HomeMy WebLinkAbout11-07-11 1505610140
RE -1500 ~ (°'-'°,
ESPONDENT -THIS
Name
I V 0 V
ep
Bureau rtment of Revenue
f Individual Taxes OFFICIAL USE ONLY
Po Box
2sosol County Code Year File Number
INHERITANCE TAX RETURN
Harrisbu
E PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 1 0 3 3
NTER DECEDENT INFO MATION BELOW
Social Security Number ', Date of Death MMDDYYW
Date of Birth MMDDYYW
4 6 6 4 8 51 4 1 7 0 9 0 8 2 0 1 1 1 2 2 2 1 9 3 0
Decedent's Last Name I
B U R K H O l
~ D Suffix
Decedent's First Name MI
E R M A R Y
I
(If Applicable) Enter Survii ving Spouse's Information Below A
Spouse's Last Name II
B U R K H O Suffix
Spouse's First Name MI
Spouse's Social Security N D E R
THIS RETURN MUST BE FILED IN DUPLICATE WITH
1I THE
REGISTER OF WILLS
FILL IN APPROPRIATE OV ALS BELOW
0 1. Original Retum ~ 2. Supplemental Return
3
Rem
i
d
.
a
n
er Retum (date of death
4. Limited Estate ' ~ prior to 12-13-82)
4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Re
uired
d
th
^X 6. Decedent Died Tes
A
to ~ q
ea
after 12-12-82)
7. Decedent Maintained a Livin Tru
0
t
(
ttach Copy of Wil
9
Liti
ati
P ) s
8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust) g
.
g
on
roceeds Received ~ 10. Spousal Poverty Credit date of death
( ~ 11
Electi
t
.
on
o tax under Sec. 9113(A)
between 12-31-91 and 1-1-95)
CORR -
-- (Attach Sch. Ol
First line of address
M A R T S O N
Second line of address
1 0 E H I
City or Post Office
C A R L I S L
IOTTOaMARTSONLAW.COM
~~ ~~~~ verwmes or pequry, I tleClare hat 1 have examined this n?tum, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Decl ration of preparer other than the personal representatroe is based on all information of which orenaror ti~~ ,..., ~.._..._~__
SIGNATURE !1F oGOen~i oc
Correspondent's a-mail addr
`~l! /
.IIA ~
ADDRESS
31 TOUCHSTONE
SIG t, ,URE QFRRFgARER OTI
ADDRESS
10 E HIGH STREE
1505610,40
GTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFO
Telephone Number
O T T O I I I 7 1 7 2 4 3 3 3 4 1
REGISTER07F WILLS USE py,LY
~' ~ ---- '~;1
~' , s
L A W O F F I C E S '~ i~ `~ `
> rrl
H S T _3 U `fi -r? r~ ~,
State ZIP Code FILED -~-- -- ' '~~-'
~: r?-~
P A 1 7 0 1 3 ~~' ~~ ~
rvr[ r•ILINCi Kt TURN
'IVE
THAN REPRESENTATIVE
CARLISLE
PLEASE USE ORIGINAL FORM ONLY
Side 7
LISLE
D~E. i j....,.., ..b~.
PA 17'015
D TE
~~ -~
PA 17013
1505610140
J~
1505610240
REV-150 EX
Name: MARY ANN BURKHOLD
RECAPITULATION ~~
1. Real Estate (Schad le A) ........................................... 1.
2. Stocks and Bonds ( chedule B) ...................................... 2.
3. Closely Held Corpo tion, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages and Note Receivable (Schedule D) ......................... .
4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5.
6. Jointly Owned Prope (Schedule F) ~ Separate Billing Requested ....... 6.
7. Inter-Vvos Transfers Miscellaneous N -Probate Property
(Schedule G) ~ Separate Billing Requested ....... 7.
