HomeMy WebLinkAbout10-09-13 � _T
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�I REV-1500�"�"`-"� 1505610143
PA DepaRment of Revenue OFFICIAL USE ONLY
PQ11118Y V81118 Counly CaEe Veer FNe Number
� Bureau ot Individual Taxes �M1MNiUF11EVEX�E
ao eOx.2eoeoi INHERITANCE TAX RETURN 2 1 13 019 4
'� Harrisburg,PA 17128-0601 RESIDENT DECEDENT
EN R DECEDENT INFORMATION BELOW
S ial Security Number Date of Death Dale of Birth
02 08 2013 11 20 1929
De de�l's Last Name Su�x Decedent's First Name MI
ARBACIR RAYMOND R
(H pilcable)EM.er SurvNing Spouss's InformaSlon Balow
Sp use's Last Name Su�x Spouse's First Name MI
Sp use's Social Securily Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FIL IN APPROPRUTE OVALB BELOW
� t. Oripinat ReNm ❑ 2. Supplemental RMUm ❑ 3.Pnor andZr 3�j(om a oeau,
� 4. Limifetl Eatate � 4a.Fun+^im«ea cwipromi.s � 5. fetleral EMaM Tax Relum Required
(Eele of EecM eM1x 12-12-82)
� g. oac.aem Ww r.wU � 7. oeeeeent Ma�ntaMSe a uwne i�un 8. Total Number ot Safe Depoatt Bo�roa
(Alladi Copy o!WAp (Albdi Capy ol Tusl)
� 8. Litlpation Proceeda Received � 10.5���PZO 3My8Cr tlil'(Da95�Deeth ❑ 1 t.��S e�Eub O)�.8173(A)
C ESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRE8PONDENCE AND CONFIOENTIAL TA7(INFORMATION EHOULD BE DIRECTED T0:
Na e Daytlme T
elsphone Numbar
LISA MARIS COYNE BSQ 717 737 0454 "'0
c> �.� � �n
rn cs
RE61�R�F WILLSO�RE(�`C�
i
��.,, _;- C; ,_4 ry9
FI tLIneMAddrsss r=' '-�;�,. r''�. cD r3 �-'' �
3901 MARKET 3TREET "' �, " -n
" ' -�. -�;
��.� � ., -�r
3 ond Lina of Addross ��.> , ..:`� � ��:� � �
:� c- r-,
>, rv r-
^DATE FILED N N
CI or Post OfNCe Shte ZIP Cods
CAffiP HILL PA 170114227
C pondeM's�maNaddrps: H88�COy8iOdCOy118.CO1F1
n� aue,�co'n�°ac�`ua���"°oea.�a w��om�'e�rsme�n me p�ena0ion�i re'�peaenmw�e is.`�eae0aea'�InM�n a whld�p�rM Iw uryk��owletlpe.Eelkf.
SIG 7URE OF RSON RESPONSI FOR FILIN RENRN pp7E
Richard J. Garbacik /lJ— O8— /
A RESS
2 7 N. 17th Street, Camp Hiil, PA
SI OF EROTHER REPRESENTATIVE pp�
�
� LISA MARIE COYNE Esq O — -2D
ES6
i Coyns, P.C.
Ma�lcet Strset, Camp Hill, PA 770714227
Side 7
1505610143 1505610143 �
�\
_ _ _
� 1505610243
. REV-1500 EX
, Deeedanfa Soaal Sewrily Number
I w�a.�m.N.�: GARBACIK, RAYMOND R
ecnriruurioN
t. Real Estate(Schedule A).......................................................................................... 1.
2. Stodcs and Bonds(Schedule 8)............................................................................... 2. 1 . 4 2 3 . 8 5
3. Closely Held Cofporation,Partnership or SolaProprietonhip(Sehedule C).......... 3.
4. Mortgagea&Notas Reeaivable(Schedule D).......................................................... 4.
5. Cash,Bank De osils&Miscellanaous Pereonal Pro e 2 3 , 3 0 8 . 3 5
P P rtY(Schedule E)................ 5.
6. Jointy Owned Property(Schadule F) ❑ Seperete Billing Requested............. 6.
7. Inter-Yvoa Trensfera 8 Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested............. 7.
8. Total Gross As�ets(total Lines 1 through 7).......................................................... 8. 2 4 , 7 3 2 . 2 0
9. Furrerel E�enses and Administrative Costs(Schadule H)..................................... 9. 1 3 , 7 3 7 . 5 0
10. Debta of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10. 6 4 1 . 0 0
11. Total Dsduetlons(total Lines 9 and 10).................................................................. 11. �1 4 . 3 7 8 . 5 0
12. Nst Valus of Estate(Line 8 minus Line 11)............................................................. 12. 1 0 . 3 5 3 . 7 0
13. Charitabb and Govemmental BequestNSec 9113 Trusb for which
an election to tax has not been made(Schedule J)................................................. 13.
14. Nat Value SubJect to Tax(Line 12 minus Lina 13)................................................. 14. 1 0 . 3 5 3 . 7 0
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at Me spousal tax rete,or
trenafen under Sec.9116
(a)(1.2)X.00 15.
