HomeMy WebLinkAbout08-23-13 � �SD56�0��1
REV-1500 EX`°��'°, �
Q��� �Ya��� OFFICIAL USE C1NLY
PA t�epartment of Revenue P Y a �o���y�q�g Year File Plumber
Bureau of Indivrduat Taxes h�NHERITANCE TAX RETURN
Po eox zso6oi .2 1 r.� D b'�'�
Harrisburg PA z�i28-p6of RESIQENT DECEDENT
ENTER dECEDEN7 tNFqRMATfON BEI.OW
Social Security Number Date af Death MMDDYYYY pate of Birth MMDDYYYY
193-24-86$7 05/23/2013 11/21/1931
LJecedent's Last Name Suffix L�ecedent's First Name MI
MILLS MARJORIE A
{If Appticable}Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
M1��8 RECNARD A
5pouse's Social Secunty Number
THIS RETURN MUST BE FILEQ tN DUPLICATE WITH THE
2ao-2a-assa FtEGISTER OF WILL.S
FILL IN APPROPRIATE OVALS 8EL4W
C�7 1,Originat Return O 2.Suppiementai Return CJ 3. Remainder Return{date of dea#h
priorto 12-13-82)
t� 4.Cimited Estate O 4a.Future interest Campromise(date of C} 5. FederaE Estate Tax Re#urr�Required
death after 12-12-82}
K,'�7 B.Decedent Died 7estate O 7.Decede�t Maintained a Living Trust � 8. Total Number of 5ate DeppSiE Boxes
(Attach Copy of WiEI} {Attach Capy o(Trust}
C,a 9.L.itigatipn Proceeds Received Ci 10. Spausal Paverty Credit(date of death C1 11. Election ko tax under Sec.9113(Aj
between 12-31-91 and t-1-95) (Attach Sch.O)
CORRESPpNDENT— TNIS SECTION MUST BE COMPtETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name C?aytime Telephane Number
,THOMAS E. FLOWER {717) 243-5513
�. . . C�"�. r���— ,.,.. `��.
�ry,, i�ER OF WIE6S U3E ONL`tv
� �_
.
� .. , .
First line of address :�, �_ +` �,,.s i
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__ _ . __ � ,
FLOWER LAW, LLC '� . , 4'*� �
, ,
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Second(ine of address �"� �
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10 W. HIGH ST ,"�' < ' � rv ,;`z
City or Post Offioe 8tate ZIP Code — °� dATE FILED � ; ��
� � .�,.,�
CARLISLE PA 17013
Carrespondent's e-mail address:TOM@FL{�WER-LAUV.CtJM
Under penaities of perjury,I declare that I have examined this return,including accompanying schedules and stataments,and to the best of my knowledge and belief,
it is true,carrect and complete.Dectaratian of preparer other ihan the perspnal representative is based on a!!in#qrmation af which preparer has any knowiedge.
