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HomeMy WebLinkAbout01-03-14 -� 1505610143 REV-1500 EX(02-11) OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOx.280601 INHERITANCE TAX RETURN 2 1 13 0748 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 06 25 2013 09 03 1926 Decedent's Last Name Suffix Decedent's First Name MI DALLMEYER MARY E (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. Supplemental 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) ® 8 Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11.Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LISA MARIE COYNE ESQ 717 737 ,X0464= m m R�eGiCr�OF iijLS�EjJVLY, First Line of Address r M W 3901 MARKET STREET cn CD Second Line of Address to r_ m City or Post Office State ZIP Code ' DATE ED CAMP HILL PA 170114227 correspondent's e-mail address: lisa@coyeandcoyne.com 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. SIGNAT ON RFSPONSIBLE FOR FILING RETURN 7TE v 2 Leroy Dallmeyer /► 3 ADD ESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE LISA MARIE COYNE Esq ADDRESS Coyne&Coyne, P.C. 3901 Market Street, Camp Hill, PA 170114227 Side 1 L 1505610143 1505610143 j 1505610243 REV-1500 EX Decedent's Social Security Number DecedeffsName: DALLMEYER, MARY EMMA RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... 1. 134 , 100 . 00 2. Stocks and Bonds(Schedule B)............................................................................... 2. 8 , 619 . 4 3 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. 128 , 6 3 5 . 3 5 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 20 , 7 4 9 . 19 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. 25 , 0 3 6 . 45 8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 3 17 , 140 . 4 2 9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 44 , 418 . 42 . 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................. 10. 13 , 731 . 1 6 11. Total Deductions(total Lines 9 and 10).................................................................. 11. 58 , 149 5 8 12• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 2 58 , 9 9 0 . 84 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)................................................. 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 258 , 9 9 0 . 84 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 .045 258 , 990 . 84 16. 11 , 654 . 59 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE.................................................................................................................... 19. 11 , 654 59 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 - 0748 Decedent's Complete Address: DECEDENT'S NAME DALLMEYER, Mary Emma STREET ADDRESS 543 Magaro Road CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 11,654.59 2. Credits/Payments A. Prior Payments 11,000..00 B. Discount 578.95 Total Credits(A +B) (2) 11,578.95 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) 7 5.6 4 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;.................................................................................. ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;.................................... ❑ ❑ c. retain a reversionary interest;or.................................................................................................................. ❑ 0 d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ 0 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................................................................................................... ❑ 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 containsa beneficiary designation?...................................................................................................................... [X] ❑ 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 rXrn are still 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 decedent's 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 decedent's 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,whether by bloo�or adoption. pennsylvania • DEPARTMENT OF REVENUE SCHEDULE A INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT FILE NUMBER ESTATE OF DALLMEYER, Ma Emma Mary 21 - 13-0748 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a wilfing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Attach a copy of the settlement sheet if the property has been sold. Include a copy of the deed showing decedent's interest if owned as tenant in common. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH 1 543 Magaro Road Enola, PA 17025 134,100.00 i TOTAL(Also enter on Line 1, Recapitulation) 134,100.00 Property dapper Cumberland County, PA 93 56 106 ap 191W X94 �.a. t1�A,21) 96 �° Jr JAI�300•� T w� � r 83 A ?rte et�` • 1 O r L x ED 2) a� r� 0.80Ac + . (2)- i 1 !E 0.�4 {�l 2 �K <� k }. 'c Ol4Ac ; Ts — Ac: i Ac. �0 � �, .,� X. ,. 4r � l C i .yam aJ , 158 ar Copyright 2011 Esri.All rights reserved.Mon Sep 23 2013 01:54:30 PM. 543 MAGARO ROAD PIN:09-15-1290-094 Deedbook:201325004 Owner:DALLMEYER,LAWRENCE Land Use Code:101 Property Type:R Acreage:0.73 Squara Feet:1128 Taxable Status:T Clean&Green Status: Land Assessed Value$:48500 Building Assessed Value$:85600 Total Assessed Value$:134100 Sale Price$:1 Sale Date:Sun Sul 28 2013 08:00:00 PM Year Built:1962 Municipality:EASE'PENNSBORO TWP Height in Stories:1 Type of Dwelling:DETACH 4' Primary Exterior.Brick �l Basement Percentage:100 '�C v Air Conditioning:NO M Total Rooms:5 j Bedrooms:3 t Full Bath:1 r�r`l Half Bath: Vt l REV-1603 EX+(6.98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF DALLMEYER, Mary Emma 21 - 13-0748 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH 1 PNC Inventment Account 6.10 8,619.43 1,413.021 Columbia Strategic Income Fund (COSIX) TOTAL(Also enter on line 2, Recapitulation) 8,619.43 pennsylvania SCHEDULE E DEPARTMENT OF RETURN CASH BANK DEPOSITS AND MISC. INHERITANCE TAX RETURN � RESIDENT DECEDENT PERSONAL PROPERTY FILE NUMBER ESTATE OF DALLMEYER, Mary Emma 21 - 13 -0748 Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 PNC Investment Account 001-xxxx16 (Cash) 477.09 2 House Contents 2,400.00 3 PNC CD xxx00146849 6,505.03 4 PNC Checking xxx0111098 82,093.89 5 Burial Reserve PNC xxx00026426 6,149.26 6 MISC US Savings Bonds(See attached schedule) 3,499.08 7 Cash 27,511.00 TOTAL(Also enter on Line 5, Recapitulation) 128,635.35 Calculated Value of Your Paper Savings Bond(s) Page 1 of 1 Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 06/2013 Total Price Total Value Total Interest YTD Interest 512.50 $3,499.08 $2,986.58 0.00 Bonds: 1-11 of 11 Issue Next Final Issue Interest Interest Value Note Serial # Series Denorn Date Accrual Maturity Price . Rate R2208098EE EE 200;03/1980 : 03/2010:_ 100.00}_ 562.96{________ $662.96 MA - - a -- --- - - - ------ - - �6367268024E; E 25T11/1979r ; 11/2009; $18.75_ $91.87: ____ r $110.62; MA IC104934758E; E ;____ 75_10/19741__ ___ ------004r $56.25 $33----- T $390:06; MA K104626107E E - 75x08/1974: . 08/2004; $56 25_ $333.81x_______ 1 $390.06T_MA_ --- K104626018E; E $75:06/1974; 06/2004; $56.25; $333.81; $390.06: MA K104625988E; E75r04/19741 , 04/2004x $56.251 $329.19x________ _ $385.44;_MA_ 02483070526E; E ; 25r03/1970r ; 03/20001 $18.75; $118.61* $137.36; MA 02483070691E E X25104/1970_ 04%2000; $18.75_ $118.611________ r $137.361 MA 02479389477E; E_ 25:01/1970* ; 01/20001 $18.75_ . $118.25x_______ _$137.00:_MA K8499725E; E $75111/19711 ; 11/20011 $56 251 $322.831 1 X379.08;_MA -- K8499706E; E $75;10/1971; ; 10/2001: $56.25: $322.83; ,. X379.08; MA Totals for 11 Bonds;$512.50:$2,986-58: 3 499.08; Notes NI ;Not Issued NE ;Not eligible for pavment PS ;Includes 3 month interest penalty - -1- --------------------------- MA :Matured and not earning interest http://www.treasurydirect.govBC/SBCPrice 7/5/2013 • It _ SE. S _HEREOF WILL VEN YEARS FROM THE ISUE'GATE HEREOF W.ILI PAY - "u ISSUE DATE` WHICH JS THE FIRST DAY OF-•u 10. mss. Tla:ry Emma. Dal 1- Meyer 174-20-4316 Dctobe'r 1 71 agaro; Roan 'Enola, Pa.. 17025 �;��eriarlc�Co. st ! ISSUING AGENT'S \\ 'M-.. Rtaymorid Dal3meyer L � bATAMG 6`fAMP/1 1\ •4 1917 lei I963-. 