HomeMy WebLinkAbout10-25-13 (3) J 1505610149
REV-1500 ��°Z-,,,�F" '$
P�Y� OFFICIAL USE ONLY
PA Dapartment of Revenue CouMV Code Year FHe Number
Bureau of IntliNtlual Taxes �NHERITANCE TAX RETURN
ao sox zeoeo� 21 13 014 9
Harrfsburp,PA 17128-0601 RESIDENT DECEDENT �
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Dete of Birth MMDDYYYY
01 27 2013 05 19 1932
� DecedenCs Last Name Suffix DecedenCs First Name MI
Shoff Donald q
(If Applieable)Enter Surviving Spouse's Informatlon Below
Spouse's Last Name � Suffix Spouse s First Name MI
Shoff Shirley R
Spouse's Social Secunty Number THIS RETURN MUST BE FILED IN DUPLICATE WITFI THE
191 24 57s� REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum O 2. Supplemental Retum O 3. Remainder Return(Date of Death
Priorto 12-13-82)
O 4.Limited Estate � 4a. Fu[ure IMerest Canpromise(date of � 5. Federal Estate Taz ReWm Required
death atter 12-12-82)
� 6.Decedent Died Testate Q 7. Decedent Mainfained a Living Trust 8. Total Numbar of Safe Deposit Boxes
(Attach Copy ot W ili) (Attach CoDY of Trust.)
p 9.Lltiga6on Roceeds Recelvetl p 10. Spousal Poverty Credit(Date W Death p 71. EleMion to Taz under Sec.9113(A)
Belween 1231-91 arM 1-1-95) (Attach Schetlule O)
CORRESPONOENT-THIS SECTION MUST BE COMPLEfED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SXOUID BE DIRECTED T0:
Name Daytime Telephone Number
Elyse E . Rogers, Esquire 717 612 �$01 �
_ c> w � rn
W �ISTER O�Y�IILL'..^' ONLY
� � U� S
r^ s c� � c�
First Line of Address '� D r � M n'1
� ?_ � � C:II �,7 C3
635 North 12th Street , Suite 400 a `"• x o c>
v � � --a -n -n
Second Line of Address c'> � -r� � ± '�
c� C �., -=, C7
N �
�7 � D IL �' O
City a Post Office State ZIP Code N �
Lemoyne PA 17043
corros�,ondeM�s e•ma�i address: erogers@ssr-attorneys.com
Under penal�es of perjury,I declare Net 1 heve e�mined this retum,IncWCing accarpenying schetlules and slatemeMS,and to lhe best af my knowledge and bellef,
tt Is true,Cortect antl co�lete.Decleration W preparar other then Ma peisonal represeMelive is basetl on all infortnetion of which preparer has any k�rowledga.
SIG RE OF PERSON� PONSIBLE FOR�IyNG REfURN � �7 �
✓� �"��s
AD RESS 317 Sanderson ' e
Mechani r , PA 17055
SIGNATUR EPARER THA RESENTATNE DAT�E/
� � �7 ��
ADDRESS Oft � � tre � —
Lemoyne, P 17043
PLCAS[USL ORIOINAL FORM ONLY
Side 1
� 1505610149 1505610149 J
�
� 1505610249
REV-1500 EX(FI) Decedent's Social Security Number
oece�lent�sNan,e: �on81d A Shoff
RECAPITULATION
t. RealEshte{Schedule A}.......................................... 1. � �a�
2. Stock&and Bonds(Schedule B) 2 ,7 6 6,4 5 0 � 0 7
. ... ... .. . .. . .. ... ... ... ... ... . .. . .. 2.
3. Closely Heid Corpaation.Partnership ar SWaProprie#orship{Schedute C} ..... 3. d•��
4. Martgages and Notes Receivable(SChedule D) ... ... ... .. . . ... ... ... ... 4. � • ��
5. Gash,8ank Daposits and Miscetlaneous Personal Properiy{SchedWe E} . .,... 5. Z t 3 2 616 41-2 6
6. Jointly Owned Prpperty(Schedule F) � Separate Billing RequesterJ .... 9. � '�0
7. �nter-Yvvs Trazfsfers s Miscfll�aneous Non-Probate Prop�ty y,y 8�,$9 8 .9�!
(Scheduie G) O S�aerate Bilting ftequested .... 7.
8. Total Grou Assets(totsl Lin�7 through 7) ...... ..... .... .. .......... 8. 5,3 2 3,9 9 0 • 7 7
8. Funeral E �ses and Administrative Costs Scheciule H s. 3 2,6 91-0 0
xP ( } .................
10. Debts W Decedent,Mortgage Liabilities and Liens(Schedule I) . ...... . .. .... 10. 2 8 4 �2 4 3 • 6 8
11. Tatai Deduetions(total lines 9 and 10} ....... ....................... 9 9. ��6�9 3 4 .6 8
12. NetValueofEstate(Line$minusLinell) ................ ............ f2. $,007,056 .09
13. Cha Itable and Gov�nmentai BequesfsiSec 9113 Trusts for which
an elecGon to iex has not been made(Schedule J) . .. . .. . .. .... ... . .. ... . 13. 3,815 ,157 •1�
44. Nat Yalue Su6jsct to Tax(�ine 52 minus Line t3} ...................... 14. L+141�8 9 8 �9 4
TAX CAICUlAT10N-SEE INS7RUCTIQN5 F6R APPLICABIE RATES
15. Am4unt of Line 14 tauable
at the spousal tax rata,or
transfers under Se!c.911fi
(ax1.2}XA 0 11���� .(�� 15. 0 ���
16. Ampunt of Line 14 taxable
atlinealrateX.O as 1,180,89$ • 94 ��. 53,140 . 45
17. Amount o�tine 14 t�abie
atsiblingrateX.12 �`�� 17. �'��
18. Amount of Line 14 taxable
at collatera�rate X.t5 0 . Q 0 1g, 0 �00
19. TAX DUE ... . .. .... . .. ..... ....... .. ......... .. . ......... .... 18. 5��1�#� • 4 5
20. FIL41N 7HE OVAt If Y6U ARE REGiUESTING A REFUND OF AN OVERPAYMENT �
S�de 2
� 1505610249 1505610249 �
REV-1500 EX(Fl) Pege 3 � FIIO Numbat
DecedenYs Complete Address: 21 13 Q149
6ECEDEttT'S NRME
Danaid A. Shoff
STREET ADDRESS
30A Easf Eimwood Avenue
GTY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. 7az Due{Page 2,Li�19} {1} 53140.45
2. CreditsiPaymeMs
A.Prior PaymeMs 0.00
B.Discount p.40
Total Cred�ts(A+B} f2l 0.00
3. Interest (3) 0.00
4. If Line 2�gre�er than Ut�e t+Line 3�e�rtar tfie difference.Ths is the 04ERPAY#AEN7.
F8 in ar�wt Page 2,Line�W request a rofiatd. �4}
5. If line 1+une 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 53,140.45
Make check payable ta: REGISTER OF WILLS, AGENT.
