HomeMy WebLinkAbout04-27-15 j REV-1500 EX(01-10) 1505610143
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania Countycode Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOx.280601 INHERITANCE TAX RETURN 2 1 14 00476
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
04 07 2014 06 06 1928
Decedent's Last Name Suffix Decedent's First Name MI
WERTZ SR . JAMES R
(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 ❑ 2. 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)
® 6. Decedent Died Testate ❑ 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.91 13 A
between 12-31-91 and 1-1-95) E] ( )
(Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
SAMUEL L ANDES 717 761 5361
.-.a
cE
REGISTER 9FFWILLS USlE ONS'
First line of address IL-1 -r n
17T 1
525 NORTH 12TH STREET t tv
(j)
Second line of address
City or Post Office State ZIP Code DATE AILED O €
co
LEMOYNE PA 17043
Correspondent's e-mail address: SamuelAndes168@gmail.com
Under penalties of perjury,I declare thajAhave examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
itis true,correct and complete.Decla i n of preparer other than the personal representative is based on all information of which preparer has any knowledge.
PWIGRATOPEW PERSOX N%QA.FArR FILING RETURN DATE
Debra A. Forker
ADDRESS
5082 Carrolton DriveArrisbmra, PA 17112
SIGN F P E HAN E ESE ATIVE DATE I
Samuel L Andes
AD
525 North 12th Street, Lemoyne, PA 17043
Side 1 k
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: WERTZ, JAMES R SR.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1. 63 , 000 . 00
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. 986 . 82
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7 , 233 . 29
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7.
8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 71 , 220 . 11
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 9 , 165 . 53
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1)................................ 10. 16 , 843 . 12
11. Total Deductions(total Lines 9&10)...................................................................... 11, 26 , 008 . 65
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 45 , 211 . 46
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. 45 , 211 . 46
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.
16. Amount of Line 14 taxable
at lineal rate X .045 45 , 211 . 46 16. 2 , 034 . 52
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18•
19. Tax Due..................................................................................................................... 19. 2 , 034 . 52
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. a
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21 - 14 - 00476
Decedent's Complete Address:
DECEDENT'S NAME
Wertz, James R Sr.
STREET ADDRESS
128 Hummel Avenue
CITY STATE ZIP
Lemoyne PA 17043
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 2,034.52
2. Credits/Payments
A. Prior Payments 3,000.00
B. Discount 101.73
Total Credits(A +B) (2) 3,101.73
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 1,067.21
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;.................................... ❑ Fxl
c. retain a reversionary interest;or.................................................................................................................. ❑ ❑x
d. receive the promise for life of either payments,benefits or care?.............................................................. ❑
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... ❑
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... ❑ 0
4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which
contains a beneficiary designation?...................................................................................................................... ❑ 0
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 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 decedent's siblings is 12 percent[72 P.S.&9116(a)(1.3)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,whether y blood or adoption.
war
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Wertz, James R Sr. 21 - 14-00476
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts.Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
8 Single family residence at 128 Hummel Avenue, Lemoyne, Cumberland County, PA, in 63,000.00
advanced state of disrepair. Value based upon arms-length sale of property to independent
third party(see settlement sheet attached).
4
I
TOTAL(Also enter on Line 1, Recapitulation) 63,000.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH PENNSYLVANIAOF PERSONAL PROPERTY
INHERITANCE
RETURN TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Wei, James R Sr. 21 - 14-00476
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 DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
8 2002 Chevrolet automobile no longer operating. The vehicle was sold for scrap. 275.00
9 Miscellaneous items of household furnishings and personal property in poor condition 350.00
10 Final pension payment from Commonwealth of Pennsylvania State Employees Retirement 361.82
System (for 7 days in April)
TOTAL(Also enter on Line 5, Recapitulation) 986.82
SCHEDULE
COMMONWEALTH RITANC TAX PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Wertz, James R Sr. I FILE NUMBER
