HomeMy WebLinkAbout10-10-13 (3) _ _ __ ____ _ . . . .
1 150561�143
� REV-45�0 EX��.,,, �#
OFFICIAL USE ONLY
PA Dapartment of Revenue pennsylvanla Cwnry coae rear File N4mbar
Bureeu of Individual Taxes °°'"'""°"°'"�YB1�
PO BOX28�01 INHERITANCE TAX RETURN 21 13 0 912
Ha�rlebUrg.PA 17128-0601 RESIDENT DECEDENT
EN1�ER DECEDENT INFORMATION BEIOW
Social Security Number Date of Deeth Data ot Birth
07 12 2013 09 17 1919
DeckdenPs Last Name Suffix DecedenPa First Name MI
C�,ARK SETTY I
(If ppliwble)Enter 9urvivinp Spouss'a Information Below
Sp�se's Last Name Suftix Spouse's First Name MI
Spduse's Social Security Number
THIS RETURN MU3T BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FIL��.IN APPROPRUTE OVALS BELOW
� 7, Orlpinal Retum � 2. Supplemenfel Retum � 3. RemainCer Retum(Date of DeeN
Poorto 12-13-82)
� q. LimfteA Estete � y� Fulun IM�re�t Campranise � 5, FeOeral Eatate Taz Retum Required
(tlsla ol Aeelh aller 1P-12A2)
� 8 p�.��p��7�. � � Dec.tls�ornai�ined��ivinp irust g, Total Number W Safe Depo6tt Boxee
�uma�cwrmwuq tA�^ cr
� 9. liU9ation Proceeda Receivetl � 70.�nPQ'�j�j��{Da��W Deaen � 71.�A�Scneauk O)�`.9113(A)
CO RESPONDENT•THIS SECTION MUBT BE CONMLETED.ALL CORRESPONDENCE AND�CONFIDENTIAL TAX IMPORMATION BMOULD BE DIRECTED TO:
Na e � Daytlme Tslephone Numbsr
CHAEL L BANGS 71'7h730 7��0 :xa ��
i C:.: ru F�'�t C7 �.
', R�c�r3Teit p�w�i�'s usr✓or�i,4
= �_. ,
F_• .;r
FI t Lln�of Address � c.;::� `� ��
- .
�_�. r-,
429 SOUTH 18TH 3TREET ' • -� '� -"�
,:i _ `n
S ontl Line of Adtlresa � '��" ����
� ' r v ' t'rt
i ' : :, r—
- ; n� �z T
+" DATE FII�D
CI or Post Offlce State ZIP Code
g=7,y PA 17011
c rrosPo�wsne�a«m�diaddreaa: mikeban�ver�zon.net
R 1 Uue� rt�att a�ntl��np�oe�nGOn DroP.rc�otl er�than�th�e�pen�n�rep�feaonpah�tivb I�eed on alUl�nu�amedon'of�wn�lch pre�roar I�b eny��k�naMedge belief,
31 NA OF PERS RESP E FOR FILING RETURN DATE
Sha ne Honaflus /0 7 .�o
AD ESS
1 na ne nf u PA 17055
SI NREOFVR ROTHER ENTATIVE DATE
Mlchael L. Bangs /b j oi.?
RESS
�429 South 18th Street Camp Hill PA 17011
Side 1
� 1505610143 1505610143 �
tl�'\
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1 15p5610243
�..1
REV-1500 E7(
DacedenPe Sociel SecuHly Number
DecstleM'sNeme: CIB�IC� Betly I.
� �tECAPINUITION
'�1. Real Estete(Schedule A)....................................................................................... 1.
'.2. Stocks and Bonds(Schedula B)............................................................................. 2.
�,3. Closely Held Corporetion,Partnership or Sole-Proprietorship(Schedule C)......... 3.
'4. Mortgages&Notes Receivable(Sthedule D)........................................................ 4.
