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Home My WebLink About07-02-121505610140 REV-1500 EX `°'-'°' PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO Box 2sosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 1 0 4 4 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 4 6 4 2 4 9 5 4 9 0 4 0 2 2 0 1 1 0 5 0 5 1 9 2 3 Decedent's Last Name Suffix Decedent's First Name MI B U R L E S O N R O B E R T L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate 0 6. Decedent Died Testate (Attach Copy of WiII) 9. Litigation Proceeds Received Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust 0 (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) MI 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name 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 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 P A 1 7 0 1 1 r~.> --- ------ REGISTER Q9WILLS US - ~-'-i - E t~Y - 'T-f - -- C T r ~ , , ~ `~ J j F ` ~ - '~ ' I,~J ` ~n ~..~ DA~ FILED N ~n~r1 ---- -- -_ ~. _ _ +. Correspondent's a-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 com lete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P 9N RE;a~O _ LE Fq~ FILING RETU _ _J DATE ADDRESS ~ 497 WO DCREST DRIVE MECHANICSBURG PA 17050 SIGNATUR OF PREPARE THER THAN REPRESENTATIVE DATE ~~~.~_ - ,~~_z ~/~ z 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: ROBERT L• BURLESON 4 6 4 2 4 9 5 4 9 RECAPITULATION ~~SOO.Do ........................................... 1. Real Estate (Schedule A) 1 2. Stocks and Bonds (Schedule B) ...................................... 2. 1 1 3 7 8 . 6 4 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .................... .... .. 4. 1 1 2 1 4 7 4 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .... .. 5. . 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 1 6 9 9 6 5 1 6 (Schedule G) ^ Separate Billing Requested . .... .. 7. . 8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. 2 7 0 D 5 8 • 5 4 9. Funeral Expenses and Administrative Costs (Schedule H) ............ .... .. 9• 2 9 3 0 . 5 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 8 5 1 8 . 7 9 11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 1 1 4 4 9 . 2 9 12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. 2 5 8 6 0 9 . 2 5 13. Charitable and Governmental Bequests/Sec 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. 2 5 8 6 D 9 . 2 5 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 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 2 5 8 6 0 9. 2 5 16. 1 1 6 3 7. 4 2 17. Amount of Line 14 taxable 0 0 0 17 0 0 0 . at sibling rate X .12 . . 18. Amount of Line 14 taxable D O D 0 O D at collateral rate X .15 18. . 19. TAX DUE ............................................... ..... ..19. 1 1 6 3 7• 4 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q Side 2 1505610240 150561D240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 11 0444 DECEDENT'S NAME ROBERT L• BURLESON __ _ _ __ STREET ADDRESS 3755 SULLIVAN STREET CITY STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: ~ • Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 10 , 7 0 0.0 0 B. Discount 563.14 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 2, Line 20 to request a refund. 5. If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 11,637.42 TotalCredits(A+g) (2) 11,263.14 (5) Make check payable to: REGISTER OF WILLS, AGENT (3) (4) 0.00 374.28 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 ................................................................................................ ^ ^X d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3. Did decedent own an "intrust for" or payable-upon-death bank account or security at his or her death? ......... ^ Q 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 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 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, undE 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 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: SCHEDULE A REAL ESTATE FILE NUMBER: ROBERT L- BURLESON 21 11 0444 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 property 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 3755 SULLIVAN STREET, MECHANICSBURG, PENNSYLVANIA - DECEDENT 77,500.00 OWNS AN UNDIVIDED ONE-HALF INTEREST IN THE REAL ESTATE (COPY OF DEED ATTACHED AND APPRAISAL WITH DATE OF DEATH VALUE) APPRAISED VALUE AS OF 4/2/11 IS X155,000.00 DECEDENT ONE-HALF INTEREST IS $77,500 TOTAL (Also enter on Line 1, Recapitulation.) ~ $ 77, If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT L• BURLESON 21 11 0444 All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 182 SHARES OF PRUDENTIAL COMMON STOCK 11,378.64 TOTAL (Also enter on line 2, Recapitulation) ~ $ 11, (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, 8~ MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: ROBERT L• BURLESON 21 11 0444 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M & T BANK - CHECKING ACCOUNT X18707696 9,429.61 2• 1992 FORD TOPAZ 200.00 3• PERSONAL PROPERTY 1,500.00 4• BOWLES ENERGY REFUND 85.13 TOTAL (Also enter on Line 5, Recapitulation) I $ 11, 214.7 4 If more space is needed, insert 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 ROBERT L• BURLESON 21 11 0444 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 NUMBER DESCRIPTION OF PROPERTY INCLUDETHE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH ACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IiFAa~ICne~E) TAXABLE VALUE 1. AMERICAN UNITED LIFE INSURANCE CO• - ANNUITY 169,965.16 50.00 84,982.58 1/2 TO ERIC L• BURLESON - GRANDSON 2• AMERICAN UNITED LIFE INSURANCE CO• - ANNUITY 169,965.16 5D•OU 84,982.58 1/2 TO ALAN J• BURLESON - GRANDSON TOTAL (Also enter on Line 7, Recapitulation) I $ 16 9 , 9 6 5.16 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 ESTATE OF FILE NUMBER ROBERT L• BURLESON 21 11 0444 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. SULLIVAN FUNERAL HOME B. 2. 