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HomeMy WebLinkAbout07-06-15 (2) J pennsylvania 1505618403 DEPARTMENT OF REVEN J=IX(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburq, PA 17128-0601 RESIDENT DECEDENT 21 14 1184 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 11 19 2014 08 03 1929 Decedent's Last Name Suffix Decedent's First Name MI BLOUIN LESLIE L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI BLOUIN DORIS I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW FRI 1. Original Return 11 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) ❑X 7. Decedent Died Testate 8. Decedent Maintained a Living Trust 0 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. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) 13. Business Assets 2 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 MARIELLE F HAZEN ESQ 717 540 4332 First Line of Address 2000 LINGLESTOWN ROAD Second Line of Address SUITE 202 City or Post Office State ZIP Code HARRISBURG PA 17110 ,E -~ Correspondent's email address: info(&hazenelderlaw.com REGISTER OF WILLSiU t QN4Y rn 3 C ; REGISTER OF WILLS USE ONLY I f t! rn Cn DATE FILED MMDDYYYY Cl) G DATE FILEDLOAMP © 6 t Side 1 I IIIIII ILII VIII VIII IIID VIII VIII IIIiI VIII VIII IIII IIII 1505618403 1505618403 1505618411 REV-1500 EX Decedent's Social Security Number Decedent's Name: Blouin, Leslie L 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. 33,803 - 00 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 167 ,803 - 83 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 2111-,606 . 83 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 201,606 - 83 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. 201,606 . 83 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 2011606 . 83 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 0 . 0 0 16. 0 . 0 0 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 . 0 0 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 0 . 00 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. SIGNATURE OF PERSON RESPONSIBLE WR FILING RETURN Doris I Blouin � ' E5 ADDRESS lhc�-� 13 George Circle, Mechanicsburg, PA 17055 Sl!�� 17 ER THAN REPRESENTATIVE Marielle F. Hazen Esq. tITfl.� �- I ADDRESS 2000 Linglestown Road, , Harrisburg, PA I IIIIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIII Side 2 1505618411 1505618411 REV-1500 EX Page 3 File Number 21-14-1184 Decedent's Complete Address: DECEDENT'S NAME Moulin, Leslie L STREET ADDRESS 13 George Circle CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 0.00 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) 0.00 Make Check Pa able 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............................................................................................................... ❑ ❑x 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 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. Rev-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OFPERSONAL PROPERTY INHERITANCE TAXAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Blouin, Leslie L 21-14-1184 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 1957 Ford Fairlane-appraised value 32,000.00 2 2002 Mercury Sable GS-150,000 miles 1,803.00 TOTAL(Also enter on Line 5, Recapitulation) 33,803.00 (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) Rev-1510 EX+(08-09) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF MISC. NON-PROBATE PROPERTY RET INHERITANCE TAXAXRETURRNN RESIDENT DECEDENT ESTATE OF FILE NUMBER Blouin, Leslie L 21-14-1184 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 %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF RNAME OANSFERSATTACH A COPY OF TFEREE THEIR IHE DEED OR REAL ESTATE. VALUE OF ASSET NSHIP TO DECEDENT AND INTEREST (IF APPLICABLE) VALUE 1 USAA IRA 58900286436 73.117.33 73,117.33 2 USAA Retirement Annuity J528175426-beneficiary is 94,686.50 94,686.50 spouse TOTAL(Also enter on Line 7. Recapitulation) 167.803.83 (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) REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Blouin, Leslie L 21-14-1184 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF DECEDENTDo Not Lost SHARE OF ESTATE AMOUNT OF ESTATE PERSON(S)RECEIVING PROPERTY a (Words) ($$$) ITAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Doris I Blouin Spouse All rest and 201,606.83 13 George Circle residue Mechanicsburg, PA 17055 Total 201,606.83 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 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) 2002 Mercury Sable GS Wagon 4D Trade In Values-Kelley Blue Book http://www.kbb.com/mercury/sable/2002-mercury-sable/gs-wagon-4d... at ZIP CODE:17110 1 Sign in(or Sign up) Home Car Values I Cars for Sale I Car Reviews I Awards&Top 10s I Research Toots I Popular at KBB.com COO,= pip THE ONLY PREMIUM MIDSIZE PICKUP. 