HomeMy WebLinkAbout05-29-14 1505610105
REV-1500 Ex(oara)(FI)Ta
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 28o6ot INHERITANCE TAX RETURN
_ Harrisburg PA 17128-0601 RESIDENT DECEDENT CZ I 4- 061`f
ENTER DECEDENT INFORMATION BELOW
.Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
192-14-6615 02/28/2014 : 01/18/1925
Decedent's Last Name Suffix Decedent's First Name MI
Swartz C
Robert
(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@D 1. Original Return O 2. Supplemental Return O 1 Remainder Return(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)
COD 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 CONFIDENTIALTAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
George W. Porter, Esquire (717) 5g3-7130
sZ7 Fri
REGIS OF WILIMISE @;P}l- "
M
First Line of Address � rn
h IV 1
rn
z ..r7l
909 East Chocolate Ave. G e
Second Line of Address n o -CD
rtrri
:Z H ' m
City or Post Office Stale ZIP Code -0 DATE FI CU r Cn.
�
Hershey PA 17033
Correspondent's e-mail address:twomangeorge @verizon.net
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.
SI UREA S ESP SIBLE FOR FILING RETURN DATE
d
5= -�y
ADDRESS
Lori L. Keefer, Ex., 1 Chelmsford Dr., Mechanicsburg, PA 17050
SIGNATURE OF PREPAR OT ER THAN REPRESENTATIVE DATE
i1 S Z
ADDRESS E1SI
George W. Porter, Esquire, 909 East Chocolate Ave., Hershey, PA 17033
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
�J
1505610205
REV-1500 EX(Fl)
Decedent's Social Security Number
Decedent's Name: 192-14-6615
RECAPITULATION
1. Real Estate(Schedule A). . . . . . . . . .. . . . . ... . .... . ... ... ... ... ... .. . . .. 1.
2. Stocks and Bonds(Schedule B) . . . .... . . . .. .. . . .. . . ... . ... . . .. . . ..... . 2. 140,889.17
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.
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. . . . . 6. 89,058.94
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested... . .. . . 7.
8. Total Gross Assets(total Lines 1 through 7)... .. .. .. .. . .. .. . .... .. .... .. 8. 229,948.11
9. Funeral Expenses and Administrative Costs(Schedule H)... . .... . ... . ... .. . 9. 8,770.19
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1).. . . . .. . . ..... . 10. 1,323.12
11. Total Deductlons(total Lines 9 and 10). . . . . .. . . ... . . ... . .... . . . . ..... . 11. 10,093.31
12. Net Value of Estate(Line 8 minus Line 11) . . .... .... . ... . .. .. . ... . .... . . 12. 219,854.80
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. 219,854.80
TAX CALCULATION-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.0_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0 45 219,854.80 16. 9,893.47
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. 9,893.47
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
1505610205 1505610205
IREV-1500 EX(F1) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Robert C. Swartz
- — — -
STREETADDRESS-_
770 Poplar Church Road
un
STATE I ZIP
Camp Hill PA 17111
Tax Payments and Credits:
1, Tax Due(Page 2,Line 19) (1) 9,893.47
2. Credits/Payments
A.Prior Payments --
B.Discount _ 494_._6.7_
3. Interest Total Credits(A+B) (2) 494.67
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 9,398.80
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 properly transferred.......................................................................................... ❑ E
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ N
c. retain a reversionary interest .............................................................................................................................. ❑ 0
d, receive the promise for life of either payments,benefits or care?.,............................:....................................... ❑ N
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 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) (1)).
For dates of death on or after Jan. 1, 1995, the lax 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 return 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 blood or adoption.
REV-1503 EX.(8-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Robert C. Swartz, aka Robert Charles Swartz 21-14-0274
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1' Prudential Financial Inc.Stock-396 Shares @$84.68(See Exhibit"A")
33,533.28
2 The Hershey Company Stock-1024.378273 Shares @$105.87(See Exhibit"B") 108,450.93
3 The Hershey Company Stock-10 Shares @$105.87(See Exhibit"C") 1,058.70
TOTAL (Also enter on Line 2, Recapitulation) $ 140,889.17
If more space is needed,insert additional sheets of the same size
REVV-''15```009 EX+(o1-1o)
pennsy(vania SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Robert C. Swartz, aka Robert Charles Swartz 21-14-0274
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. Lori L. Keefer 1027 Chelmsford Drive Daughter
Mechanicsburg, PA 17050
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER,ATTACH DEED FDR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 08125108 Wells Fargo#725219651JDSU Stock 125 Shares @$13.86(Exhibit"D") 1,732.50 50% 866.25
2. A. 08125/08 Wells Fargo#7 2 521 96 51Rite-Aid Stock 1000 Shares @$6.74(Exhibit'E") 6,740.00 50% 3,370.00
3. A. 07106182 Wells Fargo Bank Checking#ending 2695(Exhibit T") 3,792.78 50% 1,896.39
4. A. 06107107 Wells Fargo Bank Savings#ending 5023(Exhibit"F") 2,149.98 50% 1,074.99
5. A. 08/25108 Prudential Co.Securities,LLC Fund#09990119811 (Exhibit"G") 163,702.61 50% 81,851.31
Dept.Revenue Notice-ACN 14502372 is incorporated as No.5 above.