3. 4. 5. 6. 7 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State Year(s) Commission Paid: AttomeyFees: REAGER & ADLER, PC Family Exemption: (If decedent's address is not the same as claimants, attach explanation.) Claimant Street Address City State _ Relationship of Claimant to Decedent Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS Accountant Fees: Tax Retum Preparer Fees: ZIP ZIP 45.00 2,600.00 285.50 TOTAL (Also enter on Line 9, Recapitulation) I $ 2 , 930.50 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, H~ LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT L• BURLESON 21 11 0444 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. MANOR CARE - NURSING HOME 5,008.32 2• PP & L - ELECTRIC 122.84 3• EAST PENNSBORO TOWNSHIP - TRASH 232.50 4• VERIZON - PHONE 91.71 5• DEBBIE LUPOLD - TREASURER - REAL ESTATE TAXES 1,164.42 6• HEARTLAND PHARMACY OF PA - MEDICATION 8.00 7• EAST PENNSBORO - AMBULANCE 42.00 8• RE/MAX - APPRAISAL 325.00 9• BILL FENICLE/JOHN ALFORD - LAWN MAINTENANCE 825.00 10• NATIONWIDE INSURANCE - HOMEOWNER'S INSURANCE 699.00 TOTAL (Also enter on Line 10, Recapitulation) I $ 8 , 518.7 9 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE I BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ROBERT L• BURLESON 21 11 0444 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 [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. ERIC L• BURLESON Lineal 129,304.63 1727 CHALCEDONY STREET, APT• #18 SAN DIEGO, CA 92109 2• ALAN J• BURLESON Lineal 129,304.62 120 PROWELL DRIVE CAMP HILL, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 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, use additional sheets of paper of the same size. Evaluation Only. Created with Aspose.Words. Copyright 2003-2010 Aspose Pty Ltd. LAST WILL AND TESTAMENT OF ROBERT L. BURLESON I, Robert L. Burleson, a resident of Mechanicsburg, Pennsylvania declare this to be my Last Will and revoke all former Wills and Codicils. ARTICLE I Identification of Family At the present time I am unmarried. In making this Will I have in mind my children, Robert E. Burleson, born 1944, and John E. Burleson, born 1949, but does not include any children hereafter born to or adopted by me. Any reference to a "child of mine" or "my children" shall include the persons named or referred to in this Article. A. Disinheritance Provision. I, intentionally and with full knowledge of the consequences, disinherit and omit any provision in my Will for the following children: my son, Robert E: Burleson, and my son, John E. Burleson. Further, I intend that this disinheritance specifically defeat the application of any statutory heirship interest or any reference to child, children, descendants, heirs, or issue, in this Will, with respec~~hese children. =ate n-rn _.~ ,~ r-- ~r> `_ =:7 ~' ~~' ARTICLE II ~=~ -- - -~~~ Appointment of Fiduciaries '' ~ `` ~'~' -, c ~- .~ ~ --i A. Appointment of Personal Representative. I appoint my son, Join E. Burleson, as Executor of my estate. If John E. Burleson is or becomes unable or unwilling to serve, I appoint my daughter-in-law, Karen L. Burleson as alternate Executor. B. Bond; Court Supervision. My Executor shall have the right to serve without bond and to administer and settle my estate without the intervention or supervision of any court, except to the extent required by law. Nothing herein shall prevent my Executor from seeking the assistance of the court in any situation where my Executor deems it appropriate. ARTICLE III Disposition of Residue 1. Provision for Others. I give 50% of the rest and residue of my estate, wherever located (hereafter referred to in this Article as "residue"), to my Will of Robert L. Burleson Page 1 of 6 Initials: {? 1 ~ Date: ~ 0 :~ -r-: ; -~ `. ,i_i ~ ~=,- '= -.