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HomeMy WebLinkAbout07-21-11 (2)1505610101 REV-1500 EX (O1-SO) ' ~YL OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes OEPARfMENTOPPEMENIIE County Code Year File Number .......... INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 1128-0601 RESIDENT DECEDENT ~ ~ ~ ~ ~-, ~ `~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY t v ~ .,. ~ (~ -- ~ ~ ~ ~~ 05/01/2011 07/14/1934 Decedent's Last Name Suffix Decedent's First Name MI Green 'James E (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 3. Remainder Return (date of death prior to 12-13-82} O 4. Limited Estate O 4a. Future Interest Compromise (date of O ;i. Federal Estate Tax Return Required death after 12-12-82} a 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust El. Tatal 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 ';Andrew C. Sheely, Esquire ' ! 717-697-7050 ~,.v;. _ Mechanicsburg PA '17055 Correspondent's a-mail address:andrewc.sheely@verizon.net Under penalties of perjury, l declare that f 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 ail information of which reparer h s any knowledge. S E F P O I FOR FILIN R TURN ^ Laura M. Frampton, Executrix, 223 Bonnybrook Road, Carlisle, PA 17015 S1~~N~~R~ PRE/~ REPRESENTATIVE .~/~U r-~~Ol/ - pnnRGCC f Andrew C. Sheely, Esquire, 127 S. Market Street, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY L 1505610101, Side 1 1505610101 _. J 1505610105 REV-1500 EX Decedent's Sociat Security Number Decedent's Name: Green, James E. / (p ~'~ a ~, - Gjl ~ 7 p RECAPITULATION 1. Real Estate (Schedule A) .......................................... ... 1. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. ..,.. ~'' .. , r....a,. ~ .. _~.m-. ,_ M._..~.. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. I 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. t $58,368.00; ~~ n.. ...~_. .,.,,.._, .~, ......,~ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. !, $3,878.98',' 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property _ .. ` - ~~ (Schedule G) O Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. ! 62,246.98" 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. ', $10,944.57'; 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............ . 10 .. _._.... _.. _.m..m ......,_. ......~_, $1,346.09 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. ', 612,290.66'+. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. $49,956.32;; 13. Charitable and Governmental BequestslSec 9113 Trusts for which j " i ~ ~ ~°"°""""°" """""`"""" ~" "~ "°° ~ an election to tax has not been made (Schedule J) ...................... .. 13., 14. Net Value SubJect to Tax (Line 12 minus Line 13) ...................... .. 14. $49,956.32' -- TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unda• cec. 9116 _ _ _ ___ _ _ (a)(1.2) X .0. ' 15. 18 able ~ -- ~ ~, A ~~.~~~ ~~.~~~ .~~ ~-~ ~,~ ~~~.~ $49 9 56 32 a t lineal ate X 045 16 $2, 248.03 17. ®.~s. .. W ..~ m~~ ~ ._ .. ,.,_ .. ~~.. Amount of Line 14 taxable _.... .~... _ . ~.. w .. at sibling rate X .12 ', ' 17. 18. Amount of Line 14 taxable ~ ~~ '~ ~~ ~~~ ~~~~~ ~~- '~~ "`~~~~ ~"`"~""~~ " "~~ at collateral rate X .15 ' 18. ', _...~ _......~.. .~e~., em 19. TAX DUE ....................................................... a2,248.03 .. 19.' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 J REV-1500 EX Page 3 File Number Decedent's Complete Address: ~~ - l(- a ~ ~ DF~'Fr1FNTC NAAAF James E. Green STpCCT AI'II~DCCC 325 Wesley Drive Apartment 108 IT\/ Mechanicsburg (STATFpA Zi 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments _ _. B. Discount ~ / /oL • ~~d 3. Interest 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits (A + B) (2) (3) (4) (5) $2,248.03 $112.40 $2,135.63 Make check payable to: REGISTER OF WILLS, AGENT. .: .. ~~; .: ., ..w .,. . ,, ~. 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? ................................................................ ...... If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death 2 . without receiving adequate consideration? ........................................................................................................ h? " ...... ^ ^ ........ ar payable-upon-death bank account or security at his or her deat 3. Did decedent own an "in trust for ...... 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 ;mposed 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)J. 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-1508 EX+ (6-98} ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT` SCNEDVLE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER James E. Green 21-11-0555 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. (If more space is needed, insert additional sheets of the same size) M~,y. 13. 1111 ~,~~,rM r~~ ~a~x 4ll-1U1-1r'~; ~ ~Vo, ou~~ r. ~ ~ ~~vc LFADRi6T4fEWAY May 13, 20l I Andrew 5heely Attorney at Law 127 S Market St Mechanicsburg, PA 17055 RE: Name: James E to een SSN: 168-26-4170 D(~D: 05-01-2011 Dear Mr. Shccly: Yn response to your request for Date of Death (DOD) balances far tkte customer noted above, our records slow the following: Checking Account Account # 5005565505 Established:10-13-2009 JAMES E G~tEEN LAURA M FRAMP'fQN DQD balance: $7,757.95 + 0.01 accrued interest Intexest paid 01-01-2011 thru 45-01-2011 $1.G5 YTD Savfn~s Account Account # 5005568757 Established: 12-22-2049 JAMES E GREEN DOD balance: $55,816.10 + 5.34 accrued interest Intexest paid 41-01-2011 tbru OS-01-2011$62.41 YTD Please note that this office provides date of death belar~ces for deposit accounts (1RAs, CDs, Checking and Savings). We do not process sny ~inanc~l trsnsstetion$ or provide statements, Ifyou need assistance with any of these items, please call 1-88$-PNC-aANK (1-88g-762-2265 or stop by your local pNC $ank branch ot~ice. Sincerely, National. Financial Services Center 1'I'~tC $ank, N.A. Member ~'b1C Page 1 of 2 REV-}Sog EX+ (oi-lo) ~ - pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F 30INTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: James E. Green 21-11-0555 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. 30INTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT 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 i. A. 1011312009 PNC Checking Account #5005565505, date of death balance of $7,757.95 $7,757.96 50% $3,878.98 accured interest $ .01, total date of death balance: TOTAL (Also enter on Line 6, Recapitulation) I $ $3,878.98 If more space is needed, use additional sheets of paper of the same size. REV- j511 EX+ (10-09) s ~ ~ : Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF James E. Green ITEM NUMBER A. FUNERAL EXPENSES: 1' Geisel Funeral Home 2~ Lincoln cemetary -grave opening Decedent's debts must be reported on Schedule I. DESCRIPTION FILE NUMBER 21-11-0555 AMOUNT $8,196.27 $900.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: $0.00 Name(s) of Personal Representative(s) Laura M. Frampton Street Address _223 Bonny Brook Road city _Carlisle _. state PA ZIP 17015 Year(s) Commission Paid: _ 2. Attorney Fees: ,~i`~Q~l'C ~..1 C ~ ~f~C~ C.~'/ ~ ~~lv/~-~ $1,025.00 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 __ $199.50 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: ~. Filing Fee $15.00 $~ Misc. Postage $8.80 s. Reserves to conclude Estate administration $600.00 10,944.57 TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ^41'L~11 1~:~~ 717-~64-1114 0~,1 ~ ~ ~ w ~ ~ ~ t~ ~ h ~ ~~ ~. ~ ~ ~ ~ ~c o Q ~ ~~ Y• ~ ~ ~ o. ~~ ~ +~ ~ N ~ ~ 7 +(p ' ' ~ r ~ O: W 41 N N ~? ~. .,+ ~^ ~ ~ ~ ~, r ~ ~ r N ~' ~ ~, ` 4 t~ ra 0 v Q ~ 4 o w ~. m ~ -v a a as ~ a ~` a ~ - FUhJERAL HOSE ~EISEL CJ C ~~ ~ ~ ~ m ~ ~ -~ ~ T -0 3 ~ ~ ~ ~'o ~ ~ ° ~~`s' ~ 'i'n -nGr ' ~ ~R ~; ~ ~n Ca ~ 3 ~ ~, ~ ~ o ~' w ~ ca a°~ -„ .' o ~ ~ h a ci own ~~ . `°~~ ~'~ ~a ~ v' T ~ o ~ a ~ ~ ~ CD "-~ iA .(~a ll1 u ~*" a c3 ~ ~ C~ d ..