HomeMy WebLinkAbout12-19-11
1505610105
REV-1500 °`~°~"'~" ~1
PA Depar6nent d Revenue f~ orF1aA~ ttsE orLY
Code Year Fie Number
Bureau d IrMividual Taxes INHERITANCE TAX RETURN
Po sox iso5ot n~ I I 10 a I
HarrisbtirQ, PA ig>zs-o6oi RESIDENT DECEDENT oc.. _ I
ENTER DECEDENT INFORMATION BELOW
3oGal Sewrily Number Date d Death MMDDYYW Date d Birth t~DYYYY
192-34-5448 09/25/2011 07/16/1918
DeoedenPs Last Name Bollix DecedertCs First Name MI
Juhl Heinz G
(M ApplipbM) Enter Survlvinp Spouse's M/orrrration Below
Spouse's Last Name SutTut Spouse's First Name
MI
Spouse's Social Security Number THE RETURN MUST ~ FH.ED ~ WPL.lCA1f YYRFI 111E
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Orightal Return O 2. St~plenrental Return O 3. Rem Return (Date d D~th
Prior to 12-13-82)
O 4. Umiled Estate O 4a. Fubse Interest Compromise (dated O 5. Federal Este Tax Relum Required
deattt alter 12-12-82)
~ 6. Decedent Died Testate O 7. Decedent Mafnfakted a Living Tnrst 0 8. Total Number d Sala Deposit Boxes
(Attach Copy d wuq (Attach Copy d Trust)
O 9. Litigatlon Proceeds Received O 10. Spousal Poverty Credit (Data d Death O 11. Election to Tax urxlw Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - TIES BECTpN MUST BE COMPLETED. ALL CORRESPDNDENCE AND CONFlDENTiAL TAX IISORMIITION tillOUtA UE DIRECTED T0:
~~ Daytime Telephone Number
P^R
YotTe & Yot1e, P.C. by Jetirey N. Yo1ie, Esq. (717) 975-18~ e:'
First Line d Address
214 Senate Avenue
second Urte dAddreas
Suite 404
City or Post Olfice
Camp Hill
State ZIP Code
PA 17011
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comspona.nc's e-rrWl address: )yofte~vetizon.net
under penalties of perJtny, I dedaro that I have examined ttrb return, indudhp acaonipenying achedulea and efetarnents, erd ro the best of my Imowledge and belief,
it Is true, correct and compete. Declaration of preparar other than the persorrel representative is based m ei irdorrnetbn d which preparer hoe arty Wawledge.
SIGNATURE OF B~ ~i1SPONSIBLE F ` L RETl1RN Estate Of Heinz G. JuM DATE
O~>L'Ia v ~ .~ ~~ Rosemarie Greaser t c~ ~ t.e: I ~n t t
8670 Franchi Blvd., Ft. Myers, FL 33919
SIGNATURE OF PREPARE ~ PRE '
ey
N. YotTe, Esq. ~~ 1 Z'IO ~~ r /
214 Senate Avenue, Suite 404, Camp Hill, PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1 ,
L 1505610105 1505610105 J
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1505610205
REV-15th EX (FI)
Decedent's Social Security Number
Decedents Name: Heinz Georg Juhl ' 192-34-5448
RECAPITULATION
i.. _. _. ,
1. Real Estate (schedule A) ............................................. 1. ; 118,000.00
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) O Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O 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 q ...........:... 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
an election to tax has not been made (Schedule J) ........................ 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14.
_-
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 45 638,968.70 ' 18,
17. _.._____w_ _ .. _..__ _______. ....__..
Amount of Line 14 taxable
a[ sibling rate X .12 ' 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18,
19. TAX DUE .........................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
26,592.60
693.87
27,286.47 .
638,968.70
638,968.70
O
Side 2
1505610205 1505610205
J
28,753.59
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
File Number
DECEDENTS NAME
Heinz Georg Juhl
_. _--
STREETADDRESS
1100 Claremont Nursing Home
CITY ----- STATE --- 21P ---
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
e. Discount 1.437.68
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.
