HomeMy WebLinkAbout09-04-12J 1505610140
REV'-1500 ~` ~°'-'°~
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN County Code Year File NumtKrr
Harrisbu PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 7 6 9
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY
Date of Girth MMDDYYYY
1 2 2 4 2 0 1 0 1 1 1 5 1 9 3 9
Decedent's Last Name
Suffix Decedent's First Name
0 T T MI
M A R I 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
FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS
0 1. Original Return ~ 2. Supplemental Return
3
R
i
4. Limited Estate
~
4a
F
t .
ema
nder Return (date of death
prior to 12-13-82)
[]X 6. Decedent Died Testate
~ .
u
ure Interest Compromise (date of
death after 12-12-82)
7
D ~ 5. Federal Estate Tax Return Required
(Attach Copy of Wlll)
9. Litigation Proceeds R
i .
ecedent Maintained a Livin Trust
(Attach Copy of Trust) 9
~ 8. Total Number of Safe Deposit Boxes
ece
ved ~ 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
~ 11 • Election to tax under Sec. 9113(A)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX NFO
Name
RMATION SHOULD BE DIRECTED T0:
G E R A L D J S H
E
K L E T Daytime Telephone Number
S K I E S Q 7 1 7 7 7 4 7 4 3 5
First line of address
4 1 4 B R I D G E S T
Second line of address
P 0 B O X E
City or Post Office
N E W C U M B E R L A N D
REGISTER gF~VILLS USE 0
r,, :x-
--, .:_~
~~ ~-- ~_}
State ZIP Code ___ __ D FILED ~'~ -- ' '~
`~
P A 1 7 0 7 0
Correspondent's a-mail a,tdress: G S H E K L E T S K I a S T O N E L A W• N E T
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.
IGNATURE OF PERS IBLE FOR FILING RETURN pp
ADDRESS ~ ~T
'1ARIE E NENNINGER, 227E EASANT VIEW RD•, HALIFAX PA /17032
iIGNAT E
ATIVF
GERALD J vSHEKLETSKI ESQ• 414 BRIDGE ST., NEW
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140
i`.
UMBERLAND PA_17070
1505610140
J 1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: MARIE E• O T T
RECAPITULATION
1 . Real Estate (Schedule A) ........
.............................. ..... 1.
•
2. Stocks and Bonds Schedule B
( ) ......
........................... ..... 2.
•
3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C) ..... 3.
•
4. Mortgages and Notes Receivable (Schedule D) .
.................... .
.... 4. •
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).. ..... 5. 1 1 5 4 0 • 0 4
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested
7. ...
Inter-Vivos Transfers ~ Miscellaneous N n-Probate Property
(Schedule G) ~ Se
ar
t
Bi .... 6.
•
p
a
e
lling Requested ... .... 7.
•
8. Total Gross Assets (total Lines 1 through 7)
.... • • , • , , ..
••••~••••.. .... 8. 1 1 5 4 0. 0 4
9. Funeral Expenses and Administrative Costs (Schedule H) ..... .
~•~•••••
~••• 9• 6 0 5 5. 9 6
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... , . , • , , • 10
•
11. Total Deductions (total Lines 9 and 10) ..
......................... .... 11.
6 0 5 5. 9 6
12. Net Value of Estate (Line 8 minus Line 11)
13. ............ .
Charitable and Governmental Bequests/Sec 9113 Trusts for which
12 5 4 8 4 . p $
an election to tax has not been made (Schedule J) ... , .. • • • . 13
14. Net Value SubJect to Tax (Line 12 minus Line 13 •
.
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLIC ............
..
ABLE RATES
....
..
.1a. 5 4 8 4. 0 8
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 .
0 .
0
0
at lineal rate X .045 5 4 8 4. 0 8
17. Amount of Line 14 taxable 16' 2 4 6 . 7 $
at sibling rate X .12 ~ ~ 0 0
18. Amount of Line 14 taxable 1 ~~ 0 • 0 0
at collateral rate X .15 0 ~ 0 0
18. 0 • 0 0
19. TAX DUE .........
......................... .............. ..... .19.