21 - 14-00476
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
Debra A. Forker 5082 Carrolton Drive Daughter
A Harrisburg, PA 17112
JOINTLY OWNED PROPERTY:
LETTER DATE 9%SCRIPT.10 JF PR0 R %OF DATE of DEATH
ITEM FOR JOINT MADE Include name o nandp Ins I u Ion an ban account numbe DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT or similar identifying number.Attach deed for jointly-held real VALUE OF ASSET estate. INTEREST DECEDENTS INTEREST
1 A 2009 Regular share account No. 01 with PSECU 2184 50% 108.92
2 A 2009 Checking account No. 04 with PSECU 4,900.42 50% 2,450.21
3 A 2009 Money market account with PSECU 9,348.32 50% 4,674.16
TOTAL(Also enter on line 6, Recapitulation) 7,233.29
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EVENSES&
INHERITANCE TAX RETURN
RESIDENT DECEDENT -DMINCMTI ECOSTS
ESTATE OF Wertz, James R Sr. FILE NUMBER21 - 14-00476
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Parthemore Funeral Home and Cremation Services, Inc. (balance of funeral bill was 40.80
paid by prepayment program with SecurChoice)
2 Parthemore Funeral Home and Cremation Services, Inc. (transportation services for 810.00
remains)
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Years)Commission paid
2. Attorney's Fees Samuel L.Andes, Esquire 1,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills 218.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
8 The Sentinel (advertising) 158.68
TOTAL(Also enter on line 9, Recapitulation) 9,165.53
'
`
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN AdrdnishalwI04stsconfimsd
RESIDENT DECEDENT
ESTATE OF Wertz, James R Sr. FILE NUMBER
9 Cumberland Law Journal (advertising) 75.00
10 2013-2014 School real estate taxes 1,562.64
11 2013-2014 per capita taxes 9.80
12 expenses incurred to maintain home(see Schedule attached) 4,590.11
13 Miscellaneous costs incurred for the sale of real estate(see lines 1110 through 1114 200.00
of settlement sheet attached)
Page 2ofSchedule H
K
x
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN LIABILITIES, & LIENS
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Wertz, James R Sr. 21 - 14.00476
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
8
9 VA Prescription Services 48.00
10 West Shore EMS 244.28
11 Verizon 101.62
12 2014 Municipal and county real estate taxes 772.24
13 Homeowners insurance 719.01
Citi Financial (balance owed on home equity loan 12,858.59
Citi Financial (credit card balance) 200.00
14 PSECU (balance owed on auto loan) 870.67
15 Comcast bill 1,028.71
TOTAL(Also enter on Line 10, Recapitulation) 16,843.12
REV-1513 EX+(11-08)
SCHEDULE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Wertz, James R Sr.
1 21 - 14-00476
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS rinclude outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 James R.Wertz,Jr. Son one-third
128 Hummel Avenue
Lemoyne, PA 17043
2 Catherine L. Smith Daughter one-third
128 Hummel Avenue
Lemoyne, PA 17043
3 Debra A. Forker Daughter one-third
5082 Carrolton Drive
Harrisburg, PA 17112
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
OMB Approval No.2502-0265
lllill A.Settlement Statement (HUD-1)
B, Type of Loan
e.Fife Number. J.Loan Number. 8.Mortgage Insurance Case Number:
1. ❑FHA 2. M RHS 3. Conv.Unins. CAA-Feirzlee-
4. E]VA 5. M Conv.Ins. A06190645
C.Note; This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.Items marked
were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
O.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender:
Kevin Felmlee Estate of James R.Wertz,Sr.,Debra A.
PA Forker,Executrix
PA
MaArgaret Felmlee
P
G.Property Location: H.Settlement Agent: I.Settlement Date:
128 Hummel Avenue Capital Area Abstract Inc.,David J. 03/ifJ2015
Lemoyne,PA 17043 Lanza
Phone Number:717-303.0322
Cumberland County 2132 Market Street
Camp Hill,PA 17011
Place of Settlement:
2132 Market Street Camp Hill,PA 17011 Disbursement Date:03H6/2015
J. Summary of Borrower's Transaction K.Summary of Seller's Transaction
100.Gross Amount Due From Borrower 400. Gross Amount Due To Seller
101.Contract sales price $63,poo.00 401.Contract sales price $63,000.00
102.Personal property 402.Personal property
103.Settlement charges to borrower(line 1400) $1,420.50 403.
104• 404.
105. 405.
Adjustments for items paid by setter in advance Adjustments for items paid by seller In advance
106.City/town taxes to 406.City/town taxes to
107.County taxes 0311612015 to 1213112015 $624,88 407.County taxes 0311612015 to 1 213 112 01 5 $614.86
108.Assessments 0311612015 to 0 613 012 01 5 $444.73 408.Assessments 0311612015 to 0 613 012 01 5 $444.73
109, 409.
110. 410.
ill. 411.
112. 412.
120.Gross Amount Due From Borrower $65,480.11 420.Gross Amount Due To Seller $64,059.61
200.Amounts Paid By Or In Behalf Of Borrower 600.Reductions In Amount Due To Seller
201.Deposit or earnest money 501.Excess deposit(see instructions)
202.Principal amount of new loan(s) 502.Settlement charges to seller(line 1400) $1,929.08
203.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to
204. 504.Payoff of first mortgage loan Citi,Fin (est) $13,000.00
205, 505.Payoff of second mortgage loan
206. Rent Credit to Buyer $1,020.00 506.Rent Credit to Buyer $1,020.00
207. 507,
208. SOB.
209. 509.