8. Total Gross Assets total Lines 1 through 7) ........................... 8.
9. Funeral Expenses an Administrative Costs (Schedule H) .................. 9.
10. Debts of Decedent, M rtgage Liabilities, and Liens (Schedule I) ............. 10.
11. Total Deductions (to I Lines 9 and 10) ............................... 11.
12. Net Value of Estate ( ine 8 minus Line 11) ............................ 12.
13. Charitable and Gove mental Bequests/Sec 9113 Trusts for which
an election to tax has of been made (Schedule J) ...................... 13.
14. Net Value Subject to ax (Line 12 minus Line 13) ...................... 14.
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 to ble
at the spousal tax rate, or
transfers under Sec. 9 16
(ax1.2) x.o _ 2 9 9 5 3. 4 8 15.
16. Amount of Line 14 to le
at lineal rate X .045 D . D D
17. Amount of Line 14 taxa le 16.
at sibling rate X .12 D . D D
18. Amount of Line 14 taxa le 17.
at collateral rate X .15 ~ 0. D D 18.
19. TAX DUE .........~ ............................................ 19.
20. FILL IN THE OVAL IF Y
IU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 15056102 0
0. D 0
0. 0 0
3 3 6 0 5, 9 8
0. D 0
0. D 0
3 3 6 0 5. 9 8
3 6 5 2. 5 0
3 6 5 2. 5 0
2 9 9 5 3. 4 8
0. D 0
2 9 9 5 ~_ U u
Decedent's Social Security Number
4 6 6 4 8 5 4 1 7
15056.10240
0. D 0
0. D 0
0. D 0
0. D 0
0. D 0
REV-1500 EX Page .3
Decedent's Complete
DECEDENT'S NAME
Ann Burkholder
STREET ADDRESS
311 Touchstone Drive
CITY
Carlisle
Tax Payments and Cre
~ • Tax Due (Page 2, Line 19)
2. CreditsJPayments
A. Prior Payments
B. Discount
3. Interest
4. If Une 2 is greater than Line 1 +
Fill In oval on F
5. If Line 1 + Line 3 is greater than
File Number
less: 21 11 1033
STATE
PA
ts:
3, enter the difference, This is the OVERPAYMENT.
2, Llne 20 to request a refund.
2, enter the difference. This is the TAX DUE.
Total Credits (A + B )
ZIP
17015
(1) 0.00
(2) 0.00
(3)
(4) 0.00
(5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER T E FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or ncome of the roe transferred' Yes No
P P rtY ~ .............................. ^
b. retain the right to designate who shall use the roe transferred or its income; ~ ^ X
P P rtY .................
c, retain a reversi interest; or ""°••••••••
ry ................................................................................................. ^
d, receive the promi a for life of either payments, benefits or care? .......... .
2. If death occurred aft r December 12, 1982, did decedent transfer property within one year of death ^ ^
without receiving ad uate consideration?
3. Did decedent own a 'in trust for' orpayable-upon-death bank account or securi at his or her death . ^ X
4. Did decedent own an individual retirement account, annul or other non- robate~ro ~
~' P p party, which
contains a beneficia designation?.....
............................................................................................. ^ XQ
IF THE ANSWER TO ANY OF THE A OVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,194, and before Jan. 1,1995, the tax rate imposed on the net value of transfers to or for the use of the survi ' •~
3 percent [72 P.S. §9116 (a) (1.1) (i)]. ving spouse i,
For dates of death on or after Jan.1, 19 5, 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 oes 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, 200
• 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 hild is 0 percent [72 P.S. §9116(x)(1.2)].
• The tax rate imposed on the net value f 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(x)( )].
• The tax rate imposed on the net value f transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(x)(1.3)]. Asibling is defined, under
Section 9102, as an individual who ha at least one parent in common with the decedent, whether by blood or adoption.
I
REV-1508 EX + (g_98)
COMMONWEALTH OF PENNSYL~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MARY A. BURKHOLDER
ITEM
NUMBER
1• Orrstown Bank,
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Include the proceeds of litigation and the date the proceeds were received by the estatel
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
cking Account No. 106004531
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
i
VALUE AT DATE
OF DEATH
33,605.98
I
REV-1511 EX+ (10-C1g) '
pennsylvanija
DEPARTMENT OF REVENUE
INHERrTANCE TAX RETURN
RESIDENT DECEDENT '
ESTATE OF
MARY A. BURKNnr.nFU i
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
FILE NUMBER
21 I1 103.
Decedent's debts must be reported on Schedule I.