SIGNATU P OiV RESPOtVSIBIE FOFt FILING RETi1RN OATE
•~• �� 08/23/13
ADDftESS
R1C RD A. MILLS, EXECUTOR, 342 W. FIRST ST., BOIL�NG SPRINGS, PA 17007
SI NATU OF P� ER THAN REPRESENTAFIVE DATE
-- 08l22/'I 3
ApDRESS
TNQMAS E. FLQWER, FLOWER LAW, LLC; 14 W. HfGH STREET, GARLISLE, PA 170'i3
PLEASE USE ORIGINAL FORM ONI.Y
Side 1
� �,5�56],01�01 1,5�561,CJI,D1� �
� �5Q561��05
REV 1500 EX
DecedenYs Sociai�ecurity Number
Decedent's t�ame: MARJdRIE A. M1LLS 193-24-8887
RECAPITULATION
1. Real Estate(Schedule A}. .... . .. . ... . . . ... .. ... ......... .. ... . . .. .... t.
2. Stocks and Bonds(5chedule B} .............. ............ ..... ........ 2.
3. Closely Heid Corporation,Partnership or Sole-Proprietorship(Schedule G) ..... 3.
4. Mortgages and Notes Receivable(Schedule D) . . ... . .. . . .. . . . .. . . . . ..... . 4.
5. Cash,Bank Deposits and Misceilaneous Personai Property(Schedule E}. . . . . .. 5. 27,009.95
6. Jointly Clwned Praperty(Schedule F} C} Separate BiI(ing Reques#ed ....... 6.
7. Inter-Vivas Transfers&Miscellaneous Non-Probate Property
(Schedule G) C? Separate Billing Requested........ 7. !
8. Tatal Grass Assets(total Lines 1 through 7).. .. ....... ... ... ... . .. ..... . $. 27,009.95
9. Funera!Expenses and Admin�strative Casts{Scheduie H}... ... .. . . ... ... .. . 9. 4,653.04
10. Ctebts of Decedent,tvlortgage Liabilities,and Liens{Scheduls I}........ ..... . 1Q.
�1. Total Deductions{total Lines 9 and 10)... ... .. ............ ............. 11. �,��r�3.��,
12. Net Value of Estate(Line 8 minus Line 11) .. .... .... . .... .. . .. . .. .. . .. . . 12, 22,356.91
93. Charitabie and Governmenta!BequestslSec 8113 Trusts fpr which
an election to tax has not been made{Schedule J} .. . .. .. . . . . . ..... .. . . ... 13.
i4. Net Value Subjeat to Tax{Cine 12 minus[.ine 13) ....... 22,�r��.�.�
........... . 14.
TAX CALCUL,ATION-SEE INSTRUCTIONS POR APPUCABLE RA7ES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a}(1.2)X.0 00 22,4�6.91 15.
0.00
1&. Amount af Line 94 taxabie _
at lineal rate X,p_ �6
17. Flmaunt of Line 14 taxable
at sibling rate X.12 ��
18. Amount of Line 14 taxabfe
at collaterai ra#e X.15 �g.
19. TAX DUE.......... ..... ....... .. .. . 19, Q.Q�}
............... .............. .
20. FILL IN TNE QVAL IF YOU ARE REQUESTtNG A REFUND OF AN OVERPAYMENT �
SICI@ 2
� 1�5Q56�C]7,C15 1�5Ci567,{]�,05 J
F2EV-1500 EX Page 3 File Number r� �f � ������
Deceden#'s Comple#e Address: ,►�
pECEDEN7'S NAME
MARJt?R(E A. MII.�S
STREETADDRESS
342 W. FIRST STREET
S. MIDDLETON TOWNSHIP
GITY __ _ STATE ZEP
BOILWG SPRINGS PA 17007
Tax Paymen#s and Credits:
1. Tax Due(Page 2,Line 19) (1} 0.00
2. Credi#slPaymen#s
A.Prior Payments .
B.Discour�t
Total Credits{A+8 j (2) 0.40
3. Interest
{3� 0.40
4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT.
Fil!in aval on Page 2,line 20 to request a refund. (4} Q.00
5. if Line 1 +Line 3 is greater than Line 2,enter the tlifference.This is the TAX DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLtJWING QUESTIONS BY PLACING AN "X" 1N THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes Na
a. retain the use or incame of the property transferred:.......................................................................................... ❑ �
b. retain the right to designate wha shalE use ihe property trans#erred ar its income:............................................ ❑ �
c. retain a reversionary interest;or.......................................................................................................................... ❑ �
d. �eceive the promise for life of either payments,benefits nr care?....................._................,..........................,... ❑ �
2. Cf death accurred after Dec.12,1982,did decedent transfer property wi#hin ane year oi death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent owo an"in trust for"or{�ayable-upan-death bank account or security at his or her death?.............. ❑ �
4. Did deCedent awn an individual retirement account,annuity ar other non-probate property,which
contair�s a beneficiary designation? ....................................................................._.........,....................................... ❑ 0
IF THE ANSWER TO ANY 0�'THE ABOVE QUESTIONS IS YES,YOU MU5T COMPI.ETE SGNEDULE G ANQ FILE IT AS PART OF THE RETURN.
