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HomeMy WebLinkAbout07-08-15 ]Ma6eT000C J 1505618627 pen�sylvania 'EZN��a1 Q6i REV-1500 �F���A�u5E���T �o���,��e rea, F;�eN�mee� e�ree�mi�a���a�ai-a.�s INHERITANCETAXRETURN 21 y5 0069 ao eox ieoeoi RESIDENT DECEDENT HemsOu� , PA 1]1280fi01 ENTER �ECEDENT INFORMATION BELOW SoclelSecurltyNumoer oaleolDealM1 MMoorvvv Deteo(Bitlh MMDovvvv 01102015 0814192� Decedenfs Las�Name SWfix oece0enfsFlrstName MI KARNS BETTY I Qt Applicable) Enter Surviving Spouse's Information Below MI Spouse's Last Name Suffix SOouse's flrs�Name THIS RETURN MUST BE FlLEO IN OUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS 9ELOW � 1. Ori �nalReWm �_�"i �� SupPlementalReWrn 3. RemaintlerReWm(tlateofdeatM1 9� prior to 12�13-82) � 4. AgriculWreExemption(tlaleof � 5. Fu�ureln�erestCompmmise(daieot � 6. FetleralEslaleTaxRetumRequiretl dea1�on or et�er]4-20127 deaih efler 12-�2A2) O ]. Decetlenl Dietl Tes�ale ❑ 8. Decetlenl Maintalned a Lihng Tmsl 0. 9 Total Number ol5afe�eposit 9o+es (Atlec�mpy of will.) � (Atlech copy ol imSL) � � 10. Liligalion Procee�s Receivetl �� Non-Pmbate Trans(eree ReWrn � �Z, �eferraVElection oi Spousal Tmsis (Schetlule F antl G Assets Only) � 13. Business Assets � 14. SOouse Is Sole Beneflciary (No�mst involvetl) CORRESPONDENT- THIS SECTICN MUST 6E CCMPLETE�.FLL LORRESPONOENCE PNO CONFIOENTINL TA%INFOFMATION SHOULO BE OIFECTEO i0'. Name Daylime Telephone Number KEITH 0 . BRENNEMAN 717-697-8528 Firet Line of Atldress 44 WEST MAIN STREET Secontl Line of Adoress Ciry ar Post 0((Ice Slala ZiP Cotle MECHANICSBURG PA 17055 ,o � � cn � m CorresponEenfsemailatltlresr. _ -- - � - � �9.Y��� — � � � � � 0.EGISTfTfICFAJII(L511S ONLT�p 1 a =. r rim � REGISIEROFWILLSOSEONLY C ' C� � :_] 0 DATE FILEO MMO�VYYY � O 1.J �J C r �� T �l � � 3 � � N � �n I . =' � I oP�viiEosrnnw^i (n �J _`� PLEASE USE ORIGINAL FORM ONLV Side 1 IIIII����IIIII��I��I�IIIIII�����IIIII���IIIIIII����IIIIIII�� � L 15�5618627 1505618627 J I J � 1505618635 REV-1500 EX(TP) DecetlenYs Social Sewriry Number oe<ee��r.NameKARNS BETTY I 2� RECAPITULATION 1. Real Es�a�e(Schetlule A) . . . . . . . . . . . . - ' - . . . . 1. � ��� 2 S�ocks and�ootls(ScheOule 6) . . . . . . . . . . . . . . . . . . . . . . . . . 2. � •�0 3. Closely He10 Cotporatlon.Patlnership or Sole-ProprietorsM1lp(Sclmdule G7 , , , , 3. 0 • �� 4. Morlga9es and Notes Receivable(Schetlule 0). . . . . . . . . . . . . . . . . . 4� � •�� 5. cesh.aank oepasi�s en�Mlscenaneous Personai Pmpetly(SeneaWe E), . . . . . 5. 212+656 • 65 6. Jolmly Ownetl Pmpetly(Schedule F) � Separato Billing Requesletl. . . . . 