PLEA$E ANSWER THE FQLLOWING QUESTIONS BY PLACING AN"X" IN THE APPROPRIATE BLOCKS
t. Did dacederrt maka a trsnsfer and: Yes Na
a. retain the use or income of the property transferred ... ... . ... .. . ... .. ... ... . ... .. [] �
b. retain tha right to desgnate who shall use the properry transferred or its income ....... 0 �
e, retain a teversionary irrt�e&t. ................................................ ❑ �
d. receive the promise for life af either payments,benefits or care? . . .. . .. . .. . .. . .. ... . � �
2. If death accurred after Dec. 12, 1982,did deceden#transfer praperty within one year of
death without receiving adequate consideration? ................................... ❑ �
3. Did decedent own an"in trust for"or payable-upon-death bank account or securily at his ar her death?. .. ❑ �
4. Did decedent own an individual retirement accourrt, annuity br other nomprobate
property,which contains a beneficiary designation?.................................. (� ❑
IF THE AN5WER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART QF THE RETURN.
Fw dffies oi death on or after Juiy 1,1994,�d befae J�r.1,1995,the taz rate imposed on the net value�transfers#o a for the use of the survlvirrg spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)1•
For dates of death on or�ter Jan.t,1995,the tax rate imposed on the�ret value of transfers to w forthe cise of the survrvirn�spouse is 0 percent
[72 P.S.g91 t8{a}{1.1){ii}].The statute does not e�c�n�a tr�sfe,rta a s�aviving s�e from t�,�d tt�e statulory te�uirements fpr disclosure of asseis az�d
fling a taz retum are still applicable even if the surviving spouse is the onty beneficiary.
For dates ot de�h pn or a(ter July 1,2000:
, r The taz rate imposed on the net v�ve�tra�fers frwn a deceased chi�d 21 ye�s of age or ya�rn�r��akh to wfor tl�e use�e natural p�ent,an
adoptive parent ar a stepparent of the ohild is 0 percent(72 P.S.§9116(a)(1,2)j.
• The taz rate imposed on the net value of transfers ta or for the use of the decedent's lineal ben�ciaries is 4.5 perc5�,except as�oted in[72 P.S.§9i 16(a){t)J.
. The tau rate imposed on the nef v�ue of transfers to rn for the t�e of the t�cedeM's sib�ir�gs�s 92 percertt[t2 P.S.§9116{a)(1.3)].A siGling is defirred,
under Sectian 9102,as en individu�whq has at least one parent in canmon with the decedent,whethsr by blood or adopGon.
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REV-1503 EX+ (8-12)
�P��� SCHEDULE B
CEMk7MFIROF�RlYlMYE
INHERfTANCETAXRETURN STOCK5 & BONDS
RESIDENT 6ECEDENT
ESTATE 4f FILE NUMBER
Danald A. Shoff 21 13 0149
AY proQeriy,�uintly Owafed wNlt rtpht dsuMvorahip must be dtsdosed Mt Sdaed�e F.
�M DESCRIPTIpN VALUE AT DATE
NUMBER OF pEATH
1 100.504$shares Apple Inc 44,732.17
2 800 shares Archer Dan�eis Midiand Co 22,998.00
3 1,000 shares Boeing Co 74,687.50
4 1,000 shares Consolidated Edison Inc � 56,277.50
5 250 shates Caterplttar Ina 24,131.88
B 800 shares Coca Cola Co 29,626.00
7 12,040 shares Generai Electric Company 287,66d.00
8 600 shares Generai Mills Inc 25,Q33.50
Dividend on abave stock declared prior to decedenPs death 198.00
S 1,{?44 shares ifiinois Zooi Wks inc 85,Q5d.00
10 4,000 shares Johnson &Johnson 294,420.00
11 12 shares Motors Liq Co � 277.53
12 6,000 shares PPG Inds Inc 854,367.6q
13 1,d00 shares Prqcter&Gambie Co 73,105.00
Dividend on above stock deciared prior ta decedenYs death 562.00
14 �2,000 shares Public Service Enterprise Group 60,845.00
15 2,040 shares Sou#hwest Airlines Co 22,94d.Q0
16 250 shares 3M Ca 25,106.25
17 1,000 shares Assurad Guaranty Muni Holdings 6.25°l0 25,102.40
Dividend on above stock declared prior to decedenYs death 390.80
18 1,500 shares Assured Guaranty Muni Holdings 5.6°/0 37,325.7d
19 51,293.T54 shares Biackroek Mun Bd Fd inc 573,4SA.17
Total from con6nuation Scheduie(s) 188,149.27
TOt'AL {Aisa errter on line 2, Recapitulatian} 2,786,45QA7
If more space is needed, insert additional sheets oP the same size
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Page 2
Estate of: Donald A. Shoff 21 13 0149
Schedule B - Stocks and Bonds
Item Value at Date
Number Descriotion
of Death
20 6,288.434 shares Blackrock Equity Dividend Fund 130,862.31
21 $25,000 Chambersburg PA Area Schooi District Mat 2/1/13 27,343.08
Interest on above bond accrued as of decedenPs death 571.56
22 $25,000 West Shore PA Area Auth Hosp Mat 1/1/2021 29,273.88
Interest on above bond accrued as of decedenYs death 98.44
23 Generai Motors Corp Note Sr 7.25% 0.00
Worthless per statement
TOTAL. (Carry forward to main schedule) . . . . . . 188,149.27
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REV-1508 EX+ (OB-12)
{����s SCHEDULE E
11T ���MOFAlMNUE �pSH, BANK DEPOSITS & MZSC.
lNMEAITANCETA%RETURN p��ONAL PR4PERTY
RE5IDEP7T DECEDENi
ESTATE OF: FILE NUMBER:
Donald A. Shoff 21 13 0149
Indude tt�e w�s of iitigation ar�Gie date the praeeds were�ived by the esiate.