Adjustments for items unpaid by seller Adjustments for Items unpaid by seller
210.Ci /town taxes to 510.City/town taxes to
211.County taxes to 511.CountV taxes to
212.Assessments to 512.Assessments to
213. 513.
214. 514.
215. 515.
216. 516,
217. 517.
218. 518.
219. 519.
220.Total Paid By/For Borrower $1,020.00 520.Total Reduction Amount Due Seller 515,949.09
300.Cash At Settlement FromiTo Borrower 600.Cash At Settlement To/From Seller
301.Gross amount due from borrower(line 120) $65,480.11 601.Gross amount due to seller(line 420) S64,059.61
302.Less amounts paid by/for borrower(cine 220) ( $1,020.00 602.Less reductions in amt.due seller{line 520} $15,949.08
303.Cash ® From ❑To Borrower $64,460.11 603.Cash ®To ❑From Seller $48,110.53
The public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and
reporting the data.This agency may not collect this information,and you are not required to complete this form,unless,it displays a
currently valid OMB control number.No Confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to
a RESPA covered transaction with information during the settlement process.
Previous editions are obsolete Pagel of 3 HUD-1
L. Settlement Charges
700.Tata(Real Estate Broker Fees
f}ivIsIOn of Commission(fine 700)as follows:
701.$ Paid From Paid From
702.$
to Borrower's Sellers
Funds at Funds a
703.Commission paid at Settlement to t
Settlement S urdse
704.
800.Items Payable In Connection With Loan { P.o.c.by
601.Our origination charge
802.Your credit or charge(points)for the specific interest rate chosen $ (from GFE#1)
803.Your adjusted origination charges $ (from GFE#2)
804.Appraisal fee to (from GFE A) $0.00
805.Creditreport to { Ro'c'by i(from GFE#3)
806.Tax service to i PAC by
l i(from GFE#3)
807,Flood certification PAC by i(from GFE#3)
8.08, i P.o.c.by i (from GFE#3)
809.
810,
811.
812.
9D0.Items Required By Lender 7o Be Pald in Advance
901.Daily interest charges from
902.Mortgage Insurance Premium far to @$
/clay(from GFE#10)
to months. (from GFE#3)
903.Homeowner's insurance for
to years.
{from GFE#11)
904,
to years.
905.
1000.Reserves Deposited With Lender
1001.tnitiai deposit for your escrow account
1002.Homeowner's insurance (from GFE#9)
1003 Mortgage insurance months @$ per month $
1004.Property taxes months @$ per month $
1005. months @$ per month $
1006 months @$ per month $
1007.Aggregate Adjustment months @$ per month $
1100.Tina Charges $ 0.00
1101.Title services and lender's title insurance
1102.Settlement or Closing fee (from GFE#4) $15.00
1103.Owner's title insurance (issued through :gel
evri ty Title $
1104.Lender's tine insurance (from GFE#5) $696.so
1105.Lender s title policy limit$ $
1108.Owner's title policy limit$63,000.00
1107,Agents portion of the total title insurance premium stract, Znc.
1108.Underwriter's portion of the total title insurance premium security Title $592,02
1109• sn2 $10C48
1110, Notary Fee to Notary public
1111, Wire Transfer Fee to CAAbstract, Xne. $5.00 $20.00
1112. overnight Fee to CAAbstraot, inc. $10.00
1113. Tax Cert. Reim. Fee to CAAbstract, Xnc,
$30.00
1114. Dead Prep. Fan to Samuel Z. Axid.,1115. � $20.00
1200.Government Recording and Transfer Charges $150.00
1201. Cumbar2and County RBQOrdar a,f Daada
1202.used$79.00 Government recording charges: (from GFE#7) $79.D0
Mortgage$ ;Releases$
1203.Transfer taxes LTrmberland County Recorder of Deeds
1204.City/COun taxtstam s: from GFE#8) $630.00
I .State tax/stamps: Deed$630.00 Mortgage $ $630.00
1206. Deed$630.00 Mortgage $
1207. $
1208. $
1209. $
1300.AdditionalSettlement Charges $
1301.Required services that you can shop for
1302. (from GFE#8)
1303. $
1304. $
1305.
1306.
1307. 2025 CountylBorOugh Taxes to Faith Nicola
1308. Final Sever Bill to Lemoyne Borough (Nov. 6 - ayarch 26) $773.90
1309. $325.18
1400.Total Settlement Charges(enter on lines 103,Section J and 802,Section K)
$1,920.50 $1,929.08
Previous editions are obsolete
Page 2 Of 3
HUD-1
t
Certification
(continued from HUD-1)
I hove carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,
it is a true and accurate statement of all receipts and disbursements made on my account or by me in this
transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement,
Seller or
Borrower: �Akfl- -�tL Date: —311(:j LS Agent: L I< Date:
Kevin Felmlee Debra A.Forker, Executrix
Estate of James R.Wertz,Sr.
