HomeMy WebLinkAbout03-03-14 J 1505610105
REV-1500 Ex�o=_��,��, :::;
enns OFFICIAL USE ONLY
PA Depa�tment of Revenue PEppqr�E Y�vania
Bureau of Individual Taxes � "'°F"`°`"°` County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN � / ��;
Harrisburq,PA 1�128-o6oi RESIDENT DECEDENT �
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
05/29/2013 ' 12/27/1924
DecedenYs Last Name Suffix Decedent's First Name MI
ROSS I MRS ' BETTIE 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
C� 1.Original Retum O 2.Supplemental Return O 3. Remainder Retum(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
� 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 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 T0:
Name Daytime Telephone Number
PEGGY L. MILLER ' ',(717)697-9265 ,,,� ,
�
REGIS WILLS U�ONLY� �
�C rt� .,�
rn � �r'> �:
?J I�"= � �
First Line of Address � 1 -_'_
_
4521 ROLO CT ' p� ., � f, � �
Second Line ofAddress �� � , �?
4 �
D,..� .. �
City or Post Office State ZIP Code DA7E FILED'�
MECHANICSBURG PA 17055
Correspondent's e-mail address:
Under penalties of perjury,I declare that I have examined this retum,inGuding accompanying schedules and statements,and to the best of my knowiedge and belief,
it is true,correct and complete.Oedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN�R��PEIj£�ON RE/�BLE FOR FILING RETURN DATE
o�/ 02/28/2014
ADDRES
4521ROL0 CT, MECHANICSBUR , PA 17055
SIGNATURE�P�O ER T RESENTATIV�� DATE
. .
02/28/2014
ADDRESS
WALBORN NAUGLE ASSOCIATES, 1714 N. SECOND ST., HARRISBURG, PA 17102
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 15056101D5 1505610105 �
�
� 15056102�5
REV-1500 EX(FI) • DecedenYs Social Security Number
oecedent's Name: BETTIE J. ROSS '
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1. '
2. Stocks and Bonds(Schedule B) ....................................... 2. ' 26,495.00
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. '
4. Mortgages and Notes Receivable(Schedule D) ........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. '' 19,677.00 ',
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. ' 7,204.00
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. 27,153.00 '
8. Total Gross Assets(total Lines 1 through 7)............................. 8. ' 80,529.00
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. ' 1,117.00 '
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I}............... 10. ; 0.00 '
1L Total Deductions(total Lines 9 and 10)................................. 11. 1,117.00 '
12. Net Value of Estate(Line 8 minus Line 11).............................. 12. 79,412.00
13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which '
an election to tax has not been made(Schedule J) ........................ 13. '
14. Net Value Sub'ect to Tax Line 12 minus Line 13 14. 79,412.00 '
J � ) ........................
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 I
�a)�1.2)X.0- ' 15. ',
16. Amount of Line 74 taxable
at lineal rate x.0 45 ' , 16. 3,574.00
17. Amount of Line 14 taxable '
at sibling rate X.12 17.
18. Amount of Line 14 taxable '
at collaterai rate X.15 ' 18.' '
19. TAX DUE ......................................................... 19. ' 3,574.00
20. FIIL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C�
Side 2
� 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number 7�J3 �06117
G 7/
Decedent's Complete Address:
DECEDENT'S NAME
BETTIE J, ROSS
STREETADDRESS
4521 ROLO CT
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 3,574.00
2. Credits/Payments
A.Prior Payments 3,500.00
e.Discount 179.00
Totai Credits(A+B) (2) 3,679.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 105.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
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 Vansfer and: Yes No
a. retain the use or income of the property transferred.......................................................................................... ❑ �
b. retain the right to designate who shail use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for I'rfe of either payments,benefits or qre?...................................................................... ❑ �
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
contains a�neficiary 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 suroiving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the suroiving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a suroiving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax retum 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[/2 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 definetl,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV,-iso3 EX+(8-sz)
� i pennsylvania SCNEDULE �
� DEPARTMENTOFREVENUE
INHERITANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
.�8�'�'�'/�' J. /'P�S,,S �O/�— 00���
All property jointly owned with right of survivorship must be disclosed on Schedule P. �
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
i. �U7'�j-l-n/ �9�S9.Cu7''� /P�TuRN /�o /�ur/�? c G � -�� ��.�
TOTAL(Also enter on Line 2, Recapitulation) $ �' �f 9�
If more space is needed,insert additional sheets of the same size
July 12th,2013
Wiliiam Haddix
Wiiliam.haddix{�pnc.com
RE: 005-820547/Bettfe Ross-fndividual
Dear Wiiliam:
The value of the abave-referenced account on May 29th,2�13 is as fottows:
Symbol/ ;DOD
Amount Description ' Cusip Price DOD Value Accruecl Inteiest
0.210 Biackrock Liquidity Tempcash QTCDQ $ 1.00 $ 021
2,6U2.628 Pufiam Absolute Retum 100 Fund CL C PARQX $10.18 $26,49475
'"' Transamerica ** '°"
$26,494.96 $ -
Grand Total(Market Value+Accrued Interest) a 26,494.96
"Piease note the carrier must provide the date-of-death value of the annuity. PNC investments serves only as the broker/dealer.
