HomeMy WebLinkAbout11-12-14 1505610143
REV-1500 EX(02-11) S9,7
PA Department of Revenue �iy OFFICIAL USE ONLY
p penns Ivania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 60x.280601 INHERITANCE TAX RETURN 21 14 0336
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
03 22 2014 11 27 1920
Decedent's Last Name Suffix Decedent's First Name MI
LOWDERMILK NEVIN W
(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
1. Original Return 1:12. Supplemental Return 3. Remainder Return(Date of Death
Prior to 12-13-82)
4. Limited Estate 4a.Future Interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
8 Decedent Died Testate 7. Decedent
Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) c
9. Litigation Proceeds Received 10.be ween 12 a %1 r dtjDatte f Death 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 Telephone Number,
JAMES D BOGAR (717)c7,z37 871
r rM
REGISTEr%0P- 1VLS l Sf�E ONLY
a r71
First Line of Address ob
ONE WEST MAIN STREET
Second Line of Address CJ t;_ h
r— 1'17
• C� CJS G7
DATE FILES -71
City or Post Office State ZIP Code
SHIREMANSTOWN PA 17011
Correspondent's e-mail address: jibogar(cabogarlaw.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.D claration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATOR PERSON R/ESP IBLE R FILING RETURN DATE
/�, Ann L. Parkins
ADDRESS
111 Chester Road. Enola PA 17025
SIGNA E 0 PREP THER THAN REPRESENTATIVE DATE
7
James D. Bogar I(,
ADDRESS
One West Main St et, Shiremanstown, PA 17011
Side 1
L 1505610143 1505610143 J
1505610243
REV-1500 EX
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&Miscellaneous Personal Property(Schedule E)............... 5. 33 , 734 . 87
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 91 . 62
7. Inter-Vivos Transfers&Miscellaneous Ikon;Probate Property
(Schedule G) u Separate Billing Requested............ 7. 16, 958 . 20
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 50 , 784 . 69
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 7f279. 60
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10.
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 7 ,279 . 60
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 43,505 . 09
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. 43r505 . 09
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 . 00
16. Amount of Line 14 taxable 43 ,505 . 09 16. 1, 957 . 73
at lineal rate X .045
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. 1, 957 . 73
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑X
S
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-66-0336
Decedent's Complete Address:
DECEDENT'S NAME
Lowdermilk, Nevin W.
STREETADDRESS
2100 Bent Creek Boulevard, Suite 150
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,957.73
2. Credits/Payments
A. Prior Payments 1,924.35
B. Discount 97.89
Total Credits(A +B) (2) 2,022.24
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 64.51
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 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;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ 0
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?.................................................................................................................... ❑ 0
3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?....... ❑ ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
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.
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 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-1508 EX+(11-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lowdermilk, Nevin W. 21-66-0336
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 schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Santander-Savings Account No. 1261813448. 86.41
2 Santander -Money Market Account No.2334088781. Principal balance at date of death 33,648.46
$33,643.62;accrued interest$4.84.
TOTAL(Also enter on Line 5, Recapitulation) 33,734.87
(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)
40 SantaII nder'�
Court Order Processing Decedents- NMI-MB3-02-10 P.O.Box 841005 Boston,MA 02284
April 14, 2014
James D. Bogar
Attorney at Law
One West Main Street
Shiremanstown, PA 17011
RE: Estate of Nevin W. Lowdermilk, Sr.
Date of Death: March 22, 2014
Dear Mr. Bogar:
Per your request, enclosed please find the account information as of the date of death
for the above-named decedent. For your information, accrued interest is not included in
the date of death balance. There was no safe deposit box on file.
Please feel free to contact me if I can be of any further assistance.
Ve truly yours,
Linda Spavento
Team Leader
617-514-5189
Santander
ESTATE OF Nevin W Lowdermilk
SOCIAL SECURITY#:
DATE OF DEATH: March 22, 2014
Account 0571120733 Type: Checking Open date: 9/1/1984_
In the name of. Nevin W Lowdermilk or Mary E Lowdermilk or Ann L Parkins
Date of Death Balance: $183.23
Int.(YTD) from 1/1/2014 to 3/4/2014 $0.03
Accrued interest to date of death: $0.00
Other Info:
Account#: 1261813448 Type: Checking_ Open date: 7/23/2010
In the name of: Nevin W Lowdermilk, Ann L Parkins Guardian
Date of Death Balance: $86.41
Int.(YTD) from - 1/1/14/ to 3/22/2014 $0.00
Accrued interest to date of death: $0.00
Other Info:
Account#: 2334088781 Type: Money Market Open date: 6/6/2011
In the name of. Nevin W Lowdermilk or Mary E Lowdermilk(Ann L Parkins POA)
Date of Death Balance: $33,643.62
Int.(YTD) from 1/1/2014 —to 3/4/2014 $24.62
Accrued interest to date of death: $4.84 —
Other Info:
Page 1 of 1
Rev-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lowdermilk, Nevin W. 21-66-0336
If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Ann L. Parkins 111 Chester Road Daughter
Enola, PA 17025
B.