�5. Cash,Bank Depostts 8 Miscellaneous Personal Property(Scheduk E)............... 5. 44$�559 . 40
�!6. Jointly Owned Property(Schedule F) ❑ Separete Bllling Requasted............ 6. 11 , 134 . 51
�I7. Inter-VNos Transfers 8 Miscellaneous fycq-Probate Property
� (Schedule G) U Separete Billing Requested............ 7. 2O3 , 484 . 23
I8. Total Groas Assets(total Linea 1 through 7)........................................................ 8. 66O, 175 . 14
I 9. Funeral Expensea and Adminiatrativa Costs(Schedule H).................................... 9. 17 , 929. 88
p0. Debts of Decedent,Mortgage Liabilities and Liena(Schedule q............................ 10. 9S1 • 8�
h1. Tofal Deductlona(total Lines 9 and 10)..........................._................................... 11. 1H , 881 . 68
2. NM Valus ot Estats(Line 8 minua line 11).......................................................... 12. 641�2 96 . 4 6
3, CharRable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
4. Net Valus SubJeet to Tax(Line 12 minus Line 73)............................................... �q, 641 ,2 96. 4 6
AX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
5. Amount of Line 14 taxeble
I, at the apouaal taz rate,or
transPon under Sec.9176 �5 0 . 0 0
(a)(1.2)X.00
18. AmountofLinel4taxable 641 �296. 46 ts. 28, 858 . 34
at lineel rate X .045
I17. Amount of line 14 taxable � . �0 17. � • ��
�, at sibling rate X.12
I18. AmountofLinel4taxable 0 . 00 18. 0 . 00
! etcollataralreteX.t5
�I19. TAXDUE................................................................................................................ 19. �LB ,858 . 34
���I20. FILL IN THE OVAL IF YOU ARE REQUESTINO A REFUND OF AN OVERPAYMENT. �
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I Side 2
� 1505610243 1505610243 J
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REV-15q0 EX Page 3 Flle Number 21-13-0912
Decedent':Complete Address:
DECED NT'S NAME
Clark, BeHy I.
STREE �ADDRESS
805 E.Trindle Road
CITV � STATE ZIP
echaniesbury PA 17065
Tax Pa ments and Credits:
1. 7ax ue(Pege 2, Line 19) (1) 28,858.34
2. C ita/Payments
A. rior Payments 27,415.42
B. iscount 7,442.82
I Total Credks(A +B) (2) 28,858.54
3. Inter st (3)
p, If Lin 2 ia greater tMn line 1 r Line 3,enter the difference. This is the OVERPAYMENT. (4)
Ch k box on Page 2,Lirre 20 to requot a rofund
g. If Lin 7 +Line 3 is greater than Line 2,enter the diHerence. Thls is the TA7(DUE. (5) �.00
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Make Check Pa able to: REGI$TER OF WiLLS AGENT.
LEASE ANSWER THE FOLLOWING QUESTIONS BY PIACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent meke a transfer and: Ves No
a. retaM the uae or income of the proPertY transferred�............................................................................... �x
b. retein tha right to designate who shall use the property tranaferced or its income:.................................. �
c. retain a revenionary intereat;or............................................................................................................... x
d. receive the promlae tor life of eRher payments,beneflts or eare9............................................................
2. If death occurred aRer Dec. 12, 1982, did decedent transfer property within one year of tleath without
recelving edequate wnsideretion9.................................................................................................................... ❑ 0
3. Did decedeM own an"in trust for° or payable upon death benk accaunt or security at his ar har death?....... ❑ ❑x
4. Did dacedent own an individual retirement account,annuity,or other non-probate property which
containa a beneNCiary dasignetion7.................................................................................................................. ❑X ❑
IF THE SWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPIETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For det of death on or after July 1, 1994 and before Jan. 1, 1995,the tax rate imposed on the net value of transfen to or for the uae of tha surviving
spouae i 3 percent[72 P.S.§9118(a)(1.1)(I)].