4Y C. .Aw)e!Ol1NJJ�Y y✓ ' ..'•GN.DOSORTMV-.i3if:WNwrro7i crrCDh[n�xsaxoco«ortl�o Vuwnxo.a[kOnor w•vx[xrixmCma. p !6 TREASORY OEtMR!MCHT Y IE_S:E: K8 499 708 E d ry /,i.imsvey ' 1,�1• - (� W QD 0 !1 :^0 1 q-� ........... SEVEN YEARS FROM THE ISSUE DATE HEREOF WHJQH IS THE FIRST DAY 1tl 70 -Mrs.. Bt�y Ewa Dallmeyer 17.x-2(3-431°6 Nave'mber IF71. _ 717 rib ails E .'iv i 516` �iaii6 R. oa�a Fx Enol , P°a' 17o2S" B��;�; &Trust Co. `, F'• � sJll-. ! •IGSUING AGE NT`S \\'• m-d �allx,67er p,7n °`� X97 aym • /•' s ,�. �.. \ DNTING STAMP' �\ 1963` '".t'SIt_NOF'ivHFt i$QflF"LQVNT.RY ,eenols issumuHaa wumomivor i' [.tY Ortxow e.ws AHtxom.3nvrs-su°- �AYI �ti DoyvR.rbll .fSKx'NA'�Y[777"- _-' -" �cctio ..s v,.oeo ortton-mm[ 0 R k ,$-io"vxrRY acm a oxm,wxo o[w[vmar r�n H'.eM*:nvoa. . Ta[!SUiM D[VAaTMGM - � - ` ASM OTOH i sl:h K8 499 725 E: k-R-Iffl- +.0 -7 ) g M.S Ek 1 - r 1 ! ' SEVEN YEARS PROM THE ISSUE DATE HEREOF WILL PAY ISSUE DA7'E * p0gyM M5 WHICH IS-THE FIRST DAY bF' %Y hri ry E. Dallmeyer 1174 M...�33 543 Migare Road ca .oTayexsna� 17' .5 s� \. ..c 16gS'I 'VA � \ S. Mr, 'Raymond L. Dallmeyer 2D3 14 0'875 J�� �•• - \ DATING STAMP r` Main'Office - •— •,� � ii�roonoa�ssum OL�. 0 2 4 7 9 3 8 9 477 E -7 � S�eryMN.urmniry� . - \� :5',..- '•rfr^.h 4+ J o�� 1.�Z•i-8 �,` S` 3. c ¢.''~Y�,_, FLVE YEARS AND TEN MONTHS FROM'THE ISSUE DATE HEREOF*164 PA'Y - ry, lF......L•bY ~"rSt,•�-'. [ 11� 'HSUE_DATE ay WH7C I5 THEc FIRST DAY:O�'.: ' ry' 'o. : a'llme-yer 314 2 4.&L6 April .19710 _5:4:3, Via' �j �j - ---- - - garo Ro',a ' . (A10NTH) -- 4YEAR'7� En'o1� �, Pemna'. 1'70:25 :Nat'l. rik&Trsta. -- ottenlral Pen, a. t 2+1 ymo�ad .e 3Qa13atey'e'r 203 10 ©II75 C.lT - ��~' �`'���� - � �Harrisbirg-Est 9fFc�� �?,• O I ,H�.roo«o�iaim p«roLnavrXOam y sKTbK_ _ ,L ;0r.rtXD.R.....LXDm.,XD n sDe_ ARISURG,,�F�XI ... - scwDLe'�XO u:,LO.no«ociniR oL. .wru aL v.uo oXir rr ou[r r«_ i UOXIXG R[C[IMOL MYXtnYYN[RVD0. ' fK� 'IHGSURY D[D.IRMCHT -' .. f � � Z WASH XGTOH -v!+U. yj , YY -PVT I"_.z ......._-5 -4 8'3 7 p I r < ' r 'P�� 7�ve � .�_•�' @t D.� k :H'.t _ �d!� _ I 0` —..1. �G ! `-�;•_ '�,� �.. � `, �,<-•. � — '"`'�`3"i' � TNT r W +�?Jr' •" A FIVE YEARS AND TEN MONTHS FROM THE ISSUE DATE HEREOF?WILL••PAY �• - 7 - e " D v - ISSUE.DATE ' � - WHICH IS'THE FIRST DAY.O� y Dallmeyer* =74 20 x'31.6 ,. w•r:� �u •� 14a.r � Via: Xagara Road. ".'- 4 h',• Pe a a e _70 2:5 ;#';• o�Cent.a! .P.ermac; + e(' p S _ ��� 1' �•-•;• MAR" ill9 !16V1NO E '� a.ym.ond, I s Rallmeyer t.w- S5 Vtr - •'L` f I 1 DATING li; T P' }igrisburg East_OfW11 s t�{pg� :�_ta_ _ _ tXS o'TM.,ia:s:,�oco:wrro«s°sm,.Tio�r -~�-DOXn:n..s.HLXOm.wXDlssuo_ HARRISKIM e _ ♦o o.rzo,.LXOSCUVLRmm.X rt•v«u Di v«uo a«[r,moun r«- i lHhY1X0 RKnrtOi M�tiCrr,iHL°L,D0. TRE W-HI NLMN,GLHT 070 5 2 E WASH D,DH Q 2 4 8.3 • erg °° ':. _ s_ °,�N„,-,�.Yry • __ ___ -_�•_ sue`_- _._tee= '{\.�!!rt•�i-_ �'� � Bl. 0 � W :�E 1 � b.. � � T � - ..'-. .D! °tea:;=- - - -- Y - .\ SEEM r AT T.ME'ORIGINAL MATURITY HEREOF WILL P.AY �� � 1SS1JE DATE WHICH-IS�?NEiRIR 7 DAY_OF A/OfJTtyTY,�.Y? •;_�TA•2AR7 y ,r fry -9-ary E Dallmeyer 174-2n-43:16 1917 1963`: -`-- _ [•F:�>..'” -'1 GA.Tiiva=6AA1Rn1.. S .+s i f N N?E O r - y.a �•^ nv� i� ) r� . •�.�S.I!•9'�(7�-%AAT_T'.$PR OHM' _ .4 A Lky�",�. :LL'.d, 1J u..3...,nei .y^.f .. -T.WbD.lUR1Dt�=�EYAitxwl�Tq(f=-—:�" TXn.Ewo mUm Yxoiw�wmwnn or �• �--,<<-•„"�` ; • Gacao�YpR•�iSir��QUk,YR7==` wn.m anoxwLic'oir'ui _ ° o v°'u' �iw, C• f t 7 ��'°' '- -'�_ 'e�` iltlAfYRY DLR[m iM, _ _ o :T`�«Lni�v � Y3v(Jr w • w w a,D =fib - _ _: X -10.4 INE- -- - - '-_ _ter-rte'"_ , u ��---• iR�. i ` "'� �—_�_ .