ITEM i
NUMBER
DESCRIPTION
A• FUNERAL EXPEN ES:
1.
B• ADMINISTRATIVE OSTS:
t • Personal Represe tative Commissions:
Name(s) of Personal Representative(s)
Street Add~ass
City II State
ZIP
Year(s) Co mission Paid:
I
2. Attorney Fees:
3. Family Exemption: (If ecedent's address is not the same as claimant's, attach explanation.)
Claimant .William Burkholder
Street Addre 311 Touchstone Drive
City Carlis a State PA
ZIP 17015
Relationship f Claimant to Decedent souse
4• Probate Fees: Cum erland County Register of Wills
5. Accountant Fees: III,
s• Tax Return Preparer F es:
~• Register of Wills filing fee, inheritance tax return
AMOUNT
3,500.00
137.50
15.00
TOTAL (Also enter on Line 9, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size.
3
I
REV-1513 EX+ (01.1 pi i
pennsylvani;a
DEPARTMENT OF REVENUE''.
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
MARY A. BURKHOLDER
NUMBER NAME AND AD RI
I. TAXABLE DISTRIBUTIO S
1. L. William Burkhold r
311 Touchstone Driv
Carlisle, PA 17015
II.
1
SCHEDULE J
BENEFICIARIES
~S OF PERSON(S) RECEIVING PROPERTY
(Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).)
FILE NUMBER:
21 11 1033
~TIONSHIP TO DECEDENT
Do Not List Trustee(s)
Spousal
AMOUNT OR SHARE
OF ESTATE
29,953.48
ENTER DOLLAR AMOUNT FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
NON-TAXABLE DISTRIBUT ONS:
A. SPOUSAL DISTRIBUTIO SUNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
I B. CHARITABLE AND GOVEl~NMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENTEl~ TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
If more space Is needed, use addltlonal sheets of paper of the same size.
0
ORRS
0
~~
~_
~~
CHECKIIV~G ACCO UNT S
Page 1
106004531
Accaunt Title Mary Ann Burkholder
Reward Checkin
Account Number
106009531 Check Safekeeping
Previous Balan
e
~ 33
605
98 Statement Dates 9/13/11 thru 10/11/11
Deposits
Credits ,
.
00 Days In The Statement Period
29
1 Checks/D
S bits .
33,605.98 Average Zedger
Average Collect
d 23.176.53
ervice Fee
Interest Paid .00 e
Interest Earned 23,176.53
Current Balanc 7.39 Annual Percentage Yield Earned 0
40
.00 2011 Interest Paid .
60.05
0
H
0
M
0
0
0
N
0
0
0
0
0
0
0
0
°o ~
o
o ~i
o v~
0
~~
Dsposita aad Lions
Dats Desc ptioa
10/03 Inter st Deposit
Electronic Debi s and llithdr:xaL
D:t• Descr ptj.oa
10/03 Close Account
Amount
33,613.32-
Daily B:Zaace
Date
9/13
Date 10/11/11
Primary .account
Enclosures
~n~~~~u~~~~nnn~~i~~~u~~n~~~n~~~~~~~nm~~~ni~~i~u~~
000307 0.4500 AT 0.365 'I'R00002
Mary Ann Burkholder
311 Touchstone Dr
Carlisle PA 17015-6950
Aazoust t
7.34
formation
lance Date
33,605.98 10/03
Balance
.00
Interest Rate
THANK YOU FOR
~4DRRS'I~OWN.~ANK
A Tradition of Excellence
P.O. Box 25
Shippensbur~, PA 17257
Temp-Rehm Service Requested
I
9/12 0.250000
WITH ORRSTOWN BANK
.S c h~d~~-~ C
• 1
j _ _.