For dato of death on or after January 1, 1995,the tax rate imposed on the net velue of trans�ers ta or for the use of the aurvivin8 spouae is 0 percent
[72 P.S.§9118(a)(1.1)(ii)]. The etatute doea not exempt e tronster to a surviving spouae from tax,and the statutory requirements for diaGosura of
asseta a d filing a tax relum are still appliceble even if the surviving spouae is the only beneficiary.
For date of death on or aftar July 1,2000:
. The t rate imposed on the net velue of trensfen from a deceased child 21 years of age or younger at death to or for the use of a natural perent,an
adop ive perent,or a ateppamnt oT the chlld is 0 percent[72 P.S.§9718(a)(1.2)].
. The x rete impoaed on the nat value of trensfen to or for the use of the decedenYs linea�beneNciaries is 4.5 percent,excapt as noted in
[72 P S.§9116(e)(7)J.
. The t x rote impoaed on the net value of tranafers to or for the use of the decedenPs siblings is 12 percent[72 P.S.§9718(a)(1.3)]. A
siblin Is defined under Section 9102,as an indfvidual who has at least one parent in common wkh the decedent,whether by blood or adoption.
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Ravd60!EX��H-0O) .
3CHlDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
pEPMTMENTOFREVENVE pERSONAL PROPERTY
INHERRqNCETq%RETyRN
RESIDENT OECEDENT
ESTAT OF FILE NUM�ER
I Clark, Betty 1. 21-13-0912
�'�. InduMIMpraa�d•dlkI�IianaMlMd�NtMpoc�W�x�rorauiwtlby IMeWte.
��.. All propMy jolntlyowmE wNh tlro rlpM of tuMvonhip mu�l M Nwlo�sdm�eMUW�F.
ITEM VALUE AT DATE
NUMB R DESCRIPTION OFDEA7H
7 Refund from Capital Blue Cross 290.24
2 Refund irom CouMry Meadows 2,038.77
3 Refund from Country Meadows �6��
4 Refund from Kemper insurence 94.00
5 Commonweakh Finanelal Networlc-Investment Account H2Y138240 made up of vaHous 443,121.89
invesfinents as set forth on the attachment hereto.
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' TOTAL(Also enter on Uns 5, RscapitulaUoN 445,558.40
(H mare apace ia neeAed,aGEltlonel papsa W Me eame aize)
Copyrig t(c)2010 form software only The Lackner Group,Inc. Fortn PA-7600 Schedub E(Rev. 11-10)
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R�v-760Y EIN(07-10)
pennsylvania SCHlDULE R
pEPA1t7MENTOFREVENUE JOINTLY-0WNED PROPERTY
Iry11ERITANCE T/p(RETURN
RE6IDENT DECEpENT
ESTATIE OF PILE NUMBER
Clark Be I. 21-13-0912
' n�n�wl wu m�M pIM wlMin on.ywr a eM a«�Mnt'.Mb of tlwM,le mw�a nporeM on wMAUN o.
�URVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. S ayne Honaflus 12 Sna Lane Dauyhter
Mechanicsburg, PA 17055
B.
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C. II
JOIN I LY OWNED PItOPERTY:
DESCRIPTION OF PROPERTY °�OF DATE O�FJ DEATH
ITE FOR�JOINT DMADE INUMBER O SEMIIARNDENTIFVI NG IN7UMBER.�ATfACHK EED�FOR DATE OF DEATH DECD�S DECEDENTS IMEftEST
NUMB R �NANT JOINT JOINTLV-HELDREAlEBTATE. ALUEOFASSE INTEREST
1 A 01101N878 PNC Benk-Cheeking account 18.578.77 50.000% 9,788.39
2 I A 72109N888 PNC Baak•Savfnga Account 2,882.24 50.000X 1,346.12
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' TOTAL(Also enter on Llne 8, Recapituladon) 7 7,194.51
'I (If more spece ia neetletl,e0tlitbnal papet of the aeme eize)
CopyrigTt(c)2070 form soRwaro oniy The Lackner Group, Inc. Form PA-7S00 Schedule F(Rev.Ot•10)
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R�v4610 EK�(0!-0Y)
scN�►u« 6
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPAR7MENT OF REVENUE
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTA E OF FILE NUMBER
� Clark, Betty I. 21-15-0812
'.. Thia echeGUle mu�l Ee complMetl antl(letl it the enswer lo eny W questiona 1 lhrouph 4 on p�pe t�rss ol Uw REV-7500 is ye�.