~ - ~ -- --, _ _.._ -~=; .. ,_ ;, grandson, Eric L. Burleson. I give 50% of the residue to my grandson, Alan J. Burleson. If my grandson, Eric L. Burleson does not survive me then I give all of his 50% of the residue to my grandson, Alan J. Burleson. If my grandson, Alan J. Burleson does not survive me then I give all of his 50% of the residue to my grandson, Eric L. Burleson. If I am not survived by any party named in this provision, I give the entire residue to my heirs. ARTICLE IV Alternative Methods of Distribution A. Purpose of Article. Recognizing that under certain circumstances the terms of this Will may direct that property be distributed outright to a person who is under age twenty-one (21) or under a legal disability; I make the following provisions to facilitate the distribution of property to such persons. B. Alternative Methods. Whenever the terms of this Will direct my personal representative (referred to in this Article as the "fiduciary") to distribute properly outright to a person who is then under age twenty-one (21) or under a legal disability, the fiduciary may retain pursuant to Paragraph C. of this Article or distribute all or any portion of that property in any one or more of the following ways: 1. Delivery directly to the beneficiary; 2. Delivery to the parent or stepparent of the beneficiary; 3. Delivery to the guardian of the beneficiary's person or property; 4. Delivery to any Custodian for the beneficiary under the Uniform Gifts to Minors Act; 5. Delivery to any then existing trust created for the beneficiary; 6. Deposit in a financial institution in an account established in the name of the beneficiary alone pursuant to the laws of the State of Pennsylvania; 7. Storage of any tangible personal property in safekeeping with the costs of storage to be borne by the beneficiary; or 8. Sale of any tangible personal property and delivery of the proceeds in any manner permitted by this Article. Provided the fiduciary acts in good faith, upon delivery of any property in accordance with the provisions of this Article, the fiduciary shall be discharged from all responsibilities in connection with the property. Will of Robert L. Burleson Page 2 of 6 Initials: Date: ~~ ~ ~O C. Discretionary Trust. Any property not distributed as provided in Paragraph B. of this Article shall be retained by the fiduciary in trust for the beneficiary on the following terms and conditions: During any period in which the beneficiary is under a legal disability or under twenty-one (21) years of age, the fiduciary shall pay to or apply for the benefit of the beneficiary so much of the income and principal of the trust as the fiduciary, in its sole and absolute discretion, determines is advisable for the beneficiary's health, support, education and general welfare. At such time as the beneficiary is neither under a legal disability nor under age twenty-one (21), the fiduciary shall distribute any remaining trust assets to the beneficiary. If the beneficiary dies before all of the trust assets have been distributed, the fiduciary shall distribute any remaining trust assets to the beneficiary's estate. ARTICLE V Administrative Provisions A. Powers and Duties of Personal Representative. My personal representative shall have all of the powers and duties granted to or imposed upon personal representatives serving with non-intervention powers pursuant to the laws of the State of Pennsylvania. B. Debts and Ezpenses. All expenses of administration chargeable to principal, the expenses of the disposition of my remains, and all my legitimate debts, if and when paid, shall be paid from the principal of my residuary estate. No debt need be paid prior to its maturity in due course and except as otherwise provided in this Will no interest in any property passing under this Will need be exonerated. C. Tazes. All estate, inheritance or other similar death taxes, together with any interest or penalties thereon, arising by reason of my death with respect to any property includable in my taxable estate, and any adjusted taxable gifts, whether passing under or outside of this Will, shall be paid from the principal of my residuary estate without reimbursement from the recipients or beneficiaries of such property, provided, however, that in the event any proceeds of insurance upon my life or any property over which I held a power of appointment are included in my estate for purposes of determining the federal estate tax liability of my estate, then the residue of my estate shall be entitled to receive from the recipients of any such proceeds or property the portion of such federal estate tax liability attributable to such proceeds or property determined in accordance with IRC § § 2206 and 2207. ARTICLE VI Miscellaneous Will of Robert L. Burleson Page 3 of 6 Initials: ~ >; Date: ~~ A. Number and Gender. Unless the context indicates a contrary intent, the plural and singular forms of words shall each include the other, and every noun and pronoun shall have a meaning that includes the masculine, feminine and neuter genders. B. Survival. To "survive" me, as that term is used in this Will, a person must continue to live for thirty (30) days after my death. C. Descendants. The "descendants" of an individual include only the following: 1. All such individual's biological descendants, except any person not born in lawful wedlock and his descendants, unless the biological parent who would otherwise cause him or her to be a descendant has acknowledged paternity or maternity in legitimation proceedings, or in an unambiguous signed writing identifying such person by name, or by raising such person in the same household; and 2. Persons adopted by such individual or one of his or her descendants, and their descendants. If the parent, who would cause a person to be a descendant as defined above, is replaced in an adoption proceeding, such person shall remain a descendant unless such parent voluntarily