C.
JOINTLY OWNED PROPERTY:
DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM DATEFOR JTOINT MADE ER (NUMBER OR IMILARNCLUDE NAME OF nIDENTIFYING ANCIAL (TUTION AND BANK NUMB R.ATTACH DEED OUNTFOR DATE OF DEATH DECD'$ DECE DENT'SINTEREST
VALUE OF
NUMBER TENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSE INTEREST
1 A Santander-Checking Account No. 183.23 50.000% 91.62
0571120733. This account was jointly owned
with Ann L. Parkins,the Decedent's daughter.
mary E. Lowdermilk,the Decedent's spouse,
who is also listed as a co-owner,died April 7,
2012.
TOTAL(Also enter on Line 6, Recapitulation) 91.62
(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)
Santander-
Court
"Court Order Processing\Decedents- MAI-MB3-02-10 - P.O.Box 841005 - Boston,MA 02284
April 14, 2014
James D. Bogar
Attorney at Law
One West Main Street
Shiremanstown, PA 17011
5
RE: Estate of Nevin W. Lowdermilk, Sr.
Date of Death: March 22, 2014
5
E Dear Mr. Bogar:
Per your request, enclosed please find the account information as of the date of death
for the above-named decedent. For your information, accrued interest is not included in
the date of death balance. There was no safe deposit box on file.
C
Please feel free to contact me if I can be of any further assistance.
n
Very truly yours,
4
z _
Linda Spavento
Team Leader
5
617-514-5189
s
m
V
O
3
Z
3
5
x
i
Santander .
ESTATE OF Nevin W Lowdermilk
SOCIAL SECURITY#:
DATE OF DEATH: March 22, 2014
Account#: 0571120733 Type: Checking Open date: 9/1/1984
In the name of. Nevin W Lowdermilk or Mary E Lowdermilk or Ann L Parkins
Date of Death Balance: $18323
Int.(YTD) from 1/1/2014 to 3/4/2014 $0.03
Accrued interest to date of death: $0.00
Other Info:
Account#: 1261813448 Type: Checking Open date: 7/23/2010
In the name of: Nevin W Lowdermilk,Ann L Parkins Guardian
Date of Death Balance: $86.41
Int.(YTD) from 1/1/14/ to 3/22/2014 $0.00
Accrued interest to date of death: $0.00
Other Info:
Account#: 2334088781 Type: Money Market Open date: 6/6/2011
In the name of. Nevin W Lowdermilk or Mary E Lowdermilk(Ann L Parkins POA)
Date of Death Balance: $33,643.62
Int.(YTD) from 1/1/2014 to 3/4/2014 $24.62
Accrued interest to date of death: $4.84
Other info:
Page 1 of 1
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE �A /►
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lowdermilk, Nevin W. 21-66-0336
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.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECO'S EXCLUSION TAXABLE
NUMBER THE DA E OF TRANSOF FER.SFEREE THEIR ATTACH A COPY OF THE DEED OR HIP TO REAL ESTATE. VALUE OF ASSET EDENT AND INTEREST (IF APPLICABLE) VALUE
1 American General Life Insurance Company-Annuity 16.958.20 16,958.20
No. BX205983. The Decedent's three(3)children are
the named beneficiaries of this account.
TOTAL(Also enter on Line 7,Recapitulation) 16,958.20
(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)
American General Life Insurance Company
The United States Life Insurance Company in the City of New York
June 16, 2014.
JAMES D BOGAR
ATTORNEY AT LAW
I W MAIN ST
SIREMANSTOWN PA 17011
Re: Annuity Contract#BX205983
Dear Mr. Bogar:
The Internal Revenue Service (IRS)requires reporting of all death benefits for federal estate tax
purposes. As this contract is an annuity,IRS Form 712 is not applicable and will not be issued by
American General Life Companies.