(1) 28,753.59
Total Credits (A+ B) (2) 1,437.68
(3)
(4)
(5) 27,315.91
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 m income of the property transferred ................................................................................... ....... ^
b. retain the right to designate who shall use the property trensferted or its income ..................................... ....... ^
c. retain a reversionary interest ....................................................................................................................... ....... ^
d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^
2. If death occurted after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................................... ....... ^
3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? ........ ...... ^
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
REV-1502 EX+ (11-OB)
Pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE REAL ESTATE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Heinz Georg Juhl 21-11-1091
All real property owned solely or as a tenant fn 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 jointly-owned with right of aurvivorahlp must 6e distloaed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
REM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
i. 2 Brier Road, Camp Hill, PA 118,000.00
TOTAL (Also enter on Line 1, Recapitulation.) ; 118,000.00
If more space is needed, insert additional sheets of the same size.
IN THE MATTER OF THE PUBLIC SALE
OF THE PROPERTY OF ESTATE OF HEINZ GEORG JUHL
CONDITIONS OF SALE
1. The real estate being offered for sale is all that certain tract or parcel of land, with a
dwelling house thereon erected, situate in East Pennsboro Township, Cumberland
County, Pennsylvania, being commonly known as 2 Brier Road, Camp Hill, PA, as more
fully described in Cumberland County Deed Book B20 Page 767.
2. The property will be sold to the highest bidder as determined by the auctioneer. In the
event of dispute as to the highest bidder, the property may, at the option of the seller, be
put up again at a former bid. The seller reserves the right to reject all bids until such right
is waived, which waiver will be announced by the auctioneer.
3. The purchaser will pay fifteen thousand ($15,000.00) dollars at the time the property is
stricken down. The balance of the purchase price shall be paid on or before thirty (30)
days after the date of the auction, at which time the deed will be delivered. Funds must
be paid by electronic transfer to an account designated by the Seller.
4. Title will be good and marketable fee simple title, subject only to existing easements and
rights of way for highways and utilities, if any, and any building and use restrictions in
the chain of title affecting the premises which do not interfere with its use as a single
family dwelling. No warranty is made as to the zoning which may be in effect for the
property. Possession will be given at settlement.
5. The property is being sold by Rosemarie Greaser, Executrix of the estate of Heinz Georg
Juhl, by Jeffrey N. Yoffie, Esq. her power of attorney. Accordingly, no property
disclosure statement is available or is being offered. The purchaser expressly
acknowledges and understands that the purchaser is buying the property in its present
condition and that the seller makes no representations or warranty of any kind whatsoever
with regard to the condition of the premises or any of the components thereof, including,
but not limited to, the roof, the electrical system, the plumbing system, the heating
system, or any other parts of the structure or any of the improvements on the land. The
seller makes no representation or warranty with regard to insects or insect infestation or
any damage resulting therefrom. The seller makes no representation or warranty with
regard to radon or the levels thereof, or with respect to any type of insulation which may
have been used at any time in the property. The property is being sold "as is" at the time
of the auction, and at the time of settlement.
6. Seller has no knowledge of lead-based paint and/or lead-based paint hazards in the
housing and has no reports or record pertaining to lead-based paint and/or lead-based
hazards in the housing. Purchaser waives any ten (10) day lead-based paint assessment
period.
7. Taxes will be prorated to the date of settlement, with the school tax being prorated on the
fiscal year ending June 30s' and the Borough and County taxes on the calendar year.
8. Al l realty transfer taxes will be paid by the Purchaser.
9. The hand money deposited when the bid is accepted will be forfeited as liquidated
damages in the event the purchaser fails to make settlement as agreed.