2 4 6.
7
8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
D
Side 2
L 1505610240
1505610240 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
MARIE E• OTT __
STREET ADDRESS - - --
1.700_ MARKET ST •
------------
ciTY
CAMP HILL
Tax Payments and Credits:
~~ Tax Due (Page 2, Une 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
File Number
21 12 0769
STATE ~ZiP
PA X17011
(1) 246.78
Total Credits (A + g) (2) 0 • 0 0
4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. (3) 12 • 51
Fill in oval on Page 2, Line 20 to request a refund.
(4) 0.0 0
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5) 259.29
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:
a. retain the use or income of the property transferred; Yes No
b. retain the right to designate who shall use the property transferred or its income; ............................... Q
c. retain a reversionary interest; or ......................................
d. receive the prdmise 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? a
............. ^ X
3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .........
4. Did decedent own an individual retirement account, annuity or other non-probate property, which D
contains a beneficiary designation? .................................................................................................. ^ 0
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 survivin s
3 percent [72 P.S. §9116 (a) (1.1) (i)j, g pouse
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-1508 EX+ (11-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHE1~tJLE E
CASH, BANK DEPOSITS, 8 MISC.
PERSONAL PROPERTY
w~r~rc Vr:
MARIE E • 0 T T FILE NUMBER:
21 12 076`
Indude 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
NUMBER DESCRIPTION
~• METRO BANK CHECKING ACCOUNT 536279029
2• METRO BANK SAVINGS ACCOUNT 626193932
TOTAL (Also enter on Line 5, Recapitulation) S
If more space is needed, insert additional sheets of paper of the same size
VALUE AT DATE
OF DEATH
11,437.06
102.98
,540.04
RE•V-1511 EX+ (10-09)
pennsylVania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
MARIE. E• OT
SCHEDULE H
FUNERAL EXPENSES AND
ADA~AIISTRATIVE COSTS
i .
FILE
21
0769
.L C
DeCedeM's debts must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
A• FUNERAL EXPENSES:
~• DAILEY FUNERAL HOME
652 S• 28TH ST., HARRISBURG, PA
• ADMINISTRATIVE COSTS:
~ • Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
State Zip
Year(s) Commission Paid:
I
2. AttomeyFees: GERALD J• SHEKLETSKI, ESQ.
3, Fam11y Exemption: (If decedents address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City
State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: LETTERS TESTAMENTARY
5• Accountant Fees:
6• Tax Retum Preparer Fees:
7• CUMBERLAND LAW JOURNAL - LEGAL ADVERTISING
8• UPPER DAUPHIN SENTINEL - LEGAL ADVERTISING
9• MANOR CARE, CAMP HILL
10• ADS - PORTABLE ULTRASOUND
11. FERENSIUS MEDICAL CARE NORTH AMERICA
Z2• FILING FEE - INHERITANCE TAX RETURN
13• FILING FEE - INVENTORY
If more space is needed use addi8onal sheets of paper of the same size.
TOTAL (Also enter on Line 9, Recapitulation) I ;
AMOUNT
2,635.00
1,000.00
1D7.50
75.OD
60.50
1,089.20
5.94
1,052.82
Z5•DO
15.00
6, 055
REV-1513 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE)
BENEFICIARIES
-~~n~cvr:
MARIE E . 0 T T
FH.E NUMBER:
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 21 12
RELATIONSHIP TO DECEDENT 0769
AMOUNT OR SHARE
j, TAXABLE DISTRIBUTIONS [Indude ought spousal distributions and transfers under
Sec. 91 6 (a) (1.2)
j Do Not List Trustee(s) OF ESTATE
1. .
