HomeMy WebLinkAbout03-16-15 � 15056�0101
REV-15Q0 Ex�o�_�o; ��
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes "' County Code Year File Number
_,,..,,,�:,v::
PO BOX z8o6o1 INHERITANCE TAX RETURN
Harrisburg PA i�i28-o6oi RESIDENT DECEDENT 2� 15 0245
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death ti1MDDY"YY Date of Birth MMDDYYYY
233-60-8072 02/18/2015 04/09/1940
DecedenYs Last Name Suffix DecedenYs First Name MI
BARTOS ROBERT B
(If Applicable)Enter Surviving Spouse's Information Befaw
Spouse's Last Name Suffix Spouse's First Name MI
BARTOS BARBARA F
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
o4a-ao-o6o2 ' REGISTER OF WI�LS
FILL IN APPROPRIATE OVALS BELOW
t� 1.Originai Return O 2. Suppiementai Return O 3. Remainder Return(date of death
prior to 12-13-82)
p 4.Limited Estate O �1a. Future Interest Compromise(date of p 5. Federai Estate Tax Return Required
death after 12-12-£i2)
� 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust __ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9.Litigation Proceeds Received O 10. Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.All CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Numb�r_;
'THOMAS E. FLOWER (717) 24�5�3 `J�' r:�
- .. �,,� -� ;=�
—=� -
REGISTE&'f�Fi�VILLS=FJ9E ONLY -
f F_a.
,��_ � [i��?
First line of address
FLOWER LAW, LLC =-s
_�
Second line of address r�:, f �
10WHIGHST � ':.� ` '
DATE FILE�— �
City or Post O�ce State ZIP Code
CARLISLE PA 17013-2922
CorrespondenYs e-mail address: TOm�p FIOWer-Iaw.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 infarmation of which preparer has any knowledge.
SI �TURE pF PERSO��ESP�NSIBLE FOR FILING RETURN DATE
��:�C(`bcn:vl"�Y�X'1'19z, '�—i 1`� ��.D�S'
ADDRESS
BARBARA F. BARTOS, EXECUTRIX; 317 CRAIG LANE; CARLISLE, PA 17013
SIGNATJ�V ' LEPARER � THA,� N REPRESEN7A71VE �/ /IE/
\ (�� O /S
ADDRESS
FLOWER LAW, LLC; 10 W HIGH ST; CARLISLE, PA 17013
PLEASE USE ORIGINAL PORM ONLY
Side 1
� 1,5�561,01�1 15�561,0],�1 J
1
��
� 15�5610105
REV-1500 EX
Decedent's Social Security Number
�ecedent's tvame: ROBERT B. BARTOS 233-60-8072
RECAPITULATION
1. Reai Estate(Schedule A). . . ... .. ... .. . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . 1.
2. Stocks and Bonds{Schedule B) 2. 61,650.11
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3.
4. Mort a es and Notes Receivable Schedule D 4
9 9 � ) . . . . . . .. . . . . .. . . . ..
5. Cash,Bank Deposits and Misceilaneous Personal Property(Schedule E). . . .. . . 5.
6. Jointiy Owned Property(Schedule F) O Separate Billing Requested .. . . . . . 6. 80,195.38
7. Inter-Vivos Transfers&Misceilaneous Non-Probate Property
(Schedule G) O Separate Billing Requested... . . . . . 7. 1,091,217.28
8. Totai Gross Assets(total Lines 1 through 7). . . . . . . .. .. . . . .. . . . .. .. .. . . . . &. 1,233,062.77
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . .. . .. . . . 9.
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I} . . . . . . . . . . . . . . 10.
11. Total Deductions(total Lines 9 and 10). . . .. . . . . . . . . . . .. . . . .. . . . . . .. . . . . 11.
12. Net Value of Estate(Line 8 minus Line 11) . . . . .. . . . .. . . . . . . . .. . . . . . . . . . . 12.
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. 1,233,062.77
TAX CALCULATION-SEE INSTRUCTIONS FQR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a}(1.2)X.0 0 1,233,062.77 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X.0_ 0.00 1 g. O.00
17. Amount of Line 14 taxabie
at sibling rate X.12 �.�� 17 �.��
18. Amount of Line 14 taxable 0.00 �$ 0.00
at collateral rate X.15
19. TAX DUE .. . .. . .. .. ... .. . . . . . . . .. . . . . . . . . . . .. . . . .. . . . . . . . . . . .. ... . 19. 0.00
20. FILL IN TNE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 1,50567,01�5 15�56],Oy05 J
REV-1500 EX Page 3 File Number 21-15-0245
Decedent's Complete Address:
DECEDENT'S NAME
ROBERT B. BARTOS
STREETADDRESS
317 CRAIG LANE
sTaTEPA Z1P17013
c�CARLISLE
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) � _ _ _ 0.00
2. CreditslPayments
A.Prior Payments __— _ __
B.Discount
Total Credits(A+B) (2)
3. Interest
(3)
4. if Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. �4) ____._.__._ __._.___._._. _.__
5. If Line 1 +Line 3 is greater than Line 2,enter the tlifference.This is the TAX DUE. t5)
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:.......................................................................................... � �
b. retain the right to designate who shall use the property transferretl or its income:............................................ ❑ �
c. retain a reversionary interest;or.......................................................................................................................... ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... � �
2. If death occurred after Dec.12, 1982,did tlecedent 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?.............. ❑ �
4. Did decedent own an individual retirement account;annuity or other non-probate property;which
containsa beneficiary designation? ..............................................__...................................................................... 0 ❑
IF THE ANSWER TO ANY OF THE ABQVE 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,end 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)j.