10 Best Car Deals of the Month THE ALL-NEW 2015 GMC CANYON Advertisement Why ads' Home>Car Values> mercury >Sable> 2002>Category>Style>Options>GS Wagon 4D Mercury Sable 2002 Go Your Blue Booko Value show used Car Prices I Price Your Next Car 2002 Mercury Satite THE ALL-NIEW 2015 CMC �T style: GS Wagon 4D 11 IM ,,j Edit options i Check specs Mileage: 150000 Change LIk* Trade In Get an Instant Sett to a Print report to a Dealer Cash Offer Private Party Redefining the midsize pickup truck. LEARN MORE Price a New Car Advertismert Why ads? Then browse reviews,photos, parr reoa specs and more. c very Cwd re. C—d ond— $1,803 C-61,on THEALL-NEW20 See what you should pay 15 GMC CAN C—dmom Sell Your Current Car Reach millions of buyers on KBB.corn and AutoTrader,com —4— Place an ad Redefining the midsize pickup truck. Fair Condition LEARN MORE Private Party Values /12/2015valid for your area through Adverts Why ads' 2 Track this car's values Tell Us About This Car Owners like you rated the 2002 Sable 8.1 out of Write your own review 10. Next Steps to Setting Your Car llu�ve;ed luv Get an Instant Cash Start your offer Auto Offer nader(.= Find dealers ready to buy or trade in your car-today! Adveftisemert Why ads? 1 of 2 2/11/2015 10:34 AM ;20i5 E? FUSION oorxrner +HYBRiC7 `'" rret e w b. r• 2015 FUSIONGe Fvmwr +HYBRID 71 12075 FUSION +HYBRID Chorre Mai r acursr>Chattga Year&Modal> Change options>Values14 ---—�. fr345r'-7t7-G4a«'. 1957 Ford Fairlane 500 Skyliner 2 Door Retract.Hardtop l Research another classic or Values Original Low Average neigh MSRP Retail Retail Retail Base Price $2,942 $15,800 $31,700 $59,000 I Optiorlst ithann e) 312/245 HP V8 Engine 15% 15% 15% TOTAL PRICE: $2,942 $18,170 $36,455 $67,850 Sell your classic or performance car fast!Ust It with AutoTawecaossics,com now. l i I f Search Local Cars for Sale Classic Car Financing Find 1957 Ford Fa!riane 500 Skyliner Collector Car Loans: listings near you Get approved quickly and safely Powered by AlrtaTrader Classics Classic Car Buying&Selling Services Starch Iota!used car listings Buy a classic car price guide 11)31 or newer:?Get the full vehide history free insurance quote for your classic car Sell your car now on AutoTrader Classy:s YattNe T1�ae Definkians Manufacturer suggested Retail Price LOW Retail Valise This vehicle would be in mechanically functional condition,needing only mirror reconditioning.The exterior paint,trim and Interior would show normal wear,needing only minor reconditioning.May also be a deteriorated restoration or a very poor amateur restoration.Most usabie'as-is'.This value does 11Stt represent a'parts car'. NOW;Some of the vehicles in this publication could be considered'Daity Drivers'and are not valued as a classic vehidw When determining a value for a daily driver,lit is recommended that the subscriber use the low retail value. Average Retail Value This vehicle would be In good condition overall.It could be an older restoration or a weli•mainta!ned original vehicle. Completely operable.The exterior paint,trim,and mechanics are presentable and serviceable inside and out.A'20-footer. Investment Statement USAA April 1 to June 30, 2014 USAA Investment www.usaa.com Management Company 1-800-531-8722 (USAA) 03476.1FB8Y.JSS880740871.05.01.83 4 P.Q. Box 659453 San Antonio, TX 78265 LESLIE L BLOIJIN USAA FED SVGS BNK CUS I L Member number 0005$2467 Member since 1962 LESLIE L BLOUIN 13 GEORGE CIR MECHANICSBURG PA 17055-4708 You asked, we listened! Simplify and consolidate now We now offer Deposit@Home and Deposit@Mobile for Get professional advice, education, market insights and tools investments. Eligible non-retirement investment account types to simplify and consolidate your portfolio. Visit include brokerage, mutual funds, and managed money usaa.com/investments. portfolios. You must qualify for this service; for eligibility requirements visit usaa.com. Portfolio Summary "POW6: iu Portfdlio:-perfoirmance w�*i . .......... .......... Portfolio value $70,592. 13 $80,00 March 31, 2014 Earnings 475.48 $60,00 Change in market value 2,284.51 $40,000- Total portfolio value $73,352. 12 $20,00(L June 30, 2014 $0- 2010 2011 2012 2013 2014 Annualized total portfolio return 15, 12% The total return is the annualized percentage change in the value of your mutual fund portfolio over the past 12 months. Value on % of June 30, 2014 portfolio Large Cap Stocks $44,751.44 61.01 Taxable Bonds and CDs 28,600.68 38.99 Taxable Bonds and C s Total portfolio value $73,352.12 100.0046 ... Large Cap Stocks Please review this statement and notify us of any inaccuracies within 10 days, Oral communications should be re-confirmed in writing to protect your rights. For details on the Information in this statement,see"About Your Account". 