HomeMy WebLinkAbout07-06-15 Pennsylvania 1505618403
DEPARTMEHf OFR f=x(03-14)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 14 1140
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
11 23 2014 11 11 1915
Decedent's Last Name Suffix Decedent's First Name MI
KIESLING LILLIAN M
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
N1. Original Return 2. Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
4. Agricultural Exemption(date of ❑ 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
n7. Decedent Died Testate 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
10. Litigation Proceeds Received 11. Non-Probate Transferee Return 12. DeferraUElection of Spousal Trusts
(Schedule F and G Assets Only)
13. Business Assets 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
MARK A MATEYA 717 241 6500
First Line of Address
55 W CHURCH AVENUE
Second Line of Address
City or Post Office State ZIP Code
CARLISLE PA 17013
Correspondent's email address: mam(rDmateyalaw.com
REGISTER OF WILLS USE ONLY
REGISTER OF WILLS USE ONLY
DATE FILED MMDDYYYY c
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1505618403 1505618403 ��
1505618411
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Kiesling, Lillian M
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 and Notes Receivable(Schedule D).................................................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 17,951 - 26
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............ 7.
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 17 ,951 - 26
9. Funeral Expenses and Administrative Costs(Schedule.H).................................... 9. 15 ,2 7 5 • 6 2
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 1-,447 - 93
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 16,723 - 55
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1 .,227 - 71
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. 1,227 - 71
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.00 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 0 0 16. 0 . 00
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 1,2 2 7 • 71 18. 184 - 16
19. TAX DUE................................................................................................................ 19. 184 - 16
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNA RE F PSO RE IBLE FOR FILING RETURN Mark A Mateya
ADDRESS
55 W Church Avenue, Carlisle, PA 17013
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Mark A. Mateya DATE
ADDRESS
55 W. Church Avenue, Carlisle, PA
I IIIIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII III Side 2
L 1505618411 1505618411
REV-1500 EX Page 3 File Number 21-14-1140
Decedent's Complete Address:
DECEDENT'S NAME
Kiesling, Lillian M
STREET ADDRESS
210 Big Spring Road
CITY STATE ZIP
Newville PA 17241
Tax Payments and Credits:
1. . Tax Due(Page 2,Line 19) (1) 184.16
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3)
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
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) 184.16
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;.................................. ❑
c. retain a reversionary interest;or............................................................................................................... ❑ Nx
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 21ears of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a step-parent 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.
NUTEYA LAW FIRM
A PROFESSIONAL CORPORATION
55 W. Church Avenue
Carlisle, PA 17013
Phone 717-241-6500 Fax 717-241-3099
www.mateyalaw.com
July 6, 2015
Department of Revenue
Estate&Trust Division
Harrisburg, PA 17128
Re: Kiesling, Lillian: Cumberland County 21-14-1140
To Whom It May Concern,
Schedule J of Lillian Kiesling's REV 1500 reveals that no residual amount remained for
distribution and that only$2,500 of the$5,000 specific bequest was distributed. This was due to
lack of funds in the estate.
Please contact me if you have any further questions.
Sincerely,4ata Mark A.
