The URL can be used to link to this page

Home My WebLink About01-04-12 (2)1505610101 REV-15.00 °` c°~-~°' '~1 OFFICIAL USE ONLY PA Department of Revenue pennsylvaMa ~~EMa County Code Year File Number Bureau of Individual Taxes Po Box 28o6oi INHERITANCE TAX RETURN Hanisburg PA i~i28-o6oi RESIDENT DECEDENT. ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY ~ ~, ~ sr~ ~ a - o Decedents Last Name Suffix L! L0 (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth MMDDYYYY foTaT~ 3 I ~~~ Decedent's First Name MI ~OTSTE~TMtA~R~ 11~rrri Spouse's First Name MI rrrr-r~-rrr~ ^ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE r ~ REGISTER OF WILLS FILL IN APPROPRWTE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Retum O 3, Remainder Retum (date of death prior to 12-13-x) p 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) ~ 6. Decadent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total 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(!1) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ~, r S u G t, I 1 ~ r[ ~--. ~,_r., ~~;~ _ _~ ~- First line of address ~~ ~ „a _ _ -- Second Tine of address ~-y-e v t .t` City or Post Office State ZIP Code DATEFtLt?D ~ a N i c a ® l~'-~IorS~ s-I'~~r71g1 Correspondent's e-mail address: ~ M ~-'r 9 ~ 1 ~_ UN.r1,ZO n . FJ~ Under penalties of perjury, I dedare that 1 have examined this return, induding accompanying sdredules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparef other than the personal representative is based on all information of which preparer has any ImoMAedge. PERSON RESPCE FCSpF~fG RETURN SIGNATURE OF PREPARER OTHER DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 15.05610101 J 1505610105 Decedents Social Securely Number REV 1500 EX Decedents Plame: 1. Real Estate (Schedule A) ............................................. 1. ~ ~ .. ^ ~~ 2. Stocks and sonds(Schedule B) ....................................... 2. I ~ D 3. Closely Held Corporation, Partnership or Sole-Proprieto-ship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 8. Jointly Owned Properly (Schedule F) p Separate Billing Requested ....... 6. Q Q 7. Inter-Vlvos Transfers 8~ Misc:elianeous Non-Probate Property (Schedule G) p 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 Fatale (Line 8 minus Line 11) .......... . ........:.......... 12. 13. Charitable and Govemmentat Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. Q 6 14. Net Valus Subject to Tax (Line 12 minus Line 13) ........................ 14. RECAPITULATION 15. 16. 17. 18. 19. TAX DUE ................................................... ... 19.I 20. fILL !N THE OVAL IF YOU ARE REWIEt3TING A REFUND OF AN OVERPAYMENT transfers under .9116 (ax1.2) X .0 18. Amount of Line 14 taxable at lineal rate X .0'r~ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at coNaterai rage X .15 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or O Side 2 1505610105 15056101D5 J REV f5~ EX Page 3 Decedent's Complete Address: File Number ~lll_dv~~ aECE~ENrs NAME ~osn -~ct.r~ e ~~ ~ ~ ~ l~ sTREETADORESS 3' u rat" ~~' `~ VYI e.~an; c.S h yr STATE/~~ ZIP / /V Tax Payments and Credits: 1. Tax Due (Page 2, line 19) 2. Cre~slPaymer~ts A. Pray Paym~ts B. Discorxlt 3. Interest 0 4. ff Line 2 is grew than-Lane 1 + Line 3, enter the difference. This is the OVERPAYMENT. FNI M oval on Page 2, Line 20 to request a refund. 