AN properkyr jointly owned wRh riyht of survivar�ip must 6e disdoacd arr Sd�edut�F.
ITEM DESCRIPTI4N VALUE AT DATE
NUMBER OF 6EATH
1 Merriii i.ynch Money Market Account 872-36833 1,365,641.7$
2 2006 Lfncoln Sedan 10,000.00
Sale price
3 1990 Mercury SW 1,OOO.pO
Value fram D. Burgard-vehicle daes not run
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TUTAI, {Aiso enter on line 5, Recapitulation) 1,376,641.76
If more space is needed, use additipnal sheets of paper of the same size.
REV-1510 EX+ (08-09}
��nr�va�a SCHEDULE G
OENUIIM6MfOFNEVENUE
INTER-VIVOS TRANSF6RS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE RRQPERTY
RGqDENT DECE�ENT
ESTATE dF FILE NUMBER
Donaid A. Shoff 21 13 0149
7t�is�.hedule muSt be canpie�d ard f�d if the enswer to any cf que9.iars i th�h 4 w�page three�tl�e REV-ISIX}is Yes.
I7�M DESCRIPiION OF PF20PERN DATE OF DEATH %OF DECD'S EXCW SION TAXABLE
NUMBE INCWDETHENAME6FTHETRqNSFEREE,THEIRftEIATIONSHIPTpDECEDENT VAWEOFASSET INTEREST IFAPPLICABLE
ANDTHEDATEOFTRANSFER.ATTACHCOPYOFTHEDEEDF00.REqLESATE. ( ) VALUE
1 Merrlll Lynch IRA 730,788.44 10Q 730,788.44
Beneficiary: pecedenf`s daughter, Anne
Burgard
Per Nistorical data from Merriii Lynch
2 2/2p/12$4,049 Cash gift to DecedenYs son-in- 4,048.00 100 3,000.00 1,048.00
law, ponaid R. Burgard
3 OS/18/12$1,50675 cash gift to DecedenPs � 1,566J5 100 0.00 1,508.75
son-in-law, Dpnald R. Burgard
d 05/18/12$1,506.75 Cash gift to Decedent's 1,506.75 1d0 d.00 1,508.75
daughter, Anne E. Burgard
5 7118112$5,Q49.04 Cash gift to DecedenYs 5,449.00 100 3,d00.00 2,449.00
daughter, Anne E. Burgard
6 12J25112$5,000 Cash gift to DecedenYs son- 5,p00.00 1Q0 0.00 5,400.04
in-law, Donatd R. Burgard
7 12125I42$5,000 Cash gift ta DecedenYs 5,00a.oa 100 0.00 5,404.4Q
daughter,Anne E. Burgard
8 1/16/13$14,000 Cash gift to Decedent's 14,000.00 t00 3,000.00 11,04bA0
daughter,A�ne E 8urgard
9 01116/13$14,tl00 Cash gift to DecedenYs son- 14,p00.00 100 3,000.00 11,000.00
in-law, Donaid R. Burgard
10 01/16/13 Cash gift to Decedent's grandsan, 14,Q00.00 100 3,000.00 11,OOO.pO
Robert A. Burgard
11 01/18/13$14,p00 Cash gift to DecedenYs 14,000.00 100 3,000.00 11,000.00
granddaughter, Holly R. Burgard
,
12 01116/13$14,000 Cash gift#o DecedenYs 14,060.00 100 3,Oq0.Od 11,OOd.Od
granddaughter, Cassandra D. Burgard
13 41J24113$14,OOd to 529 Plan Contribution paid 14,404.� 100 0.00 14,d00.00
for the bene�t of DecedenYs grandson, Rabert
A. Burgard
Totai from cantinuation Schedule(s} 365,OOp.QO
TQTAt {Also enter on Line 7, Recapitulation} 1,184,$9$.94
If more space Is needed, use additianal sheets of paper of the same size.
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Page 2
Estate of: Donald A. Shoff 21 13 0149
Schedule G - inter-Vivos Transfers and Misc. Non-Probate Property
Item Date of Death %of Dec's Exdusion Tauable
Num Descriotion of Prooerty Value of Asset Interest (if applicable) Value
14 01/24/13 $14,000 to 529 Plan Contribution paid 14,000.00 100 0.00 14,000.00
for the benefit of DecedenYs granddaughter,
Holly R. Burgard
15 01/24/13$37,000 Cash gift for the benefit of 37,000.00 100 0.00 37,000.00
DecedenYs grandson, Robert A. Burgard
16 01/24/13 $125,000 Cash gift for the benefit of 125,000.00 100 0.00 125,000.00
DecedenPs granddaughter, Holly R. Burgard
17 01124l13$175,000 Cash gift for the benefit of 175,000.00 100 0.00 175,000.00
Decedent's granddaughter, Cassandra D.
Burgard
18 01124/13$14,000 to 529 Plan Contribution paid 14,000.00 100 0.00 14,000.00
for the benefit of DecedenYs granddaughter,
Cassandra D. Burgard
TOTAL. (Carry forward to main scheduie) . . . . . . 365,000.00
REV-151Y EX+ (10-OB)
'�penr�syt�rania SCHEDULE H
����� FUNERAL EXPENSE ANd
�"s o�rn"oECE�rri�'R" ADMINSTRATIVE COST5
ESTATE QP FILE NUM6ER
Donald A. Shoff 21 13 p149
DecndeM's daMs�tx repoKad on Sdae�e I.