6. � • 00 1. mter-Vivos Translers 8 Miscellaneous Non.Pwbale Pmpetly � O� (SCM1eduleG) r ] SeparaleB111ingRequesletl. . . . . �� s. rotai cross nssets Ootai �ines t mmugn�) . a. 212,656� 65 9. Funerai expenses ano ndminisvative Cosis(ScnetlWe n�. . . . . . . . . . . . . s. 5�4 2 2 � 46 10. Deots o(�ecetlent Mortgage Gebiii�ies aotl Llens(SchetlWe p. . . . . . . . . - 10 4 �$58 ' 3� i t. rotai oeauctions(to�ai �ines s ana ID1. . . . . . . . . . . . . . . . . . . t t. 9,980 � 76 i 2. r+et vaiue oi estate(�ine 8 minus�ine t t) . . . . . . . . . . . . . . . . . . . t 2. 2 0 2�67 5• 89 13. Chari�able antl Govemmenlal BequeslslScc.91131'ms�s lor whic� 3 113,498 •50 an elec�ion lo�ar�as no��een ma�e(Sc�etlule J). . . . . . . . . . . . . . . ia Netvamesuejectroia.(Linetzminus�inet3). . . . . . . . . . . . . . . . ia. 89,177 • 39 TAX CALGUTATION- SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount oi Line t4 laxable at�ne spousaltaxrate.or IransfersuqQerSec_9118 � �� 0 ,00 lel(t 21 X 0�� 15 16. Hmount of Line 161axable 0 • �� aliinealratex.04b � • �� ��' n. nmount oi Line ta�axable � �� 0 �0� a� siou�q raie x .iz "� is. amoumm ����ei< �n*aeie 89,177 � 39 �a. 13,376 � 61 a�cone�erei ra�e x .is i5. tnxoue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �s. 13,376 -61 20. FlLL IN THE BO% IF VOU ARE REpUESTING A REFUNO OF AN OVERPAYMENT O Untler penalt�es ot p¢llury.I tleCare�M1at I�ave examine0��i5 reWm.Including accompanying sc�e0We5 and s�alemen�s,an0�o�M1e�est o!my knowle0ge entl�elial. �e �is v�e c e��em mmvieie oeCa,enon or p�eva, ,mne��nen ino v=w� 2.000sieie ro� nn����na rewro is eazoe o� en ���om,aoo�o�wmm� p«aa,�r nes eny knowledge DA1E SIGNAIURE PE SON E ON IBL$ _ E FOR�I TURN/ � � /— �C—�S ��/�l! r� �° qooaE s STANLEY MIJRP Y, EXECIJTOR 599 MARGARO ROAD, ENOLA , PA 17025 SIGNA1URPj�PREPFHEROIHERTHANPEH50NHF5PON51f1LEFORFlIINGTH[REiURN �ATE �d 1�� � � �� AUURE55 KEITH 0 � BRENNEMAN, ESRIJIRE 44 WEST MAIN STREET, MECHANICSBIJRG, iiiiiiiiiiiiiiiiiiIiiI iIiiniii�ii�iii�i�iimuiiuiiimi s�de z � 15056 6 1505618635 J �mncasi0000 Htv-isoo Ex�rv:, aage s F;m Humter DecetlenYsCompleteAtltlress�. 21 15 0069 uECEOENrs NnME KARNS _._ _ _BETTY . _ ._ I -- . STREFI�ADDF655 @ETHANY V.TLLAGE 3�L�SLE 'L7LR �__ — - – ------ LOWER ALLEN _TWP - , C M�AND COUNTx . . cm . .. .. -. . _srnre –� zia - MECHANICSBURG PA 17055 Tax Payments and Credits: i. 1a*ouafPaee z���,e ieJ (i) _ 13 ,37 6 � 61 2 GretlltslPaymenls A. PriorPaymen�s __ LD ,oqo_. 00 e o;��o��, s o o . o 0 (Sae�msimc�ions.� TotaiCratllts(n� o) 1�1 ,_, 10'5�� •�� 9. Inleres� (3) � . 0� 4. I�Line 2 Is grealer IM1an LNe 1 � Line 3,enle���e di�ference T�Is Is�he OVERPAYMENT. Flllin oval on Paqe 3,Line 30torequesta relvnd (4) - — � � ��_ 5. it�'�net . �ines ��sgreaierman�ine2.Pn�ermeaiaerenrz.misismernxoue. �si __ .