5. tf Line 1 + Line 3 is greater than Lme 2, enter the difference. This is the TAX DUE. (4) Make check payable to: REGISTER OF WELLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or incaraz of the property transferred :..............:............................................................. b. retain the right to designate who shaA use the property transferred or its incorr>e : .............................. c. retath a reversionary interest; or ............................................................................................................ d. receive the promise for life of either payments, benefits or care? ........................................................ 2. If death occurred afar 1.12, 1982, did decedent transfer property within one year of death wittwut receiving adequate consideration? ................................................................................................ 3. Did decedent own an in trust fior" or payable-upon~ath 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 beneficary designation? .........................................:.......................... Yes No ...... ^ ...... ^ ...... ^ ...... ^ .~ ~ THE ANSVYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G: AND FIFE R AS PIU2T OF TtIE RETURN. for dates ~ death on or afar 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 stxvivmg 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 u~ of fate surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) fN~J. Tire statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for d~OStme of assets and Bing a tax return are stia' applicalble ever) d the surviving spouse is the only beneficiary. For dates of death on or after Jt~y 1,2000: The tax rata imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use ~ a natr~ parar-t, an adoptive parent or a stapparertt ~ the dtild is 0 percent ]72 P.S. §911ti(a)(1.2)]. • The tax rate ' on the net value of transfers to or for the use of the det~dent's lineal beneficiaries is 4.5 percent,: excel ~ noted in 72 P.S. §911ti(1P.S. §9116(a)(1)]. • The thx-rate on-the net value of transfers to or for the use of the decedent's siblirxJs is 12 percent [72 P.S. §911ti(aK1.3)]. A sxj ~ defined, under Section 9102, as an individual who has at lest one parent in common wilt the decedent, whether by blood or adoption. c1) 3~a1.i'o Total Credits (A + B) (2) REV-1500 EX+ (6-98) SCNEDt~LE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Po I i ~ I O, n O~~~r, ~ ~ FILE NUMBER 1'~ a ~ ~ ~ - ~6aa All property jointty-owned with right of survivorship must be disclosed orr Schedule F. ~Gt/LQ~ (If more space is needed, insert additional sheets of the same size) atva5oa oi. ~+~en COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF n /~ FILE NUMBER p6 ~ i ~ 1 ~ , 'ISO SR~IM Gt,r i Y~ /~• ~? 1 1 I - O O o~ ~ Indude the proceeds of litigation and the date the proceeds were received by the estate. All properly jointlyowned with the right of survivorship must be dfscbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~J e,1 GO Co w~ vr~ un i'+'~ Crc,c~ ~~' IJ~ ~ o h I ~ ~ S~v~~owQ,Y ~IV(,~ I~,rr i s b ~-r~ ~A I'~ I I 1 Q~~~~~ I ~~ ~ g~ U ~a~,0a~.a0 TOTAL (Also enter on line 5, Recapitulation) I S ~1-}' , s~'`/e / (,.~ (If more space is needed, insert additional sheets of the same size) ~9 8TATEMENT OF ACCOUNT E t~ ww~w~beloo~org ~~~~ ~,k~b~, ~ COMMUNITY CREDIT-UNION , ~ BuAwse ~i ft iS~iY rivcrty: fIAiN'OFFlGE: 4t9 @isanhowar Bbd. Ffartisbutg, PA 12111 -58113 1 AV .0.335 JONiTOWNERB I~ulllu~i~lu~.#~lulrl~~l~l~lu~llu.fl~6~~dFJ~1~.~.1~11 SALVATORE A. POLILLO ROSEMARIE A. POLILLO 939 ENt 1y Dr NECHANICSBUR6 PA 17055 - .. _ _, , - - - ~ _ ~~ _ _ . _ ::,,.skis ' .. _ h O`tD'1 ___ _' s~ . - ... _ BAiAN£f ~;:..._ .S22~t~TN1; _s~rvlN.: ..._::. _._. __.._.. 