HomeMy WebLinkAbout12-14-05 (3)
REV .1600 IX ~ (H6)
REV-1500 ~ _
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COMMONWEALTH OF PENNSYLVANw INHERITANCE TAX RETURN FlLE NUMBER
oEPAR~ ~ENt,E RESIDENT DECEDENT 21 os oosg6
HARRISBURG, PA 171280801 COUNTY CODE YEAR NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
i Stott, Elizabeth C. 083-12-3540
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0 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-0D-YEAR) 71{Ig RETURN YUST BE RLED IN DUPLICATE VYITH THE
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~ 06/04/2006 10/28/1921 REGISTER Of WILLS
i (fF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL
SOCIAL SECURITY NUMBER
® 1. Original Return ~ 2. Supplemental Return ~ g Remainder Return (date of death prior to 12-13-82)
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^ 4. Limited Estate
^ 4a. FWxe Interest Comprortdse (date of death aver ^ 5. Federal Estate Tax Return Required
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® 6. Decedent Died Testate (Arced, copy 12-12$2)
^ 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes
a of ~)
9. Litigation Proceeds Received Dopy of Trust) -
~ 10. Spousal Poverty Credit (date of death between ~ 11. Election t0 tax under Sec. 9113(A) (Arad, sd, 0)
12-31-91 and 1-1-95
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Z AME
'Craig A. Diehl
Esquire COMPLETE MAILING ADDRESS
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6L p IRM NAME (If appRcetNe)
d Law Offices of Craig A
Diehl 3464 Trindle Road
.
E Camp Hill, PA 17011-4436
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PHONE NUMBER
j 717/763-7613
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V
~ 1. Real Estate (Schedule A) (1) None
2. Stocks and Bonds (Schedule B) (2) -0-
~ 3. Closely Held Corporation, Partnership orSole-Proprietorship (3) None
~ 4. Mortgages & Notes Receivable (Schedule D) (4) None
5. Cash, Bank Deposits 8 Miscellaneous Personal Property
(Schedule E) (5)
_ 19,894.30
6. Jointly Owned Property (Schedule F) (6) None
^ Separate Billing Requested
7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (7) S 1 1,663.86 ~
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 8,438.79
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 999.63
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
~~.~r iaa,~ ~ ~~c ~I,I~ ~.
(11) 9,43 8.32
(12) 622,1 19.84
(13)
(14) 622,119.84
SEE INSTRUCTIONS ON REVERSE S{DE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15}
or transfers under Sec. 9116(a)(1.2)
19. Tax Due
20. ^
16.Amount of Line 14 taxable at lineal rate 622,1 19.84) x .045
17. Amount of Line 14 taxable at sibling rate x .~ 2
18. Amount of Line 14 taxable at collateral rate x .75
» BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND
(16) 23,496.39
(17)
(18)
(19) 23,496.39
MATH «
Copyright 2000 form software only The Lackner Group, Inc. Fonn REV-1500 EX (Rev. 6-00)
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Decedent's Complete Address:
iTREET ADDRESS
355 Sporting Hill Road
i
~~ Mechanicsburg STATE PA ZtP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 23,495.39
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 22,000.00
C. Discount 1,15 7.8 9
Total Credits (A + B + C) (2) _ 2 3 , I S 7.8 9
3. Interest/Penalty ffapplicable
D. Interest
E. Penalty
Total Interest/Penatty (D + E) (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 Llne 20 to request a refund
5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ 3 3 7.5 0
A. Enter the interest on the tax due. (5A) .
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3 3 7.5 0
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 1'lfe 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 hanlr ~~~-••-• - death?......... ® ^
4. Did decedent own an Individual Retirement Account, a :h
contains a benefaary designation? ............................... .................... ® ^
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,' ~ ~/~ ~ tND FILE R AS PART OF THE RETURN.
Under penaHies of perjury, I dedarE that I have examined This raWm, including accompanying '/ sdge and belief, ft is true, coned and complete. Declaration oT
praparer other then the personal representative is based on all infortnatbn of which preparer I
TORE OF PERSON RESPO SIBLE F FLING ETURN ADDRE
Doa W. Stott,
S G RE O ERSON RESPONSIBL FOR ETURN ADDRE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS
Craig A. DieYl, Es sire
3464 Trindle Road
DATE
/"~ -~ ~3
~. ~_ C Camp Hill, PA 1 701 1-4436 ~~
For dates of death on o~~``r alae~~r J-ufy 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[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 anti filing a tax return are still applicable even 'rf the surviving spouse is the only beneficiary.
