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HomeMy WebLinkAbout10-31-14 REV-1500 EX(02-11) la 1505610143 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County code Year File Number Bureau of Individual Taxes DEPAUMEM OF REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 9 L,{. nA Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 08 08 2014 03 15 1924 Decedent's Last Name Suffix Decedent's First Name MI UTTS JANET R (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI UTTS HAROLD L 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 (date ofdeath after 12-12-82) El 5. Federal Estate Tax Return Required pp 6 Decedent Died Testate 7. Atcea deG M int ined)a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) C El 9. Litigation Proceeds Received 10.b8tvieen i2 31_ andatt(Da95�f Death O 11.Election to tax under Sec.9113(A) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telepzone Number LAUREN E KAYS 717 73M4 c§761 `_ rn � rTj r.7 � rn REGISTER Of LPUSUNLY_-q r'- F--A rel r'n First Line of Address M- ONE WEST MAIN STREET ate: c� Second Line of Address � Co P11 7� N C1) N � City or Post Office State ZIP Code DATE FILED SHIREMANSTOWN PA 17011 Correspondent's e-mail address: Ikays(a_bogarlaw.com Under penalties of perjury,1 declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RET RN DATE a*NA*-& L Cdr Sandra L. Cardinal 10 •a a, ADDRESS 51 Hog Hollow Road, Shelburne Falls, MA 01370 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Lauren E. Kays t0 L? ADDRESS c One West Main Street,Shiremanstown, PA 17011 Side 1 L 1505610143 1505610143 1505610243 REV-1500 EX Decedent's Social Security Number .Decedent's Name: Utts, Janet R. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 837 ,811 . 17 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. 13, 812 . 00 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) U Separate Billing Requested............ 7. 9, 701 . 17 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 861 ,324 . 34 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines,9 and 10)................................................................ 11. 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 861,324 . 34 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. 861,324 . 34 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 8611324 . 34 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 0 . 00 16. 0 . 00 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 L 1505610243 1505610243 J Rev-1603 EX+(6.88) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN r RESIDENT DECEDENT ESTATE OF FILE NUMBER Utts,Janet R. 21 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM CUSIP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 Merrill Lynch-Account No.81 c-11076. Principal value at 754,088.07 date of death$750,515.68;accrued interest$3,572.39. 2 Merrill Lynch-.Account No.81c-15862. Principal value at 65,694.79 date of death$65,543.28;accrued inteiest$151.51. 3 Merrill Lynch-Account No.81c-58708. Principal value at 18,028.31 date of death$18,028.31;accrued interest$0.00. TOTAL.(Als6 enter on Line 2,Recapitulation) 837.811.17 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1600 Schedule B(Rev.6-98) < C7 0) M mv�� 0 All C— M 0 PD 0 m z x Om CA (D Cl > C) p b10 z r m;v C) 0 e5 CO 0 C) CD zr C) Ma C0 z o:1 f C) -C cc 0 c r N. (ODD o co C) R ;a Z -NMO G)>rlo 2; . 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ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2010 Subaru Forrester-VIN#JF2SH6CC4AH717807-Kelly Blue Book value 13,812.00 TOTAL(Also enter on Line 5, Recapitulation) 13.812.00 (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 I-(Rev. 11-10) NIL- 5N aL, N '14 1;Mull "Ir 4 zul i ��" .���6- �t�}' �7_ .9 � �"CyikX� .Ir/D�. �� (�*�Idir��a l:��,+f �.e�Y„�..r;�y�'L'l`r'`X�`�y�� t(.'F�}..'�'�.x"k l`. r''� t-5 i-w 1.4 V.—mrr, par IM­ ugu:�p aw Fl":,t .ZL- Z, ZIA ”�-:..�.hi.�'t',".'."!Ys:'�?".:r%' �:.rF� "tw'.,r.i., Mc zr�'i B,�t•" nor,` �.� �����j��'�Y-€,,� '� ''�a'.• r'r t --zc-. MWE- LT ti 'o ME N15 7 WE TOM= I LIAE ljo co EA 14-ft ........... ........... N R L.