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J 1SQ561Q143
REV-15�0 °``�-"' �
QFFICIAL USE QNLY
PA pepartrr�nt of Revenue pgnnsyivania coudyCade Ye� filaNuMiar
, Buteau of Indhridual Taxes ���
Po eax.2soso� INH�RITANCE TAX RE?URN 21 13 1].66
Harrisbury.PA 1712&0601 RESIDENT pEGEDENT
ENTER DECEDENT INFORMATfON BELOW
� Social Securi[y Nurt►ber Qate of Death Date of Hirth
09 13 2013 02 11 1917
DecedenYs Last Name Suffix DecedenYs Flrst Name MI
�=R CHLOE M
� (If Applicabie)F�tsr Surviving Spouse's Information Below
; Spouse•s t.ast Name Suffix Spouse's First Nama MI
i
i Spouse's Soaal Security Number
� THIS RETURN MUS7 BE FILED IRI DUPUCA'fE WITH THE
� REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
Q 1.Orf�nal ReUxn � 2. Supplementat Retum � 3. P��;R�e4BU2j(Date of Death
� 4.UMIt2d Est�e q�,FuRwe kAerestCam�ronisa $. F
� � (dete of de�efter 12.12-ffiy ❑ ederai Estate Tax Retum ReqUired
' � e.t��d y� � 7. �PY�}e�T"� e. 7otal Number of SaFe Depvsit Boxes
: � 9. L1lipai�n ProCeeds Receiwed � 18.����,�-1��Daelh - � 11.E�dbn lo tax urWer Sec.8113(A)
(Attach Schedule O)
CORRESPONDENT-THIS SEC7taN IAUST BE COMPLETEp,ALL CORRESP4NDENCE AND CONfiOENiIAL TAX INFQRMATiON SHOULD BE pIRECTEd TQ:
+ Name Daytime Telepho�e Numbe�
` ROBERT C SAIDIS (717} 243 5222
REGISTER OF WILLS USE ONLY
, Flrst Line of Address c`�'_—'� �
� 26 W HIGIi STREET � Q --� t"� c-rn�
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Second Line at Address �-� � { c.� ;;�y
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City or Post Ut�ice � � � '� `�
Sfate ZiP Code DA'f� � '� {>
� CARLI SLE PA �.7 Q 13 4-� c-� �, .-� ' ��t
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• Correspondent's e-maN address: rsaldis�ssr-attornevs.com . � W t" �il
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U�der P�16es af .i deciare ihat f t�ve eocamined this retum.Ind�in9 axompanyb�gs�We�an�statemeMs and ta ihe b�te`Tnry kno+vled� 'Tl
�is tr�.correcx .oedaratbn a preparer ott�er ihan ir�e pers�al rep�ese�tetive Ia hesed on Na infonnauai otwn�h a�rer 8es�v knoywed�. �,
SIC�NA OF RES i6L F FLLIN(3 RETURN � UATE
� Mary Ann Boilinger p /
; ss
9 7 W ite ane CaHisle PA 17013
� SIONATURE R REPREBENTATNE pq .
Robert C.Saidis ' � �
; aaut s
� 26 W.FEigh Street,Ca�lisle,PA
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I� � Side 1
15�561�143 35�Sb10b43 ,�
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� 150561�243
REV-1500 EX
DecedenYs Social Security Number
Decedent'sName: Halr� ChlOe M.
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscelianeous Personal Property(Schedule E)............... 5. 35, 950 . 72
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 13, 919. Fi 1
7. Inter-Vivos Transfers&Miscellaneous��q Probate Property
(Schedule G) U Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1 through 7)........................................................ g. 4 9, 8 7 0 . 33
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 8,356. 14
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 2, 13 6. 9 6
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 10� 4 93 . 10
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 3 9, 3 7 7 .2 3
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. 3 9, 3 7 7 . 2 3
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. 0 . 0 0
16. AmountofLine14taxable 39 377 . 23 16. 1, 771 . 98
at lineal rate X .045 �
17. Amount of Line 14 taxable
at sibling rate X.12 0 . �0 17. 0 . ��
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. � . 0 0
19. TAX DUE................................................................................................................ 19. 1, 771 . 98
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �X
Side 2
� 1505610243 15D5610243 J
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REV-1500 EX Page 3 File Number 21-13-1166
Decedent's Complete Address:
DECEDENT'S NAME
Hair, Chloe M.
STREET ADDRESS
1 LongsdorF Way
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 1,771.98
2. Credits/Payments
A. PriorPayments 1,750.00
B. Discount 87.50
Total Credits(A +B) (2) 1,837.50
3. Interest (3)
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 65.52
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)
Make Check Payable to REGISTER OF VIFILLS, AGENT
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TWE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred:............................................................................... ❑ Ox
b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ ❑x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ �x
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 ❑ a
contains a 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.
