HomeMy WebLinkAbout10-03-13 i
.-�--� REV-1500 �"°'^°' 1$p5610143
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. PA Department M Revanue pen va�ia ' 6FFlCIAi_USE ONCY
�I 8ureau of Individual Taxes �^MTMe�F�E�«�F cw�nycaae re.r Fp.rmmoa
PO BOX.280601 INHERITANCE TAX RETURN 21 1 g 017 5
ttarrisbur�,PA 17128-0601 RESIDENT dECEDENT
E DECEDENT tNF6RMATtON 9ECOW
30 'al Security Number Data of Deatfi Date of Bidh
12 28 2012 03 14 1929
De denPS t.ast IVarrw Su�x DecetleM's First IVame MI
HUGHEY CARROLL J
(!f ppticabie}E�ter Surviving Spouse's Informatian Beiow
Spo se's Last Name Su�x Spouse's Firet Name MI
Sp use's 8ocial Security hfumber
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
�i �w aar�zoP�are av,+as s��aw
� 1. Oripinal Retum ❑ 2. SuppiemeNal Retum � 3.Remalnder Retum(tlate ot Geaih
� pdorto 12.18•82)
[� ) 4. LNnited Es�Ue CJ 4a{wq a�ce.�,�4r�� t�2-12n�} ❑ b. Fedeiai EEtaM Tax RflWnt RequkEtl
� g, DaasOent DNtl TeMMe � �, De�n t MeinleiMd s LivinB TNe1 � B, Totel NUtt14@f o(Safe�BpO41l BoxeB
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� 9. litlgeibn PrCCaetls Recei+�f � 10.bet�iva�e t�2at B,��-t�-&S}�aeath Q 1 t.EkcUOrf tb tatt under Sec.8513(A}
(AtiacM1 Sch.O)
CO RESP4NDENT•THIS SECTION MU3T BE COMPLETED.ALL CORRESPONDENCE AND CONFIqENTIAL TAX INFORMATION SHOU�D BE DIRECTED TO:
Na e Deytime Tele{�o�Numbar
� C AZG A DZ&HZ, ESQUZRF CPA 717 763 :2-613
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� � Deneen C.Riccio /
AD E6S
3 82 Enola Road,CariF&le, PA 17015
$ICa TURE qF PFtEPMER pTMER THF R RESENTATIVE DATE
` Craig A Diehl Eequire CPA
R E
64 Trindie Road, Camp HiU, PA 17011
Side 1
� 15056101M3 150561t1143 �
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II' REV-1500 EX
'�, DecedenYs Social Security Number
o�a�,r.N�: HUGHEY, CARROLL J
ECAPRULATION
1. Real Estete(Schedule A).......................................................................................... 1. 15 7 � 5 0 0 . 0 0
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Held Corporalion,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedula D).......................................................... 4.
5� Cash,Bank Deposits 8 Miscellaneous Personal Property(SChedule E)................ 5. 1 4 � 1 7 0 . 8 5
6. JoinUy Owned Property(Schedule F) ❑ Separete Billing Requested............. B. 1 0 9 . 8 5
7. Inter-Vivos Transfers&Miscellaneous Non-Probate PropeAy
(Schedule G) ❑ Separate Billing Requested............. 7.
8. Total Grosa Assets(total Lines 1-7)....................................................................... 8. 1 7 1 � 7 8 0 . 7 0
9. Funeral Expenses 8 Administrative Costs(Schedule H)......................................... 9. 13 , 8 5 4 . 9 3
0. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 3 6 � 2 4 2 . 7 5
1. Total Deductlons(total Lines 9 8 10)...................................................................... 11. 5 O , 0 9 7 . 6 8
2. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 1 2 1 , 6 8 3 . 0 2
3. Charitable and Governmentai Bequests/Sec 9113 Trusts for which
an election to tax has not been made(SChedule J)................................................. �3.
4. Net Value SubJect to Tax(Lina 12 minus Line 13)................................................. 14. 1 2 1 , 6 8 3 . 0 2
AX COMPUTATION•SEE INSTRUCTIONS FOR APPLICABLE RATES
5. Amount of Line 14 taxable
at the spousal tex rate,or
transfers under Sec.9116
(a)(12)X .00 15.
