HomeMy WebLinkAbout08-20-15 (2) i ,
� 1505607121
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po eox 280601 RESIDENT DECEDENT 2 1 7, 5 0 1 7 0
Harrisbur ,PA 17128-0601
ENTER DECEDENT INFORMATION BELOW Date of Birth
Sociai Security Number Date of Death
1, 1 2 0 1 2 0 1 4 0 4 0 7 ], 9 6 3
Decedent's Last Name
Suffix DecedenYs First Name M�
H a r b e r t T h o m a s M
(If Applicable)Enter Surviving Spouse's Information Below MI
Spouse's Last Name Suffix Spouse's First Name
H a r b e r t C y n t h i a �
Spouse's Sociai Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REG157E� 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(date of � 5. Federal Estate Tax Return Required
death after 12-12-82)
Q 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• Attach SchaOunder Sec.9113(A)
between 12-31-91 and 1-1-95) ( �
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE.D�RECTED T0:
Daytime Telepltege Number � � rn
Name
D a v i d R G e t z E s q u i r e 7 1 7 � �4 4� 8';��
G'7 J
Firm Name Qf Applicable) REGISTER- F,, IL USF�ILY •--- r�
, ..._� O C.J
W i x W e n g e r & W e i d n e r ,�
First line of address � f�
� � `'�
5 0 8 N o r t h S e c o n d S t r e e t ' � �- � ,,
e
Second line of address p �
. W �7 I
P Q B 0 X 8 4 5 DATE FILED
City or Post Office State ZIP Code
H a r r i s b u r g P A 1 7 1 0 8 0 8 4 5 ��,
I
CorrespondenPs e-mail address:d 2tZ www alaw.com I
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, I
it is true,correct and complete.Declaration of preparer other than the personal representative�s based on all information of which preparer ha�ny�Ewled� I
SI ATURE OF.PER R SPO SIBLE FOR FILING RETURN � ' ,
ADD ss Mechanicsbur PA 1,7050 I
1,3 D onshire S uare AT� �
SIGNA R F PRE ARE THER N REPRESENTATIVE • � J ;
ADDRESS � PA 171,08-0845
Wix W
en er & Weidner� PO Box 845 Harrisbur
PLEASE USE ORIGINAL FORM ONLY
Side 1 I
I
� 1505607121, �
1505607121, �
J 1505607221
REV-1500 EX DecedenYs Social Security Number
�ecede�t'sName: ThomaS f`1 • Harbert 1i 9 0 5 8 1 5 8 4
RECAPITULATION
1. Real estate(Schedule A) � �
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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.
1 8 5 5 . 3 7
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 1-7) . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 8 5 5 . 3 7
9. Funeral Expenses&Administrative Costs(Schedule H) . . . . . . . 9� '
10. Debts of Decedent, Mortgage Liabilities,&Liens(Schedule I) . . . 10. '
11. Total Deductions(total Lines 9&10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. •
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . �2 1 8 5 5 , 3 7
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 8 5 5 , 3 7
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(�.2)x.00_ 1 8 5 5 . 3 7 15. O . 0 0
16. Amount of Line 14 taxable � � Q O � . � �
at lineal rate X.�_ 16.
17. Amount of Line 14 taxable � � � � �� Q . � 0
at sibling rate X.12
18. Amount of Line 14 taxable � . � � 18 � . � Q
at collateral rate X.15
19.Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
� . � �
20. FILL IN THE OVAL lF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
� 15056�7221 1505607221 �
REV-1500 EX Page 3 File Number
DecedenYs Complete Address: 2� 15 0��0
DECEDENT'S NAME
Thomas M. Harbert
STREET ADDRESS
802 Briarwood Lane
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
�. Tax Due(Page 2 Line 19) (1) 0.00
2. Credits/Payments
A.Spousal Poverty Credit
B.Prior Payments
C.Discount
Total Credits(A+g+�) (2) 0.00
3. Interest/Penalty if applicable
D. Interest
E, Penalty
Total InteresUPenalty(D+E) (3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
A.Enter the interest on the tax due. (5A)
B.Enter the total of Line 5+5A.This is the BALANCE DUE. (5B) 0.00
Make Check Payable fo: 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 .....................................�......................................................... � �
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? ....................................................................................... � 0
3. Did decedent own an"in trust for"or payable upon death bank account or security at his or her death? ......... ❑ ❑X
4. Ditl decedent own an Indivitlual Retirement Account,annuity,or other non-probate property which
contains a beneficiary designation?.................................................................................................. ❑ �
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 tleath on or after July 1,1994 and before January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three(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 zero(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 tlisclosure 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 imposetl on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a stepparent of the chiltl is zero(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 four and one-half(4.5)percent,except as noted in
72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the tlecedent's siblings is twelve(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 atloption.