16. Amount of Line 14 taxable
at Iineal rete X .045 �6�
17. Amount of Lina 14 taxable
at sibling rete X .12 9 , 6 4 1 . 7 8 ��� 1 , 15 7 . 0 1
18. Amount of Line 14 texable
at collateral rate X .15 7 1 1 . 9 2 �e 10 6 . 7 9
19. TAXDUE................................................................................................................... 19. 1 , 263 . 8U
20. FILL IN THE OVAL IF YOU ARE REQUESTINO A REPUND OF AN OVERPAYMENT. ❑
Slde 2
1505610243 1505610243 J
_ i __ _ _ __ ___
RE1✓-1500 EX Page 3 File Numbsr 21 - 13 - 0184
cedeM's Complete Address:
' GARBACIK, RAYMOND R
S REETADDRESS �
108 April Drive
CI � STATE ZIP
Camp Hill PA 17011
Ta Paymertts and Credits:
t. TaxDue(Page2,�ine19) (�) 7,263.80
2. CredftslPayments
A. PriorPayments 1,000.00
e. Diacount 52.63
TotalCredits(A +e> (Z) 1,052.63
3. Intereat
(3) 0.00
4. If Line 2 is greater then Line 1 +Line 3,enter tM difference. Thia is the OVERPAYMENT. (q)
Chsek box on Page 2,Lins�0 to roquest a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the diHerence. This is the TAl(DUE. (5) 211 .17
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWINC, QUESTIONS BY PLACING AN "X" IN THE APPItOPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. rotain the use or incoma of the property trensferred:.................................................................................. ❑ x
b. retain the right to designate who ahall use the property transferred or its income:.................................... � x
c. retain a rovenionary interest�or.................................................................................................................. �
d. receive the promise for life of either payments,beneflts or care?.............................................................. �x
2. If death occurted efter Dac. 12, 1982, dW decedent trensfer property wHhin one year of deeth without
receNing adequate conaMeretion9....................................................................................................................... ❑X ❑
3. Did decedent own an"in trust for° or payable upon death bank aaount or security at his or her death7......... � �
4. Did decadent own an individual relirament account,annuity,or other non-probate property which
contains a beneNCiary designation?....................................... .......................................................................... ❑x ❑
IF THE ANSWER TO ANY OF THE ABOVE OUE$TIONS IS YES,YOU MUST COMPLETE SCHEDULE O AND FILE IT A8 PART OP THE RETURN.
Fw dates ot deeth on or aRer Jup t,1994 and before Jan. 1,1995,the tax rate impoead on the nat value of hansfe�a to or for the use of the surviving
s uee is 3 percent[72 P.S.§9116(a)(1.1)(i)1.
For��tss of Math on or aftsr January 1, 1995,the tax rate imposed on tM net velue of transfen to or kr the use of the surviviny apouse is 0 pereant
[72 P.S.$9118(a)(t.1)(i�]. The sfaeute does not exempl a tranafer to a aurviving spouae trom tax,and the statutory requimmonta for disGOSUro ot
es and t�ing a lax rofum erc sNll applkabb even if the auniving spouae is the oniy benMeiary.
For dates of death on or aRer Juy 1,2000:
hx raPo imposed on the net value of tranafero from a deceased child 21ye ars of aga or younger at death to or for fhe use of a natural parent,an
�a optive parent,or a atepparent of the child ia 0 percent(72 P.S.§9116(a)(1.2)].
•T tau rate imposad on the net value of trensfen to or far the use of the decedanfs lineal beneficiariea is 4.5 percent,except as noted in
[7 P.S.§9118(a)(1)].
hx nte imposed on Me nM value of transfen to or for the use M the decedenfs siblinys is 12 percent[72 P.S.59116(a)(1.3). A
•s Ilnp is AeRned under Section 9102,as an Indivitlual who has at bast one paront in common with tha decedent,wFether by blo�or adoption.
_ _ _ _ _ _ _ _
REV4607 EX�(ilYt�
�i SCHEDULE B
�uTM��gn�� STOCKS & BONDS
�. iwenrnwcenvc�nnH
. REBpENTOECEDEM
FILE NUMBER
ESTATE F GARBACIK, RAYMOND R 21 - 13-0194
All prope JolMly-owrrod with rlgM of survivoiship must bs discloasd on Schedule F. �
ITEM DESCRIPTION ' UNIT VALUE ' VALUE AT DATE OF
NUMBER ' DEATH
1 ' 362 Common Shares of Allied Irsh Bank(AIBYY) , 99 358.38
2 I 31 Common Shares of Welis Fargo(WFC) �� 34.37 ' 1,065.47
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TOTAL(Also enter on Iine 2,Recapltulatlon) 1,423.85
T __ . _ _ __ _
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99+
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Dow j0.65 Nastlaq j1.18%
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VYells Far Q�COfl��fl�/�WFC) - NY3E Atltl to PqHolb��, ;� Like 314'.
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Da1e Open Hph Low Ciose 4bhims MJ Cbss'
Feb ,20Y3 1A1 1.01 0.88 0.99 53,100 0.99
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� �ennsylvania SCHEDULE E
� PARTMENT OF REYENUE �i�u � I
IN ER7'fAqC€TAXftETURN K {7, ANK DEPOStTS AMD MISC.
R�'SIDENTOECEDENT � PERSONAL PROPERTY
__---;— - ---- -- —
YFItE NUM86R
ESTATE F �ARBACIK, RAYMOND R I21 - 13-0194
_----_ _- - --�—.----- L�—_.-
Indude th proceeds of liUgation and the date#he proceeds were raceived by the estate.AIi property 1�Mty.awnsd with#he right of
survivora ip must be disciwed on scheduie F.
�TEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1� 2414 Jeep Pahiot SUV{B(uebook Value-143,000 mi(es} ' 8,234.00
2 Wilminton P�ime Money Market(M&T Securities)Account No.AZD-318988 14,074.35
3 Misc. Personal Property and Fumiture 1,000.00
�_. _—__ TOTAI{Atao ertter an Llne 8,Rscapltulatlon} 28,308.35
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��� � � �r�
� 499 Mitc6e11 Roed,Millsboro,DE 19966 Adjustrnmt Smices �
. � � Phone 888-502-0349 .
F ax (302)934-2955 �
oyne&Coyne,P.C. �12,zois
ttarneys at Law
1 Market Street
amp HiIl,PA 17011-4227
0 L� [� � 0 d �
APR I 5 2013 D
Re: E�p+P of R�mond R Gazbac' �
Social Securitw 207-22-7678
Date of Deai#t• Februerv 8 2013
Sir or Madam:
e�'}�an'i�uny on April 4,2013,please be advised that at the time of death,the above-named decedent l�ad on
' with this bank Uie followmg:
1. Type ofAccrnmt ChecldngAccoio�
Accowt Nwnba 9859314809
Owr�slup(Nanes ofJ Ricluvd.l. Ga�bocik
Raymond R Gmbacik
�P�B�e 11/70/2072
Balmice on Dote ofDeath $974.80
Accrued buerest S .00
Totd $974.80--------------
2 TypeofAccv+ou SavrngsAccaoit ,
Accwo�lNronber 15004220420860(close�d03/Q8/2012)
Ow�shq�(Nmnes ojJ RicJ�dJ. Garbacik
Raymond R Gmbaci,E
�P�+S�e 03/30/1009
Balmrce on D�e ofDeadr $0.DO
Accnied buerest S .00
Totd - -----------------------------------
• $0.00
� _ _ __ _ _
'�.. For any odditlooai iuformation on the above accounp,including ownerohip end any cha�es,cloeurea and/or rdmbunemtet of fLnde,. � �
_ �'�.. pineenlltheWntShorcPl�aat717-T31-1730. � � .