TOTAL (Also enter on Line 6, Recapitulation) $ 89,058.94
If more space is needed,use additional sheets Of paper of the same size.
REV-1511 EX+ (10-09)
Y-, ; SCHEDULE H
] i 0 pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESIDENT CE ED RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Robert C. Swartz, aka Robert Charles Swartz 21-14-0274
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
Hoover Funeral Home 1,682.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP —.._.
Years)Commission Paid:
Z. Attorney Fees: 6,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City_ __- _____— —_ .___—._
_ State
Relationship of Claimant to Decedent
4. Probate Fees: 19150
S. Accountant Fees: 500.00
6. Tax Return Preparer Fees:
7 Cumberland County Law Journal-Legal Publication 75.00
B. The Sentinel-Legal Publication 116.20
9. Postage&Certified Mailings 13.49
10 Notary Fees 20.00
11. Register of Wills,Additional Probate Fee 170.00
TOTAL (Also enter on Line 9, Recapitulation) $ 8,770.19
If more space is needed,use additional Sheets of paper of the same size.
REV-1512 EX+ (12-08)
* y
pennsylvania SCHEDULE I
t�
e�7 DEPARTMENT of REVENUE DEBTS OF DECEDENT,
INHERITANCE RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES & LIENS
ESTATE OF
FILE NUMBER
Robert C. Swartz, aka Robert Charles Swartz 21-14-0274
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,Including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Commonwealth of Pennsylvania-Department of Revenue-2013 Income Tax 967.00
2. Alixarx Pharmacy 356.12
TOTAL(Also enter on Line 10, Recapitulation) $ 1,323.12
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(0140)
'r� pennsyivania SCHEDULE ]
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Robert C. Swartz, aka Robert Charles Swartz 21.14-0274
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS Ifndude outright spousal distributions and transfers under
Sec 9116(a)(1,2),1
1. Lori L.Keefer, 1027 Chelmsford Or.,Mechanicsburg,PA 17050 Daughter 50%
2. Brian D.Keefer, 1027 Chelmsford Dr., Mechanicsburg,PA 17050 San-in-Law 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1 SOO COVER SHEET,AS APPROPRIATE.
II
NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1
i
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART 11— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET. $
If more space Is needed,use additional sheets of paper of the same size.
P e S
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION APPRAISEMENT ALLOWANCE OR DISALLOWANCE pen nsylvania
PO BOX 280601 OF DEDUCTIONt AND ASSESSMENT OF TAX ON
HARRISBURG, PA 17128-0601 SECURI"1'Y ACCOUNTS HELD IN DEPARTMENT OF REVENUE
BENEFICIARY FORM aevas:e.,er uzan
DATE 05-26-2014
ESTATE OF SWARTZ ROBERT C
DATE OF DEATH 02-28-2014
FILE NUMBER 21 14-0274
COUNTY CUMBERLAND
SSN/DC 192-14-6615
LORI L KEEFER ACN 14502372
1027 CHELMSFORD DR APPEAL BY DATE: 07-25-2014
MECHANICSBURG PA 17050-2192 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE - '� RETAIN LOWER PORTION FOR YOUR RECORDS <° - --
REV-1548A AFP (12-13)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE: 05-26-2014
ESTATE OF: SWARTZ ROBERT C DATE OF DEATH: 02-28-2014 COUNTY: CUMBERLAND
FILE NO. : 21 14-0274 S.S/D.C. NO. : 192-14-6615 ACN: 14502372
TAX RETURN WAS: (X) ACCEPTED AS FILED ( )CHANGED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: PRUDENTIAL ACCOUNT NO. : 192146615
TYPE OF ASSET: C ) SECURITIES C X SECURITY ACC ( ) STOCK C ) BONDS
DOD Valuation 163,702.61 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 0.500 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 81 ,851 .31 UPPER PORTION OF THIS NOTICE
Debts and Deductions . 00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 81 .851 .31 REGISTER OF WILLS AT THE
Tax Rate X .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 31683.31 OR MONEY ORDER PAYABLE TO:
TAX CREDITS:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
PAYMENT MUST BE MADE BY 11-29-2014X. TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 3,683.31
INTEREST AND PEN. . 00
TOTAL DUE 31683.31
• IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. >
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
PURPOSE OF
NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 02000. (72 P.S. Section 9140).
PAYMENT: Detach the top portion of this notice and submit with your payment to the Register of Wills printed on the
reverse side. Make check or money order Payable to: Register Of Wills, Agent.
