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Home My WebLink About01-18-131505610101 REV-1500 °"°'-'°' ~l PA Department of Revenue Pennsylvania Bureau of IndtvldualTaxes `"~'~~ `~°""'~ Po sox zao6ot INHERITANCE TAX RETURN Harrisburg, PA iytz&0601 RESIDENT DECEDENT OFFICIAL USE ONLY County Code Yaar File Number ~Z' `D'0;95,~ Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ___ __.. ,Zai /6. 6.~?:9'' 0,~7orZ-for/? oG~/'y,/9~> Decedent's Last Neme Suftix Decedent's First Name • MI af~G.~ ~~t~~. •k~a~~~yN ;...;~ U N r.Ws_W. ~ _ - . _ (If Applleable) Enter Surviving Spouse s Information Below Spouse's Last Name Suffx Spouse's First Name MI Spouse's Social Security Number _ ... THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _ _:__.,, , ~y,~~,-~s„Wj REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remaintler Return (tlate of death pdor to 12-13-52) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Fedeeral Estate Tax Return Required death after 12-12-52) O 6. Decedent Dietl Testate O 7. Decedent Maintelned a Living Trust 8. Total Number of Sate Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceetls Received O 10. Spousal Poverty Credlt (tlate of death O 11. Election to tax under Sec. 9t13(Aj between 12-31-g1 and 1-1.95) (Attach Sch. O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number 1 ~- REGISI~F,R OF WILLS USE ONLY i ~ cr:~ `'' r'U m m First line of address ~ c. - 47 O ... .. ... -.. f ~ ~ ~ C A (- . "'ir M t~ ... t..w.a.~..5 ~-v--°a---`~Knr q o m t l 1 0 ~~ ~ ZJ LL~ 4n --+ c~Y U P , d .---/.L-~ Q-_ ~ r- F-' r7't rnt Second line of address r - 1"r1 Cyy ,;~a '' .,3 o qr~ FIL~E~O City or Post Office State ZIP.Code r ,, ~ -~ F . ~ k r ,....- ) ~ .. L.w~m., r ~ t 'f-'i rv _ 4~.Y1 -- Correspondent's a-mall address: Under penalties of perjury, I dedare that I have examined this realm, inducting accompanying schedules and statements, and to the best of my knowledge and belief, it is we, correct end complete. Oedaretbn of praperer other then the personal represen(eUve is based on ell information of which preparer has any knowledge, SIG RE OF PERSON R55P,ONfIBLE FOR FILING RETURN DATE Side 1 1505610101 1505610101 15D561D1D5 Number Decedent's Social Security ~z-._I - - ~ ,GMT b REV-1500 EX ~~ ~1 7J ~ pecedent's Name'. ECAPITULATION .... , , L • ~~ .. ,.. ,_~......iw.u <._. 1. Real Estate (Schedule A). ~ ~ ~ • ~ ~ ' ' ' e •.Ya,A ....... ...... 2 ' 2. Stocks and Bonds (Schedule B) ............. ........ 3 »~, „ ~ , ~~ Schedule C) ~ • ~ q ~ . Y )-~ 3. Closely Held Corporation, Partnerehlp or Solo-ProPhetorehlp ( 4 .• r` ~ t2 q, Mortgages and Notes Recerveble (Schedule D) • • ~ • • • • 5 ~ ~~L, 1~r~ Ileneous Personal PropeAy (Schedule E)..... y _ sits end Mlace t - 5, Cash, Bank Depo ., g ' cuepafete Billing Requested .... ~ . ,, ,Y = _,;, -.y:.3'~.~, edulp F O ~ T 3 V 1 ~' r g. Jointly Owned ProPen1' (Sch Q Separele BIIIIn9 Requested.. 7. Inter-Vlvos Transfers & Miscellaneous Non-Probate PrdPertY , b (Schedule G) ~ - g. Total GroesFweta (total Lines 1 through T) ~ • ' ' ' ' • • • • ~ 1 ' 2`~ g. Funeral Expenses ano rm„~~~~~.•-- - . , , .. , , 10. `•, e LlabillUea, end Llena (Schedule I) ..... 10. Debts a( Decedent, Mortgag • , , . 11. ? 11. Total Deductions (total Lines 9 and 10) ...... ~ ~ ~ ~ ~ ' , ... , .. 12. 12. Net Value of Estero (Line 8 minus Llne 11) ............ ~ •' • • • • • ... 13. 9113 Trusts for which 13. an election t dtax has not been made (Schedule J) ~ ~ ~ • ~ ~ ~ ~ ' ............ 14. 14, Net Value Subject to Tax (Line 12 minus Llne 13) ~ ~ • ~ ~ ~ ~ ~ ' ' ' ' -__._.,e ano sPPLICABLE RATES IFA ~.nr.. 15. Amount of Llne 14 taxable at the spousal tax rate, or transfers under Sec. 9118 (a)11.2) X .0._ 1 g, Amount of Line 14 tezeble at lineal rate X .0 - 17. Amount of Line 14 taxable at sibling rate X .12 1 g. Amount of Llne 14 t~xeble at collateral rate X .15 ~,~,,,~_-- -, .......... x.._ . .................. 19. TAX DUE ................ . ., 2p FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15O561D1O5 Side 2 b r_. `... . . 15O561D1O5 O REV-1500 EX Page3 FII•NUmWr p~0 ~~" V6 /C~.LO decedent's Complete Address: DECEDENT'S NAME STREET ADDRESS / q ~~/OI(.~J ~/1 CITY 1 u/ STATE ~~ ZIP / n /,U / 7 Tax Payments and Credits: 7. Taz Due (Page 2, Line 19) 2. CrediL4Payments A. Price Payments B. Discount 3. Interest (7) t3~/0 Total Credits (A + B) (2) • (3) 4. If Line 2 is greater than Line 1 + Llne 3, enter the ddference. This is:the OVERPAYMENT. FIII In oval on Paga 2, Lim 20 to squat a rotund. (4) 5. If Line 7 + Line 3 is greater than Line 2, enter the diRerence. Thb is the TAX DUE (5) 8 ~, ~~ Make check payable;to;,R~GISTER OF WILLS, AGENT. _..... . PLEASE ANSWER THE FOLLOWING QUESTIONS BY~PLACING AN "X" IN THE APPROPRIATE BLOCKS 1, Did decedent make a trensfer and:. Yes No a. retain the use or irroome of the propeAytransferted :.:.................................................................................. ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary Interest; w .......:............................................................................................................ ...... ^ d. receive the promise for Ilse of either payments, benefits a care7 ................................................................ ...... ^ 2. If death occurred after DBC. 72,1982, did decedent Vanater properly within one year of death without receiving adequate consideretbn4 :.............::...:i..,...........tr:.,..::.............,:............................................ ...... ^ ^ 3 Did decedent own an 'In W st for' ar payable-upondath bank account or security at his or her death9 ........ ...... ^ 4. Dld deardent own an individual retlrement aaount, annulry or other non-probate propeAy, which contains s benefldary designatlon7 ...........:.:.................................................................................................... ...... ^ IF THE ANSWER TO ANY OF THE ABOVE G AND FILE IT AS PART OF THE RETURN, For dates of death on or after July 7, 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)]. . , ..... ~. ..: __ - _ Fa dates of death on a after Jan, 1, 1995, the tax rate Impl>sad 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)J. fie statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a fax return are sell applicable even H the surviving spouse it the only beneflciary. Fa dates of death on a 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 p2 P.S. §9118(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The fax rate imposed on the net value of transfers to a fa ihe.use of the decedents siblings is 12 percent [/2 P.S. §9t16(a)(1.3)j. 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-1502 EX+ (O1-10) i~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF; FILE NUMBER: Kathryn M Varner 2012-00756 All real property owned solely or as a tenant In common must ba roportad 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 la Jolntlyowned with right of survivorship must ba disclosed on Schedule F. Attach a copy of the settlement sheet I/the property has been sold. ITEM Include a copy of the deed shpwing decede~'s Interestlf owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 Decedent did not own any real estate k ' TOTAL (Also enter on Llne 1, Recapitulatiori.) ; If more space Is needed, use addltldnal sheets of paper of the same size. REV-1504 EXt (1-97) ~ ~. ~: ..SCI~~~,YLE ;C ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN .,~„ ~, CLOSELY HELD CORPORATION, "PARTNERSHIP OR ~~t`/ RESIDENT DECEDENT SOLE•PROPRIETORSHIP ESTATE OF FILE NUMBER Kathryn M Varner 2012--00756 Schedule C-1 or G2 (including all supporting Inlormatlon) must be attached for each closelvheld cornnraueornnn~e.e~,~., ~......__, _..~_ .___._ .._ ..___ ~ .... ..,,,.~.~„~~.~ anev.a vi me acme srzeJ _. REV-t 505 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF - FILE NUMBER Kathryn M Varner 2012-00756 1 Name of Corporation • ro i o ~ State on Incorporation Address City 2. Federal Employer I. D, Number 3. Type of Business a ProducUService Business Reporting Year STOCK TYPE VotinglNon-Voting TOTAL NUMBER OF SHARES OUTSTANDING pARVALUE NUMBER OFSHARES OWNED BY THE DECEDENT VALUEOFTHE DECEDENT'S STOCK Common $ ___._ Preferred $ Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? If yes, Position • _ State Zip Code Total Number of Shareholders ................................. ^ Yes X41 No _Annual Salary $ Tme Devoted to_/Business 6. Was the Corporation indebted to the decedent? ................................... ^ Yes 17 No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes §YfJo I! yes. Cash Swrerlder Value $ Ne! proceeds payable S Owner of the policy 8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Ves l~No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Anach a separate sheet for additional transfers and/or sales. Consideration Date 9. Was there a written shareholder's agreement in eHed at the time of the decedent's death? ....~ Yes $f No If yes, provide a copy of the agreement. N!y 10. Was the decedent's stock sold? ..................................................... ^ Yes ^ No ~ /" If yes, provide a copy of the agreement of sale, etc. II t t was the corporation dissolved or IiQuidated after the decedent's death? .................... ^ Yes ^ No N / If yes, provide a breakdown of distdbutions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ....:........ ^ Yes ^ No / If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • ~ ~• • ~ ~ A. Detailed calculations used in the valuation of the decedents stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete addresses and estimated fair market value/s. It real estate appraisals have been secured, atlach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedents stock. Date of Incorporation (If more space is needed, insen additional sheets of the same size) REV-1506 EX+ (9-W) COMMONWEALTH OP PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-Z PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER Kathryn M Varner 2012-00756 1 Name of Partnership Date Business Commenced ._ Address Business Reporting Year _ _ Gty State Zip Code 2. Federal Employer I.D. Number ~ 3. Type of Business. _ _ ProducUService a. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................. ^ Yes fil"No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes ~No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in thla partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes O No It yes, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in eflect at the time of the decedents death? ... ... ^ Yes ^ No /J~p If yes, provide a copy of the agreement. t 1. Was the decedents partnership fntgrest sold? .................................... ... ^ Yes ~ No N~~ If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedents death? ................ ... ^ Yes ^ No /~. /J~~p If yes, provide a breakdown of distribtrtions received by the estate, including dates,arld amou nts received. ~ / 13 Was the decedent related to any of the partners? ................................. ... ^ Yes ^ No If vas. explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ~ Yes ^ No ~/~ If yes, report the necessary information on a separate sheet, Including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedents partnership Interest, B. Complete copies of financial statements or Federal Partnerahlp Income Tax returns (Forth 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedents partnership interest. REW 1507 EX+(197) ;„. • ~. SeC/~~#•EDCULE_ D COMMONWEALTH OF PENNSYLVANIA M~RIGAGE~ ~ NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF Kathryn M Varnez 2012-00756 ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kathryn M Varner SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 2012-00756 Indude the proceeds of litige6on end the date the proceeds were receNed by Ne estate. All property Jointtycwned with Ne right of sunrivonhip must ire disclosed an Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Checking account Orrst wn Bank 7,055.39 ~ /030o SplgB 2. Personal Furniture sold 2,927.75 3. CD for Funeral Payment 12,062.07 This was held by the funeral home ~, TOTAL (Also enter on line 5, Recapitulation) I s 2 2 , 0 4 5 .81 (If more space is needed, insert additional sheets of the same size) ' REV-1510 E%+ (OB-09) pennsylvania ~i7 OEPARTMENTOFREVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF Kathryn M Varner 201 ~ILE~y~t This schedule must be completed and f led if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY iNCwoE iNE xaNE OF rRE iRANSFEaEE, TNna REUnoaswvrooaceoENr ano THE OaTE OF TRANSFER, anaaacoPr ormeoEEO FOR aEU ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION Ir avvuuau: TAXABLE VALUE 1. • TOTAL (Also enter on Line 7, Recapitulation) ; 0 If more space is needed, use additional sheets of paper of the same size. nEV~iae IX.116n COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN RESIDENT DECEDENT ESTATE OF Kathryn M Varner SCHEDULE F JOINTLY•OWNED PROPERTY 56 If an asset was made joint within ons year of the decedent's date of death, h must be reported on Schedule G. SURVIVING JOINT TENANTiS) NAME A. 8. C. JOINTLY-0WNED PROPERTY: RELATIONSHIP TO DECEDENT REM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCJUPTION OF PROPERTY Inciutle name of firunciy InetlWUOn and bank aocounl number ar elmllar Mentlfylnp number. Attach deed kx pintly-held fey eatye. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. (if more space is TOTAL (Also enter on line 6, Recapitulation) I S tional sheets of the same size) 0' REV-1511 EX+(1006) SCIIEDIlLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ~/ygEg ESTATE OF ~ thryn h Varner ~1~7 Z-00756 Debts of decadent moat be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, Copy of bill attached 12,062.31 Paid to Fogelsanger Bricker Funeral Home Food provided to funeral by Ronald Varner 487.35 Marker paid to Wagoner's Memorials 2,520.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Exactor Fee • Name of Personal Repreaentatlve(s) Ronald L Varner 1,139.90 Street Address 110 Afar Nnl low Rnac3 City Newburg State P~_Zip 17240___.,_ Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Streef Address City Slate Zip __ ,_.__ Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanl'sFees Enclosed bill break down 1,355.00 6. Tax Return Preparer's Fees ~. Each child recieved $500.00 from sell of personal assets of Kathryn M Varner 2,500.00 TOTAL (Also enter on line 9, Recapitulation) I S.?0,06 y~ (If more space is needed, insert additional sheets of the same size) REV~1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY 82 TERM CERTAIN heck Box 4 on REV-1500 Cever Sher ESTATE OF Kathryn M Varner FI 8E ~- 0756 his schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89. actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE fS PAYABLE _ ^ Life or ^ Term of Years _ ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Lite or ^ Term of Years _ ^ Life or ^ Term of Years t. Value of fund from which life estate is payable ..........................................