For dates of death on or after Jufy 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one 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% [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 berfefit~aries is 4.5°h, except as noted in 72 P.S. §9116
1.2)172 P.S. §9116 (a) (1)].
The tax rate imposed on the net value of transfers Co or for the use of the decedent's siblings is 12°~ p2 P.S. §9116 (a) (1.3)). A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
SCHEDULE E
CASH, BANK DEPOSITS, ~ MISC.
COA410~NYFJILTN OF PENNSVLVANW PERSONAL PROPERTY
MIHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Stott, Elizabeth C.
j 21 - OS - 00586
Include the proceeds of litigation and the date the proceeds were received by the estate. Ali property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 PNC Bank 17,894.30
Checking Account # 5 1 4006260 1
Account balance at date of death (non-interest bearing)
2 1994 Oldsmobile Cutlass Sierra 2,000.00
~ _
TOTAL (Also enter on Line 5, Recapitulations 19,894.30
SCHEDULE G
INTER-VIVOS TRANSFERS ~
COMMONWEALTH OF PENNSYLVANIA i
INHERfTANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Stott, Elizabeth C.
21 - OS - 00586
This schedule must be completed and filed if the answer to an of questions 1 through 4 on page 2 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
Indude the name of the transferee, their relationship to decedent and the date of transfer.
Attach a copy of the deed for r~l estate. i
DATE OF DEATH
VALUE OF ASSET °~ OF
DECD'S
INTEREST ~
EXCLUSION ~ TAXABLE VALUE
(IF APPLICABLE)
~
1 TD Waterhouse IRA Account # 50598625 31,951.37 100% 31,951.37
c/o ISI Financial Group, Inc.
25 A East Roseville Road, Lancaster, PA 17601
Transferred to beneficiary 8/18/05:
Douglas W. Stott, Jr.
2 Heatherwood Circle ~,
Middletown, PA 17057
See ISI correspondence attached hereto
as Exhibit G. ~
2 TC Waterhouse TOD Account # 50861391 479,712.49 100% 479,712.49
c/o ISI Financial Group, Inc.
25 A East Roseville Road, Lancaster, PA 17601
Transferred to beneficiary 8/18/05:
Douglas W. Stott, Jr.
2 Heatherwood Circle
Middletown, PA 17057
See ISI correspondence attached hereto as Exhibit G.
~~
- - - _ - - -
i
~
I
-~ I
I
- -- ~-- -
,~ TOTAL (Also eater on line 7, Recapitulation) i 511,663.86
- - -
9(~-®IJLE H
con~noNwEA~TN of rENNSr~vANw
N~AfERRANCE TAX RETURN 771 /C n/'~T~
RESIDENT D
„~G V~J`7 ~
7
~
ECEDENT
ESTATE OF '~ FILE NUMBER
Stott, Elizabeth C.
21 - OS - 00586
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION ii AMOUNT
A. FUNERAL EXPENSES:
1 Trefz & Bowser Funeral Home, Inc. 2,256.20
114 W. Main Street, Hummelstown, PA 17036 -Cremation services
I
~
B.
ADMINISTRATIVE COSTS: I
1. Personal Representative's Commissions
Social Security Number(s) ! EIN Number of Personal Representative(s):
Street Address
CttY State Zip
Year(s) Commission paid
2. Attorney's Fees Law Offices of Craig A. Diehl -Craig A. Diehl, Esquire 5,315.58
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
CnY State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 102.00
5. Accountant's Fees
6. Tax Return Preparer's Fees Seligman and Friedman & Company - 2004 Income taxes ~ 434.30
7. Other Administrative Costs ,'
1 Cumberland County Legal Journal -Estate advertisement 75.00
2 The Sentinel -Estate advertisement ~
144.29
Total of Continuation Schedule(s) 111.42
TOTAL (Also enter on line 9, Recapitulation) 8,438.79
Schedule H
COMMONWEALTH OF PENNSYLVANIA • `~ ""y
INHERITANCE TAX RETURN A.~L,..~;~..~/~.,, /+„~i ,,,~~,y;,~,,,~,~
RESIDENT DECEDENT /'M~ ~ ~ ~~.7YaYYC V~A~ biA Iv ILIC.L
ESTATE OF FILE NUMBER
Stott, Elizabeth C.