ITE DESCRIPTION OF PROPERTY DATE OF DEATH x oF oeco•s p](CLUSION TAXABLE
NUMB R TME OATE OF ETR�ANF 8FER.8ATfACN A COPV OFTTME OEEO F�OREREAL E8iATE. VALUE OF ASSET ��'�TEREST (IF MPlICA9LE) VALUE
1 Commonwealth Financfal Network-IRA aceount 5.833.65 700.000% 5,833.65
H2Y188290. The deeedenYs three childrsn are the
bsneficlarles of this IRA.
2 MetLite-Investors USA Annuky Contract A2073368. 197,850.58 700.000% 197.850.58
TM dscedenCs throe children were die beneflclarles
of dNs annuity.
II
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� TOTAL(Also entsr on Line 7, Recapkulatlon) 203,484.23
(II rtwre apacs is neaAatl,atlCltlonel papes ot the aama aize)
Copyrig t(c)2009 fortn sofhvere only The Lackrrer Oroup,Inc. Fortn PA-1600 Schedule G(Rev.OB-09)
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REV.7677 E%F(10-0Y)
pennsylvania SCHEDULE N
DEPMTMENTOFREVENUE FUNERAL EXPENSES AND
RESIOENTO�c�"��`" ADMINI3TRATIVE COSTS
E3TATff OF FILE NUk�ER
Clark Be I. 21-13-0872
DecedenPs debts must be reported on Schedule I.
ITE DESCRIPTION AMOUNT
p. , FUNERAL EXPENSE3:
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��I Ses continuation schedule(s)attached 11,733.00
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a, aoMiNisrraanve cosTS:
t Penonal Reprosentative's Commissiona
Name of Personal Reproaentativa(s)
Street Address
City State _ Zio
Year(s)Commission Paid
qnomev�s Feea Mlchael L. Bangs 5,000.00
Family Exemption: (If decedenYa address is not the aame as claimanYs,attach explenation)
Claiment
I, StreetAddreas
�I CRy State Zio
Relationshio of Claimant to Decadent
4�. Probate Fees 498.50
�. AecountanPs Paes 500.00
Q. Tax Retum Proparer's Fees
�. OtMr Administrative Coats 198.38
' See coMlnuatlon schedula(s)attached
TOTAI(Also enter on Iine 9, Recapkul�tlon) 17,929.88
Copyrig t(c)2009 form soflware only Tha Lackner Group, Ine. Fortn PA-7500 Schedule H(Rev. 10-09)
_ _ .. _. __ _._. . . . . _. ._. . . .. .
sCHEDULE N
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTA E OF FILE NUNI9ER
' Clark, Betty I. 21-13-0912
i� ',
NUMB R DESCRIPTION AMOUNT
Funsnl E:pgnses
1 Gingrich Memorials 45.00
2 Myers-Hamer Funerel Home, Inc. 11,688.00
'ii H-A 11,733.00
IOther Admin�trativa Costs
3 Cumberland Law Joumal•esfate adveRlseme�t 75.00
4 I The PatNot Newa•estate advertisement 123.38
i H-67 798.38
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Copyriglht(c)2002 form aoflware only The Leckner Group, Ina Form PA-7500 Schedula H(Rev.&98)
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rt.v-�e�x ex+pxae�
scw��u�E i
pennsylvania DEBTS OF DECEDENT,
DEPARTMENTOFREVENUE MORTGAGE LIABILITIES AND LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDEN�
ESTA E OF FILE NUMBER
' Clark Bs I. 21-13A912
,
�. PpoM MM�Ineurt�tl Ey M�Ge�Mnl qlof b dwlh tMt nm�IMd unPUtl tl tM Gb M MM�.InClWinp unrNmbwtM m�MUI�:pm�w.