$ 2. Actuarial factor per appropriate table ........................................ ....... . Interest table rate - ^ 3 1/2 % ^ 6 % ^ 10% ^ Variable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ NAME(S) OF LIFE ANNURANT(S) DATE OF BIRTH • NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNURY IS PAYABLE _ ~ ^ Life or ^ Term of Years _ ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable .......................................... .$ 2. Check appropriate block below and enter corresponding (number) ......................... . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (a) ^Serm-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - O 3 1/2 % ^ 6 % ^ 10 % ^ Variable Rate 6. Adjustment Factor`(see instructions) ........................................... . 7. Value of annuity - If using 31/2%, 6 % , 10%, or if variable rate and period payout is at end of period, calculation is: Llne 4 x Llne 5 x Llne 6 ..........................$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ............................................. ...$ /U Q/~ rvu I t: I he values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. Qt more space is neetled, insert additional sheets of the same size) REV-1512 EX+ (12-OB) Pennsylvania ii7 DEPnRTMENT OF REVENUE INNERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Kathryn Varner 2012-nn~sF Neport aeo[s mcurreu by the tlecedent OrfDF to death that remained unpaid ar Fh. Mai. ni d..«w ~..~...~__ ..___~_...___. __ _... . .~ ~~~~~~ >R,~< ~> Neeueu, mserz aaDinonai sneers of me same size. REV-1513 EX+ (11-08) Pennsylvania DEPARTMENT OF REVEN UE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER I II SCHEDULE BENEFICIARIES 1. 2 3, 4 5. 1 Kathryn M Varner • NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DE (XABLE DISTRIBUTIONS [Include outright s ousal di t ib Do Not List Trust p s r utions and transfers under Sec. 2116 (a) (1,2j.] Joyce A Stayer 176-46-6194 126 Bennelton Drive Shippensbur P daughter 172 g, a 57 Debra Stouffer 160-54-9772 10048 Tower Road Shippensburg Pa 17 57daughter , Margret H2nsel 196-40-3373 302 Hill top Rd Newburg, Pa 17240 daughter Gerald E Varner 190-42-8837 407 Roxbury Rd. Newville Pa 17241 son Ronald Varner 205-36-8861 110 Bear Hollow Road Newburg, PA 17240 son FILE NUMBER 2012-00756 CEDENT AMOUNT OR SHARE ee(s) OF ESTATE $500.00 $500.00 $500.00 $500.00 $1,639,90 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II -ENTER TOTAL NON-TA)(ABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. 3ti~9.9D u more space Is needed, Insert additional sheets of the same size. •REV-isaaEx.l3.oa. INHERITANCE TAX scNE~u~~~ COMMONWEALTH OF PENNSYLVANIA REMAINQER PREPAYM N RESIDENTEDECEDENTRN OR INVASION OF TRUST PI I. ~ ESTATE OF Varner M I (Lest Name) _ (First Name) Irmame inn~aq This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of ce~e,.n eta n1 rhw Inhwritance and Estate Tax Act of 1981 or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate .............................. .$ 2. Stocks and Bonds ......................... .$ 3. Closely Held Stock/Partnership .............. .$ 4. Mortgages and Notes ...................... .$ 5. Cash/Misc. Personal Property ............... .$ 6. Total from Schedule L-1 ..................... .................... .............$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities .......................... .$ 2. Unpaid Bequests .......................... .$ 3. Value of UninGudable Assets ................ .$ 4. Total from Schedule L-2 .................... ..................... .............$ E. Total Value of trust assets (Line C-8 minus Line D-4) .................... .............$ F. Remainder factor (see Table I or Table II in Instruction Booklet) ............ ............ . G. Taxable Remainder value (Line E x Line F) ....... ..................... .............$ (Also enter on Line 7, Recaptulation) III. I INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) or Annujtant(s) Kathryn Date of Birth Age on date Term of years income corpus or annuity is payable consumed C. Corpus consumed ............................................................$ D. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ . E. Taxable value of corpus consumed (Line C x Line D) .................................$ (Also enter on Line 7, Recapitulation) FILE NUMBER 2012-00756 PEV.IMS E%a (/J31 INHERITANCE TAX SCHEDILILE L-1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- FILE NUMBER 2012-0075Fi I. ~ Estate of Varner Kathryn M A. Real Estate (please describe) Total value of real estate g _ (Include on Setlion II line C-1 on Schedule L) B. Stocks and Bonds (please list) Total value of stocks and bonds g inducts on Section II, Lins G2 on Schedule L C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Hald/Partne (include on Section II Lins C-3 on D. Mortgage: and Notes (please list) include on Section TI; Line C-4 on Schedub L) - ' E. Cash and Miscellaneous Personal Property (please list) include on Section II, Lins C-5 on S`chsdula L) Iil. TOTAL (Also enter on Section 11 Line C 6 on Schedule L) g (If more span is needed, attach additional 8S4 x 11 sheets.) 