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Home My WebLink About03-21-12J 1505610140 REV-1500 EX (°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Po Box 2sosol INHERITANCE TAX RETURN County Code Year File Number Harrisbum PA 17128-0601 RESIDENT DECEDENT 2 y y 1 0 7 3 1 ENTER DECEDENT INFORMATION BELOW ~ - Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 2 0 1 2 2 1 2 4 6 0 5 2 7 2 0 1 1 1 1 0 6 1 9 2 8 Decedent's Last Name Suffix Decedent's First Name MI T R A C Y C L A R E G (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 ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-82) 5. Federal Estate Tax Return Required ^X 6. Decedent Died Testate (Attach Copy of Will) ~ death after 12-12-82) 7. Decedent Maintained a Living Trust ~ A 8. Total Number of Safe Deposit Boxes 9 Liti ation Pro d R i ( ttach Copy of Trust) . g cee s ece ved ~ 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 CORRESPONDENCE AND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D A V I D W R E A L E R 7 1 7 7 6 3 1 3 8 3 First line of address 2 3 3 1 M A R K E T Second line of address City or Post Office C A M P H I L L S T R E E T State ZIP Code REGISTER WILLS USE ONLY t^ Q r-.~ 1C7 7s~ C t '' ~ t _t r . ~ C7 r.. .. - ~r ~ N I. =- ~~~ , ~ ~ -. r? ~ - ~ P A 1 7 0 1 1 Correspondent's a-mail address: DWREAGERaREAGERADLERPC . COM t.~; `~~ t. r-4~ £~.:~ r--; t" .,.; 'r , f J i'~"1 _~ ..~ ~~~~ pena~ue~ or pequry, i aeCiare that I nave examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaraUon of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI ~~AT`UR~E ~OF PERSON g~SPONSIBLE FOR FILING RETURN DATE ADDRESS 419 SPRINGH E ROAD CAMP HILL PA 17011 SIGNATURE PRE R OTjiER THAN REPRESENTATNE ....__ ~ ~ 1~~ L. 2331vMARKET 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: CLARE G• TRACY 2 0 1 2 2 1 2 4 6 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 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. 1 2 9 1 5. 3 5 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ... .... 6. 9 9 0 2 . 4 0 7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property (Schedule G) ~ Separate Billing Requested ... .... 7. 0 . 0 0 8. Total Gross Assets (total Lines 1 through 7) ....................... .... 8. 2 2 8 1 7 • 7 5 9. Funeral Expenses and Administrative Costs (Schedule H) .............. .... 9. 9 5 5 5. 7 1 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ......... .... 10. 9 9 6 . 8 4 11. Total Deductions (total Lines 9 and 10) ........................... .... 11. 1 0 5 5 2. 5 5 12. Net Value of Estate (Line 8 minus Line 11) ........................ .... 12. 1 2 2 6 5. 2 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 14. an election to tax has not been made (Schedule J) . Net Value Subject to Tax (Line 12 minus Line 13) . .............. .............. ... ... .... 13. .... 14. 1 2 2 6 5. 2 0 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 .045 1 2 2 6 5. 2 0 1s. 5 5 1. 9 3 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 0. 0 0 19. TAX DUE .................................. ............. ... ....19. 5 5 1. 9 3 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: Flle Number 21 11 0731 DECEDENTS NAME CLARE G• TRACY _ STREET ADDRESS 801 N• HANOVER STREET CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: ~ ~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 21, 811.00 B. Discount 27.60 3. Interest (1) 551.93 Total Credits (A + B) (2) 21, 8 3 8.6 0 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. (3) (4) 21,286.67 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 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 : ...................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^ c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^ 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' orpayable-upon-death bank account or security at his or her death? ......... ^ X^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ^ X^ IF THE ANSWER 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 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 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)J. • 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-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RES DENTED EDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER CLARE G• TRACY 21 11 0731 Indude the proceeds of litigation and the date the proceeds were received by the estate. All properly jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. JOHN HANOCK LIFE INSURANCE COMPANY - REFUND OF LONG 3,456.00 TERM INSURANCE 2• NEW YORK STATE AND LOCAL RETIREMENT SYSTEM - PENISON BENEFIT 1,328.13 3• (PERSONAL PROPERTY ~ 100.00 4• (CHURCH OF GOD AND TWO EMPIRE PLAN ~ 7,800.09 5• IGILBERT L• DAILEY FUNERAL HOME INC• - REFUND ~ 231.13 TOTAL (Also enter on line 5, Recapitulation) I S 12 , 915 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (01-t0) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NU BER: CLARE G• TRACY 21 11 0731 ff an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SCHEDULE F JOINTLY-OWNED PROPERTY SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. CLARE M• KOERNER 419 SPRINGHOUSE ROAD CAMP HILL, PA 17011 DAUGHTER B. C JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTERESI 1. A. 10/97 MEMBERS 1ST FEDERAL CREDIT UNION 5.00 50• 2.50 SAVINGS ACOCUNT #171666-00 2• A- 12/09 MEMBERS 1ST FEDERAL CREDIT UNION 6,067.25 50• 3,033.63 CHECKING ACCOUNT #171666-11 3• A• 9/09 MEMBERS 1ST FEDERAL CREDIT UNION 13,732.54 50• 6,866.27 MONEY MARKET ACCOUNT #171666-05 TOTAL (Also enter on Line 6, Recapitulation) I S 9 , 902 4 0 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ~~ i Ai t ur FILE NUMBER CLARE G• TRACY 21 11 0731 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: 1. FUNERAL LUNCH AND DINNER 1,438.21 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2, AttomeyFees: REALER 8 ADLER, PC 5,000.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address C~' State ZIP Relationship of Claimant to Decedent 4• Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 93.50 5 Accountant Fees: KERN AND COMPANY, PC 425.00 6. Tax Retum Preparer Fees: 7• EXECUTOR EXPENSES - TRAVEL ACCOMMODATIONS FOR NEW YORK BURIAL 1,599.00 8• MONTFORT MISSIONARIES 1,000.00 TOTAL (Also enter on Line 9 Recapitulation) ; 9 , 5 5 5 71 If more space ~ needed, use additional sheets of paper of the same size. REV-1512 EX+ (12.08) Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, ~ LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER CLARE G. TRACY 21 11 0731 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• NEWSDAY ADVERTISING -LONG ISLAND NEW YORK NEWSPAPER OBITUARY 768.DD 2. DARRYL K. GUISTWHITE, D.O., INC. - MEDICAL BILLS 169.12 3. CERTIFIED MAIL 11.18 4. PINNACLE HEALTH - MEDICAL BILL 43.54 5• DEPOSIT FOR TRUST ACCOUNT 5.00 TOTAL (Also enter on Line 10, Recapitulation) I S 996 If more space is needed, insert add~6onal sheets of the same size. REV-1513 EX+(01-10) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ca i A i r ur: FILE NUMBER: CLARE G. TRecY cy JAL u fib RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Indude outs' ht spousal distributions and transfers under Sec. 91 f6 (a) (1.2).] 1. EDWARD J• TRACY, JR• Lineal 337.54 3017 SOUTH COURT WILLIAMSBURG, VA 23185 2• CLARE M. KOERNER Lineal 10,239.96 419 SPRING HOUSE ROAD CAMP HILL, PA 17011 3• JOHN T• TRACY Lineal 337.54 3783 WARES FERRY ROAD MONTGOMERY, AL 36109 4• MARIAN C• WILLAUER Lineal 337.54 43 QUINN LEA ROAD HARPERS FERRY, WV 25425 5• BERNADETTE MOWAD Lineal 337.54 150 BICKERSTAFF ROAD CLEMMONS, NC 27012 6• ANNE E- WILLAUER Lineal 337.54 4381 BRIDLE PATH LANE WINSTON SALEM, NC 27103 7• DOROTHY A• KOCHNER Lineal 337.54 6070 GREENHAVEN DRIVE WINSTON SALEM, NC 27103 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, S ~~ ~~~~~~ ~N~ ~~ ~ ~~~,, ~~C euunwnai snee[s or paper or [ne same size. 1 ~ ~tt~# tXl ~~ C`~es#~n~~ ~f CLARE TRACY I, Clare Tracy, of 4222 Nantucket Drive, Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking any and all prior wills and codicils thereto by me at any time heretofore made. FIRST I direct that all my just debts and the expenses of my last illness and funeral shall be paid from the assets of my estate as soon as practicable after my decease. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my grave. E ND I give and bequeath all automobiles, household effects and other tangible personal property, not including cash or securities, owned by me at my death, together with all policies of insurance thereon, in equal shares to my children, Edward Joseph Tracy of Buffanlo,~N-ew York; Clare Marie Koerner of Camp Hill, Pennsylvania; John ~" Clare Tracy Page 1 of 9 Thomas Tracy of Montgomery, Alabama; Marian Clare Willauer of West Virginia; Bernadette Mowad of Clemmons, North Carolina; Anne Elizabeth Willauer of Clemmons, North Carolina; and Dorothy Agnes Kochner of Central Islip, New York; as are living on the date of my death. In the event Edward Joseph Tracy is not living on the date of my death, I give and bequeath his share of my personal estate to Lee Ann Tracy. In the event any of my other children are not living on the date of my death, I give and bequeath their share to their children, per stirpes. Any item of personalty passing to a minor under this paragraph may be delivered to the minor or to any person to hold for the minor, as my Executor thinks advisable, and the receipt of any such person, including the minor, shall constitute a full and complete discharge to my Executor. THIRD I give, devise and bequeath the residue of my estate, of every nature and wherever situate, in equal shares to my children to be divided between or among them equally, share and share alike, the share of any deceased child to pass to his or her descendants, per stirpes. However, in the event Edward Joseph Tracy fails to survive me for whatever reason, his share shall pass to Lee Ann Tracy. ~i C-~~ Clare Tracy Page 2 of 9 FOURTH In the event any beneficiary who is entitled to a share of the residue under Item Third has not yet attained the age of twenty-three (23) years at the time for distribution to him or her, then I give, devise and bequeath the share of each such beneficiary to my trustee hereinafter named, IN TRUST, nevertheless, upon the following terms and conditions: A. The income and so much of the principal as may, in the sole discretion of my trustee, be necessary for the maintenance, support, medical expenses, and education of the beneficiary, shall be paid to the beneficiary or shall be applied directly for his or her benefit. B. Any income not so paid or applied shall be accumulated and added to such beneficiary's share of the trust estate. C. Any income and principal remaining in such beneficiary's share of the trust shall be distributed to such beneficiary when he or she attains the age of twenty-three (23) years. D. In the event any such beneficiary who has not yet attained the age of twenty-three (23} years at the time of my death dies before distribution of his or her entire principal share, then such share shall be distributed to such beneficiary's then living descendants, ~/ '~~ ~~/ Clare Tracy Page 3 of 9 per stirpes, absolutely; or in default of such descendants, it shall be distributed in accordance with Item Third of this Will. E. Any income or principal payable to a beneficiary under this Item Fourth may be accumulated or expended for the maintenance, support, medical expenses, or education of such beneficiary as the trustee, in his sole discretion, may determine. My trustee may, in his discretion, pay the said income or principal directly to the beneficiary, to the person having the care or control of such beneficiary, or to any institution entitled to such payment by reason of services rendered to or to be rendered to said beneficiary, without the intervention of a guardian. FIFTH All principal and income, until actual distribution to the beneficiaries, shall be free of the debts, contracts, assignments, alienations and anticipations of any beneficiary, and the same shall not be subject to any levy, attachment, execution or sequestration. ~-~' c', t-~ Clare Tracy Page 4 of 9 SIXTH I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expenses of the administration of the estate. SEVENTH My personal representative and trustee shall have the following powers in addition to those vested in them by law and by other provisions of this Will: A. To retain any or all assets of my estate, real or personal, without regard to any principle of diversification, risk or productivity. B. To invest in all forms of property as my fiduciary may deem proper, without regard to any principle of diversification, risk or productivity. C. To purchase investments at a premium or discount. D. To exercise all rights of a security holder or shareholder in any corporation; to give proxies; to join in any