'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 wiff be
taken from the previous business day's closing price.
If you have an�questions,piease contaet ouF€state�esolution Desk at 800-622-7086.
Sincerely,
Omar Omar
PNC fnvestments, LLC.
Estate Resolution Desk
The summaries,prices,quotes and/or statistics contained herein have beert obtained from sources believed to be reliable
but are not necessarily complete and cannot be guaranteed.They are provided for informational purposes only.Past
pertormance does not guarantee futt�re results.
RE�/-iso8 EX+(08-12)
� i pennsylvania SCHEDULE E
�' DEPARTMENTOFREVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX REfURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
�,�`y"`I`J,E'J. /2os,,, �0/3- �o���—
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointiy owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
�. c.D � c� r� z�►vs -�.avs r co. �9 0..��
�• �vn���9',� ,�/Dr�� - /��l�L,,/,fl �O
..� • ./'yl�'�?/G/I'�' �9.���' ° IP,�Fvrl�°� �
�}. ��-°"U�/�'t2 /:T �i°�"�u,�/� —.2�p1..3 vra/�
TOTAL(Also enter on Line 5, Recapitulation) $ /�j ��
If more space is needed,use additional sheets of paper ot the same size.
PLEASE DETACH BEFORE DEPOSITING AND RETAIN FOR YOUR RECORDS
60-0830
0313
No. 198152
Date:June 14,2013
Pay to the
Order of Estate of Bettie J Ross Amount S ******19,052.11
Nineteen Thousand Fifty-Two and 11/100******"******************** DOLLARS
� CASHIER� CHECK
closed acct 1'�10N-I�1EGC)TIABLE
Memo Authorized Signature
CIISTOMER COPY
60-0830
0313
No. 198152
Date:June 14,2013
Pay to the •
Order of Estate of Bettie J Ross Amount $ ******19,052.11
Nineteen Thousand Fifty-Two and 11/100*************************''* DOLLARS
CASHIERS CHECK
closed acct NOl`I-NEGOTIABLE
Memo Authorized Signature
1174 Wellsboro Branch 2 06-14-2013 06-14-2013 09:58:32 AM
FILE COPY
ii' i98 L 5 2ii' �:0 3 L 308 30 2�: 8 50 5696 i��' 28
RE'J-iso9 EX+(oi-io)
� � pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RENRN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
.8�'7"'�,�' �.J, rPo s.S ,�O/��- 0 0� 7
If an asset became jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G. �
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RElATIONSHIP TO DECEDENT
A. �.� .l�'�y �, 7Yl��l��P /�.S°�� ,,�0�� �--! � �j�"1J Cli�7�"'/v
fi��c,y,�Nl�s..&'v�E.'c�� �i9� l�o,�s'
B.
C.
70INTLY OWNED PROPERTY:
IEfTER DA7E DESCRIPTION OF PROPERTY %oF DATE OF DEATH
IfEM FOR JOINT MADE INCLUDE NAME OF RNANCIAL INSTIMION AND BANK ACCOU�IT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER 7ENANT ]OINT IDENTIFYING NUMBER.ATTAqi DEED FORlOINTLY HELD REAL ESTATE. VALUE OFASSEf INTEREST DECEDENT'S INTEREST
�. A. ��o 09 ��v c ���K �y�7 .�'o y�o�
49'cc�y�/`�' n/p. .s'ooSy327Z`�
TOTAL(Also enter on Line 6, Recapitulation) $ �� �O �f 0.00
If more space is needed,use additional sheets of paper of the same size.
s�- .