�l ` Kelley Blue Book Page I of 2 ' +i Kelley Btue Book The Trusted Resource' s ...need I say More? f u; Adverbsemem - Why ads? Used 2010 Subaru Forester Buy from a Private Party Pricing Report G..d Ver= Cond;;an L�ozd+teon Cxc..lsn3 $23,$12 $24,257 conati.., t52r61nxi.;+ $14.753 Style:2.SX sport utility 4D Co�xtrtwn ! Mileage:sa,soo $22.573 Vehicte Hightightsr=,s. Fuel Economy: Max Seating:5 Private Party Values valid for your area through 9/4/2024 City 20/Hwy 26/Comb 22 MPG Doors:4 Engine:4-Cyi,2.5 Liter Drivetrain:AWD Transmission:Automatic,4-Spd w/Overdrive&SportShift EPA Class:Sport Utility Vehicles Body Style:Sport Utility Country of Origin:Japan Country of Assembly:Japan Your Configures! Options Our pre-selected options,based on typical equipment for this car. Options that you added while configuring this car. Engine Comfort and Convenience Lighting 4-Cyl,2.5 Uter Keyless Entry Daytime Running Lights Transmission Air Conditioning Wheels and Tires Automatic,4-Spd w/Overdrive& Power Windows Steel Wheels SportShift Power Door Locks Drivetrain Cruise Control AWD Steering Braking and Traction Power Steering Hill Start Assist Tilt Wheel Traction Control Entertainment and Instrumentation Vehicle Dynamic Control AM/FM Stereo ABS(4-Wheel) CD(Single Disc) Safety and Security Dual Air Bags Slde Air Bags Head Curtain Air Bags Glossary of Terms Suggested Retaii Price-suggested Retail Price is representative of dealers'asking Tip. p rg prices.It assumes that the vehicle has been fully reconditioned and takes Into account the dealers'profit and costs for Kelley Blue Book pricing is advertising.The final sale price will likely be less,depending on the car's actual condition,popularity, based on actual transactions warranty and local market factors, http://Www.kbb.com/subaru/forester/201 0-subaru-forester/25x-sport-utility-4d/?condition=g... 9/4/2014 `Kelley Blue Book Page 2 of 2 Kelley Blue Book®Fair Purchase Price(Used Car)-This is the price people are typically paying a and adjusted regularly as market dealer for a used car with typical mileage in good condition or better.This price Is based on actual used- Conditions Change. car transaction and adjusted regularly as market conditions change. Fair Market Range(Used Car)-The Fair Market Range is Kelley Blue Book's estimate of what you can reasonably expect to pay this week for a vehicle with typical mileage and configured with your selected options,excluding taxes,title and fees when purchasing from a dealer.Each dealer sets and controls its own pricing. Kelley Blue Bookib Certified Pre-Owned(CPO)Price-This is the dealers'asking price of a car that meets the manufacturers'CPO program,which Includes an additional warranty beyond the original factory warranty.It includes certification program costs,dealer profits and retail costs.The final price depends on the car's actual condition,popularity,warranty and local market faders. Fair Market Range(CPO)-The Fair Market Range is Kelley Blue Book's estimate of what you can reasonably expect to pay this week for this year,make and model Certified Pre-Owned vehicle with typical mileage configured with your selected options,excluding taxes,title and fees.Each dealer sets and controls its own pricing. Kelley Blue Bookp Private Party Price-This is the starting point for negotiation of a used-car sale between a private buyer and seller.This Is an'as ie value that does not include any warranties.The final price depends on the car's actual condition and local market factors. Private Party Range-The Private Party Range is Kelley Blue Book's estimate of what you can reasonably expect to pay this week for a vehicle with typical mileage in the selected condition and configured with your selected options,excluding taxes,title and fees when purchasing from a private party. Excellent Condition-3%of all cars we value.This car looks new and Is in excellent mechanical condition.It has never had paint or bodywork and has an interior and body free of wear and visible defects.The car is rust-free and does not need reconditioning.Its dean engine compartment Is free of fluid leaks.It also has a dean title history,has complete and verifiable service records and will pass safety and smog Inspection. Very Good Condition-23%of all cars we value.This car has mirror wear or visible defects on the body and interior but is in excellent mechanical condition,requiring only minimal reconditioning.It has little to no paint and bodywork and is free of rust.Its dean engine compartment is free of fluid leaks.The tires match and have 75%or more of tread.It also has a dean title history,with most service records available,and will pass safety and smog Inspection. Good Condition-54%of all cars we value.This car is free of major mechanical problems but may need some reconditioning.Its paint and bodywork may require minor touch-ups,with repairable cosmetic defects,and Its engine compartment may have minor leaks.There are minor body scratches or dings and minor Interior blemishes,but no rust.The tires match and have 50%or more of tread.It also has a dean tide history,with some service records available,and will pass safety and smog Inspection. Fair Condition-18%of all cars we value.This car has some mechanical or cosmetic defects and needs servicing,but Is stili in safe running condition and has a dean title history.The paint,body and/or Interior may need professional servicing.The tires may need replacing and there may be some repairable rust damage. ©19952014 Kelley Blue Book Co.',Inc.All rights reserved. 