—AT.THE.Ohl'GINAL'MATURITY HERE'pqY DATE rTHEF�Il{2}57DAY..GF•_._ • 1s73J` �rercgL•r Mrs., :Miary E. Dallmeyer' 1�4 6um� , � 13 ;..: 5451 raag.ara #goad . � �'1 t [may- +7;}:��I} .!, , ;< 7�• T.�•., P,aymnd Da l:lm�t er 1917 -.. ! p��� rte. Y 1963 J. 6, l --NN Ik-$ �Ll�t-1' :GA; M'NAZYOOXCOORS'�P-- .. � --- '✓rtAbd !L�?�'1!'R+t?°F1YIY-:=''_- m-rs mwD Uhsumu ur,wAmol c"rac'nX+inui'.%`vuoac`r�n�ws- ' clAC�'Q AfIR-�'d'rtiA�ist7"'-- n,c ..[o i.00mrows o�cn ron [,w- _� [OJDVnw w[CtlROr MW[XLT P. '-ty - ` 5 MM ,x ( 14 626 08'E . 't3 __ qT_TM E'-ORI GINAL..MATU RITY HE REO,FrrW�I4L- C! AT 1Y,Hlem ISSHE2FITLM.T DAY_OT- To 4b7 mg' - - - 3�—.—.r� x '.� lor 1 (MONTMI Z�f; ,'�-•a-.T." 2�'; _ - '�. 195UINSi Ap L�[Z•$s 1917 — W.Aikimcadm. � _- _ SerMaryrarn.e Xry-, __...�u,br Ir•,-,„ 11"� ?v 2'�°�- 01 Mow I _ N • AT THE ORIGINAL MATURITY HEREOF WILL PAY .�" ISSUE.DTE o-, WHICH IS iHE FIRSST DAY--OF.?,^° ry, 174-2 543 9a-garo Road S} "• '. a.-' 1 ISSUING AGEk7re t 0 mAT{NG+6'iI.MPr�.,l�....� @ Ar 1917 1963" �, .I,[�•' "'A�[�O�•irRAT M!!rA"C`oDANf`Rx T"ummo-c�T[w�wsiwmm�ert nvnm ar wow.°nu n.u�w aom.ii ou,v'uo- rc^^ �,��w `� c ,.2'nt/�DZAR �-w:siovm[Y�'ov Xs s..Tru c n n[ X- yY�' a t`?' �Q:tJ'1,�,iiC9• CwiFY,CO FOR,7 !R`S.D7J�.7RY.^. see,amwwn owTm...wnxw[n[mm�n .w[cnnw Mwewrrwnrcrog. - ' (U,I R' [nEA.YnY OCAURM[XT E' w.=X,X�X K 104 934 7 5 _ems ek, t' MR al' _ 'pp4zppp� 98 _ rr - .: MGM t.r, — -- _-__ --_ ,„. n f .urMOnmo.�i n"v°�u o'•Vi oMOm� - � 1tA5b0/4�f�f1�8— - F - �iIlEASVEKO[sANTMGIT D I• _ � WASHINGTON : •s .Q 6 3 fi 7 2 6 8 02 4:.E_ - _.a,..,,r,m __ mw`,iYy .. ;,''_„°' r• _ ----- --- - = o0 o tt e+t e s d o r - n �T THE MATURITY HER WILL:PAV -� _.(ram. �• — .- ,. _ -_ __ - .. I ZU „1 �' � _____ - � _ .•vii' rsr+s!✓w �.E' °�L (MONyT,HI ���y^ea'-' .•" _ _ _- AFL '`_a +I$I Q ON ov - Y a; /u j ISuAINC'y.'09 -- —_ �Q ' f e rs a 'aye b t°- �•. ����� L'ir }�k' iz �L+�a�1YigEYE _ ]gC: �muEDUxoERAVnro tME �ONDALTKAMEND[D, R2 208049 8� �__- bYNFDT]OTMET -:InlrACK NEIICDE. ry • _.. .__—_ _____— DEt.V1TMf�imxaEiMnCiiVM Sir d7hri _- =_ . rig•g-^ - %` M L 1�-LWr 1AU64 goall� IS Hl E.1, T too - vi 3 _C_,_� npl&olqz d--e A—101 C,o )46 Le- If IA P -s- -7- LL qu VA",nu s rk C>`P .6Y,S 'MAgA-I-o /2c.4 1-70 ZS- AJ 41 r 26. 20.13 11 :32AM PNC Bank No. 0372 P, 1 _r July 26,2013 Lisa.Marie Coyne Esq.- Coyne&Coyne P.G. 3901 Market St Camp Hill,PA 17011-4227 RE: Mary E Dallmeyer SSN: DOD:06-25-2013 Dear Ms.Coyne. In response to your request for Date of Death(DOD)balances for the customer noted above, our records show,the following: JCertificate of Deposit Account#21001030347 Established: 04-30-1988 500(8 .. MARY E DALLMEYER LAWRENCE DALLMEYER. DOD balance: $ 5,000.00+ 1.17 accrued interest Interest paid 01-01'?013 thm 06-25-2013 S 9.99 YTD Account#31100146849 Established: 01-19-1999 MARY E DALLMEYER DUD balance: $6,504.97+0.06 accrued interest Interest paid 01-01-2013' 06-252013 $,2.84 YTD .Account#3120014233$ Established: 11-05-1998 MARY B DALLMEYER RICHARDSON FUNERAL HOME BTJ'fiIAL RRSERVE ACCT DOD balance: $6,149.59+0.67 accrued interest ' Interest paid 01-01-2013 tluu 06-25-2013$6_,12 YTD Account#31500026426. Established: 02-02-19961° ' MARY E DALLMEYER LAWRENCE R DALLMEYER DOD balance: $ 5,73336+0.73 accrued interest Interest paid 01-01-2013 thri106-25-2013 $ 5.71 YTD Page 1 of 3 v Juf. 2b. 2013 11`. 32AM PNC Bank No, 0372 P. 2 /Account#31700025865 Established: 02-02-1996 LAWRENCE R DALLMEYER MARY E DALLMEYER DOD balance: S,1,448,4.50+0.10 accrued interest Interest paid 01-tit.2013 thru 06'-25-2013 $ 0.75 YTD Account#31600298902 Established: 08-10-2006 - LAWRENCE R DALLMEYER MARY E DALLMEYER DOD balance: S 8,835.29+0.22 accrued'interest Interest paid 01-01-ti013 thru 06-25-2013 S 4.14 YTD Checking Account Account#5140111098 Established: 02-01-1970 MARY E DALLMEYER DOD valance: S 82,093.71 +0.18 acowed interest Interest paid 01-01-2013 thru 06-25-2013$ 3.86 YTD /Savings.Account Account#5080054289 Established: 