Far dates of death an or after July 1, 1994,and before Jan. 1, 1995,the tax rate impased on the net value of transfers to or for the use of the surviving spouse is
3 percent�72 P.S.§9136{a)�1.1}{i}�.
For dates of death on or after Jan. 1, 1995, the tax rate imposed on khe 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 s#atute does na#exempt a transfe�to a surviving spouse from tax,and the statutary requiremenfs far disclosure of assets and
filing a tax return ara stiii applicable even if the surviving spouse is the only beneficiary.
Far detes of death on ar after July 1,24Q0:
. The tax rate imposed on the net value of transfers from a deceased child 21 years pf age or younger at death to ar for the use of a natural parent, an
adoptive parent ar a stepparent af the child is 0 percent j72 P.S.§9116(a�(1.2j].
• The tax rate imposed on the net value ofi transfers to or for the use of the decedenk's lineai beneficiaries is 4,5 percent, except as noied in
72 P.S.§9116(1.2�(72 P.S.§9116(aj(1)].
+ The tax rate imposed on the net value of transfers to ar for the use of the decedent's sib(ings is 12 percent[72 P.S.§9116(a}(1,3)j.A sibling is defined,under
Section 9102,as an indivitlual who has at least one parent in common with the tlecetlent,whether by blood or adoption.
REV-15o8 EX+(i1-1o)
� � �'`pennsylvania SCNEDULE E
DEPAPTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: � FILE NUMBER:
MARJORIE A. MILLS 21-13-0644
Include the proceeds of litigation and the date the proceeds were received by the estate.
Ail property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. FUNDS ON DEPOSIT,MEMBERS 1 ST FCU CHECKING ACCOUNT 10,872.00
2. FUNDS ON DEPOSIT,MEMBERS 1ST FCU CERTIFICATES OF DEPOSIT 16,137.95
TOTAL(Also enter on Line 5, Recapitulation) $ 27,009.95
If more space is needed,use additional sheets of paper of the same size.
. - . :.{� . .. . .. . . . ... � ..
�� Send Inquires to: Statement of Accounts
5000�ouise Drive
PO Box 40
Mechanicsburg,PA17055 May 25, 2013 thru Jun 24, 2013
www.membersl st.org
Mal�Switchboard: (800)283-2328
EZ Call: (717)697-4372 or(800)283-4372 Account N umber: 213586
� TDD: (717)697-5312 or(800)283-2328 e�.5312
TeleBranch:. (800)237-7288 galances 8t a Glance:
MEMBERS 1St Checking: 10,624.29
FEDERAL CREDIT UNION 26,535.48
Savings:
i�� i av 0.360 353-177 CertlflCateS. O.00
��Il,li��l��l��lnl����i�iri�ll�i���nl�lll��i�ll�i�l�l�l��il�ll
RICHARD A MILLS � Loans: 0.00
34z w FiRST sT Money Management: 0.00
Boiurv�sPRiN�s Pa �7007 Swipe 5 YTD Reward: 0.70
Page: 1 of 2
Your aggregate balance as of June 1st is $2,295.38.
An aggregate balance of$2,500 and having 3 products
will place you �n the Silver MLR level.
Go paperless and sign up for eStatements today!
See the enclosed insert for more details.
,
_.._..a... _..�..�....�._., .„ ._,...x�.�., _ .__ _ _ -__ _..��.:__._ _ _
�� ` �`e�HECKING `ACCOUNTS
00"11 -CHECKING
'Date Transaction Descrip6on Additions Subtractions Balance
- M+�1G.:�5 �,� F.o.l�id 525.29
._,r..�._...,r.__ _. . . __ __.