0 1014 Kelley Blue Book Co.,Inc.All rights reserved.8129120)4-91412014 Edition for Pennsylvania 17055.The specific Information required to determine the value for this particular vehicle was supplied by the person generating this report.Vehicle valuations are opinions and may vary from vehicle to vehicle.Actual valuations will vary based upon market conditions,specifications,vehicle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction.This report Is Intended for the Individual use of Me person generating this report only and shall not be sold or transmitted to another party.Kelley Blue Book assumes no responsibility for errors or omissions.fv.14090) http://www.kbb.com/subaru/forester/201 0-subaru-forester/25x-sport-utility-4d/?condition--g... 9/4/2014 Rev-1510 EX+(08-08) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OFMISC. NON-PROBATE PROPERTY RET INHERITANCE TAXAX RETURRNN RESIDENT DECEDENT ESTATE OF FILE NUMBER Utts,Janet R. 21 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REVA 500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OECD's EXCLUSION TAXABLE NUMBER HE DATE OF TROANSFERSATTACH A COPY OF TE THEIR HE DEED OR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Members 1st Federal Credit Union-Checking Accouni 11,641.41 1,940.24 9,701.17 No.565066-11 and Savings Account No.565066-00. Principal balance at date of death$11,641.30;accrued interest$0.11. This account was opened and made joint with Martha L.Jones, Harold L.Utts and Janet R. Utts on June 16,2014,less than one(1)year prior to the date of Decedent's passing. One-third of this account was a gift from Harold L. Utts and Janet R. Utts to their daughter,Martha L.Jones. Therefore, one-half of one-third of this account($1,940.24)is taxable to Martha L.Jones as a gift in anticipation of death from her Mother,Janet R. Utts at the rate of 4.5%. "(AN EXEMPTION IN THE AMOUNT OF$1,940.24 IS CLAIMED IN ACCORDANCE WITH THE PROVISIONS OF THE INHERITANCE AND ESTATE TAX ACT, BEING 72 P.S.SECTION 9108(c)AND 72 P.S.SECTION 9107 (c)(3)). TOTAL(Also enter on Line 7,Recapitulation) 9,701.17 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09) MEMBERS 1" FEDERAL CREDTf UNION PRIMARY ACCOUNT OWNER: MARTHA L.JONES REGULAR SAVINGS ACCOUNT: Account Number/Suffix 565066-00 Date Account Established 06/16/2014 /Principal Balance at Date of Death $5.00 Accrued Interest to Date of Death $0.00 Total Principal and Accrued Interest $5.00 Name of Joint Owner Harold L. Utts Janet R. Utts Date Joint Ownership Established 06/16/2014 CHECKING ACCOUNT: Account Number/Suffix 565066-11 Date Account Established 06/16/2014 Principal Balance at Date of Death $11,636.30 Accrued Interest to Date of Death $0.11 Total Principal and Accrued Interest $11,636.41 Name of Joint Owner Harold L. Utts Janet R. Utts Date Joint Ownership Established 06/16/2014 _......_._ ._. . ._._. E BERS.1.ST.FEDERAL.CRl� UNION an A. Kline Lending Insurance Support Supervisor September 25, 2014 Estate of: JANET R. UTTS Date of Death: 08/08/2014 Social Security Number: 152-26-6859 5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsylvania 17055 • (800)283-2328 • www.memberslst.org REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Utts,Janet R. 21 NAME AND ADDRESS OF RELATIONSHIP TOSHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT Do Not List Trustee(s) (Words) ($$$) I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Harold L. Utts Spouse Rest, Residue 861,324.34 5225 Wilson Lane,Ste.318 and Remainder Mechanicsburg,PA 17055 Total 861,324.34 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND 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) LAST WILL AND TESTAMENT OF JANET R. UTTS 1, JANET R. UTTS, residing at 184 Roycroft Circle, in the Town of Aurora, County of Erie and State of New York, being of sound mind and memory and aware of the uncertainty of human life, do hereby make, publish and declare my Last Will and Testament as follows: FIRST: I direct that all my just debts and funeral expenses be paid as soon as practicable after my death. I further direct that any and all death, inheritance or like taxes be paid from my residuary estate without apportionment. SECOND: All the rest, residue and remainder of my estate,both real and personal, of every nature and wherever situate, whether owned