JENNIFER HENKEL BRUENING
132 EAST PLAINS AVENUE
CLOVIS, NM 88101 Lineal 457.01
2• DANIEL T. BERDEL
3808 SERENE WAY Lineal
LYNNWOOD, WA 9808? 457.01
3• JEFFREY W. BERDEL
173 APT. H WEST VINE ST•
SHIREMANSTOWN Lineal 457.01
4• , PA 17011
NICK MACY
583 ATWOOD COURT Lineal
NEWTOWN, PA 18940 457.01
5• DEREK OTT
100 GREENWOOD DRIVE Lineal
NEW CUMBERLAND, PA 17070 457.01
6• KEITH GREISSER
411 WESTDALE PLACE Lineal
GREENSBORO, NC 27403 457.01
7• KATELYN GREISSER
18 MOUNTAIN AVENUE Lineal
FLANDERS, NJ 07836 457.01
II ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T
N HROUGH
. ON-TAXABLE DISTRIBUTIONS:
18 OF REV-1500 COVER SHEET, AS APPROPRIATE
1.
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX .
IS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER CNFGr
~~ ~~~uie space Is needed, use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
MARIE E. OTT
Decedent's Name 21 12 0769
Page 1
File Number
Schedule J -Beneficiaries -1
NUMBER NAME AND ADDRESS OF PERSON S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
i TAXABLE DISTRIBUTIONS [Include outs' ht s usal distributions and transfers under
Sec. 91 i6 (a~1
2)
) Do Not List Trustee(s) OF ESTATE
8• .
.
STEVEN OTT
100 GREENWOOD DRIVE Lineal 457.01
NEW CUMBERLAND, PA 17070
9. WILLIAM OTT IV
852 WEST 2ND ST. Lineal 457.00
LANSDALE, PA 19446
10 WILLIAM OTT
100 GREENWOOD DRIVE Lineal 457.00
NEW CUMBERLAND, PA 17070
11 JASON OTT
100 GREENWOOD DRIVE Lineal 457.00
NEW CUMBERLAND, PA 17070
12 JULIA OTT
31 N. PENN AVENUE Lineal 457.00
ROCKLEDGE, PA 19046
JL.aL`~1~~ 'y `Y ~L~.S ~l y Jl~ ! ~~~C'~1Y1~.L y 1
'~~
~l[~~~~ ~. ~O .~l ~`
I, MARIE E. OTT, having my legal residence at 515 Market Street, New Cumberland,
Cumberland County, Commonwealth of Pennsylvania, do hereby declare this to be my Last Will
and Testament, revoking all other Wills and Codicils heretofore made by me.
I declare that I am widowed and that the following persons are my natural born children:
Marie Berdel; Linda Greisser; Joseph Ott; Francis Ott; and William Ott III. The following
persons are my step-daughters, and were raised as if my natural born children: Carol 1-Ienkel and
Debora Macy. The following persons are not biologically or legally related to me but were raised
by me as if my natural born children: Grace Kim; Christine Kim and Boaz Kim. The previously
mentioned ten persons shall be included per capita by any reference hereinafter to my `•Children."
All references to my children shall include all of the above ten persons without regard to their
biological or legal relation to myself.'
ITEM ONE: I direct that all my valid debts and the expenses of my last illness and
funeral be paid from my estate as soon as practicable after my death.
ITEM TWO: I give and bequeath all of my tangible personal property to my
residuary heirs under Item Four, below as follows:
A. All items of tangible personal property shall be inventoried and valued at a fair
market value.
B. There are two separate items of personal property that I wish to bequeath specifically
as follows:
1. I give one of Grandma Ott's vases with flowers to my daughter Marie Berdel.
2. I give the other one of Grandma Ott's vases with flowers to my daughter, Debora
Ott.
C. I may leave a Memorandum listing some of the items of my tangible personal
property which I wish certain persons to have and request that my wishes as set Forth
in the memorandum be observed by my Personal Representative. I suggest but do not
require that any items of tangible personal property not so designated shall be divided
and distributed among my Children as follows:
1. Each of my Children may select one item, in rotation, in order determined by lot,
until such time as my Children wish to make no further selections.
2. Any items not selected shall be sold and the net proceeds added to the residue of
my estate.
3. To the extent my Children are unable to agree, the decision as to what may
constitute "one item" for purposes of this selection shall be made by my Personal
Representative(s).