21 - OS - 00586
3 Law Offices of Craig A. Diehl -Certified mail fee for DPW correspondence 4.42
4 Commonwealth of PA -Vehicle transfer I 87.00
5 Cumberland County Register of Wills -Filing fee for Family Settlement Agreement j 20.00
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
-TMOFr~-arsnvaNw LIABILITIES ~ LIENS
INHERITANCE TAX RETURN ~
RE&DENT DECEDENT
ESTATE OF FILE NUMBER
Stott, Elizabeth C. ~
21 - OS - 00586
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Discover Card -Credit card balance 54.71
2 Andrew Zeiter, Esq. -Revision to Decedent's will 85.00
3 Links 2 Cate -Private duty nursing services 670.00
4 Country Meadows Nursing Home -Final bill 189.82
TOTAL (Also enter on Line 10, Recapitulation) ~ 999.53
REV-~su Ex+ laool
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stott, Elizabeth C. FILE NUMBER
21 - OS - 00586
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT AMOUNT OR SHARE
OF ESTATE
I. TAXABLE DISTRIBUTIONS (indude outright spousal distributions) ,
1 Douglas W. Stott, Jr. Son 1/3 Estate Residue
2 Heatherwood Circle
Middletown, PA 17057-3321
2 Carol E. Gulick Daughter 1/3 Estate Residue
1208 Jim Johnson Loop
Plant City, FL 33455-4767
3 Linda E. Grove Daughter 1/3 Estate Residue
12314 Quercus Lane
Wellington, FL 33414-4126
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
EXHIBIT E
ALIT ~-2~-~llP~ 2~ ~ 2S PNCEANi:
~I V~~~~
August 24, 2005
air ~5J J4S8 ~.~~i~4_,1
Craig A I1ieh1 scp/al
Attorney at Law
3464 Ttindle Rd.
Camp Hill, PA 17011-4436
RE: Estate of Elizabeth C Stott (Deceased)
SSN~ 083-I2-3540
DOD; 06-04-2005
Dear Mr. Diehl:
In response to your request for Date of Death balances for the custorrxer noted above, our
records show the fallowing:
Checking Accour-t
Account #5140062601 Established Ol-O1-1966
ELIZABETH C STOTT
DOD balance: $17,894.30 + $0.00 accrued interest
Pease note that this office only provides date of death balances for deposit accounts
(LRAs, CDs, Checking and Savings accounts). We do not process auy financial
tramsactions or ~xovide statements. If you need assistance with any of these items,
please call 1-s88-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
off ce.
Sincerely,
~~~ ~
Erica L Schlegel
I-800-762-1775
P7-PFSC-04-F
500 First 6w~,
Pittsburgh PA 15219 McmberFDIC
TOTAL P. D1
ISI Financial irroup lilc.
PORTFOLIO SUMMARY
~Et:,E,4JEu
ELIZABETH C STG-TT
50861391
June 4, 2005
Pct. Cur. Est.Annual
Security Type Total Cost Market Value Assets Yield Income
Equities
MUTUAL FUNDS 283,629.46 315,427.74 65.8 1.9 6,142.16
283,629.46 315,427.74 65.8 1.9 6,142.16
Fixed Income
BOND FUNDS 158,041.32 158,448.91 _ 33.0 _ 2.1 _ _ 3_,349.30
158,041.32 158,448.91 33.0 2.1 3,349.30
Cash and Equiv.
MONEY MARKET 4,485.84 4,485.84 0.9 2.3 104.52
FUNDS
CASH AND 1,350.00 1,350.00 0.3 0.0 0.00
EQUIVALENTS
5,835.84 5,835.84 1.2 1.8 104.52
TOTAL PORTFOLIO 447,506.62 479,712.49 100.0 2.0 9,595.98
ICI Financial Group inc.