0105 TRANSFER WITHI~1 SAME ACCO FROM S15 5x04 95 0105 TRANSFER WITHIN SAME ACCO FROM S 4 842 50 010'5- TRANSFER/OTHER PRIME ACCT 889813 -6254 96 +0131 `DiV'iDEND 89 THE A1+FNUAL PERCENTAGE RATE IS 0.50 THE ANNUAL PERCENTAGE YIELD IS 0.50 -.THE ANNUAL PERCENTAGE YIELD EARNED IS 6. 1 0131 ` 'NEM1 BALANCE OV RDRAFT AND RETURNED ITEM FEES SUMMARY - S1 - Si ZLI ---- - -- ------ - I TOTAL FOR I I THIS PERIOD ( YEA ---- ----- ---------------I--------------------- ---1-- -- --- IOTA -DYER RAFT FEES i $ 0.00 I $ TOTA R'ETU' NED ITEM FEES I 6 0.00 I PAiQE 1 $ ~xxxsD 80GIAL 8BGUpCiY tEMaTe P~wo .1011 0:13111 ,. i 5412 4: 62547 b 5 0 7 4 7 9 AV N S 1 AL -D 0. 0 0. 0 0101 ' ,PREVIOUS $ALANCE ,~ ~ SAVVY , EN~IOR_ ;0105 TRANSFER WITHIN SANE ACCO TD S 1 -842 50 01.31-- - DIVI'DENII.. __ _ . - - --_ _- _ 37 - _ THE ANNUAL PERCENTAGE RATE IS 0.75 THE ANNUAL PERCENTAGE YIELD IS _0.75 THE ANNUAL PERCENTAGE YIELD EARNED IS 0. 0 A131 NEW BALANCE OV RDRAFT AND RETURNED ITEM FEES SUMMARY - S4 - SA VY EN OR ----- ----- ------------------ I TOTAL FOR I TO AL ( THIS PERIOD ---- I ---I-- - YEA --- -T -- -D -- ----- IOTA ----- OVER ---- ----------I----------------- RAFT^FEES ( ~ 0.00 I - S 0• TOTA "RETU 'NED ITEM FEES I 8 0.00 I • 0. **CONTINUED** forll~rrtprwcrptHA."" DMd~I1d~ ti M StOa we , wN be 1ep011~d b fii Y~Mr1W'fiwtNNN SafvlC! 10f'tll! C~flIMl~1 Yeu 'WDIGRTE$ fO:FfR;TIVE GATE 842 0 0 7 S 4 -----~ - 0608E37 7~O~II1L IEfI1NCE fN W lf! 1f fIA1FTOiIIIEE iorelbena NOTICE: See reveiae aide for impoilar~t irMoirneion -v: LL vwrvvbelrnoig 1.~~~~ G4MML7NITY CREDIT UNION 8etause /c f es~vr living. MAW OFFIGf: 149 Ei:er+hovws;Blvd. Hrnisb~xp, PA 17111 ROSEMARIE A. POLILLO 105 0105 0131 TOT TOT STATEMENT OF ACCOUNT JOINT OWNERS SALVATORE A. POLILLO UIVIQEND THE ANNUAL PERCENTAGE RATE IS 1.00 THE ANNUAL PERCENTAGE YIELD IS I.00 TWE ANNUAL PERCENTAGE YIELD EARNED IS 1. 0 TRANSfER WITHIN SAME ACCO TO S 1 -5004 NEN~BALANCE CLOSEDz 010511 OV RDRAFT AND RETURNED ITEM FEE5 SUMMARY - S15- ---- ------------ - - 1 TOTAL FOR 1 THIS PERIOD i ---- ---------------~--------------------- ---1-- OVER AFT FEES I $ 0.00 ( R`E~'U NED :ITEM FEES 1 ~ 0.00 1 PApf 2 S xxxxsa 1011110131.1 0 0 MO M T S15 0 AL YEA 'T -D .r ~.- - - -s-i-- S 0. 0 8 0. 0 for SDI ~ r~ A11•TO~OIN~t 8.74 7~0~01~ IOMN~ 17UROi YiA1470~O1d6 0.0 0 tllra.ndr . r;~o a aaa, ww ~ n~porhal zo+n.In~enw Rrwd» Swvl~s NQTICE: Sea ~a~er~a aldo iot ~nponart irtom~e9on rorw.c~~d.rr.r ososasa •MrDK'•11TES Fl`FECI11tE DJ1TE REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEpt~LE N FUNERAL EXPENSES & ADMINISTRATNE COSTS ESTATE OF Po 1 ~ ~ ~~ ~®~l-'1Gtr a P~ ~ FILE NUMBER'' _ C7 ~ a a Debts of decedent must be reported' on Schedule L cc~xl ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: AID p~,y~,1~~~ ~ MQ'~~ZZ~ ~n~Y" ~o~l,q~ ~~L! / ~C7'~ 1. v ~ ~~ I'7Q~~ T co ~+~~k~ ('Ica.- W~ct~, tic Serv~cc.~ Fac.i ~ Iii Ys ,~' Cr~.Wl14.'f ~~ " #13, (7~- TrC,h SPar~~,r' Grtva~•~ ~IM~+-b'r ~ 1~ /~- ~jr~(.SS Ury- '~ ~ T~5 C~s~ a,~var cers fio ~'-) ~~~ ~ 1'7S d.fc,r flo sJ~ l3~,,S~ B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions .,/~ Name of Personal Representative(s) ~(ILL~,If~h 1' i ~G~Y'~'i~ ~ ar g $ $~ g Street Address (~`~ ~ ~1M 1 ~ to City ~ ~ ~ - `a, 1 ~ S~ Y' State ~ Zip Year(s) Commission Paid: ~~ 6 SsW igo-lOO-I y-~3 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ~r O Claimant ~P Street Address City State Zip Relationship of Claimant to Decedent 4. I Probate Fees I ~ r~3 ~~ 5. Accountant's Fees +d~ 0 6. Tax Return Preparer's Fees U 7. ~ ~I SG~I IAhB3J~~ GO~ J ~ ~./ TOTAL (Also enter on line 9, Recapitulation) I $ 8 ~ i O `t' . (If more space is needed, insert additional sheets of the same size) • REV-1512,EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDI~LE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Pol~lll, ~~~-Q-hnari~ ~ atlt-~~a~ Report debts incurred by the decedent prior to death which remained unpaid as of 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) ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ~a~ ~~ Io , ~o-a~Metri!