Listed below is the death benefit information for this contract.
Contlract Number � X2D5983
Type of Annuity Contract: (Single Premium Non-Qualified Tax Deferred Annuity
Date of Issue: May 22, 2003
Contract Owner's Name (s). Nevin W. Lowdermilk
Accumulated Value as of $16,958.20—principal: $12,252.15; Interest: $4,706.05
Date of Death on 03/22/14:
Total Death Benefit as of $17,076.72
06-16-2014
Proceeds to be made payable Nevin W. Lowdermilk, Jr., Ann Parkins, &Lois Young
to Beneficiaries:
Mr. Bogar, we appreciate the opportunity to assist you. Should you have any questions,please
contact our Client Care Center at 1-800-424-4990.
Sincerely,
Ramona Giromini
Annuity Claims Department
Annuity Service Center• P.O. Box 871 •Amarillo,TX 79105-0871
Administrator for Renaissance Life&Health Insurance Company of America Administrator for John Alden Life Insurance Company
LH-AGL/USL
REV-1511 EX+(10-09) SCHEDULE H
pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDNTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Lowdermilk, Nevin W. 121-66-0336
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 1,837.29
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State ZiD
Year(s)Commission Paid
2. Attorney's Fees Bogar& Hipp Law Offices 4,200.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zip
RelationshiD of Claimant to Decedent
4. Probate Fees 188.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 1,053.81
See continuation schedule(s)attached
TOTAL(Also enter on line 9, Recapitulation) 7,279.60
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Lowdermilk, Nevin W. 21-66-0336
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Auer Cremation Service-fee for Death Certificates 90.00
2 Bullfrog Brewery-funeral luncheon 200.42
3 Patriot News-obituary 151.87
4 Sanders Mortuary 495.00
5 Wildwood Cemetery-interment fee 900.00
H-A 1,837.29
Other Administrative Costs
6 Alert Pharmacy Service 18.81
7 Register of Wills-fee for Short Certificates 15.00
8 RESERVES:-Costs to conclude administration of estate,including preparation and filing of 1,000.00
final Personal Income Tax Returns and Fiduciary Income Tax Returns
9 Santander-fee for date of death valuations 20.00
H-B7 1,053.81
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lowdermilk, Nevin W. 21-66-0336
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not List ee
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions,and transfers
under Sec.9116(a)(1.2)]
Nevin E.Lowdermilk,Jr. Son One-third of rest,
Deceased -6/16/14 residue and
remainder
Ann L. Parkins Daughter One-third of rest,
111 Chester Road residue and
Enola, PA 17025 remainder
Lois E.Young Daughter One-third of rest,
941 South Mountain Road residue and
Dillsburg, PA 17019 remainder
Total
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as appiopriate.
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
NEVIN W. LOWDERMILK
I , NEVIN W. .LOWDERMILK, of Mechanicsburg, Cumberland
County, Pennsylvania, make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me .
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, to my children,
NEVIN W. LOWDERMILK, JR. , ANN L. PARKINS and LOIS E . YOUNG,
provided that should any of my children predecease me, I give and
bequeath such child' s share unto his or her issue per stirpes by
representation, and if there be a failure of same, then I give
and bequeath such deceased child' s share to my surviving children
t
as provided herein.
SECOND: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, 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 (.including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it .
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate .
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value .
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments .
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws .
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will , and for
investment purposes .
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable .
THIRD : I direct that all inheritance , estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate .
2
FOURTH: All interests hereunder, whether principal or
income, which are undistributed and in the possession of the
fiduciaries acting hereunder, even though vested or distribut-
able, shall not be subject to attachment, execution or sequestra-
tion for any debt, contract, obligation or liability of any
beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
FIFTH: I nominate and appoint my daughter, ANN L.
PARKINS, Executrix of. this, my Last Will and Testament . In the
event of the death, resignation or inability to serve for any
reason whatsoever of the said ANN L. PARKINS, I nominate and
appoint my daughter, LOIS E. YOUNG, Executrix of this, my Last
Will and Testament . I direct that my Executrix, and their
successors, as the case may be, shall not be required to post
security or a bond for the performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set m hand and
seal to .this, my Last Will and Testament, t is I/ day of
2012 .
-W
_ (SEAL)
NEVIN W. LOWDERMILK
3
Signed, sealed, published and declared by the above-
named Testator as and for his Last will and Testament in our
presence, who, at his request, in his presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses .
Address
Address
4