HomeMy WebLinkAbout03-05-12 1505610140
REV-1500 EX (°'-'°,
PA Department of Revenue
Bureau of Individual Taxes OFFICIAL USE ONLY
Po Box 2aosD1 County Code Year File Number
INHERITANCE TAX RETURN
Harrisbur PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 1 0 3 7
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
4 7 3 2 8 3 4 2 3 0 8 2 6 2 0 1 1 0 7 2 9 1 9 2 0
Decedent's Last Name Suffix
Decedent's First Name
H E I S E Y MI
I R E N E
E
(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
1. Original Return ~ 2. Supplemental Return
3. Remainder Return (date of death
4. Limited Estate ~ prior to 12-13-82)
4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
d
OX 6. Decedent Died Testate ~
A eath after 12-12-82}
7. Decedent Maintained a Livin Trust
9 ~
{
ttach Copy of Will)
9
Liti
ati
P 8. Total Number of Safe Deposit Boxes
{Attach Copy of Trust)
.
g
on
roceeds Received 10. Spousal Pove Credit date of death
~ ( ~ 11. Election to tax under Sec
9113(A)
b
t
.
e
ween 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT • THIS SECTION MUST BE COMPLETE
Name D. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
S U S A N H C O N F A I R 7 1 7 7 6 3 1 3 8 3
REGISTER OF WILLS USE ONLY
IZI;i:O1tUl~a) Ol~l~f(a~: Ole
First line of address
2 3 3 1 M A R K E T S T R E E T 2012 MAR 5
Second line of address r a.l'.1ZK C )I'
r fit',Atl~l ~;RI.:1 ~ I~ (;t )~1R1', Y:A
City or POSt Office State ZIP Code I________ DATE FILED J
C A M P H I L L P A 1 7 0 1 1
Correspondent'se-mail address: SCONFAIRaREAGERADLERPC.COM
Under penalties of perjury, 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. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SIGNATtJgE OF PERS6~A ~it S ONSIBLE FOR FILING RETURN
ADDRESS
5113 INVERNESS DR VE MECHANICSBURG
SIGNATURE OF PREP ER OTHER THAN REPRESENTATIVE
ADDRESS
331 MARKET STREET CAMP H1
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 150561014D
__Z~i ' l
PA 17050
DATE
~-~- / Z
PA .17011
150561D14D J
.....,, 1505610240
REV-1500 EX
Decedents Social Security Number
Decedents Name: I R E N E E. H E I S E Y 4 7 3 2 8 3 4 2 3
RECAPITULATION
1. Real Estate (Schedule A) ............... .
........................
... 1.
2. Stocks and Bonds (Schedule B) ................................... ... 2. 1 7 1 8 4 3, 4 1
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. 4 9 8 1 9 , 7 7
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested
7. ....
Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) ~ ... 6.
Separate Billing Requested .... ... 7. 2 2 8 2 8 3, 0 1
8. Total Gross Assets (total Lines 1 through 7) ........................ .. . 8. 4 4 9 9 4 6 , 1 9
9. Funeral Expenses and Administrative Costs (Schedule H) ............... ... 9. 1 1 4 6 9 . 9 3
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10. 7 8 4 0 . 5 6
11. Total Deductions (total Lines 9 and 10) .... , ..... , , . , . .. 11 ], 9 3 1 0 4 9
12. Net Value of Estate (Line 8 minus Line 11 }
13. ............... .
..........
Charitable and Governmental Bequests/Sec 9113 Trusts for which
..12.
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
(a)(1.2) X .0 _ 0 . 0 0 15
16.