10. The sale includes no items of personal properly.
11. The seller will continue to bear risk of loss from fire or other casualty covered by
insurance until settlement. In case of damage to the premises by fire or other casualty
prior to the settlement, purchaser shall have the option of rescinding this agreement and
obtaining a refund of the hand money or of settling and obtaining from the seller an
assignment of the insurance proceeds.
12. Purchaser is responsible for obtaining financing, and this contract is in no way contingent
upon the availability of financing. The seller will not pay points, settlement costs, or
otherwise render financial assistance to the purchaser in this regard.
Rosemarie Greaser, Executrix of the
Estate of Heinz Georg Juhl
By: / U
ffrey Yoff , Esq., Power of
Attorney for Rosemarie Greaser,
Executrix
I/We, ~~1~~I~ ~, S ~11~~J'1 0[ ~4(l/~/ fi, S~~/J~, hereby
acknowledge, that Uwe have become purchaser of the real estate described above, sold at public
sale at the price of $ (i ~~Uu O , UU and further agree to be bounded by the terms and
conditions of sale as set forth and publicly announced at the sale.
WITNESS, rr
~jv 1/Bmjo~~
~~~ s ,~
~''~~y L
s~,.~
RECEIVED of
$1 S,o~, ob _ - --
Rosemarie Greaser, Executrix of the
Estate of Heinz Georg Juhl
By: ~ ~
y N. Yoffie, E ., Power of
Attorney for Rosemarie Greaser,
Executrix
REV-i5o8 EX+ (11-io)
pennsylvania
LV DEPARTMEN70F REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEpYLE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Heinz Georg Juhl 21-11-1091
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property ioi~ly owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1, Net proceeds from sale of personal property at auction 4,856.38
2 PSECU Money Handler 6,689.77
3 PSECU S50 CD 20,000.00
4 PSECU S52 CD 35,000.00
5 PSECU S53 CD 40,500.64
6 PSECU S55CD 60,000.00
7 PSECU S58 CD 80,000.00
g PSECU S60 CD 20,012.92
g Sovereign Bank CD 1934 15,000.00
10 Sovereign Bank CD 6337 20,500.00
11 Sovereign Bank CD 3499 10,000.00
12 Metro Bank Checking Account 2,326.36
13 Metro Bank CD 735 10,006.00
14 Metro Bank CD 498 30,000.00
15 PNC Bank Checking Account 2565 15,071.07
16 PNC Bank Checking Account 1631 36,122.15
17 PNC Bank CD 7820
21,247.49
18 PNC Bank CD 6219
60,222.65
1 g PNC Bank CD 6602
60 699 74
TOTAL (Also enter on Line 5, Recapitulation) ~ 548,255.17
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (SO-04)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Heinz Georg Juhl 21-11-1091
DeeedeM's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I' Rolling Green Cemetery 5,977.48
2 Invitations to Celebration Of Life Event 53.65
s Celebration Of Life Service 839.14
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
5,000.00
Name(s) of Personal Representative(s) ROSemane Greaser
Street Address 8670 Franchi Blvd. ___
._...........
City Ft. Myers _ State FL ZIP 33919
Year(s) Commission Paid: 2011
z. Attorney Fees: 10,000.00
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
4. Probate Fees: ' 589.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
~• See Attached Supplement 4,132.83
TOTAL (Also enter on Line 9, Recapitulation) $' 26,592.60
If more space is needed, use additional sheets of paper of the same size.