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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 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 naturat parent,an
adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)).
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
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Rev-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENTOFREVENUE pERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hair, Chloe M. 21-13-1166
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 scnedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Final pension payment 486.23
2 Genworth Financial-Long Term Care Insurance payment 440.00
3 Omnicare 7.41
4 Orrstown Bank Checking Account No. 106004967-See attached letter dated November 15, 32,774.26
2013 from Orrstown Bank
5 Refund from 2013 Income Tax 1,120.00
6 Refund from Highmark for prescription costs 1,079.82
7 Refund from Highmark for prescription costs 43.00
TOTAL(Also enter on Line 5, Recapitulation) 35,950.72
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10)
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Saidis, Sullivan&Ragers
26 West High St
Carlisle, PA 17013
Fax: 717-243-b486
Re: Estate of Chloe M. Hair a��la��Ioe �iari�. i-iai��
Soeiai Security��um�e�° �?9-12-3�21
Date af death 9f 13/I?
IT IS HEREBY CER`I'.�FIED TF��:j,•���H�'.AB�)�1�:.1�Aia-1��:� �)���::��:��='�:`� ��:�L l,�
FOLLOV�7ING ACCO�:NT WdTH;�?�°�-�OZ�B��;�K_:
CHEE'KING ACCOUNI'
Account No.- �Q�004967
Account Type- �C-- Interzst Chec.kin=_�
Account Title- '"hloe M TTai�
Date Opened- � ��i�/0�
Joint Accaunt{name/dat�}- ��c
Balance- `;}2%72.96
Account Interest- �� 7!?
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Rev1509 EX+(07-10)
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hair, Chloe M. 21-13-1166
If an asset was made joint within one year of the decedenYS date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Mary Ann Bollinger 1207 White Birch Lane Daughter
Carlisle, PA 17013
B. Dianne M. Kronenberg 509 Eaton Way Daughter
West Chester, PA 19380
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE 'NUMBER OR SEMILARNDENTIFY NG INUMBER.ATTACFIKD EDOFOR DATE OF DEATH DECD�S DECE ENT'S INTEREST
NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSE INTEREST
1 A, B 03/01/2002 1st Ed Credit Union Savings Account No. 41,763.01 33.330% 13,919.61
41050-99-See attached letter from 1 st Ed
Credit Union dated November 15,2013
TOTAL(Also enter on Line 6, Recapitulation) 13,919.61
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10)
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Credit `llnion www.1 edCU.org
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Working Together to Make the Grade!
November 15, 2013
Saidis, Sullivan & Rogers Law Offices
26 W High Street
Carlisle, PA 17013
Subject: Estate of Chloe M. Hair
Dear Mr. Saidis,
In reply to your letter dated November 7, 2013,the following is information regarding accounts
held by Chloe M. Hair.
Primary name on account: Chloe M. Hair wi�h joint owners, Mary A. Bollinger and Dianne H.
Kronenberg.
Account number 41050-99 (savings account)
Balance as of September 13, 2013: $41,760.04. Accrued dividends: $2.97.
This account was opened July 16, 1995 with Mary A. Bollinger as joint owner. On June 25, 1999,
Mary A. Bollinger was removed and Dianne M. Kronenberg was added. Then on March 1, 2002
the account was made joint with Dianne M. Kronenberg and Mary A. Bollinger. This account
has been reported to the State of Pennsylvania for inheritance tax purposes.
If any other information is needed, please feel free to contact me.
Sincerely
v�(Jf.i(i <-�' ��
G�C/i�
/
Tracy Burg r
Member Services Rep.