.__.... ._._
: May 31 Deposit Swipe 5 Rebate 0.20 525.49
_ Jun 07 ` Withdrawal pebit Card CHECK CARD 50.51- 474.98
k�f2ANSACTION DATE - 06i06/2013 '
�` ° ` i UTTER'S FARM STORES��# CARLISLE PA � � � �
;
!'"'�����f�� > • � � 10,474.98
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:, Jun:07 _ `Check'001068 T.iace� 0000234792 ' 27.60- 10,447.38
.' Jura ;12 � Withd�awal PbS�#247541 . ' 95.90- 10,351.48
'��� �t�S-�1F�S."26285I'�BLDG 844�CARLISLE��PA �� � �
' Jun�.14 Withdrawal Debit Card CHECK CARC� �` <,� �f 100.00- 10,251.48
06/13 BOI�ING SPRINGS TAVEs�ZN BOILING SPRIN P � � �
Jun 14 Deposit by.Check `�, , 2,5QU,00 12,751.�,°,
Jun 14 Withdrawal �, '� " 500.00- 12,251.4t3
Jun 16 Withdra�val Debit Card CHECK C D 66.17- 12,185.31
�Tf�4NSZIETION DATE - 06 5Y2013� �� � � � � � �
06/14 RUTFER.'S FARM S RES # � 'LISLE PA
� � 13,057.31
�. J�r��19 r.�Deposr �r ,_ ec, � �� � 112.00 � 13,169.37
� Jun 19 `Ch�ck'001�7� Tracer 0000223875 1,500.00- 11,669.31'
'. J�an 20 ;Uhl�thd�aw�`al�D�bit Card CHECK CA D ��� 60,51- 11,608.80
�,r� ` � 0��'19�K�tLYS KORN R I� �.y �
` Jun�20 Chec"k 001069�'Tracer 000024 ��
�x�� J''' �2� ithdraw�`�a�`� ��bt�Card CHE �B �`-�- 11,583.80
, p � � �
�.��.��: � .:��,.����,��� �,� � �. -
�'� 37.71 11;546.09
�;�� - � �; �ISA�TIQN DAT���J.�O/201���� s�.��;� �_����a`,.`^�
;�� � r��' ���`0�6=��,9,;�R,lJ,,,,�TER S„FARM S.TORES�# CARUSLE PA
� ��1 ,� � Wi�hdra�f�D��it Card�CHECK CARD `
���� �;;��.� t� r ��4,7(�6/�2�*��1TTER'S FARM STOF2ES # CARLiSLE PA `�.�- 11,500.06
� ,� � �-1I�itl��i�au��P�,��C�rd�.CI�ECK.,CARD
99.19- 11,400.87
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�- �,4����'� �R � � � Q6� ��FA�IRFI��D INN & SUITE H FiUNTINGDON PA
�:, �� �; � �Check�001�73:T�r�acer 0021828142 776.58- 10,624.29
"'� ' �.���r �� t ��'ro��sse��J,�C�ieek CHASE Tl'PE: CHECK PYMT ID: 9200602070
�,;�,�un�4 ��ding.6�a/ance 10,624.29
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St $end Inquiresto:
��. 5000 Louise Drive Main Switchboard: (800)283-232$
EZ Call: (717)697-4372 or(800)283 4372 May 25, 2013 thru Jun 24, 2013
PO BoX 40 TOD: (717)697-5312 or(800)283-2328 ext.5312 354-1]] Account Number: 213586
MEMB�1" Mechanlcsburg,PA 17055 TeleBranch: (800)237-7288 page: 2 Of 2
www.membersl st.org
CHECK SUMMARY
Check # Amount Date Check # Amount Date
001068 27.60 Jun 07 001072* 1,500.00 Jun 19
001069 25.00 Jun 20 001073 776.58 Jun 24
*Astensk next to number indicates skip in numbe� sequence
4 Checks C/eared fo�2,329. >8
vSAVINGS -ACCOUNTS >:.