merger, consolidation, reorganization, voting trust plan, or other concerted action of security holders; and to delegate discretionary duties with respect thereto. E. To sell at public or private sale, to exchange or to lease, for any period of time, any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. Clare Tracy ~~~~ Page 5 of 9 F. To allocate receipts and expenses to principal or income, or partly to each. G. To borrow money and to mortgage or pledge any real or personal property as security therefore, in their sole discretion. H. To compromise any claim or controversy without order of court or consent of any beneficiary. I. To exercise any option, right or privilege granted in insurance policies or arising from ownership of investments. J. To permit my minor to occupy any real estate retained or acquired upon such terms and conditions as my trustee may deem proper. K. To make any distribution herein provided for in cash, in kind, or partly in each, at valuations fixed by my personal representative or trustee at the time of distribution. L. My fiduciary may, in his or her sole discretion, donate any part or all of my tangible personal property to any charitable organization(s) which would benefit from such donation. My fiduciary is then instructed to use the value of said donation(s) as a tax deduction for any inheritance tax return which may be required to be filed as a consequence of my death. •-~ , Clare Tracy Page6of9 EIGHTH I appoint Clare M. Koerner of Camp Hill, Pennsylvania as Executrix, of this, my Last Will and Testament. Should Clare M. Koerner, predecease me or for any reason fail to qualify as such Executrix, or having qualified, fail to serve as such Executrix, then I nominate, constitute and appoint Bernadette Mowad of Clemmons, North Carolina, Executrix of this My Last Will and Testament. NINTH I appoint Clare M. Koerner of Camp Hill, Pennsylvania as trustee of the trusts created under this Will. If the aforesaid Clare M. Koerner is unable or unwi]].ing to act or to continue to actin that capacity, then I appoint Bernadette Mowad, of Clemmons, North Carolina, as trustee of the trusts created under this Will. TENTH My Executrix and Trustee shall not be required to post security in any jurisdiction. Clare Tracy Page 7 of 9 IN WITNESS WHEREOF, I have hereunto set my hand anal seal to this, my Last Will and Testament, consisting of nine (9) typewritten pages, the first seven (7) of which bear my initials in the margin for the purpose of identification, this 13th day of November, 1996. `/ l Clare Tracy, Testatrix Signed, sealed, published and declared by the above-named Testatrix, Clare Tracy, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~ ~ Address ~-3~~ ,~I,t-lf~- ~~ ~ ~~,1,~", ~~L~l s` ~, `..~ / .~ ~ ,.~. ( ~--- Address , =:' -~ ~ j2-1 ~(, z- t/_ ~_ ,~~~_ ~~ ,; .. ~` , Page 8 of 9 COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ~ I, CLARE TRACY, THE TESTATRIX, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TESTAMENT; THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED. SWORN OR AFFIRMED TO AND ACKNOWLEDGED BEFORE ME BY CLARE TRACY, THE TESTATRIX THIS 13TH DAY OF NOVEMBER, 1996. ~; Clare Tracy, Tes#atrix O~ Notary P is COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND NOTARIAL SFAI,. RHONDA L. WOODS, Notary Public SS: ~ Hill 13oro. Cumberland County My Commission Expires Sept 1,1997 Member, Penmty+wania a--~,~;,,,:,,, e! Notaries ~' ~ ~ ~ - k1'',i AND /~~~ C=-vt~-s c: ,.~ % ~ G.(? mac`.' ~~~, L~ THE WITr~WHOS AMES ARE SIGNED TOT HE FOREGOING INSTRUMENT, BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT AND SAW THE AFORESAID TESTATRIX SIGN AND EXECUTE THE INSTRUMENT AS HER LAST WILL AND TESTAMENT; THAT SHE SIGNED WILLINGLY AND THAT SHE EXECUTED IT AS HER FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT EACH OF US IN THE HEARING AND SIGHT OF THE TESTATRIX SIGNED THE WILL AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT THE TIME EIGHTEEN (18) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE. SWORN OR AFFIRMED TO AND SUBSCRIBED TO BEFORE ME, THIS 13TH DAY OF NOVEMBER, 1996. F ~ _L~` "~itnet°ss ~, Witness RHONDA L. WOODS, Notary Public Camp Hill 8oro. Cumberland County My Commission Expires Sept. 1, 1997 Page 9 of 9 of tl! 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