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HomeMy WebLinkAbout02-14-12 (2)1505610140 REV-1500 ~` ~°'-'°' PA Department of Revenue OFFICWL USE ONLY Bureau of Individual Taxes County Code Year File Number PO sox 28oso1 INHERITANCE TAX RETURN 2 1 1 1 0 6 3 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 1 8 4 1 8 5 8 8 3 0 5 1 4 2 D 1 1 0 6 2 5 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI Y O R K A K E N N E T H (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 O 1. Original Retum ~ 2. Supplemental Return ~ 3. Remainder Return (date of death pnorto 12-13-82) 4. Limited Estate [] 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 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 Name D A V I D W R E A G E R First line of address 2 3 3 1 M A R K E T Second line of address S T R E E T City or Post Office C A M P H I L L State P A AND CONFIDENTUtL TAX INFORMATION SHOULD BE DIRECTED T0: Daytime Telephone Number 7 1 7 7 ~~ 1 8 3 , -, ~ ~ ;-, REGISTER G3~t1SE (Y - _ ~ ~ !~ _7 r - t= r..~ ~;: ~.z.~a `j . ~_ ' 'a rv ~ ~ ~ L~ ZIP Code ~ DATE FILED 1 7 0 1 1 CorrespondenYse-mail address: SCONFAIRaREAGERADLERPC-COM Under penalties of pery'ury, 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. Dedlaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT RE OF P N ~P/~SI FOR FILING RETURN ADDRESS ~ ' 6117 WALLIN RD k~1ilY MECHANICSBURG PA 17050 SIGNATURE OFpRE f3r;R OJHE HAN REPRESENTATIVE DALE 2331 MARKET STREET - CAMP HILL PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: A• KENNETH YORK 1 8 4 1 8 5 8 8 3 RECAPITULATION 1. Real Estate (Schedule A) ..................................... .. .... 1. 2 2 4 9 0 O. D D 2. Stocks and Bonds (Schedule B) ................................ .. .... 2. 3 0 1 8 3 8. 9 2 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) . .... 3. 4. Mortgages and Notes Receivable (Schedule D) .................... .. .... 4. 1 1 3 8 0. 4 2 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .. .... 5. 6. Jointty Owned Property (Schedule F) ^ Separate Billing Requested . .. .... 6. 1 4 5 2 D . 5 9 7. Inter-Vivos Transfers & Miscellaneous N -Probate Property arate Billin uested hedule G ~] Se Re S 7 2 3 8 D 3 2 9 g ) p q . ( c .. .... . . 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 5 7 6 4 4 3. 2 2 9. Funeral Expenses and Administrative Costs (Schedule H) ............ .. .... 9• 6 8 9 1. 8 0 10. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 9 9 ( ) ....... .. 10. .... 8 9 7 2 5. 8 8 11. Total Deductions (total Lines 9 and 10) ......................... .. .... 11, 9 6 6 1 7. 6 8 12. Net Value of Estate (Line 8 minus Line 11) ...................... .. .... 12. 4 7 9 8 2 $ . 5 4 13. Charitable and Govemt!nental BequestslSec 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. 4 7 9 8 2 5. 5 4 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.o _ 0. 0 D 15. O. D 0 16. Amount of Line 14 taxable at lineal rate x .045 4 7 9 8 2 5. 5 4 16. 2 1 5 9 2. 1 5 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. D. 0 0 18. Amount of Line 14 taxable 0 0 0 0 D O . at collateral rate X .15 1 g, . 19. TAX DUE ...................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 2 1 5 9 2. 1 5 Side 2 1505610240 1505610240 ^ REV-1500 EX Page 3 Decedent's Comalete Address: File Number 21 11 0636 DECEDENTS NAME A. KENNETH YORK STREET ADDRESS SD10 INVERNESS DRIVE CITY MECHANICSBURG STATE PA ZIP 17D5D Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments 2 D, D D D• 0 0 e. Discount 1, 0 5 2.6 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 P, Line 20 to request a refund. (1) 21,592.15 TotalCredits(A+~B) (2) 21,052.60 (3) (4) D • OD 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5 3 9.5 5 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 : .............................................................. ........ ^ 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 without receiving adequate consideration? ............................................................................... ........ ^ 3. Did decedent own an "in trust for" or payable-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 AEOVE 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 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 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 bf 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 dhild is 0 percent p2 P.S. §9116(a)(L2)]. • 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) p2 P.S. §9116{a){1')j. • The tax rate imposed on the net va{ue 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-1502 EX+ (01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: A• KENNETH YORK 2'1 11 0636 All real property owned solely or as a tenant in 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 properly that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• 5010 INVERNESS DRIVE, MECHANICSBURG - REAL ESTATE SOLD ON 224,900.00 9/20/11 - SETTLEMENT SHEET ATTACHED TOTAL (Also enter on Line 1, Recapitulation.) ~ S If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + (8-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS $c BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER A. KENNETH YORK 21 11 0636 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTfON OF DEATH 1. MORGAN STANLEY SMITH BARNEY ACCOUNT WITH 17 BONDS, MUTAL FUNDS 301,838.92 AND MUNICIPAL BONDS, ACCOUNT #724-25795-19 364 TOTAL {Also enter on line 2, Recapitulation) ~ ~ 301, 8 3 8 (If more space is needed, insert additbnal sheets of the same size) REV-1508 EX + (6-98;1 SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DENT DECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER A- KENNETH YORK 21 11 0636 lndude the proceeds of litigation and the date the prooaeds were raoeived by the estab. All property Join -owned with right of survhrors ih p must be discbsed on Schsduk F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. TAXES, SEWER'1HOA PRO RATION FROM SALE OF REAL ESTATE 1,548.79 2- 2001 TOYOTA CAMRY SOLARA 5,900.00 3• PERSONAL PROwERTY 500.00 4• FINAL PENSION PAYMENT - USSTEEL 1,642•D9 5• PROCEEDS FROM AUCTION - CINDY FENTON, AUCTIONEER 1,504.80 6• VERIZON REFUND 112.07 7• SCOTTrS LAWN SERVICE REFUND 51.85 8• CHASE - ESCROW ACCOUNT 37.32 9• ENCOMPASS INSURANCE - REFUND 83.50 TOTAL (Also enter on line 5, Recapitulation) ~ S 11, 380 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (Ot-70) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: A. KENNETH YORK 21 11 0636 ff an asset was made jointly owned within one year of the decedents date of death, it must be reported on Schedule G. SURVMNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. HEATHER Y. SEENO 6117 WALLINGPORD WAY DAUGTHER MECHANICSBURG, PA 17050 B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE ME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDE~IFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE ()F DEATH VALUE OF ASSET 96 OF DECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. 4/D9 PNC BANK, N•A• - CHECKING ACCOUNT 18,945.71 50• 9,472.86 5005375648 2• A• 7/09 PNC BANK, N•A• -SAVINGS ACCOUNT 10,095.45 50• 5,047.73 SD05374135 SCHEDULE F JOINTLY-OWNED PROPERTY TOTAL (Also enter on Une 6, Recapitulation} I ~ 14 , 520.59 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+ {08-09~) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF ~ FILE NUMBER A• KENNETH YORK 21 11 0636 This scheduNe must be completed and filed ff fhe answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER OES~RIPTION OF PROPERTY ~~~~THEOFTHE'~RAMSFEREE,THEIRRELATIONSINPTODECEDENTAND THE DATE OF TRANSFE . ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET 96 OFDECD'S INTEREST EXCLUSION pF uR.icAe~ TAXABLE VALUE 1. MORGAN STANLEY SM TH BARNEY-IRA-724-25795-19 23,803.29 33.3334 7,934.45 BENEFICIARY, DAUGHHTER - HEATHER Y• SEENO 2• MORGAN STANLEY SMITH BARNEY-IRA-724-25795-19 23,803.29 33.3333 7,934.42 BENEFICIARY, DAUGHTER - GRETCHEN Y• LINDQUIST 3• MORGAN STANLEY SMITH BARNEY-IRA-724-25795-19 23,803.29 33.3333 7,934.42 BENEFICIARY, DAUGHTER - HOLLIS C• ALEXANDER TOTAL (Also enter on Line 7 Recapitulation) ~ 5 2 3, 8 0 3 2 9 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ {10-0~) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER A• KENNETH YORK 21 11 0636 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSf~S: 1. NEILL FUNERAL HOME (7,607.00 PREPAID BY INSURANCE) 387.50 2• GOOD SHEPARI) CATHOLIC CHURCH - FUNERAL LUNCHEON 500.00 3• FLOWERS 95.24 4• FOOD FOR WAKE 192-56 B. ADMINISTRATIVE COSTS: 1. Personal RepresentStive Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2, AltomeyFees: READER & ADLER, PC 5,000.00 3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation.) Claimant Street Address. City State ZIP Relationship of claimant to Decedent 4• Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 581.