by me now or hereafter acquired,I give,devise and bequeath to my husband,HAROLD L. UTTS. THIRD: In the event my husband,HAROLD L.UTTS,does not survive me,or dies in a common disaster with me so that it is difficult or impossible to determine who is the survivor, then I give, devise and bequeath all of my property aforesaid to my daughters, MARTHA L. JONES, SANDRA L. CARDINAL and REBECCA J. HAMILTON, in equal shares. FOURTH: If any of my daughters shall predecease me leaving children, then I give, devise and bequeath the share of said daughter to her child or children (being my grandchildren), share and share alike. However, if any of my daughters shall predecease me leaving no children, then the share of said predeceasing daughter shall be added to the shares of those daughters who do survive me, or who leave surviving children, per stirpes and not per capita. FIFTH: I nominate, constitute and appoint my husband, HAROLD L. UTT S, as Executor of this my Last Will.and Testament. In the event he predeceases me or cannot serve for any reason whatsoever, then I appoint my daughter, SANDRA L. CARDINAL, as substitute Executor. I direct that my Executor, or any substitute named herein,whether in the State of New York, or any other-state or country, shall be permitted to serve without being requirect to give any bond or other security for the faithful performance of their duties as such. SIXTH: Without limitations of the powers conferred on it by statute or general rules of law, my Executors are specifically authorized and empowered: a. To retain any or all property owned by me at my death, acquired by purchase or otherwise,and retain,temporarily or permanently,any kind of realty or personalty,including stocks and unsecured obligations, undivided interests, interests in investment trusts, mutual funds, discretionary common trust funds, leases and property which is outside of my domicile,all without diversification as to kind or amount and without being limited to i.nvestments'authorized by law for trust funds and hold funds uninvested for temporary periods,or deposit any monies in one or more savings or other banks in any form of account: - 2 - h�s b. To render liquid my estate or any trust estate in whole or in part at any time or from time to time, and hold the proceeds in cash or in readily marketable securities of little or no yield for such temporary periods as my Executors may deem advisable: C. To sell,exchange or otherwise dispose of realty and personalty,publicly or privately, wholly or partly on credit or for any consideration including stocks, bonds, or other corporate obligations and grant options for the purchase',exchange or other disposition of any such property: d. To make distribution in cash or in kind, or partly in each, including undivided interests, even though shares be composed differently, and allocate particular assets or portions thereof to any one or more of the beneficiaries hereunder: e. To delegate discretionary powers to agents,remunerate them and pay their expenses; employ and pay the compensation of accountants, custodians, legal and investment counsel: f. To borrow money from itself or others and pledge or mortgage any property for any purposes: 9. To manage, insure against fire or other risk,retain,repair,.improve,alter,subdivide, dedicate to public use or.lease real property,or grant easements with respect thereto,for periods to begin presently or in the future,without regard to statutory restrictions on leasing and even though any such period may extend beyond the term of any trust: h. Complete power and authority in all matters and questions and power to do all acts which I might or could do if living, including, Without limitation, complete power and authority to invest (without being restricted to investments permitted by law), to sell (at public or private sale,for cash or credit, with or without security) mortgage, lease,dispose of and distribute in kind my entire estate, real and personal, at such times and upon such terms and conditions as they may deem advisable. - 3 - SEVENTH: I direct that any person who shall die at the same time as 1, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine which died first, shall be deemed to have predeceased me. EIGHTH: I hereby revoke all prior Will's and Codicils and any other,instrument of a testamentary nature made.by me at any time heretofore. IN WITNESS WHEREOF, I have made,published and declared this to be my Last Will and Testament this 3rd day of January, 2014. L.S. —UJANET R-UTTS The foregoing instrument was signed,sealed,published and declared by JANET R.UTTS, the Testatrix above named, to