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HomeMy WebLinkAbout95-0326f -~ ~~ CI~~p~,~0 M,SS.,A3 Rw. &S'7 nPE»wNT x, rERMANErHr ~~ w 2 3 ~` J 2 w U yW O This is to certify that the certificate hereunto attached is a true and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L. 304. Date AUG 16 200 Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLWINIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ~e Ply L',tnnn F ni '~- MIME aFOECEOENT6R MIOW.L.W 8E% SOCIAL SECURITY NUMSEII DATEOF DF.IEN pardl. ~av. ~I ~• G W er a ~. 171 - 03 -5859 •~ t^~2 ~ L ~ ~ (Q AGE M1a+ewWaq U11DE117 rEAR uNDEllt 6Y OREOPaE,rN erRllrucElL~,r+Aa rLALSas DERNfCAerJICM'on.-iwiru.urJOnsanallwr adM MNYi. DM Naaw ~ MYaW IMOM.Oaq,'Rn1 SW.a iurT ~ + "'"~° c owr.. ERaI.,.n«. ^ Da^ Ibl 76 Yn< 12-24-19].8 ~ Hazelton ~s I. ^ R.e.p.^ ~^ , l C couMrocDE~a„ eaa.nvraFDEaN R,curvwwEd.a..eti~m.w.r.w,nal..le.l wle~pg~pp~GCalerAnlcoanlr~r RACE-A.1«+ra.lllerl.el.acvw,ll...l~ ~ 1b C] N. L~ M M. ~ObY~1a14 ~M White 1 y9 V ~H I ~ 2R 2~i .a~~-YCLI nxC ~vt c=A~C~-L C AJTC,2 a~wlr•I.w.bRrAR..~ ~a DECEOOrt•EUSUAL000UrIaan Icwoseu~,ESSnND,IS,Rr ,wDECEDO,TEYERIN oECEDENraEwaE,DN MA,roasoEw•M.d.d w•e waawrbanp .mr u.a ARMEOFONCEE'I wr.r MU,NS. MEawwa d••nrli.l Na; as AS U..raFa.) r.® Ns^ ~ar~rier Postal ~o-,a p "`~' Wi~ec~' ~~ ,.. ,: ,x ,a DECmo,rS MAILE,o AD011E85 ~ CaA~..l. 9p., npCaeq 1921 Princeton Ave ~+~~+• a ~ ,Ta.O ~~••~+~~ -P. Camp Hill, Pa 17011 ~~~ ~ : + " ~ r ,a ,.. I ,m Cumberland nv ,,~1 ~ wd . °'~ °y RENER•a NAME 1FnLLWOa, LA,B Alvin G. Wa er Sr. ~ aNAME ..L Mbdw Awe.,s..n.,w ~ Helen Deathe~ .,roaMAMrsNAME~,PrPNb Sharon D. Legge nce`~.o'n ~ve"~a~mp Hill, 17011 MET„DD DIEPamIaN el.w^ cnardw^ Rarnar.lAaaSW.^ oFOlsroslraN DrANaII PLACEOFDEilOBITM7N•rr11.aC.lurwa.Rrolr >a•.wo. Lacala,.Cw«.•I,.sl+..nvcoe. , ~. °""""^ °r""~" $rri~~tEee::E: ~ >na 4-21-1995 „~ Rolling Green Mem Park ra Loxer Allen Twp aEroa,R,EarnRIERALSERVICEUCFl18EEOR ACTINDASSIrca, LICE/bE NAME ANDAm,EasarRlcurr ~2~ L ~Musselman Funeral Home Inc. Lemoyne Pa a.. 0 2 y1,.lerRrlsa~E,a,aa tll~aad4a'~d b Er ~~rlo•Nda..awn•oe.,watdra,n.. e.r.m PNe•wa•. uCENSE NUMBER avE STONED C. wn dtr+~ a.lw, a..aawn. K . ~ awl.xas•w„a,aA,w.Ndl+r o.aen.A• PI•,lalalaw aaEl TaE:aFDEa„ DATEPRONOI1NCEppEAplMy,n.pay.~An1 w~scASERr~E:wEDroMEDICALOUMINERIOOR owER~r b. RARfk Elrnwa.....a leF.I.>mmyc.xu.wlalul.wu.awn. DOnd.law Sr m•d.dal+o.ala.cra.ear.apbalayanw..IaeaaMan haura. ~ Ay0•AYaNa MILT! Otlrr.gnilplamrdbl. a.IrtWYq Mawr, ha lit ol11y onadAran aatA M. i ~~ 1 ~ nolnw•Wlpin tlruWwµge.w9l.wF W111fL YIEDIATECAUE[(Fnal I da,arar o W aa m I n,lirp •Idra,-~ DUEro(OR ASA DUENLE SaOw•Ye, 811ia,l0ai.rr C 1 ^an,I N.igbYlwrdr. DUE 70lDR ASACDNSEOUENCE Oik I ~ CAME! (D4a.,a ar ir*.y i dnl alw e r , awn DUEro,CR ASACONSEOUENCE OF}. I NaWYp NdwyLAST YINSAN AUroPSY WERE AUlO-EY RNdlai9 MANNER OF OE/S,1 DATE OF EiR1RY TIME OF SiIURY NIILWYATWORK, OESCREE IIOW SAAIIlY OCClN11ED. PERFpM1EDi AYARAEIE PIEDIIW ~./ (,,,dyl. p,y.wy) ~CD•lLETION Of CAUSE M.wr IXI - Na idd ^ n . Att,dwa ^ P.r16pNv.pipWpn ^ 1M ^ No ^ 1~, ,Ya ^ N•Id Yp ^ ND ^ Sdtida ^ C•dd nd Wd.l.nNnW ^ PLACE Of MLRIRY.N Iwn• Mn W..1 h.do. olAn Y. IACAf10N Sh G f . . . y, a+. W o+~.. S1.W I IM. ja, n.i16q. MC. (Sp.CMy1 aa.. ]Of. CERT~ICn kpYy pny •~CERTMYNS ~'~I,IPn,'~.and.dyng wsd aeaYl w,w. anallr PnY,kan na, Paqunt.aawn an0 tdnPlnea ham 231 w a a •^••• • SIGNATURE TITLE OF CER~ ry .. . a><vma aw b aw ~••..I+l and nnlNUr r wl.a.......... ~ 9•, ............................................ ^ 7,a •vRDNO,N+anoANDeERrvrwon,YSN:,w«tvnr•~mno,o„a,,,o„oawn.,~a,•~.,,,.aa.ma LICENSE MSER SONED, ~•- D ©~ ~ ~ ~ TaEl.ewa.ynR•.+.aw.a..noea..wawuR..ew...aal.~•..Reswmu»..w•I.I.Iw.lw...e.w.e .......................... 7 I j 5 ~G ~, , . M NAME AND ADDRESSDF PERSON 1VIN)COMPLETED CAUSE 'MEDICAL EXAAIMiER/CORONER (Ilartl27) Typa of PdM R , ~~ g~ K,,,~ Q ~-(~ 1 ~ On U,a ba.M a •aal,lYlaRa1 aM/a IrrvaaUgali•n. In my oPlnk•1, datlh aecunW C IM Ilma, dab, and Pon. and dua to DI• uuaa(a) and ~ N : Yj Q ~ 5 26 T ~,.. REGISTRAR'S 3NiN/TURE AND NUMBER ~ 1,. / DATE FlIED (Napo. D.Y. 1'w1 ].. f v ~`` ~~'3~- ~ 50~.8a~~5 rcty- I~ov Ex+ 17-94) r FOR DATES OF DEATH AFTER 12!31191 CHECK HER ~~ ~ tNHERITA CE TAX RETURN 1F A SPOUSAL POVERTY CREDIT IS CLAIMED ^ RES NT DE CEDENT FILE NUMBER COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE CTQ FILED IN DUPLICATE 21 DEPt. 280601 HARRISBURG PA 171 H REGISTER OF WILLS ~ 95 0326 , 28.0601 COUNTY CODE YEAR NUMBE DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITI DECEDENT'S COMPLETE ADDRESS WAGNER, ALVIN G. ~ 1921 Princeton Ave. z SOCIAL SECURITY NUMBER DATE OF DEATH E OF BIRTH Camp H111, PA 17011 W 171-03-5859 4/18/95 12/24/18 co~~t CUMBERLAND p (lf A-PLICAlLEJ SURVIVING SPOUSE'S NAME MAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) ~ ®1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return >z ~ ~ ,~'.~ d v ° ^ 4. Limited Estate (for dates of death prior to 12-13-8; ^ 4a. Future Interest ompromise ^ S. Federal Estate Tax Return Re uired ~ o: ° ar' ®6 Decedent Died Testate q (for dates of Bath after 12-12-82) ^ 7 D d i d . (Attach copy of Will) . ece ent a ntoine a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach opy of Trust) '{ORRESPONDENCE AND CONFIDENTIAL I FORMA~ ON SHO°BE~I~tEGTSO;~O: y z z NAME Richard W. Stewart, Esq. COMPLETE MAILING ADDRESS JoYu>I son Duffie St & W id ~ , , e ner v ~ TELEPHONE NUMBER 301 Market St • , P 0. BOX 109 717 761-4540 PA 17 109 1. Real Estate ISchedule Al r t T 8 7.000_00 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) u-~ 4. Mortgages and Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits $ Miscellaneous Personal Property (S) 18.493.04 - Z (Schedule E) ` " b. Jointly Owned Property (Schedule F) (b) 4, 930.28 _/ _. ' a '' 7. Transfers (Schedule G) (Schedule L) (7) _~' ' _- -- t.,~ r- a 8. Total Gross Assets (total Lines 1-7) (g) 110,423.32 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 7,534.16 Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 724.55 11. Total Deductions (total Lines 9 & 10) (11) 8,258.71 12. Net Value of Estate (Line 8 minus Line 11) (12) 102,164.61 13. Charitable and Governmental Bequests (Schedule J) (13) -0- 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 102,164.6]. 15. Spousal Transfers (for dates of death after 6.30.94) See Instructions for Applicable Percentage on Reverse (15J Side. (include values from Schedule K or Schedule M.) x,_= -0- 16. Amount of Line 14 taxable at b% rate (16) 102.164.61 ob = 6.129.88 x (Include values from Schedule K or Schedule M.) . 17. Amount of Line 14 taxable at 159/0 rate (17) x 15 = -0- zo (Include values from Schedule K or Schedule M.) . c 1B. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) 6,]„29.88 ~ 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + 5.000.00 + 263 _ 16 _ (19) 5, 263.16 a ~ 20. If Line 19 is greater than Lins 18, enter tho difference on Line 20. This it the OVERPAYMENT. (20) ~ ^ .. 2 1. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE . (21) 866.72 A. Enter the interest on the balance due on Line 21A. (21A) -0- B. Enter the total of line 21 and 21A on line 21B. This is the BALANCE DUE. (21B) 866.72 a e Cheek Payable to: Register of Wills, Agent it is nis return, including accompanying schedules and statements, and to the ber has been reported at true market value. Declaration of preparer other than dge.. AVe. ' "' Y6V1.7 nVVRCJJ ,~~~ ~y 301 Mi3rket St. P. O. Box 109 ©--z~-., Lemoyne, PA 17643 0109 -.~.1.,.~..ia,a ... vu a.• a,-~aA. ~' '~ - ~f my knowledge and belisl Te personal representative i DATE ~~~ y~ D E i ~'s Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: • 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 e 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1% (.O1) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98 • Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (rj IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: 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$ ....................................... X 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration$ If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate.consideration$ ................................................................................................... X 3. Did decedent own an 'in trust for'. bank account at his or her death$ ...................................... 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. - _ ~ ~;i2~ LAST WILL AND TESTAMENT OF ALVIN G. WAGNER I, ALVIN G. WAGNER of the Borough of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testa- ment, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II - I devise and bequeath all my estate of whatever )IS, GUIDO ~fASLAND Market Street mp Hill, PA nature and wherever situate unto my children, Charles G. Wagner, Barry K. Wagner and Sharon D. Legge, in equal shares, the share of a deceased child to be paid to his or her issue per stirpes. III - I appoint my children, Charles G. Wagner, Barry K. Wagner and Sharon D. Legge, Executors of this, my Last Will and Testament. None of my personal representatives shall be required to post bond in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the 7`I day of 1993. ~~ ~~ ( SEAL ) _ Alvin G. Wa er Signed, sealed, published and declared by ALVIN G. WAGNER, Testator therein named, on this and one (1) other sheet of paper as and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ( `? ti~ ~` ~~~ 4 . Address Address CIS, GUIDO [ASLAND Market Street ip Hill, PA COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) SS. WE, the undersigned, the testator and the witnesses, respectively, whose names are signed to the foregoing instru- ment, being first duly sworn, do hereby declare to the under- signed authority that the testator signed and executed the instrument as his Last Will and Testament and that he signed willingly (or willingly directed another to sign for him), and that he executed it as his free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator signed the will as witnesses-and that to the best of their knowledge the testator was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. IDIS, GUIDO MASLAND )9 Market Street 'amp Hill, PA Subscribed, sworn to and acknowledged before me by the j testator, and subscr~i,b:ed and sworn ~i be_ore me by both witnesses, this 'y- day of ~2~ :~ 1993 /~ l I /Notary Public NOTARIAL SEAL THELMA;. PA.cGAJSLIN, Notary Public Camp Hiii, f,~~i,uerland Go~nty tJly Co.