07-26-1994 MARY E DALLMEYER LAWRENCE R DALLMEYER DOD balance: $ 1,681.94+0.00'accrued interest Interest paid 01-01-2013 tbru-06-25-2013 $ 0.09 YTD Account#5080396641 Established: 07-26-1994 LAWRENCE R DAI U4EYER MARY E DALLMEYER ' DOD balance: $ 18,760.99+0.02 accrued interest Interest paid 01-01-2043 thru 06-25-2013 $2.82 YTD investment Account The decedent maintained Investment Account# 1675016 _ For further information,you may call the Brokerage Department at 1-800-762-6111. Please note that this ofce�provides date of death balances for deposit accounts(HC As,CDs,Checking and Savings). We do not process agcy financial transactions or provide statements. if you need assistance with any of these items,please call 1-888-PNC-BANK.(1-888-762-2265)or step by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC Page 2 of 3 JjAj B I C D E F H I 1 2 3 September 6th,2013 4 5 PNC Investments Center 6 7 8 9 RE: 001-675016/Mary Dallmeyer-Individual 10 11 12 13 The value of the above-referenced account on June 25th,2013 is as follows: 14 DOD _ 15 Amount Description Cusip Price DOD Value Accrued Interest 16 17 477.090 Cash N/A $1.00 $ 477.09 18 1,413.021 Columbia Strategic Income COSIX $6.10 $8,619.43 19 Metlife Ins ** 20 $9,096.52 $ 21 22 Grand Total(Market Value+Accrued Interest) $9,096.52 23 *Please note the carrier must provide the date-of-death value of the annuity. PNC Investments serves only as the broker/dealer. 24 r 25 *Note:DOD price is based off the closing price on the day the client has passed away,if this is a non-business day the price will be 26 taken from the previous business day's closing price. 27 28 If you have any questions,please contact our Estate Resolution Desk at 800-622-7086. 29 30 Sincerely, Ti-= _ 32 Omar Omar 33 PNC Investments,LLC. 34 Estate Resolution Desk 35 36 37 The summaries,prices,quotes and/or statistics contained herein have been obtained from sources believed to be reliable 38 but are not necessarily complete and cannot be guaranteed.They are provided for informational purposes only.Past 39 performance does not guarantee future results. 40 REV-1509 EX+(01-10) pennsylvania DEPARTMENT OF REVENUE SCHEDULE F INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF DALLMEYER, Mary Emma FILE NUMBER 21 - 13-0748 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT Lawrence Dallmeyer 543 Magaro Road SON A Enola, PA 17025 PA 17024 JOINTLY OWNED PROPERTY: pE N Q F �y ITEM LETTER DATE Include name of financ al rIAu�tlon and bank account numbe DATE OF DEATH %OF DATE OF DEATH NUMBER FOR JOINT MADE or similar identifying number.Attach deed forjointl -held real VALUE OF ASSET DECD'S VALUE OF TENANT JOINT 9 t y INTEREST DECEDENT'S INTEREST estate. 1 A 04/30/1988 PNC CD 5,001.17 50% 2,500.59 xxx01030347 2 A 02/02/1996 PNC CD 5,734.09 50% 2,867.05 xxx00026426 3 A 02/02/1996 PNC CD 1,484.60 50% 742.30 xxx00025865 4 A 08/10/2006 PNC CD 8,835.51 50% 4,417.76 xxx00298902 5 A 07/26/1994 PNC Savings 1,681.95 50% 840.98 xxx0054289 6 A 07/26/1994 PNC Savings 18,761.01 50% 9,380.51 xxx0356641 TOTAL(Also enter on line 6,Recapitulation) 20,749.19 REV-1510 EX+(08-09) pennsylvania DEPARTMENT OF REVENUE SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF DALLMEYER, Mary Emma FILE NUMBER 21 - 13-0748 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECD'S (IF APPLICABLE) TAXABLE VALUE and the date of transfer. Attach a copy of the deed for real estate. INTEREST 1 Metlife Investors Fixed Annuity 25,036.45 100% 25,036.45 Beneficiaries: Lawrence and Leroy Dallmeyer, Sons of Decedent TOTAL(Also enter on line 7,Recapitulation) 25,036.45 7 zo � 0 minx �rz� zon Z r D o tT7 v o z c l C Dx w n � Z � ,3H D.D0 C7 dD y x z 5. w o o t7 to m a g r Z t�Tf 'i7 - w TZ N 7 n b N rn U7 o � ' t7 7 w. p„ ? T.' 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U,f- , n � D cam° mma m a - r n ��' m � 9 Z a �` D 3 , C n r t m m < ° m O ? m m C om m a 0 a o � vmm, N Z{ C (P_ > m D � (P:3 'o C C C CL a � t co ?' 