MAM/ mam@mateyalaw.com
enclosure
Leave A Legacy
Rev-1508 EX+(08-12)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OFPERSONAL PROPERTY
INHERITANCE TAXAXRETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kiesling, Lillian M 21-14-1140
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 PNC Bank-Decedent's Checking Account No. 5.140034141 6,923.55
2 Miscellaneous Furnishings-Household furnishings including Mahogany table and costume 2,000.00
jewelry
3 Anthem Bluecross&BlueShield-Refund 78.38
4 Myers Harrier Funeral Home-Pre-paid funeral account 8,949.33
TOTAL(Also enter on Line 5, Recapitulation) 17,951.26
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12)
HEV-1511 Ex+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX R
RESIDENTDECEDENTTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Kiesling, Lillian M 21-14-1140
Decedent's debts must be reported on Schedule 1.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 13,738.72
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid Waived
2. Attorney's Fees Mateya Law Firm 1,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
RelationshiD of Claimant to Decedent
4. Probate Fees 145.50
5. Accountant's Fees 140.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs 251.40
See continuation schedule(s)attached
TOTAL(Also enter on line 9,Recapitulation) 15,275.62
Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Kiesling, Lillian M 21-14-1140
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Myers-Harner Funeral Home, Inc.-Funeral Expenses 12,391.00
2 Myers-Harner Funeral Home-Non-Guaranteed items for funeral 1,347.72
H-A 13,738.72
Other Administrative Costs
3 Cumberland Law Journal-Legal Advertisement of Estate 75.00
4 The Sentinel-Legal Advertisement of Estate 176.40
H-B7 251.40
Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12.12)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF
RET
INHERITANCE TAXAXRETURRNN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kiesling, Lillian M 21-14-1140
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 East Pennsboro Ambulance-Ambulance Service-Account No. 14-1717 158.00
2 Green Ridge Village-Expenses for Assisted Living 1,222.91
3 Millennium Pharmacy Systems, Inc.-Prescription drugs-Account GRVA1208 24.98
4 Millennium Pharmacy Systems, Inc.-Prescription drugs-Account GRVN2139 42.04
TOTAL(Also enter on Line 10, Recapitulation) 1,447.93
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-12)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kieslin , Lillian M 21-14-1140
NUMBER NAME AND ADDRESS OF DECEDENT RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S)RECEIVING PROPERTY 1 (Words) ($$$)
Do Not LisTruqtPP(_q1
I TAXABLE DISTRIBUTIONS [include outright spousal
• distributions,and transfers
under Sec.9116(a)(1.2)]
1 Francine Drupp Friend Mahogany 3- 50.00
275 Eisenhower Road legged table
Palmyra, PA 17078
2 Charles Z. K. Kinney Cousin Two Thousand 2,500.00
4038 Diane Way Five Hundred
Doylestown, PA 18902 ($2,500.00)
3 Donald&Nancy Renninger Friend Miscellaneous 50.00
11 Cedar Court East
Carlisle, PA 17015
Total 2,600.00
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
S
C(4
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
Record 1 of 1
Estate of Lillian M Kiesling PA
Set from: Spouse Fi #1 Fid#2 i #
1 Ben Details Transactions Joint Owners .
y Will Details
Presbyterian Senior Living Decd Date of Death
State of Domicile 1 PA —j
Beneficiary Allocations jQ§ Federal State
NameLast Living1a Bequests(Cash) (Sch A,B,C,F)
' 1b Bequests(in Kind) (Sch A,B,C,F)(F->�1--- _1
First 2a Joint/Spousal (Sch E-1) I►1
Middle Senior 213 Joint/Non-Spousal (Sch E-2) I'
Suffix 3 Transfers (Sch D,G,H,I) > /
4 Pre-Residue (Sch A-1) >
Estate/Trust/Organization Name 5a Resid(Fed) xi 00.000/0
Presbyterian Senior Living 6b Resld(St) 1227.71 x100.00°/6 1,227.71
6 Bony Share Pre-Tax 1,227.71
Addressl
7 US Est Tax - 0.00x100.000/0
Address2 Ste 201 8 US GST Tax 0.00x100.00%
City 1 � 9 St Dth Tax 184.18x100.00%
10 Total Tax Bear No Tax
State Cal 11 Bony Share Post-Tax ® 1,227.71
ZIP 17019 Residue 100.00000 This amount used
All Ben o on 706,Page 2
Relationship Charity
to Decedent R%
Share of
Residue
Tax Class EXEMPT Share of Estate Residue of estate plus desk,ladder back chair,
(Words)(PA only) radio/tape player combo,three paneled silk screen,
Soc Sec unknown none Beneficial Interest
or EID# blank Notes
%Share of00I l III View by-Assets;(706),Bony
.0000%
Residue(Indiana) �, . s > View b Assets(XXD),Bony
��+�r+ F01 View by Beny,Assets(706 vs.XXD)
Gross Estate(Page 1 Line 1)
MinusDebts and Expenses(Sched J, K, L). ........................................................................
Grossminus JKL................................................................................... ....