ESTATE OF HEINZ GEORG JUHL
SUPPLEMENT TO SCHEDULE H
ADMINISTRATIVE COSTS
1. East Pennsboro Township Sewer (to maintain real estate, 2 Brier Rd,
Camp Hill, PA) $151.80
2. PPL (to maintain 2 Brier Rd, Camp Hill, PA) $14.20
3. UGI (to maintain 2 Brier Rd, Camp Hill, PA) $8.63
4. Homeowners Insurance (to maintain 2 Brier Rd, Camp Hill, PA) $59.50
5. Enterprise Rentacar of Executrix (Rosemarie Greaser, Executrix lives in Florida.
She made a trip to Pennsylvania in October 2011 for the
purpose of taking out letters of administration, organizing the
estate and beginning the process of carrying out her duties
as Executrix). $260.93
6. Parking of Executrix (in Harrisburg) $5.00
7. Gas paid by Executrix for car rental $32.32
8. Mailing box of documents to Florida $36.00
9. Southwest airline flight of executrix to BWI and return $237.10
10. Hotel stayed at by Executrix $92.65
11. Parking expense of Executrix for car left in Ft. Myers, Florida $48.76
12. Automobile insurance for car of decedent to insure until end of Nov. 2011 $224.31
13. PPL to maintain 2 Brier Rd, Camp Hill, PA $20.12
14. UGI to maintain 2 Brier Rd, Camp Hill, PA $9.71
15. Fee to Scott Bendinsky to clean up 2 Brier Rd, Camp Hill, PA $500.00
16. Fee to Scott Bendinsky to sell real estate (2% of $118,000.00) $2,360.00
17. Water bill to maintain 2 Brier Rd, Camp Hill, PA $71.80
TOTAL $4,132.83
Rev-TSiz ex+ [IZ-ash
Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Heinz Georg Juhl 21-11-1091
Report debts incurred by the decedent pNor to death that remained unpaid at the date of death, including unrcimburaed medical a><penaea.
ITEM VALUE AT DATE
NUMBER DESCRIP170N OF DEATH
1• Pinnacle Health Cardiovascular 15.00
2 Alert Pharmacy 96.91
3 Cumberland County Aging 80.44
4 Baric Scherer, LLC (Law Firm) 238.50
5 Roy D. Gottshall, Auctioneer 120.00
6 Reimbursement to PA State Employees Retirement System for overpayment 143.02
TOTAL (Also enter on Line 10, Recapitulation) # 693.87
If more space is needed, insert additional sheets of the same size
REV-1513 EX+ (O1-10)
r pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE ~
BENEFICIARIES
ESTATE OF: FILE NUMBER:
Heinz Georg Juhl 21-11-1091
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not Llst Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1• Marina Terwilliger Daughter 173671.98
2 Ray Juhl Son 173671.98
3 Rosemarie Greaser Daughter 173671.98
4 Jason Greaser Grandson 29488.19
5 Karl-Heinz Greaser Grandson 29488,19
6 Conan Greaser Grandson 29488.19
7 Thomas Heinz Juhl Grandson 29488.19
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S 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.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
~t ~~!'clG a~zt~~~ltairreertG
of
Heinz Georg Juhl
I, Heinz Georg Jnhl, of East Pennsboro Township, Cumberland County, Pennsylvania,
make this my Last Will and Testament, hereby revolting all my former wills and codicils.
FIRST: I am the widower of Eva Juhl, who preceded me in death. I have three children,
Rosemarie Greaser of State College, Centre County, Pennsylvania, Marina Terwilliger of Hegins,
Schuyllcill County, Pennsylvania and, Raymond Juhl, of Detroit, Michigan. All references to
°my children" ate to them respectively.
SECOND: I direct my Executor to pay all my just debts, funeral and adminisUration
expenses from my estate.
TfIIRD: I direct my personal representative to liquidate my saving accounts and
certificates of deposit and from this fund I give and bequeath the sum of $40,000 to my dear
friend, Eva Albrecht of Camp Hill, Pennsylvania. ~"4 f c;% a L f c k c-/ 7r ~/ 27~ d 3+ ~b ~~k ~o . ~ ~ 3 g
FOURTH: I give and bequeath the remaining portion of the fund referenced in paragraph
THIRD to my three children to be divided between them in equal shares. In the event that any of
my children predecease me, but he or she is survived by a child or children of their own who
survive me, the surviving child or children shall receive the share that their deceased parent
would have received if they had survived me. In the event that any of my children predecease me
but are not survived by a child of their own who survives me, the share that my deceased child
would have received shall be divided among those of my children who survive me.