'�We�vere uoable to louh any e�fe deporit boz for Me abovo-menHoned decedmt � ��
.. �I 17tir k10er doo not indude auy accoanh in whic6 We dxnetd mry hm bem tl�ed u Power ot Atlorney,C�todhn d Uoi/urm 1Yaoder�,
ReprnentaBvePSYx,arTtwkeunderaWrittmA�ut , �
$IIICCfE]y,
. ��8[1C'�CET ��� � �
AdJustment ServiceS
�- ._ _. .
Rev.,s�oex.�alao� gEPARATE BILLING REQUESTED
p�nnsylvania
DE ARTMENTOFREVENUE SCHEDULE G
INH�RITANCETAXRENRN INTER-VIVOS TRANSFERS 8
RE IDENTDECEDENT MISC. NON-PROBATE PROPERTY
— � _ _ '
ESTATE O GARBACIK, RAYMOND R FILE NUMBER
21 - 13-0194
Th(s schedule must be completed and flled ii the answer to any of questions 1 through 4 on page 2 la yes.
— —
ITEM ��II DESCRIPTION OF PROPERTV � DATE OF DEATH ��. y'�F EXCLUSION I
inauae uie nsme a m.vanaaros,drolr ideaa,.nip a aeceaen� oeco s TAXABLE VALUE
NUMBER �p�dpeolVansbr. Att�ch�copyofMeCeeGlan�leNme �ALUEOFASSET INTEREST (�F�PP����) �
1 ; Real Estate Gifted to Brother, Richard J. Garbacik on ' ias,�oo.o0 3,000.00 140,100.00
' September 26, 2012: 109 April Drive, Camp Hill, PA ' ! I
(Assessed Value) ' '
�I Separate Billing Requested: ', �
I Richard J. Garbacik I�
' 221 N. 17th Street, Camp Hill, PA 17011 � i ,
i
�I� � I�
2 MetLffe Mnuity No. XXXXX1913 sa,o�a.�s � i� ' 34,074.19
' Beneficiary: Richard J. Garbacik, Brother '
i , i
II Separate Billing Requested: I I 'i
� Richard J. Garbacik, Brother II I
I I
I
3 American Generel Life Annuity No. AXXXX950A t�5,nt3a , 115,721.34
Beneficiary: Richard J. Garbacik, Brother ' ,
Separate Billing Requested: ', '� , I
Richard J. Garbacik ' ' ��
Brother ,
4 American General Life Mnuity No. AXXXX048A ' 9e.e�3.�2 ' ; 98,873.12
Beneficiary: Richard J. Garbacik, Brother ', I
ISeparate Billing Requested: ' �� I
I
Richard J. Garbacik, Brother ' ', !,
i
i
_ i
TOTAL(Also enter on Ilne 7,Recapitulatlon) 447,268.13
- _ _ _ _ _ _ .
reev.istoex.�deoq SEPARATE BILLING REQUESTED
� �ennsylvania SCHEDULE G
D PARTMENTOFREVENUE INTER-VIVOS TRANSFERS &
�N�ERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
R SIDENTDECEDEM
continued ;
� - -- —--
ESTATE P GARBACIK, RAYMOND R FILE NUMBER
21 - 13-0194
This sehedule must be completed and Rled i(the answer to any of questlo�s 7 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTV ' DAiE OF DEATH I %OF '�, EXCLUSION
NUMBER� ��d�����������'������ad���� � VALUEOFASSET �' OECD'S '��,,(�FAPPUCABLE I' TAXABLEVALUE
rM the MM N tramlx. Atlach�mpy of qro EeeE fa roal e�tele �� INTEXEST � .
Western National Life Annuity No. XXXX3674 zi,eea.se I , � 21,994.98
Beneficiary: Richard J. Garbacik, Brother
��! Separete Billing Requested: ' , �
Richard J. Garbacik, Brother ,!I ll I
, �
Westem National Life Annuity No. XXXX8458 za,s2s.�o ', i 24,529.70
Beneficiary: Richard J. Garbacik, Brother , i
i
' Separate Billing Requested:
' Richard J. Garbacik, Brother II I
� Cash gift to Richard J. Garbacik on 2/4/2013 from �a,000.ao I' � 3,000.00 II' 11,000.00
j M&T Bank Checking Account ', �I 'I �I
I Beneficiary: Richard J. Garbacik, Brother I
, !
Separate Billing Requested: ,
�i Richard J. Garbacik I II
8 ' M&T Bank Joint Checking Account No. XXXXX809 s�a.ao , 974.80
Made Joint on 12/10/2012 with Brother, Richard J. II �
Garbacik , I
' Separate Billing Requested: ;
Richard J. Garbacik, Brother ' , �
, ' II
i
i I
, !II
II
– —
Page 2 of Schedule G
COYNE & COYNE
� A PRQRESSIONAI.CORPOH.ATI6N
A'PTORNE'YS AT LAW
�Heary F. Coyne 3901 Market Street 7p7.?g7_p,�¢
!Liaa Zvfaria CoYge Camp Hill,Pennsq3vaaia Fa:4: 717-98'7-51&1
17011-4227 awvw.coynsandcoyne,com
Maq 7, 2013
Registes af Wills ,
Cumberland Carwty Courthouse
One Courthouse Squarc
Gariisle,PA 17413
� Re: Esim"e ofRhymo�d R Cmrhacik
No. 2I-I3-01.��!
3ir or Madam:
Eaclased plesso find Clieck no. 108 fratn Mr. Richard 7. Garbacik in dze am6urrt of$50,9S9.Q0
'oh represeats a discount gayment af inheritaraaec taac owad on-�n-grohate asscts he rexeiva4 and
' 6 are subject to in5ori#ance ta�c. iTpon SIing af the Tnlieritaace Tsar Retum, a sepazaCe billiag wiII be
equcsded for thc assats Uisted on Schedule t"x of which Richartl J. Gazbac�7c is tho ben�ciary. '
Kindly aredii aud docket this paymeut from Richard 7. Garbacik, indivifluatty, and issut to me a
�eceipt for this discount paymart
Thaak you for your assistance. If you have any questions,gtease cantact me.