__ 2,876 • 61_ Make check payable to: REG�STER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS i. o�aae�eaemmakaeva�sie�a�a- v� I��OI a. retain��e use or'mcome oi IM1e O�operry vansierre0 . . . . . . . . . . . . . . . . . . . . . . . . . . . � ������ b. relam��e rigM to tlesiqnate wM10 shall use��e pmperty Vansferretl or its income . . . . . . . . . . . . . . ❑ LI c. relain a reversionary�interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 � d. receive IM1e pmmise�o�I'de of ei�M1er paymen�s.bene�i�s or careY . . . . . . . . . . . . . . . . . . . . . 2. If tlea�M1 occu�re�afler Oec. 12, 1982 aid decetlen�Iransfer pmpe�y wil�in one year ol dca�� r witM1oul receiving atlequa�e conslQera�ion'+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . �L� II x`'II 3. Uid oecetlent own an"In IrusiloP or payable�upon-0ealn Oank amounl or sF!curiN at M1is or M1er deatM19 . . . . . ❑ LAl 4. Did tlecedenl own an Intlivitlual re�iremenl accounC anwlty,ot ol�e�nompmba�e pmper�y.wM1ich �v� conlainsabeneliciarytlesignalion9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � u IF THE PNSWER TO ANY OF TNE A60VE pUESTIONS IS YES, YOU MIIST COMPLETE SCHEOOLE G NN� FlLE IT AS PART OF THE RETURN. Fw Ga�es oi deat�on or ailer July t. 1994, antl be�nre Jan. 1. 1995.Ihe lae rate Imposttl on I�e net value of transfers�o or tor�M1e use ol I�e surviving spouse Is 9 percenl�]2 P.S.�9t 16(a)(1.p(l)�. for aates o� 4ea�M1 on or aflcr Jan. 1. 1995. IM1e tar ra�e Imposed on �M1e net value of trans�ers lo o� br ibe use of �M1e surviving spouse Is � percen� �]Y P.S.§9116 (a)(1.1)(li)�.T�a s�aW�e tloes no� exempt a hansie�lo e survlving spouse from lax.and(M1e sla�ulory reqwremen�s�or dlsclosure of asu�s antl filinq a lax reNm are still appllcaDle even If ihe survivrng spouse Is iM1e only Oeneflciary. Por tlale5 01 tlPdt�on or diter July 1.2000'. • The tax rale imposetl on ihe net velue of hansfers irom a Ooceasetl cM1lld 21 yoars of ege or youngor at tleatM1 to or for IM1e use of a naWrel perenL an adop�ive Oarenl or a s�ep-pdren�o�IM1e chlld is 0 percen�[]2 P S§9�16(a7�1 2J�. • TM1e tax ra�e Imposetl on the ne�value o��rans(ers�o or for I�e use of iM1e deceden�'s llnoal bene�iciaries ls 4.5 perwnl.excep�ds no�ed m�>2 PS.§9116�a)(¶�. • ihe lax rato Imposetl on IM1e nat value of Iranslere lo or for IM1e use o(Ino tlecetlenfs siblings Is 12 perceN �12 P.S�91 i6(a�(1 3)�. A sibling Is tlefinnd. untler Sedlon 9102,as an InOividual w�o M1as at least one parem In common wI�M1�M1e dewaen�.wne�M1er by blootl or atloplion ou�cv� acoo u_v-isoe�rc.wa.n i '� pennsylvania , SCHEDULE E �P�+*�M�F�E�^'uE ' CASH, BANK DEPOSITS 8 MISC. '""Ea"^"`t"'a"0P"� PERSONAL PROPERTY FlLE NUMBER: ESTATE OF. HettY I. Kar_n@ . _ _. ._ _�r � . . . 2115 0069._ __ Indutl �� p tl5o�litg 1 ne0alelF poceetls - . �yl sta�e. Allpro0etly�o tly wnetlwt� 'g��ofsurvivo5��pm __�. _ —.- ust ee tlisclo a SCM1etlule . IT[M � � VAWFATDATF NUMBER� . DESCRIPTION ...�, OFDEATH � � 139,311. 