HomeMy WebLinkAbout08-21-13 ' 1 y5Q561�140
�J REV-� r3�Q ex �o,.,o�
PA pepartment of Revenue OFFICIAL USE ONLY
Bureau of Ind'+vidual Tazes Camty Gode Yeaz F�e NumDer
PO 8dX 280601 �NHERITANCE 7AX RETURN 2 1 1 3 0 1 4 2
Hardsbum PA)7128-0601 FtESIQENT DEGEpENT
EN7ER DECEDENT INFORMATION BELOW �
Socia!Security Number Date of Oeath hihsDDVVYY Date of Sirih rAMDOrYVv
0 2 Q 1 2 Q 1 3 0 4 C! 2 1 9 2 1
Decedenfs Last Name Suffix DeCedent's First Name MI
L A C K E Y C L Y D E A
fif Appiicabiey Enter Surviving Spouse's Mformatlon Beiow
Spousa's Last Name Su�x Spouse's First Name MI
Spouse's Social Seaurity Numbar
TNIS RETURN MUST BE FtLED IN DUPLICATE W4TH THE
REGISTER OF WILLS
FIII.IN APPRpPRlATE OVALS BELOW
Q 1.Original Return � 2.Supptementa!Return � 3.Remaindet Retum(dste af death
prior to 12-1382j
� 4.Limited Estate � 4a.Future Intereat Campmmise(dste af � 5. Fetlerai Estate Tax Retum iiequired
death after 12-12-82)
Q 6. Decedent Died Testate � 7.Decedent Maintained a Living Trusd _ &.Tafal Number of Safe Deppsit 6ox8s
(Attach Copy of Wiii} (Attach Copy of Trust)
� 9.litigation Proceeda Received � 10.Spousa!Poverty Credk{date of death � t 1.Election to tax under Sec.91 i3{A}
belwean 1231-91 and 1•t-95) �ttach Sch Oj`: °:n
CORRESPQNDEN7-iNlS SECTpN MUST BE C06�I.ETEQ.AL!CORRESPONDENCE AMD C6}lFIOEN71Al 7AJ(INFQ�iAT�N UlD$E Oq�CTEp T4:
Name Daytir�T�flphone Number � �'
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S U S A N J • H A R T M A N 7 �rn"� �c 4 r,`� 7 , 7�:i 8 Q
;ra-..;,;.,,,A,.�rr.,.. r_' -. , -rs
�@g6157E$�AF WILLS U9E ONLY �
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� ) c: ' 3
First line pf address � t�� . -
. � - t
1 I R V T N E R 0 W � � ' c� y ;:;,
�� ��
Second line of address
City or Poat Office State ZIP Cade _�_. �ATE fltED
C A R L I S L E P A 1 7 0 1 3
corresPonaenrse-maiiaadreas: susanolduncanhartmanlaw•com
Untler par�sitlan W PerNi�Y,i tladare Met!tfeve exsmhied tlrti reWnt.inciudLq acCOmpAiryinp BChetluks aM stemtnenta,and i01he bast of my knowf0dga and beiiet,
il ia We.caTed and compleM.DBCIargNpn o/propeMr other than tlro peiaonal repreaentative ie bmgd on all inlqmalkn tN whkfi pre{f9rer h8a arry knowle�lge.