,
v��y ya�
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pay�bN To: ANET L MILLER,TAX COLLECTOR Ortks Mours: MAR-0CT WE�NESDAY 11-2 8 4-6 BIN No: s80
R9B WALNUT 6TREET APR 27 5 30 48 BtlI WH: &1M2
�PAMP HILL,PA 17011 CASH ONLYAFTER 12f5N2 CartrN No:011D02393
HONE(71�783-0177 �
MM NO: 1-22-0631�10. A�V�: �q:�,epp Irtyxonmst�t 103,500 T 143,100
,.. prc: tOB APRII DRIVE py�H F�a PaWy
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e tty RE 1.9D2 5288.74 S2T2.18 E298.A0
. TRINDLE VILLAGE ��p� q � 743 �p.� ttp,qg �2.51
LOT 18-C !���L -
� �� JpNET L � ar ou� a.oz2 sazs� Srn.00 t�s�e�
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TAXPA R'S COPY-KEEP THIS POR710N FOR YOUR RECORbB
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;�exoM.r�rreR+ nz . 2012 8LtemsM of R�d EM�b Tws .
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+AYMIE v tw ' 34 600 103 500 . 0 lf if1Q.
ro: sa..rra mms,usau e asy. ..
JANET l.MILLER�TAX COLLECTOR nm
19�W STREET cA��1 S.o. � .
CAMP HI PA 170t1 - u� .oiaisasa .oiaisaao � 3* io• .�.
B�ooL $ i e .si .
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lfiINDLE YILLA(3E � . RE7111tlI BLLVYRN PAYIABrt.FpR�BPf H�CL09E SELF,�RB9�
RES�D AL� FAAAILY - � � � � - BT�eNBLOPES4�f�DPESOFaF.L
ux GARBA 11�RAYMONDR FNOTPADt1f1�INt28LLw14�8E8BiT . .
��.e� 409 IL f�AIV� To r�x cwr Fort cou.ECnon a�ei3 A waorerrv uoo.
CAMP ILL PA 17011 ��
NOTICE�PROPERTY TAX RELIEF ..
� Your ent,ioaed te�c dA iKiudas a tax redadion tor ya¢hanssmrd arWlor tanns�{
}q.,p�p-�q-� Ai aa llaneslMd#nNa fYnmt�d OwiMr,you tiave feaeWetl
xre� VYED 11• AND 46 JULY-0CTOBEft �����T�g��djg�,,��P�t��ylve��Generel
aune: SPEC i2-2 Al1G�23&90 p�g�y flee�netl f0 reduae Your properly taxes.
$p 4$AUG 24&35 . , . ..
PHONE: 17)763-017i � � �
_. _�. _...���......_.. �.__.._...-�.-_._....__.-_'----------�-^-_._.___..�....,
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Tax Parcel No. 01-22-0531-010
DEED
THIS DEED,made this��day of in the yeaz two thousand twelve
(201 )
B RAYIMIUND R GARBACIIC,CamP Hill,PennsYl�ania,
Grantor,
AND
RICHARD d. GARBACIIZ,CamP Hi11,Pennsylvania,
Graat�,
WITNESSETH
IN CONSIDERAT`ION of the simm of ONE and A9/100 (S1.90) DOLLAR in ha�i paid, the
mcei �vhereof is hereby acknowledged, the Grantor does hereby grant and convey unto Grantee, his
heus assigns:
ALL THAT CERTAIN piece or pamel of land situats in the Borough of Camp HiII
(formerly Hampden Township) Cimmberland Coimty, Peansylvania, more particutarly
bouaded aad describod as follows,to wi�
BEGINNING at a point on the Eastern side of April Drive which point is at the division
]me of Lots Nos. 15 and 16 on Uu hereinafta me�ntioned plan of lots; 1`HEN+GE North
71 degrees 15 minutes East along said division line a distance of one htmdred thirty-*�inP
and thirty-thrce hundredth(139.33) fcet to a point aY lands now or late of the Camp Hill
Reaity Corporatioa; THENCE South 20 degre�s 23 minutes East a distance of sixty-five
and three hundredth(b5.03)foet W a point at the division lines of Lots Nos. 16 and 17 on
said plaa; THENCL South 71 degrees 15 minutes West atong said division }ine a
disiance of one hundred forty-oae and sixteen himdredth (14i.1� fce�t to a point on the
Eastem side of April Drive; T'HENCE North 18 degrees 45 aunutes Wast along
aforem�ationed April Drive sixty-five (6�feet to a poi�the place of B�GINNING.
J _ _ _ __ _
TT BEiNG Lot No. 16, Block "C" in Plan of Trindle Village, Section 3, which plan is
recorded in and for the County of C�mberland in Plan Book#10,Pages 54, 55 and 56.
' HAVING THEREUN erected a single dwelling house lmown and numbered as 109
April Drive.
TT BEING the same premises wluch Charles F. Shenk and Lysha L. Mooney Shenk, by
deed dated December 18, 1969 and r�orded in Dced Book M, Volume 23, Pege 543,
C�mberland Coimty Recorder of Deeds Office, grsnted and convcyed unto Raymond R
Garbacik and Frances M. Garbacik, his wife. Frances M. (3arbacik died on March 23,
2005, whereupon tide remained vested in Raymond R. Garbacik; suiviving tena�by the
entireties, Crrantor herein.
UNDER AND SIJBJECT to easeme�s, conditions, res�i�Eions�and other matters of reeord°�nrl
any all matters which an inspection or survey of the property would disclose.
TOGETHER with all aad singular the buildings, improvemerns, waYs, �, �eYs,P��B�,
water-courses, rights, libaties, privileges, hereditameMs and appta�tenances whstsoever
belonging, or in any wise appertaining, and the revorsions and remainders, rents, issues and
pro thereo� and all the esrtate, right, titie, interest, property, claim and demand vvhatsoever of hers,
the 'd Gtantor,ia law, equity, or otherwi�howsoever,o� in,to or out of the same.