1156 Kennebec Drive • Chambersburg, PA 17201
717-264-6506 • 888-968-7828 Toll Free • 717-264-1441 Fax
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REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE F U N E RAL EXP E NS ES AN D
RESIDENTDEC ENT URN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Hair, Chloe M. 21-13-1166
DecedenYs debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 3,984.79
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2. Attorney's Fees 3,500.00
See continuation schedule(s) attached
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees 193.50
See continuation schedule(s)attached
5. AccountanYs Fees
6. Tax Return Preparer's Fees 270.00
See continuation schedule(s) attached
7. Other Administrative Costs 407.85
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 8,356.14
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
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SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hair, Chloe M. 21-13-1166
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex e�
1 Andy Hoke-music minister fee 150.00
2 Baughman Memorial Works Inc.-Death date inscription 195.00
3 Deb Brandberg-church manager fee 100.00
4 George's Flowers 246.98
5 Hoffman-Roth Funeral Home 1,006.89
6 Jennifer McKenna-minister fee 200.00
7 Karns-memorial service luncheon 179.92
8 Westminster Cemetery-fee to open grave 1,906.00
H-A 3,984.79
�4ttorney Fees
9 Saidis,Sullivan&Rogers-estimated legal fees 3,500.00
H-B2 3,500.00
Probate Fees
10 Regiser of Wills-probate fees 193.50
H-B4 193.50
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
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SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Hair, Chloe M. 21-13-1166
ITEM
NUMBER DESCRIPTION AMOUNT
Tax Return Pre�arer Fees
71 Boyer&Ritter, LLC-tax preparation 270.00
H-B6 270.00
Other Administrative Costs
12 Cumberland Law Journal-advertise letters 75.00
13 Harry and David -thank you basket for personai care staff 97.09
14 Harry and David-thank you basket for skilled nursing staff 72.90
15 Postage 6.11
16 The News-Chronicle Co. -advertise letters 156.75
H-B7 407.85
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
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Rev-1512 EX+(�y-OS)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hair, Chloe M. 21-13-1166
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expensas.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Diakon Lutheran Social Ministries 1,827.58
2 Omnicare-pharmacy bill 110.87
3 Omnicare-pharmacy bill 0.66
4 Omnicare-pharmacy bill 197.85
TOTAL(Also enter on Line 10, Recapitulation) 2,136.96
(if more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
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REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hair, Chloe M. 21-13-1166
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S)RECEIVING PROPERTY (Words) ($$$)
Do Not List T stee s
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
1 Mary Ann Bollinger Daughter 1/2 residue
1207 White Birch Lane
Carlisie, PA 17013
2 Crystal E. Fields Granddaughter 1,OU0.00
909 Biackstone Lane
Rock Hill,SC 29730
3 Amy M. Kappeler Granddaughter 1,000.00
19 Ashton Street
Carlisle, PA 17015
4 Dianne M. Kronenberg Daughter 1/2 residue
509 Eaton Way
West Chester,PA 19380
5 Melissa E.Ott Granddaughter 1,000.00
336 Woodlawn Terrace
Hollidaysburg, PA 16648
See continuation schedule attached Continuation 1,000.00
Totai 4,000.00
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AIVD GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
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SCHEDULE J
BENEFICIARIES
(Part I,Taxable Distributions)
ESTATE OF:
Chloe M. Hair 09/13/2013 179-12-3923
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$j
6 Kim M.Russeli Granddaughter 1,000.00
1713 Bow Tree Drive
West Chester, PA 19380
Total 1.000.00
1
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LAST WILL AND TESTAMENT
Ok'
CHLUE M. HAIR.
T, CHLOE M. HATR of C'arlisle, Cumberland County,
PennsyZvania, being of sound and disposing min.d, memoxy and
unde�standing, do hereby make, publ.ish and declare thia as and
� for my Last WiZl and Testament, hereby revoking a11 other Wi].ls
and Codicils heretofore made by me.
FIRST
I direCt the payment of my juat debts and e3cpenses of, my
r last illness and funeral from my esta�te as soon after my death
as �onvenien�]_y may be done . If t;here be no cemetery lot
. avazlable �'or my interment owned by me at the time of my death,
. I authoxize my personal representafiive to purchasP such �
aemetery lat with a contrart for pe.rpetual care, using
, therefore funds trom my estate in such amount as he �hall
; consicler necessary and desirable, and T �uthorize my personal
� represen�ative to cause title to or ownership of such lot so
;
purchased to be ves�ed i.n such person as my personal
repres�ntative sha11 designat.e. ;
i
SAIDIS, Fur�her, I au�hori.ze tny per.sonal represent�tive to expend j
SHUFF � a
MASLAND �und� f.rom my estate, in. such amoi�rxt as my personal �
A7�ORNBY3•ATN.AW
z6w.HighStreet representative sha11 consic��r neCes�ary and desirabla for the j
cartiale,PA
;
purchase, erection and inscription of a suitable marker tor my •
�
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grave, i
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SECOND
I give, devise and bequeath the sum of $1, 000 . 00 to each
of the followa.ng gxandchildren if they are living thirty (30)
days after the date of my death KIM M. RUSSELL, CRYSTAL E.
FIELDS, MELISSA E. HATR and AMY M. BOLLINGER.
: THIRD
I give, devise and bequeath all. the rest, residue and
remainder of my estate equally to my two claugh�ers, DIANNE M.
� KRONENBERG and MARY ANN BOLLINGER, per stirpes. In the event my
� daughter, MARY ANN BOLLINGER predeceases me her shaxe of my
estate shal]. pass to her issue, per stirpes. Zn the event my
� daughter, DTANNE M. KRONENBERG predeceases me her share of my
estate shal.l pass to KIM M. RUSSELI�, per stirpes .