For dates of tleath 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 tloes not exempt a transfer to a surviving spouse from tax, and the statutory requirements for tlisclosure of assets and
filing a tax return are still applicabie even if the surviving spause is the only beneficiary.
For dates of tleath 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 chiltl 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(1.2}[72 P.S.§9116(a)(1}].
. The tax rate imposed on the net value of transfers to or for the use of the tlecedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)j.A sibling is defined,under
Section 9102,as an indivitlual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-i,o3 EX+(y-ii)
�'pennsylvania SCHEDULE B
DEPHftTMENT OF REVENUE $TOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROBERT B. BARTOS 21-15-0245
All property jointly owned with right of survivorship must be distlosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1' AMERIPRISE BROKERAGE ACCOUNT#00022150031 133 61,650.11
TOTAL(Also enter on Line 2, Recapitulation) $ 61,650.11
If more space is needed, insert additional sheets of the same size
REV-15o9 EX+(oi-1o)
' � � pennsylvania SCHEDULE F
��� DEPARTMENT OP REVENUE �OINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ROBERT B. BARTOS 21-15-0245
If an asset became jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVINGJOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIPTO DECEDENT
A• BARBARA F. BARTOS 317 CRAIG LANE, CARLISLE, PA 17013 SPOUSE
B.
C.
JOINTLY OWNED PROPERTY:
lEffER DATE DESCRIPTION OF PROPERIY %OF DATE OFDEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JO[NT IDENTIFYING NUMBER.ATTACH DEED FOR]OINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTEREST
1. A. AMERIPRISE FINANCIAL SPS ACCT.00045924025 133 160,390.76 50 80,195.38
TOTAL (Also enter on Line 6, Recapitulation) $ 80,195.38
If more space is needed, use additional sheets of paper of the same size.
�tE--ZSrQEk. r08-09j
���' pennsylvania SCHEDULE G
LL7' DEPARTMENTOfREVENUE INTER—VIVOS TRANSFERS AND
� INHERITANCE TAX RETURN MISC. NON—PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROBERT B. BARTOS 21-15-0245
This schedule must be completed and filed if the answer to any of questions 1 khrough 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY pATE OF DEATH °!a OF DECD'S EXCLUSION TAXABLE
ITEM ':NCLUDE THE NAME OF THE TfuWSPEREE,hiEIR RELAIlONSHiP TG DECE�ENT.4ND
NUMBER THE DATE OF IRANSPER. ATfACF A COFY OF TFE DEED FOR REAL ESTATE. VALU E OF ASSET INTEREST ?P APPIICABLEj VALUE
1. AMERIPRISE FINANCIAL, IRA ACCT.#00039419914 133 92,383.84 100 92,383.84
BENEFICIARY:BARBARA F.BARTOS-100%
AMERIPRISE FINANCIAL,ANNUITY CONTRACT#93008281715 004 104,300.06 100 104,300.06
2' BENEFICIARY:BARBARA F.BARTOS-100%
AMERIPRISE FINANCIAL ANNUITY CONTRACT#93008450151 004 83,099.71 100 83,099.71
3' BENEFICIARY:BARBARA F.BARTOS-100°/a
AMERIPRISE FINANCIAL ANNUITY CONTRACT#93108176350 004 g�1,433.67 100 811,433.67
4' BENEFICIARY:BARBARA F.BARTOS-100%
TOTAL(Also enter on Line 7, Recapitulation) $ 1,091,217.28
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
�`` pennsylvania SCHEDULE �
DEPAftTMENT Of REVENUG
���� INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ROBERT B. BARTOS 21-15-0245
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. BARBARA F.BARTOS,317 CRAIG LANE,CARLISLE,PA 17013 SURVIVING SPOUSE 100%
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:
i,
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
1
Ameriprise �
Financial
Account Summary for the Estate Settlement of Robert B Bartos, Client ID 11949206
1)Type of investment:Ameriprise Brokerage/Ameriprise ONE Account
Product Name:Ameriprise Brokerage Account
Total Account Value(as of Date of Death):$61,650.11
Account Number:00022150031 133
Account Registration: Robert B Bartos
Beneficiary Designation:
How the account(s)proceeds will be settled:
We will transfer assets in this account according to direction received from the estate representative. If the estate is not being
probated, please contact us for alternatives.