�M DESCfiIPTION AMOUNT
NUMBER
A. PUNERAIEXPENSES:
1 Shirley R. Shaff, reimbursement for paymenf to Roliing Green Cemetery 17,005.D0
2 Malpezzi Funeral Home 14,756.00
6. ADMINlSTRATIYE COST5:
S. Persanai Representative`s Cammissions:
Name(s) of Personal Representative(s)
Street Address
Clty Stake _ ZTP
Year(s) Commission Paid:
2. Attorney Fees:
3. Family Exemption: {IY decedent's address ts rrot th�same as ctaamanYS,attach exptanat�on.) 3,540.Oa
Cla�mant Shirley R. Shoff
street address �4 East Elmwaod A�enue
�;�, Mechanicsburg state ?A ZIP �705�
Relationship pf Claimant to Decedent SUNIVing Sp0U58
4. Probate Fees:
5. Accountant Fees: �
6. Tax Return Preparer Fees:
7 Cumberiand Caunty Register of Wills, additionai prabate fee 2,040.00
I 8 Cumberiand Caunty Register of Wilis,filing fees 30.00
TOTAL (Aiso enter on �ine 9, Reeapitulation) 32,691.Od
If mare space fs needed, use additional sheets of paper of the same size.
REVd512 EX+ (12-12)
�'par�,�eytvania SCHEI3UI.E I
"�M��` DEBTS OF DECEDENT,
INNERiTANtE TAX RE?URN {�pRTGAGf LIABILITIES & i.IENS
RESIDENT DECE-0ENT
ESTATE dF FILE NUMBER
Donald A. Shoff 21 13 0149
Reportd�Ina+nad by me aeaeaeM p�rw ae�h that eemaN,ad�psW atn�a daFe wawttr,M+d�np�aueNnbureed me8cai�em�.
ITEM DESCRIPTiON VALUE AT DATE
NUMBER OFDEATH
1 Commonwealth of PA A0,000.00
2 US Treasury 210,OOO.p4
3 Shirley R. Shoff, reimbursamenYS for payment to Hospice of Centrai PA 2,250.Q4
4 Shirley R. Shoff, reimbursement for payment to Home Instead Sr. Care 4,093.93
5 US Treasury 21„OOQ.QO
8 Commonwealth of PA 6,000.00
7 Holy Spirit Hospital 899.75
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TOTAL (Also enter on Line 10, Recapituiatfon) 284,243.88
If more space is needed, insert additional sheets of the same size
REV-1513 EX+ (OS-10)
��""'�� SCHEDULE J
GlMIIIMlMOF IIEYENUE
INHERITANCETAXRETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUM6ER:
Donald A. Shoff 21 13 0149
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELA710NSHIP TO DECEDENT AMOUNT OR SHARE
Do Not Llst Trustae(s) F E T TE
I TAXABLE DISTRIBUTIONS[Include outrightspousal distributions and
transfers under Sec.9118(a)(12).]
See schedule attached
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-7500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1 The Donald A. Shoff Residuary Trust 3,815,157.15
Under Item V of Will dated September 13, 2006
NO ELECTION TO TAX IS MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TO7AL OF PART II— ENTER TOTAL NON-TAXABLE DISTR[BUTIONS ON LINE 13 OF REV-1500 COVER SHEEf. $,$�5,157.15
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Page 2
Estate of: Donald A. Shoff 21 13 0149
Schedule J, Part I - Taxable Distributions
Amount or Share
Num. Name and Address of Person(s)Receivina Prooerty Reladonshi�to Decedent of Estate �
1 Shirley R. Shoff Surviving spouse 11,000.00
304 East Eiwood Avenue
Mechanicsburg, PA 17055
2 Anne E. Burgard Daughter 750,344.19
317 Sanderson Drive
Mechanicsburg, PA 17055
3 Donald R. Burgard Son-in-law 18,554.75
317 Sanderson Drive
Mechanicsburg, PA 17055
4 Holly R. Burgard Granddaughter 150,000.00
317 Sanderson Drive
Mechanicsburg, PA 17055
5 Cassandra D. Burgard Granddaughter 200,000.00
317 Sanderson Drive
Mechanicsburg, PA 17055
6 Robert A. Burgard Grandson 62,000.00
317 Sanderson Drive
Mechanicsburg, PA 17055
7 Donald A. Shoff Residuary Trust Testamentary Trust 0.00
c/o Shirley R. Shoff Trustee
304 East Elmwood Avenue
Mechanicsburg, PA 17055
REV-1514 EX+ (04-09)
�';yp�,��� SCHEDUL� K
{s�► �'""�^��F LIFE ESTATE, ANNUITY
INHERITANCE TAX RETURN 8k TERM CERTAIM
RESIDENT DECEDENt (�71ECK 60X 4 ON RGV-SSQO CQYfR SFFEET)
ESTATE OF FILE NUMBER
Donald A. Shoff 21 13 p149
mis sc�ctule�ukt be us�rM an sir�le-�fe,�a w�ive��fe es�ana t�n,-cerr�n s�a,�.Fw aabes�aeatt,�r m s-x-as,
ac�ariai factors for singirii(e plcuiadons ran be obtainect frorn tlie Departrnent of Revenue.
Actuarial Pactors can be found in IRS Publiotion 1457,AcWarial Values,Atpha Volume fix da6es of death fran 5-1-89 ro 4-30-99,
and in Al�ph Volume fur da�s of death from 5-1-99 and IhereaPoer.
irWicate 6ebw tlie tyPe�insWment tltat created the fuNre intwrest arad aUad�a copy of R ta tlie tax retum.
{1f�
5hirtey R. Shoff 06117/1932 $1 �ure or ❑Term of Yeats
❑ LJfe or ❑Tertn of Years
(.� [i(e cx 0 Term Pf YE2rs
Q Life or ❑Term of Y�rs
❑ Ltfe or ❑Tertn�'Yeats
i. Value of fund fivm which life csWte is payable ........................................... 3,615,157.15
2. tutuar&�!faceflr per apP�pria�ta6� ................................................... Q.0747'f
Interest Yable rate-(� 3.5°h ❑ 6% ❑ 10% � Varfable Rate 1 %
3. vatue w Ore�aroe tw,e 1 rm,�try u„e z� ..................................... zs6.osa.ss
❑t.iEe or [j Term pf Years
❑ Life or ❑Term W Years
❑ti(e or ❑Term of Years
❑ L.ife or 0 Tertn of Years
l. Vaiue of fund from whirh annuitY�PaYabie .............................................