~.. ~ ~ b "`~ ~ O o w ~ r~ ~ ~. f ~ ~* ~ ' ~C Q \ i Y ° ~ ~ ~ o ~. rt w ~ ~ ~ -cam ~ .~,, ~~~' ~' c ~ °~' a ~ m ~ a ~ ~ t~ ~`'' ~ l V y z~ ~ r ~ ".~ ~~ ~ n ` ' ~ ~~ ~ dN~v} ~~ rr ~ ~~ ~"~ .~ ~ ~. ~~ ~ ~ ..a O ~ a ~ ~ r ~ ~ j a~ -, ~ ,~,......,.......,....I i 3 ~ ~ ~; . , . G~~~ x L ~I m ow"'~ ~" ~~"~i 7 c rn G7 .......... ~ ~~ ~ . a~~ ~ ~: ~, ~ ~ ~~ r~~ Q rn a 3.~ RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 5/06/2011 Cumberland County - Register Of Wills Receipt Time: 14:05:28 One Courthouse Square Receipt No.: 1065521 Carlisle, PA 17613 GREEN JAMES E Estate File No.: 2011-00555 Paid By Remarks: LAURA M FRAMPTON WZ ------------------------ Receipt Distribution Fee/Tax Description Payment Amount Payee Narne PETITION LTRS TEST 135.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 5.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 16.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN Check# 1222 ---------------- $199.50 Total Received......... $199.50 • REV-:512 EX+ (12-08) r ~ pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER James E. Green 21-11-0555 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+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICfARiES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER James E. Green 21-11-0555 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. Melanie J. Fogal, 46 Pearson Lane, New Boston, NH 03070 Daughter 33 1J3% of Rest, RP~irlf iP R RPmainriPr 2. Edward R. Green,12 North Bolton Street, New Oxford, PA 17350 Son 33 1 /3% of Rest, Residue & Remainder 3. Laura M. Frampton, 223 Bonnybrook Road, Carlisle, PA 17015 Daughter 33 1 !3% of Rest, Residue & Remainder ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON RE V-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT - OF JAMES E. GREEN I, JAMES E. GREEN, of b 15 Apple Drive, Mechanicsburg, {Borough of Mechanicsburg}, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. ~: I direct that all inheritance, estate, transfer, succession and death taxes, as well as my just debts and funeral expenses, o#' any kind whatsoever, which may be payable by reason of my death, shall be paid out of the principal. of my estate as.the same can conveniently be done. SECOND: I give, devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, as follows: {a} Thirty-three and one-third percent {3 3 1 /3 %) thereof unto my daughter, MELANIE J. FOGAL, of New Boston, New Hampshire, provided that should MELA,NIE J. FOGAL predecease me, I give and bequeath her share unto her issue, share and share alike; and (b} Thirty-three and one-third percent {33 l/3%) thereof unto my son, EDWARD R. GREEN, of New Qxford, Pennsylvania, provided that should EDWARD R. GREEN predecease me, I give and bequeath his share equally unto his issue, share and share alike; and {c} Thirty-three and one-third percent {33 l/3°/©}thereof unto my daughter, LAURA M. ON, of Carlisle, Pennsylvania, provided that should LAURA M. FP;ANJ~'T'ON predecease me, I give and bequeath her share unto her issue; share and sharealike. ~: Should my grandchild or grandchildren not have attained the age of twenty-two (22) years at the time for distribution to him or her, I give, devise and bequeath the share of each such grandchild to my hereinafter named Trustee, IN SEPARATE TRUSTS, to hold, manage, invest and reinvest the shares so received, and to use and apply from time to time such portion of income and principal for each said child's .education (including college, trade school or other similar training or education}, support and welfare as my Trustee, in his or her sole discretion, deems advisable. My Trustee may make the payments for the support and maintenance of my grandchildren directly to said children or their Guardian, as required. Any payments made by my Trustee pursuant hereto shall be made without further responsibility to the said children, Guardian, or to any person taking care of my grandchildren. The Trustee, in exercising his or her discretionary