BUREAU OF INDIVIDUAI TAXES Penns Ivania lnheritance Tax = � '= er11'1S lvania
Po BoX zso6o� y � P Y
HARRISBURG PA 17128-0601 Information Notice fF DEPARTMENT OF REVENUE
�---�-�����-�- REV-1543 EX OocEXEC(OB-12)
And Taxpayer Response
FILE NO.2113-0647
ACN 13136326
DATE 07-01-2013
Type of Account
Estate of BETTIE J ROSS Savings
SSN 201-18-9646 X Checking
Date of Death 05-29-2013 Trust
PEG6Y L MILLER County CUMBERLAND Certificate
4521 ROLO CT
MECHANICSBURG PA 17055-5889
nr S' -
PNC BANK NA provi�ed the department with the information below indicating that at the death of the
above-named decedent you were a joint owner or beneficiary of the account identified.
Account No.5005432?29 Remit Payment and Forms to:
Date Established 08-03-2009 REGISTER OF WILLS
Account Balance $14,407.(!0 1 COURTHOUSE SQUARE
Percent Taxab.le X 50 CARLtSLE Pi4 17013
Amount Subject to Tax $7,203.50
Tax Rate X 0.150
Potentiaf Tax Due $1,080.53 NOTE'`: If tax payments are made within three months of the
decedent's date of death,deduct a 5 percent discount on the tax
With 5%Discount(Tax x D.95j $(see NOTE') due. Any inheritance tax due will become delinquent nine months
after the date of death.
PART st� 1: Please eheck the a
y p ppropriate boxes below.
A �No tax is due. I am tf�e spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed to Step 2 on.revecse. Do not check any other boxes and disregard the amount
shown abcve as Potential Tax Due.
g �The information is The above information is correc#, no deductions are being taken,and payment will be sent
correct. with my response.
Proceed fo Step 2 on reverse. Do not check any other boxes.
C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent, child,grandchild,etc.)of the deceased.
(Select correct tax rate at
right,and complete Part � �2% I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Comp/ete Part 2 and part 3 as appropriate on the back of this form.
E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritance tax form Return filed by the estate representative.
REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes.
Please sign and date the back of the form when finished.
_��c., (�;; (.'^)
� pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERIfANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
t��5'7'/,�' J�, /�'asS ���.�- DD��f 7
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM IN0.UDEIHENAMEOFTHETRANSFEREE,THEIRREIATtONSHIPTODKmBJTAND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THEDAlEOFTRANSFER.ATfAC}IACOPYOFIHEDEEDFORRFALESTATE VALUEOFASSET INTEREST (IFAPPIICABLE) VALUE
1. �/��'/1�..�/�"��fG/� �1�� /J✓.5�. CD .
��NV�'YY Z"/,l.s'� .�� �
�'/Pi��t/aS�k72�� :
aP,�GG y .�, �'l�LL�'JQ - .Di9UGh/7�'
TOTAL(Also enter on Line 7, Recapitulation) $ � JS3 0.00
If more space is needed,use additionai sheets of paper of the same size.
� �ic)`�����J!����y�("C�� /� Admiraish-ative O�ce:
•���� r� '� �'� n 4333 Edgewood Road NE
� L(F E I N S U R A N C E C C7 NI P A N Y Cedar Rapids,IA 52499
www.transamericaannuities.com
July 02, 2013
PEGGY L MILLER
4521 ROLO COURT
MECHANICSBURG PA 17055
RE: Annuity Number(s) 02CBT167959
Dear PEGGY L MILLER:
A check for $26, 830 .40, representing the full and final death benefit
payment for the above listed Non-Qualified tax deferred annuity has been
sent . Next January, you will receive a Form 1099-R reporting this
distribution as follows :
Gross Distribution: $27, 153 .41
Taxable Portion: $2 , 153 .41
Federal Withholding: $323 . 01
State Withholding: $0 . 00
Please note if you elected to have your check sent overnight, your check
will reflect a $20 . 00 deduction from the above listed check amount for
the overnight fee.
Transamerica Life Insurance Company does not give legal, tax, or
accounting advice. You may wish to consult your own attorney,
accountant, or tax advisor with questions or specific points of interest
to you.
Any additional questions regarding this annuity can be directed to the
Annuity Service Center at 1-800-553-5957: A Transamerica Life Insurance
Company representative will gladly assist you with any questions you may
have regarding this annuity and help you meet your financial goals .
�
Sincerely,
Claims
Transamerica Life Insurance Company
an AEGON company
'riEV-l.Sil EX;- (Cr,-i:ij
i pennsylvania SCHEDULE H
� � DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDEM DECEDENT
ESTATE OF FILE NUMBER
.�,�-�1� _). /r oss �0�13 - o o,!y�
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
i.