2. Check appropnate blodc below and enter corresponding number ............................
�.n�.v�aav«,c- ❑ wee�r(s2) � s�-�eear t�e} ❑ r�miy�iz}
[] Quarterly(4) ❑ Semi-annually(2) ❑ Annually(1} ❑ Other( )
3. Amountofpayoutperpenod .........................................................
4. A99�9ate annual paymeM,Line 2 multiplied by Eine 3 ....................................
S. Annuity Fador(see instrvctiorrs)
i Interest table rabe-Q 3.5°!0 � 6°!a ❑ ZO°k ❑ Vxriabie Wate °lo
6. AdjustmentFad:or(Seeinstructlons.) ..................................................
?. Yalue oP�uity-Tf usit�3.5,5,w 10'30,a�vaHabie rate and periac�
payout is at end of period,caiCUlation is tlne 4 x Une 5 x Une 6 ...........................
fi using variable rate and period payout is at beglnning of perial,cakulation Is
(Llne4xline5xtlne6)+1.1ne3 ..................................................
N6TE:The vaiues of Uie fu�s ffiat cr�te the above firture intera-IS must be reported as part oF the estate asse.#s on Sd�ciu{es A thruugh G�the i
I�x reW m.The resultlng Ilfe or annuity In[erest should be repdted at Ne a{�Upha6e t2x rdbe on Ilnes 13 and 15 through 18 tlf Me retum.
If more space is needed,use aciditional sheets of Me same size.
Rev-iea� Ex+ �oz-ia�
�p�variia SCHEDULE M
°NY0.1M6NT0F�"�` FUTURE INTEREST COMPROMISE
ES DENT CDECEDENRT",� �CI�IBCIC BOX 4$! Of! REY�SS��
ESTATE pF FILE NUMBER
Donald A. Shoff 21 13 0149
Thk is apprqpriate only for�o€decadents rvho died�Dec.12,1982.
This sctsedule is to be used fur all tup ire interes�s where the ra[e of tax that wifl be appGcable when the firture interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrvment that aeated the fuWre intere5t and atbch a copy to the tax reCum.
� WiII ❑ Tnast ❑ Other
i. Benefieiaries
NAME 4F BENEFICIARX RELATFONSHIP DA'FE 6F BIRTH AGE 70
PdEAREST BIRTHDAY
s.Shirley R. Shoff Surviving spouse p6/17/1932 81
2.
3.
A.
5.
II. For decedents who died an or afrer tuly i:1994,�a surviving spaue exetc�ed or intends h�exerri�a ri�ht�withcirawai wikhin
nine months c�the decedenrs d�th,ct�edc the appropriabe brnc belav and attadt a copy of tfie document in which the wrviving
sqouse exercSSes such wlthdrawal right.
❑ Un1lmiCed right of withdrawat � Limibad right of withdrawal
m. 4q�Ienatwn oY Co�romice ortear.
Mr. Shoff was survived by his wife, one daughter, and three grandchildren. In the trust
created under Item IV of his W ill, he created a life estate for his wife,with the remainder ta his
then i'�ving issue.There is no provision in the Wiii far property to pass to anyrsne ottrer than his
sppuse or issue. The trust is a sole use Must.
7hfs future interest campromise is being prepared and filed as a result of 61 Pa. Code 94.3.
The Pennsylvania inheritance Ta�c AcE, 72 P.S.9113, is quite ciear as to the IawFui imposition
an the death af the first spouse of the inheritance tax with respect ta a soie use trust when fhe
defauR rule, not electing to pay the inheritance tax on the death of the first spouse is followed.
iv. Summary af Compnmise OfPer:
1. Amount of fikure interest .....................................
.................. g 3.53Q 126.76
2. Value of Line 1 euempt from tax as amdunt passing to diarik3es,etc.
(Also include as part of total shown on Line 13 of REV-1500.) .. $
3. Value of Line f passin9 ta spause at appivpriate iax rate
CfiECK 608. � 59�6� � 3°la, � 0°In .............. $
(Also Include as part of tatal shown on Line 15 oP REV-1500.)
4. Value oP Line 1 taxable at lineal rate
! �eckare. ❑ 6°to, ($�4.5°lb ...................... S 3,53tf�126.78
� (Aiso inciude as part of tota)shown on Une 16 of REV-1500.}
5. Value pf Line 1 taxable at sibling rate(12%)
(Also include as part of total shown on Line 17 of REV-2500.} .. $
6. Vat�e af line 1 taxable at coltakeral rate(15°Jo)
(Also include as part of total shown on Line 18 of REV-1500.) .. $
7.Total value of future interest(sum of Lines 2 thru 6 must equal Line 1) .................. $ 3,530,128.78
If mare space is needetl, use additlpnal sheets of paper af the same size. �'
B1/31/13 13:29;Z6 888-299-565B -> 717 533 1942 Merrill Lynch Page 883
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----__
I
LAST WILL AND TESTAMENT
of
DONALD A.SHOFF
I,DONALD A.SH6FF,a resident of the Borough of Meohaniosburg,Couniy of
Cumberland,and Commonwealth of Pennsylvania,being of sound and dispasing mind,�namory
and understand3ng,dp make,publish and dectare this as and for my Last VJitt and Testarnent,
hereby revoking all Wills and Codicils by ma at any time]�eretofore made.
ITEM I:Ail inheritance,estate and similar taxcs bewming due by reason of my doaih
("Death Taxes"),whether such Dcath Ta�cas shall be paya6le by my estate or by any recipiant of
any property,shail be paid by my 8xewtor fixst out of the property passing under ITEM TV of
this Wil]and second,if,only if and only to t6e extent that said property is not sufficient,out of
tlse property passing under ITEM V of this Will as an axpense and cost of administration of my
estate;provided,however,that if any properiy held in any tesiamentary or inter vivos trust
� ereated by my wife,SHIRLEY R.SHOFF("My Wife"),is includable in the estate for purposes
of any Beath TaY and Yhe fallow'sng amaunt is not ozUtnvise paid to my estate as a resuit of the
includability of such property,dxen the amount of such Deatl�Tax attributable to the inclttsion of
such property in my estate for pwpases of such Death Tat shall be paid out of suc17 groperty or
by the recipients of such property;and,if such amount is neverdielass paid by my Executor,I
direct my Executor to obtain reimbursement or contributian for such amount. Othervrisa,my
Executor shall have na duty or obligation to obtain reirnbursement for any Death Taxes paid by
my Executor,evan though paid with resgect ta pmceeds af insurance or athex properry not
passing under tl�is Witl. �
iT�M II:I hereby exercise a11 powers af appointment whSch I may have�t the rime aF my
deatl�in favor of my Cxecutor,and all propoMy subject to all such powers of appoimment shall
I be included in my estate and be governed by the provisians of this Will;providcd,havrever,that
=� I specifically declina to exercise mny power of appointment given to me in az�y Will,Codicil, _
a3
P.C.
