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Home My WebLink About12-30-13 � REV-1500EX(02-11) $� 1505610143 PA De artment of Revenue OFFICIAL USE ONLY p pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENTOFREVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 13 0 8 7 6 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 085 26 0400 05 23 2013 02 09 1931 DecedenYs Last Name Suffix DecedenYs First Name MI CLIFFORD LOIS J (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return ❑ 2. Suppiemental Return � 3_Remainder Return(Date of Death Prior to 12-13-82) � 4. Limited Estate � 4a.Future Interest Compromise � 5. Federal Estate Tax Return Required (date of death after 12-12-82) g Decedent Died Testate � Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes � (Atlach Copy of Will) � (Attach Copy of Trust) � 9. Litigation Proceeds Received � 10.between 12-3 gCr2ed�it;Da95j f Death ❑ ��'�AttachnSchedule O)Sec.9113(A) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone:tJumber JEAN D SEIBERT 71� 236 �01r� 7 . � ;� cs"� RE�T��2�6f WIEL-8 USE��Y � ,�,�. !—' GJ w";; 9.�'i �"° �y �"El � ::..� First Line of Address �.� - :� �:� � + 109 LOCUST STREET �` < ~� � `� ��k �-:: _., ,__, 4 , .__ . � � , � Second Line of Address �' ' � �� . , ,..� a�, _ S — - ` ......r r.. ,�.' .�.;.,, � .�^�, 4,;;�.:? ' DATE FIC� � City or Post Office State ZIP Code HARRISBURG PA 17101 CorrespondenYs e-mail address: H/ZS @ m i n d s p r i n g.C o m Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE �,..�,�n�, Duncan H.Johnston L �� _�Y� ADD Mt. Calvary Episcopal Church 125 North 25th Street, Camp Hill, PA 17011 SIGNAT OF PR THER THAN REPRESENTATIVE DATE Jean D Seibert / �til ADDRE Wi ,Zulli and Seibert 109 ocust Street, Harrisburg, PA 17101 Side 1 � 1505610143 1505610143 � � � 15�5610243 REV-1500 EX DecedenYs Social Security Number oeoede�t'S Naroe: C L I F F O R D� L O I S J. 0 8 5 2 6 0 4 0 0 RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3. 4. Mortgages&Notes Receivable(Schedule D).......................................................... 4. 5• Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 1 1 3 , 19 3 . 8 7 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) � Separate Billing Requested............. 7, g. Total Gross Assets(total Lines 1 through 7).......................................................... g. 1 1 3 , 19 3 . 8 7 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 5 , 9 41 . 4 2 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10. 8 2 6 . 5 0 11. Total Deductions(total Lines 9 and 10).................................................................. 11. 6 , 7 6 7 . 9 2 12• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 1 O 6 , 4 2 5 . 9 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)................................................. �3. 9 6 , 4 2 5 . 9 5 14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 1 0 , 0 0 0 . 0 0 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 15. 16. Amount of Line 14 taxable at lineal rate X .045 �6• 17. Amount of Line 14 taxable at sibling rate X ,�2 17. 18. Amount of Line 14 taxable at collateral rate x .15 10 , 0 0 0 . 0 0 �8� 1 , 5 0 0 . 0 0 19. TAXDUE................................................................................................................... 19. 1 , 500 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 � 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21 - 13 - 0876 Decedent's Complete Address: DECEDENT'S NAME Clifford, Lois J. STREET ADDRESS 3605 Kohler Place Apt. 1 CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,500.00 2. Credits/Payments A. PriorPayments 1,425.00 B. Discount 75.00 Total Credits(A +B) (2) 1,5 0 0.0 0 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4� Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. �5) 0.