0.EV-16d6 E%+ la.eel INHERITANCE TAX SCHEDULE.L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FILE NUMBER 2O~ 2-OO7Sfi I. Estats of Varner Kathryn M (last Name) (First Name) (Middle Initial) II. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities $ include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests h l $ O include on Section II, Line D-2 on Sc edu e L C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are not included for fax purposes or that do not form a part of the trust. Computation as follows: Total unindudable assets $ include on Section II, Line D-3 on Schedule L III. TOTAL Also enter on Section II, Line D-4 on Schedule L $ O (If more space is needed, attach additional 8Y~ x 11 sheets.) REV-l6a] E%+ (0240) S"~~ ~' pennsylvania SCHEDULE M oEPRRTHENT or aeveNUE FUTURE INTEREST COMPROMISE • INHERITANCE TAx RETURN (Check Box 4a on REV-ssoo) RESIDENT DECEDENT ESTATE OF FILE NUMBER Kathryn M Varner 2012-00756 This schedule is appropriate only for estates of decedents who died after Dec. 12, 1982. This schedule is to be used for all future interests where the rate of tax that will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument that created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries NAM~OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents who died on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check the appropriate box below and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of future interest ..................... • • • • .. • • • • • ~ ~ ~ • ~ • ~ ~ ~ ~ • ~ • ~ ~ ~ • • ~ ~ ~ ~ ~ $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (Also include as part of total shown on Line 13 of REV-1500.) ........ $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check one. ^ 6%, ^ 3%, ^ 0% .................... $ (Also include as part of total shown on Line 15 of REV-1500.) 4. Value of Line 1 taxable at lineal rate Check one. ^ 6%, ^ 4.5°~ .......................... $ (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate (12%) (Also include as part of total shown on Line 17 of REV-1500.) ........ $ 6. Value of Lined taxable at collateral rate (15%) (Also include as part of total shown on Line 18 of REV-1500.) ........ $ ~ ~ 7. Total value of future interest (sum of Lines 2 thru 6 must equal Line 1) ....................... $ f% ` O If more space is needed, use atltli[ional sheets or paper or the same site. REV-1649 EX+ (OB-09) Pennsylvania DEPPPTMENT OF PEVENUE INHERITANCE TA%E$ RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNpER SEC.zii3(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF Kathryn M Varner Flifori('F'-~6~s6 Do not complete this schedule unless the estate is making the election to tax assetr under Section 2113(A) of the Inheritance and Estate Tax Act. If the election to more than one trust or similar arrangement, a separate form must be fled for each trust. This election applies to the Trust (marital, residual A, B, by-pass, Unifed Credit, etc.). If a trust or similar arrangement meets the requirements of Section 2113(A) and: a. The trust or similar arrangement is listed on Schedule 0 and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then [he transferor's personal representa- tive may specifcally identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar proper- ty treated as'a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal ro the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denomi- nator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the Part B Total If more space is needed, use additional sheets of paper of the same size. PART B: Enter the description and value of all interests included in Part A for which the Section 2113(A) election to tax is being made. ' Description Value .Y R$CEIPT~"FOR PAYMENT asasssassaasssassso ' t (:`~~ r~. ~ .. GLENDA FARMER STRASBAUGFi Cumberland County - Register Of Willa One Courthouse S uare Carlisle, PA 1713 VARNER KATHRYN M * DUPLICATE Receipt Date: 7/112012 Receipt Time: 2: 1:48 Receipt No.: .107.0585 Estate File No.: 2012-00756 -° Paid By Remarks: HO NALD VARNER EA ------------------- ----- Receipt Distribution ----- ----____ _______ ____ Fee/Tax Description Payment: Amount Payee Name PETITION LTRS TEST WILL _ 60;00. CUMBERLAND COUNTY GENERAL FU SHORT CERTIFICATE JCS FEE 15.00 '8.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FU FU AUTOMATION FEE 23-.50 5.00 BUREAU OF RECEIPTS CUMBERLAND COUNTY . &:CNTR GENERAL M. FU Cash Total Received..... gill'. 