^miss~on Exaires ~uiy 3,15 f (~Je J,//Testa or REV•1502 EX+ (12-85) ' R SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WAGNER, ALVIN G. 21-95-0326 (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All reol estate should be reported at fair market value which 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. ITEM NUMBER DESCRIPTION VALUE AT DATE OP DEATH 1. zeal tJstate - No. 1y11 Princeton Avenue, Borough of Camp Hill, Cumberland County, Pennsylvania. (Deed Book "V", Colume 12, Page 344) Sale Price (Copy of Settlement Sheet attached.) $ 87,000.00 6~ _ TOTAL (Also enter on line 1 Recapitulation) I $ 87, ~~0 ~~ (if more spore is needed, insert additional sheets of same size.) REK1508 EX+ (2-87) SCHEDULE E i ~ ~ '~~ CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS INNERtTANCETAxRETURN PERSONAL PROPERTY RESIDENT DECEDENT Please Print or Type ESTATE OF FILE NUMBER WAGNER, ALVIN G. 21-95-0326 (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Household Goods -Appraised value ~ $ 1,165.00 2. 1989 Pontiac Sedan -Sale Price ! 5,000.00 3. Farmers Trust -Checking Account No. 9-06476 i Date of death balance, plus accrued interest. ~ 5,059.51 4. Patriot-News Co. -subscription refund 126.35 5. Erie Insurance -automobile insurance refund 438.00 6. Bell Atlantic -telephone service refund ~ 8.14 7. Sammons Comrnsnications -cable service refund ~ 5.35 8. Valley of Harrisburg -refund of deposits for scheduled trips. j 250.00 9. Harsco Employees Pension Plan Trust Fund ~ Lump Sum Vested Benefits i 6,221.18 10. UGI Utilities, Inc. -refund -decedent's budget account balance ~ 219.51 TOTAL (Also enter on line 5, Recapitulation) $ 18,493 04 (Attach additional 815^ x 11" sheets if moro spots is needed.) REV-1504 EX+ (12.88( COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WAGNER, ALVIN G. Joint tenant(s): NAME A' Sharon D. Legge g, Charles G. Wagner ~, Barry K. Wagner Jointly-owned property: ADDRESS 1909 Princeton Ave. Camp Hill, PA 17011 7715 Talhelm Road Chambersburg, PA 17201 3118 Harvard Ave . Camp Hill, PA 17011 FILE NUMBER 21-95-0326 RELATIONSHIP TO DECEDENT Daughter Son Son ITEM NUMBE LFORR J T ANT DATE MADE J INT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DECD'S % INT. DOLLAR VALUE OF DECEDENT'S INTEREST ~• A,B,C 9/93 Harrisburg Postal F]nploye Credit Union j` Regular Savings 882-015 2,621.77 25~ 655.45 2. A,B,C 9/93 Harrisburg Postal Employees Credit Union ~ Investment Savings 882-095 15,069.45 25~ 3,767.36 3: ~ ~~g.~ ~ Harrisburg Postal Employees Credit Union Certificate Account 882-OA5 2,029.88 25~ 507.47 ~/ / ~~ i /~ ~~~~ ~t S~~ ~ ~~~/ TO7AL (Also enter on line 6 Recapitulation) I $ 4 , 930 28 (If more space is needed insert additional sheep of same size) SCHEDULE F JOINTLY-OWNED PROPERTY REK1511 EX+ (786) SCHEDULE H FUNERAL EXPENSES, COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND INHERITANCE TAX RETURN _ RESIDENT DECEDENT MISCELLANEOUS EXPENSES Please Print or Type ESTATE OF FILE NUMBER WAGNER, ALVIN 