Agreement af Trust or other instrument esecated by My Wife.
I III: I give and bequeath all of my household fiuniture and fumishings,
�.._ . . . . .__ _. .. :,. .- ... _....._..___ ,...._,_...----......__..__.. .._.._.__.. ....�._�..._,....�
utomobiles,books,pictures,jewelry,china,crystal,appliances,silverware,wearing appare]and
I other like articles of household or personal use or adomment to My Wife,if she survives me.
f my wife does not survive me,then and in that event,I give such articles to my daughter,
amely,ANN E.BURGARD,or her issue if she does not survive me.
ITEM N:I give,devise and bequeath to my Trustee hereinafter named,IN TRUST �
EVERTHELESS,to be held,administered and disposed of in accordance with this TTEM N
herein referred to as the"Unified Credit TrusY')an amount equal to the balance of the dollaz
ount not ta�ced in my estate due to the application to my estate of the unified credit against
federal gift and estate tax(the"Unified CrediP�,after deducting therefrom the value,for federal
state tax putposes,of(a)assets included in my federal gross estate which pass or have passed
other than under the terms of this Will and which will utilize a portion of the Unified Credit,(b)
any bequests under the preceding ITEMS of this Will which will utilize a portion of the Unified
Credit and(c)adjusted taKable giRs not included in my federal gross estate but included in the
computation of the tentative federal estate tax in my estate. My Trustee stisll have,hold,
manage,invest and reinvest the assets of the Unified Credit Teust,collect the income therefrom
and
(a) If My Wife survives me,beginning at my death,my Trustee shall pay over
the net income of the Unified Credit Trust to My Wife during her lifetime,in installments
not]ess frequently than querter-annually. In addition,my Trustee shall pay such amounu
of the principal of such trust as,in the sole discretion of my Trustee,may be necessary
for the maintenance,support and medical and nursing care of My Wife,[aking into
consideration any other means readily available for such purposes.
(b) Upon the�death of the survivor of My Wife and me,my Trustee shall
� distribute the principal and any undistributed income of the Unified Credit Trust to my
then living issue,per stirpes;provided,however,that(1)should any such issue be the
,ES issue of a deceased child of mine who has not attained the age of twenty-five years,each
R B[
'�P��� such issue's share shall be retained by my Trustee,IN TRUST,NEVERTHELESS,to be
-2'
�
. _. _
hald,administered and disposed of as a sepazate trust estate in accordance with ITEM VI
(the"Grandchild's TrusY').
ITEM V:I give,devise and bequeath all of the rest,residue and remainder of my
property,real,personal and mixed,wherever situate,not disposed of in the preceding portions of
this Will,to my Trustee hereinafter named,IN TRUST,NEVERTHELESS,ro be held,
administered and disposed of in accordance with this I1'EM(the"Qualified Terminable Interest
Property trusP',herein refened to as the"QTIP TrusP'). My Executor shall have the right[o
elect on the federal estate tax retum prepared on behalf of my estate to have a portion or all of
the property passing under this ITEM as"qualified temilnable interest property"in order to
qualify such portion or all of the property for the marital deduclion for federat estate tax
puiposes. If my Executor elects to qualify a portion rather than all or none of[he proper[y
passing under this ITEM,my Trustee may hold and maintain such elected partion of the property
as a separate trust estate and hold and maintain the balance of the property govemed by this
ITEM as a sepazate trust estate or my Trustee may hold and maintain the elected portion and the
balance of the property governed by this ITEM as a single trus[estate. Each such sepazate trust
estate(or if there is a single[rust estate,then the single trust estate)shall be held in trust for the
following uses and purposes.My Trustee shall have,hold,manage,invest and reinvest the assets
of each such trust,collect the income therefrom and
(a) If My Wife survives me,beginning at my death,my Trustee shall pay over
the net income of each such trust to My Wife during her lifetime,in installments not less
frequently than quarter-annually. In addition,my Trustee shall pay such amounts of the
principal of each such trust as,in the sole discretion of my Trustee,may be necessary for
the maintenance,support and medical and nursing care of My Wife,talcing into
consideration any other means readily available for such purposes. Upon the death of My
Wife,my Trustee shall distribute any undistributed income of each such trust to My
� Wife's estate.
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(b) During the lifo of My Wife,my Trustee shall pay to My Wife from the
principal of each such wst at any[ime and from time to time such sums or specific assets
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as My Wife may designate by written notice to my Trustee;provided,however,that no
withdrawal,when added to the aggregate amount or value previously withdrawn by my
Wife pursuant to this subparagraph(b),during the calendar yeaz in which the withdrawal
is to be made,shall exceed the greater of(1)$5,000 or(2)five(5%)percent of the
aggregate value of each such trust at the time of such withdrawal.
(c) Upon the death of the survivor of My Wife and me,my Trustce shall
distribute the principal of each such trust to my then living issue,per stirpes;provided,
' however,that(1)should any such issue be the issue of a deceased child of mine who has
not attained the age of twenty-five yeazs,such issue's share shall be retained by my
Trustee,IN TRUST,NEVERTHELESS,to be held,administered and disposed of as a
separate trust estate in accordance with ITEM VI(the"Grandchild's TrusY');provided,
however,my Ttustee shall prior to making any such distribution pay to the estate of My
Wife out of the principal of each such trust an amoun[equal to any increase in
inheritance,estate and similaz taxes becoming due by reasoa of My Wife's death("My
Wife's Death Taxes")attributable to the inclusion of any of the asseu in such tcust in My
Wife's estate for purposes of My Wife's Death Taxes,so that My Wife's Death Ta�ces in
excess of said amount do not exceed My Wife's Death Taxes which would have been
payable if none of the assets in such trust were includable in My Wife's estate for .
purposes of My Wife's Death Taxes.
ITEM V I:My Trustee shall have,hold,manage,invest and reinvest the assets of each
Grandchild's Trust,collect the income therefrom and
(a) Until the issue of a deceased child of mine for whose benefit the
Grandchild's Trust was established(the"Grandchild")shall have attained the age of
twenty-five years,my Trustee shall from time to time pay to or for the benefit of the
Grandchild such amounts of the net income and principal of the Grandchild's Trust as,in
F�=� the sole discreuon of my Trustee,may be necessary for tlr,e grandchild's maintenance,
I(ER&
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support,medical and nursing care an education,including college and gra uate
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education,taking into consideration any other means readily available for such purposes.