Minus Deductions Claimed on 1041 (instead of 706)...............
Bequests and Non-Probate Transfers(Taxable)...........
707
Bequests and Non-Probate Transfers(Marital)............. 0, r� —I
Bequests and Non-Probate Transfers(Charitable)....... ►
Gross Residue(before TAXES)..................................................... Residue
Gender r—
Title rr
Short t
Salutation
Date of Birth
Date Death
Age 0 Decedent's Death
E-Mail Address
Tier 1 Distribution% �T
Life Estate? I.
Intestate Heir?
copy
LAST WILL AND TESTAMENT
OF
LILLIAN M.KIESLING
I, LILLIAN M. KIESLING, of Cumberland County, Pennsylvania, make this my will. I
revoke any other wills or codicils to wills made by me.
ARTICLE I. DISTRIBUTION OF MY ESTATE
A. I give, devise and bequeath, specifically, the following:
1. The sum of FIVE THOUSAND ($5,000.00) DOLLARS to my cousin,
CHARLES Z.K.KINNEY,presently residing in Doylestown,Pennsylvania.
In the event that he should predecease me the amount given to him shall be
distributed to his heirs.
2. A diamond ring(in blue velvet box)to Dorothy Kinney,presently reisiding
Doylestown, Pennsylvania.
3. A Mahogany 3-legged table to Francine Drupp,presently residing in Palmyra,
Pennsylvania.
4. My diamond stick pin to Marc Bouganim,presently residing in Harrisburg,
Pennsylvania.
5. A cut glass decanter with silver trivet, pair of lamps (white glass with
flowers), all to Donald and Nancy Renninger, or the survivor of them,
presently residing in Carlisle, Pennsylvania.
6. A desk, ladder back chair, radio tape player combination, three paneled
screen, picture of parents in silver frame,mantle clock, and entertainment
center, Monet painting, tobacco jar with silver lid,pair of crystal bedroom
lamps, all jewelry and miscellaneous knickknacks to Abe and Beatrice
Rusho,or the survivor of them,presently residing in Lower Allen Township,
Pennsylvania.
Should any of the above-named individuals fail to survive me,then the articles given to them
shall become a part of my residuary estate.
B. I give the residue of my estate to the GREEN RIDGE VILLAGE FUND,of 210 Big
Spring Road,Newville,Pennsylvania.
C. Whenever property is to be distributed to the descendants of person(the"ancestor")
such property shall be divided into equal shares,one share for each then living descendant in the first
generation below the ancestor in which at least one descendant is Jiving, and one share for each
deceased descendant in such generation who has a descendant then living. Each share created for'a
living descendant shall be distributed to such descendant. Each share created for a deceased
descendant shall be divided an'd distributed according to the directions in the two preceding
sentences until no property remains undistributed.
D. A person who has a relationship by or through legal adoption shall take under this will
as if the person had the relationship by or through birth,except that a person adopted after reaching
age twenty-one and descendants of such a person shall not so take.
E. Any beneficiary or the legal representative of any deceased beneficiary shall have th6
right, within the time prescribed by law, to disclaim any benefit or power under my will and this
interest so disclaimed shall be distributed as if such beneficiary predeceased me.
F. Gifts of specific items of property mentioned in this will or any separate writing that
is binding upon my Executor shall fail to the extent that 1, or any duly authorized-agent of mine,
dispose of such property prior to my death.My Executor shall not substitute cash or any other assets
for any such property.
ARTICLE 11. PAYMENT OF EXPENSES AND OTHER CHARGES
I desire a traditional Christian burial. I direct my funeral expenses, including any and all
costs associated therewith, to be paid from my estate. The estate, inheritance and similar taxes
assessable on my death(including taxes on assets not passing under this will) shall also be paid as
a cost of administering my estate and my Executor shall not request any beneficiary to pay any part
ofsuch tax.