9800 Fredericksburg Road, !\ t*S44.M S;tn Antonio.Texas 78288 t us ® Contract Information Sheet Contract Details Type of Contract: Flexible Retirement Annuity Annuitant: Leslie L. Blouin USAA M 0582467 Contract M J528175426 Beneficiary: DORIS I BLOUIN Contract Benefits Summary 1 Accumulated value: $94,686.50 i Documents to return Return the following documents in the envelope provided or fax them to 1-817-43.5-7099: • Claimant's statement • Copy of death certificate stating cause of death: required before funds can be disbursed. • Annuity Claim Settlement Request Form • Tax Withholding Election Form: If we do t rec 'v a completed from, we will withhold 10% of the taxable amount r federal i c e tax and state tax when applicable. The value as of this date s $9,686.5 . If y u have a different tax withholding preference, please indic it on the enc sed form. • Beneficiary Designation Form: Complete rm only if you are changing ownership Recommendations • If you arc selecting a lump sum payment, we can open an account with USAA Federal Savings Bank that will pay you all additional 0.5% above the daily posted rate for one year. Please call 1-800-531-8455. • We have allotted time with a financial advisor at no cost to you. During your appointment, your advisor will answer your questions, provide guidance, address any concerns and review your financial plan. Option(s) The following are the options available to receive the proceeds of the above contract: • Change Owner: You may elect to change the contract ownership and become the new owner and annuitant. All other terms and conditions will continue in the contract's current status. • Single Premium Immediate Annuity (SPIA): If a settlement option that provide for regular periodic payments is selected, IRS regulations require that such payments begin within one year from the date of death. If you are interested in this option, please call 1-800-531-8455. • Lump Sum: You have the option to receive the proceeds in one lump sum. The interest on these proceeds will be taxable in the year paid. Financial advice provided by USAA Financial Planning Services Insurance Agency, Inc. (known as USAA Financial Itsurance Agenqy in California), a registered investment adviser and insurance agency, and its wholly owned subsidiary. 98183.1214 REGISTER OF WILLS CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA AF CU No. 2014- 01184 PA No. 21- 14- 1 184 Estate Of: LESLIE L BLOUIN O �a (first,Middle,Last] 1 Late Of: UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY Y 1 1 Deceased 1750 Social Security No: WHEREAS, on the 17th day of December 2014 an instrument dated August 11th 1993 was admitted to probate as the last will of LESLIE L BLOWN (First,Middle,Last) late of UPPER ALLEN TOWNSHIP, CUMBERLAND County, who died on the 19th day of November 2014 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, LISA M. GRAYSON, ESQ. , Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: DORIS I BLOWN who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VA NIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 17th day of December 2014. AA 2CIPc- Hegis W of Will l ly'v A �. ,1 eputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TESTAMENT rri C> ac ri — OF FC11.2 7J LESLIE L. BLOUIN 171 C-3 I, LESLIE L. BLOUIN, of the Commonwealth of Pennsylvy�nia,Ide�i4.re that this is my LAST WILL AND TESTAMENT and I revoke all othet--?dif1s7n' and codicils previously made by me. LD FIRST: I appoint my Wife, DORIS I. BLOUIN, as my Personal Representative concerning this Will . If she is unable or fails to serve, I then appoint my daughter, CORINNE P. REBINSKI to serve as my Personal Representative. a. I request that my Personal Representative be permitted to serve without bond or surety thereon and without the intervention of any court, except as required by law. I direct that my Personal, Representative act in unsupervised administration so as to administer my estate with a minimum of court supervision. If it becomes necessary to have ancillary administration of my estate in any jurisdiction where my Personal Representative is unable or does not desire to qualify as ancillary legal representative, I appoint as such ancillary legal representative such individual or corporation as my Personal Representative shall designate, in writing. b. I direct my Personal Representative to pay the expenses of my last illness, the expenses of a funeral appropriate to my station in life and custom of living (including a suitable monument or marker for my grave) , and written charitable pledges which I have made. I grant my Personal Representative the power to extend or renew