�0 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred:.................................................................................. � � b. retain the right to designate who shall use the property transferred or its income:.................................... � �x c. retain a reversionary interest;or.................................................................................................................. ❑ ❑X d. receive the promise for life of either payments,benefits or care?.............................................................. � � 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................................................................................................... ❑ 0 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... � � 4. Did decedent own an individual retirement account,annuity,or other non-probate property which contains a beneficiary designation?...................................................................................................................... ❑ � IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before Jan.1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax re�urn are stiil applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: •The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. •The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)]. •The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.&9116(a)(1.3). A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wFether by bloo�or adoption. �� pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH BANK DEPOSITS AND MISC. INHERITANCE TAX RETURN 7 RESIDENTDECEDENT PERSONAL PROPERTY FILE NUMBER ESTATE OF Clifford, LOIS J. 21 - 13 -0876 Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorsh�p must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 M&T Bank Checking Account No. 9844831637 13,434.27 Accrued Interest 0.08 2 M&T Bank Savings Account No. 15004211160045 16,266.99 Accrued Interest 0.29 3 M&T Bank Certificate of Deposit No. 31003914534944 30,000.00 Accrued Interest 7,7g 4 Sovereign Bank Checking Account No. 1200511638 278.4g 5 Sovereign Bank Checking Account No. 1271149532 3,151.89 Accrued Interest 0.02 6 Sovereign Bank Certificate of Deposit No. 1685209361 50,044.20 Accrued Interest g.gg TOTAL(Also enter on Line 5, Recapitulation) 113,193.87 REV-1511 EX+(10-09) �.�'�� pennsylvania SCHEDl1LEN � , �� DEPARTMENT OF REVENUE FUNERAL DCPENSES AND RESIDENT DEC D NT URN ALJIYIINh7 1 IW 1 1 V G VW 1 J FILE NUMBER ESTATE OF Clifford, Lois J. 21 - 13-0876 DecedenYs debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Mt. Calvary- Funeral Services 200.00 2 Auer Cremation Services 352.92 B. ADMINISTRATIVE COSTS: �. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. attorney's Fees Wion, Zulli and Seibert--Jean D Seibert 4,725.00 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Probate Fees 218.50 Additional Probate Fee 170.00 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs � Central Penn Business Journal-Advertising 150.00 See attached 125.00 TOTAL(Also enter on line 9, Recapitulation) 5,941.42 Schedule H � Funeral Expenses& COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN Adminisfiative Cosis continued RESIDENT DECEDENT FILE NUMBER ESTATE OF Clifford, Lois J. 21 - 13-0876 2 Cumberland Law Journal -Advertising 75.00 3 Sovereign Bank- Date of Death Balance Service Charge 20.00 4 Reserve for postage, copies, etc. 30.00 Page 2 of Schedule H � � � pennsylvania SCHEDULE I �' DEPARTMENTOFREVENUE DEBTS OF DECEDENT INHERITANCETAXRETURN , MORTGAGE RESIDENTDECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF Clifford, LOIS J. 21 - 13-0876 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 09-19-13 PSERS- Pension overpayment 210.64 2 09-19-13 PPL Electric 222 45 3 09-19-13 Verizon 166.57 4 09-19-13 MD at Home-Medical Services 25.39 5 09-20-13 Conodoguinet Creekview Apts. - Rent 201.45 TOTAL(Also enter on Line 10, Recapitulation) 826.50 REV•1513 EX+(01-10) �ti,F�' �: ��% pennsy�vanEa E