SIG �`E O�SOtf RESPONS BLE FOR FIUNG RE(URN pp(�
r6"� 1-/ //�GS�` �0/.1r
�.�
A • OE�BOX � '�'1 .� SHEPHERDSTOWN WV 25443
SIGNATURE Of PREPAftER OTHfR 7HAN REPRESENTATIVE DATE
A6DRESS
PLEASE USE 4RIGINAL PORM ONLY
Side 1 �
� 15U561014� 15�561014� � �l
• � 1505610240
REV-1500 EX
DecedenPS Social Security Number
oecredenesName: CLYDE A. LACKEY
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. L 5 7 4 4 5 . 1 6
2. Stocksand Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. ,
4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. B 4 � � , 6 2
6. Jointly Owned Property(Schedule F) � Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property �
�scned�ie c� � Separate Billing Requested . . . . . . . 7. 1 1 2 8 , 7 4
8. Total Gross Aaseb(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 6 6 9 7 4 , 5 2
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. $ L 3 8 . 5 0
10. Debts of Decedent,Mortgage Liabilities, and Liens(Schedule I) . . . . . . . . . . . . . 10. 1 6 2 2 7 6 . 4 5
11, Total DeducUons(total Lines 9 anA 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 t, 1 6 7 4 1 4 . 9 5
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. - 4 4 0 . 4 3
13. Charitable and Governmental Bequests/Sec 9113 TmsLS for which
an election to tau has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Taz(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . iq. - 4 4 0 . 4 3
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rete,or
transfers under Sec.9116
(a)(12)X A _ � . 0 � 15. � . � �
16. Amount of Line 74 taxable
at�inea�rate X .o_ � . 0 0 �g_ 0 . 0 U
17. Amount of Line 14 taxable
at sibling rate X .12 0 . � 0 77. � � �
18. Amount of Line 14 taxable
at collateral rete X.15 . 1 g, 0 . 0 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. � . � �
20. FILL IN THE OVAL IF YOU ARE RE�UESTING A REFUND OF AN OVERPAYMENT �
Side 2
L 1505610240 1505610240 J
REV-1500 FJ( Pege 3 Fllp Number
Decedent's Compiete Address: ��' �� d14�
DECEDENTSNAME
CLYDE A . LACKEY
—�—�__.._—..— —_.—,_------
STREEFADDRESS
535 SUMMIT_ DRIVE_ii
----- __._. —_.�—— -------- -- ���--- --- --
CI7Y STATE ZIP
CARLZSIE PA 17013
Tax Payments and Credits:
t. Ta�c Dua{Page 2,Line 19j {1} Q.p a
2. Credi�s/Payments
A.Priqr Payments
B, Discount
tot�Gredfts(A+8} t�) 0�0 D
3. Interest
(3}
4. If Line 2 is greater ihan Line i +Line 3,enter the difference.This is the OVERPAYMENT.
Fi31 in ov�d on Page 2,Uns 20 ta requat a refund. (A} p .0❑
5. 1f�ne 1+��e 3 is greater tharr Line 2,enter the difierence.This is the TAX WE. {5) 0 ��D
Make check payable to: REGISTER bF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X" IN THE APPROPRIATE BLOCKS
1. Did derzdent make a trarasfer and: Yes No
a. retai�the use or income M Ure property trans(erred: ..................._............._......._.......---.....---....... ❑ Q
b. retain the right to designate who shell use the properry transferred pr its income; .............
c. reGain a reversiarary interesk;w ......_......._............................................................................... ❑ �
d. receive the promise tor life of either payments,banefits or care7 ....................................................... ❑ �
2. If death occurred after December 12,t982,did decedent transfer property within one year of death
withuutreceivingadequatecrosideration? ..................._......................_........._....._.._._..............._ ❑ �
3. Did decedent own an`in hust(a"or payable-upon-death bank account or securiry a�his pr her daath9 ......... ❑ 0
4. Did decedent rnm�t irsdiriduat reHtement ao�ur�t.�nuity or othet twn-pr�5�e property�whidt
containsabeneficiarydesignation?............................................................__................_................ � ❑
IF THE ANSWER TO ANY OF 7HE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RE7URN.
F�dafes of deatlt ar or a€ter July 1, 2994,and before Jan. 1, 1995,the t�rate imposed an ihe net value of transfers to or for the nse of the surviving spouse is
3 percent(J2 P.S.§9116{a)(1.11(i)1.
For dates of death on or after Jan. 1, 1995,ihe tau raie imposed on the net value of transfers ro or for the use of ihe surviving spnuse is 0 percent
(72 P.S.§9116{aj(1.1)(a)�.fie staEute�es rrot exempt a Uansier to a s�troiving spouse tr�n tsx,and i�e statutory requirements fw disdosura af assets an@
filing a tax relum are s611 applicable even if the surviving spouse is the only benefiaary.
For dates of deafh on or aftet July 1,2QOli:
• 7he tau rate imposed on ths net v�e of Uansfers from a deceased child 21 years af age or youru�er at deattr to�for the u�of a natur�parent,an
adop6ve parent or a stepparent of ihe child is p perc�t[72 P.S.§9116(a)(1.2)].