0000 -REGULAR SAVWGS
Date Transaction Description Additions Subtractions Balance
�" May 25 Ba/ance Fonvard 933.60
May 31 Deposit Dividend 0.150% 0.11 933.71
Annua/ Percentage Yie/d Eamed 0. >50�from 05/01/2013 through 05/3>/20>3
�.� 5,903.76
�IE XXXX�OWCX Snare 0000
�Jun 07 ������ � 17,071.66
�O XJ�;}OCKXXXXX Share 0000
Jun 08 Withdrawal at ATM #t003556 300.00- 16,771.66
MEMBERS 1ST FCU 321 YORK ROAD CARLISLE PA
Jun 14 Deposit by Check 10,500.00 27,271.66
Jun 19 Deposit ACH XXSOC SEC : 972.00 28,243•66
ID: 9031736013 CO: XXSOC SEC
Jun ;19 Withd�a�wal Transfer To Share 0019 872.00- 27,371.66
,w.�J3rn--19_._�.�:,�1Ni�hd��wa1,...�.n�.� .... ....__w,�:���_,__.:a__4....��= w. _ ._ . _.._, _ 836.18- 26,535.48
���-Vi"sa` Payment � � � � ��
✓un 24 Endiny Balance 26.535.48
YTD SUMMARIES
�.�, rtK�u.�;�TOTAL'�..DI�1t7�NDS`P�41D� . .:. __. ..._..___�, .._ .._ . _ _
Od00 REGULAR SAVtNGS 0.56
0011 CHECKING 0.00
Total Year To Date Dividends Paid 0.56
NOTE: Total includes closed shares
Don't forget about our r�ew Member Loyalty Rev+[ards Program.
The moreproducts you h�re with us, the mor" be�efits you'll receive.
Ask an associate for details or vis� our website at w�.r��mbers1 st.org for details.
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��'; pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City-- - _ __ State ZIP
Year{s)Commission Paid:
Z• Attorney Fees:
750.00
3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.)
3,500.00
Claimant RICHARD A. MILLS
Street Address 342 FIRST STREET
City BOILING SPRINGS State PA ZIp 17007
Relationship of Claimant to Decedent SPOUSE
4• Probate Fees: 138.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
�• THE SENTINEL,PUBLISH ESTATE NOTICE 189.54
s. CUMBERLAND LAW JOURNAL,PUBLISH ESTATE NOTICE 75.00
TOTAL(Also enter on Line 9, Recapitulation) $ 4,653.04
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(O1-10)
�� �' pennsylvania SCHEDULE �
� DEPARTMENT OFREVENUE
[NHERIfANCE TAX REfURN BENEFICIARIES
RESIDENT DECEDEM
ESTATE OF: FILE NUMBER:
MARJORIE A. MILLS 21-13-0644
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. RICHARD A.MILLS,342 W.FIRST ST,BOILING SPRINGS,PA 17007 SPOUSE 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
�
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��t�� �i11 �t�t� C�����x�en�
OF
MARJORIE A. MILLS
i, MARJORIE A. MILLS, of 1218 Claremont Road, Carlisle, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this as and for my Last Will and Testament, hereby
revoking and making void any a�d all former Wills, Codicils, or writings in the nature
thereof, by me at any time heretofore made. �
FIRST: I hereby order and direct my Executor, hereinafter named, to pay
�
all my just debts, funeral expenses, testamentary expenses and all lnheritance, Estate,
Transfer and Succession Taxes, as soon as may be conveniently done after my death,
out of my residuary estate. �
�
�
SECOND: I authorize that any organs or tissue which may benefit any
!iving ind���ir�ual may be removed from my body ��pon my death, and direct that m�.� body
be cremated. �
THIRD: I have left a list of various items of personal property with my
Will, designating specific individuals to receive some items of personal property which are
�
not mentioned in the Will. I direct my Executor to distribute said items of personal i
i
property in accordance with this list. i
�
�
�
i
I
I
_ I
, �
FOURTH: i hereby give all the rest, residue and remainder of my estate ;
�
to my husband, RICHARD A. MILLS, provided he survive me by thirty (30) days. �
FIFTH: In the event that my said husband shall predecease me or fail
�
;
to survive me by thirty days, I hereby make the following specific bequests: �
A. If not given by my husband previously, or at his death, I hereby
I
give his Browning 308 deer rifle to his son, SCOTT A. MILLS;
B. If not given by my husband previously, or at his death, I hereby
i
give the gold coins presently in his safe deposit box in Dauphin Deposit Bank & Trust `
i
�
Company to his grandson, MAITHEW SCOTT MILLS; ;
' I
C. I hereby give the jewelry which my husband gave to me to my �
1
husband's children, CRAIG A. MILLS, SCOTT A. MILLS, and CHRISTY A. CLARK; '
D. I hereby give my diamond engagement ring and diamond
pocket ring to my husband's grandson, MATTHEW SCOTT MILLS; �
E. I give my mother's diamond engagement ring to my grandson,
KIEL JAMES FISHER.