REFUND (CR): A refund of a tax credit, which was not requested on the tax return, may be requested by completing an
"Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available from
the Department's Web site at www.revenue.state.Pa.us, am Register of Wills or Revenue District Office or from the
Department's 24-hour answering service: 1-800-362-2050; services for taxpayers with special hearing and/or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the aPpraisem.nt, allowance or disallowance of deductions or assessment of tax
(including discount or interest) as shown on this notice may object within 60 days of the data of receipt of this
notice by:
A) Protest to the PA Department of Revenue, Board of Appeals by filing a Protest online at
www.boardofappeals.state.pa.us on or before the 60-day appeal period expires. In order for
an electronic Protest to be valid, You must receive a confirmation number and Processed date from the
Board of Appeals Web site. You may also send a written protest to: PA Department of Revenue,
Board of Appeals, PO Box 281021, Harrisburg, PA 17128-1021. Petitions may not be faxed; or
B) Elect to have the matter determined at the audit of the personal representative account; or
C) Appeal to the Orphans' Court.
ADMIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, PO Box 280601, Harrisburg, PA 17128-0601
or call (717) 787-6505. See Page 4 of "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501)
for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is Paid within three calendar months after the decedent's death, a five Percent discount of the tax Paid
is allowed.
INTEREST: Interest is charged beginning with first day of delinquency or nine months and one dayfrom the date of death to the
date of payment. Taxes which became delinquent before Jan. 1, 1982,bear interest at the rate of six Percent per
annum calculated at a daily rate of 0.000164. All taxes which became delinquent on or after Jan. 1, 1982, will bear
interest at a rate which varies from year to year with the rate announced by the PA Department of Revenue.
Rates for 1962 through 2006 can be found in the Pennsylvania Resident Instruction Booklet (REV-1501),
the Pennsylvania Non-resident Instruction Booklet (REV-1736) or on the Department of Revenue Web site
www.revenue.stat..P..us. The applicable interest rates for 2007 through 2014 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor - Year Rate Factor Year Rate Factor
2007 8% .000219 2008 7Y .000192 2009 5% .000137
2010 4Y. .000110 2011-2014 37 .000082
Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
Any notice issued after the tax becomes delinquent will reflect an interest calculation to15 days
beyond the data of the assessment. If Payment is made after the interest computation date shownon the
notice, additional interest must be calculated.
(Computershare
Computershare Investor Services
250 Royall Suee,
Canton Massachusetts 02021
www.computershare.com
GEORGE W PORTER
909 EAST CHOCOLATE AVE
HERSHEY PA 17033
r
April 7, 2014
Company: PRUDENTIAL FINANCIAL INC
Registration: ROBERT C SWARTZ
Holder Account Number: C0010835593
Document I.D.: 14091 WF00413444
Our Reference: PRU/0002806426/l/
Dear Sir/Madam:
Thank you for contacting Computershare, Prudential's transfer agent. We appreciate the opportunity to be
of service to you.
On February 28, 2014, account number C0010835593 held 396 shares. On that date, the closing price was
$84.58 per share. —NU 4g�-),(D S I- e cwt+cjk ec3_
Prudential pays a quarterly dividend of $0.53 per share in the months of March, June, September and
December.
Attached are the form and instructions needed to transfer stock to a new account or another holder.
Alternatively, for most accounts, the Computershare stock transfer wizard will walk you through the
transfer process and assist you in completing the necessary documentation to complete the transfer.
Please see our website at www.transfermystock.com.
Should you have other account related questions, please call us at 1-800-305-9404 between the hours of
8:30 AM and 6:00 PM Eastern US time, Monday through Friday. Please note that any available
representative can assist you. A telecommunications device for the hearing impaired(77Y/TDO)is also
available at 1-800-619-2837.
Sincerely,
CL 5
Service Representative
Enclosure: US Holder-Deceased Transfer Package.pdf
Prudential Financial Inc., PRU Historical Quote - (NYSE) PRU, Prude... http://bigcharts.market watch.com/historical/default.asp?symb=PRU&c...
Enter Symbols or Keywortls SEARCHJ
/®
Cf �r u�,O t11 1� 11 p0 3ct L S �s
Form Markett+rYatch ',Aue_ .�( 18'C•
PRU 53
1 Basic Chan I AtivanceA Chart Interactive Chan, 3� 1 ,
111 1
,Mr Home Ouotes News Industries Markets HisWrical Ouotes BigReports
This Hate ical Quotes real ail you to look up a s mutt's exact closing pica, r te•
Simply type in the symbol am a historical dare to mew a quote am mini chair for that security.
`-zf'&" Enter Symbol PRU Enter Dates 2/28/14
IPrudentlal Financial Inc.
PRU Set ly ea
n Feb30,3014
Closing Price _ 84.58 v— car
;open 84.39
'Hg^ 85.491
I,L°w 83.98 so
Veto— 2.297.2711
No splits
Hems l About l bb Oppodurnes l Conrad lb l Feedback l Help wmaw
CopyngM 2014 Markelacreh,Inc All ignite red...A
By using the are you agree to the Term of We,Fulfil Pblop and Cookie Policy
Ireabay Data pro wed by SIX Financial Information And earned to fors or use
referent aM current mbar d d,bala p,.aided by SIX Finanoal Ntormalron In,today data belayed per exchange requirements.Sara w Jones Mdidas(Set from Dow Ames B Company,Ne All quotes are in bear exchange rime Real tome
last auto data provided by NASDAQ.
More information on wer traded symbols and their current rmandal status.
