(
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
Nam
H e
ANTHONY A DAMS 71 7 532 3270
REGISTER OF WILLS USE ONLY
First line of address
4 9 WE S T
Second line of address
S U I T E 3
City or Post Office
ORANGE
S H I P P E N S B UR G
S T R E E T
State ZIP Code
DATE FILED
P A 1 7 2 5 7
Correspondent's a-mail address: htadamslaW(a~P-rbargmaii COm
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, corzect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON R PONSIBLE FOR FILING RETURN ATE
.., ~ ~ 1
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
49 WEST ORANGE STREET, SUITE 3 SHIPPENSBURG PA 17257
PLEASE USE ORIGINAL FORM ONLY
1505610140
Side 1
1505610140
1505610240
REV-1500 EX Decedent's Social Security Number
1 9 8 1 0 3 8 1 6
Decedents Name: MARY A. HOLTRY
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) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) ~ Separate Billing Requested ....... 7.
8. Total Gross Assets (total Lines 1 through 7) ........................... 8.
9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9•
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10.
11. Total Deductions (total Lines 9 and 10) ............................... 11.
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13.
an election to tax has not been made (Schedule J) ..................... .
~ 4 Net Value Subject to Tax (Line 12 minus Line 13) ...................... 14.
1 1 5 2 5 5, 5 6
1 1 5 2 5 5, 5 6
1 2 0 5. 5 0
8 5 3 5 2. 8 5
8 6 5 5 8. 3 5
2 8 6 9 7. 2 1
2 8 6 9 7.2 1
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 Q
Q ~ 15.
(a)(1.2) X .0 ~
16. Amount of Line 14 taxable 2 $ 6 9 7 2 1 16
at lineal rate X .045
17. Amount of Line 14 taxable ~ Q 0 17.
at sibling rate X .12
18. Amount of Line 14 taxable ~ 0 0 18
at collateral rate X .15 .
19.
...................
TAX DUE ..................
.......... ..... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610240
Side 2
0. 0 0
1 2 9 1. 3 7
0. 0 0
0. 0 0
1 2 9 1. 3 7
1505610240 J
REV-150o•EX Page 3
File Number
21 11 0282
LIGVGM~i1 ~~v vvu"r.v r." ..~•~••----
DECEDENTSNAME
MARY A. HOLTRY --
STREET ADDRESS
1000 WEST SOUTH STREET
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 1,291.37
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits (A + B) (2)
0.00
3. Interest
(3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
4
.
Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,291.37
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; .............................. .
^
c. retain a reversionary interest; or ............................................................................................... .
^
d. receive the promise for life of either payments, benefits or care? ...................................................... .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
^
^X
without receiving adequate consideration? ......................................................................................
? .
^
........
3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death .
Did decedent own an individual retirement account, annuity or other non-probate property, which
4
.
contains a beneficiary designation? ................................................................................................. . ^ ^X
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
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, unde
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)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARY A. HOLTRY 21 11 0282
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned wdh right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
ITEM OF DEATH
NUMBER DESCRIPTION
~ M&T BANK CHECKING ACCOUNT 115,206.56
2, IHUMANA INSURANCE REFUND I 49.00
TOTAL (Also enter on line 5, Recapitulation) ~ $ 115,255.
(If more space is needed, insert additional sheets 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
MARY A. HOLTRY 21 11 0282
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B.
1
2.
3.
City State ZIP
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
Attorney Fees: H. ANTHONY ADAMS
Family Exemption: (If decedents address is not the same as claimants, attach explanation.)
Claimant
Street Address
Relationship of Claimant to Decedent
4. Probate Fees: REGISTER OF WILLS
5 Acxountant Fees:
g, Tax Return Preparer Fees:
7
ZIP
900.00
305.50
TOTAL (Also enter on Line 9, Recapitulation) I $ 1,205.50
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-OS)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MARY A. HOLTRY 21 11 0282
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. COMMONWEALTH OF PENNSYLVANIA ESTATE RECOVERY PROGRAM 84,841.04
2. (CARLISLE REGIONAL MEDICAL I 440.00
3. MILLENIUM PHARMACY 71.81
TOTAL (Also enter on Line 10, Recapitulation) $ 85 352.85
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (0 9-10)
Pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MARY A. HOLTRY 21 11 0282
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. KENNETH EUGENE HOLTRY Lineal
56 FOX HILL ROAD 1/3
SHIPPENSBURG, PA 17257
2. PAUL RAYMOND HOLTRY Lineal
46 FOX HILL ROAD 1/3
SHIPPENSBURG, PA 17257
3. BETTY J. ALLEMAN Lineal
5 MTN WIEW TERRACE 1/3
NEWVILLE, PA 17241
I 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:
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.
~~
OF
MARY A. HOLTRY
NOW THIS~~day of ~l-1~ _~ 1983, I, Mary A. Holtry,
presently residing in Cumberland County, Commonwealth of Pennsyl-
vania, with a present mailing address of R,D. 1, Shippensburg,
Pennsylvania 1725.7, Being of sound mind and body, but nevertheless
mindful of my mortal nature,- do hereby ,publish and declare, in the
presence and hearing of the undersigned witnesses, this as my Last
Will and Testament,.fiereby revoking all previous wills and codicils
executed by me.