Seller or
Borrower: MkL•"4 4A Date: Agent: Date:
Marg et Felmlee
The HUD-1 Settlement which I have prepared is a true and accurate account of this tran tion. I have
caused or will cause the funds to be disbursed in accordance with this statement.
Date: Settlement Agent: Date:
David J.Lanza
WARNING: It is a crime to knowingly make false statements to the United States on this or any other
similar form. Penalties upon conviction can include a fine and imprisonment. For details
see:Title 18 U.S,Code Section 1001 and Section 1010.
Estate of Wertz,James R. Sr.
21-14-00476
Schedule B
PA American Water Company $761.34
Lemoyne Borough sewer bill $963.83
UGI $1,243.64
Penn Waste refuse bill $174.00
2015 Municipal and county taxes (less $159.02
proration at settlement)
PPL electric service 1 288.28
$4,590.11
i�
WILL
OF
JAMES R. WERTZ, SR.
I, JAMES R. WERTZ, SR., of the Borough of Lemoyne, Cumberland County, Pennsylvania,
declare this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all
expenses of my last illness,and any and all taxes and assessments imposed by any governmental body as
a result of my death, whether on property passing under this will or otherwise, shall be paid from my
residuary estate as soon as practicable after my decease as a part of the expense of the administration of
my estate.
ITEM H. I give,devise,and bequeath all of my possessions and estate of every nature and
4
wherever situate to such of my issue,per stirpes, as survive my death by sixty(60)days.
ITEM III. I appoint my daughter, DEBRA A. FORKER, executrix of this my last will. Should
my said daughter predecease me or otherwise fail to qualify or cease to serve as executrix of this my last
will,I appoint my son,JAMES R. WERTZ,JR.,of this my last will.
ITEM IV. In addition to the other powers and authorities granted to my personal representative
by Pennsylvania Law and by the other terms and provisions of this will, I hereby give to my personal
representative the following powers and authorities effective without court approval and until actual
distribution of all property: to compromise any claim or controversy;to make distribution in cash or in
kind, or partly in cash and partly in kind, and in such manner as my personal representative may
determine and at valuations finally to be fixed by them; to invest in all forms of property, including any
stock or other securities in any corporate fiduciary or its successor without restriction to investments
authorized for Pennsylvania fiduciaries, as my personal representative deems proper,without regard to
any principle of risk or diversification; to retain any or all assets of my estate,real or personal, without
regard to any principle of risk or diversification; to sell at public or private sale, to exchange,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 or conditions as my personal representative deems proper; and to allocate
ceipts and expenses to principal or income or partly to each as my personal representatives deem proper
in their sole discretion.
Page 1 of 3
ITEM V. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or
to voluntary or involuntary alienation nor shall they be subject to any execution or attachment.
ITEM VII. I direct that my personal representatives and fiduciaries shall not be required to give
bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this day of
2407..
ES R. WERTZ, SR.
The preceding instrument,consisting of this and one other typewritten pages, each identified by the
signature of the testator was on the date thereof signed,published, and declared by JAMES R. WERTZ,
SR., the testator therein named, as and for his last will,in the presence of us, who at his request,in his
presence, and in the presence of each other, have subscribed our names as witnesses hereto.
Safnuel L. Andes
Amy Ha6m`-�
Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA }
( SS.:
COUNTY OF CUMBERLAND }
The undersigned,being the testator whose name is signed to the attached or foregoing instrument,having been
duly qualified according to law,does hereby acknowledge that I signed and executed the foregoing 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.
JANV R.WERTZ, SR. 41
Sworn or affirmed to and acknowledged
before me by the testator named above
this F�day of � 2007.
z
,:= t1TAIMAO.lEA� j
'
PUKC
Notary �c 1Co.
COMMONWEALTH OF PENNSYLVANIA )
(SS..
COUNTY OF CUMBERLAND )
WE, SAMUEL L. ANDES and AMY HARK.INS,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 the
testator sign and execute the instrument as his last will;that he signed it willingly and that he executed it as his
free and voluntary act for the purposes therein expressed;that each of us in the hearing and sight of the testator
sighed the will as witnesses; and that to the best of our knowledge,the testator was at that time 18 or more years of
age,of sound mind,and under no constraint or undue influence.
y 2w-
Sainuef L.Andes
Sworn or affirmed to and Amy HaAns
ackno le
5j dged before me this
day of ,2007.
Notary ublie L
LVW �
�FES.J.209
4
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