Intraday data delayed 15 minutes for n atlaq,and 20 mnmes for other exchanges
Sual' wAntis indices SM)from Dow ones s company,no
SERI intraday data is provided by sa Financerl InferrRtien and is at least so-mnmea balayed.
Al g.area are in bcal euhanae ti.
I of 1 3/21/201x42:28 PM
�
�o �m �
�����UUare
documents antJ nore. -Enrolf FREE t&-lay at tomputershare Investor Services
� Z58Roya|| Street
Canton Massachusetts 0Z0O
*wwcomputeuho/ecnm
GEORGE VVPORTER
9O9 EAST CHOCOLATE AVE
HERSHEY PA17033
April 7, 2U14
Company: THE HERSHEY COMPANY
Registration: ROBERT C5YVAK7Z &
HELEN R5YVARTZ]TTEN
Holder Account Number: C0000498637
Docunnentl.D.: 14097VVFUU645334
Our Reference: MR5H/0002806426/1/
Dear5ir/Madano:
Thank you for contacting Computershare, the transfer agent for THE HERSHEY COMPANY. We appreciate
the opportunity tubeof service t0you.
Below is the account balance information you requested as of February 28, 2014 for the above account.
Shares Held by Agent: 914.]7R273
Shares Held in Certificate Form by Holder: 11O
Total Shares:� 18I4378Z7]
/ � ~�
Closing Price Per Share: $84.S8 —/�[�~ ����(�+�u11^'�/" �c �^
Hershey pays a quarterly dividend of$.485 per share in the months of March, 3une, September and
December.
Attached are the form and instructions needed to transfer stock to a new account or another holder.
Alternatively, for most accounts, the Computershare stock transfer wizard will walk you through the
transfer process and assist you in completing the necessary documentation to complete the transfer.
Please see our vvebsitea| ,
Should you have other account related questions, please call us at (800) 8514216 during regular business
hours. Please note that any available representative can assist you.
Hershey Co., HSY Historical Quote- (NYSE) HSY,Hershey Co. Stec... http://bigcharts.marketwatch.com/historical/default.asp?symb=[-ISY&,c
Enter Symbols or Keywords SEARCH
fflCharrstsas
shor an M a r k etW a t c h
HSY [IlCh AcIvert i slku,r-r-,
) oc
How cul Notes Iridurgrejes Markets HiW"l Outskirts BlIgReporde You Ib look ups se
Sim lyrd 0 the 5,quad and a histronsel data to meArt queleford mini armor for that reverry.
Enter Symbol: HSY Enter Date. 2/28/14
Hershey Co.
Fri,Feb 28.2014
clon",wke. __-__--.-_—______-_-_._.__.-_.______
105.82
!Open 105.81
................. —------------ --------------------
ulgh 106.59
L..............--------------------------------------
105.201
widual
1,131.395
-------------- ------------------- No Splits
win manrnwawuw r4ohnse I Amin I Jab 011amolum I Co...LE I mandrose,I Poly
Cool 2011 equirevauch,Ino.All of reserved
By mar,this site,you agree 10 the Term Of We.Privacy Pon,.,a Cori Peter.
ladminvy Outs provided try So Financial offoreation and subject to lerms,of use
itarAland dead inall data provided ly 11 Fornival Information Intraday data delayed no,evolar,requirements SusPoi dones Indent;froal from Dow Lnez8Common,no All quotes are in Il armor lor Seat time
and the data Planned by IVol
More inforrNtion on- a'
SOAQ If ded symbols and their current financial Malay
rome.,dale ee,qy.15 unnales her W ads,...20 inhales So she,themarl
Sidn'Orso James Indicate(SIA)from 0-.,as.Ciandery,to
SEW intraday dale is provide.by Sly Forohni Imlionsionsin and is.1 line seminaries delayed
All equals,are local.11rom,If-
1 of 1 5/8/20111 12: 11 11M
Hershey Co., HSY Historical Quote -(NYSE) HSY,Hershey Co. Stoc... http://bigeharts.marketwatch.com/historical/defatilt.asp?syinb—IASYclt
7E1.1 Symbols or Keywords SEARCH
SCharts"
From MarketWatch
Ittle'.11111=Chll o'I,
HSY Chart Advanced Chart C
ED
Horna, Oul Nell INWISNOW" Markets Historical Quotes ONgRep"
Thus Historical Onales lot allows you to look up a securhys eXect clashn pfjob
SNmpyv lype is the symed and a hislorq-Cal net,to Amb,a Quote Bad mini Oat,to,In......1,
li'; Enter Symbol: HSY Enlei,Date 2/28114
...............