any debt for such time as my Personal Representative shall deem appropriate. C. All estate, inheritance, succession and other death taxes with respect to all property passing under this my Will shall be paid from and borne by the principal of my residuary estate, without regard to reimbursement, as if such taxes were administration expenses . My Personal Representative may pay such taxes at any time deemed advisable, whether or not then due and payable. d. My Personal Representative is requested to settle my estate as soon after my death as may be practicable, and to pay or deliver every legacy or bequest to my beneficiaries without waiting any time that may be believed to be customary in probate matters . PAGE 1 5 PAGES e. I have served in the Armed Forces of the United States. Therefore, I direct my Personal Representative to consult with a Legal Assistance Attorney at the nearest military installation and with the Department of Veterans Affairs and the Social Security Administration to ascertain if there are any benefits to which my family members are entitled by virtue of my military service. f . I may leave a letter of intent with the executed copy of this Will for the purpose of giving guidance to my Personal Representative concerning the distribution or sale of certain items of my property. I request, but do not require, that my Personal Representative honor my wishes therein expressed. SECOND: I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or possessed, or to which I may be entitled, at the time of my death, wherever situated or of whatever nature, be it real, personal, or mixed, to my Wife, DORIS I . BLOUIN, as her sole and absolute property if she shall survive me. THIRD: In the event that my Wife, DORIS I. BLOUIN shall not survive me, I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or possessed, or to which I may be entitled, at the time of my death, wherever situated or of whatever nature, be it real, personal, or mixed, as follows: Twenty-five ( 25% ) percent of my net estate to my son, LESLIE E. "PETE" BLOUIN and Seventy-five (75% ) percent of my net estate to my daughter, CORINNE P. REBINSKI. a. If any of my children shall not survive me, then the share of that deceased child shall go to the descendants of that child, who are to take per stirpes and not per capita. If any of my children shall not survive me and shall not be survived by any descendants, then the share of that deceased child shall be distributed to my surviving children and the descendants of any of my other children who fail to survive me, in the manner set forth above. b. If they are unable to agree, the division among my children and the descendants of any of my children who fail to survive me shall be made by my Personal Representative, in that person' s sole and absolute discretion. I empower my Personal Representative to sell any or all of such property, if such property is not distributed in kind hereunder, and to distribute the proceeds among my said children in substantially equal shares . Any determination of my Personal Representative as to what should pass or be sold under this paragraph and to whom it should pass or be delivered or at what price it should be sold shall be conclusive. PAGE 2 X-e-,4 - &C(F 5 PAGES FOURTH: If there is a complete failure of takers under the preceding paragraphs , the property undisposed of shall go to my heirs determined at the time of my death, pursuant to the Statutes of Descent and Distribution in effect, in the state of my domicile, at the time of my death. FIFTH: Except as otherwise provided in this Will, I have intentionally failed to provide for any other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. SIXTH: Any beneficiary who fails to survive until one hundred twenty ( 120 ) hours after my death shall be deemed to have predeceased me, and the gift to that beneficiary shall be disposed of accordingly. SEVENTH: Definitions : a. The term "children" as used in this Will includes adopted and afterborn persons . The term "children" as used in this Will shall also include step-children, the natural born or adopted children of a person' s spouse who are not the natural born or adopted children of the person. A relationship by or through legal adoption shall be treated the same as a relationship by or through blood for purpose of succession to property under this Will . b. The term "descendants" as used in this Will means the immediate and remote lawful, lineal descendants by blood or adoption of the person referred to who are in being at the time they must be ascertained in order to give effect to the reference to them. C. The term "Personal Representative" as used in this Will means Executor, Executrix, Independent Executor, or any other title of like import which is used to describe such a fiduciary. d. The term "per stirpes" as used in this Will. means that whenever a distribution is to be made to the descendants of any person, the property to be distributed shall be divided into as many shares as there are (1 ) living children of the person, and ( 2) deceased children, who left descendants who are then living, of the person. Each living child (if any) shall take one share and the share of each deceased child shall be divided among his then living descendants in the same manner. PAGE 3 !'