F:IFILESIDATAFILE1EstatdPlanning15932.I-W.WILL200q
!D ~ LAST WILL AND TESTA
MENT
I~ MA Y ANN BURKHOLDER, of 97 Winding Oak Drive, Callawassie Island, Okatie,
South Carolina, being of sound and disposing mind and memory, do hereby make ubli
declare this to e my Last Will and Testament, hereby revoking any and all former Wi ls~d
Codicils by me made. or
ITEM ONE
I direct t at all my legally enforceable debts, funeral expenses, testamentary expenses and
all inheritance axes shall be paid to the extent possible from the assets held or passing under
ITEM FOUR h reof as soon as practicable after my decease and as part of the administration of
my estate.
ITEM TWO
In the eve~t my husband shall predecease or fail to survi
such items of pe onalty as are itemized in a certain list, if any, ttached hereto (30) days, then I give
thereon, which li t is signed and dated by me at the end thereof. to the persons named
If my hus and, L. WILLIAM BURKHOLDER, JR., is living thirty (30) days after my
death, then I give devise and bequeath all of my estate, both real and personal property, unto m
said husband, L. LLIAM BURKHOLDER, JR., absolutely. If my said husband does not so
survive me, then give, devise and bequeath all of my estate, both real and personal property,
unto my Trustees o be held or distributed by such Trustees under the pr. ovisions of ITEM FOUR
hereof as annlica tP
ITEM THREE
In the eve t my said husband, L. WILLIAM BURKHOLDER, JR., shall disclaim all or
any portion of an devise or bequest made to him under the foregoing ITEM TWO, then the
amount otherwise payable shall be held by my Trustees under ITEM FOUR hereof. Fo
purposes of the T st established under ITEM FOUR hereof, my said husband shall not be
deemed to have pr deceased me by virtue of his exercise of the right to disclaim set forth herein.
ITEM FOUR
My Trustee;
any, for the followi
RESIDUARY AND DISCLAIMER TRUST
shall hold the assets received under ITEMS TWO and THREE hereof, if
g purposes:
Page 1 of 7 Pages
~I
M.A.B.
I
A• y Trustees shall pay the net income, at least quarter-annually, to my husband,
L. WILLIAM B OLDER, JR., for life. In addition, my Trustees in their sole discretion,
may invade the rincipal of the Trust to provide for the proper and adequate support of my
husband, L. WI LIAM BURKHOLDER, JR..
B. In
my Trustees to I
the year of my c
Dollars or five
power shall be nc
him and delivere
C. LTI
Trustee shall holc
1.
grandchilc
ROBERT
grandchild
shall be he
maintenanc
principal a
accumulate
follows: O
(21) years,
twenty-five
2.
children, K~
absolutely.
addition to the above provisions, my said husband shall have the power to direct
~y to him or to apply out of the principal of this Trust in each year, including
path, an amount not in excess of the greater of Five Thousand ($5,000.00)
%) percent of the then aggregate value of the principal of this Trust. This
icumulative and maybe exercised only by an instrument in writing signed by
to my Trustee within the first thirty (30) days of fiscal year of this Trust.
~n the death of my said husband, L. WILLIAM BURKHOLDER, JR., my
the principal of the Trust as follows:
Forty percent (40%) thereof shall be distributed in equal shares to my
en, STEPHANIE LYNN KERB, TIMOTHY ANDREW KERR, JOHN
{ERR and KRISTINA ANNE KERB. The share of any of my said
~n who shall be under the age of twenty-five years at the time of distribution
i by my Trustee and the net income therefrom shall be used for the support,
and education of said beneficiary. My Trustee shall also use as much of the
shall be deemed necessary for said purposes. The principal and any
'. income of any such share held in trust shall be paid to such grandchild as
e-half (%Z) thereof upon said beneficiary's attaining the age of twenty-one
nd the remainder of such, share upon said beneficiary's attaining the age of
25) years.