6. Amounf of Line 14 taxable
at lineal rate x oa5 121 � 6 8 3 . 0 2 �6. 5 � 4 7 5 . 7 4
7. Amount of Line 14 tarzable
al sibling rate X .�p 17.
8. Amount of Line 14 taxable
al collateral rate X .15 18•
9. 7ax oue..................................................................................................................... �9. 5 � 4 7 5 . 7 4
0. FILL IN THE OVAL IF YOU ARE REQUESTING A REPUND OP AN OVERPAYMENT. ❑
Sid@ 2
1505610243 150561U243 J
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RE�'-1500 EX Page 3 File Number 2 7 . 1 3 - 0175
De edenYs Complete Address:
Hughey, Carroll J
ST EETADDRESS
3292 Enola Road
CI STATE ZIP
Carlisle PA 17015
Ta Payme�ts and Credits:
1. ax Due(Page 2,Line 19) (1) 5,475.74
2. redits/Payments
� Prior Payments
. Diacounl
Total Credit9(A +g) (2) 0.00
3. nteresl
(3) 0.00
q. I Line 2 is greater than Line 1 +Line 3,enter the difference. This is tha OVERPAYMENT. �q�
Check box on Page 2 Line 20 to requeat a refund
5. I Line 1+Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 5�475.74
Make Check Payable to: REGISTER OF WILLS, AGENT.
;"�"3�'�'��xht.w�.,.<....t,'.�i.a,'.�3�...._u..b�.'��'L'i�s;..<'s'.-,r:�.. , ......c�.v... ..�,�.,i�, �iE".... 1i. ..u,.'v�.'�'t '�vL:�.�re`w�e � �Y'v��rS"� �°.io���
PLEASE ANSWER THE POLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. ralain the use or income of the property transferred:.................................................................................. x
b. retain the right ta designate who shall use the proparty trensferred or its inwme:.................................... � �
c. retain a reversionary interest�or.................................................................................................................. X
d. receive the promiae for lite of either paymenis,banefita or care4.............................................................. X
2. If death occurred afler December 12, 1982,did decadent trensfer property within one year of death without
receiving adequate consideralion7....................................................................................................................... ❑ �
3. Ditl decedent own an"in trust for' or payabb upon death bank account or security at his or her death?......... � �x
4. Did decedent own an Individual Retiremenl Account,annuity,or other non-probate property which ❑ ❑
contains a beneficiary designation?.................... . ... ....................................... x
IF E ANSWER TO ANY OP THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
t � , . ..�:.? ,.�' ..iw,. '��ii :.:'k"�`--`�� .
f_. �f`L� v� :'��P4`�: 6cMC t..i6 :.k"'�.3� 1 .
For eles of death on or efier July 1,1994 and before Jan.1,�995,the tax rate imposed on the net value of transiere to or for the use of the surviving
spou a is 3 per�nl[72 P.S.§9116(a)(1.1)(i)1.
For atea of death on or after January 1,1995,the tax rate imposed on the nel velue of transfers to or for the use of Ihe surviving spouse is 0 percent
p2 .S.§9118(a)(1.1)(ii)]. The sfetute does not e�rempt a trensfer to a surviving spouse from tax,and the statutory requirements for discloaure of
asse and filing a tax rafurn are still applicable even�f tfie surviving spouse is the oniy beneficiary.
For ates W dealh on or aftar July 1,2000:
•Th lax rete imposed on the net value of transfers from a deceased child 21ye ars of age or younger at death lo or far the use of a netural parent,an
ed ptive parent,or a stepparent oi the child is 0 percent p2 P.S.§9116(a)(1.2)].
•Th tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in
72 .S.§9116 12)[72 P.S.§9116(a)(1)1.
•Th tax rate imposed on the ne!value of transfers to or for fhe use of the decedenPs siblinga is 12 percenl[72 P.S.69116{a)(1.3)1. A
sibi ng is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether Dy blootl or adoption.
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� SCHEDULE A
� TM„�,,,v,,,, REAL ESTATE
IME��NCE TN(RETURN
� PEBIOEMOEGEOEM
ESTATE F Hughey, Carroll J FILE NUMBER
21 - 13-0175
All real p pe owned sole{y or as a tenant in common muat be re�portsd at fair market value. Falr market value Is deflned as the prlce
at which p opert would be exchanged between a wiNing buyer and a wiNing seper,nekher befng compelied to buy or sell,both having
reasonabl knowledge of the relevant facts. Real property which Is Jolntly-owned with right of survivorship must be disclosed on
schedule .