�/Q n/� D
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) D
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: Q
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: Q
5. Accountant Fees: � D
6. Tax Return Preparer Fees: y�o
/
�. �.�G/�'J"�4 Ol� f�/�,�.5 - �#�`,�/�/C� ���5 Z� �
d'� ,�i9 /n/cam� �i�k - .B/'�,�,�-�tl cG .�a �.� .�Jd
TOTAL(Also enter on Line 9, Recapitulation) $ � //�
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
� � pennsylvania SCHEDULE ]
DEPARTMENT OF FEVENUE
INHERITANCETAXREfURN � BENEFICIARIES
RESIDENT DECEDEIYT
ESTATE OF: FfLE NUMBER:
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVI(�G PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
�. ,�.��-�y ,�ou �oss �,L,z,� .o�����.� -�'°�
�.. ,l o�iv>v,g ,,�'. l�bs� ciPO�rrJ�'12 ,o�tf�,y7"�' �O/ "
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II—ENTER TOTAL NON TAXABLE DISTRIBUlIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
� ,: r _ m. �
� e
�T , .
`. REGISTER OF WILLS CERTIFICATE OF
CUMBERLAND COUNTY GRANT OF LETTERS
PENNSYLVANIA
,��
'�Aaxrr .
No. 2013- 00647 PA No. 2�- �3- 0647
Es ta te Of: BETTIE J ROSS
� lFirst,Midd/e,Lastl � '
Late Of: NORTH MIDDLETON TOWNSHIP �
CUMBERLAND COUNTY
Deceased "'
Social Securi ty No:
WHEREAS, on the lOth day of June 2013 an instrument dated
December 30th 2003 was admitted to probate as the last will of
BETTIE J ROSS
fFi�st,Mrdd/e,Last)
late of NORTHM/DDLETON TOWNSH/P, CUMBERLAND County,
who died on the 29th day of May 2013 and,
WHEREAS, a true copy of the will as pro.bated 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:
PEGGY L MILLER °q"°
xi.-.
who has duly qualified as EXECUTOR(R/X)
and has agreed to administer the estate according to law, all of which ,,.
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the �Oth day of June 2013.
.����/T <���,.
Register of Wills
�
. �
Deputy
A�i..�
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) „
. , _
LAST WILL AND TESTAMENT
I, BETTIE J. RQSS, of West Branch Township, Potter County, Pennsylvania, being of a
sound and disposing mind and memory, do hereby declare this to be my Last Will and
Testament, hereby revoking all Wills by me heretofore made.
I.
It is my will that all my just debts and funeral expenses be fully paid as soon after my
death as my executor deems advisable.
II.
I give, devise, and bequeath all the rest, residue and remainder of my property, real and
personal or mixed and wheresoever located and all property to which I may be entitled or which
I may have any power of disposition or appointment and whether aCquired during or after my
lifetime to Harold C. Ross, my husband, provided he survives me for a period of three(3)
calendar months after my death.
III.
In the event my husband predeceases me or dies within three (3) calendar months after
my death, then all the rest, residue and remairider of�n��propert�sl�all go equa�ly;o�e-half$aid�
residue shall go to Peggy Lou Ross Miller, my daughter, and one-half to Joanne K. Ross
Croumer, my daughter, and:in the event either is not living, then her share shall go to her
children then living. Peggy Miller, my daughter., is to receive my blue willow dishes.�
. : . . IV.. . .
I hereby nominate, constitute and appoint my husband, Harold C. Ross,.as the sole
executor of this my Last Will and Testament. In the event the said Harold C. Ross refuses or is
unable to act for any reason, I then hereby nominate, constitute and appoint Peggy Lou Ross
Miller as the sole executrix of this my Last Will and Testament.
1 IN WITNESS WHEREOF, I have hereunto affixed my hand and seal this day of
',. �. 2003. . . . . � . . . , . , ,
. . � . . � � � � � ".� : :�.�
, . ,. _ ,,� :. .:'�. ; � (s�
� Bettie J. oss � � � � �- � �
. , . � . °° ,� cn �
, �
ma �`' _; cs
� y, r- t-� ,�, �7
A `� �rn�f,,. � ''"i �
. � � �C �1 +::�
. , � � � � �°+ -�t
�7 � - , � �
. .' . " . .. . . ' .. �J � �.._.; �."�
.. �y C-� �__' f':i
�. � � '-7 � � jg S�
�� � ��
� . �
�
The fore oing instrument consisting of two (2) pages was on this�..��}-h day of
�% 2003, subscribed to on Page 1 and at the end thereof by Bettie
J. Ross,the above named Testatrix, and by her signed, sealed and published and declared to be
. her Last Will and Testament, in the presence of us and each of us who thereupon at her request,
in her presence and in the presence of each other, have hereunto subscribed our names as
attesting witnesses thereto.
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