Sixty percent (60%) thereof shall be distributed in equal shares to my
HRYN BURKHOLDER KERB and L. WILLIAM BURKHOLDER III,
', Page 2 of 7 Pages
f~?.j Pte,
M.A.B.
shall deem advis ble; p ey
B. To invest and reinvest all or any part of said property in such stocks, bonds,
securities or oth property, real or personal, as in their discretion they shall deem proper,
without regard to statutes limiting the property which a fiduciary may purchase;
C. To ell, transfer, exchange or otherwise dispose of, any part of said property, for
cash ar on terms, ublicly or privately, or to lease, even for a term exceeding five (5) years or
the duration of a y trust herein, without liability on the purchasers or lessees to see to the
application of the roceeds, and to give options for these purchases without the obligation to
repudiate them in avor of a higher offer;
D. Toe ecute and deliver any deeds, leases, assignments or other instruments as may
be necessary to c out the provisions of any trust hereunder;
E. To orrow money, including the right to borrow money from any bank and to
mortgage or pledg any asset of the estate as security;
F. To a sume continuance of the status of any beneficiary with regard to death,
marriage, divorce, i lness, incapacity and the like in :the absence of information deemed reliable
without liability for disbursements made on such assumption;
G. To p y from the trust, or the income therefrom, all debts or claims against my
estate, ar any taxes r similar charges on my estate;
I-I. To ke any distribution hereunder either in kind or in money, or partially in kind
and partially in mon y. Distribution in kind shall be made at the market value of the property
I~ ITEM FIVE
', POWERS OF EXECUTORS AND TRUSTEES
In addition to the powers conferred by case law, by statute, and b other rovi
Y p sions
hereof, my Exec for and Trustees and their successors, shall have the following discretionary
powers applicable to all property held by them which powers shall be effective without order of
any court and sh 11 exist until final distribution:
A. T retain any property of any nature received by them for whatever eriod th
Page 3 of 7 Pages
L! ~
M.A.B.
distributed, and my Trustees, in their absolute discretion, may cause the share distributed to any
distributee to b I composed of property similar to or different from that distributed to any other
distributee; ',
I. T exercise any subscription right in connection with any security held hereunder,
to consent to or p rticipate in any recapitalization, reorganization, consolidation or merger of any
corporation, co pany or association, the securities of which may be held hereunder, to delegate
authority with re pect thereto, to deposit investments under agreements, to pay assessments, and
generally to exe cise all rights of investors;
J. T invest in endowment, insurance or annuitypolicies on the lives ofbeneficiaries
of any trust here der;
K. T continue in any partnership, joint venture, joint ownership or other business
enterprise of whi h I am a part at the time of my death;
L. T compromise claims;
M. To continue for whatever period of time as they shall deem necessary any
ownership as a to ant in common or as a partner, in real estate or other property and to act as I
could have done ad I been living;
N. To
the estate or from
any securities or c
any time and fron
O. In t
hereunder to a rr
adjudicated to be
disability is, in th
amounts, such am
discretion in any o
ena money to my estate or to any trust created hereunder or to purchase from
ny trust created hereunder, at the market value thereof at the time of purchase,
her property tendered to them by my estate or any trust created hereunder at
time to time within a period of nine (9) months after my death;
e event that any amounts are payable hereunder or under any trust created
nor, or to a person otherwise under legal disability, or to a person not
n incapacitated person, but who, by reason of illness or mental or physical
opinion of fiduciary(ies) hereunder, unable to properly administer such
ants may be paid by the fiduciary(ies) hereunder in his, her or their sole
the following ways as he, she or they may deem best:
is~: ,~ ~.
M.A.B.
Page 4 of 7 Pages
1 Directly to such beneficiary;
2. To a legally appointed guardian of such beneficiary for the benefit of such
;ia~-y;
3. To a person having custody of such beneficiary for the benefit of such
i ;
4.
of such b
Evidence of the
complete dischar
This paragraph s]
P. To
mypersonal repre
for such services
Q. To
management, inve
All income
in any way or mangy
such interest, whit
contracts, obligatic
sequestrations unde
I nominate, c
as Executor of my e
as Executor, then I a
By the fiduciary(ies) hereunder using. such amounts directly to the benefit
~iarv.
pplication or payment of an amount in such a manner shall be a full and
of the fiduciary(ies) hereunder to the extent of such payment or application.
ill be applicable to payments of income as well as principal.
mploy agents, attorneys and proxies and to delegate to them such power as
:ntatives and Trustees consider desirable and to pay reasonable compensation
may be rendered by such agents, attorneys and proxies;
.o all other acts in their judgment necessary or desirable for the proper
tment and distribution of my Estate.