• The tau rate imposed on the net vaiue ot transfers to or#or the use of the decedenYs iineai beneficiaries is 4.5 percent,except as noted in
�z as.§s�ts(�.2►p2 P.s.gs»s{a?(�)]
• The tau rate imposed on ffie net value of transCers to or for the use of ihe decedenYs siblings is 12 percent p2 P.S.§9116(a)(1.3)].A sibling is defined,under
Sec6on 9142,as art individu�vAto h�at feast one parent in camrnatt with the decedent,wheiher by 6bod w adoqtion.
REV-1502 EX�{01-1Q)
pennsylvania SCHEDULE A
• OEPARiMENT pF RE4ENUE
REAt ESTATE
INHERIiANCE TAX RETURN
RESI�EN!DEGEOENT
ESTATE 6F: FiL6 NUMBER:
C�YDE A • �ACKEY 21 13 0142
Aii reai ptoperty owned aat�yt w as a tenaM fn comman muat be repoRed at fair maricet vaiue.Fair market vai�e is defined as the price al which prc�petty
would be exchangeed between a wiAing huyer and a wiNing sel�,nee�hhw beiru� M 6uy ar seN,botlt having raasa�abie krrowledge�the reiea�tt facts.
Real proparty that ta Jolnityowned wkh right of eurvlvonhip muat be dixcloeed on Schedule F.
Attach a copy M Ne settlement sheet if the propeAy has been soW.
ITEM Include a copy M the deed showing decedenPs interest'rf owned as tflnant in aNnm�n. VALUE AT DATE
NUMBER �ESCRIPTI�N OF DEATH
7,. 535 SUfiMIT DRZVE 157,445•16
CARLISLE, PA 17013
CSEE HUD SHEET ATTACHE4]
ToTa�.(tdso�ter on t;r�e t,Recapimlati«i.} S 157,4 4 5.16
M mae spacs is neaded,ase sddi6anal sheeh cd paperof tlre same size.
REV-i508 EX*(&98)
, � SCHEDULE E
COt�NWEAITtiOFPENNSYLVANiA ti+Aa7H, BANK QEPOSlTS� Ot ����.
INHERRANCHTAXRETURN p��SONAI PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CLYDE A � LACKEY 21 13 0142
lnch�de ttre proceeds IN Cfigation and tlte da§�the proceeds were 2teived by the esiate.
All property joi �uwnad with figM o!survHon6ip must be dbebsW on&heduN F.
ITEM VA�UE AT DATE
NUMBER DESCRIPTION OF DFATH
t. M8T BANK ALtT• # 423270 2,8$2 .6`1
CSEE DOD lETTER ATTACNEDI
2. M8T BANK ACCT . # 4232?Q 429•49
CSEE 40D LETTER ATTACNED]
3 • BANKER�S LIFE - REFUND 80.75
4 � CAPITAL BLUE CROSS - REFEtN➢ 212 .19
5� �ENTINE� - REFIlND 42.41
6 • SALE OF tHAIR 20.�0
7• FR4CEEDS PROM SALE 4F PERSONA� PROPERTY 1,117 .18
8 • AAA REFUND 46.75
9. INA - 4HS0 tASUALTY REFUND 124 .U�
10. REAL E3TATE ESCROW FORFEITED 8Y PURCHASER tDEFAUt�T) 1,�00-t}❑
11 • COUNTY TAXES 08/082 013 TO 12/31/'cd13 42Q•47
CSEE Hl1D SMEET ATTACHED]
12• SCHObI TAXES 08Ii18/2D13 TO 06f3012�14 2,1724 .69
[SEE NUD SNEET ATFACHEDI
TQTtd.(Risa enter on line 5,Recapituiation} S 8,4 00•6 2
(it mae spare is r�eeded,i�sert addiN�onai sheeis ot ihe sart�e sizej
qEV.gan cx+(98-0P;
pennsylvan'ra SCHEDULE G
. pE:P,�=�NTO�R�,�N�E INTER-VIVOSTRANSFERSANd
iNr�ERiTar�TrxaETUwu MISC. NON-AROBATE PROPERTY
RESIDENiOECEDENT
�STA7E OP FRE NUIt�ER
CLYDE A • LACKEY 21 13 Q142
'fi�ssciieduW must be completad and filad i(ihe ariswer to arry o(questions i Nrough d on page three oF the REV-15W�yes.