Attach e copy of the selllement sheat it the property has been sold.
Include a copy af the deed showing decedenPs interest if owned as tenant in common.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 3292 Enola Road 157,500.00
Carlisle, PA 17015
Assessment= $157,500.00 x. 1.0 CLR Factor
TOTAL(Also enter on Line 7, Recapitulation) 157,500.00
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� SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
c Tnor�r»�srwraw PERSONAL PROPERTY
INIERRANCETNIRETURrv
MEBIOEH�OECFDENT
FILE NUMBER
ESTATE F Hughey, CB�roll J 21 - 13-0175
Include th proceeds of Iltigation and the date the proceeds were received by the estate.All property Jolntly-owned with the right of
survivors tp must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Citizens Bank-Checking Acct.#6100705854 734.31
2 Citizens Bank - Checking Acct. #6234005288 13,436.54
TOTAL(Also enter on Line 5, RecapltulaUon) 14,170.85
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I� ' SCHEDULE F �
CO ONWEALTHOFPENNSVLVANIA �
INHERITANCETN(RETURN ; JOINTLY-OWNED PROPERTY
RESI�ENT DECEDENT
ESTATE F HUghey, Caf�011 J FILE NUMBER
21 - 13-0175
If an asse was made Joint within one year of the decedenYs date of death, tt must be raported on schedule G.
SU VIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
D neen C. Riccio 3292 Enola Road Daughter
p Carlisle, PA 17015
Sh ryl A. Ward 221 Pine Boulevard Daughter
g Orwigsburg, PA 17961
JOINTL OWNED PROPERTY: N
ITEM LETfER DATE Indude name o i ancwl in�tRUQion an ban account numbe DATE OF DEATH %OF DATE OF DEATH
NUMBER ���INT MADE or similar identifying number.Attach deed forjointiy-hald real VALUE OF ASSET DECD'S DECE ENrs i�rreaes'r
TENANT JOINT estate. INTEREST
1 A, B 08/16/1996 Member's 1st Federal Credit Union 3Z9.58 33.3% 109.85
Acct.#72961-00
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TOTAL(Also enter on Iine 6, Recapitulation) 109.85
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SCFIEDIA.E H
n�oc p�anvnrvw ���&
INMERRpNCE TIJt RERIRN AI'NIR\�CT�A?1�Ic/+/X�TQ
0.EBIOEM oECEOENT fYJ111A1\F71 f W I IYG V W 1�7
FILE NUMBER
ESTATE o Hughey, Carroll J 21 - 13-0175
Debts of decedent must be reported on 3chedule i.
ITEM DESCRIPTION AMOUNT
NUMBER FUNERA�EXPENSES:
A. 1 Malpezzi Funeral Home- Funeral Expenses � 8,933.00
2 Mechanicsburg Cemetary Association -Opening & Closing Grave Costs 1,150.00
3 Mechanicsburg Presbyterian Church - Funeral Service Cost 100.00
B. ADMINISTRATIVE COSTS:
t. Personal Representative's Commissions
Name of Penonal Representalive(s)
Street Address
i .City Stale Zip I
Year(s)Commission paid �
z. nnor�eys Fees Law Offices of Craig A. Diehl 3,000.00
3. Family Exemption: (If decedenPs address is not the same as claimanYs,atWCh explanation)
Claimant
Street Addreas
Ciry State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills . 353.50
5. AccountanPs Fees �
6. Tax Return Preparer's Fees
Z i Olher Administrative Costs
1 i Cumberland Law Journal- Estate Advertisement 75.00
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TOTAL(Also enter on line 9, Recapitulation) 73,854.83
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C MONVJEALTH OF PENNSYLVANIA I A .. ..F�I�I E/���E�&
INHERRMlCE TA%RETURN /�'■n��yyp�'(�`a'��'N,�
RESIOENf DECEDENT
ESTATE F Hughey, Carroll J FILE NUMBER
21 - 13-0175
2 The Sentinel - Estate Advertisement 200.16
3 Law Offices of Craig A. Diehi-Reimbursement of DPW Certified Mail Costs 6.11
4 Citizen's Bank-Service Charge on Estate Checking Account 7.17
5 Citizen's Bank-Maintenance Fee on Estate Checking Account 9.99
6 Cumberland County Orphans Court- Family Settlement Agreement Fee 20.00
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Page 2 of Schedule H
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SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
,„„�,,�E�,��,r�;^��^ LIABILITIES, & LIENS