, FOURTH
, I direct that any and all inheritance, estate, and
transfer taxes imposed upon. my esta�e passing under this Wi7.l
; or otherwise sha11 be paid. aut of the principal of my xesiduary �
' estate.
Fzrxx
� Tn addition to the powers conferred by law, I authorize
�
; any personal repr_esentati.ve acting under this instrument, in
SAIDIS, his/hex absol.ute discretion:
° SHUFF &
: MASLAND (a} To re�ain in �he form xeceived, or to sell '
ATf�R��YS�AT�I4AW
Z6 W.High Slreet ;
� Carlisle,PA either at public or private sale any real or personal :
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property; '
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(b) To exercise any opta,ons to subscribe for '
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-;,�, -�,��.���.
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stocks, bonds, o� other investments.
, (c) To join in any pl.an ot lease, mortgage,
consolidation, e�change, reo.rganization or torecloaure
of any corporation in. whir_h my estate or any tru�t may
hold stocks, bonds or ather securita.es;
(d) To se11, tran.sfer, convey, mortgage, pledge,
lease or exchange any property, real or persona7., which
; at any time may form part ot my estate, for the payment
of debts or taxes, or �or any purpose of administration
� or diatribu�ion, for such prices and upon such terms
as my personal representati�re, in his/her sole discretion,
' may deem wise, an.d to execute and del.iver deeds of
� conveyance or transfer thereof�
(e) To make settlements and compxomises on such
terms as my pexsonal rep�esentative in his/her sole
discretion may deem wise without the necessity of
obtaining any court approval thereof; '
(f) To make distribution hereunder ei�her a.n cash
or kind, as my persona7. representa�ive in his/her
discretion may deem wise.
SIXTH
I do hereby nominate, con��itute and appoint my daughters, '
SAIDIS, DIANNE M. KRONENBERG and MARY ANN BOLLINGER, to act as ;
SHUFF & � j
MASLAND Executrices, ot this my Last Will and Test�ment . Prava.ded, ;
A7TURNEYS•A7'�T.AW
r
26 W.Aigh Street E
Carlisle,PA however, that if either is unwillin,g or unab].e to serve, the �
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other sha1.1. act as sole Executrix. i
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SEVENTH ;
I direct tha� no personal represen�ative, guardian,
trustee o� other fiduciary appointed under this instrument
shall be required to give boncl for the faithful performance of ,
their duties in any jurisdiction. '
'
IN WITNESS WHEREOF, I, CHLOE M. HAIR, have hereunt4 set my ,
' hand and seal to this my Last Wi11 and Testament, consisting of
foux (41 typewritten. pages, the first three (3) of which bear
my signature in the margin for identification, this /�-'���day
of �J 14�� 1999 . �
,
HI,OE M. HAIR
Signed, sealed, publi�hed and declared by the above-named
Testatrix, CHLOE M. HAIR, as and for her Last Will and '
, Testament in the presence of us, who have hereunto subscribed
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oux names at her request as witnesses th.ereto, In the presence
of said Testatrix and of each other.
ADDRESS �� � ��'�,�
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� sAZnzs,
� SHUFF 8t
MASLAND
ATfORNEYS�A7•LAW
� Z6 W.Hlgh Street
� Carlisle,PA
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;�,�.��,�,�.�.�. �.. �,� �-� W���,.,�,,.� �,�-:�-� -� �,����� � �, ,�. , ���:::� . ,
' COMMONWEALTH 4F PENNSYLVANIA:
: SS
COUNTY OF CUMBERLAND .
: W�, CHLOE M. HAIR, ROBER'P C. SAIDIS 1lld SUE E. ROTZ
, the Testatrix and witnesses, respectively whose
names are signed to the foregoing or attached instrument, being
first duly sworn, do hereby declare to the undersigned
authority that the Testatrix signed and executed the instrument
as her Last Wil.7. and Teatament and that she signed wa.11ingly
and that she execu�ed as her free and voluntary act for the
purposes therein expressed, and that each of the witness�s, in
the presence and hearing of the Testatrix signed �he Will as
witness and that �o �he best of their knowled.ge the Testatrix
was at the time 18 or more years ot age, of sound mind and
under no conetraa.nt or undue influence.
�
� CHL .- HAIR
, ��
ROBERT C. SAIDIS , WltriE'SS
�.�. �. �'��.
sU� E. Ro�rz , Wi�ness
Subscribed, sworn to and acknowledged be�ore me by CHLOE
M. HAIR, the Testatrix, and subscra.bed to and aworn or affirmed
' SAIDIS,
� SHUFF � to before me by RO�i�RT c, sASbzs and suF E. z�o�z
MASLAND `
ATTOANEY9�AT•LAW v' �—
z6w.HighS[reet Witnesses, this � day of �. , 1999 .
' Carlisle,PA
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�!�e�o,cu�tuwncou�r
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