90 1., Fultw Bank �. '�.Certi£icate of Deposit R223-0028298 Interest accrued to 1/10/2015 539.40 2 MST Hank 53,153.46 checking accovnt N33366632 Interest accrued to 1/10/2015 0.05 3 PNC Bank, N.A. 21,624 .20 Centi£icate of Deposit, account #31600154384 Interest accrued to 1/10/2015 2�' 64 9 State Employees' Retirement System 0.00 Pension payment in the amount of $555.07 due the decedent. This is non-taxable and is listed for information purposes only ' . _ _ — . .._ I� ._ _ __—__. .._ _- TOTAL IAlso emer on Ilne 5.RecapiWlation� S I 212,656.65 zwnsnu x o0o u moro:paoe a�e aee.�se aaenlo�aizneeis m peoerama same sa.e. � � ""`"`" °"„' SCHEDULE H �� pennsylvania o� � aE„� .,�E �� FUNERAL EXPENSES ANO I c RErp,� ADMINISTRATIVECOSTS io ..m. � —�.— . _ .——. _-, —_ ___. —.__ . ___-- _---_-_ -- -- RLENUMBER ESTnTE OF 2115.0069__ _ - _— Aet�._.I. Karns . _ - � -- � � DecetlenPs tleb[s mus[be reponed on SCM1etlWe I. _ _ . _ _ . . . _- . .. - . . _.__ . _ _—_ _. _ . ._ _—.. NUMBER �' DESCRIPTION � AMOUM ._ . tI "--_ . _ _ .— _— _. A. IFUNERALEXPENSES� � � 544.56 � IMusselman Funeral Home B. 'I ADMINISTRATNE COSTS. �. PersonalRepresenla�iveCommissions�. , Neme�s7 of Personal Represemative(s)_ ._ .. _ . . --- - SireelNtltlress ._ - --.. - .. . Ciry __.�._ _ .__ Stale _ _ 21P _ _ Year(s)Commission PaiQ._ .__. - ---- �— �--—I z. . FlimmeyFees: Snelbaker & Srenneman, P.0. (Es[ima[ed) 3,000.00 3, Family Exemption� (If deretlenCs atltlress is not ihe same as claimanfs,atlacM1 e�lanatim.) Claimant ____ _-- .— - -- - - , SVee�Atldress _ . ._— . - ._ ._--.- — _—_ � �.�Y Stale _.. _ZIP _ Rela�ionsMp of qaiman��o Decedenl _ . ____ ._. _-- --- -- 330.50 4. Pmbale Feei � 250.00 5. AccountaniFees' 6. TaxReWmPreparerFees'. ]. 1 Cumberland Law Journal ' adveztising £xecutor's Notice "l5.00 2 The Sentinel I advertising Executoz"s Notice 222'4� ITotal £rom continuation schedules . . . . . . . . . I 1,000.00 .� . _ . . . . II.. __ _ .- _. ____ _— TOTq�(nlsoenteronLine9,Recepiwlalion)� _ 5 4� 22.46 wn5we z000 If moro space Is neetle0. use atlditlonalsheels o(paperof��e same 4ze. 21 15 0069 Estate o£: Betty I. Karns Schedule H Yart � (Page 2) 3 Reserve £or £iling fees, accountant £ees and other miscellaneous costs associatad with the 1,000.00 administration o£ the decadevt's estate 1,000.00 Total (Carry £orward to main schedule) " � SCHEDULEI pennsylvania ' ce o .e�tiue DEBTS OF DECEDENT, � �� � �.ET�v� MORTGAGE LIABILITIES & LIENS a sce cect * .-_— __. _ ._:-_- ._. _ —.. .._._ _ _ _ _ . ESTATEOF FLLENUMBER Betty _I._ Karns 21 15 0069 Report tlebis Incwretl by tbe decetlent prior to tlea�M1[�at remainetl unpai��at IM1e tlate of tleatq intlutling umeimburse0 medlcal espenses. ':EM ''. � �. . �� VAWFAT�ATE Ni�MqEpj pESCRIViION. .__._. ._ .. _ _ OFDEATH -�__. _ . .