ITE VALUE AT DATE
NUMB R DESCRIPTION OF DEATH
1 Dismond Phartnacy-1108 350.39
2 Dlamond Phartnacy 558.52
3 Dr.Jeffrey A. Marka, DPM 42.89
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TOTAI(Also enter on Line 10, RscapkulaHon) 857.80
(II more apace ia neetled,additlonal pepea of the aame aize)
Copyrig t(c]2008 form software only The Lackner Group, Inc. Fortn PA-1600 Scheduk I(Rev. 12-08)
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nev-�et� �uc.�o�.�o�
pennsylvania SCNEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARI ES
RESIDENTDECEOENT
ESTATE OF FILE NUMBER
Clark B L 27-13-0912
�' RELATIONSHIP TO
NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE
NU BER PERSON(Sl RECEIVING PROPERTY DECEDENT �yypro$� caaa�
I ', TAXABLE DISTRIBUTIONS [indude outnght spousal
.. d�stributions,and transfera
' under Sec.9176 a 7.2
' Richard H.Clark Son one-third
108 Summervlew Lane
, Cary, NC 27578
Tina Famham Daughter one-third
119 Saratoga Drive
I McMurray, PA 15317
II Shayne Honaflus Daughter one-third
'i 12 Sna Lane
IMschanicsburg, PA 17055
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Total
r moun for distributlona shown above on linea 15 thro h 18 on Rev 15 cover s r nate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
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II B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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OT P II•ENTER TOTAL NON-T LE DISTRIBUTIONS ON LINE 13 OF REV-1500 ER S EE
Copyright(c)2010 fortn software only The Leckner Group, Inc. Fortn PA•7500 Schedule J(Rev.01-10)
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���>,4Q�t':Nt)!d�4'EAI;I'H ftnanc'ra�net�uark
Date of De�ih aluation For
.._...._..._.._....__...__.._._....__.._........._....................._...._..
qat IYaie: BEfTY�CIARK
.
,
._.._...._....._ __.__..�..___._....._......_...._.......t.._.._.._...____..._....._.._....._....__.._........_............._................
Auaunt 1 H2Y13l240
_._.._..�. _r..._._..__...._....._.........._._....._........t..__.._....__..._...�..__..__...Y...__...__...._..._._._
Dak of De�h: 1�12�2013
. .__..._...._...._._..._...._._...._....�,._.._..._...._...._....._ ...._............_....._.....
AcmuntV�lwtlo� -.— �...1�12n013
OAY HIGH DAY lOW MAAKtT VAIUE B
SECUAITYt�1E SYMBOI QUANTITY PRKE PRI[E CL06NWP�CE f�Nt1A1RKETYALUE BASEDONflip�PRICE
hNRUAIRN�
MNKDFPOSIT NqMtAMfd[fll6ltE � iQPRM4 2�78.160 L00 $ lA0 $ 23A�.16
kder+hd Fa�dpA ,/ SfWI 8061.289� ' 4.05�$ 9.05 $ 1;954.Q
Api Elfidert Front Y�ane Fmd d l � AFiIX 3315386' 1139'S 11.39 S 31,196A2'
Ttll�bbn6bbd hMdqC v iE6�( iB65.995 ' 13A6 $ 33A6 $ 3),429.l9
qYwonehdtic � PINC% i i413.2841 loss'S 10.55 S �A1�•u
Pnden�l Total R Loed Fmd d C ✓ PDBO( 2565.88L 16A0 S 11A0�$ 35,92233,
FrailhMTax InmmeFunddC � � FRP1X 3385.118 10A0�$ 10•10 $ 35,205.lS 3
Feder�0ed� hndn8 ✓ SINBM 1824818 9.04 S 9A1 S 16,t9635
9pp(S , S . i
fiWefa�s, ifSl ZiW.AB 65.11; 6tA! 6196 S b�� S 13l,61L12
EmqnMobN iNOM 102.663 93.15; 9L73 93A0 S 93A9 $ 9,SS6S1
_. .___.._ _.....,_.._ _...__..._ ,__._..._... ........_._. . _...._...._.. ..._._ . _._.. ., ._,.__._ .._..._ ..._.......___..._..__.. ..._._._.___. _.......