SCHEDULE J INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Clifford, Lois J. 21 - 13-0876 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY oo Not�ist rrustee(s) I, TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Judith A. Kleinfelter Friend 10,000.00 484 Granite Quarry Road New Cumberland, PA 17070 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Mt Calvary Episcopal Church - 100% of Residue 96,425.95 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 96,425.95 �� t11 �n� �P�t�x�n��tt OF LOIS J. CLIFFORD I, LOIS J. CLIFFORD, of Lower Allen Township, Cumberland County Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby declare this as and for my Last Will and Testament, hereby revoking all Wills and Codicils previously made by me. 1. I direct the payment of my debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I direct my burial to be in the Columbarium at Mt. Calvary Episcopal Church, Camp Hill, Pennsylvania and that the services of the Cremation Society of Pennsylvania to be used at the time of my death. 2. I give all my articles of personal or household use, including any automobiles I own� at the time of my death, to my friend, MARY BETH WATKINS, if she survives me. 3. I direct all the rest, residue and remainder of my estate, whether real or personal, and wherever the same may be situate or located, be converted to cash and given and bequeathed to MT. CALVARY EPISCOPAL CHURCH of Camp Hill, Pennsylvania to be used in whatever manner is felt necessary for the continued services of thz Church. This gift shall be given in memory of my late husband, k` EDMUMD S. CLIFFORD and myself. � 4. I direct that any and all inheritance, estate and transfer 6 � � taxes imposed upon my estate, passing under my Will or otherwise, hall be paid out of the principal of my residuary estate. 5. In addition to powers given it by law, my Executor acting , ,� ereunder shall have the fullest power and authority in all matters and questions and to do all acts which I might or could do if � _ ,.,, � �= � :a - `: . c! - ._.. r- - ' py ;_) `. I` •^t � 1-fV (=` , C,.7 ' -7 �:J (': =_J ', c� �^� • <, c_% - r�; � ...3 •:�� l�� ";3 CJ -,y i-� N � � �living, including, without limitation, complete power and authority � � to invest (without restriction to investments permitted by law), � i � sell (at public or private sale, for cash or credit, with or without � � security), mortgage, lease and dispose of and distribute in kind, � all property, real and personal at such times and upon such terms , • � and conditions that it may deem advisable. � �� 6. I nominate, constitute and appoint DAUPHIN DEPOSIT BANK AND � TRUST COMPANY of Harrisburg, Pennsylvania as Executor of this, my � � Last Will and :estament. i � � 7. I hereby relieve my personal representative from the � � i � necessity of posting security in connection with its duties as such � i � in any jurisdiction in which it may be called upon to act insofar ! as I am able by law to do so. ! � � IN WITNESS WHEREOF, I have hereunto set my hand and seal to � i � this, my Last Will and Testament, consisting of two typewritten � f pages, the first one of which bears my signature in the margin for i � the purpose of identification, this ��'�^ day of � � � ____ •��r�,Y��•�, , 1994. , � � � ' , � � ' 'a� (SEAL) � f "�s''' ' - � � L s J. liffor � � ! f Signed, sealed, published and declared by the above-named Testatrix, € Lois J. Clifford, as and for her Last Will and Testament, in the sigh�t I and presence of us, who, at her request, and in her sight and � � presence and in the sight and presence of each other, have hereunto 3 subscribed our names as witnesses. f � �1��'.;7 �L�.��`��...{}..�t..�.