•- Q o~ll ~- o0ao~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] '' ~os~.Ph Pol ll~ , q - N ~-,~ 5fi , bow n~c+~hs~ac~¢.>, son a0° 10 PA -~o~~ 51~.an-~• W ~,ms~ e.~ r '~ 1 La~,~~l ~r~ d~ ~~,r- 2,6 °'lo ~~~~~ '(~ ~'705~ ~ 5d~~ '1'G ~ i 4'O ~ ~o~ 1~PXrhOIM ~~'~ 50'1 p~~a Mt,~ ar ~ cg ~ur~ (~ l~~' ~ s~~~ P~1111~ , ~ row P~ , A~~ s~-y. ao ~-~ ~~~~ti s~ G,Q q ~i o7 r J~~,wh ~,r~ ~ ~~~ ~Yh+ ~ CCCiV h~l~ ~~ ~MG~,artGsSu~' ~ P-A 7~3 ~ II 1 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ S (If more space is needed, insert additional sheets of the same size) .w_~r_ ~. _ t. SUZANN M. POLILLO, is married at the time of ~y dew and survives my by thirty days, I give to her the option to purchase my home, together with or without all of the fiuniture contained therein, from my estate at fair market value, as agreed upon by all of my beneficiaries under this Will or as determined by appraisal in the absence of an agreement. This right must be exercised by written notice to the estate fiduciary within ninety days Docament#:222380.1 Pagel of 6 ,3: .; ~ 5 ~~., «~., ~(~, following my death and closing must be held within ninety days after serving written notice of exercise of the option.: If SU7.ANN M. POLII,LO wishes to exercise this option to purchase, her . ~ K..J notice of that intent must specify whether or not she will purchase the furniture contained in the . ,. ,:S;,~Tailw~ toinclude such a specification shall act as notice to purchase only the real estate., If b1e pe~sanai possessions not `? ghber, SLfZANN M. POLILLO, under Item 3(a) or (b) above, or the proceeds from the sale of them, in as nearly equal shares as practicable to my children, SUZANN M. POLII,LO, JOSEPH G. POLII,LQ SHARON L. WAMSLEY, JAMES POLII,LO and JEFFERY S. POLILLO, subject to the survival provisions of Item 4 of this Will. (d) I give the rest, residue and remainder of my estate in equal shares fiA mychildzen, SUZANN M. POLII.LO, JOSEPH G. POLILLO, SHARON L. WAMSLEY, JAMES . . S ,PQT:,,.TT.T.O,jeet~t:~ " ~ ~ ,provisions of Item 4 of this Will. r ~_,.r ~~,~ -.. •s ssiZe ~y drys, per stapes. If the deceased beneficiary has no issue that survive me by thirty days, then the rem_an~ beneficiaries of each gift subject to this Item shall take shares of each.gift subject to this Item in the proportion they would receive had the deceased beneficiary with no surviving issue not been included in that gift. Document #: 222380.1 Page 2 of 6 ITEM 5. Notwithstanding any other provision of this Will, I direct that if any beneficiary of mine is under eighteen (18) years of age, my Trustee shall retain whatever share such beneficiary otherwise would have received hereunder and apply so much of such share or the income thereof as my Trustee considers advisable for the beneficiary's support, education and welfare, accumulating any income notneeded for these purposes: When a beneficiary ~~~ " ~aml income of Ids or'her sue, of the trust. ITEM 6. My Executor(trix) and Trustee(s) shall have the following powers in addition to those vested by law and by other provisions of my Will applicable to all property, whether principal or income, exercisable without court approval, and effective until actual distribution