OESCRIPTION OF PRqPER7Y
ITEM n�ur��t�µ�pvn�rau�s�nEe.rrcmneunC+swpTOOecEOerrtam DATEOFDEATH %OF6fCD"S EXCLUSION TAXABLE
NUMBER ri+eoahaarnu+SCea.nrrAC�+�,coevorrr�a�oFOasea.ESUh. VAlUEOfASSET INTEREST �svci.r..ei,� YA�UE
t. ANNUITY 1,128�74 1�0-OQ Z,128.74
T4TA1. Also enter on l.ine 7,Rec�ilutatlm S 1,12$•7 4
It mwe space's needed.uge additlanal ahee�ot P�erof tlie s�ne size.
RE'V��15'1 FX+(10-p9)
pennsylvania SCHEDULE H
� oep�wrn+errroFR�� FUNERALEXPENSESAND
INNEPoTANCETAXRE7URN ADMINISTRATIVE COSTS
ftES40ENT L�CEDENT
ES'TATE 4F PILE NUMBER
CL.YDE A . LAtKEY 21 13 �142
�scedenCS de6b mu�t be npoRed e�SehmduM 7.
ITEM
NUMBER DESGRIPTION AF�iOUNT
A. FUNERAL E?(PENSES:
1.
B. ADMINISTRATIVE COSTS:
i. personai Representative Commissions:
Namats)of Perwnal Represenfative(s)
Stleet Address
City S� Z!P
Year(sj Comm�issa�Paid:
7, ntromerFees: DUNCAN & HARTMAN, Rt 5,000•Od
3. Famityy Exemptian:(7t tlecede�Cs addresa ia rrot the same as dsimenCS,atlach eupienaibn.)
GlaimaM
Street Address
City State ZIP
RelaGOnship of Claiment W Decedent
4, propa�epe�s: REGISTEft OF WILLS 138.5U
5 AcwuMant FeeS:
6. Tan ReNm Preµa2r Fees;
7.
TOTAL(Alsq enter an Line 9,Recapitulatlon) S 5,y 38•5{i
If rtara spa:e o needed.use additlonal sl�eep of paper of Ihe same siae.
REV-t572 EX*(72-OB?
pennsylvania SCHEDULE !
. °ER'�T"�"TOFRE"E""� DEBTS OF DECEDENT,
iNr+�RiTANC�Tn�cRETUw+ MORTGAGE LIABILiTIES,8 LIENS
ftESI�ENT DECEOENT
ESTATE OF FII.E NUMBER
CI.YDE A . LACKEY 21 13 0142
Report dabb incurred by the decedent prior fo deaN that remained unpaid�the date af de�,iaciuding unre}mbuned medical expanaes.