REB�EMOELEOENT
I
FILE NUMBER
ESTATE F Hughey, Carroll J 21 - 13 -ot75
Report de ts incurred by the decedent prior to death that remained unpaid at the date of death, Including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 PA Department of Revenue-2012 PA Income Tax Liability 19.00
2 Pam Burkeholder- Lower Frankford Township Tax Collector-2012 Local Taxes 395.16
3 AmeriGas Propane- Final Gas Bill 280.00
4 Century Link- Finai Telephone Bill 91.76
5 Adams Electric- Finai Electric Bill 220.00
6 Direct TV- Final Television Bili 86.38
7 United Consumer- Loan Payoff 264.39
8 American Heart Association -Yearly Membership Fee 30.00
9 Citizen's Bank- Equity Line of Credit Account No. xxxxxx0933 34,856.06
TOTAL(Also enter on Line 10, Recapitulatfon) 36,242.75
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REV-067J EXi(1 I�-081
i SCHEDULEJ
CO MONWEALTMOFPENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE F Hughey, Carroll J I FILE NUMBER
j 21 - 13-0175
! RELATIONSHIP TO I SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) �. DECEDENT I (WOMs) ($$$)
RECEIVING PROPERTY De Net Lbt Tru�l�e�a)
I, iTAXABLE DtSTR�BUTIONS[include oulrght spousal —`
distributions and lrensfers �.
under Sec.$116(a)(12)] �
1 Deneen C. Riccio Daughter 1/7
3292 Enola Road
Carlisle, PA 17015
� Sheryl A. Ward Daughter 1/7
�I 221 Pine Boulevard I
' Orwigsburg, PA 17961 'I
Tami G. Keck Daughter 1/7
309 E. Portland Street
Mechanicsburg, PA 17055
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Enter dollar amounGS tor distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,es appropriate.
II NON-TAXABIE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
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B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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TOTAI OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O.00
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REVd610E%+(8 0)
' SCHEDULEJ
�o MONWE�LTHOFPENNSYLVANIA BENEFICIARIES continued
INHERRANCE TAX RENRN
RESIDENTDECEDENT
ESTATE F Hughey, Carroll J FILE NUMBER
21 - 13-0175
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBE NAME AND ADDRESS OF PERSON(S) DECEDENT ; (WOMs) ($$$)
RECEIVING PROPERTY Do Nat Lirt Tru�layq
I, TAXABLE DISTRIBUTIONS[include outright spousal �'�
disiribulions and lransfers '�..
under Sec.5116(a)(12p I,
Kim P. Hughey Daughter 1/7
276 Ridge Hill Road
Mechanicsburg, PA 17050
Lucinda S. Aaronson Daughter 1/7
I 101 East Main Street, Apt. 3 '
j Mechanicsburg, PA 17055 '
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Georgina H. Buziak Daughter 1l7
288 Red Cedar Lane
Marietta, PA 17547
Gregory M. Hughey � Son 1/7
431 West Simpson Street ' ��
Mechanicsburg, PA 17055 �,
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Page 2 of Schedule J
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�c`��� ���� c`�xl.� l'J��,'�'�c��1�x1�
OF
CARROLL J. HVGHSY
I, CARROLL J. I3IIGHEY, of Lower Frankford Z'ownship, Cumberland
ounty, Pennsylvania, being of sound and disposinginind, memory and
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nderstanding, do make, publish and declare this to be my Last Will
- nd Testament, hereby revoking and making void a11 pYevious Wilis
nd Codicils heretofore made by' me .
FIRST
I order and direct my peraonal representatives hereinafter
amed to pay all of my juat debts, -funeral expenses and exp�naes
nvolved or connected with the admin'iatr�tion of my estate as sooa
fter my death as reasonably possible. However, my person�l
epresentatives need not accelerate and pay those unmatured
bligations which, in their opinion, it might be proper and more
dvantageous to retain or renew and pay as they become due and
ayable . I hereby authorize and direct my personal representatives
o have my physical remains interred at the Mechanicsburg Memorial
emetery.