4. Any disputes concerning this method of allocation shall be resolved by my
Personal Representative(s) in my Personal Representative's sole discretion.
5. To the extent my Personal Representative is unable to resolve a dispute among
two or more of my Children concerning the in-kind distribution of any of my
personal property, I direct my Personal Representative to sell the disputed
property and the net proceeds there from be added to the residue of my estate.
ITEM THREE: I direct that my Personal Representative shall sell any interest in any
real property I may own, and the net proceeds or insurance therefrom be added to the residue of
my estate and distributed to my grandchildren under Item Four, below.
ITEM FOUR: I give, bequeath and devise all the residue of my estaie, of whatsoever
nature and wheresoever situate, to the children of my Children, as defined above, who are:
Jennifer Henkel, Daniel T. Berdel, Jeffrey W. Berdel. Nick Macy, Derek Ott, Keith Greisser,
2
Katelyn Greisser, Steven Ott, William Ott IV, William Ott, Jason Ott, Julia Ott, and not any after
born children of my Children as defined above (heicinafter referred to individually as Grandchild
and collectively as "Grandchildren's in equal shares pro rata. It is my specific intention to not
include my natural born, step or otherwise described. Children under this Will not for any lack of
love or affection, but because it is my intention to provide for my above-described Grandchildren
in their stead. It is also my specific intention to include only those Grandchildren who are
hereinabove named, and to not include any children of my Children who have not yet been born
or adopted by my Children.
ITEM FIVE: Should any Grandchild of mine be under the age of eighteen (18)
years, my Persona! Representative shall give such Grandchild's share of my estate to the one of
my Children who is the parent of the Grandchild to invest and reinvest on behalf of the
Grandchild until the Grandchild reaches the. age of eighteen (18), at which time the Grandchild
shall have use of the principal and investment income therefrom. If any of my Children who is
the parent of one of my Grandchildren be under the age of eighteen (18) is unwilling or unable to
invest and reinvest on behalf of that Grandchild until the Grandchild reaches the age of eighteen
(18), then I would ask that my Personal Representative otherwise provide that function. All
shares of principal and income hereby given shall be free from anticipation, assignment, pledge or
obligation of my beneficiary(s), and shall not be subject to any execution or attachment.
ITEM SIX: I appoint, my daughter, Marie E. Berdel, Personal Representative of
this my Will. In the event Marie E. Berdel is unable or unwilling to act or continue to act as my
Personal Representative, Iappoint my daughter, Linda Greisser, my Personal Representative. In
the event Linda Greisser is unable ~ or unwilling to act or continue to act as my Personal
Representative, I appoint my daughter, Debora Macy, my Personal Representative.
ITEM SEVEN: No bond shall be required of any fiduciary hereunder in any jurisdiction.
No fiduciary hereunder shall have any liability for any mistake or error of judgment made in good
faith.
3
ITEM EIGHT: I authorize my Personal Representative(s) and Trustee(s) to exercise the
following powers in addition to those given bylaw, to be exercised in their sole discretion:
A. To retain any or all of the assets of my estate, without regard to any principle of
diversification, risk or productivity;
B. To invest in all forms of property without restriction to investments authorized for any
type of fiduciary;
C. To compromise any claim or controversy;
D. To loan money to or buy property from my estate;
E. To borrow money from any person, including any Executor or Trustee, and to mortgage
or pledge any real or personal property;
F. 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, all for such
prices and upon such terms and conditions as they deem proper,
G. To allocate receipts and expenses to principal or income or partly to each as they deem
proper,
H. To repair, alter or improve any real or personal property;
I. To distribute in cash or in kind or partly in each at valuations fixed by them;
J. To keep reasonable amounts of cash, in a bank utinvested if deemed advisable for the
protection of the principal;
K. To subscribe for or to exercise options for stocks, bonds or other investments; to join in
any plan of lease, mortgage, merger, consolidation, reorganization, foreclosure or voting
trust and to deposit securities thereunder, and to generally exercise all the rights of
security holders or employees of any corporation;
L. To register securities in the name of a nominee or in such manner that title shall pass by
delivery;
M. To add to the principal of any trust created by this instrument any real or personal
property received from any person by Deed, Will or in any other manner,
N. To exercise all power, authority and discretion given by this instrument after the
termination of any trust created herein until the same is fully distributed;
O. To use their sole discretion in deciding whether stock dividends on stock they hold in
trust should be apportioned to principal or income, except stock dividends of regulated
investment companies which shall be added to principal;
P. To commingle the assets of any trust estate created by this Will in any one or more
common funds for greater convenience and flexibility;
Q. To employ agents, accountants, engineers and such other persons, professional or
otherwise, as may be necessary for the proper administration of this estate or trust and to
