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HomeMy WebLinkAbout12-08-14 1505611185 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN 21 14 452 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 03292014 07071920 Decedent's Last Name Suffix Decedent's First Name MI DIAMOND SPERO G (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I DIAMOND ELIZABETH J Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW a1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) a6. Decedent Died Testate FRO 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number VICKY ANN TRIMMERQ 717-620-2440 RESTER OF WIL12Y SE ONLY CM First Line of Address m rr" O rn in xt PERSUN & HEIM, PC }' m M Second Line of Address )> f!> C7 PO BOX 659 ( ::3 �t _ City or Post Office State ZIP Code `D DATE F ::E c-n MECHANICSBURG PA 170550659 c,� cin o Correspondent's e-mail address: VATRIMMER@PERSUNHEIM • COM Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. TORE OF PERSONRES O0 !IBLIE FOR FILING R RN DATE - r �- /-1 . ADD RE8• (� EL ABETH �Y• DIAMOND STEPAHNIE P - DIAMOND SIGNATU E OF RE ARER OTHER THAN REPRESENTATIVE DATE ADDRES VICKY ANN TRIMMERQ PO BOX 659 MECHANICSBURG, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 1505611185 i 1505611285 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: DIAMOND SPERO G RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 .00 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). . . . . 3. 0 .00 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . 4. 0 . 00 5, Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) . . . . . 5. 54,123-00 6, Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . 6, 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . 7. 11201i962 -00 8. Total Gross Assets(total Lines I through 7) . . . . . . . . . . . . . . . . . . 8. 1-1256 A85-00 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9. 10,624 -00 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . 10. 2,659-00 11. Total Deductions(total Lines 9 and 10), . . . . . . . . . . . . . . . . . . . . 11. 13,283-00 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . 12. 1,2421802- 00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J). . . . . . . . . . . . . . . . 13. 0 .00 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . 14. 1,242,802-00 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 0 324162?.00 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0 15 918,177-00 16. 41,318-00 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. 41,318-00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I A I Side 2 1505611285 1505611285 OM4648 3.000 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 14 452 DECEDENTS NAME DIAMOND SPERO G STREET ADDRESS 465 F ELMWOOD AVENUE CUMBERLAND CITY STATE ZIP MECHANICIBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 41,318 - 00 2. Credits/Payments A. Prior Payments 0 .00 B. Discount 0.00 Total Credits A+B (2) 0.00 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line I +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 41,318-00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . . FQ F� b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . F� FX c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑ 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . El F_X] 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? F❑I FX] 4. Did decedent own an individual retirement account,annuity,or other non-probate property,which —1 FX-1 contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E 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)(11.11)(1)). 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 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 172 P.S.§911116(a)(11.3)1.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. OM4671 MOO REV-1508 EX,(08.12) pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS& MISC. INHERITANCE TURN RESIDENTDECE ENTPERSONAL PROPERTY ESTATE OF: FILE NUMBER: Spero G. Diamond 21 14 452 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I. Wells Fargo Account #1744-7485 54,123 TOTAL(Also enter on line 5,Recapitulation) $ 54,123 2w48AD 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(pg-09) SCHEDULE G pennsylvania DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC.NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Spero G. Diamond 21 14 452 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 INCLUDETFENAMEOFTHE TRANSFEREE.THEIR RELATIONSHIP ToOECEDENTAND DATE OF DEATH %OFDECDS EXCLUSION TAXABLE NUMBER THE DATE OFTRANSFER.ATTACHACOPY OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE 1• CCB&T IRA 18,568 100.0000 0 18,568 Surviving Spouse is beneficiary 2 Spero G Diamond Trust 1,183,394 100.0000 0 1,183,394 Only asset is S.G. Diamond, Inc. stock. See attached valuation materials. TOTAL(Also enter on line 7,Recapitulation)$ 1,201,962 If more space is needed,use additional sheets of paper of the same size. 9W46AF 2.000 REV-1,,511EX-(0&73) SCHEDULE H pennsylvania DEPARTNFNTOF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Spero