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: 7, EXECUTOR EXPENSES 135.OD TOTAL (Also enter on Line 9, Recapitulation) I S 6 , 891.80 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-Oa) Pennsylvania SCHEDULE 1 DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, ~ LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER A• KENNETH YORK 21 11 0636 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. JP MORGAN CHASE BANK - MORTGAGE PAYOFF 63,653.30 2• REALTOR COMMISSION, TRANSFER TAX AND MISC• FEES FROM SALE OF REAL 16,582.00 ESTATE (SETTLEMENT SHEET ATTACHED) 3• PA AMERICAN WATER 88.33 4• PPL 449.79 5• UGI 44.55 6• JP MORGAN CHASE HOME MORTGAGE - MORTGAGE PAYMENTS 1,641.84 7• MICHAEL LANGAN', TAX COLLECTOR - SCHOOL REAL ESTATE TAXES 1,785.19 8• HAMPDEN TOWNSHIP - SEWER AND REFUSE 150.00 9• HOMEOWNERS INSURANCE - ENCOMPASS 86.50 10• UGI HVAC SERVICES 199.00 11• A•H• REIFF LANDSCAPING - MULCH 174.90 12• LEN BAER - 6/3D/11 - YARDWORK 150.00 13• TARGET - STAGING 69.93 14• BOB PORTER - NEW' DEHUMIDIFIER, REPAIR TO HARDWOOD FLOOR, SERVICE 500.00 2 BURNERS ON STOVE, PURCHASED HIBISCUS TREE 15• MISC• - STOP PAYMENT FEE 25.00 TOTAL (Also enter on Line 10, Recapitulation} ~ S 8 9 , 72 5 • If more space is needed, insert addfional sheets of the same size. Continuation of REV-15001nheritance Tax Return Resident Decedent A. KENNETH YORK 21 11 0636 Decedent's Name Page 1 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, $ Liens ITEM NUMBER DESCRIPTION AMOUNT 16. HOME INSTEAD SENIOR CARE 1,146.96 17• AT & T - PHONE/TVlINTERNET 513.60 18• CHASE CREDIT CARD 89.13 19• MEDICAL - PULMONARY AND CRITICAL CARE 33.78 20• MEDICAL - HERITAGE CARDIOLOGY 5.09 21• MEDICAL - PA GASTROENTEROLOGY 118.47 22• MEDICAL - WEST SHORE ANESTHESIA 23.02 23• MEDICAL - MOFFITT HEART AND VASCULAR 68•D7 24• MEDICAL - QUANTUM IMAGING 70.67 25• MEDICAL - INTERNISTS OF CENTRAL PA 175.86 26• MEDICAL - HOLY SPIRIT HOSPITAL 1,082.72 27• MEDICAL - UROLOGY OF CENTRAL PA 4.37 28• MEDICAL - KANTOR AND TKATCH ASSOCIATES 8.01 29• MEDICAL - PRISM - PHYSICIANS OF REHAB 67.95 3D• MEDICAL - WEST SHORE EMS 113.40 SUBTOTAL SCHEDULEI ~ 3,521.10 Continuation of REV-1500 Inheritance Tax Return Resident Decedent A. KENNETH YORK 21 11 0636 Decedent's Name Page 2 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 31• MEDICAL - SP RIT PHYSICIAN SERVICES 59.94 32• MEDICAL - CHARLES INNERS, MD 188•(]5 33• MEDICAL - CENTER FOR KIDNEY DIEASE 8.01 34• MEDICAL - HE R'S HEY KIDNEY SPECIALISTS 78.08 35• MEDICAL - HEALTHSOUTH REGIONAL 226.39 36• MEDICAL - PRISM - PHYSICIANS OF REHAB 17.33 37• MEDICAL - SOLLENBERGER COLOAN AND RECTAL 13.10 38• MEDICAL - ORTHOPEDIC INSTITUTE 2.79 39• MEDICAL - MOFFITT CARDIOLOGY 10.76 SUBTOTAL SCHEDULE I 6 ~ 4.4 5 GRAND TOTAL SCHEDULE I 3 89,725.88 REV-1513 EX+ (01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER: A. KENN ETH YORK 21 11 0 636 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTION [Indude outr' ht spousal distributans and Uansfers under Sec. 9116 (a) (t.2).] 1. HEATHER Y• SEENIO Lineal 167,955.57 6117 WALLINGFOR'D WAY MECHANICBURG, Pµ1 17050 2• GRETCHEN LINDQU~ST Lineal 158,434.98 626 COLUMBIA HOUSTON, TX 77p07 3• HOLLIS ALEXANDE~t Lineal 153,434.99 7508 MENDOTA PLdtE SPRINGFIELD, VA 22150 ENTER DOLLAR AMOUNTS a0R DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTI S: 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 LINE 13 OF REV-1500 COVER SHEET. S n inure space ~s neeaea, use aoomonai sneers or paper or the same size. ..