50 .... $111.50 °~. .., r--- ,.; __.. \, o o ~ -- a ~ ~~~ ~ o~ ~ ~~ ~Q NJ ~' ~_J I ~ A 1_ ~ ~ ~~ 1 r a ~~ o ~' ~~ `J C { I y : . O - ~-~ ^ ^ •, ~,~ ~^ I ~ ~ m ~ O c ~ S ~ y y V ~ y y0 y a S C1 T ~ r Z n y \ ///VVV N O e ~ o 3 ~ ;, untitled Prior to death Mrs Kathryn Varner owed me rent which was paid once a year. The year was up in Tune 30,2012, in which she still owed me 1,000.00 for the prior year from 7uly 1 2011 ti 11 Tune 30,2012. thank you. Mrs Wayne. Hensel i.- ~d/~ Page 1 ~ qq~ Z o g ,m b ~ ~ R T~~~, ~g~k~ ~€ ~~~~ ~~~~~ $ m .` §3$~5 ~~.n { 99T 4 ~ ~~~~SO m o ~ ~,~ ~ i ID" o' 7 O ~ ~.~$~$ _~ ~ ~~ ~ ~ i g ~~ r v a ~~~ D ` T T ~ d p N ry 3 0 CCO O N N N N ~ ~ o ~ ~I~~~ ~ fA m n y g gg~ ~t I 0 m Z n W m 0 0 r O T G: 3 n N u D ry37 j y D T (1 A CC"_g '_ ~ ~ ~ ~ m~°Z m ~ o o ~ f ~~„ ~ ^ ~ ~ F ~ y J ~ y O ~ II•~ O N N ~. j fD T.T. N N r t ~. ~ N ^ ~ H H N d/ f// fA fR. M fR dl fA fA fA y~ y ~• 4 0 e °~ .. 0 e d o d G I1!o'.nu> HLb Y:IIi This is to certify that the information here liven I correctly copied from an original Certificate of Dea[ duly filed with me as Local Registrar. The origin: certificate will be forwarded to the State Viu Recor ~ ffice fo ~ ^t filing. ~ ~ ~`~ ',/c al Regis[rar Date Issued LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is Illegal to duplicate this copy by photostat or photograph. Fec for this certificate, $6.00 P 18538004 Certification Number Pe/Pt n PB ~m4 i. 0.u°•n<', L•ial N•m• lilr,t. n KATHRYN M VARNER s. N.-L.rt nr[ne•v tvr. a 88 °r Rwm.nL. t5t. .lira ce •RerAio q.uben . Icepntvl t Cumbobno Fvter In VS q O•P P o ., ~ o`~nknn_.. 3 Y Y COMMONWEq LTry Oi PENrvSV LVANIA • nEPggTMENi Oi ryEALTry VITgL REEOROS rcErTr.-..-. __ __ F•msl• 201-16-8388 Jun• 14, 1Y28 201 West Crs•k Ro•tl ~ v. eenemt Ilwe - --- - ...., o ben.Npn un•. swa ' _........ t,.. pan n w.m. p.wmae Fr.nkun jbe•er Dbpp lea r er e n Lou n er opPeanen tnN er T°wn xm •n° zlP) ~ v. •m•eerv.mem•.pl.ee July 10, 30t3 S i P ^Q HIII C•m.bry PP•nsburp PA 2 9 i '` I n n 5..., _"7\ )•lun •r-Bricker Furonl Hom• 1 t2 W Kin 8t. 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King Street Shippensburg, PA 17257 Ph: 717-532-3446 Fax: 717-530-1958 December 13, 2012 To; Estate of Kathryn Varner File # 12-00756 i Copies of supporting documentation for tax return. $50:00 Tax Return Preparation fee.for Pa Dept of Revenue .. $355.00 . _ Estate Tax Return $200.00 K-1 s prepared for Heirs to file with their 2012 tax returns $250.00 Letters sent to Public welfare with paperwork $100.00 Includes mailing and delivery of all paperwork 4 Meetings with family to discuss distributions $200.00 Paperwork filed with court house in duplicate $200.00. Total due for services $1,355.00 If you have any further queatlons, please call. Thank you, Ruth Ann Mooney Ronald Varner 110 Bear Hollow Road Newburg, Pa 17240 Social Security # The estate repaid me for the following items Food I supplied for the funeral $487.35 Travel to courthouse in Carlisle 3 trips 90 miles round trip 270 miles Travel to accountant 5 trips @ 22 miles round trip 110 miles Travel to State representive office for concerns with estate 44 miles Travel to get marker for grave 1 trip 90 miles Travel to bank to change accounts and open estate 3 trips 60 miles Travel to Department of Public Welfare (2 trips @ 22 miles) 44 miles I have also charged the estate for Administrative cost I have spent a lot of time and travel to get this estate settled I was listed in the will as Executor of my mother Kathryn M Varner's estate. I have collected a fee of including travel $1,139.90 REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No. 2012- 00756 PA No . 21- 12- 0756 Estate Of: KA THRYN M VA RNER lFint Middle, Lutl Late Of: HOPEWELL TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 201-16-6389 WHEREAS, on the 11th day of July 2012 an instrument dated February 9th 1997 was admitted to probate as the last will of KATHRYN M VARNER !First, Midtlla. Unl late of HOPEWELL TOWNSH/P, CUMBERLAND County, who died on the 2nd day of July 2012 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: RONALD L VARNER who has duly qualified as EXECUTOR(R/Xl and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WXEREOF, I have hereunto set my hand and affixed the seal of my office on the 11th day of July 2012 **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TESTAMENT OF _.'