TO HAVE AND TO HOLD the said lot or picxe of gmund above described,with the buildings
and im�rrovements thereon crected, hereciit8ments and premises hereby giarned or mcrnioned, and
� to be, with the appurtenances, u�to 13�e Grantee, his hcirs and assigns, to and for the only
use aad behoof of the Gtantee,his heirs and assigns,forever.
And the Grantor hereby covenants and agras thal he will warrsnt specialty the properry
here y coaveyed.
__. . . 'i'� IS A 17tA�TS�R FROM BR{}THER TO BRt�`t�R AND �fi 'T�RE�
EXEMPT FROM REALTY TRANSFER TAX,
IN WITNESS WHEREOF, the Cnanwr has hereunto set his hand and seal the day and year
first above writben.
S' seeled and de/ivered
In e pnsence of•
�,.,,...,k�f-.y.�.�i1 cs��
OND R.GARBACIIC
2
. _ _ _
s
CO1�IlIIONR'EALTH OF PENNSYLVAIVIA .
: sa
CO ' OF CUMBERLAND ,
On this, the �day of 2012, before me the undersig�ned officer,
na11y appeared RAYMOND R GARBACIK, lmown to me (or satisfactorily proven) to be the
n whose name is subscribed to the within instrvment and aclmowledged thai he executed the seme
for e purpose therein contained.
IN WITNESS WHEi2EOF,I have hereunto set my hand and seai.
Notary lic
cot�ror�w�r�n+oF Pax+sr�vnnw
w�rwsw
o..�vwn.�.�rwmoo
umaN+eaA.cw�ewrna cway
c:a w oa � tia�Mn.ts mta
I hereby certify that the precise address of the Graatx herein is as follows:
221 N. i 7m Sh�eet
Camp Hill,PA 17011
���b �,
P.trornay for c�rantor
EGM: 316594 ' .
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�� Metropolttan Life Insurance ComP�Y ����
�. P.O.Box 70342
�. Des Moines N 50308-0342
�
" March Q 2013
RICHARD GAFi&4CiK
221 N 17TM ST
CAMP HILL PA 17011
RE: METROPOLlTAN LJFE INSURANCE t�IPANY CONTRACT 073331913_
__ _ _ _ --- - _ _
--- - - DEC`EA$��RAYAAdND aC�AR8�4CIK
D�r Mr.Gazbacik:
We processed a lump-sum distribubon represerrdng �o You un�'1he above-referenced
armuity.We are sending a chedc in the amouru ,074.19 to a�ourrt at MetHfe.
The mxaWe portlon oF your proceeds is s14,d74.19. An IRS Fortn 1�B-R wili bs maqed to you by
January 31,2014.
:� A Tomi Ccxmol AccouM(TCA) has been esmblished for you In the amourat shown above. You wiit be
�9 YWr checkbook and rtiaterial describinp your accour�t shortg+• if you need acc�s ta funds in
the acxourrt P�w�o receivin9l+our oheckbook, piease cali our�H iree number to speak to a Customer
Service Consul�t.
I
If you have any�estlons,piease corrtact your representative w cali aur Cusmmer Servkk:e Genter at
1-800-638-7732( Itent Line) Monday through Friday berireen 9;00 a.m.and 6:00 p.m.,ET.
Sincerely, j
�P Fa9��9 t _ _
Annuity flepr�ve-Post Issue Proc:essing
. ,
MetLife Mnuity Operations and Services
XNp w qry eomNeMd: Pleeee keeP us uDdeOed wilh re�peCt ro aY who are meodLLW wllh tlda ca�tract,k�n0 tl�e oMmer,the
arannWiC s�d arry WnaAc�lea. i�ite aiue tlbt vrs havs V�e iollowkg httomntlon kr al psrauro tv a�fWe: nrns.s�rem,
a6�wre.b�y ca�INng a�x�Smvice C�ed the��d ebove��c�^9 Y�R���-
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Ab71eC1(�&Z.�Cal:I'18'f8�"L!'fe IRSUf1fSCB COtYIp377y VEMDOR hf0, � pOLICY Nt7. � CNECK NO. .-
. . - OAS �. A637t25854A t0903B30 � �2-15
� P.O. 8ox 8Q08�AmariUO. TX 7910� � . � - � - � " 3ii-_
. . . � - ._ 9NY Mellon Truet nF�Naware �� �
- - _ � - � NEW�flKAEL4WAflE . .
- ; , � �" .. PAY TNlS.dM6UAtT �
: �a � � . . . ..
s�*�* �` �NDI�U FIF'L"�ffi�i T'FYOIISANLI_,`SSV,�i FIIINDRED TWENTY-C?NF and 34f100 IiOLLAIt3 , '
n :e,t�-._, �y 2 �f�
h � 1 . . . ��;SiM.Mi#ti1�V�72.1..��fil: . ".
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. - � t�'�lE�D��['f,t}3J�0/t3� � � Twp signaCUres�.required - � -
3
I° � �' ' �.� , � if over 5254,000.00 -� .
w�S01�1�FTER'g b80 DAY3 `� � , .
- 3.'Yi:.r;� ,_. . �, .=. �c ,'.._._� . ._- , i:,- - i�a.
'��" PAY `='�rRt�EtARD J GARBACfK . - - - " . .
�, � T�TNE - - 221 N,4 7'FI ST -��. . . .
�� �DN.y'D.�ER�� Cnh4P�i`ii�;Fn ��o�� / 7,�7.r4� ` �
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JI '' u' iC}9Q363Q�' r:Q3ii0Q35i+: 03C![39563Q7�'
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�A. Ba � amer�o, nc 7st� ct3[�cK� �o9oasao
• iNTfRNAL REFEAENCEC 220q018246
TRANSACF#ON STATHNENT
NAME: RAYMOND R. GARBA�IK March 2a, 2073
POL.iCX: R837'l259�fiA
TRANSAC174N: DEATH CGAtlAA. PROCEEDS
� OVIVMER: RAYMONp R. GARBACIK
PIP S 115.�21.34
� AMOUNT OF CHECK S 11b.72t.34
TAXABLE tNCOME $ 40,72i.34 I
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HLEASS DETACii ADtD �8P TH25 3TU8 FO'I2 YODR RECORDS
�
^�^w�?�-'iaF^.�'tS;^-"s�,%�3�....;c�.s^.-3-�:,4c�.'ls s�.(....E.3_ , t.�hFrn. s�3 ?�:x., � L axm.x�e3l ra*4�+s�Str e'�3T' T
.