G. Diamond 21 14 452 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, Holy Trinity Greek Orth. Church 765 2 Grave Marker 11000 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 5,000 1 Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) 3,500 Claimant Elizabeth Diamond Street Address 485 E Elmwood Avenue City Mechanicsburg State PA ZIP 17055 Relationship of Claimant to Decedent SPOUSE 4. Probate Fees: 359 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. None TOTAL(Also enter on Line 9,Recapitulation) $ 10,624 3W46AG 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE DEPARTWNTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Spero G. Diamond 21 14 452 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 Lowe's Credit Card 2,659 TOTAL(Also enter on Line 10,Recapitulation) $ 2,659 2w46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX-(01-10) SCHEDULE J pennsylvania DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Spero G. Diamond 2114 452 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. George S. Diamond 25% of Residue: 306,059 Son 306,059 2 Stephanie P. Diamond 25% of Residue: 306,059 Daughter 306,059 3 Thespina M. Spivey 25% of Residue: 306,059 Daughter 306,059 4 Elizabeth J. Diamond CCB&T IRA Inventory Value: 18,568 25% of Residue: 306,059 Surviving Spouse 324,627 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 DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 9 W 46AI 2.000 If more space is needed,use additional sheets of paper of the same size. ORMI WILL OF SPERO G.DIAMOND 1, SPERO G. DIAMOND, of Cumberland County, Pennsylvania, declare this to be my will,and I revoke all previous wills and codicils that I have made. ARTICLE I Specific Gifts k g., A. I give my tangible personal property: (together wtt °"ani aZgrlablo, `n�ce }a , .: t< policies thereon), including any household furniture and furnishings, automobiles;books,pictures, jewelry, art objects, hobby equipment and collections, wearing apparel, and other articles of household or personal use or ornament, but excluding coins held for investment and paper currency, to my wife, ELIZABETH J. DIAMOND ("my spouse"), if my spouse survives me, or, 4 if my spouse does not survive me,to my children who survive me, to be divided as they shall agree or, if they shall fail to agree upon a division within six months after the date of my death, in shares of substantially equal value as my executor shall determine. B. I may leave a memorandum (which is not to be a part of this will) listing some of the items described in paragraph A of this Article that I wish certain persons to have and request (but do not require)that my wishes as set forth in the memorandum be observed. C. All costs of safeguarding, insuring, packing, and storing my tangible personal property before its distribution and of delivering each item to the residence of the beneficiary of that item shall be treated as administration expenses. D. If any child of mine has not reached legal age under the law of the jurisdiction in which the child is domiciled at the time set for distribution under paragraph A of this Article or is otherwise then disabled, then the individual having personal custody of the child (whether or not court-appointed)shall represent the child in any division of the property. ARTICLE H Gift of Residue I give my residuary estate,which shall not include any property over which I have power of appointment,to the trustee of that certain trust already created by me and known as the "Spero G. Diamond a/k/a S. George Diamond, Trustee, or his successorsder the Spero G. thereto",as in effect at my death,of which I am currently the Trustee; ARTICLE III Payment of Taxes and Expenses A. Subject to the provisions of paragraph B of this Article, my executor shall pay from my residuary estate all estate and inheritance taxes (including any interest and penalties), and all administration expenses, payable in any jurisdiction by reason of my death, whether or not the assets generating those taxes and expenses pass under this will, and those items shall be charged generally against the principal of my residuary estate, without apportionment..I waive any right of reimbursement for, recovery of, or contribution toward the payment of those taxes, except that, to the maximum extent permitted by law, my executor shall seek reimbursement for, recovery of, or contribution toward the payment of estate taxes attributable to property which is included in my gross estate under Section 2036, 2041 or 2044 of the Code, and which taxes are not otherwise paid or payable. Any generation-skipping tax resulting from a transfer occurring under this will shall be charged to the property constituting the transfer in the manner provided by applicable law. 2 v y B. If a taxes anc expenses c re' t t�o�be o is I'MtIMY-estate;wgei;ner w"n (i)my legally enforceable debts, including debts owed by me to a trustee individually,except debts secured by real estate which were incurred primarily to acquire or