. ~~ ~ rn xATHRYN M. VARNER ~ ~'r c_ c> ~. ' ~-~ c ~'-; i~~ n, „-, v. :, _v;~ I, KATHRYN M. VARNER, Social Securit Number 201-1~~ ,, ~ ~~ ~~ State of Pennsylvania, declare that this is my LAST WIL~ A1VD9TElb`~PAM~~ and I revoke all other wills and codicils previously made by m~ FIRST: I appoint my son, RONALD L. VARNER as my Personal Representative concerning this Will. If my son, RONALD L. VARNER is unable or fails to serve, I then appoint my daughter, MARGARET M. HENSEL to serve as my Personal Representative. a. I request that my Personal Representative be permitted to serve without bond or surety thereon and without the intervention of any court, except as required by law. I direct that my Personal Representative act in unsupervised administration so as to administer my estate with a minimum of court supervision. If it becomes necessary to have ancillary administration of my estate in any jurisdiction where my Personal Representative is unable or does not desire to qualify as ancillary legal representative, I appoint as such ancillary legal representative such individual or corporation as my Personal Representative shall designate, in writing. b. I direct my Personal Representative to pay the expenses of my last illness, the expenses of a funeral appropriate to my station in life and custom of living (including a suitable monument or marker. for my grave), and written charitable pledgee which I have made. I grant my Personal Representative the power to extend or renew any debt. for such time as my•pereonal Representative shall deem appropriate. c. All estate, inheritance, succession and other death taxes with respect to all property passing under this my Will shall be paid from and borne by the principal of my residuary estate, without regard to reimbursement, as if such taxes were administration expenses. My Personal Representative may pay such taxes at any time deemed advisable, whether or not then due and payable. •d. My Personal Representative is requested to settle my estate As soon after my death as may be practicable, and to pay or deliver every legacy or bequest to my beneficiaries without waiting any time that may be believed to be customary in probate matters. SECOND: I give, devise and bequeath, absolutely and forever, all of my estate and ro erty _ which I may be entitled, atftheltime ofymbe seized or possessed of whatever nature Y death, wherever situated or ~~ JANET E. VARNER asp be it real, personal, or mixed, to m me. _ her sole and absolute property if sheyshallhsurvive THIRD: In the event that all previously named takers under this will shall not survive me, I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or Possessed, or to which I may be entitled, at the time of wherever situated or of whatever nature, be it real mixed, to my sons mY death, MARGARET M. HENSEL,R~pYCE A. VARNER and GERALD E, V' personal, or child or children that have been or mad DEBRA A. STOUFFER anddtoganyra, shares of substantially equal value toy be born to or adopted by me, in be divided as they may agree. share of that If any of my children shall not survive me, then the deceased child shall qo to the descendants of that child, who are to take per atirpea and not per capita. If an shall not survive me and shall not be survived b the share of that deceased child shall be distributed to m my children children and the descendants of an Y anY descendants, then survive me, in the manner set forth above other children whosfailvtog children and the they are unable to descendants of an agree, the division among my me shall be made by my Personal Representativearin thatfail to survive and absolute discretion. I empower my Personal Representative to sell any or all of such Person s sole kind hereunder Property, if such property is not distributed in in substantiall aed to distribute the proceeds amon Representative ae to awhataehouldAny determination of my said children and to whom it should _ pass or be sold underythissonal be sold shall be cbncluaive~ be delivered or at what Paragraph price it should FOURTH: If there is a complete failure=of takers under the preceding paragraphs, the property undisposed of shall o determined at the time of my death, pursuant to the Statutes of Descent and Distribution in effect g to my heirs my death. , in the state of my domicile, at the time of FIFTH: If any beneficiary to any share of my estate which is not y be created by this willeis at the timelofodistributionuof hiscormher share the laws of his or her domicile, I direct that the minor's share beder converted into qualifying property and delivered to the minor's Guardian as custodian for the minor under the Uniform Gifts to Minors either the ataterinTwhichethetbeneficiarytorstheyCustodianlresidest or any other state of competent jurisdiction. a. The Uniform Gifts to Minors Act or The Uniform Transfers to Minors Act, as may then be in effect in the state concerned, is hereby incorporated by reference. The property affected by the Act shall be managed, held, and distributed in accordance with the provisions of the Act. b. The financial custodian will serve without bond or surety and without intervention of any court, except as required by law. principal or incomeetransferrede Custodian, for the minor, of any full acquittance and dischar a ofumsuant to this paragraph shall be a Trustee, as applicable, fromgliabilityewitharespectstotsuchetransfer and from further accountability for the principal or income so transferred. SIXTH: Except as otherwise provided in this Will, I have intentionally failed to provide for any