PAGE 1 OF 5
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L�AST WILL AND TESTAMENT OF CAI2RC}LT, J. HUGAEY
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I g}ve, devise and bequeath the rest, residue and remainder of
y astate together with all insurance praceeds thereon of
hatsoever nature and wheresoever situate in equal shares to my
�hildren, SHERYL A. WARD. DffiNBSN C. R2CCI0, KSM 8.. ��88Y, LLIGTAiDA
. AARBNSON, t380Rt�INA H, P�NDSLTON, TAtfi� G. 'ICECK, aad t�31�H{�ORX M. _
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C3�EY, who aurvive me by thirty (30) days, per stirpes . I direct
y parsonal representatives to divide ainong �ueh berieficzar�ee alI
ersanal property of 'a sentimental r�r fami7:y nature (excluding
�ash, stocks, bands and the like) , -including but - not� 3zmited to
ewelry, househald goods, antiques, furniture and meznorabilia, in-
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�ccardance with a separate memorandum which I may place with my
i12 or deposit with- my attorney. In Che- --absence of suc�t
ispasition by memorandum, I dir�ct that the eaid taslgibTe" pereOfiai"'" "' �
roperty be divided between my residual 'beneficiaries with due '
egard for their personal preferences in as nearly equal shares as
ractical, with the value of such dispositions being credited to
he� share of each respective recipient. I£ the said benefieiaries- -
o not agree to the da.vision of the personal property pravided for
ereuncler, the decision af my persanal represantatives, including
he decision ta sell the property at public or private saZe and
istribute the proceeds therefrom as pravided hereinafter, shall be
final and eonclusive on all parties.
PAGE 2 C?F 5
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ILAST WILL AND TESTAMENT OF CARROLL J. HUGHEY
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' T82RD
I grant my personal representatives the following powers in ,
ddition to and not in limitation of such powers as my personal
epresentatives shall hold by law:
(a) To retain, all, property received including the. stock of ,
ny corporate fiduciary acting' hereunder, provided such property
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emains productive.
- (b) To joi�-- in any corporation, partnership;
ecapitalization, merger, reorganization or voting tr-ust p1an; to
elegate autharity with respect thereto; to� deposit investments
nder agreement@ and pay asaesaments; and generally to exercise all
ighta of investors, including but not limited to, the voting of -
hares . _
-, (c} To manage, operate,- repair, improve; mortgage or lea�e on'
ny terms any reaZ=--estate held or owned by my estat�: '
(d) To operate any -business that I may own at my death.
(e) To inveat any funds of my estate in any stocks, bonda,
otes or other, securitiea ,or property,, real or personal„without- - -- -
egard to the principle-of diversification or any other statute or
eneral rule of law in their absolute discretion, it being my
'ntention to give my personal repreaentatives the broadest
investment powers possible, providing such investments do not
u necessarily prevent the prompt aettlement of my estate .
PAGE 3 OF 5
C':-�' ;�`,
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LAST WILL AND TESTAMENT OF CARI20LL J. HUGFIEY
( {f} To sell or atherwise dispose of any presperty, real or
personal, tangible or intangible, at any time forming a part af ,my
�( state in any manner and an such terms and canditions as my
ersonal representatives shall see fit in their absolute
iscretiqn.
� {g} To barrow rnone for the
y payment of Caxes o-r for "any other
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roper purpoaes in the administration of my estate, and to mortgage
�r pledge estate assets as-security.- ..
' (h) To cornpromise claims without court approval ' including,
ut not limitsd to, any-aontroversies .aith the Un;ted States- ot
merica or the Commor�wealth of Pennsylvania concarning estate and -
nheritanoe taxes on any interests that may pass under this my Last
ill and Testament.