Hershey Co
led Feb 28,2014
--------------------—--
cob.,In-
105.82
--------------
105.81
106.59
low ............ ........... ........ ..........05.20
105.20
ecaNnae 1,131,395
------------ ................. . ....................... .......................... ......... No Splits
I About I Job OPP.1herylay.I Contact Us I Feedback)NNcb
SONINg"2011 XhusluMuch.Inc AN(also chnnVed
By Unmq this sh,you Isrs,1.11.Teams of Use.Pl...,pose,I Deals,P.1111
ansday Data Pov,ded by SIX Financel Information and subject to terms of use
nstoncal and cuncat oNday data Provided by SIK b—dal Infa-1cm,Inlayyy note delled no,tceaanNo cclue—erls S&PAD.v,Jants aence,tS.I 11—D—Nb-eX as C.,no."Nc.1 u-sas are In local even...... cy"n-
'a..sale"IS"a"a"d A, iASDAQ
e
Ma aveneeflon an""5DA0 lall.1 symbols and Inter anent financal status
Enhance,OsIX delayed 15 ne—les lot Nal.,a 20 Inaunn.for cyne(eleausages
"'Pa""'a"c"indn'to IS.)No.DI.C.Naa.a'an.
SE.Whad,data Is ro,,I,d It,SIX I....dial aff—Ion,and is a 11...I 60,nnia,les dented
NI a 1.1s.an a No.,anchan"time
I of 5/82014 1 1 1 A
'm tit 0�'
F17 U ti
Men r 00
I M
FIRST NATIONAL CITY BANK
J.
a
REM
k
'I lWal I"
M
0
ON
z
...ixg,
M K
We ta N
<
11�14 �z
I Ilk
<
'Iw X
IN
—1 ..�TN
�=.1"ItO
Ip. • 7)NVd�WO:)is ns8f�
JDS Uniphase Corp.,JDSU Historical Quote-(NASDAQ)JDSU,JD— http:tt bigcharts.niarketNvatch.comthistorical/defatilt,asp?smlb=lt)St)&..,
3 I Enter SymCols or Keywo C5 HEn M l
'® F 4l V�
MChar!s" 05 U S�� � � J !Stns!n�s
rt.,9ktw�, 1 ccA�,3 e,, ,8(e peu�t
JDSU Roslc Chart Rdvancao Chart Imprei iw Chan
Home ouotes News Industries Markets Historical Ouotes eigReportf
.ar
i114 FStIXtatCwes lnarnbwa}W(O F.yk nPa 60PItR/S C/Mtiblhq pki.
SanptrrypP3r Mnal+nOdnrrQ nM1bio4ca14ni 1PNCw n4wRalgmkMUMM1 btml SeLUl1Y
'W.71:
I t j 1 Enter SYmbol: JDSU �'! Enter Date: 2128!14
JDS Uniphbse Corp. II
F4,Fea M,M14
Cb N Riy. 13.78
Coors. 14.09
tpn 14.135
sov: 13.71 !
4wu,m. 3,209,489 (4
No Splits
tb+rvtNMi.dneapwwnaksi COmse W lFee4n.tlrl tk4
0""V."'4 MXIIe !m M.N !rnNnen.
9VNtlp Nb.YO.YM Krtt In Itp TNI 01 ye,RWq Poky.N Conlin rbtlry
Wh .,Drtn 1M CY SttFinaM01 h'.wrmllm.MSLG}w, bittmsIN Vaa.
rtEtwitM.*E autmtLN9cEaf 4Ya wa MSD:Fignur MwmNtltl W10" ih ft*K4 PwntN.Nn(mhtwmb SdP2brbnea FeGeatSM)hwr,OwhnesbCnnP.FY M Mwsss ce HbW nNanO.tac FaNimro
bt uk tlili d1' WtM$eiQ.
fibre Ntnrmalpn onµ450MIr 1, WI...M IMIr Mi W.Nf. C'W.
Xlr.nry n.la nttly4tl 15 rtirwld brµtglq..M TI mn4tN Iw aVrer eGlry}Ra.
FdPNM'.b^es tlnY[t ISM)Irom NwbnN 6 YArN.rry,M.
b[N(IMrpaY noL bAnNY CYSIX.io pWnssnannbatk.GBPrMUtCdtllhY
m uxe s m nn
N e p beat a:m.npe ume.
I of 1 3121/2014 1:59 I'M
0 O
N O
`o E o z`
7 ry N N
w T � t; R
rn N N W
m m
L C N
c � = E
0 ° c =
p t = 00 d
NOov 9xxxx
c rnx � a
E m c =
E `w _ o
p O` U N
E p CO c
N 7
O O O E N
Q O a O
cv 0 l0 A O LN
co O � cv > N
.. O 3 T OI> O r
ZF wa .. C O v m
Q0' UW M O p — � Y N
�Q D g R m m° o
w3 mmc a
FjN .-Z w d 5 'u o = N v
W a arY O > 'c
Y. WZ
'w Oo v c `p 0 a ° E
00 OL)
W OQ .GI N � OC C N4= � N
N NL O d CCj'O
O wo - E E Vp o
E
vav
= C.1 O LL 0 p 0 w=y *a O O - M=
O m F- m
a
a
z
N
O
K
N
m
� W
Q K m L)
our U W � .x ? o
Q cL
LL (n O ..