TOTAIIICfAUlRVALUE S 143,12L89
. . . .. �M . ,.:r��.raao::«mc:::cc�:re�tte��ra�x�v¢.,:�u:c�ro,rc:..K;,,:�ox:., .. .-....
misir�mnatimis iponmu�erhekerNro6etnxmMoauroce,6uttlxrompktenessadacurayunotguarameed6yCommorarcalthfinannal�MMak Reasecorrwltrtatcmtntsproriaed�yindiiAu�
natodpnswpraduct facwnpleteinfmnation 7kosenotethevaluatandoesnWirzludeonyasse6heldoutvdea(theabweacounc Pos�perfwmaKersnotindualroeoJfuNrerewlh. MutuolfuMVduoOans
oredore6osedonNet tYalueaNdlotherservr�s6asedonFarMOrketVdcePrkeja[hedayindaat¢d.
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29$aw��30 100 W251 A$pee1,SU�e 1800
W�rn, p2453.94�i San Dieyo,CA 92101�3706
800237. 1 877.347.1982
181.136.0 ha�c 619.47t.9701far �+��h.� �FINRA/SIPC,8o5idiStotkF�xl�ge
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� PlU C
July 25, 2013
� Shayne C Honatius
' 12 Sna Ln
' Mechanicsburg PA 17055
I
� RE: Betty [ Clark
SSN: 204-0i-0846
DOD: 07/I 2/201;
Deaz Sir/Madam:
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
IChecking Account
Account# 5 1 4001 1 804 Established: OI/Ol/1978
BETTYICLARK
SHAYNE C HONAFIUS
DOD balance: $19,576.77 + 0.05 accrued interest
Savings Account
Account # 5000729558 Established: 12/09/1996
BE7�TY I CLARK OR
SHAYNE C HONAFIUS
DOD balance: $2,692.24 + 0.06 accrued interest
Please nore that this office provides dam of death balances for deposit accounts (IRAs, CDs, Checking and
Savings). We do oot process any financial transactions or provide statements. If you need assistance with
any of these items, please call I-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
INational Financial Services Center
!, PNC Bank, N.A.
I Member FD1C
I Page 1 of 2
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This neessage is intended jor the use oJthe individual or enlity to which it is addressed and may
contain injorma6on thal is privileged, confidential and exemptJrom disclosure under applicable
' law. Ijthe reader oJthis message is not the intended recipienl or the employee or agent
', resportsible jor de[ivering this message to the intended recipient,you are hrreby notifted fhat any
', dissemination, disbibution or copying of this communicutions is strietly prohiAited if you have
' reeeived thrs communication in error,p/ease nntiJy me immediately hy rep/�• nr by te%phone at
I 800 762-1775 and immediotely destroy this fazed document.