=fl,��' i`��L/�':�%��i ��'Y I � Nam . A dress �..,�� L. � N ddress i � � f ; , � ; , � � i � s 2 � � � � ; I ! i � t i f E � � k � I COMMONWEALTH OF PENNSYLVANIA . : SS COUNTY OF DAUPHIN We, Lois J. Clifford � � , � and �� , the Testatria and t e wit esses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn and qualified according to law, do hereby declare to the undersigned authority that we were present and saw the Testatrix sign and execute the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another to s�gn for 7ier), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence, and I, the said Testatrix, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. � ,� �� 1 � Te tatr z � � �, � �'�.�_�;��.�-1 � ? �,.��.�.=��'` Wit es ' � � W' ess Subscribed, sworn to and ack;;owl�dged before me by Lois J. Clifford the Testatrix, and su scri ed and sworn to befo. ��ne by , ,. L,,i % � � �and � �' ; � , � w''tness�" _ �a• _ , Y'".. , this ' �, � ay of —' � A.D. 19 94. , .. , � � ��L-'Z . .�_ otar�� uls'I"ic NOTARIAL SEAL KAY L. D'„UL.T, h:etarv Fubltc Harrisbur9, C�u�ii;� C�un�Y� PA My Ccmmissicn Expl;es March tg� �g;E • "_"'—'------------•______. ' i i , , ; . . � . i � � CODICIL TO � ��t�t �tII ct1T� �P�tctll�tPYL� � � � I �� i I i $��.c�.��o� ig��3= ��.I�'�'a3�Tt9,of Lower A11en Township, Cumberland County, I iPennsylvania, dec?are this to be a Co�icil io my T ast VJill and Testament dated September I ; 13, 1.994. I I � � FIRST: I revol:e Paragrapl-�2 oi n�y Last VJi�1 a�-�d Testament aforesaid, and in lieu I I ' i �liF�eof sci�sti�izte the folIowing��ragra�'_�: � �� "2. I gve all my ai�icles of personzl o�-household use,including any ' automabiles I own at the t i t-n e o f m y d e a t h,t o m y f r i e n d,N D I T H A. � KL,EINFELTE R,if sh e s u r v i v e s m e." I � l S�;COI�D: In alI other respects,I ratify and canfum my Last Will and Testament ! � �iated Septeiri�er 13, 199��, � � f � - iiv�✓'I i ivr,�z�ti'riricEGr,i iiave i�ereu;�iu sei niy i►anci asi�l seal iius:��y oi ( I � � - ! � ' �!_[:`�E��c.�{,.� , 1997. J (� , ; � >>-; � �� ' � --��,�'� � ��%�'-° �' (Seal) Lois J. Cliiford ,' J � � � ;�i��e3, sea?e�,,��1�!ished anc� deciared by the a�z�ve-named Lois J. Clifford as and for a ?�c�?�.il'iJ ii+,:I�.asi��'iil and Te�t�s-�e�t, in:he�resence of us,who, at her request, and in the prrs,�:�c;�of cacl� ot�er•,r,a��e:nere�tto s�l�scrillECl O�.II'lIc1I112S SS W1�1leSSeS. �� <7��r�� --7_ ' ,_��-. � Na�e Address cr � � � -'1",�,1,/ > l��`U..'3'7� �-�Q�`�-'�..�(��--��1�`�C��_�1�r �� Na.�ne Aa�'ress ' � . � _ . I _ � � ! � �:� �i � � � *'"j I — - �-, ' _x :� _ ! f" -• CO :., \� _r �:� c> � �c.�� ,; . —� ' <.�3J `J '�� N — �.i � ..�� `' C..� vt> ;�3 -''�' N � � I � f � f � Commonwealth of Pennsylvania : : SS County_ of Dauphin : We, Lois J. Clifford _ , r� %� `_,/_ ) — � �j-�� and ' ' �� :�" �� ' � �l ,tne Testatrix and the witnesses, respectively,whose n es are signed to the attached or foregoing instrument,being first duly sworn, do l�ereby declare to the undersi��ed authority that the Testatrix signed�,nd executed the instrument as a Codicil to her Last Will and Testament and that she had signed willingly(or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses,in the presence and hearing of the Testatrix, signed the Codicil to the Will as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen (18)years of age or older, of sound mind and under no constraint or undue influence. 1�� y /;I �' � �` ./�.f'`t..i' ,' , �t /� �'/ ' -c' '�F��'l Testatrix �! � !�/,i �%(� if v/'��'„r�/.re'�_ Witnes %�-��C��. <�l�:��.L� C�' Witness ' ` � Subscribed, sworn to and acknowledged before me by_Lois J Clifford the Testatrix, and subscribed and sworn 1 to before me by;��rl �., -�.,/�;,L and ff�;1,�- _j. ��„� ,witnesses, this. /,�-�day o ��!2t_<<t_:_t..� , 19 97. _ �- , /'�- L.- f. ./�('��`t�.C:Ci� J Nota,ry'` ublic � k.--.___-�-______ �r-.r.; �cr,--°-°-•�•.