o W L)
0 o N Y v
200 Fwv � a (�95
UmO xco cN XZ `
2a. co U0iL
IC
C
O c
•y m
o
O v
E N
� E
a
. GCI M E = d U
C OWr O c ui p o W
a+
N � It o
C J d C O y N N m
i W w t O o x > o
OZia LL QmF- � U
;Z iZ
Z�
z,i
O <j
30
I z z
Z
U) No
LY
LLJ ca N
Qa Uui
Lli M
LU af I z D 0
Y- Lu 7. w 10 10 w 3
C.0-) ,g
(Y. zn o10
W 00 .I . n r N wl�
0�,co �Io ()w z i
C)0 U o 0'0 y i I Lf; (el (6
C�l N
-I(Y. 04 Uw
<
�Wj 0
w o m '0
(D
z
<
li n
C3 ,
td m LL
LU
ui
CL
I
lu!.o
0
o
C) 0
CL W w
0 -0 0
C ZIQ O U. 0
0 m 0 x 0 0
F- f6 cl� rla -: �
U),U)
0
u >>I w
0 tv NISI 0
0 0
l
a. 0 C/) w
V) ;o 0 < ;�l E�[t- t-
D-a
Rite Aid Corp., RAD Historical Quote- (NYSE) RAD, Rite Aid Corp.... ht tp:/Ibigcharts.marketwatch.comt historical/default.asp?syntb=RAD&...
Enter Symbols or Keyvmrds SEARCH
ccap
ffCharats* 19 - w() 5v w
rrga MuketWatm
RAD `---— ' — 6aslc Chart Advanced CAen Imeroalve Chan
� Home Quotes News Industries Markets H3brkal OUOms &gRepwts
TRh 16bodes oueas I"eaaws M le area UP s[pdsys ema testae erles.
S-Pe hem le the IM W[Ids n61geal eme ID New a o1KKe[Itl mM 0.M 1.a,aar,,
:11 Enter Symbol', RAD ,Enter Dato: 2/28114
l
Rite Frit eta or II
Rit Poid Cp.
or
ck w R. 6.69 07 1
opn
e.6o
t-t,e 6.81
° 6.51
21,320,088
No Split.
le^a'I Rape I m OpaatluMeal[anlatl l!I FHEeatk Mb
CegveM Ml[NaheeV am,Yc as teM texrvN
Gy eal,IRh eae,Yw"tee w Ne Term at 1pe,RN[q Polm are Caatie Par"
ka.'Y pear gelded LI'3IX FMertYI lntatmlwn ere aWpq to tnrn el w
IMprkel erd anrml[Me1daY eale pwdeE pY aIXGneM41 nlpnvMn elrMaydatadebYee Mrl su,alluY[menle.%P/Nx.enp egiwe(8411eem M+brae6CoiryenY et MyuNef neabui ertfenpp time.Reel Yrrc
ast we data pom.o,NWDA0,
ware b fe,mna,m WSGIG vad[d syeWb and IRek Mrere mandial uew.
Hukl,data deayed 15 eamlea e e
r....eM 20 rtul.Ip.1",..1.
aSPlL .—Mk.ISM)egne `lama 5 Cgry 'ac
EEW.stray'dataw pawed eY SIX FM.—I FMeelun aM Is al least Wrrinuras the as
M true.are M Baal[ ,,a ire.
I of 1 3/21/2014 2:01 PM
lO pQ
V G O '�$
y C SF
`o o E p zN
m u W
O C
t C d
c , = E
G O`
U
N o �° CXXXX
c ms c a
N t9 c
E v _ =O
= Y N U
M U U N
E v° m c
U) N OO O c C U O,
O m O O c d w
M U Q a O
O T
w" N - — d
m C = c N > y
2 .. O 3 T
O .m,> +�+
Z N uJ L r C o °gyp 10
QK Uw f0 O p - O r N
a'G wm m m Y m y o
w3 ' n m a z
W y Z 0 5 or y v
W U Q'F C C Y
Yc WZ Ni m .
JW 00 U .0 p pU « .0 o E
Km FU O QF E «° iO+N' cEp>
OJK O¢ d L N60c C hwp `m
o v 41 ccEZ
O d o m E pro
Eop�
= U LL O pO � O O mmxs
(7 v 3: .d
CL
a
z
0
O w
� 0zNd �
Q >< � O
O O O w > Y Z O
LL U) O � ,✓
o wUm K
00X5 YF 'o � pwLL
200 J W -190 `� aC7 c
C) m O d' m C N X z N
F
O U) OJ
� d pJ a, tL
C u
Q C
.y m
CD o
0 d Y
E N
L E af
CL
.. >
N M y E � ,o
C N m o
E uoj O c ui p O w
N C
7 a' W O c m = N N
Y
• C c 7 m ' x " m
o
�. war O mom > o
00 � � a v u. QmF sU
Qai
! IZ Z
V_ Zp
., O Q ILI I '.
N ~
ILI
T
w ; g �Q .d
D p I Z !Z
p w i0!0 ! !