be her Last Will and Testament and in our presence,and we,at her reque st,and in her presence,and in the presence of each other,have hereunto subscribed our names as witnesses this 3rd day of January, 2014. -�1��P�ct.Pat,�:. ��( ', residing at 40 West Home Rd. Barbara A. Schaus Bowmansville NY 14026 OiL� gjz' -xesiding at 66 Belvoir Rd. Daniel P. Schaus Williamsville, NY 14221 -4 - PROOF OF WILL {3A) Surrogate's.Court, Erie County, State of New York IN THE MATTER OF PROVING THE LAST WILL AND TESTAMENT OF JANET R. UTTS Testatrix Estate No. STATE OF NEW YORK,} COUNTY OF ERIE )ss'. Daniel P.Schaus, being duty sworn says: I reside at 66 Belvoir Rd. in the Town of Arnhers#in the County of Erie, and State of New York. I am acquainted with Janet.R. Utts, of the Town of Aurora, in said County of Erie, and have known her for some time. I am one of the subscribing witnesses to'Last Will&Testament, bearing the date the 3rd day of Janua , 2014. The subscription of the name of said Testatrix at the end of said instrument was made by the Testatrix in the presence of myself and Barbara A. Schaus, the other subscribing witness thereto. At the time of such subscription the said Testatrix declared the said instrument so subscribed by her to be her Last Will and Testament and I thereupon signed my name as a witness at the end of said instrument at the request and in the presence of said;testatrix. 11 also saw said Barbara A. Schaus,the other subscribing witness, sign her name as a witness at the end of said instrument,and know that she did so at the request of said Testatrix and in her presence. The said Testatrix, at the time of so executing said instrument, was upwards of the age of eighteen years and of sound mind, memory and understanding,and was not under any restraint to the best of my knowledge and belief,and in myopinion was competent to make a will. That said Testatrix could, read,write and converse in the English language and was not suffering from any defect of sight,hearing or speech or from any physical or mental impairment which would affect her capacity to make a valid will;that the Testatrix signed only the original of the said will on said occasion. The instrument is being executed contemporaneously with the execution of said Will pursuant to the law in such cases made and provided. DANIEL P. SCHAUS Subscribed and sworn to before me this 3rd of Janua , 2014. Notary Public KAREN'14. NOTMRY NjB'lvl,este of f�etit�Ys}rlj Qu2iiiiesl ir,Erie-Cou=tty lti?y eai�F $i"t r ;)ires July.15 PROOF OF WH L (3A) Surrogate's Court, Erie County, State of New York IN THE MATTER OF PROVING THE LAST WILL AND TESTAMENT OF JANET R. UTTS Testatrix Estate No. STATE OF NEW YORK,) COUNTY OF ERIE : }ss. Barbara A. Schaus, being duly sworn says: I reside at 40 West Home Road in the Town of Lancaster in the County of Erie, and State of New York. 1 am acquainted with Janet R. Utts, of the Town of Aurora, in said County of Erie, and have known her for some time. I am one of the subscribing witnesses to Last Will & Testament, bearing the date the 3rd day of January, 2014. The subscription of the name of said Testatrix at the end of said instrument was made by the Testatrix in the presence of myself and Daniel P.Schaus, the -other subscribing witness thereto. At the time of such subscription the said Testatrix declared the said instrument so subscribed by her to be her Last Will and Testament and I thereupon signed my name as a witness at the end of said instrument at the request and in the presence of said Testatrix. I also saw said Daniel P. Schaus, the other subscribing witness, sign his name as a'witness at the end of said instrument, and know that he did so at the request of said Testatrix and in her presence. The said Testatrix, at the time of so executing said instrument, was upwards of the age of eighteen years and of sound mind, memory and understanding,and was not under any restraint to the best of my knowledge and belief,and in my opinion was competent to make a will. That said Testatrix could, read,write and converse in the English language and was not suffering from anydefect of sight,hearing or speech or from any physical or mental impairment which would affect her capacity to make a valid will;that the Testatrix signed ohly the original of the said will on said occasion. The instrument is being executed contemporaneously with the execution of said Will pursuant to. the law in.such cases made and provided. BARBARA A SCHAUS Subscribed and sworn to before me this 3rd of January, 2014. ILA 2-4 Notary Public iaOV'RY PUE.-Li0,Sia,e of idew York Qua'ified in&i;,County ��yCo?rr�ls!-n r.u!r,aJlLily,t5, f