ARTICLE III. MISCELLANEOUS PROVISIONS
Matters of Interpretation.For simplicity,I have expressed pronouns and other terms in one
number and gender,but where appropriate to the context these terms shall be deemed to include the
other number and genders.The bold headings are for convenience and shall not affect interpretation,
ARTICLE IV. APPOINTMENT OF FIDUCIARIES AND POWERS
A. I name Mark A.Mateya,Esquire, presently of Boiling Springs,Cumberland-County,
Pennsylvania to be my Executor. If administration of my estate or trust should be necessary in any
jurisdiction where my Executor is unable to qualify, or if my Executor deems it necessary for any
other reason,I give to my Executor the power to designate any individual or corporation with trust
powers to serve with my Executor or in my Executor's stead. I request that no security be required
of any Executor, including an Executor named pursuant to the preceding sentence. References in
my will to my "Executor" are to the one or ones acting at the time, except where other-wise
specifically provided.
B. Any corporate Executor or Trustee shall receive for its services the compensation for
which it is willing to undertake similar services for others at the time such services are rendered,as
evidenced by its published fee schedule in effect from time to time,unless it is willing to agree upon
a fee that is less than its customary fee. Any individual who serves as Executor or Trustee shall be
entitled to receive reasonable compensation for his or her services and, whether or not such
individual receives compensation, shall be entitled to be reimbursed for expenses incurred for such
services.
C. I grant my Executor the powers set forth in 20 Pa.C.S. §§3311-3332 and 20 Pa.C.S.
§§ 7771-7780 respectively. In addition, my Trustee may merge any trust under this will with any
trust having the same trustee and substantially the same dispositive provisions. If at any time after
my death the size of any trust under this will is so small that,in the opinion of my Trustee,the trust
is uneconomical to administer,my Trustee may terminate the trust and distribute the assets to the
person or persons authorized to receive the trust income in such shares as my Trustee may deem
appropriate. No Trustee who is also an income beneficiary of the trust at issue shall exercise any
discretion granted in the preceding sentence. My Executor and my Trustee may'distribute tangible
personal property passing to a minor to any adult person with whom the minor resides, and that
person's receipt shall be a sufficient voucher in the accounts of my Executor and my Trustee.
D. I request that my Executor confer with Mark A.Mateya,Esquire, in the handling'of
my estate, he being familiar with my affairs.
ARTICLE V. DEFINITIONS
I. The use of the masculine shall include the feminine or neuter and the use of the
singular shall include the plural, and-vice versa.
2. The term "estate,"where appropriate, shall include any trust hereunder.
Executed this day of 12007.
au (SEAL)
LILLIAN M. KIESLING
Signed, sealed, published, and declared for and as her last will and testament by the testatrix
in our presence,we all being present at the same time; and we, in her presence and at her request
and in the presence of each other,have subscribed our names as witnesses whereof,all on the date
las A above wrift
117 Race Street
N A OF Boiling Sprinps,PA 17007
IQ
OF
J
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND,to wit:
Before me,' the undersigned authority, on this date personally appeared LILLIAN M.
KIESLING., and Mark A. Mateya,Esquire and Cmk V- -Q6Lu,5 5
known to me to be the testatrix and witnesses, respectively, whose names are signed to the
foregoing instrument and, all of these persons being by me first duly sworn,Lillian M. Kiesling,
the testatrix,declared to me and to the witnesses in my presence that said instrument is her last will
and testament and that she had willingly signed and executed it in the presence of said witnesses
as her free and voluntary act for the purposes therein expressed, that said witnesses stated before
me that the foregoing will was executed and acknowledged by the testatrix as her last will and
testament in the presence of said witnesses who in her presence and at her request and in the
presence of each other did subscribe their names thereto as attesting witnesses on the day of the
date of said will and that.the testatrix, at the time of the execution of said will, was over the age
of eighteen years and of sound and disposing mind and memory.
Sworn and acknowledged before me by Lillian M. Kiesling, the testatrix,
-Mark A. Matgyaand —7::401VA 00""kls
-, Esquire witness.
witness, this day of 0
2007.
LILLIAN M. KIESLING
Witness
Wim s
4ota�ry Public
My
My commission expires:
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Frances A.Aumiller,Notary Public
South Middleton Twp,Cumberland County
My Commission Expires Mar.16,2010