Important Details about this account:
There are sponsor controlled assets in this account.Additional paperwork may be needed to complete the transfer of
ownership after the initiai settlement requirements are satisfied.The required paperwork will be provided after the new account
has been estabiished for the beneficiary.
2)Type of investment:SPS Advantage/SPS Advantage ONE Account
Product Name:SPS Advantage
Total Account Value(as of Date of Death):$92,383.84
Account Number:00039419914 133
Account Registration: Ameriprise Trust Company C/O Robert B Bartos As Custd For The Robert B Bartos Ira
Beneficiary Designation:
PRIMARY BENEFICIARY
BARBARA F BARTOS SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING,LAWFUL CHILDREN IN€QUAL SHARES 100.00% ,
How the account(s)proceeds will be settled:
We will transfer assets in this account to an account for the beneficiary(ies).
Important Details about this account:
N/A ,
3)Type of investment:SPS Advantage with ONE features
Product Name: SPS Advantage with ONE featufes
Total Account Value(as of Date of Death):$160,390.76
Account Number:00045924025 133
Account Registration: Robert B Bartos and Barbara F Bartos Jt
Beneficiary Designation: ,
How the account(s)proceeds will be settled:
Assets in this account will be transferred to an account for the surviving joint owner(s).
Important Details about this account:
N/A
4)Type of investment: Deferred Annuity-Successor annuitant possible
Product Name: Deferred Annuity-Successor annuitant possible
Total Account Value(as of Date of Death):$104,300.06., - -
Account Number:93008281715 004
Account Registration: Robert B Bartos
Beneficiary Designation:
PRIMARY BENEFICIARY
BARBARA F BARTOS SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING, LAWFUL CHILDREN 1N EQUAL SHARES 100.00%
How the account(s)proceeds will be settled:
We wiil distribute proceeds to the beneficiary.
Important Details about this account:
N/A
5)Type of investment: Deferred Annuity-Successor annuitant possible
Product Name: Deferred Annuity-Successor annuitant possibie
Total Account Value(as of Date of Death):$83,099.71
Account Number:93008450151 004
Account Registration: Robert B Bartos
Beneficiary Designation:.
PRIMARY BENEFICIARY
BARBARA F BARTOS SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING,LAWFUL CHILDREN IN E�UAL SHARES 100.00%
How the account(s)proceeds will be settled:
We will distribute proceeds to the beneficiary.
Important Details about this account:
N/A
6)Type of investment: Deferred Annuity-Beneficiary
1
Ameriprise �
Financial
Product Name: Deferred Annuity-Beneficiary
Total Account Value(as of Date of Death):$811,433.67
Account Number:931 081 76350 004
Account Registration: Robert B Bartos
Beneficiary Designation:
PRIMARY BENEFICIARY
BARBARA F BARTOS SPOUSE 100.00%
SECONDARY BENEFICIARY
LIVING,LAWFUL CHILDREN IN EQUAL SHARES 100.00%
How the account(s)proceeds will be settled:
We will distribute proceeds to the beneficiary.
Important Details about this account:
N/A
LAST WILL AND TESTAMENT
OF
ROBERT B. BARTOS
I, ROBERT B. BARTOS, of 317 Craig Lane, Carlisle, Cumberland Counn�,
Pennsylvania 17013, being of sound and disposing mind, memory and understanding,
do make, publish and declare this as and for my Last Will and Testament, herebjr
revoking and making void any and all former`Y�'ills, Codicils, or writings in the nature
thereof, by me at any time heretofore made.
FIRST: I hereby order and direct my Executor, hereinafter named, to pa5�
all my just debts, funeral expenses, testamentary expenses and all inheritance, Estate,
Transfer and Succession TaYes, as soon as may be conveniently done after my death,
out of my residuary� estate.
SECOND: I give my entire estate to my wife, BARBARA F. BARTOS,
provided she survives me by thirty (30) days.
THIRD: In the event that my= wife, BARBARA F. BARTOS, does not
survive me by thirty (30) days, I make the following bequests:
1. I give one-hur.dr��d thousand (�100,000) to the Shippensburg
University Foundation for the continuing support of the Bartos
Childcare Family Center.
2. I give all the residue and remainder of my estate to my son,JASON B.
BARTOS.