pay their compensation from such funds; and
R. To disclaim all or any interest in a property passing to me or my estate.
4
ITEM NINE: I realize that Personal Representatives are given discretion by law to
make various elections which affect the income' and. estate taxes payable by estates and
beneficiaries, as well as the relative shares of beneficiaries, such as taking administration
expenses as deductions for either estate or income tax purposes, selecting options for the
payment of employee death benefits, electing to take a qualified terminable interest as part of the
marital deduction, selecting alternate valuation dates, postponing the payment of taxes, filing
joint income tax or gift tax returns and redeeming corporate stock. The decisions made by my
fiduciaries in any of these matters shall be binding upon, and not subject to question by, any
affected persons. I rely upon my fiduciaries to take into consideration the total income and estate
taxes payable by reason of their decisions including those payable by my survivors, and they are
authorized in their discretion, but not required, to make adjustments between income and
principal as a result thereof.
ITEM TEN: I direct.that all estate, inheritance and other taxes in the nature
thereof, together with any interest and penalties thereon, becoming payable because of my death
with respect to the property constituting my gross estate for death tax purposes, whether or not
such property passes under this my Last Will and Testament, shall be paid from the principal of
my residuary estate, and no person receiving or having a beneficial interest in any such property,
whether under this my Last Will and Testament or otherwise, shall at any time be required to
contribute to or refund any part thereof; PROVIDED, however, that this direction shall not apply
to the taxes on any property included in my estate solely because of a power of appointment
thereover which I possess but have not exercised or on any qualified terminable interest or to any
generation- skipping transfer taxes.
ITEM ELEVEN: If any beneficiary, person or entity in any manner, directly or
indirectly, contests or attacks this Will or any of its provisions, or objects to the accounts or actions
of my fiduciaries, without probable cause, such beneficiary, person or entity shall pay all costs,
including but not limited to attorneys fees, arising in connection with such contest, attack or
objection incurred by my estate, such trust or such fiduciary personally, In the event that such
5
beneficiary, person or entity does not prevail in such action, any shaze or interest in my estate or
such trust which would otherwise pass to such beneficiazy, person, entity or remainderman under
this Will shall be revoked and the property consisting of such share shall be disposed of in the
manner provided herein as if that contesting person or entity had predeceased be without surviving
issue.
ITEM TWELVE: Should any of the provisions of my Will be for any reason declared
invalid, such invalidity shall not affect any of the other provisions of this Will and all invalid
provisions shall be wholly disregarded in interpreting this Will.
ITEM THIRTEEN: This Will shall be construed, regulated and governed by and in
accordance with the laws of the Commonwealth of Pennsylvania
IN WITNESS WHEREOF, I have at Camp Hill, Pennsylvania, on October~0 , 2010,
set my hand and seal to this my Last Will and Testament consisting of six (6) pages plus any
witness, acknowledgement, affidavit and certification pages.
~~~ SEAL)
MARIE E. OTT
SIGNED, SEALED, PUBLISHED AND DECLARED BY MARIE E. OTT, the above named
Testatrix, as and for his Last Will and Testament, in the presence of us, who, at her request and
in her presence, and in the presence of each other, have hereunto subscribed our names as
witnesses.
~.~ ' ~.