� n`�Y' P`.Itn:T.,s',� � L. n; �� h•�°risburgJ r;;•° ;:�`z^y °ubiic �Y Cram;s�ian ._,:�; Ccur,i,. PA [r,P�'"es '•isrch i� ;Q�r�r _"`------.._"'------,_ � SECOND CODICIL TO ��x�r �ili �.n� U��t�n�tPrtt OF LOIS J.CLIFFORD I,LOIS J.CLIFFORD,of Hampden Township,Cumberland County, Pennsylvania,declare this to be a Second Codicil to my Last Will and Testament dated September 13, 1994. FIRST: I revoke Paragraph 2 as set forth in the First Codicil,dated February 26, 1997,to my Last Will and Testament aforesaid,and in lieu thereof,substitute the following Paragraph 2: "2. I give and bequeath all my articles of personal or household use,and the sum of Ten Thousand($10,000.00)Dollars to my friend,JUDITH A. KLEINFELTER,if she survives me." SECOND:In all other respects,I ratify and confirm my Last Will and Testament uaiCt'��?YiGii:i'lc^i i�� ni�-�r. IN WITNESS WHEREOF,I have hereunto set my hand and seal this �� `�day of__ /�`#�� ,2005. —� r'`�, � �, �,.�f;r• �, ,/'`..�.C`i°t.v� � ;��,-.->>��`P (Seal) Lois J.Cli£fozd r'.! ! �,�: `�,J. Signed,sealed,published and declared by the above-named Lois J. Clifford,as and for a Second Codicil to her Last Will and Testament,in the presence of us,who, at her request,in her presence,and in the presence of each other,have hereunto subscribed our names as witnesses. ( rC�,��,/l��`•r�t:=�1� �[.fir;�/r�,� �c.c� f �'7� r c Nam�/` Address J ./f�/.:iS . �!i�� J��/�'�( �•�T '_ s Name ' Address � �:� ��' _� r- r, :> �>> - �: :� ,,, �-;' <:-. �,^J "�. 1 � ':" :'. �� . �. �.� L' ^ _� '.'�5 r� -i �::.? �-J� N ;-;S ` ` �-'T '7 :3 N Commonwealth of Pennsylvania . : SS County of Dauphin . \7�1e Lois J. Clifford '��{ �� /��,� �+ , `�i;;c.�lL '� -�-�'C.�.i'll(__ � � �� / and ��;; ;� .�j��,y�� ,the Testatrix and the witnesses, ,,� respectively,whose names are signed to the attached or foregoing instrument,being first duly sworn,do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as a Codicil to her Last Will and Testament and that she had signed willingly(or willingly directed another to sign for her),and that she executed it as her free and voluntary act for the purposes therein expressed,and that each of the witnesses,in the presence and hearing of the Testatrix,signed the Codicil to the Will as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen(18)years of age or older,of sound mind and under no constraint or undue influence. .> ��, p � ,r ii� 4 .�L a'�,��(i , !�l r�w,� xsf � Tesiatnx( k �1 - ��; �� ",��" V��tness u �- ��-..�i�y�%��,_. Wrtness Subscribed,sworn to and acknowledged beforemeby Lois 7. Clifford � the Testatrix,and subscribed a-nd sworn to befo�e me by�,t`�2i�-�:.�'l.`�;f��- and �GZ-` ;�'.. ��;;�-c- ,witnesses, this ��(��*`�' day of �%,t.�.- ,2005. ��y '� � _ !I_ ��?/{,L i-G" �, � ,� r, �'2.� � 2.,�:.�� 1�3"otar�Public � P�ixLC�7i'iVE:+L7FlO�S�z,:A^iSY.::F,;ti':. � v ��Ti�iii?� .__._....,._._. R SH�'v6!'.A:STciiii:'�'�i:-;Far>, ., � �iiyofti�i�iS��::'u,'u`_:!'^��: - ��}'��ii7,Tii33 S_i��::�`i�.`��.,;...._..__:_<_.-- LAW OFFICES �i�i'/�J�G c'S�� EVr//`T/ ./ P.O.Box I 121 HARRISBURq PA 17108-1121 DAVIDA.WION —'-----------'------'—" FRANCIS A.ZULLI I O�LOCUST STREE'� -----------�-----'--"—" JEAN D.SEIBERT HARRISBURG,PA 17101 ��3 E.MAM S'iRFFT SHELLYJ.KUNKEL HUMMELSTOWN,PA I�O3G (717)236-9301 (7�7)566-2501 (717)232-1488 Fax(717)236-6100 EMAIL:WZS a MINDSPRING.COM December 26, 2013 Register of Wills Cumberland County Courthouse 1 Courthouse Square, Room 102 Carlisle, PA 17013 Re: Estate of Lois J. Clifford No. 2113-0876 Dear Register of Wills: Enclosed please find a Pennsylvania lnheritance tax return for the above mentioned estate. Also enclosed is a check made payable to your office for the additional probate fee in the amount of$170.00. Kindly stamp our file copy and return in the envelope provided. Thank you for your attention to this matter. Very truly yours, Je n . Seibert ��' c �-�-> � rn JDS/dm � � �? �.�.� � Enclosures � �4 r � �:; ;�� "` ., j-T�e � " � '� i�7 -r.. , ., ..... '' . � � ~ _`.� Cr� —. .._. '_� I__ , , _...� !_. r�a} ..,�,� �r V�'j �:,.�J " C,+', .'�,o � N � 1 � O E-a .. ;/] � W r-. Q U � � Q � � � �O � 3 ;` o � z ,-�d �o a: �cy.., � � � � � � � . � ¢ x