Amount of Line 14 taxable .
at lineal rate X .045 4 3 0 6 3 5. 7 0 16
17. Amount of Line 14 taxable
at sibling rate X .12 0 . 0 0 17
18. Amount of Line 14 taxable
at collateral rate X .15 n n n . _
19. TAX DUE ....... ............... 19
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505610240
4 3 0 6 3 5.7 0
4 3 0 6 3 5.7 0
O.o 0
1 9 3 7 8. 6 1
0. 0 0
0. 0 0
1 9 3 7 8. 6 1
0
15056],0240 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 11 1037
IRENE E• HEISEY__
STREET ADDRESS
100 MOUNT ALLEN DRIV
CITY
MECHANICSBURG
STATE
PA
ZIP
17055
Tax Payments and Credits:
~• Tax Due (Page 2, Line 19)
2. Credits/Payments
A, Prior Payments 18 , 8 0 0.0 D
B. Discount 968.93
3. Interest
Total Credits (A + B )
(1) 19,378.61
(2) 19,768.93
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2, Line 20 to request a refund. (4)
390.32
5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5) 0.00
ke check payable to: REGISTER OF WILLS, AGENT
_ ;, a
.__ _, _ ,
PLEASEANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE
" " APPROPRIATE BLOCKS
1
Dld 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 pro
ert
t
f
d
p
y
rans
erre
or its income;
...............................
c. retain a reversionary interest; or .........................................................................................
o
a
.......
d. receive the promise for life of either payments, benefits or care? .....................................
..................
^
0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate considerationl .............................................................................
3
..........
. Did decedent own an 'intrust for' orpayable-upon-death bank account or security at his or her death? ..
.
XQ
.
.....
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? .......................................
................................
...........................
HE ANSWE _ ,
R TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
... - _.
For dates of death on or after Jul 1, 1994, and before Jan. 1
Y , 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 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 child is 0 percent [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 beneficiaries is 4.5 percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)],
• The tax rate imposed on the net value 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-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
IRENE E. HEISEY FILE NUMBER
21 11 1037
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
~~ EXXON MOBIL - 2,365.685779 COMMON SHARES AT X72.64 A SHARE OF DEATH
171,843.41
TOTAL (Also enter on line 2 Recapitulation) I S
171,843
(If more space is needed, Insert addltronal sheets of the same size)
REV-1508 EX+ (11-10)
Pennsylvania
SCHEDULE E
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN CASH, BANK DEPOSITS, 8a MISC.
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF:
IRENE E • HEISEY FILE NUMBER:
Include the proceeds of litigation and the date the proceeds were received by the estate, 11 10 3 7
All property jointty owned with
i
h
ITEM r
g
t of survivorship must be disclosed on Schedule F.
NUMBER DESCRIPTION VALUE AT DATE
~• PNC BANK, N.A• - CHECKING ACCOUNT #5110556627 OF DEATH
600 GRANT STREET 48,074.30
PITTSBURGH, PA 15219
2• SILVER CERTIFICATES - 26
26.00
3• SERIES EE UNITED STATES SAVINGS BOND - L200711853 EE
100.40
4• PERSONAL PROPERTY
500.00
5• EXXON DIVIDEND REFUND CHECK
1,119.07
TOTAL (Also enter on Line 5 Recapitulation) I $
If more space rs needed, insert additronal sheets of paper of the same size 4 9 , 819 7 7
REV-1510 EX+ (08-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
IRENE E
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
EY
NU
- ~.u JIL JIU ~
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes
ITEM
DESCRIPTION OF PROPERTY .
NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL DATE OF DEATH % OF DECD'S EXCLUSION
7. ESTATE.
DELAWARE INVESTMENTS - REFERENCE #958300215p
VAL
T
EST
N
I,F„~,~e
TRANSFER ON DEATH - GLENN P. HEISEY - SON 94,110
38 OO
25
2. DELAWARE INVESTMENTS - REFERENCE #9583002150
TRANSFER 94,110.37 25.00
ON DEATH - JAMES R. HEISEY - SON
3• DELAWARE INVESTMENTS - REFERENCE #9583002150
TRANSFER 94,110.37 25.00
ON DEATH - MICHAEL D. HEISEY - SON
4• DELAWARE INVESTMENTS - REFERENCE #9583D02150 94,110.37 25
00
TRANSFER ON DEALTH - WILLIAM K. HEISEY - SON .
5• AMERIPRISE FINANCIAL COMPANY - MUTUAL FUNDS 134,172.65 25
00
REF. #p11313818400002/020147999294002 .