Witness
~-1 F ~lea:~ View 12oad
Na.~~~a~r P~ 1032
Address
ess
G~.s~i/ ~',~
Address
6
SELF-PROVING-AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
. SS:
We, MARIE E. OTT, mQa'IP~ ~. L~irC~f
and ..~d~r1 ll) ~ RPf~ ,the Testatrix and the witnesses
respectively, whose names aze signed to the attached or foregoing instrument, being first duly
sworn, do hereby declaze to the undersigned authority that the Testatrix signed and executed the
instrument as her Last Will and Testament that she had signed willingly (or willingly directed
another to sign for her), and that she executed it as her free and voluntazy act for the purposes
therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix,
signed the Will as witness and that to the best of their knowledge the Testatrix was at that time
eighteen years of age or older, of sound mind and under no constraints or undue influence.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
MARIE E. OTT, Testatrix ~
0 r /QJZ.~.~t. C_ • D J1 ~•/
WITNESS
~_
TNESS
ss
On October ~~ , 2010, before me the undersigned officer, personally
appeazed ~ud ~D•NP~ Esquire (Pennsylvania Supreme Court ID No. ?7y It
known to me or satisfactorily proven to be a member of the baz of the highest court of
Pennsylvania and certified that he was personally present when the foregoing acknowledgement
and affidavit(s) were signed by CYfa.rte E. OC{, I'~1Qr~ E. l3c--dd and ~j.,,~ ~. R~,~
IN WITNESS WHEREOF, [hereunto set my hand and official seal.
C hQ~
Notary Public
NOTARUIL 8EAL
~ PAULA K YNNTE
Notur Pu01k
UPPER ALLEN TWF!, CUMAERLANO COUNTY
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND : SS:
I, ~~ E. OTT, the Testatrix whose name is signed to the attached or foregoing instrtunenti having
been duly qualified according to law, do hereby acknowledge that I signed and executed the instrumental
my Last Will, and that I signed it willingly and as my free and voluntary act for the purposes therein
expressed.
MARIEE. OTT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
On October o~ ~ , 2010, before me the undersigned officer, personally appeazed
0.U d ~. NP~-~ Esquire (Pennsylvania Supreme Court ID No.
satisfactorily proven to be a member of the bar of the highest court of Pennsylvati andlcertified that he
was personally present when the fore oin ac 5 ledgement and affidavit(s) were signed by
i'Y~r~~ ~ • Ottt. g 8 ~t~±
!N WITNESS WHEREOF, I hereunto set my hand and official seal.
~uQ.c~~,
Notary Public
NOTAAlAL SEA!
PAULA K VIRNTE
Motor Publk
UPPEN ALLEN T1MP., CUAI9ERLANO CC'tJN1Y
1Nyr Comiaio:fOA Expl»s Apr S, 2012
8
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF CUMBERLAND
.,
a witness whose name is signed to the
attached or foregoing instrument, being duly sworn and qualified according to law, do depose and sa}r
that that I was present and saw~the Testatrix sign and execute the instrument as her Last Will; that she
had signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that
each subscribing witness in the hearing and sight of the Testatrix, signed the Will as Witness; and that to
the best of my knowledge the Testatrix was at that. time eighteen (18) years of age or older, of sound
mind and under no constraints or undue influence.
~'=_~DpQ
Witness
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND : ss
On October .~o , 2010, before me the undersigned officer, personally appeazed
~U ~ d ~ • ~lc5b,~ ,Esquire (Pennsylvania Supreme Court ID No. y ( ,known to me or
satisfactorily proven to be a member of the baz of the highest court of Pennsylvania and certified that he
was personally resent when a fore oing acknowledgement and affidavit(s) were signed by
YY~cw~~ ~ ~ ot~,, (YLi.rre E~ I~dg~l c~c-1 John (,c~ . Rare .
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public -~
NOTARIAL SEAL
PAULA K WINTE
UPPpI ALLEN TYY UA~18E ANA C0~
ll~ip Canmissios Expbss Apr 6.201?