i
FIFTH: I direct that the residue and remainder of my estate be divided into three equal
shares and I give, devise and bequeath one of these shares to each of my three grandchildren,
Jason Greaser, Karl-Heinz Greaser and Conan Greaser. In the event that any of my
grandchildren predecease me but are survived by a child or children of their own who survive
me, then the child or children of my decreased grandchild shall be entitled to the share that their
deceased parent would have been entitled to receive had he survived me. In the event that any of
my grandchildren predecease me, but are not survived by a child of their own who survives me,
then this decea.ed grandchild's share shall be divided among those of my grandchildren who
survive me.
SIXTH: I direct that ail estate, inheritance, and other death taxes (including any interest
thereon and penalties with respect thereto) federal, state and other, imposed by reason of my
death, in respect of property passing under this will or otherwise, shall be paid out of my
residuary estate as an administration expense of my estate.
SEVENTH: I appoint my daughter, Rosemarie Greaser, as Executrix of this will. In the
event my daughter is unable or unwilling to so serve, I appoint my son, Raymond Juhl, as
Alternate Executor. No one acting as Executrix or Executor shall be required to fiunish any
bond or security of any kind for the faithful performance of his duties as Executrix or Executor.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ?~. _day
of /4 /+ r % ( 2003.
ei eo uhl
WE, the undersigned witnesses do hereby certify and attest that the foregoing instrument was
subscribed by the above-named testator, Heinz Georg Juhl, in our presence, and that the said
testator, at the time of making such subscription, declared the said instrument to be his last will
and testament, and we thereupon, at the request of said testator, and in his presence and in the
presence of each other, have signed our names hereto as attesting witnesses,
AL~XRND~~ T. TS~HFQXFFnesiding at 2910 Kt~~.s y~'1 ~~/~ rS/as•~: s_ ~~ l~i,~Q /7ip~
i
bra ~ ~ /ya n o v residing a~i~~3 ~4 ms o ~ ~s-. f~cr is b~ /^~,. !7 /D~
~1~1,~r ~/A,rov residing at ~/~/ f;/a!(~~~~~, ~y /jc~Gu.,,~~sSc~
/?o.s'cJ
Commonwealth of Pennsylvania
ss.
County ofC~ ~ 6 Q,R,l~or.,a ,
Before me, the undersigned authority, on this day personally appeared Heinz Georg Juhl, the
Testator,p/rr~..rJa~ T T~~.~•~t}+a,FF raa~,,.~ 1J~4nro V
,and 'D~ a.,a e, IJa,~,i ay
known to me to be the Testator and the witnesses,respectively, whose names are signed to the attached
or foregoing instrument and, all of these persons being by me first duly sworn, Heinz Georg Juhl, the
Testator, declared to me and to the witnesses in my presence that said instrrmaent is his Laat Will and
Testament and that he had willingly signed and executed it in the presence of said witnesses as his free
and voluntary act for the purposes therein expressed; that said witnesses stated before me that the
foregoing will was executed and acknowledged by the Testator as his Last Will and Testament in the
presence ofeach other, did subscribe theirnamesthet+eto as attesting witnesses onthedayofthe dateof
said will, and to the best oftheir knowledge, the Testator was over the age of 18 years and of sound and
disposing mind and memory.
(~)
J
Wi
c~i,~.e, l/~~
witness
Witness
Subscribed, sworn and acknowledged before me by Heinz Georg Juhl,
the Testator, subscribed and sworn before me by ~.. ~,~, ~ , r: T "'1"h c 1.a.R.~1 aR f
witnesses, this ~.~ of - - - - 2003..
Notary Public
My commission expires:
NOTARIAL 8E/U.
LOlA8 J. l~OFiE, Notary PubNo
~PonMnlMiOn Er~irosApra~t4
4