-__ _. _ . _. - �� �Hethany Village � nursing home care 4�49�'S� 2 Medicine Shoppe perscription medication expenses 15.15 3 Mobilex medical services provided to the decedent �, 95.58 I _- ._- __ . _ .. . _ —'"__ _._ — "'. _—_ __ . TOTnL(Aiso emcr on Line 10,RocapiWla�ion� E _ _4 558.30 ,,n,,,�pry z oo� If more space Is neetleq Inseh atltlitional sbeets o(Ne same size. �`�^�„�'.,°, ,°, SCHEDULE J � pennsyivania x«�^^F�^�F°E�^"� BENEFICIARIES ���,ER�,���E.Ax RE,�RN rssoeNroecec�Hr . �.. _ — --. _. --.. _._ __—. — — .—.--.-- --- � � ' FlLENUMBER: ESTATE OF'. pl 15 0069 . _ Bet� I. Kains__ . _. - —� ' � �-" � RELAlIONSHIPTODECE�EM �AMOUNTORSH�RF DNMENNOA�ORESSOFPERSON(5)RECEIVINGPROPGRTV DONatListTmstee157 OFESTATE NUMBEN _ _ _._ - � - �— I � .nx�e�EoisTRieunoNslmseosi�6�(alpu2 j � er mna�s�e�s��ae� � IStanley Murphy ', 599 Margano Road Enola, PA 1"]025 444 0£ Residue: 89,19"]. 39 None 89,199.39 I I �EMERWItARAM0UM5FORDISiRIBlIDON55lfJNMFBOVEONLMLSt51tlROUGHtIBOFNEV-150�COVERSHEET.ASA�VROPRIATE _ �� NONTA%FBLE�ISTRI9UTIONS I A SPOUSAL DISiRI�U11GN5lIN�ER SECt10N 91ll FOR WIIICH AN E�EC.LION i01A%IS NOT TBKEN� 1 � 9 CtWRITPBLEANOGOVERNMENTAL�15TR19U��ONS � See Attached 1 I _ _ —.— �_ . -_ _ _—_ . . . _ _. TOTALOFPARTII-EN1£RTOTALNONTAXABLEDISTRI�UTIONSONLME190FREV-0SOOCOVERSHC-ET. IS_ . 1�3 498.50. - ��-�— � II more space is neetlerl. use atldltionzi sM1eets of paper of ibe same size. Estate o£: Betty I. Karns 21 15 0069 Schedule J Part 2H (Page 1) Item No. Descniption Amount 1 Grace Onited Methodist Church 309 Herman Avenue Lemoy�e, PA 1�043 938 of Aesidue: 8�,150. 63 8�,150. 63 2 Christ Lutheran Church Filey's 15 South Filey's Road Dillsburg, PA 17019 54 of Residue: 10,133.�9 10,133.79 3 Bethesda Misson P.O. Box 3041 Harrisburg, PA 19105 34 of Residue: 6,080.28 6,080.28 4 Christ Lutheran Church Filey's Cesetery Association 15 South Filey's Road Dillsburg, PA 17019 24 0£ Residue: 4,053.52 4,053.52 5 Samaritan's Purse P.O. Box 3000 801 Bamboo Road Hoone, NC 28607 39 of Residve: 6,080.28 6�080.28 I ��iN'II.L;A?DTh�I ASIcNI c�F - 6C I'I 1' I_F 11:�'ti ���� I. HG7Tll I.�RVS,cIOplcrlllen�I�o�cnshipQ�mhadundC�. nicPcnus�li�anl�a. I ���wn ol : un�on� I p ununiL mc nup�nd un0 r t i 1 '.do h -.l. n Lc. publ � ��ul � de i e�na as und hr in I�u� \4ill and Tt�mmcnt h � L ��king an I ur�A'ng coiA m" id ull wlllsb- atun}'w h �i I� e ��J� �, I dimet that�II my J�bts�nd fvuerol eapu�ses be pald u�'s n +pmcti�I ofi�r my .��,�� d�athb� nYGsuvt � hr�liaftcrn�md. i I lurther Ji thN�II CIXes tli��mey be tis'tssal Li cons'equcn�c c t m�dmtli Fe paid �� Cmmm r 'il� v} eslite�s'pnnofili sEe�scsoCudmv'vuio�of�n �latr. I �,i ��,dc i e and Mque �h J7 tbe rest,rc due�nd mmai� 1 r o�my esta2.reul. pe�suwl and mix�d.and uh<resoe i Mc:ome ma h�s�luat�.as f�Ilu�+ q, I pivc Fonr-Cou�puccnwm(44°/oJ ofmc csmtz m STAVLEY MGILPHI'. R. I yive Furty-Uvrz pcmvnwm(43°o)o(my wia¢to GkAC H G61 fF.D .