UNREALIZED GAINS AND LOSSES
L~ C.~fPi~~1J
ELIZABETH C ST®TT
50861391
Jaa:e 4, ?005
Cfnit Totai
Date Quantity, Security Cost Cost Price
BONB FUNDS
09-02-04 7,468.944 DFA FIVE YEAR 10.57 78,957.24 10.67
GLOBAL F[XED
INCOME PORTFOLI
09-02-04 7,923.066 DFA TWO 1'R 9.98 79,084.08 9.94
GLOBAL FIXED
INCOME
158,041.32
MUTUAL FUNDS
09-02-04 1,511.14400 DFA INTL SMALL CO 12.67 ] 9,152.77 14.56
PORTF
09-02-04 3,416.88300 DFA INVESTMENT 17.70 60,478.52 20.27
DIMENSIONS LARGE
CAP VALUE
09-02-04 1,663.40100 DFA INVESTMENT 16.86 28,044.90 ]8.73
DIMENSIONS U S
SMALL CAP PO
09-02-04 1,418.88300 DFA INVESTMENT 24.42 34,646.63 26.05
DIMENSIONS U S
SMALL CAP VA
09-02-04 1,490.00800 DFA INVT 15.73 23,431.05 17.48
DIMENSIONS GROUP
INC LARGE CAP IN
U9-02-04 922.42SOU DFA REAL ESTATE 21.19 19,549.91 23.49
SECS PORT
09-02-04 1,702A5600 DFA U S LARGE CO 33.00 _56,161.93 35.]9
PORTPOL
09-02-04 3,027.46300 DIMENSIONALINVT 13.93 42,]63.75 16.00
GROUP INC DFA
INTL VALUE
MONEY MARKET FC1NllS
TD WATERHOUSE MONEY
MARKET PORTFOLIO (SWEE
CASH AND EQUIVALENTS
Cash Account
TOTAL PORTFOLIO
283,629.46
4.4RS.R4
___ 1,350.00
1,350.00
447,506.62
Market
Value
79,693.63
78,755.2R
158,448.91
22,002.26
69,260.22
31,155.50
36,961.90
26,045.34
.21,667.76
59,895.35
48,439.41
4,485.84
4,485.84
1,350.00
1,350.00
,x79,712.49
Unrealized "/„
Gain/Loss G/L
736.39 0.9
-328.80 -0.4
407.59 0.3
x,849.49 14.9
8,781.70 14.5
3,110.60 11.1
x,315.27 6.7
2,6]4.29 11.2
2,117.85 10.8
3,733.42 (i.6
6,275.66 ] 4.9
31,798.28 1 1.2
32,205.87 7?
Security Type
Equities
MUTUAL FUNDS
Cash and Equiv.
MONEY MARKET
FUNDS
TOTAL PORTFOLIO
ISl Financial Group Inc.
PORTFOLIO SUMMARY
1JE I.,~~f J'~11
ELIZABETH C STQTT
50598625
June 4, 2005
Pct. Cur. Est.Annual
Total Cost Market Value Assets Yield Income
29,085.10 31,313.87 98.0 1.6 490.25
29,085.10 31,313.87 98.0 1.6 490.25
637.SU 637.50 2.0 2.3 14.85
637.50 637.50 2.0 2.3 14.85
29,722.60 31,951.37 100.0 1.6 505.11
ISi rinanciai ciroup inc.
UNREALIZED GAINS AND LASSES
uELE~SE~
ELIZABETH C STO'TT
50598625
June 4, ?005
Unit Total Market Unrealized "/„
llate Quantity Security Cost Cost Price __ Value Gain/Loss G/L
MUTUAL FCINDS
09-02-04 2,S33.8340U DIMENSIONAL INVT 10.26 29,085.10 11.05 31,313.87 2,228.77 7.7
GROUP INC GLOBAL
60/40 PO
?9,085.10 31,313.87 2,228.77 7.7
MONEY MARKET FUNUS
TD WATERHOUSE MONEY 637.50 637.50
MARKET PORTFOLIO (SWEE
637.50 637.50
TOTAL PORTFOLIO 29,722.G0 31,951.37 2,228.77 7.5
OF
~~~~~~~~ ~o ~~~'~
BE 6T REMEMBERED, that I, ELI~~BETH G. STC3TT, of 406 Orchard Lane,
i~oc~;hanicsburg, Upper alien Tawnsi~ip, Cumberiand County, Fennsyivania, being of sound
mind, memory and understanding, do make, publish and declare this as and for my Last
Will and Testament, hereby revoking and making null and void any and all Wills and
Testaments and writings in the nature thereof by me at any time heretofore made.