At the end of each year any undistributed income Shall be added to the principal of the
Grandchild's Trust.
(b) After the Grandchild shall have attained the age of twenty-five yeazs,my
Trustee shall distribute the remaining principal and any undistributed income of the
Grandchild's Trust ouhight to the Grandchild. If the Grandchild shall have died before
attaining that age,upon the death of the Cnandchild,My Trustee shall dishibute the
remaining principal and any undistributed income to the then living issue of the parent of
the Grandchild who was a child of mine,per stirpes,or if such pazent has no then living
issue,then to my then living issue,per stirpes;provided,however,if any such beneficiary
is then a beneficiary of a Child's Tmst or a Grandchild's Trust hereunder,[he shaze of
such beneficiary shall be added to the principal of such Child's Tmst or Grandchild's
Trust and become a part thereoE
I1'EM VII:It is my intcntion to conform to the pmvisions for the allowance of � the
merital deduction for federal estate tax purposes. I therefore direct that any provisions of this
Will nonvithstanding,the powers granted herein to my Executor and Trustee shall be construed
in accordance with said intention and st�all not be interpreted or e.xercised so as to disqualify any
portion of the QTIP Trust elected by my Executor to qualify for the federal estate tax marital
deduction.
ITEM VIII:No interest in income or principal of my estate or any trust created hereunder
shall be subject to attachment,levy or seizure by any creditor,spouse,assignee or trustee or
receiver in bankruptcy of any beneficiary of my estate or of any trust created hereunder prior to
the boneficiary's actual receipt thereo£ My Executor or Tnutee shall pay over the net income
and the principal to the beneficiaries herein designated,as their intaests may appear,without
regazd to any attempted anticipation(except as may be specifically provided herein),by pledging
° or assignment by any beneficiary of my estate or of any trust created hereunder and without
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regazd to any claim thereto or attempted levy,attachment,seizure or other process against said
beneficiary.
ITEM IX:Any person other than My W ife who shall have died at the same time as I
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r under such circumstances that it is difficult or impossible to�determine who shall have died
irst shall be deemed to have predeceased me. If My Wife and I shall have died at the same time
r under such circumstances tlia[it is difficult or impossible to determine who shall have died
ust,My Wife shall be deemed to have survived me. Any person other than me who shall have
ied at the same time as any then beneficiary of income of my estate or a trust created hereunder
r under such circumstances that it is difficult or impossible to determine who shall have died
� first shal]be deemed to have predeceased such beneficiary.
ITEM X:In the settlement of my estate and during the continuance of any m�st created
hereunder,my Executor and my Trustee shall possess,in addition to those powers conferred by
law,the following powers to be exercised,without authority,from any court,for the best interests
of the beneficiaries;subject,however,to the restrictions set forth below as to any portion of the
QTIP Trust qualified for the federal estate[au marital deduction:
(a) To retain any investments I may have at my death so long as my Executor
or Trustee may deem it advisable to my estate or trust so to do.
(b) To vary investments,when deemed desirable by my Executor or Trustee,
and to invest in such bonds,stocks,notes,real estate mortgages oi other securities or in
such other rea(or personal property as my Executor or Trvstoe shall deem wise,without
being restricted to so called"legal investments.°
(c) In order to effect a division of the principal of my estate or trust or for any
other purpose,including any final distribution of my es[ate or trust,my Executor or
Trustee is authorized to make said divisions or disttibutions of the personalty and realty
partly or wholly in kind. If such division or disVibution is made in kind,said assets shall
be divided or distributed at their respective values on the date or dates of their division or
distribution. In making any division or distribution in kind,by Executor or Trustee shall
divide or distribute said assets in a manner which will fairly allocate any unrealized
appreciation or depreciation among the beneficiaries.
- (d) To sell either at public or private sale and upon such texms and conditions
as my Executor or Tnutee.may deem advantageous to my estate or trust,any or all real or
personal property or interest therein owned by my estate or avst severally or in
conjunction with other pasons,and to consummate said sale or sales by sufficient deeds
or other instruments to the purchaser or purchasers,conveying a fee simple tille,free and
cleaz of al]trust and withovt obligation or liability of the purchaser or putchasers to see to
the applications of the purchase money or to make inquiry into the validity of said sale or
sales;also,to make,execute,acknowledge and deliver any and atl deeds,assignments,
options or other writings which may be necessary to desirable in carrying out any of thc
_� powers conferred upon my Execvtor or Trustee in this paragraph or elsewhece in this
'& Will.
P.C.
(e) To mortgage or pledge real or personal property owned by my estate or
trust and to make lesses of real or personal property for any tersn.
(fl To bonow money from any party,including my Executor or"Irustee,to
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pay indebtedness of mine or of my estate or trus[,expenses of administration,Death
Taxes,other taxes or for any other purpose;provided,however,that this provision shall
not authoriu bonowing from any portion of the QTIP Trust qualified for the federal
estate marital deducrion without adequate interest and securiTy.
(g) To pay ail costa,Death Taxes,other taxes,legally enforceable debts,
expenses and charges in coanection witl�the adminishation of my estate or trust,the
expenses of my last illness and my funeral expenses;provided,however,that no such
costs,Death Taxes,other taxes,debts,expenses or ehazges in connection with the
adminisha[ion of my estate,such expenses of my last illness or such funeral expenses
shall be paid from any portion of the QTIP Prust qualified for the federal estate ta�c
marital deduction.
(h) To vote any shares of stock which form a part of my estate or wst and to
otherwise exercise alt the powers incident to the ownership of such stock and to hold and
actively manage and operate any unincorporated business,including any sole
proprietorship,joint venture end partnership,with al]the righu and powers of any owner
thereof.
(i) In the discretion of my Executor or Trustee,to unite with other owners of
suni]az property in carrying out any plans for the reorganizalion of any corporation or
company whose securities form a part of my estate or trust.
(j) To assign to and hold in my estate or trust an undivided portion of any
asse[.
(k) To hold investrnenu in the name of a nominee.