� _ ' ' _. :.. - . >�'�—"`�e� . ,_]:�� _.�'t+»+lk� ,. ti , _,v
a,rt10�IQe7;i Genera!�.Gfe If1SUF3fiC2�COrt1F18I1�/ � VENDOR NQ � _ POLICY N0. CHE CK NO - � -
' P.O:"8aR 90Q6 Amariilo, TX 79105 . -� ORS � - A637126048A 70<_10363t �'�� �- sz-3s
. . . . __;i�_'
- '-. 8NY Mellon 7ruc[of Oelaware
, ..` ;,. �: . . . - � NEW4FK.DE[AWAAE
`� . , �. .. . r . PAY' THIS AMOUNT .
�** .1�'2N8TY-SIGHT THOUSISND SIGIiT FfIINDRgD SgV�NT7C-THRES aad 12/100 DOLLARS ***
� _�f_ _' � . : . . ." .: �:5=.......98.�73.72* ��.. � - - .
OT�VALI�:BEEORE'di6CK QATE� � � - - ..
_ " -�� GWECi�DATE 03/20/13 � - � �Two signamres �equired ' ��� ��-
- if nver 3250,OOO.DO '� �
•�VOIb qFfER '�780 �AYS - �
� ;: t ' -
�. ' -
� �� PAY r,=p1�HARD J GARBkCIK � - ' .
'� ��THE � 221-,N.77TW ST . . �_ ��/►A , �'����F�1JL(gi���� .
'��� , CAFiP`;H�LL PA 77071 - �����
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�Ni090363iM �:03ii00351�: Q3009 56 30 7ir
__ _._.__-
Ganeral Lifa k�na�ncs Company
� PA. �JOOB AmadNO. TX 79105 CHECK3 70903831
- INTERNAL REFEpENCE6 2200016299
TRANSACTION STATEMINT
MAME. RAXMOND R. GARBAGK March 20, 2013
�V�: A837128048A
TRANSAGTION: DFJ�TH CLAfM PROCEEDS
� d��� RAYMOND R GARSACIK
� 8 98,873.12
AMOUNT OF ChFECK 8 98,873.12
TAXABLE IfVCQME S 508.65
�
PLEASE DSTACH A4ID &ESP THIS STQS FOR YO� RBCORDS
'm.a.'?�?'t. 'F°--3.'„ C .§.° sv�.,,.-.�.^,�s^,. .�''*�. "„'.,w,'t- ' 1-5`_!11:!ht*43..��:a- i"v�,v?.�-':."+�'.r�4G1"7,T�'",'x'a�',�iX..:�`"-r:--..r:f��rT"47a_.,"9?i'^"dSu.-�''`.�.-�h'�Pc�u"�L�
W,este�n. Nationat t�fe lnsurance Company ve;vooR rua Po��cv r�a. cx�ex nto - . , _.
° P.O. Bax 871. Amarilla, 7X 78t05-087'1 � . OAS . GVP223&�4 ... 1678i596 ��'. � � 6z-J5
. ... :-: � . .. , . ��.�-- . � . - 311�_
. . . . _ � 9NY Mellon TN6C of ONaware � .
� . . . ' � . . ,�;.�.. � � - NEWRRK.OEtA.WAAE �
_ . ._ . . ,. -' . .. .. PRY 3NIS RAi2DUPf't �
'�** 1FF18Af'C7t-ON$ THOIISAND NIUTS HUNURED FORTY-POUR and. �8/100 I10LLPiIZ$ ***
� �- � " � _���gs..+..s.s21.844.9$i . . _
�""�*`°k"T�7'�YRLTti 8Ebt3BE CNECK DkTE . ..
�'.>` � .i GHECK OATE p3fY4113�� � - -7wo signafi�res-�ie4uired . . . -� .:
� - �� iP over S25Q0�0:00 �
. .y010 AFTEfi�.Y80 ORYS " � � �� ��
- PAY �' = RtCitARD J'GkRBACtK � - �
y �' � TH � 221 N 1'7TH ST ��:r�,
'��� � CA1NP HII.{. PA 77dY1 � .. .�. ��t� ��
�-_ '17F . . .- - . . - - _ -
�i ' a� i6i8i546M t:D3i1DD35Ly 03!'?ff95CIQ3?a' . .. ,
..�, ._ � ... . .. ........_
W Mrt�onat Lii�» t�ua�nce Comupany
PA. Bo 87'!. Artta��o. TX 79105.p871 CiiECKt 16f8'l596
INTERNA4 REPERENCEd 220420075b
� TRANSACSION STATEMEN7'
PIAME: ftAYMONC7 GAFi$ACIK March 2Q, 2013
POtICY: VP2236?4
TRANSACTlON: DEATH CLAlM PROCEE�IS
� ���►� RAYMONCI GRflBACIK
QMQUNT OF CHECK S 21,944,98
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7AXA8LE INCOME 8 1,103.36
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PI,EASS DETACH AND RSEP TEIS STU$ FUR YC1UA RECORDS
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1NTERNAL REFEffiENCES 2200200185
� r�,a�sac�rtarv s-ra�erur
NAME: RAYMOND GA1iBACiK March 20, 2013
POI.lCY: W2284$8
TEU�NSAC7tON: DEATli CLA{M PRO�E7S
� OWNER: RAYT�OND GAR8ACIK
AMOUNT OF CHEGK S 24,529.70
TAXABLE INCOME 5� �,fi29.70
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PLBASS DSTA(�i AtII� &SSP THIS 8TQ8 P01Z YOIIR RBCORDS
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� �ennsylvania St�fDU.E H
D PARTMENTOFREVENUE � '�.' �D
IN ERITANCETAXRETURN fY.�711W�Kh71�7
R SIDENiDECEDEM
ESTATE F GARBACIK, RAYMOND R FILE NUMBER
21 - 13 -0194
_ DecedenYs debts must be reported on Schedula 1.