ITEM VALUE AT DATE
NUMBER DESGRiPTION OF DEATN
t. SUSQIIEHANNA OZL CBMPANY 290-�0
2. LENTURYLINK 122 . 53
3 • PPL 47.35
4 . CIA 89 •85
5- BOROUGH OF CARLISLE 72. 9p
6 - SHANE BOUDER 6S�•�q
?� SUSQUEHANNA 4iL C4h1FANY 290 �D0
$ . PPL 30•78
9- OHIO CdSUALTY HO►1EOWNERS INSURpNtE 125.�0
1Q• PPL 25 .77
11� 3USQUEHANNA OIL COMPANY 29�.�D
12, CENTURYLZNK 4 • 10
13. PPL 2Q. 5?
14 . tENTURYIINK 25.88
15= 90R4UGH 4F CAftt�ISLE — W8S 72 �90
rorai(ruso ema a�une»,R�iw�i«t) S 16 2,2 7 6 • 4 5
11 nwre space is needed,irue�t�di6onaf she8C4 at the 9ame 3'¢e.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
•CLYDE A. LACKEX
DecedenPSName 21 13 0142
Page 7 File Number
Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16 • YARDWORK AND REPAIRS 230. 00
17. PPL
18 . 90
18 • CENTURYLINK 25.88
19 . CRIME INTERVENTION ALARM C0. INC• 89. 85
20- PPL 20 �77
21 . CENTURYLINK 25 . 88
22 • OHIO CASUALTY 125•�0
23• PPL 27• 51
24 • YARD MOWING 80 • OD
25. CENTURYLINK 27.07
26 . ACCP INC . 896 • 64
[SEE HUD SHEET ATTACHEDI
27. STATE TAX/STAMPT DEED 1,550.U0
[SEE HUD SHEET ATTACHEDI
28 • 2013 COUNTY/TWP TAXES TO BOROUGH OF CARLISLE 1,179 • 88
CSEE HUD SHEET ATTACHED]
29 . 2013-14 3CHOOL TAXES BOROUGH OF CARLISLE 2,259•97
CSEE HUD SHEET ATTACHED]
30• OVERNIGHT PAYOFF TO SADIS SULLICAN ROGERS yy , 07
CSEE HUD SHEET ATTACHED]
SUBTOTAL SCHEDULE I 6,571. 4 2
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
•CLYDE A. LACKEY
DecedenPSName 21 13 0142
Page 2
File Number
Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
31 . FINAL WATER/SEWER TO BOROUGH OF CARLISLE 85 • 86
[SEE HUD SHEET ATTACHED]
32 • PAYOFF OF FIRST MORTGAGE TO FINANCIAL FREEDOM 145,502• 7B
CSEE HUD SHEET ATTACHED]
33 • REALTORS ' COMMISSION 7,750• ��
34 . PPL
8 . 76
SUBTOTAL SCHEDULE I 15 3,3 4 7• 4 U
GRANDTO7ALSCHEDULEI S 162,276.45
Rev-�s�a ex.�a+-�o�
pennsylvania SCHEDULE J
' OEPARTMENiOFREVENUE BENEFICIARlES
INHERITANCE TAX RETURN
RES�OEkT OECEOEH7
ESTATE OF: FILE NUMBER:
C�YDE A - LA{KEY 21 13 Dy42
REtATIONSHIP TO DECEt7ENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S}RECElVfNG PROPERTY Da Abt llat Truatee{s} dF ESTATE
I. TAXABLEQI5TRIBU710NS pndudea�+mMSpousaidisv�wtiansazMtramt�,asu�
Sec.9iis(ai172).]
i. J • LEE LACKEY Collateral
P• 0 • BOX 1971 50% SHARE
SHEPERDS7'{SWN, WV 25443
2. STEVEN C. LdCKEY
9 RIDGE R6AD SOi SHARE
ESSEX JUNCTION, VT �5452
ENTER QOLIAR AlJIOUNTS FOR DI3TRIBUTEONS SNOWN ABOVE 4N LENES t5 TNROUGN 18 dF REV-1500 C6VER SHEET,AS APPROPRIR7E.
j�, NON-1AXAS�E DISTRISUTl4NS:
A.SPOUSAL OISTRIBUTIdNS UNDER SECTlON 9113 FOR WHICN AN ELECTIQN TO TAX IS NQT TAKEN:
1.
B.CHARITABI.E AND GflVERNMENTAt LNSTRIBUTK}NS:
t.
T4TAI.8F PART II-ENTER TdTAL NON-TAXABLE DISTRIBUT(ONS ON LINE 13 OF REV-1500 COVER SHEET. S
If rtare space is ne5ded,use additionai sheets o1 paper of the same size.
- � - .
LAST WILL
&
TESTAMENT OF
I, CLYDE A. LACKEY, of 535 Summit Drive, Cazlisle, Cumberland County,
Commonwealth of Pennsylvania, being of sound and disposing mind,memory and understanding,
do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking
any and all other wills and codicils heretofore made by me.
FIRST. I direct that all my just debts and funerai expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be interred within my family's burial plot in Letort
Cemetery in accord with my expressed wishes.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a swtable mazker for my grave.
FOURTH. I give, devise and bequeath all of my estate of whatever nature, be it real,
personal or mixed, and wherever situate unto my nephews, J. LEE LACKEY and STEVEN C.
LACKEY in equal shares, per stirpes.
FIFTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my
estate Passing under my will or otherwise, shal( be paid out of the principal of my residuary
estate.