improve the encumbered property, and (ii) the expenses of my last illness and funeral, exceed the value of the cash and readily marketable assets of my residuary estate, as determined by my executor (after taking into account all reimbursements for, recoveries of and contributions toward taxes which my executor is directed to seek pursuant to paragraph A of this Article), then my executer may so certify part or r all;of the ahiount'of that excess to the acting trustee of that cet j , . bequest under this will which provides for the payment,of that,exees , atitt my=�eutoi shall enforce recovery of the certified amount to the extent the trustee shall not pay or provide for its payment. ARTICLE IV Executor Nomination and Powers A. I name my wife, ELIZABETH J. DIAMOND and my daughter, STEPHANIE P. DIAMOND as co-executrixes of this will. If ELIZABETH J.DIAMOND and STEPHANIE P. DIAMOND are both unwilling or unable to act as executrixes hereunder, I name as my successor executor, a member of the accounting firm of Hamilton& Musser, Certified Public Accountants, preferably Barry E. Musser,CPA. No executor serving hereunder shall be required to post bond. a i B. I give my executor,wherever acting,power: 1. To retain, sell (at public or private sale), exchange, lease for any term(even though commencing in the future or extending beyond the date of final distribution of my estate), mortgage, pledge, or otherwise deal for any purpose with the property, real or personal, from time to time comprising my estate, for such consideration and on such terms (with or without security) 3 as my executor shall determine; s 3 i W • - ,r," � . 4+ :: fix yti«Ln � °• fi -k .� '•3+rlvx`lzrys f c�* r . . _ � P v� r� i � _r h f", St.� •�q �+k4���S'a+� • 2. To borrow money at interest rates then prevailing;afro zndi�ndual, bank,or other source,whether or not the lender is then acting as an executor; 3. To enter into any transaction authorized by this Article with trustees, executors, or administrators of any other trust or estate, even though an executor is also a fiduciary of the other trust or estate; 4. To invest in any property; and to hold any property in the name of a x nominee or in bearer form; 5. To compromise or abandon any claims in favor of or against my estate; 6. To disclaim, in whole or in part, any property or interest therein which passed to me or which was created for my benefit, for any reason, including, but not limited to, a concern that such property could cause potential liability under any federal, state or local environmental law; 7. To employ accountants, depositaries, investment counsel, attorneys, and agents(in each case with or without discretionary powers); 8. To deal with matters involving the actual or threatened contamination of property held in my estate (including any interests in sole proprietorships, partnerships or corporations and any assets owned by such business enterprises) by hazardous substances, or involving compliance with environmental laws, including power: (a) To inspect and monitor any such property periodically, as it deems necessary,to determine compliance with any environmental law affecting such property; (b) To respond (or take any other action necessary to prevent, abate or "clean up") as it shall deem necessary, prior to or after the initiation of enforcement action by any i 4 a ;a AM A ` i yR i ,•fid, y; �^slv v�� a r ` s` x , a: r y� �} �; x x.�a,3"� ,•2gN �`"' c,• �'A:, .ti. 5.4;•:".1. such property and to any potential contamination'o (c) To settle or compromise at any time any claim against my estate related to any such matter asserted by any governmental body or private party; (d) To disclaim any power which my executor determines may cause it to incur personal liability as a result of any such matter,whether such power is set forth in my will, incorporated by reference herein, or granted or implied by any statute or rule of law; (e) To decline to serve as executor hereunder or, having undertaken to serve, resign at any time my executor reasonably believes there is or may be a conflict of interest between it in its fiduciary and individual capacities by virtue of potential claims or liabilities which are or might be asserted against my estate because of the type or condition of estate assets; and (f) To charge all expenses and costs incurred by my executor pursuant to the authority granted under this subparagraph against the income or principal of my estate as my executor shall determine; 9. To execute instruments of any kind, including instruments containing covenants and warranties binding upon and creating a charge against my estate and containing provisions excluding personal liability; 10. To make distributions from my estate in cash or in kind, or partly in each and to value any property for that purpose; and to allocate different kinds or disproportionate shares of property or undivided interests in property among the beneficiaries; and 11. To distribute to the beneficiary of a trust identified in this will any property