ITEM I"IRST
I direct my Executor to first pay my funeral expenses as soon
after my demise as may be found convenient, and also first pay all
estate, inheritance, sucession and other death transfer taxes, of
whatever nature and by whatever jurisdiction imposed and interest
and penalties in respect thereto, assessed against my estate or
payable by reason of my demise, with respect to any and all
property, life insurance, and other interest comprising my estate
for death tax purposes, whether or not such property or interests
pass under this Wi11 or any codicil thereto, without reimbursement
as if such taxes were administration expense, and also to first
pay, from my estate, all administration expense.
~~
ITEM SECOND
I give, devise and bequeath my entire estate and all my
property, whether personal, real, mixed, tangible or intangible,
wherever situated and of whatever description, which I may own,
possess or have any right to dispose of at the time of my demise
to my husband, Ross H. Holtry, providing that he survive my demise
by thirty (30) days. Should my husband predecease me or fail to
survive my demise by thirty (30) days, this gift, devise and be-
quest to him shall ,lapse or be divested, and in such event I then.
give, devise and bequeath. my entire estate and all my property,
whether personal, real, mixed, tangible or intangible, wherever
situated and of whatever description, which I amy own, possess or
have any right to dispose of at the time of my demise in equal
shares among Kenneth Eugene Holtry, Paul Raymond Holtry and Betty J.
Alleman, my three children. Should any child predecease me leaving
a child or children (being my grandchild or grandchildren) surviving
my demise, then the-share of said deceased child shall pass, in
equal shares, to their child or children (being my grandchild or
grandchildren). However, should .any child predecease me failing
to leave a child or children (my grandchild or grandchildren) sur-
viving my demise, then the share of the deceased child shall
lapse or be divested and shall pass, in equal shares, among the
surviving children.
~~ -2-
ITEM THIRD
If, pursuant to the-terms of ITEM SECOND hereof, any grandchild
of mine is entitled to receive a share of my estate and be less than
eighteen (18) years of age on the day of my demise, in such case I
appoint and nominate the Dauphin Deposit Bank and Trust Company,
Shippensburg, Pennsylvania, as guardian of the estate of such grand-
child with the Dauphin Deposit Bank and Trust Company to receive
the entire share of each said grandchild, holding and preserving
same until said grandchild attains the age of eighteen (18) years
and on such date to distribute to such grandchild their share or
that portion of their share remaining, and until the age of
eighteen (18) the guardian may distribute the income or principle.
of each grandchild's share for the use or benefit of such grand-
child's support, welfare, maintenance, education and health care.
ITEM FOURTH
I appoint and nominate my husband, Ross H. Holtry, as executor
of this Will and should he predecease me, renounce or decline this
appointment for any reason or fail to qualify or accept this appoint-
ment, I then appoint and nominate Kenneth Eugene Holtry, Paul Raymond
Holtry and Betty J. Alleman, as co-executors of this Will.
No bond or other security shall be posted or required of my
executors appointed in thei Will or otherwise qualifing for such
position,
`~
~°
~.,
-3-
In addition to all other powers which my executors may have at
the time of my demise, whether by statutory law or common law, I
also grant them the power to sell, transfer or assing any and all
property in my estate, both personal and real.
ID1 WITNESS WHEREOF, I have hereunto set my hand and seal this
.day of 1983, to this and the preceding four (4)
pages and I have also placed my initials on each page herein for
purposes of greater security and better identification.
,~ a .
Mary A Holtry ~ . ~,
SIGNED, SEALED, PUBLISHED AND DECLARED by the above named
Testatrix, Mary A. Holtry; as and for her Last Will and Testament,
in the presence and hearing of us, who at her request, in her
presence and in the presence of each other, have hereunto sub-
scribed our names as witnesses on the date first written above.
~}f~, /
(SEAL) ~~~~G~ .
Ad ress~
# (SEAT') ~~ -~ ~'
A r ss
.~ ,
:~
-4-
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF FRANKLIN SS
I, Mary A. Holtry, whose name is signed to the attached and
foregoing instrument, having been duly sworn and qualified
according to law,.do hereby acknowledge that I signed. and executed
the 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.
Sworn or aff'rmed to a d ac owledged before me by Mary A.
Holtry, this~~day of ~ 1983.
. /~ ,
Mary Hlo~try
Notary P is
SUSAP! !:, 1ESSEN, Notary PubllC
Chamo::rsb~rg, Franl:iin Co., Pa.
My Commis:lor. Expires May 13, 19&S
-5-
COMMONWEALTH OF PENNSYLVANIA:
SS
COUNTY OF FRANKLIN
We CCU:S /7' J`~L%~f' and G~tlr~.r~ L "- ~~ ,
the witnesses whose names are signed. to the attache or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw the Testatrix sign and execute the
instrument as her Last Will; that Mary A. Holtry signed willingly
and that Mary A. Holtry executed as her free and voluntary. act for
the purpose therein expressed; that each of us in the hearing and
sight of the Testatrix signed the Will as witnesses; and that to
the best of our knowledge the Testatrix was at that time eighteen
(18) or more years of age, of sound mind and under no constraint or
undue influence.
~orn o~rl of 'rmed to and subnaribedf orb; m~~~
sses, t ism ay o
otary is
SUSAN IC. JESSEN, Notary Public
Chambersb~rg, Franklin Co., Pa.
My Commissicn Ltpires May 13, 1985
Q
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