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is�ns�so � " . , oi�aa:a,p.m. ��oe-oe-zota . in
MnILiN!nvM(ors USA
P.O.Ba 1f5b
°��`U��' M�tl�if e
August B, 2U13
FAX 9t9�859�840 �O� �:
JUSEPH MATZA
COMMONWEAtTN FINANCIAI
sSau CENI'ERVIEW OR STE 421
RAIEtGH NC 27Q06
RE: METIIFf rIVE3TORS USA MISURAilCE COMPAMY CONTRACT AP073388
OECEASf�BFTTY I Cl�►RK
Deer Ax.Mataa:
TnOnk You fOr Your rooent frpuiry nep�MMy Ihe Conhact relerentxd s�6we. Our records mdkale Ihet the
date d death and tt�e accant value on that d�e are:
Dete oi Death:July 12, 2013
AccaurK Vakre:5197,850.58
if you haw arry questfone. P�ea�aoMact Yow'aDr�YVe a caN our Customer Ssnice CeMx st
1-000�2D4-�636 Ma�csaY throuGh FriOwy beh�ea+8�30 a.m.uM 6:30 p.m., ET.
Slncaely.
Vekrie FioPp
Atmulry WNiy�t
Metlile Aruu�OD�arW Sefrvic.ros
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' � THE LAW OFFICE
!, ;� of:
'� AMES 11�i. B�iCH
J
, Attcmt�+-At-Law
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LAST WII.L AND TESTAMENT
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� FOR
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1i BE�TY 1 CI.r9RK
,
L Bf'I1Y I. CLAR% of c6e TO�APSHIP of LOpER ALLEN,
' COUNTY of CU[�ERLAND, COAHrlONRALTH of PENNSYLVANIA,
' being in good bodily hnlch aed of sound�nd disposing mind wd memory, �nd aot
' i accing under duross, mcnoa,fr�w+i, w u�iw ir�rw of aay persoa whomsoever,
I ��� mercly cilling co mind c6e fr+iky of 6umm life, and being des'uous of disposing mY
�', worldly goods while I have che urcngth md capacity so co do, I do make, publish
' �nd declue chis my LAST WILL AND 1'ESTAMENT. I hereby revoke, unal
aad annul �ll my former Wills and Tescamencs, including codicils chereco, by me u
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any time made,and dalue this�loae to be my CAST�GII.L AND 1'ESTAMEIJT.
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iAS TO SUCH ESTATE IT HAS PiEASED GOD TO EN14tUS?ME lilTH
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IN THIS LIFETTIvIE,I DISPOSE OF THE SAME AS FOLLOWS,VIZ:
iI'fEM 1. I diraY chu my Exeeucon hereinafrer named,pay and discharge ill of
I, mY lust debu,funeral and ta[ameetary expeuus.
! ITEM 2. I order and dirat that I be buried az a loc, which I own sitvue u the
i Rolling Gr«n Cemetery,Camp Hili,Pennsylvania.
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iII'EM 3. All che resc, ruidue md remtinder of my mtire escue, wheraoever
situue, and whatsoever it may consist of, I give, deviu, and bequeath, abwlutely,
II and in fee,[o my dearly belovcd children,share and shue alike, per stirpes.
ITEM 4. I nominue and appoint SHAYNE C. HONAFNS ss Execucriz of
this my LAST WILL and TESTAMENT. Should che Executrix herein named hil
> to qualify or cease to act u Execucnx, thm I appoint RICHARD H. CI,ARH u
Y � 4 EYlCLL[Of i[1�Itf rtG�.
� A '�►
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� � 3' ITEM 5. I hereby direet that all my personal represenativa, u well u char
' z
',� � � � ; successors, shall noc be reqwred to give bond for che faithful performwce of char
c� duties in any jurisdittion.
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' � �
I �I BETI'2'I. CLARH
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r . �r�� i � ..a a� � �r��..� x� s.�a �
me e�c hpt snices o(jAMES l�t sACIi,is A*�areef�m7�-
'' I1'f]i( 7. I dinct th� all eacate> wooemon, k�aey� inheritanoe or o[her �roasfer
tues. hooever daignated chu shall baome payable by rason of my death in
respea of all property comprising my gross ataze for tax purpoxs, w6echer or noc
' i� such propertY Passes under chis LAST WII.L� shdl be paid by my Eatnxrix out of
II �'I
�', my raiduary atate.