9
AFFLDAyIT
COMMONWEAI,~ OF PENNSYLVANIA ,
COUNTY OF CUMBERLAND : SS:
I' J~,~ ~ • ~P~"p' a witness whose name i '
instivment, being duly sworn and qualified according to law, do de se
s signed to the attached or foregoing
and saw the Testatrix sign and execute the ins p° and say that that I was present
executed it as her &ee and volunt trument as her Last Will; that she had. signed willingly and . ,
in the hearin m3' act for the purposes therein expressed; that each subscribing witness
8 and sight of the Testatrix, signed the ,Will as Witness; and that to the b _-
knowledge the Testatrix was at that time eighteen (18) years of age or older
constraints or undue influence. est of my
of sound mind and underaa,~~;
Wi
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLANp ~ ss
On October ~p ~ 2014, befo~r~~ ~e ~dersigned officer
~~ -~ ~ IVP~n~ , Es uire Pe ~ ,personally appeazed
satisfactoril 9 ( nnsYlvania Supreme Court ID No.
was personall `~ 1 ~ ~o~ to me or
y proven to be a member of the bar of the highest court of Pennsylvania and certifie
~~P ~ .
y present when the foregoing:, ~Imow'led8ement and affidavit(s) were si d that he
_~_ ~' ~ ,-~~ ~~r~rt~f ~' (~rt~ ~-~ I.v , ~~f°se . fined by
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
Notary Public
~~ lAl SEAL
VNNTE
~ ~~ T1Ni C~~EALMIp
~ Oanmlaslon ~m Apr ~ ZQf
10
ATTORNEY CERTIFICATION ~ AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND . SS:
On October 2010, before me the undersigned officer, personally appeared DAVID
D. NESBIT, Esq. (Pennsylvania Supreme Court ID No. 77411), known to me or satisfactorily
proven to be a member of the bar of the highest court of Pennsylvania and certified that:
1 • He was personally present when the fore oin acknowled
were signed by MARIE E. 01'I', the Testatrix and witness(es~),• andand affidavit
2• Being duty qualified according to law, did depose and say that he was present
and saw the Testatrix sign and execute the instrument as her Last Will; that the
Testatrix signed willingly and executed it as her free and voluntary act for the
purposes therein expressed; that each subscribing witness in the hearing and
sight of the Testatrix signed the will as a witness; and that to the best of his
knowledge the Testator was at that time 18 or more years of age, of sound
mind and under no constraint or undue influence.
DAVID D. NESBIT, Esquire
CERTIFICATION
COMMONWEALTH OF PENNSYLVANIA _
COUNTY OF CUMBERLAND : SS:
~~ D ~ October o~ 20I0, before me the undersigned officer, personally appeared
known to me or
satisfactorily proven to be asmember of thel bar of the hi a estocrt ID No. ~l
was Personally present when the foregoing acknowledgeme t and affidavit(s) W ~ cirn eed that he
Testator and witnesses. gn d by the
IN WITNESS HEREOF, I hereunto set me hand and official seal.
~~:~
Notary Public
NOTARIAL SEAL
PAULA K WNtTE
Notery Pubtk
! UPPER ALLEN TYYP.. CUMBEAlANO COUNTY
'~1ft Canmleelon Expires Apr S. 2012
METRO
BANK
July 19, 2012
Stone Lafever & Shekletski
414 Bridge St
PO Box E
New Cumberland Pa 17070
3801 Paxton Street
Harrisburg, PA 17111
RE: Estate of: Marie E Ott
Tax Identification Number: 156-28-8095
Date of Death: December 24, 2010
888.937.0004
mymetrobank.com
To Whom It May Concern:
This letter is in reference to decedent account information you requested for the individual listed
above. We are able to provide the following:
Account Type: Checking
Account Number: 536279029
Date Opened: August 15, 2003
Date Closed: July 13, 2012
Primary Owner: Marie E Ott
Date of Death Balance: $11,437.06
Account Type: Savings
Account Number: 626193932
Date Opened: August 15, 2003
Date Closed: July 13, 2012
Primary Owner: Marie E Ott
Date of Death Balance: $102.98
Please feel free to contact me at (717) 412-6126 if I may be of further assistance.
Sincerely,
Pamela Lighty
Savings/CIF Associate
Metro Bank