~ •,.,. N c~ ~' - - ~ ~ r ~~ ~ C ~ n ~ ~? <'~~7 CtS ~ ~ ~ ~ LAST Wf LL AND TESTAMENT o -'-' ~ .~~ ~ ~ `" ~, I, A. R'ENNETH YORK, of the Township of Cook , County of Westmoreland and Commonwealth of Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament, and do revoke all wills by me at anytime heretofore made. FIRST: I direct that alI of my just debts and funeral expenses be fully paid and satisfied, as soon as conveniently may be, after my decease. SECOND: I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, as follows: A. One-third (1/3) thereof to my daughter, Heather S. Seeno. B. One-'third {1/3) thereof to my daughter, Gretchen Y. Lindquist. C. One-third (1/3) thereof to my daughter, Hollis C. Alexander. THIRD: If' any of my daughters should fail to survive me,-then I direct that her'share shall pass to her issue per stirpes. FOURTH: I appoint my daughter, Heather. S. Seeno, Executrix of this my Last Will and Testament. If my daughter, Heather S. Seeno, should be or become unable ar unwilling to serve, then I appoint my daughter, Gretchen Y, Lindquist, as Alternate Executrix. I direct that no bond shall be required of any fiduciary in any jurisdiction. ~ ` IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament this 2nd day of July, One thousand nine hundred ninety-two (1992). ~, ~. (sEAL) ~~~~~ A. RE ETH YO Signed, healed, published and declared by A. KENNETH YORK, the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence, and in the presence of each other, have hereunto subscribed our names as .~ witnesses thereto. i , ~~ ,/ ,~~` (WitMes (Wi ss) (Address) ( dress) ~ 2 r COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF WES9['MORELAND ) We, A. KENNETH YORK, GEORGE V. WELTY and MARGARET A. MORLEY, the Testator and '..the Witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed ,the instrument as his last will and that he signed willingly, and that he executed it as his free and voluntary act for the purposes tlherein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the will as witnesses and that to the best of our knowledge the Testator was at that time eighteen years''of age or older, of sound mind and under no constraint or undue influence. Subscribed', sworn to and acknowledged before me by A. KENNETH YORK, the Testattor, and subscribed and sworn to before me by GEORGE V. WELTY and MARGI~RET A. MORLEY, witnesses, this 2nd day of July, One thousand nine hundred ninety-two (1992). v, ~, ~. ~ ~ . O ~ ;;~ ~~" _ Drape F (,~p~p~~ Pbtary PtA~Irc ~' ~4' j Y `+,t ~ ~' ~\~, Ligonier Bor'o, lhl~norelarx! County ' My Commission Expires May 11. r !?!~5 ~ ~ Y• ..P ~ ~ ~ Member, PerxisylvaruaAssodation ui i'vuiriries 3 '' IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament this 2nd day of July, One thousand nine hundred ninety-two (1992). ~~ "~ (SEAL) A. R ETH YO r z Signed, sealed, published and declared by A. KENNETH YORK, the above-named Testator, as and for his Last Will and Testament, in the presence of gas, who at his request, in his presence, and in the presence of teach other, have hereunto, subscribed our names as (wi ss) (Address) ( dress) ~ 2 r 4tiiF a-~l COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF WESTMORELAND ) We, A. KENNETH YORK, GEORGE V. WELTY and MARGARET A. MORLEY, the Testator and the Witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that. the Testator signed and executed the instrument as his last will and that he signed willingly, and that he executed it as his free and voluntary act for the purposes !therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the will as witnesses and that to the best of our knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue inf 1lxence . Subscribed, sworn to and acknowledged before me by A. KENNETH YORK, the Testator, and subscribed and sworn to before me by GEORGE V. WELTY and MARGARET A. MORLEY, witnesses, this 2nd day of July, One thousand nine hundred ninety-two (1992). ~ ~ C r \ ~ ~ ~ WaRarial Seat .~ '. t`• " .~ Y ' Dime P ~' Put~lic •~j. •. ~'~ r L`~ •' .. ~ M eoro V1j°~K ~ arxllcou~ .` ~ '~ Y...p ~ ~ ~ , Member, PeruuyManiaAssodatia~ ui tJut~ties 3