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I� ITEM 8. I grwc co mY persoeal roproen�aciva hercin named, in additioa to,
I I� buc noc in Gmicacion of t6ou powers vezed bY �aa', co be exerased without prior
�I ' applicuion co or approval of any court, che power and auchoricy co reuin
I indefinicely any property, w inven and rcinvest uty assets or the proaeds derived
from che sale of aasecs, al�hough said �nvenmenu may noc be of che charaaer
prexribed by law, to xll, wnvey, assign, vans&r and encumber any property, co
pay, uttle or compromise dl claims, to make distribucion or divisiom in as6 or in
kind, and in general to exerase a11 poaen in che management of any property
hereunder which aay iudrvidual could «ercix ia che managemene of similu
i property owned in his own right,aed to execute and deliver any�nd ill inttrumenu
wd co do all ucs which may be dxmed uecasarY md proper.
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�� BE7'1'Y I. CLARIi
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I � � � � wtrivESS k.,,�__� :� h ..;� wrrrrESS J
�t �y '((LtlBERL A.R SS S NNE T.POWER
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_- _ . _I_.___________ ___.__ . . .. ..._—___ __. _... . .
� oa��►i.n�oF�n.v�ran )
. � � �
covrrrY of cuMS�u.�p )
I, $ET'1'1' I. CLARH. the TESTATRIX� whose mmc is sig�ed co che
atrsched ax foregoing inscrument, havieg ban duly quslified accordias w taw�,do
, hereby uknowledge thu I eigaed aad easacted che inttrumem u my LAST�IIZ;
chat I signerl ic willinglys �d that 1 signed it u my fra and voluntary aa for the
�� pucpox cherein eapraud.
' i Swom co or afSra�ed and �o+rkipd bekro �t, bq: BE7'1"Y i. CLARK. che
TESTA7'R11C chis�day of Sepnmber� f1�.
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BE7T'Y T. GLARIf
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' �o.Me.n l���'! �'"�'"'L=
� �� ,r,,,��'��++�w�rt J M.BACIi.ESQ�7HtE
M�u�.rn1�p�� NO'I'ARY TiJBLIC
� lKeciunictburg,PA 17055
, My Cammiasian Ezpim: d5/13103
�' AFFIDAVIT
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i � co�ax�.rx oF r�sn.unrnn >
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� { COUIV7'Y OF CLTMSHRLAND )
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We, HIMBFStI.Y A. RQSS and SUTANNE T. POWER, che witnaus
mhase nama ue signed co the atcuhed ar faregoiag inttrrxmeac, being dsstp
quali�ied according to hw,.do depase �nd say that we werc presem and saw che
TESTATFtIX sign and esecuce che insGruroen� u her LAST WILL; [hat the
( 1 �TESTA'fRiX signcd i[ willingly md shat s6e execuud is u her fr«and volanury
act fer thc pnrpau therein eacpresoed; thu each �itnas in the hruing aad tigfit of
� Ehe TFSTA27tIX signed che WQ.L zt wicnesses; md chat, co chr bert of out
Iknowledge, the TBSTA71tIX mu, u the time, 18 ar more years of age, af sound
( � � mind aad under na coascrainc or uadue influenu.
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� � I Sworn to ar affirmed and acknowledged before me, by: KA4HELRY A. ROSS and
SUZANNE T. POWER,aitncsses,�his 27ib day of�r,70�•
� � � � �
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� � � r� W1TNfi$S ��n'�G'4o( . I s9�+- WITNES$ �.w �� v�
y RIMB Y A.ROSS � �3[JZANDPE T.PO��
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b s x '� �aw M. ACH,ESQUIRE
S E I �'k��r wr 1VOTARY PUSLIG
� �I N���`4.,,M,�,� Mu3wniaburg,PA 17055
' II My Cornm'rsrion Fspirea: p5/13/03
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