�`�F 5 PAGES _ EIGHTH: In addition to any powers granted by the laws of the state in which this Will is probated, I hereby authorize and empower the fiduciaries named in this Will, to the extent of the discretion herein granted, to sell, exchange, convey, transfer, assign, mortgage, pledge, lease or rent the whole or any part of my real or personal estate, to invest, reinvest, or retain investments of my estate, to perform all acts and to execute all documents which my fiduciaries may deem necessary or proper in regard to my property. If any of my fiduciaries elect to receive compensation for services , such compensation will be that allowed by law. NINTH: If any part of this Will shall be invalid, illegal, or inoperative for any reason, it is my intention that the remaining parts, so far as possible and reasonable, shall be effective and fully operative. My Personal Representative may seek and obtain court instructions for the purpose of carrying out as nearly as may be possible the intention of this Will as shown by the terms hereof, including any terms held invalid, illegal, or inoperative. IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, this 11th day of August, 1993, set my hand and seal to this my LAST WILL AND TESTAMENT, consisting of 5 typewritten pages, each page bearing my handwritten signature. This document was prepared under the authority of 10 U.S .C, section 1044, and implementing military regulations and instructions, by JOHN F. MILLER, who is licensed to practice law in the State of Ohio. —(SEAL) LESLIE L. BLOUI PAGE 4 - !✓�/ OF 5 PAGES /� The foregoing instrument was, at Carlisle Barracks, Pennsylvania, this 11th day of August, 1993, signed, sealed, published and declared by LESLIE L. BLOUIN, the testator, to be his LAST WILL AND TESTAMENT in the presence of all of us at one time, and at the same time we, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do so verily believe that the said testator is of sound and disposing mind and memory at the date hereof . x� OF OF C '�.� ��- OF }k Cog S 7o t-3 PAGE 5 ,ice �r :z ,,p1� 5 PAGES _ COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY ACKNOWLEDGMENT I, LESLIE L. BLOUIN, testator, whose 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. (SEAL) S . BLOUIN f� AFFIDAVIT We �1�V����- S , k S f"c-K- GeOZCc" and AArl �. �.`IQ� the witnesses, sign our names to this 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 the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; 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.U 4�4 Witness Witness witntYss Subscribed, sworn to and acknowledged before me by LESLIE L. BLOUIN,, ,the testator, and subscribed and sworn to before me by e -TK Gt?b g-6C , and .� n�n Ml1�Qf the witnesses, this 11th day of August, 1993 . NOTARY U LIC My Commis fo -mumf C�te AAy Ocvrn�ssJpn F.xpirot OG.18,1 libber,Pertttsh-wia Assr&,bn M, ►�*?n,n HAZEN ELDER LAW Estate Planninz -Elder Law -Special Needs.Planning 2000 Linglestown Road TEL: (717) 540-4332 Suite 202 FAX: (717) 540-4313 Harrisburg,PA 17110 www.HazenE]derLaw.com July 1, 2015 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Leslie L. Blouin File No.: 21-14-1184 Social Security No.: Inheritance Tax Return To: The Register of Wills: Enclosed for filing please find the original and one copy of the above- referenced Inheritance Tax Return and Inventory, along with a copy of the first page of the Inheritance Tax Return. Please date stamp the first page of the return and a copy of the Inventory and return them to my office in the enclosed self-addressed envelope. If you have any questions or require any additional information, please do not hesitate to contact me. Sincerely, Tiffany J. Mutzabaugh Legal AssistantM. , o , Enclosures o, M c a.:, o cc: Doris I. Blouin M.. r--- u, rn x x a c� rnrn � > r- `- rn Mo. z � ;z p C= _.. c>. ,; o C r- trrn.. ..�. -off o coo.. .. v� �. i' NOW PITNEY BOWES RD'E1) CSF �1 ;oF $002.52° Ls O2 1P REGISTER 0000561449 JUL 01 2015 MAILED FROM ZIP CODE 17110 ?015 ALL ' ' 30 CLERY, OF ORPHANS' C,OUR Hazen Elder Law i 2Q00 Linglestown Road Suite 202 ! Harrisburg, PA 17110 TO: �I Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013