TRANSFER ON DEATH - GLENN P. HEISEY - SON
6• AMERIPRISE FINANCIAL COMPANY - MUTUAL FUNDS
REF.#D113138184000D2/0201479
134,172.65
25.00
99294002
TRANSFER ON DEATH - JAMES R. HEISEY - SON
7• AMERIPRISE FINANCIAL COMPANY - MUTUAL FUNDS 134,172.65 25
00
REF.#011313818400002/020147999294D02 .
TRANSFER ON DEATH - MICHAEL D• HEISEY - SON
8. AMERIPRISE FINANCIAL COMPANY - MUTUAL FUNDS
134,172.65
25
00
REF.#011313818400002/020147999294D02 .
TRANSFER ON DEATH - WILLIAM K• HEISEY - SON
TOTAL (Also enter on Line 7
If more space is needed, use additional sheets of paper of the same size.
TAXABLE
VALUE
2 3-._.
23,527.59
23,527.59
23,527.59
33,543.16
33,543.16
33,543.16
33,543.16
3.
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
w1Att Vf-
IRENE E• HEISEY
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
A FUNERAL EXPENSES:
~• ANDREW T• SCHEID FUNERAL HOME
2• ROYERS FLOWERS - MEMORIAL FLOWERS
3• MESSIAH VILLAGE - MEMORIAL SERVICE
B• ADMINISTRATIVE COSTS:
~ • Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
FILE
~,
State Zlp
Year(s) Commission Paid;
2. AttomeyFees: REALER 8 ADLER, PC
3. Family Exemption: (If decedent's address is not the same as claimants, attach explanation.)
Claimant
Street Address
City
State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS
5, Accountant Fees: B O R E M A N & B A B B
6• Tax Retum Preparer Fees:
7• I EXECUTORS COST - TRAVEL/VAN RENTAL/GAS/POSTAGE
TOTAL (Also enter on Line 9 Recapitulation) ~ S
If more space ~ needed, use addihonal sheets of paper of the same size.
37
AMOUNT
4,825.67
292.54
1,103.46
4,500.00
373.50
180.00
194.76
4
REV-1512 EX+ (~2.OB)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8 LIENS
IRENE E. HEISEY FILE NUMBER
21 11 1037
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• MEDICAL - ALERT RX PHARMACY
116.65
2• NURSING HOME - MESSIAH VILLAGE
7,505.46
3• DEATH CERTIFICATES - JO ANN HEISEY - DEPT- OF HEALTH
56.00
4• ESTATE ACCOUNT CHECK FEE - MEMBERS 1ST
11.25
5• STATE EMPLOYEES RETIREMENT SYSTEMS OVERPAYMENT
50.60
6• MEDICAL - CAPITAL AREA HEALTH ASSOCIATES
29.6D
7• 2011 STATE INCOME TAX - PA. DEPT• OF REVENUE
71•DO
TOTAL (Also enter on Line 10, Recapitulation) I $
If more space is needed insert additional sheets of the same size. 7 ~ 8 4 0
REV-1513 EX+ (01.10)
Pennsylvania
SCHEDULE
DEPARTMENT OF REVENUE J
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE O F:
IRENE E. HEISEY FILE NUMBER:
21 11 1037
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
I,
tnq
TAXABLE DISTRIBUTIONS [Include ou ' ht spousal distributions and transfers under
Sec. 9t f6 (a) (1.2).] Do Not List Trustee(s) OF ESTATE
1, GLENN P. HEISEY
5113 INVERNESS DRIVE Lineal 112,658.93
MECHANICSBURG, PA 17050
2• JAMES R. HEISEY
BOX 909 Lineal 92,658.93
SANTA ROSA, CA 95402
3. MICHAEL D. HEISEY
528 MEADOWAY PARK Lineal 112,658.92
WORTHINGTON, OH 43085
4• WILLIAM K. HEISEY
12301 FRESHWELL ROAD Lineal 112,658.92
CHARLOTTE, NC 28273
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN AB
II. OVE ON LINES 15 T
NON-TAXABLE DISTRIBUTIONS: HROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV 1500 COVER SHEET I
If more space Is needed, use addltlonal sheets of paper of the same size. $
~ _a
...~_ .._.... . ~Z
,~
LAST WILL AND TESTAMENT ~ ~ ~ ~ -''
=~. ~ r-
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*.7 C-
IRENE E. HEISEY -~-f '-`--- "~`
t'.~ ~~ ~
c.~:,
I, IRENE E. HEISEY, of the Township of Manor, County of
Lancaster and Commonwealth of Pennsylvania, do make, publish and
declare this as and for mfr Last Will ar_d Testament, hereby
expressly revoking all wills and codicils made by me heretofore,
and dispose of my estate as follows:
ITEM 1: I direct the payment of my legally enforceable
debts and funeral expenses, including a suitable and proper grave
marker, as soon as conveniently can be done following my decease.