(1) To abandon,compromise,settle,azbihate,pay or othmvise deal with
claims in favor of or against my estate or trust.
(m) To select,employ and compensate any person,firm or corporation
engaged in rendering investrnent counsel advice to my Executor or Trustee in making .
investments,managing securities or making decisions conceming the purchase,retention,
sale or other disposition of any pazt of my estate or hust;and to select,employ and
compensate any attomey,accountan[,broker or other specialist or firm theroof to render
services[o my Executor or Trustee with respect to my estate or trust.
(n) Only property which is fully eligible for the marital deduction for federal
estate tax puiposes shell be assigned[o the potion of the QTIP Trust quafified for the
federal estate tax marital deduction. Notwithstanding enything to the contrary contained
in this Will,my Trustee shall not retain beyond a reasonable time or invest in,as an asset
of any poRion of the QTIP Trust elected to qualify for the federal estate tax marital
deduction,any property which may at any time be or beceme unproductive.
� ITEM XI:In thesettlement of my estate:
(a) My Executor shall not be petsonally liable for loss to my estate or to my
spouse's estate or to any beneficiary of either estate resulting from my Executor's
decision made in good faith whether or to what extent to elect on the federal estate tax
retum propared on behalf of my estate to have a portion or all of certain"qualified
terminable interest property"treated as having paased to my spouse in order to qualify for
� the federal estate tax marital deduction;nor,as a result of such decision,shall any
compensating adjustments be made.
(b) My Executor shall not be personally liable for any]oss to my estate or to
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any beneficiary of my estate resulting from an election made in good faith to claim a
deduction es en income tax deduction or as an es[ate tax deduction;nor as a resuli of such
election,shall any compensating adjustments be made.
(c) In valuing property in my gross estate for the purposes of any Deatli Tax,
my Exocutor shall not be personally liable for any loss to my estate or to any beneficiary
of my estate resulting from my Executor's decision made in good faith to use a par[iculaz
valuation date;nor,as a result of such decision,shall any compensating adjustments be
made.
(d) My Executor shall not be personally liable for any loss to my estate or to
any beneficiary of my estate resu(ting from any other decision or eleclion made by my
Executor in good faith;nor,as a result of any such decision or election,shall any
comprnsating adjustments be made.
ITEM XII:If there should be established hereunder or by My Wife,either in her Last
Will and Testament or by inter vivos Deed or Agreement,any trust s'vnilar to any trust herein
established,my Trustee shall have the right and power to merge such trust herein established
with such similaz trust established hereunder or by My Wife md to operate such merged trusts as
a single trust.
ITEM XIII:I hereby nominate,constitute and appoint My Wife to be the Execu[dx of
this my Last Wil]and Testament and my estate. If for any reason,My Wife should fail to quelify
or cease to act,I nominate,constitute and appoint my davghter,namely,ANNE E.BURGARD,
to be such Executrix. If for any reason my said daughter should fail to qualify as such Executrix
or cease so to serve,then and in that ul[imate event,I nominate,constitute and appoint my son-
in-law,namely,DONALD R.BURGARD,to be the Executor hereof.All references in this Will
to my"Executor"shall also refer to any Execuhix,successor Executor and successor Executrix.
ITEM XN:I hereby nominate,constitute and appoint My Wife as Tmstee of any trust �
created hereunder. If for any reason My Wife should fail or cease to act,I appoint my daughter,
namely,ANNE E.BURGARD,my Trustee. If for any reason my said daughter should fail to
qualify as such Trustee or cease so to serve,then and in that even[,I nominate,constitute and
appoint my son-in-law,namely DONALD R.BURGARD,to be the Trustee.Al]references in
this Will to my"Trustee"shall also refer to any successor Trustee.
_s
'& ITEM XV:My Executor or Trustee shall qualify and serve without the duty qr
P.C.
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(� bligafion af filing any bond or other security. Aay Executor or Trustee shall not ba surcharged
r otherwise held(iable under any prudent investor statute or otherwisa excapt far gross
egiigence orinteutiona!wrongdoing.
ITEM XVI: In tha event that for any reason on the date of any distribution of income
r principal from mp estate or any trust created hereunder there is not a bentficiary thereof,then
such distribution shalt be made to such persons,and in sueh proportions,as woutd be entitled to
y estate had I then ditd iatestate,a resident af the Coaunonwealth of Pennsylvania
IN WITNESS WHEREOF,I have heraunto set my hand and seal and do hereby declarc
(this instrumant to be my Last Will and Testaznent,this 13�'day of September,2006.
� � -7'�/.,rt.�
� nj«G�r�`��` ;�`",Z,.'� {SEAL)
Dflnald A.Shoff r'
The preceding instrument,consisting of this and oight{S}other typewritten pages,each
identified by the signatura of the Testator,wu on the date therenf signad,sealed,pubtished and
declazed by DONALD A.SHOFF,the Testator therein namad,as and for his Last Will and
Testament,in the presence af us,whb,at his request,in her presence and in the presence of esch }
othar,have subscribed our names as wimessas hereto.
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OMMONWEALTH OF PENNSYLVANIA)
: SS.
OUNTY OF CLIMBERLAND )
We,DONALD A. SHOFF,RICHARD C. SNELBAKER and JANE J.COONEY,the
estator and the witnesses,respectively,whose names are signed to the attachod or foregoing
instrument,being first duly sworn,do hereby declare to the undersigned authority that the
estator signed and executed[he instrument as his Last Will and Testament 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 of the witnesses,in the presence and hearing of the Tes[ator,signed the
Will as a witness and that to the best of his or her Imowledge,the Testator was at that time
eighteen years of age or older,of sound mind and under no conshaint or undue influence.
�� �
Testator �
�'�--
i ess
' ess
Subscribed,swom to and acknowledged before me by DONALD A.SHOFF,the
Testator,and subscribed and swom to before me by RICHARD C.SNELBAKER and JANE J.
COONEY,the witnesses,this 13'"day of September,2406.
� � ���
� Notary Public
' COMMONWE4LTHOFPENNSVLVANIA
' PmIBnaISeY
. Sunn L Mabatl.I�bYd Publc
MachanimdW Bpro,CuMrIW Cqilg'
MY C,amrttletlon FxpYes Nov.2f,ID07
MamEr.Pmwylv�ni�Pa�adYbn qNo1MIN
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