or portion thereof given to the trustee of that trust if,pursuant to the terms of that trust,the property would immediately be subject to final distribution directly to the beneficiary with no discretion in 4 5 discharge my executor. C. The powers granted to my executor hereunder shall be in addition to all other powers granted by law and shall be exercisable in the discretion of my executor and without court order. If, under applicable state law, administration of my estate may be conducted without court supervision and approval of accounts,then my executor shall so administer my estate. No executor shall be required to furnish bond or security. D. My executor shall make such elections and allocations under the tax laws as my executor considers advisable (whether or not the election or allocation relates to property passing under this will), without regard to, or adjustments between, principal and income or the relative interests of the beneficiaries. Any decision to exercise tax elections or make allocations hereunder shall be made by my domiciliary executor,if any, in preference to any ancillary executor, and shall be binding and conclusive on all persons. E. If any portion of my estate is distributable to a beneficiary who is then under the age of twenty-one years, my executor may distribute that beneficiary's share, without further responsibility, either directly to that beneficiary, to a qualified individual or trust company designated by my executor as custodian for that beneficiary under an applicable Uniform Transfers to Minors Act or similar law, or to the individual having personal custody of that beneficiary. (whether or not court-appointed)and the receipt of the distributee shall discharge my executor. F. No executor shall be personally liable to any beneficiary or other party interested in my estate or to any third parties, for any claim against my estate for the diminution in value of estate property resulting from matters involving hazardous substances, including any reporting of r response to(i)the contamination of estate property by hazardous substances,or(ii)violations of 6 :.. ;.'t liability for its own negligence in administration of the estate property or wrongful or willful acts. G. To the maximum extent permitted by law, the executor may withhold a distribution to a beneficiary hereunder until receiving from the beneficiary an indemnification agreement in which the beneficiary agrees to indemnify the executor against any claims filed against the executor as an "owner" or 'operator" under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, as from time to time amended, or any regulation thereunder, or any other environmental law; provided further that the executor may not take any action under this paragraph which would in any way jeopardize any federal or state marital deduction for property passing at my death. .ARTICLE V Interpretive Rules For all purposes of this will: A. A person shall be considered "disabled" if a minor, if under legal disability,or if in any condition(whether temporary or permanent)which substantially impairs that person's ability to transact ordinary business. B. The term "Code" means the Internal Revenue Code of 1986, as from time to time amended. C. The term "executor" means any court-appointed fiduciary or fiduciaries of my estate from time to time qualified and acting in any jurisdiction. D. The term "hazardous substance(s)" means any substance defined as hazardous or toxic or otherwise regulated by any federal, state or local law(s), rule(s)or regulation(s)relating to the protection of the environment or human health("environmental laws)"). fS 7 E. I intend that no child born to or adopted by me before or after the date of this will shall be entitled to receive any greater portion of my estate than that portion, if any, which is provided herein. I signed this will on ,2004. PE O G DLA,10 In our presence, the above-named SPERO G. DIAMOND signed this and declared this to be his Last Will and Testament and now at his request, in his presence, and in the presence of each other,we sign as witnesses. Name Address t-7/11 i� OCOJz 41 • I, SPERO G. DIAMOND, Testator, who signed the foregoing instrument, having been ` duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and Acknowledged before me by SPERO G.DIAMOND,the Testator on 7 , 2004. l ' cr: o Pu >r PE O G.DIAMOND Notarial Seal Marielle F. Hazen, Notary Public City of Harrisburg, Dauphin County My Commission Expires Sept. 23, 2006 We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testator sign and execute this instrument as his Will; that he signed and executed it willingly as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen (18) years or more of age, of sound mind,and under no constraint or undue influence. Sworn to or affirmed and Subscribed to before me by and y1. ; Wi ess witnesses, on , 2004. Wess 1,14 otary Publ I c Notarial Seal Marielle F. Hazen, Notary Public ity of Harrisburg, Dauphin County [M: Commission Expires Sept. 23,02006 A .j•t