(i) , To distribu�:e in cash or is� kind upon any d�vision ar °
�ietribution of my estate. '
(j ) To undertake any and a11 acts deemed neceasary and praper
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�y my personal representatives for the proper, advantageous and
rampt management of the. settlament of my estata. - - - .. -
(k) In general, to exercise all powere in the management of
y estate which any indivicival coulct exercise in the management of
imilar property owned in his own right, upon such terms and
onditions as to them may seem best and to execute and deliver all
instzuments and to do a11 acts which they deem necessary or proper
t carry aut the purpaees af this, my Last Will and Testament . '
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T WILL AND TESTAMENT OF CARROLL J. HUGHEY
FOURTH
No interest of any beneficiary of my eatate, either in income
r in principal, shall be subject to anticipation or pledge,
ssignment, sale or transfer in any manner, nor shall any
eneficiary have the power in any manner to charge or encumber his
r her intAreat either in income or principal, nor shall the
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ntereat of any beneficiary be liable or subject in any manner
hi�e in th�--posaession of my personal re�Ye'sentatiives for the
iability of such beneficiary.
FIFT$
I nominate, constitute and appoint my daughters, SH�RYL A.
-- ARD and IIENEEN C. RICCIO, as Co-Executrices of this my Last Will
nd Testament . I direct thab- my personal- representatives ahall not - �
e required to give or post bond for th'e' Paithful performance of
heir duties in this or any other jurisdiction.
IN WITN$8S iqFiSREOF, I hereunto set - my hand to this .my Last .
�,
ill and Testament this �_ day of �-��.�`���z�,,e.sij , 1996 .
C
ITNESS :
�. Q . ric.C. ��r'L.��ifi-�� ���. �«-4%.l.GCi'
CARROLL J. UGHEX:f P�—
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�ST WILL AND TESTAMENT OF CARROLL J. HT3GHEY
( ACICNOWL87,}GffidENT
42+4IONF}EALTFI dF PENNSYLYANSA .
. 83.
OUNTY OP' CU/Y1B�lzc.iFn./L� •
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I , GARROLL J. HTJOHEY, the Testatrix whose name is signed to
_ he attached or_foregoizig .,instrument-,...hauing--been. dul�r.._qualifi�ci-.__ —... _
�ecording to law, do hereby acknqwledge that I signed and executed
�he instrument as my Last Will and Testament; that I signed it
illingly, and that I signed it as my free and voluntary act for
he purposes therein expressed.
_ � 7
�.��-�..Y �-. `7 .�,,n� .
. CA�E2ROLL J. HE , , , .
Sworn or affirmed and acknowledged before me by CARROLL J.
I �^
C�HBY, the Testatrix, this It3'`�'` day of � ).t.u1,7�P:rx}ak.��—
,
996 . _
� � Y ��
�-a���
NOTARIAL SEAL
HELEN E.RASMUSSEN,iVatary pul�Gc
� Camp tli3l 8orough.CumherlaaGM Oaunry
My Commissian Ezpires Aug.2, 1999
�
� S
�
�ST WZLL AND TESTAMENT OF CARROLL J, HITGHEY
( AFFZDAYIT
�flI+�dONWEALTH dF PENN$1'LYANIA .
SS.
�OUNTY Ol� ('v�1L�G�-�� .
�
�
WE. � �� I),`e k � and c��/r9��/ G�. �/'�'C2�
�he. witnesses_ whase_.namea._axe atLachect. to_-the _fnregoing. docurae�t-,____- ----
eing duly qualifiefl according to law, do depose anc3 say that we
�ere present and saw Teatatrix sign and execute the -instrument as
er Last Will and Testament; that she signe8 willing2y and that she
xecuted it as her free and voluntary aet £or the purposes therein
xpresse8; that eaeh subscribing witae�s in the hearing and sight
f the Testatrix signed the Last Will and Testament as witneesed
�nd that tn the best af our knowledge the Testatrix was at the time
8 or more years of age, af saund mind and under no constreint ar
�ndue influence .
�ti� �
f�. � �/°��!�ar�,�! .. _. .
T
� Swarn ar affirmed. and suhscribed before me by t'`tkt �` • �2.�,f
_,_ and �L�Gt.I-i L.. .Ni%LCE this � day
f �,. '�'�'A",�7-�<1.f:.�- , 1996.
f�„.:_---
( ���
NOTARIAL SEAl.�
� HELEN E.RASMUSSEN,Notary PuWic
Csnp Mill Borough,Cumberland County
- My(Ammi.^,sion Expivrix Auq.2,1999 '