authority with respect to the payment of income or principal of tl3e within Trust to my grandchild or grandchildren, shall take into consideration any income or other resources available to my grandchild or grandchildren from sources outside this 'T'rust. In addition, my hereinafter named Trustee shall have the right, in his or her sole discretion, to purchase and pay for out of the principal, as well as income, such insurance policies as will provide for the minor's medical care. Any income or principal not so applied shall be distributed to each grandchild when he or the attains the age of twenty-two X22} years. FOURTI~: In addition to all powers granted to them by law and by other provisions of this will, I give the fiduciaries acting hereunder the following powers, applicable to -all property, exercisable without court approval. and effective until actual distribution of all property: 2 (A) To sell at public or private sale, or to ]ease, for any period of tirrie, any real ar personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security} or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition. (B) To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivision, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. ~~) To compromise any claim ar controversy and to abandon any property which is of little or no value. (D) To invest in all forms of property, including stocks, corninon trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduciaries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E} To exercise any option, right or privilege granted in insurance policies or in other investments. (:~} , To exercise any election or privilege given by the Federal and other tax Iavvs, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws, (G} To make distributions to my herein named beneficiaries in cash or in kind or partly in each. (l~} To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect dr improve any property held under my will, and for investment purposes. (I } To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, erriployee stock ownership plan, or any other type of qualified plan} to the extent provided for by the plan or the law. 3 ~• I nominate and appoint xny son-in-law, BARRY FOCAL, Trustee, of the above-described Trust for the benefit of the children of MELANIE J. FOCAL. I direct that my Trustee and his successor shall serve without bond and shall receive fair and reasonable compensation. SIXTH: I nominate and appoint my daughter-in-law, MARY GREEN, Trustee, of the above-described Trust far the benefit of the children of EDV~AR.D R. GREEN. I direct that my Trustee and her successor shall serve without bond and shall receive fair and reasonable compensation. SEti~I~VT'H: I nominate and appoint my son-in-law, CHARLES FRAIV.[FTON, Trustee, of the above-described Trust for the benefit of the children of LAURA M. ON. I direct that my Trustee and his successor shall serve without bond and. shall receive fair and reasonable compensation EIGHTH: I nominate and appoint MEL.A-NIE J. FOCAL, Executrix, of this, my Last Will and Testament. In the event of~ the death, resignarion or inability to serve for any reason whatsoever of MELA-NIE J. FGGAL, I nominate and appoint LAITRA M. TON, Executrix, of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of both MELANIE J. FOCAL and LAURA M. FRAMF'T4N, I nominate and appoint EDWARD R. GREEN, Executor, of this,. my Last Will and Testament. I direct that my Executrix or Executor, as the case nay be, shall not be required to post security or a band for the performance of theix duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~ day of November, 2UQ9. (SEAL) S .GREEN a Signed, seated, published and declared by the above-named Testator as and for his ~,ast will and Testament in our presence, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~a i Tr~.~~ C~`~ /k~~ p Address /?~5~ ~~~ ~~ ~ .~ I~ l Address ~~}~ l?~ Name x! ~ Name s