ITEM 2: I direct that all State and Federal Transfer
Inheritance Tax, Estate Tax, Succession Tax or any other tax,
including any interest, assessments or penalties thereon, that may
become due and payable by virtue of my death, or by virtue of the
passing of any property either under my Last Will and Testament,
or in any other manner, shall be paid by my estate, just as if
such taxes were my debts, and no beneficiary shall be required to
pay or refund any part thereof. This shall not, however, include
taxes for assets to be administered in any foreign country. Taxes
on future interests may be prepaid.
ITEM 3: The articles of household use in the home of my
husband, J. IRVIN HEISEY, and myself are owned by the two of us as
tenants by the entirety, and I therefore make no disposition of
the same because upon my death, he will be the sole owner thereof
by operation of law, if he survives me. Should my husband, J.
IRVIN HEISEY, fail to survive me, then I give and bequeath so much
of such articles of household use in our home unto my surviving
children as they may determine, subject to me specifically
bequeathing any such items to my children or any other
beneficiaries in accordance with the Memorandum, if any, attached
to this Will. If such property cannot be selected hereunder by
agreement of the parties involved, my Executors hereinafter named,
in my Executors' sole judgment, shall divide the same among those
involved; any property remaining undivided and undistributed
pursuant hereto, shall pass into the residue of my estate.
ITEM 4: My tangible personal property (excluding money,
securities and the like) and my motor vehicles, together with all
insurance relating thereto, I give and bequeath unto my husband,
J. IRVIN HEISEY, if he survives me by thirty (30) days. Should my
husband, J. IRVIN HEISEY, fail to survive me by thirty (30) days,
then I give and bequeath all of my tangible personal property
(excluding money, securities and the like) and my motor vehicles,
together with all insurance relating thereto, unto my surviving
2
children as they may determine, subject to me specifically
bequeathing any such items to my children or any other
beneficiaries in accordance with the Memorandum, if any, attached
to this Wi:11. If such property cannot be selected hereunder by
agreement of the parties involved, my Executors hereinafter named,
in my Executors' sole judgment, shall divide the same among those
involved; any property remaining undivided and undistributed
pursuant hereto, shall pass into the residue of my estate.
ITEM 5: All of the rest, residue and remainder of my estate
of whatsoever nature and wheresoever situate, I give, devise and
bequeath unto my husband, J. IRVIN HEISEY, if he survives me.
ITEM 6: Should my husband, J. IRVIN HEISEY, fail to survive
me, then and in that event, I give, devise and bequeath all of the
rest, residue and remainder of my estate of whatsoever nature and
wheresoever situate equally unto my children, JAMES RICHARD
HEISEY, MICHAEL DENIS HEISEY, JO ANN HEISEY, WILLIAM KEITH HEISEY
and GLENN PHILLIP HEISEY; provided however, that the sum of
Fifteen Thousand ($15,000.00) Dollars shall first be distributed
to each of my children with the exception of my daughter, JO ANN
HEISEY, and the sum of Twenty Thousand ($20,000.00) Dollars shall
be distributed to each of my children with the exception of my
son, JAMES RICHARD HEISEY, in order to equalize for gifts given to
my daughter, JO ANN HEISEY, and my son, JAMES RICHARD HEISEY,
3
during my lifetime. The share of any of my children deceased as
my death, with issue surviving, shall pass by representation to
such surviving issue. The share of any of my children deceased at
my death without issue surviving shall lapse in favor of those
surviving, and those not surviving who leave issue surviving, per
stirpes.