21-95-0326 ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: 1• Musselman Funeral Home - funeral expenses 2,810.00 2. Bixler's Flowers & Gifts - funeral flowers 111.30 3. Camp Hill United Methodist Church - funeral brunch 225.00 B. Administrative Costs: 1. Personal Representative Commissions _ _ Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees - Johnson, Duffie, Stewart & Weidner 2, 500.00 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees - Register of Wills - Cumberland County 258.00 C. Miscellaneous Expenses: ~• Cumberland Law Journal - advertise letters 40.00 2• The Patriot-News Co. - advertise letters (8,97 3• Chuck Bricker - household goods appraisal 40.00 4• L. G. Connor - real estate appraisal 250.00 5• The Patriot-News Co. - Ad- sale of automobile 22.80 6• The Patriot-News Co. - Ad - sale of television 17.00 7. Bell Atlantic - final charges 21.49 8. Register o f Wills - file Inventory & Inheritance Tax Re 2 5. 0 0 Sub-Total from Additional Sheet 1,144.60 TOTAL (Also enter on line 9, Recapitulation) $ 7, 534.16 Itt more space is needed, insert additional sheets of same size.) SCHEDULE H - CONTINUED ESTATE OF: WAGNER, ALVIN Miscellaneous Expenses: 9. Borough of Camp Hill - sewer charges 10. PA American Water Co. - water service charges 11. Pennsylvania Power & Light - electric service charges 12. Stehr's Pest Control - termite inspection sale of 1921 Princeton Ave. - decedent's residence. 13. Recorder of Deeds - transfer tax - sale of 1921 Princeton Ave. 14. Assured Land Transfers - disbursing fee 15. Notary Fees - settlement documents 16. Fleet Real Estate Funding - document preparation fee 17. Borough of Camp Hill - sewer charges from 7/1 - 7/14/95 18. Ann Markley, Tax Collector - School real estate taxes - 7/1/95 - 7/14/95 21-95-0326 50.00 21.91 52.82 40.00 870.00" 35.0(}/~~ 6.00 / 50.00 3.78 15.09 Sub-Total $ 1,144.60 REV-1511 E%+ (1-93( _, SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE 7A%RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT Please Print or Type ESTATE OF FILE NUMBER WAGNER, ALVIN G. 21-95-032f ITEM NUMBER DESCRIPTION AMOUNT 1• Pennsylvania Power & Light -decedent's account electric service - 3/17-4/19/95 20.01 2. PA American Water Co. -decedent's account water service - 3/23-4/25/95 10.39 3. Polyclinic Medical Center -decedent's account balance for telephone and TV charges. 90.00 4. River Rescue of Harrisburg -decedent's account balance not covered by insurance 54.15 5. Harris Street United Methodist Church -pledge contributions decedent wanted honored. 450.00 6. Kurt Wagner, grandson, graduation gift 100.00 TOTAL Also enter on line 10, Recapitulation) $ 724.5$ (If more space is needed, insert additional sheep of same size.) RFV-1513 EX+ (Z-87) COMMONWEALTH OF PENNSYLVANIA INNERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER WAGNER, ALVIN G. 21-95-032 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: ~' Sharon D. Le e 99 Daughter One-Third 1909 Princeton Ave. - Residue Camp Hill, PA 17011 2. Charles G. Wagner Son One-Third 7715 Talhelm Road Residue Chambersburg, PA 17201 3. Barry K. Wagner Son One-Third 3118 Harvard Ave. Residue Camp Hill, PA 17011 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: 1 TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recopitulation) I$ (If more space is needed, insert additional sheets of same size)