ITEM �—
NUMBE FUNERAL EXPEN3ES: DESCRIPTION AMOUNT
A• 1 Myers-Harner Funeral Home ' 7,949.00
Honorarium 100.00
I Funeral Luncheon 200.00
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B. I ADMINISTRATIVE COSTS: '
1. �'�� Personal ReproseMative's Commissiona
; Name of Peroonal Reprcsentative(s)
� Slreet Addross ''
' ��Y State Zip
��, Year(s)Commiaaion Paid I
2. Attomeys Fees COYNE 8 COYNE, PC , 3,000.00
3. , Family Ezemption: (If decedenfs addrcas ia not the same ea GaimanYs,attach e�¢lanation)
�¢
Claiment
Street Addreaa ��,
cily SWM Zip :
Relafionship of Claimanl to Decedent '�
4. Probate Fees Regiser of Wills, Cumberland County 408.50
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5. II! AccountaM'a Feea ,I�
8. Tax Retum Proparera Fces 500.00
7. ! OtherAdminiahativeCoats �
1 ' Cumberland Law Joumal— Legal Advertisement I 75.00
TOTAL(Also enter on Ilne 9, Reeapitulatlon) 13,757.50
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C�MMONWEALTH OF PENNSriVANU r��s-T-"'-�
I. INHERITANCE TAX RETURN �C����
RESIDENT DECEDENT
ESTATE F GARBACIK, RAYMOND R FILE NUMBER
21 - 13-0194
2 I Patriot News--Legal Advertisement 140.00
3 Postage 25.00
4 II Estate Checks I 25.00
5 I Reserves ' 1,000.00
6 Executor's Mileage @$.55/mile , 220.00
7 I Filing Fee-- Inheritance Tax Retum 15.00
8 Stockbroker Commission 80.00
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Page 2 of Schedule H
� �nnsylvania SCHEDULE 1
p"�"'�"���"`� DEBTS OF DECEDENT MORTGAGf
Ih�1ER1TANGETi3(RERlRN 1
RfiSIOENTDECEDEPfr LIABILI7IES 8� LIENS
_�-- - _ - � - ,.
FILE NUMBER
ESTATE�F GARBACIK, RAYMONDR 2� - �3-01g4
Report depts incurred by the decedent priar to dcath that remained unpaid at the date of death,induding unretmbursed medical expenses.
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ITEM DESCRIPTION AMOUNT
NUMBER
v 1 Griswoid Hame Care - ---- ------ --- _ — 21.4d
2 Johnson& Duffie Law Offices 120A0
3 Uncleared Checks SOO.Op
TOTAt{Atso entsf a�i.lna 1Q Recapituistion} $41.40
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� �nnsylvania ' SCHEDULE J I
OE..ARTMENf�REVENS7E (
,N�„�c�T,��,�, BENEFtG1AR1ES
RE IOENT OECEOEM �
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ESTATE�F �FILE NUM9ER
C,ARBACiK, RAYMOND R �
---- - - -- �_ 21 - 13-0194
�T RELATIONSHIP TO SHARE OF ESTATE AMOUNT QF ESTATE
NUMBE '',T NAME AND ADDR68S OF PERSON(S) I DECEpENT (Worda) ($$$)
RECEIVINCiPROPERTY I coNaunr'w•.p�
I, �TAXABLE 4IS7RIBUFIONS{inGude outripht sp�usai .. !
� '�,.... undeb3eo��116(e)(12�] i�
Richard J. Garbacik � Brother ( 1!2 af Schedule B '
, and errtire Schedule '
� G, and 100%of
' i Residual I
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', Emily Blair Buckee Friend � 142.38
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� Gertett Jacob Buckbee Frisnd 142.38
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Brendon Roabert Jones II 1=riend ! 142.38
� Margaret Blair Wilcox ; Friend � 142.38
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I�En�r doNar amcunh for dbtributiona ahown abovd on linas 15 through 18 on Rev 1500 oover sheet,as apprapriaM. '
ji NON-TAXABLE 61STRI6UTtONS:
A.SPOUSAL DISTRIBUTONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
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B.CHARiTABLE AND GQVERt+tMEFiTAI DISTRIBU110NS
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TOTAL OF PART II-ENTER TOFAL NON•TAXABtE DISTRIBUTiONS ON LINE t3 df REV-1540 COVER SNEET! Q.00
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� p nnsylvania SCHEDULE J
DE hRTMENTOFREVENUE
IN ERITANCETAXRENRN BENEFICIARIES continued
RE IDENT DECE�ENT �
ESTATE F GARBACIK, RAYMOND R FILE NUMBER
21 - 13-0194
�'�. ii RELATIONSHIP TO SHARE OF ESTATE !.AMOUNT OP ESTATE
NUMBE '�� NAME AND ADORESS OF PERSON(S) �� DECEDENT (Wordg) '���.... ($y$)
_ RECEIVINGPROPERTY �� o,N�unrti.uq.� ��.
I, 'TAXABLE DISTRIBUTIONS[inGude outripht spousal � .
distributions and tnnsfen '��
under Sea�116(a)(12)] �'�
I Ava HaleY Friend , 142.38
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Page 2 of Schedule J
-�, � � ��. . _ .
REGISTEfi OF WILLS CERTtFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PEMNSYLVANIA
No. 2013- 00194 PA No. 21- 13- 0194
Estate Of: RAYMON� R GARBACIK
� (F>st Middb,Lasq
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I Late Of: CAMPHILL BOROUGH
CUMBERLAND COUNTY
Deceased
Social Security No: 207-22-7678
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��I WHEREAS, on ,the 15th day of February 2013 an instrument dated
Ja uary 29th 2009 was admitted to probate as the last will of
RA MOND R GARBAGK
(Fint ItltlN,Lutl � .
Iat�e of CAMPHILL BOROUGH, CUMBERLAND County,
whc� died on the 8th day of February 20I3 and,
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I WHEREAS, a true copy of the wi11 as probated is annexed hereto.
I THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and
fo� CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
ce tify that I have this day granted Letters TESTAMENTARY to:
wh� R/CHARD J GARBAC/K
has duly qualified as EXECUTOR(R/X1
an has agreed to administer the estate according to law, all of which
fu�ly appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CA�LISLE, PEA/NSYLVAN/A.
� IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of limy office on the 15th day of Feb/uary 2013.