ITEM 7: Anything herein to the contrary notwithstanding, I
appoint my daughter, JO ANN HEISEY, and my son, GLEN PHILLIP
HEISEY, Co-Trustees to hold any assets passing to any grandchild
hereunder until he or she reaches the age of twenty-five (25)
years. My Co-Trustees may exercise the powers given by law and in
addition thereto and without any order of court and in the
discretion of the Co-Trustees, may use principal as well as income
from time too time for the health, maintenance, education and
support of such grandchild, may accumulate income not so used, may
sell real and personal property at public or private sale, may
retain assets in kind, and may invest and reinvest in any property
without restriction to legal investments. If, for any reason, a
guardian over the estate of a grandchild or grandchildren is
needed or required, my Co-Trustees shall be the guardians of the
estate of such grandchild or grandchildren, with the same rights,
powers, privileges, duties and responsibilities as I have given
them as Co-Trustees.
4
ITEM 8: No assignment or order by any beneficiary by way of
anticipation of any of the principal or income of the trusts
herein created shall be valid; but the income and principal shall
be paid directly to the beneficiaries entitled to receive it; and
the income and principal shall not be subject to attachment,
execution, levy, sequestration, hypothecation, garnishment or
other process while in the hands of the Co-Trustees.
ITEM 9: I appoint my husband, J. IRVIN HEISEY, to be the
sole Executor of this my Last Will and Testament. Should he be
unable or unwilling to act or to continue serving, then I appoint
my daughter, JO ANN HEISEY, and my son, GLENN PHILLIP HEISEY, or
the survivor between them, to be the Co-Executors of this, my Last
Will and Testament.
ITEM 1.0: I direct that no fiduciary appointed in my Last
Will and Testament shall be required to give or enter into any
bond or security in any jurisdiction, regardless of the state of
their residency.
5
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
23rd day of March, 2000.
IRENE E. HEISEY
Signed, sealed, published, acknowledged and declared by the
above-named Testatrix, IRENE E. HEISEY, 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 hereunto sub-
scribed our names as witnesses thereto.
~~ of ~ ~ ~~
6
COMMONWEALTH OF PENNSYLVANIA
• SS:
COUNTY OF LANCASTER
I, IRENE E. HEISEY, Testatrix, who signed the foregoing
instrument, having been duly qualified according to law, acknowl-
edge that. I signed and executed the instrument as my free and
voluntary act for the purposes therein contained.
Sworn to or affirmed and
acknowledged before me by
IREI~TE E . HEISEY,
the Testatrix, this 23rd day
of March, 2000.
'' '~ ~ ~'
h.~t
~No ary ub is _._
IRENE E. HEIS
NOTARIAL SEAL
JUDY E. CNESTERS, Notary Public
City of Lancaster, Lancaster County
icy Commission Expires December ~, 2002
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF LANCASTER
SS:
We, the undersigned witnesses who signed the foregoing
instrument, being duly qualified according to law, depose and say
that we were present and saw Testatrix sign and execute the
instrument as her Last Will and Testament; that she signed and
executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and
hearing signed the Will as witnesses; that Testatrix is known to
each of us; and that to the best of our knowledge and observation
the Testatrix was at that time of sound mind and under no con-
straint or undue influence.
Sworn to or affirmed and
subscribed to before me by
~~ - E~ efS and
~tht( ~• ~x~n ,
wi nesses, this 23rd day
of March, 2000.
~'
/ .~
Not pub ~c
yQTARiAL SEAL '.T. - ~ ~~
JUDY E. CNESTERS, Notary Public
City of Lancaster, Lancaster County ~ ~
My Commission Expires December 9, 2002
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