of all property. (a) Subject to the specific bequests and right of first refirsal set forth in Item 3 of this Wi11, to sell at public or private sale, to exchange, to lease, to pledge, to mortgage, to transfer, to convert, or otherwise dispose of, or grant options with respect to, any and all property, real, personal, or mixed, at any time forming a part of my probate or trust estates, in such manner, at such time or times, for such purposes, for such. price or prices, and upon such terms, credits,. and. conditions as Tshall be deemed advisable~orzie~essar~ the _ fii;~-~ ~! (b) To make distribution in division of the probate estate in cash,. in kind, or partly in both; (c) To distribute items of tangible personal property to a minor or to "his or her gumdian or to eery person taking care of the minor to hold for the minor within the limits authorized by statute or rule of law; Docwnent#: 212380.1 Page 3 of 6 - ~ ° - - - - - - - - e ~,~~ ~~z I V'~~ `,gyp + ~~- }"-~ ~ ~crtx~o®o~e any claim or controversy; ,~.`,. §. ~ .: ~) To apportion between principal and income any receipts and _a .~. ~d to Main income and- principal in accordance with the statutes and rules of law.. 4 `' of'~c C'.oinmc~nwealth of Pennsylvania; ,, . ,.;;.^. (f) To make, execute, acknowledge, and deliver any and. all instruments ~~ (g) To invest and reinvest the principal of the estate together with any accumulated. income thereon in all forms of property without being limited by any statute or rule of law concgrning investments by fiduciaries; (h) To disclaim inheritances and interests in properly. ITEM 7. I appoint my husband, SALVATORE A. POLILLO, Executor. If he does not qualify or ceases to act, I appoint my daughter, SUZANN M. POLILLO, Executrix. I direct that my Executor(trix) be excused from posting bond in any jurisdiction in which he /she may act. ITEM 8. I appoint the surviving parent of each minor beneficiary as Trustee of any tn~st established for their respective children under this Will.. If any minor beneficiary does not have _.. ,, .. _. _ "; .~a,-urc~p~>m..~e~urvrvmg~t€s~,ttfy.~sr~;.m:a~,~ .,~x.. shall have the authority to appoint a Trustee for any trust created for such a minor beneficiary under this Will. Document #: 222380.1 Page 4 of 6 ~,~ ----- ~ ~~ r~r ITEM 9. For the convenience of my alternate Executrix, I note that I have retained the services of David H. Martineau, Esquire, and the firm of Metzger, Wickersham, Knauss & Erb, P.C., in connection with the writing of this Will. Executed on ~tt~..alb.~ /1 , 2001. ... ,_~, ,~ .;. ;.; ~. . ,. Rosemarie A. Polilli In our presence, ROSS A. POLII,LO signed this Will and declared it to be her Will, and now ~at her request, in her presence, and in the presence of each other, we sign as witnesses: ~~~ ~~ ,~ Residence ~~~ .~~~ Residence Docwnent #: ?2a380.r Pages of 6 :.. . _ . ~. ~ ;, >~... ~. SS We, ROSEMARIE A. POLICED, and ,~w..:a~ ~. ~.-~ h'ALw~ ,and ~S',~,~-,~,,~~,, S~cv,~,~ ,the Testntri~c and the witnesses, respectively, whose names are signed to the attached or foregoing inshvment, being first duly sworn, do hereby declare to .the undersigned a~rthority that the Testatrix signed and executed the instrument as her last Will ~ats,~~.,~_~sr ~~:kh~ g,~~ yvilingly {or willingly directed another to sign for her), and tbat,she ge ~e Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. • T trix ~~ ~~ Witness Notary Public My Commission Expires: Docioeent #: 222380.1 (S~-) NOTARIAL SEAL CAROL A. LYTER, NOTARY PUBUG Harrlsburq, Dauphin Counly My Commlasloe Expires. Dec. 28 2004 Page 6 of 6 ~~ ---- - - __ ~~_.