SIXTH I hereby nominate, constitute and appoint my nephew, J. LEE LACKEY as
Executor of this my Last Will and Testament. In the event of renunciation, death, resignation or
inability to act for any reason whatsoever of J. LEE LACKEY, I nominate, constitute and appoint
my nephew, STEVEN C. LACKEY as Executor of this my Last Will and Testament. I hereby
relieve my Executor from the necessity of posting security in connection with his duties, as such,
in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. In
addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to
retain in the form received, and ro sell either at pubtic or private sale any real or personal
property owned by me at the time of my death.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, consisting of one typewritten page this 3'�`� day of MA�, , 2005.
J
z� Q, �'k�
CLYDE A. LACKEY
,
Signed, sealed published and declazed by the above named Testator CLYDE A. LACKEY as and
for his Last Will and Testament, in the presence of us, who, at his request, in his sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
/����1���/ ,
COMMONWEALTH OF PENNSYLYANIA .
. SS.
COUNTY OF CUMBERLAND .
I, CLYDE A. LACKEY, Testator 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.
�-�/�i¢- Q� ��
CLYDE A. LACKEY
Swom or�rmed to and
acknowledged before me, by rd
CLYDE A. LACKEY this 3 day
of �v�a.J , 2005.
�cc�,tr n2 i �,�u,rnp,i�
Notary Pts '
NOTARU1l SEAL
Natlty L Mummut,Notary Pahlic
Baough of GrIhM,Cumberland Co.,PA
My Commbflan Expires Aug.11,2007
. ,
COMMONWEALTH OF PENNSYL[�ANIA .
:SS.
COUNTYOF CUMBERLAND .
We, �Sa�.S• �A�M4h and Soaw��. �a�5 thewitnesses
whose names aze signed to the attached or foregoing instrument, being duly qualified accotding
to law, do depose and say that we were present and saw CLYDE A. LACKEY sign and execute
the instrument as his Last Will; that he signed willingly and that he executed as his free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the
Testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at
that time eighteen(18) or more yeazs of age, of sound mind and under no constraint or undue
influence.
��
Swom or affirmed to and
subscribed before me by
SK 54v��� F"Gt�itneN az1d
�oo-r7. fldav.,g
, witnesses,
this 3�day of ��^�y , 2005.
J
��,tl,u, r� vY��,+m��
o� b���
NOTARIAL SFU '
Kathy L MummMR NofuY Publk
Bcrough of Carqah,Cumbwifnd�°•+�
Idy Commission Expir�_ �_ �4_���?�'r-�
o►re a�ro�r Na.ssoaozea
�� � A. Settlement Statement (HUD-1) �
1.Q FHA 2.�J RWS 3.�Cww.U�i�s- 8'' Numbar: 7.Loen NurnSef: 8.MoRpapl InwraFfo� Wunp�f:
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Page: 1 Document Name: untitled
PSCUPR03 Customer Service Workstation
EBRN6MW 09 :38 : 07
Customer Profile 13/02/06
M&T BANK
Title . CLYDE A LACKEY SSN/TIN: 174202558
535 SITMMIT DR Phones : 717-243-2166
CARLISLE PA 17013-3624
Employer . DECEASED DOB : 210402
Sex : M
RM: HI551 CONNIE KERSTETTER Maint : 130205
BK REL: PRG BK SVC: Search Company 097 ? N
Enter S To Select One of the following Customer� s Accounts:
Sel Account Number Product SubCode Status Rel Opened Balance , ,3N
423270 DDA R6 99 ??? 6709 758. 08 � �J�'',`^�-{
DDA A2 99 IND 6709 2, gg2 , 69 ��G
15004204128927 DDA 7M 99 IND 0210 429.49
F2 Options F3 Main Menu F6 Referral F7 Backward F8 Forward F12 Previous
Date: 2/6/2013 Time: 9 : 40 : 03 AM
. _ _._.._-----_____
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��/= SECURITY BENEFIT` ���� ��'f��
_ _
�l� Life Insurance Company
Check Date: febru 13 2073 Check Num: ppOgppg7gq /
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CONTRACT NO 8021222
REFERENCE NO. � �
OWNER CLYDE A WCKEY �
ANN[IITANT CLYDE A LACICEY � i . �
PAYEE SOEL L WCKEY � � �
DEATN BENEFIT - DEATH
PROCESS DATE 02/12/2013
CHECK AMOUNT $ 564.37
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