� 111 "fHODIST CHURCH in Lemoyn I �u�s'h'uni�.. Ihi:I cyimst ro Grac, Unitcd�lethudistChi chinicmo)neni adcinmu p .fine,m�nothcr_ ADA G. KI�ILNS.and am'lainil}'. C Iti eli �.� ecnmmp lotmv� tat IOIIILY'SLUIIIIR.11�'UICRCH �- In Dill Li I vIU zi euJ ��s ond p� 1 es I�hLs 1 � � :i �Je cmnrv oCtl I �I} �f01IA I It �d RCRI CC11101 I.INbGR i ) n xhei nUn � I10111A( lRK,1R\S ulim'sdl � p, Ignelhupuce�nul_°b]olm)estolem817HESDAMIS510Nu1 �1 � � I ._.9d11L � .... o . -_ �- � E�� �A']�ll'fLCI1LlI1P(��n)O� IIIA 'til'dll�0 �'��-�=��� � � ����'«�'�� �����'�� �� = EA ��� c F�u:reia��,assuci,i riuN r������ ����<�i �s��, ���i i� ,i„�.�,_ �� c i ��.��ii,�����„=z������, �-°.o,orn-�5����„s,�<u�n�:�ns �cityr.,�r Soonc.�:,rdi C.mlirn.ur iti sucJc-.�or_ I.�ihumeniV ��LCI AILltlbi}' -, ,�:Idpi�l � .�nw_IdI itl �..� dirvhu_ Iu�cculJ �� �,.,., - _ �� ,ai���<<„ i,;in�_,������,���,it.�cto�inonicrnooisrcuraui. 3. 1 hcrd�c i i w_cnn>tinue s�J'vpV�l a S I AVLt}' V�II IRI hl a>I'em�eornl thls IIIm. L � \\ I �iudlei n -i. ifinl i Iurii.v �pC. � i ��U.Jln �l � '' � nl.�muund � �o i i� Ihiihl�-li I �:u��na �lhi,di 'c-nth�C n rvaubh<� I nolc:.du. �ln am utlierjurind�wtiuu- Il�U9lNL�S VA I IChGOf, I h i "hm'cwrto sct .�}hanJ ond- ',il m thlv up' I?s� R'ill und � lrs�amenl wriitcn on T�m('_)D�'=�s Ihis 7'"d�,rv ol'Oc�oba,2(11 I. j � ���, `l ,) �� l '"-�ti&�L) i3<�i�-i. ti,a,�,.�.: � � SI•�ed.sc I d. �allis'hed and�ecda�ed b�BL 1"Il I.hARN� ih T stalns ub� �c numad, as�nJ lon c�r L:ul W iIl:md"fcsWmc�L��oi�prcs��u.�rl r,in ha pic cnc•,ut hcr�ul 'sl.and in the Prsence ol each o�hcr.Imce hercunlo suhmribed our nnme��s ou�tin3 w�messn. II 1 �—. O �/���'����l� rt�'��_ (SE,1L) � �� __ .__ _CSGAI.) .. -�. � � : �,�A _,. . , II li 'i t'OA1i�lONVA'I�ALTH OF PE\SS1'U'n�l�) SS. �iCOUNfYOFCU1:f3L:Rl.rAND ) Vl'c.6F_'iT}'L I�:1RNS I�LI Il I 0. I3RPNtiF�11:�.GSQUIRIS aad S;AV[)I:� I:. SI10��'CRS�he l'eswvls and dic wllnesses,respccG.�cic, mkosu uuinis ue xi�ial m ihc I :muched o�foreeoin__InstrimcnL Ixh�Ilrst tlulys�tiorn,do he[cl��Jcd�m W ihc undersi�ued �I owhuriry that the Tesravin signed nnd ezecutcd Ihe inxvumeul us hu Las� N'i II a;id l�esuinent ��i and thm she had slgncJ ��illingJy.and�hot she ezwvmd it us�hcc Gee and volunmry ael iorlhe purposes thcrcin eepresscd,and th�t cach ofthc wi�ncescs.in Ihe pccsence ond hcaring uflhc '.�Tesmtri�,vi��ed thc lA-ill as wimcss ond IL�at m thc best ofhis or her knowlcdee�ic Tesmvis wav at[ha�lime cight�vii ycnu of uge o�olAcc of xuund mi�d xnd under no constminl o��ndue inllucncc. 1 \ �� ��� . �_� �� �r;..= I�lus'Iauix �'� �..�`Iil!{',iL,r.,�-�1C r7:��C.�i_. wmcss I� " ��I�' _.— .._—. _ _—_. WSlncv � Subs'cribe�.s«�orn m and neknu.vledu�d hef re mc hy HF.T"["1'L ItiARNS-'fe.wv'u,uud �subscnbeQ ondstiorn to bcfo�cmc b}'KF�'I�H O. 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