consents to the relinquishment of his or her status as parent in connection with such adoption proceedings. D. Heirs. The term "heirs" shall mean those persons entitled to inherit under the then-applicable laws of the State of Pennsylvania governing the descent of an intestate's separate estate. They shall inherit in their statutory proportions. E. Exclusion of Pretermitted Heirs. Other than as set forth in this Will, I make no provision for any child of mine or descendant of a deceased child of mine. I specifically make no provision for any person (whether now living or hereafter born), other than a child named or referred to in Article I or a descendant of mine as defined in this Will, who may be entitled to claim an interest in my estate under the laws of the State of Pennsylvania. F. Legal Disability. A person is under a legal disability if my personal representative determines, in good faith, that the person is incapable of managing his property or of caring for himself, or both, or is in need of protection or assistance by reason of physical injury or illness, mental illness, developmental disability, senility, alcoholism, excessive use of drugs, or other physical or mental incapacity. G. Title to Real Property. Upon my death, title to any real property passing under this Will shall vest in my personal representative in his fiduciary capacity and shall Will of Robert L. Burleson Page 4 of 6 Initialtsq~. ~~ Date: ~~ ~ ~v remain so vested until my personal representative distributes or sells that property, at which time title shall vest in the distributee or purchaser. H. Disclaimer. Except as may be otherwise specifically provided in this Will, in the event that any beneficiary disclaims an interest arising out of this Will or any trust created herein it is my intention that the interest disclaimed shall be distributed in the same manner and at the same time as if the disclaiming beneficiary had died immediately preceding the event pursuant to the laws of the State of Pennsylvania. I. Governing Law. The provisions of this Will shall be interpreted in accordance with and in light of the laws of the State of Pennsylvania. J. Corporate Successors. Whenever a corporation or other business entity is referred to herein, the reference shall include any successor organization. K. References to Statutes. In this Will, the abbreviation "IRC" shall refer to the Internal Revenue Code of 1986 as amended. Will of Robert L. Burleson Page 5 of 6 Initials: ~' ~e Date: ~~ I have initialed and dated for identification purposes all pages of this,~y Last - ~ill, and have executed the entire instrument by signing this page on tha~'~ day of Nv ~~ ~~ 20 /U at /f~~~(C~~o ,Pennsylvania. Robert L. Burleson Attestation and Statement of Witnesses Each of us declares under penalty of perjury under the laws of Pennsylvania that Robert L. Burleson, the Testator, signed this instrument as his Last Will in our presence, all of us being present at the same time, and we now, at the Testator's request, in the Testator's presence, and in the presence of each other, sign below as the witnesses, declaring that the Testator appears to be of sound mind and under no duress, fraud, or undue influence. ,~~ u ~ \ ' [ fitness Signature] [Print Name] J [Witn ignature] rl(' -~~~I ~~ ~ISc~ [Print Name] Residing at ~~ ~,~, ~ ~~, C; ~ J~, Residing at ~ ~ ~ Will of Robert L. Burleson Page 6 of 6 Initials: ~~~ Date: ~ ~ ~ ~ SELF-PROVING AFFIDAVIT STATE OF PENNSYLVANIA } COUNTY OF b ~~ f ~~ ~ ~ J } ss. } I, the undersigned, an officer authorized to administer oaths, certify that Robert L. Burleson, the Testator, and /~d~'~''/ f L•0/1!j/ S ____/-j F6~99i1~.sG/1~5o/t~ and the witnesses, whose names are signed to the attached or foregoing instrument and whose signatures appear below, having appeared together before me and having been first duly sworn, each then declared to me that: 1) the attached or foregoing instrument is the last will of the Testator; 2) the Testator willingly and voluntarily declared, signed and executed the will in the presence of the witnesses; 3) the witnesses signed the will upon request by the Testator, in the presence and hearing of the Testator, and in the presence of each other; 4) to the best knowledge of each witness the Testator was, at that time of the signing, of the age of majority (or otherwise legally competent to make a will), of sound mind and memory, and under no constraint or undue influence; and 5) each witness was and is competent and of the proper age to witness a will. .~ [Witness Signature] ~~ {7 l~ ~ ~~rrir- r ~ [Pnnt Name] ~- ~~ Robert L. Burleson [Witness i a e] Ns~l Tint Name] ~- Residing at ~ ~; ~i ~ ~;,~;,.,,,,_f ~iT Residing at 2 ~ ~~ ~ L Section for Notary Public: Subscribed, sworn and acknowledged before me by the said Robert L. Burleson, Testator, and by the said L3~~n r~cc ~ . C~,--,..,-~ ,and ~. /)'1~~~ ~ ~ + n ~ ~ -, ,witnesses, this ~ day of. (~ ~ , ,201 ~; . [S~gnature ofN~ otary] ----1 \( ~t\'C\E~=~. ~ ^'~-~~ ~~t~tl ~ 1. ~°_ [Print or stamp name of Notary] COMMONWEALTH OF PENNSYLVANIA No~Nal Seal Donna B. Hummer, Notary Pubik CRY of Harttsburg, Dauphin County rb' Commission Expires June 10, 2014 Member, Pennsylvania Assodation of Notaries