OTEM ~ : { direcf that my hereinafter named Executor pay all my just debts, my
funeral expenses, and the expenses of the administration of my estate. nth this direction,
I authorize and empower my Executor to expend for my funeral expenses and interment
such amounts as he may consider necessary and proper, without regard to any limit that
may be prescribed by a court of law.
ITEM 2: I direct my Executor to pay all inheritance, estate, succession, and legacy
taxes of whatsoever nature and kind, to which my estate, or the transfer of any property
passing hereunder or otherwise passing by reason of my demise, may be subject, and to
charge such taxes against my residuary estate, it being my intention that none of the
aforesaid taxes, eiti~ier federal or state, on any property required io be included in my gross
estate, under the provisions of any state or federal law now in force ar hereafter enacted,
shall be prorated among the persons interested in my estate to u~vham such nronArt« is car
may be transferred , or to whom any benefit accrues.
ITEM 3: Ali the rest, residue and remainder of my estate, of whatsoever nature and
wheresoever situate, vvhether it be real, personal or mixed, including property over which
I have a power of appointment, I give, devise and bequeath unto my children, a6C,DO~S
W. STC3TT, JIB., LIIVC~~ E. ~IRC?~.~E, ancf C~^.F3QL E. OE.DL6Gt~, in equal shares, per capita.
ITEM 4: In the e~~ent that any of my enumerated chNdren should predecease me,
I direct that the share of such deceased child {apse, and that my estate be divided between
my surviving children, in equal shares.
ITEM 5: I nominate, constitute and appoint my son, 170tJGLAS W. STE3TT, JR.,
as Executor of this my Last Witl and Testament.
ITEM 6: I direct that my hereinbefore named Executor shall not be required to give
bond for the faithful performance of his duties in this or any jurisdiction.
~~
IN 1fYITNESS WHEREOF, I have hereunto set my hand and seal this °~ day
of ~/, (l!~~ULi~ 1996.
~, >> ~~~
-rte ~, ,~_['iC~~ ~ ~, ~S~ ,,..~p•L.~_.
ELIZRI$ETH C. STOTT
The preceding instrument, consisting of this and one (1} other typewritten pages, was
on the day and date thereof signed, sealed, pubiished, and declared by the Testatrix herein
named, as and for her Last Will and Testament, in the presence of us, who, at her request,
in her presence and in the presence of each other, have subscribed our names as witnesses
hereto.~~
/` ~~ "~•
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COI>/IIVIONINEALTH OF PENNSYLVANIA
COUNTY OF PORK
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/ , i~
1Ne, ELIZA TES C. STOTT, ~ '~~ ~ ~~'~t~~~-'~ , `~ and
~,-1(~~! -~~~~. 4~/r"~/~'~.~ the Testatrix and the witnesses, respectively, whose
names are signed io the attached or foregoing instrument, being fiirst duly sworn, do hereby
declare to the undersigned authority that the Testatrix signed and executed the instrument
as her Last WiII and Testament, and that she signed wilfiE~gly, and that she executed it as
her free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix signed the Wil! as witnesses, and
that to the best of their knowledge, the Testatrix was at the time eighteen X18) gears of age
or older, of sound mind, and under no constraint or undue influence.
~'"
ELI~ATH C. STOTT
~ ,~
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,~ ,
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SWORN TO AN® SUI3SCRIBE®
BEFORE IUIE THIS ,~~~ DAY
OF / ~~ , ~ 996.
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_Notarial Seal _ I
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i II IISh~~rn Gnrrr Vnrl~ rn::nh~
r,,q~! ~OnlfTii~51Gn ~Yi7ir,.G ~ :.. ?.~i~, ~ ~'~~ ~
~~r. Pennsylvznia f+ssociation of Notaries