7 0� � v m �„r• N N .p rD O w 5 S 14 i m 5 '" n co » n (=> y9 w N _ 49 fo b7 V) .69 W W O OD O (P O N ONO w n W O O O N O (0 0 G�i 7 E N N QN� a W (n co 0 0) O W yL O 00 O O) •^ � w s P a pl b O b to EA b9 1 Sdi O O 0' 07 Co Co O .OP (3) v b A A A A w (0 N O (T N 07 �° N L" u ^ W N V O (T (o W '< D s Q N n p A ~ t D - S O CL 0 D 0 r b O W �S m 3 O Z A p o a C 0 A .7rt A J d m S O tD N � w� °� a � b7- K ti rL ?::h m 0 zs -0 Irl "i ro 49 .q t. CL �69 �' ��. O W O N chi W N J OJO .7. 3 V o ° On t0 A A yy 3 y S' Z J ' 1 A � � a ti Iy0 to 40 40 4.4 A ^ M /f 1 V7 6q OWI W O V Ul W N co iy w I y m m N O_ W ' y• n o T n oil �+ "� Z n $ n d Z D D hi 0 ^•° N Q ° m 070 m �... y!� _ m o ° < .�m m O^ /� Z Dpi ( ` lT ]�L c l Q N C S U,T V l J Z CD m m M o �4 o N yJ 0 CD ►� � .� a o t- ? a o Q o <. v c g N o `. 0 o a O R jo m f' r ?m oo ( F it•'' ,lY� A N ass r d xx r• ,t~c n w ^C1 V y C V v m O PO ia N N m re ..� .� 7 7 N m m m T r• a"� w w w 3' 0 3 0 V l 0 0 0 o D m u m 0 0 7 r•* N n 7 '0 Ln O r N_ M M tye Cl W N N co N 9 0 m m-, 7 CL ! . y C O •7 w LO LO iLO 7 s rn m P rn 0 n N co co IC m W O_ co —_. -Vf-i--<D 0ca$ �—, "� DD m zp a0 � O z-,—I O ""-�B =U O o a . � �. t... mJOm r c � =C) <Z ft O ?� J J QN O V —M a m m�CZ O- ZO cr Dy '.J a0's^o M, 3 crr- -1 � (b � ❑ rr D c)fn z e od z O-< Cn m wo0 om •-'^� lTl F- 77 re rn z �i N d� J �i 3] O Z D " ° GGM cn Joo 0) , a O o _J v° v— 9 C F �c DV � " on. o r ip n < m a� � m Iola: �. N o �dooN �l W A -47W O w..:..M Z o 110 =CL - yc .r 9y 0 _ ' }J aZ W 2.Q J < y Q 72 '°: y con C37 0.°rn N z CD o 0. .+ Er Cz o o M, O- ir,�" 2 N o v Z . aK m n j ?. fOOD 00m MO CD m o o o d $ J d y u' iE x O.v r• �o p N v. ° r3oo c�'nn $ S, z CD fn o m �' �� o mS' ZT. m F m 3 m • - n J N 'f1 d o o m J J Z Z w o oC n � J d 0 D N m C • d CL o M c my _ 0 n W N N V $v 3 o �Z1 N p3j T j N 7. m N CD 3 C 04 cn � 3 m N m m a O_ W a A ' a a H a ow z =z D> �� w w � n D M o \ '°- ' ( '° ° n 3 n 0 M m i 99 H H t" w m H H u' fD 3 rIl CL Z m c--j �y C7 � z v 3 0 r.r.. 3 - Go v p o � $ � - CD .. C7 T n .. 0m y7 Z Z w v Oa O Z U3 =. L D I O OQ r J 7 m O M C G N €, C Ct7 N O t7 3 s m w 7 'a p y s D 0 n cn o O c -1 O r N N A r C, o' o M t v W a � ICJ �cn O D > > fJ x m� M cn .p CD° � M Or O � C7 C) h n N G N O O O K 0 M M D d a c M n z i O } i X w.---._ C zs i Q k 5 .0 c m M NJ NJ y3 c: w W 30 [ 000 m m 00 C O CD CL C" r) � o z 3. ..y ...l i I m t",:-` o �. 3 N w 10 fD 0 W REV-1511 EX+(10-09) Pennsylvania SCHEDULEH DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT FY.AY� h7�IV1 �+W FILE NUMBER ESTATE OF DALLMEYER, Mary Emma 21 - 13 -0748 Decedent's debts must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Richardson Funeral Home, Enola, PA 8,716.47 2 Headstone and Engraving 500.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Leroy Dallmeyer 15,514.00 Street Address 932 Hawthorne Street City Enola State PA zip 17025-292 Year(s)Commission Paid 2014 2. Attorney's Fees Coyne &Coyne, P.C. 10,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Lawrence Dallmeyer 3,500.00 Street Address 543 Magaro Road City Enola State PA Zip 17025 Relationship of Claimant to Decedent Son 4. Probate Fees Cumberland County Register of Wills 153.50 5. Accountant's Fees 6: Tax Return Preparer's Fees 500.00 7. Other Administrative Costs 1 Deed Recording 68.00 TOTAL(Also enter on line 9, Recapitulation) 44,418.42 Schedule H Funeral Expenses& COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN Administratinie Costs continued RESIDENT DECEDENT ESTATE OF DALLMEYER, Mary Emma FILE NUMBER 21 - 13 -0748 2 Cumberland Law Journal -- Legal Advertisement 75.00 3 Patriot News-- Legal Advertisement 116.45 4 Postage 55.00 5 Reserves 5,000.00 6 Mileage for Executor @ $0.55/mile 220.00 Page 2 of Schedule H pennsylvania SCHEDULE I DEPARTMENT OF RETURN DEBTS OF DECEDENT MORTGAGE INHERITANCE TAX RETURN f RESIDENT DECEDENT LIABILITIES & LIENS FILE NUMBER ESTATE OF DALLMEYER, Mary Emma 21 - 13-0748 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 Medicare 129.29 2 Golden Living Centers 10,443.48 3 Medicare Camp Hill Fire 67.83 4 East Pennsboro Ambulance 69.39 5 Highmark Retirement Plan 82.83 6 Capitol Cardiovascular Associates 13.10 7 Brian Peffer, DPM 19.53 8 James R. Harty 48.66 9 Camp Hill Emergency Physicians 33.31 10 Camp Hill Emergency Physicians 129.29 11 Kantode and Tkatch Associates 67.68 12 Alxa RX LLC 99.39 13 Quantum Imaging 130.76 14 Uncleared Checks 800.00 15 US Renal Care 921.56 16 Center for Kidney Disease 239.68 TOTAL(Also enter on Line 10, Recapitulation) 13,731.16 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT continued NNUMBER BER ESTATE OF DALLMEYER, Mary Emma FILE - N - BER 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 17 Spirit Physician Services, Inc. 435.38 Page 2 of Schedule I REV-1513 EX+(01-10) c'�;`� pennsylvania SCHEDULE J 11 ''�� DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF DALLMEYER, Mary Emma FILE NUMBER 21 - 13-0748 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Mr. Leroy M. Dallmeyer Son 1/2 mutual fund 932 Hawthorne Street shares Enola, PA 17025-2921 1/3 interst in residue of estate 2 Mr. Jason Dallmeyer Grandson 1/2 interest of John 9 Southpointe Drive Dallmeyer's 1/2 Mechanicsburg, PA 17055 interest in mutal funds (per stirpes) 1/2 of 1/3 of residue of estate(per stirpes Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. III NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX+(01.10) pennsylvani SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF FILE NUMBER DALLMEYER, Mary Emma 21 - 13-0748 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 3 Mr. Lawrence Dallmeyer Son 543 Magaro Road, 543 Magaro Road Enola, PA Enola, PA 17025 Residence and contents 1/3 interest in residue of estate 4 Mrs. Christine Gregor Granddaughter 1/2 interest of John 120 Maloney Terrace Dallmeyer's 1/2 Avondale, PA 19311 interest in mutual funds 1/2 of 1/3 residue of the estate (per stirpes Page 2 of Schedule J r REOI8TER OF WILLS - -- -- CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA 0 No. 2013- 00748 PA No. 21- 13- 0748 Estate Of: MARY E DALLMEYER (First,Middle,Last) Late Of: EAST PENNSBORO TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: WHEREAS, on the 3rd day of July 2013 an instrument dated November 19th 1997 was admitted to probate as the last will of MARY E DALLMEYER (First,Middle,Last) ' late of EAST PENNSBORO TOWNSHIP, CUMBERLAND County, who died on the 25th day of June 2013 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth 'of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: LEROY M DALLMEYER who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of, record in my office at CUMBERLAND COUNTY COURTHOUSE, CARLISLE, PENNSYL VA NIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 3rd day of July 2013, AM & . (y —_ �.. eg/ster o **NOTE** ALL NAMES ABOVE APPEAR '(FIRST, MIDDLE, LAST) LAST WILL AND TESTAMENT W c C> OF a C) r MARY E.DALLMEYER � - -� CV -t 2 I, MARY E. DALLMEYER of the Township of East Pennsba, Cumb erLipd Courray, Pennsylvania, declare this to be my Last Will and revoke any Will previously made by me. ITEM 1: I devise and bequeath my residence, including furniture and contents, situate at 543 Magaro Road, Township of East Pennsboro, Cumberland County, Pennsylvania, to my son, LAWRENCE DALLMEYER of 543 Magaro Road, Enola, Pennsylvania. In the event my son, LAWRENCE DALLMEYER predeceases me or is not living on the thirtieth (30th) day following my demise, I devise and bequeath the said residence, including furniture and contents, to my sons, JOHN E. DALLMEYER of 155 Reeser Drive, York Haven, York County, Pennsylvania, and LEROY M. DALLMEYER of 606 Belle Vista Drive, Summerdale, Cumberland County, Pennsylvania, who shall take title as joint tenants with rights of