W:9 fc to j
Nv> _liOiw
w.~ ¢i
N, !
ce
1-> m
Z I-._ lU 0' rl
Q fY. U ul
W Tl
uj;., �.
w 5: _j I
w in
W(.J fhF.. Z7 N O ' lmN
Y F- W 1 w
F-W 101 0 (X
(z. 0]_) 2.7 O!O tt> N (O I tO I of
00 UU �FIN,(°,I Uy •' iN iaOi�O
Ud
Yi
ZU,m O
wK!W I�
IX Cm t o
LL
U
i r
I
I I
I
i
r
I
I _ _
I
fD I
ft1 c fi
r � h
W w
06 C6
•° fl � � y �1� �I N c
lu; o
la m; o
ITS zjQ o I �
�•, O a Nt CD
L rn ��r f6 O o !u=,v=iiWOi
oiool <, 4o: 4o-
- y
; « # 2 ! ; f Er f ( / b ■ 772 c
W | (
( / CL/ � � \ \ � &
§
; c0 -
0,
§ ® � ! \
! - - tr.. R
] \ } -{ ƒ j
E \
/ /
, @
( \ �
§ ) (
&!
\ { r !
Id
�
05/05%14 12: 50PI-I Stine Insurance s Financial Services 7173676611 p. 02
w. �> e,2,. -poQ
George W, sorter
1l teorney(tt C,crty
909 first C'hocolatc Avenue
I ler5hey, PA 17033
I.D. 1142752
Phonc: (717) 5.13-7130 Pax: (717)
,larch '27. 701 Fl
Norman W. Stine, LL!'l,CF
Prudential Company Securities l..E..,C:;
300 .Mcadow Larke
f lershey, PA 17033
Re: E''slate oJ'Roberl C. Swariz
Dear Nonn:
As you fire aware, the. above named Decedent, Robert C. Swartz, died on February 28.
014. Qur firm is reps-cSenting Lori L. Keefer, Executrix of Decedent's %;state. in sculling the
tSsratc. We are eliclos.ing an original Short Crrti.lictae noting her appointment. by thr
Cumberizind C:ouiif 'f�eMgisl'i t'c:,(Wills, along With a copy of the Death C'er'tificate and an
Authorizatiorl signed by the F'xcelitrix.
For Pennsylvania inheritance tax purposes, kindly provide our office with the dwc of
death valo.,q, in writing. of my accounts administered by your first as Follows:
we ✓� ,
Lori
A(;Count in the rrune(s) of-. R' u�^"l�Glt l S
AcQokim Number: agq 9 O� q
Account balance on the date ordcaUi: ( 4 3, -7
S l7P)Gift;; tIIC ik(ic) li Q holdlit'g5:
Any accrued inler081 or dividends from 1/1!14 r• l, '
to the date of death 2/28/14: 01 v,� �44 :>
Name. of Death Beneficiary\('irany): G
Was thr:re a•joins tenant" 1 Cs l or`' . K
Date the accoul'u was made joint? $126(2 °o
Pti.aw also provide the following information for the Prudential stock:
"' ilce�ni:rri iit'th<i'iiamc.(sl to l'; ''�opG"�' G• swa,.. :'�';L ,
Acediuit Nurritier: ' C '00 10 '8's 5-59 3
OS/06/lA 12: 60P14 Stine Insurance 6 Financial Services 7173676611
N90 2
March 27, 2014
G 8' 396 x
A.ecount balance on the elate of death: 3 jf C J'
Number of shares held: ion Oo
Any accrued interest or dividends front 1/1/14 N� dot
to the date of death 2/28/1Q:
Name of Denth Benc ticiary (W any);
any): None
Was there a joirtl. levant? O
Irate the account was made joint?
Thank you ibr your [assistance in this reptard. Please. do lot hesitato to contact my ot'tice
if You have[ any ga Anions or require anything tiddidonal,
Very truly yours,
George W. Porter
Attorney at Law
G W V lice
I?
05/05/14 12: 50PX Stine Insurance s Financial Services 7173676611 P. O1
ADThe Prudential Insurance Company of America
Prudential 300 Meadow Lane
Hershey, PA'17033
Tel 717 307.0011 Pax 717 367.6611
Noran.5tinaQVi udentlal,com
Tot GE�,,Ce oRre-,Ye /7rTYae v Fromt Norman W. Stine, BS, LUTCF
Fax: 7 5 0 3 -!Fa o 9 pagest
Phonea 717-367-6611 Date, S'o7 o/Y
Re; kal I r dUwarz cc:
"The Information contained In this facsimile message Is confidential Information Intended only for the use of the
Individual or entity named above, If the reader of this message Is not the intended recipient, you are hereby
»otifletl that any dlsaeminatlon, distribution,duplicauun, review, uso, or the taking of any other action relevant to
the contents of this communication Is strictly prohibited. if you have received this communlcetlon In error, please
Immediately notify us by telephone and return the original massage to us by mail. Thank you."
Offering seatd8es products and SeryloaS as a Registered Revesenlalive Of Pluw Sectiftes,.LLC(ftw)• The Prudenlial Insurance Company or
Amorko,No ,rk,NJ and Pn=are Prvdon0al Financial Companlus.1.900.201-WOO
& -a
LAST WILL AND TESTAMENT
OF
ROBERT C. SWARTZ
I, ROBERT C. SWARTZ, of the Township of Hampden, County of
Cumbalznd. and Commonwealth of Pennsylvania, declare the following to be my Last
M71 Ted hereby resv1dng all NN Us and Codicils heretofore made by me.