other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. SEVENTH: Any beneficiary who fails to survive until one hundred twenty (120) hours after my death shall be deemed to have predeceased me, and the gift to that beneficiary shall be disposed of accordingly. EIGHTH: Definitions: a• The term "children" as used in this Will includes adopted and afterborn persons. The term "children" as used in this Will shall not include step-children, the natural born or adopted children of a person's spouse who are not the natural born or adopted children of the person a A relationship by or through legal adoption shall be treated the same as a relationship by or through blood for purpose of succession to property under this Will. f~ i r~~? ~~_. ~ ~., PAGE 3 immediate and remoterm 'descendants" as used in this Will means the the person referred toawful, lineal descendants by blood or adoption of ascertained in order towho are in being at the time the give effect to the reference toy must be them. means ExecutorThe term "Personal Representative" as used in this Will Executrix, Independent Executor, or any other title of like import which is used to describe such a fiduciary. whenever addistribution iartotbepeS as used in this the made to the descendantslofeans that property to be distributed shall be divided into there are (1) living children of the Y Person, who left descendants who are then livin as many shares as person, and (2) deceased children, child (if any) shall take one share andgthefsharepofseach deceaseding child shall be divided among his then living descendants in the same manner. NINTH: In addition to any powers granted by the laws of the state in which this Will is probated, I hereby authorize and empower the fiduciaries named in this Will, to the extent of the discretion granted, to sell, exchange, convey, transfer lease or rent the whole or an herein Y part of m ~ assign, mortgage, pledge, invest, reinvest, or retain investments ofrmal or Personal estate, to acts and to execute all documents which m y estate necessar y fiduciariestmaperform all elect toyreceivepcompensation formservicesty If an y deem that allowed b y °f mY fiduciaries y law. such compensation will be TENTH: If any part of this Will shall be invalid inoperative for any reason, it is my intention that the remaining parts, so far as ~ illegal, or operative. Possible and reasonable, shall be effective instructionsMforethenpurpoaeeofncarrVe may seek and obtain court fully possible the intention of this Will ying °ut as nearly as may be including any terms held invalid as shown by the terms hereof, illegal, or inoperative. IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, this daY of ~ 19~Z this my LAST WILL AND ESTAMENT ' set my hand and seal to each page bearing my handwritten signatureg of 5 typewritten pages, G ' RRNER~ xf ( SEAL ) ~x_ y~ // I}l,G~~ i._. ,~~n ~ ~,. PAGE 4 The foregoing instrument was, at Carlisle Barracks, Pennsylvania, this 'r<~ day of Tci~'~. ~.., ' published and declared by KATHRYN M. VARNER, the tt statrixedtosbelher LAST WILL AND TESTAMENT in the presence of all of us at one time, and at the same time we, at her- request and in her presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do so verily believe that the said testatrix is of sound and disposing mind and memory at the date hereof. OF ~ ( ~; ~ .n„ir ~,~~ ~/~ `, ,l OF G~JlC'l// /~~ r /].1.G',.. ~a ~i'_ _ PAGE 5 COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY ACKNOWLEDGMENT I, KATHRYN M. VARNER, testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~/l~,yity/~/ Y~1n_.,,.,~ (SEAL) ATHRY -M- VARNER AFFIDAVIT /n We, - t_ti , ~~ ~~ f,, t { / ~%'c%( , and I /)) ) II ~ - _ --c V `C~G7z'r ~< L-~ytl(r- ~i't. , the witnesses, sign our names to this instrument, being duly qualified according to law, do depose and say that we were 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 ae a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of ,--sou under no constraint or undue influe / / ~ ~.i~ i i /Y >_ ness - Witness Witness Subscribed, sworn to and acknowledged before me by KATHRYN M. VA~RNE~R, the testatrix, and subscribed a/'nd sworn to before me by __~'(~>J~- N~~3x,z/~y r ~~%/7i?.t' ;' ~~Oc~~ , and ~~CCSCR'r U<. L~UY/G- ~f2~ , the witnesses, this q' ` day of ~c?~:~A ~`7 , 19~ / ~ ~-- BLIC G' My Commissio, Notarial Seal Rosalin Juarbe, Nctary p Harrisbury. Dauphin Cps biic My Commission Expires Sopt ;g 200 ember, P'ennsyl~ vaNy gssociahon of N otaries Expires: i /~?(kf~~ IGt,' . ~ ¢~ v~ .~ o -° > .:.a 4 v '" ~° w `` W ? ~ mi ^^v^~ V ~V O Y ~ -~ `~ ~ o ~~ 4 'a '~ v v o ~ W u W ::> ~~ a rr 1. N Sa ro ~°~ !-I N ~ r 1-~ c- ro x ro a w o . v u +~ a ro .A +~ 3 W U1 wz N .-I r-1 .~ 3 w O N ~ ~ tr~ N ~ •.I N rornu .avro Naa ~ ~ ~ ~, ~ +~ ~ C NO ~ N 1~ ~ O 7'- N U O ro~~a w ro u v ~ o~ ro u o y ro ro U •r q A .-+ Ul 6 N S.i ~]U O U C O 3: ^~ cx~ _o f~l -;. C7 A r 'n <. „~ ~,,~ , ~,x ~r ~-+ "'~ -`~. _~~ '` ` J ~~ PY, r- cn o ~; ~