ITEM SIX
PROTECTIVE PROVI~T(~NS
~r principal held for the use and benefit of any trust hereunder shall not be
'r subject to anticipation, assignment, pledge, sale or transfer, nor shall any
in the possession of my Trustees, be liable for ar subject to the debts,
s, liabilities or torts of an benefici
Y ary, or to attachments, executions or
process of law.
ITEM SEVEN
itute and appoint my said husband, L. WILLIAM BURKHOLDER, JR.,
~. In the event that my said husband shall predecease me or fail to act
int KIRBY KENDEL BURKHOLDER as Executor of my estate.
Page 5 of 7 Pages
~'r
M.A.B.
I hereby
KENDEL Bl
said husband
to act as Tru
WILLIAM F
hereunder.
appoint my said husband, L. WILLIAM BURKHOLDER, JR., and KIRBY
:HOLDER as Trustees of any trust created hereunder. In the event that both my
KIRBY KENDEL BURKHOLDER shall fail or be unwilling to act or continue
s, then I appoint my children, KATHRYN BURKHOLDER KERR and L.
KHOLDER III, or the survivor of them, as Trustees of any trust created
ITEM EIGHT
WAIVER OF BOND
I direct the
to file any bond ii
they be required t~
discretion set fortl
IN WITNl;
,~
t neither my Executor nor my Trustees, or their successors, shall be required
~ any jurisdiction to secure the faithful performance of their duties, nor shall
~ obtain any order or approval of any court for the exercise of any power or
~ in this Will.
WHEREOF I have hereunto set my hand and seal this ~?'~ay of
~r.~ ~ ~.., O..ya- ° ~~ (SEAL)
Ma ~ n Burkholder
~,.
SIGNED,
as and for her Last
subscribed our
:ACED, PUBLISHED AND DECLARED by the above-named Testatrix,
mill and Testament, in the presence of us, who at her request, have hereunto
s as witnesses thereto, in the presence of the said Testatrix and of each other.
Page 6 of 7 Pages
I, Mary
undersigned at
willingly, that
that I am eight
influence.
We, _
the witnesses,
declare, gener
instrument as ;
and hearing of
to the best of o
under no const
COUNTY OF
~n Bw'kholder, the Testatrix, sign my name to this instrument this"' da of
y
~~2~, and being first duly sworn, do hereby declare to the
thorny that I sign and execute this instrument as my last will and that I sign it
execute it as my free and voluntary act for the purposes therein expressed, and
een years of age or older, of sound mind, and under no constraint or undue
v'
G~ .,
c~~-~~
Mary' Burkholder
~ y. b Trb and
gn our names to this instrument, and w~ being ~ ~~
y and to the undersigned authority, that the Te ~atrix sgys and executes th Y
Last Will and that she signs it willingly, and that each of us, in the presence
;Testatrix, hereby signs this Will as witness to the Testatrix's signing, and that
knowledge the Testatrix is eighteen years of age or older, of sound mind, and
nt or undue influence. ~
OF PENNSYLVANIA
Address
SS.
;)
Subscribed, sworn to and acknowledged before me by Mary Ann Burkholder the
Testatr~, and subs ribed and sworn to before me by. y~ y.
if G ,the witnesses, this ~ ~ and
~'~ ~~day of MCP ,1c
-= --_~
(SEAL)
(Commission Expires)v
NOTARIAL SEAL
CORRINE L. MYERS, NOTARY PUBLIC
CARLISLE BORO, COUNTY OF CUMBERLAND
MY COMNNSSION EXPIRES MAY 27, 2007
~, Page 7 of 7 Pages