FOURTH: In the everit that mj�wife, BARBARA F. BARTOS, and my son,
JASON B. BARTOS, fail to survive me by thirty (30) days, and if my son has
children who have not artained the age of 25 years, then I give, devise, and bequeath,
my� entire estate with other property which may be added unto my Trustee hereinaftcr
named, in Trust, nevertheless for the benefit of my grandchildren, and I appoint my-
son's sur�-iving spouse as the Trustee for an�- said beneficiary�. If m�� son's spouse fails
to survi��e him b�� thirty (30) days, I appoint �I&T Bank as the Trustee for anc said
beneficiary. �ny- such Tnzstee is to serve upon the following terms and condiuons:
13. The Trustee shall, invest, reinvest or distribute from
time to time all or a portion of the net income or a portion of the principal of the
Trust to or for the benefit of each beneficiary, as the Trustee shall consider
appropriate for the benef ciary's proper support, maintenance, medical care, and
education.
B. The Trustee is authorized to make distributions of income or
principal or both, in such proportions as he/she shall deem advisable in his/her
discretion, regardless whether such distributions are equal or unequal, and whether
distributed to one beneficiary and not to another. The Trustee shall impartially
consider the respective needs of the beneficiaries as they appear at the time, as I
would consider if living. Distributions may be made by my Trustee direcdy to said
children, or such of them as may be, in the sole opinion of Trustee, of such age and
abiliry to handle properly the funds so paid, or may be made direcdy to the person
having custody and care of said children, or may be made directly to any institution
entided to such payment by reason of services rendered or to be rendered to any of
said children. Payment of principal, where deemed advisable, from the un-
apportioned part of the Trust, shall not be considered advancements.
C. All payments of principal and income hereby given shall be free
from anticipation, assignment, pledge or obligarions of beneficiaries, and shall not bc
subject to any execution or attachment.
D. r�ll principal and accumulated income, not so applied, shall be
distributed to my grandchildren, per stirpes, at the times, and in the manner, provided
hereunder:
(1j ��'hen mv grandchildren attain the age of eighteen (18)
�-ears, the Trustee shall set apart for that child one share of the principal and
undistributed income of the Trust. The share shall be determined by dividing the
principal of the 'I'rust by the number of beneficiaries of the Trust �vho are living, or
have left living issue, and for whom no separate Trust has been set apart. There shall
be no distributions of income or of principal, to or for the benefit of any
grandchildren from the un-apportioned part of the trust after a separate share has
been set aside for the benefit of that grandchild.
(2) Trustee shall distribute to each beneficiary upon attaining
the age of 22 the entire principal and any undisbursed income from that beneficiary's
share of said Trust.
LASTLY: I hereby nominate, constitute and appoint my wife, BARBARA
F. BARTOS, as Executrix of this my Last Will and Testament. In the event that my
wife, BARBARA F. BARTOS, shall be unwilling or unable to serve, I appoint
JASON B. BARTOS, my son, as Executor. No Executor shall be required to file
bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
�c3
�O� day of � , 2�
�''-- (�_—_
- Robert�'s. Bartos
SIGNED, SE1�L�D, PUBLISHED and
D�CLI�RED in the preser�ce of:
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COti71�IONWE�LTH OF PENNSYLV�NI� .
: SS
COUNTY OF CU�IBERLI�ND .
I, ROBERT B. BARTOS, Testator, �vhose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that I signed
it willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed to and acknowledged before me, by ROBERT B.
BARTOS, the Testator, this � �� day of_ � , 2�-Y�'2�t3 -
�
Robert B. Bartos, Testator
���-�L�'''-�'-�—
Notary Public
���:v3arrrsr���,�rN��e���n�r�sv�.vaera�e+
.T.�...F.�.,,..�..
NQ"tA�;l�L S�:AL
THOMAS E.FLQI�JER,Notar�Pubiic
Carlisle�3aro.,Cumb�:rland�oun;y
�4�1y Ccnt�r;issior;Ex�;ir�.?�r.;fan�r?_G,2014
COi�T�IONW'E�I,TH OF PENNSYLV��II� :
: SS
COL'NT`Y OF CU�IBERLAI��D .
We, �"�'1 �• �o �-h and 1L'tav'�/�5 , the
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw Testator
sign and execute the instrument as his Last Will; that he signed willingly and that he
executed it as her free and voluntary act for the purposes therein expressed; that each
of us in the hearing and sight of the Testator signed the W'ill as witnesses and that to
the best of our knowledge the Testator u�as at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by 5� g .�(!'o��
and ___ �'Lec.v'v1 vDa 1/S this .3 0 � day of V
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`' Witness �--�`
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Notary Public
G�Pv9M�F�EIN�ALTti��'PEF3h1�Y1��/Af�di.A
� NOirf:IALSLAL
T��OMAS f�.FLOVl�ER,Notary Pubii�
��arlisle�crc�.,C��viberland County
>.�fi`'�a;�`':'�r'�ss��r��xpir�s t�t,tnb�r 26,2Q14