ARTICLE I
I direct that all my just debts and funeral expenses, including the cost of my grave
marker, shall be paid from the principal of my residuary estate, as soon as practicable
after my decease, as a part of the expense of the administration of my estate.
ARTICLE II
I give and bequeath any items of tangible personalty I may own at the time of my
death, including, but not limited to, any and all automobiles, furniture, furnishings, china,
is
silverware, jewelry, ornaments, works of art, books, pictures, and wearing apparel,
including any policies of insurance thereon to my daughter, LORI L. KEEFER, and my
son-in-law, BRIAN D. KEEFER, now or formerly of 1027 Chelmsford Drive,
Mechanicsburg, Pennsylvania, if they are then living, or the survivor of them. Any
property not so distributed shall be sold and the proceeds added to my residuary estate.
ARTICLE III
All of the rest, residue and remainder of my estate, real, personal or mixed and
wherever situate, including lapsed legacies and any property over which I may have
power of appointment, I give, devise and bequeath to my daughter and son-in-law, or the
survivor of them,named above, in ARTICLE II, absolutely, per stirpes. .
ARTICLE.IV
{{ iv -' �t� 1 t4'S`^4d'++, nr�.•iY5';.-a.'..•4"'. �."k4LL _a b. .'.N. -
W-W V%M "a I kwic tic pis,,in ad&tion to those
;-gel in them by law and by other provisions of my Will, applicable to all property,
including property held for minors, whether principal or income, exercisable without
court approval, and effective until actual distribution of all property.
A. To retain any or all of the assets of my estate, real or personal, without
regard to any principle of diversification, risk or productivity.
B. To invest in all forms of property, including, but not by way of limitation,
all types of stocks, bonds, shares of investment companies, and mortgage
investment funds without being confined to legal investments and without
repwd to aezy principle of diversification- risk or productivity. When
'C ,_ vcquhtng- exchanging, selling and
managing property for the benefit of another, my personal representatives
shall act with care, skill, prudence, and diligence under the circumstances
then prevailing, specifically including, but not by way of limitation, the
general economic conditions and the anticipated needs of my
beneficiaries, that a prudent person acting in a like capacity and familiar
with such matters would use in the conduct of any enterprise of a like
character and with the aims, to attain my goals as determined from the
language set forth above.
C. To sell, at public or private sale, to exchange or to lease for any period of
time, any real or personal property, and to give options for sales,
exchanges or leases, for such prices and upon such terms and coaditioa z---
they deem proper-
D_
pledge any or all real or personal property, as they, in their sole
shall choose, without regard for the dispositive provisions of this
instrument.
E. To compromise claims or controversies.
F. To allocate receipts and expenses to principal or income, or partly to each,
as they, from time to rime, think proper, in their sole discretion.
G. To distribute in cash or kind, or partly each.
ARIRCLE V
1 hereby mane and wpiew am tOM t- EOOMs.''''
my Last Will and Testament. If she is unwilling or unable to serve in such capacity, then
I name and appoint my son-in-law, BRIAN D. KEEFER, Executor of this my Last Will
and Testament.
3
ARTICLE 81
I hereby direct that my Personal Representatives shall not be required to give bond
for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this y
day of J fL-l'4 2007. This Document, in its entirety, consists of Five
ROBERT C. SWARTZ
SIGNED, SEALED, PUBLISHED, and DECLARED by the above named
Testator, ROBERT C. SWARTZ, as his Last Will and Testament, and in the presence of
us, who at his request, in his presence and in the presence of each other, have hereunto
subscribed our names as witnesses.
'l� }'ks:scf►zva i:�6
LORI L. KING
Duncannon, Pennsylvania 17020
Q
1
COMMONWEALTH OF PENNSYLVANIA )
SS:
COUNTY OF DAUPHIN )
WE, ROBERT C. SWARTZ, Testator whose name is signed to the attached or
foregoing instrument, and JEFFREY M. MOTTERN and LORI L. KING, the
witnesses whose names are signed to the attached or foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that ROBERT C. SWARTZ,
�_ _�.�± e'�L� C.LrLL�n�l LT ^p_^,.w+�� �. �Y �_r� �._• " Tom_�� .ti` L�
therein expressed; that the above-named witnesses were present and saw Testator sign
and execute the instrument as his Last Will and Testament; that each of the witnesses, in
the hearing and sight of the Testator, signed the Will as witnesses; and that to the best of
their knowledge, the Testator was at that time 18 or more years of age, of sound mind and
under no constraint or undue influence.
ROB RT C. SWARTZ, Testator
. MO TERN,Witness
Sworn or affirmed to and subscar-bed to before me by ROBERT C. SWARTZ,
Testator, and JEFFREY M. MOTTERN and LORI L. KING, the witnesses, this q�
day of 2007.
Notary Public
My Commission Expires:
NOTARIAL SEAL
SUSAN R NOTTERH. Notary PRb5e