II J
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Last Will and Testamer�t� � � ° °
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RAYMOND R. GARBACIK
I, R4YMOND R. GAR$ACIK, of the Borough of Camp Hill, Cumberland County,
! Pennsylvar.ia, being of sound and disposing mind, memory and understanding, do hereby make,
;
� publish and declaze this as and for my Last Will and Testament, hereby revoking and making void
any and all Wills or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS
I direct the payment of all my legal debts and the expenses of my last illness and funeral
from my Estate as soon after my death as conveniently may be done.
" ARTICLE II
SPECIFIC BEQUESTS
I direct my Executor or Successor to sell all of my shazes of stock in Wachovia Bank and
i?� si!ccessn�� z,nd my �r.?eric�n L�:gository Receipts (A?�Rs) for shazPs of stock ir. Allied Irish
Banks, p.l.c. presently, held in my brokerage account with Manufacturers and Traders Trust
Company, account number AZD-318999, into which account I have placed the above-mentioned
securities which my wife inherited and which she gave to me when she passed away in 2005 (or
� the then traceable proceeds thereof if I should sell some or all of such securities aRer the date of
my Will), and to distrihute the proceeds as follows:
. _ _ _ _ __ ___ _ _ _
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A. ONE-HALF (1/2) thereof unto my brother, RICHARD J. GARBACIK,
provided he survives me. If my brother, RICHARD J. GARBACIK, predeceases me, I
give and bequeath his,shaze unto my brother, EDWARD M. LESNl', and should he also,
predecease me, then unto his then-living issue, per stirpes;and
B. ONE-HALF (1/2) thereof, in equal shazes, one such shaze unto each of the
following who survives me: EMILY BI:AIR BUCKBEE, Shiremanstown, Pennsylvania;
GARRETT JACOB BUCKBEE, Shiremanstown, Pennsylvania; BRENDON ROBERT
JONES, Camp Hill, Pennsylvania; MARGARET BLAIR WILCOX, Clearfield,
Pennsylvania; and AVA I�IALE'Y, Glenshaw, Pennsylvania.
ARTICLE III
REST,RESIDUE AND REMAINDER
1 give, devise and bequeath all the rest, residue and remainder of my Estate, of whatever
nature and wherever situate, unto my brother, RICHARD J. GARBACIK, provided he survives
me. If my brother, RICHARD J. GARBACIK, predeceases me, I give, devise and bequeath the
same unto my brother, EDWARD M. LESNY, and should he also predecease me, then unto his
then-living issue, per stirpes.
ARTICLE IV
LJNTFORM TRAIVSFERS FOR MP.YORS
In the event any beneficiary of my Will has not reached the age of twenty-five (25) yeazs
at the time for distribution of his or her share, distribution of said share may be made in the
discretion of my Personal Representative after considering the age and needs of the beneficiary,
either directly to the beneficiary or to a Custodian for such beneficiary until age twenty-five (25)
under the Pennsyivania Uniform Transfers to Minors Act, 20 Pa. C.S.A § 5301 et seq., or the
applicable Uniform Gifts to Minors Act or Uniforcn Transfers to Minors Act in the state of
�, 2 �
_ _. __ _ _ ._
___T._� ---._____------ �.
� residence of sueh beneficiary as the case may be. My Personal Representative may designate as
such Custodian any institution or person, including my Personal Representative, qualified to act
as a Custodian for such beneficiary under such Act in effect at the time such distribution is made.
A receipt for any payment or distribution so made shall be a full dischazge therefor to my
Personal Representative, who shall not be responsible to see to, or be liable for, the application
of such proceeds thereafter.
ARTICLE V
TAX CLAUSE
1 direct that all estate, inheritance, transfer all other taxes of similaz nature payable by
reason of my death, together with any interest or penalties thereon, and imposed with respect to
any property disposed of by this Will, shall be paid out of the residue of my Estate, as an
administrative expense of my Estate.
I direct that all such taxes imposed with respect to non-probate property shall be paid by the
respec[ive beneficiary(ies) or transferees theTeof.
• ARTICLE VI
PERSONAL REPRESENTATIVE
I name, constitute and appoint my brother I2ICHARD J. GARBACIK, Exewtor of this
c:�y iast Vd411 �;,d Testa:mer.t. Shouid my bro,her, RICHARD J. GARBAi IY., fai: ta qualify cr
cease to so act, I name, constitute and appoint my brother, EDWARD M. LESNY alternate
Executor to complete the administration of my Estate. I direct that no fiduciary appointed herein
shall be required to post bond for the faithful administration of the duties required in any
jurisdiction.
3
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IN WITNESS WFIEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, this Z�� day of 2009.
� (SEAL)
OND`R. GA ACIK
Signed, sealed, published and declared by the above-named Testator, as and for his Last
Will and Testament, in the presence of us, who at his request, in his presence and in the presence of
each other, have hereunto subscribed our names as witnesses.
��� �A"�h
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4
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AFFIDAVIT AND ACKNOWLEDGMENT
' COMMONWEALTH OF PENNSYLVANIA .
: ss.
COUNTY OF CUMBERLAND '
� We, RAYMOND R. GARBACIK, EDn,c,Nv e° rn r�,�s and
�L�(�1��L �_C�9SS/j�� , the Testator and the witnesses, respectivelv.
whose names are signed to the attached or foregoing instrument, being first duly swom, do hereby
declare to the undersigned authority that the Testator signed and executed the instrument as his
Last Will and that he had signed willingly and that he executed it as his free and voluntary act for
the purposes therein expressed, and that each ofthe wifiesses, in the presence and hearing ofthe
Testator, signed the Will as wifiess and that to the best of his/her knowledge the Testator was at
that time eighteen years of age or older, of sound mind and under no constraint or undue influence.
� � __��� ,
.�,
' ND R GARBACIK
� �
Witness
L�_ �
W�tness
Subscribeti, sworn to and acknowledyed before me by/RAYIVIOND R. GARBACIK, .
7'estatrix, and subscribed and sworn to before me by �'j�/a',6�i�.� ' . f'yt ��S
and _ �11�C'i�IR�'-C '�,T. CASS /1� y , wifiesses, this � day of
r, �C,t°'.-k- , 2009.
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Notary P..0 lic �
?aiaaivs �p ' l'H FPENNSYLVAWA
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M�p�atE Rulf,No4ry P�bGc
Lertqyne Bao.Cin�bellotd CouMY
�Y�ia�E�es MaY��H
Member,Pennsvlvani?4se�iefion oF Nolaries .
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