SIXTH: I give all of the rest, residue and remainder of my estate, in
equal shares, per stirpes, and not per capita, to my children, DEBORAH S. MARTIN, of
Lancaster, Pennsylvania, SUSAN S. PRICE, of Myrtle Beach, South Carolina, and DAVID
M. SCIALABBA, of Huntingdon, Pennsylvania, and my husband's children, CRAIG A.
2
MILLS, of Huntingdon, Pennsylvania, SCOTT A. MILLS, of Cape May Court House, New
Jersey, and CHRISTY A. CLARK, of Huntingdon, Pennsylvania.
LASTLY: I nominate, constitute and appoint my husband, RICHARD A.
MILLS, to be the Executor of this my Last Will and Testament. In the event that my said
husband shall be unable to serve as Executor for any reason, 1 appoint, my daughter,
DEBORAH S. MARTIN, as Executrix. No Executor or Executrix shall be required to file
bond in this or any other jurisdiction.
, IN WITNESS WHEREOF, I have hereunto set my hand and seal this
,
i
�_ day of �,��.:��:.�i,-�..._._ , 1997.
'�;.:.�.;.s�?..�:X:..�= e��--- ���-'����'
�arjorie A. Mills
SIGNED, SEALED, PUBLISHED and ; .
DECLARED in the presence of:
� .�./-� 'j f1.
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COMMONWEALTH OF PENNSYLVANIA :
: ss
COUNTY OF CUMBERLAND :
1, MARJ{}RIE A. MIL.�S, Testatrix, whose name is sigr�ed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that 1 signed and executed the instrument as my �.ast Will; that 1 signed it
willingly; and that I signed it as my fr�e and voluntary act for the purposes therein
expressed.
�worn or affirme to and acknowledge efar� me, by MARJORIE A.
MILLS, the Testatrix, this _,.._ �)�1. day of � ; ,t _., 1997.
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:� Marjorie A. Mills, Testatrix
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COMMONWEALTH OF PENNSYLVANIA :
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COUNTY OF CUMBERLAND : ;
We, JAN�S D. FlAwER, JR. and N�.'F'►�TF' MARIi�.'VKA ,
the witnesses whose names are signed to the attached or foregoing instrument, being
duly qualified according to law, do depose and say that we were present and saw
Testatrix sign and execute the instrument as her Last Will; that she signed willingly and
that she executed it as her free and voluntary act for the purpo�es therein expressed; that
each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that
to the best of our knowledge the Testatrix was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by �� M���
and J�s D. FrAw�x, �t. this I� ,day of l� , 1997.
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tary Public
N07AF11Al8EAL -
TEREBA J.BItRICNOLDER,Notary Publfc
Carilste.Cutnberiend Cotx�ty.PA
pAy Cpmm4qslpn Expkes Fob.21.2000
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