IL`) survivorship and not as tenants in common. ITEM 2: I devise my real estate situate in Osceola, Florida to my sons, JOHN E. DALLMEYER and LEROY M: DALLMEYER who shall take title as tenants in common and not as joint tenants with rights of survivorship. ITEM 3: I bequeath my mutual funds to my sons, JOHN E. DALLMEYER and LEROY M.DALLMEYER, in equal shares, or to their respective issue,per stirpes. ITEM 4: I devise and bequeath the residue of my estate, in equal shares to my three sons, LAWRENCE DALLMEYER,JOHN E.DALLMEYER and LEROY M.DALLMEYER,or 1 to their issue,per capita. In the event the beneficiaries, noted in this Item 4, are unable to agree as to distribution of the residue of my estate, my personal representative is authorized to liquidate the items either at public or private sale and the proceeds will be part of the residue of my Estate and distribution-shall be as-stated in this Item 4. ITEM 5: Should any beneficiary entitled to a share of.my estate not have attained the age of twenty-five (25)years at the time of distribution to him or her, I devise and bequeath the share of such beneficiary to the mother of any beneficiary, in separate trusts, to hold, manage, invest and reinvest the share so received, in accumulation of income thereon, and to use and apply the income and principal, or so much thereof as, in Trustee's discretion,may be necessary or appropriate for such beneficiary's maintenance, support, and education (including college education, both graduate and undergraduate) or to any person taking care of such beneficiary. Any principal or income not so applied shall be distributed to such beneficiary absolutely when he or she attains the age of twenty-five (25) years. If he or she dies before attaining the age `- twenty-five (25); the Trust shall terminate and such share shall be distributed to his or her personal representative. ITEM 6: I direct that my body be buried in a lot which I own at Gate of Heaven a 1 ti Cemetery, 1313 South York Road, Mechanicsburg, Cumberland County, Pennsylvania, next to my late husband,RAYMOND L.DALLMEYER. ITEM 7: I direct that.my personal representatives and trustees or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. 2 ITEM 8: I appoint my son, JOHN DALLMEYER Executor of this my Last Will. Should my son, JOHN DALLMEYER, fail to qualify or cease to act as my Executor, I appoint my son,LEROY DALLMEYER,Executor of this my Last Will. ITEM 9: I direct that all my just debts and funeral expenses be paid as soon as practical after my death. ITEM 10: I direct that any tax incurred as a result of the aforementioned devises and bequests shall be paid by the respective beneficiaries of the devises and bequests and shall not be paid by the estate as a part of the administration of the estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal to .this, my Last Will and Testament,this day of 1997. MARY E.JALLMEYER Signed, sealed,published and declared by the above-named Testatrix as and for her Last Will and Testament in our presence, who, at her request, in her presence and in the presence of each other,have hereunto subscribed our names as attesting witnesses. presiding at c7 ) ? t La-d residing atQ`�Q� i 1 i i 3 COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF CUMBERLAND ) We, MARY E. DALLLMEYER, —&%,// e-vu/ and 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 her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose 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 the time eighteen (18) years of older, of sound mind and under no constraint or undue _ influence. MARY E.6ALLMEYER / Witness ��i-u Witnes Subscribed, sworn and acknowledged before me WC. by MARY E. . DALLMEYER, the Testatrix, and/I subscribed and sworn to before me by and C.-�evc, e f4i the witnesses, this-- —day-of- Notary-ziayaf-- Notary ublic SE. �anyadre Fw�s.,t ur�bc 9u: ; �A my comiln`w-pn Expires June z 7,210*0