REV-1508 EX+(6-98)
. SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS� 0[ MISC.
INHERITANCE TAX RETURN pERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Thomas M. Harbert 21 15 0170
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. UNB Bank Checking Account No. XXXX2501 1,855.37
TOTAL(Also enter on line 5,Recapitulation) $ 1 855.37
(If more space is neetled,insert additional sheets of the same size)
REV-1513 EX+(g-00)
SCHEDULEJ
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Thomas M. Harbert 21 15 0170
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under
Sec.9116(a)(1.2)]
1. Cynthia C. Harbert Spousal 1,855.37
802 Briarwood Lane
Camp Hill, PA 17011
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE,ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed,insert atlditional sheets of the same size)
�:. � .. . !
LAST WILL AND TESTAMENT (��t )���
�J�vJU
OF
THOMAS M. HARBERT
� I, Thomas M. Harbert, of East Pennsboro Township,
Cumberland County, Pennsylvania, being of sound and disposing
mind and memory, do make, publish and declare this my Last Will
and Testament, hereby revoking all wills and codicils by me at
any time made. �
ITEM I: I direct that all inheritance and estate taxes
becoming due by reason of my death, whether such taxes may be
payable by my Estate or by any recipient of any property, shall
. be paid by my Executor out of the property passing under this
Will, which is not specifically devised or bequeathed, as an
expense and cost of administration of my Estate. My Executor
' shall have no duty or obligation to obtain reimbursement for any
such tax paid by my Executor even though on proceeds of
insurance or other property not passing under this Will.
ITEM II: I give and bequeath all of my household
furniture and furnishings, automobiles, books, pictures,
jewelry, china, linen, silverware, wearing apparel and all other
like articles of household or personal use and adornment to my
wife, Cynthia C. Harbert, if she survives me, or if she does not
survive me, to my issue, per stirpes.
ITEM III: I give, devise and bequeath unto my wife,
Cynthia C. Harbert, all of the rest, residue and remainder of my
� property, real, personal and mixed. In the event my wife,
Cynthia C. Harbert, does not survive me, then I give, devise and
bequeath unto my sister-in-law, Martha C. Parvis, of Newtown,
� Connecticut, AS TRUSTEE, (the "Trustee") , all the rest, residue
and remainder of my property, real, personal and mixed, not
disposed of by the preceding portions of this Will, IN TRUST
NEVERTHELESS, for the following uses and purposes:
(a) Upon my death, my Trustee shall divide the ,
principal of the Trust into as many shares or parts as
there are then living children of mine and then
deceased children of mine represented by then living
r
' , I
i
� issue. The Trustee shall hold one such share as a
separate Trust Fund for the benefit of each then living
child of mine and one such share as a separate Trust
Fund for the benefit of the issue of each such then
deceased child of mine.
(b) In each'Trust thus established for a then
living child of mine, the Trustee shall have, hold,
manage, invest and reinvest the principal thereof and
shall, if the child has not attained twenty-two (22)
years of age, pay to or for the benefit of such child �
in not less than quarterly installments so much of the
net income and principal of said Trust as the Trustee,
in the Trustee' sole discretion, shall deem necessary
and appropriate to maintain said child in the proper
station in life, including proper support, maintenance,
medical, hospital, nursing and nursing home care, and
high school, vocational, college, university,
post-graduate and other education. Any undistributed
income shall be accumulated. Upon such child�s
attaining the age of twenty-two (22) years, he or she
shall be paid one-third (1/3) of the then assets of the
Trust and shall also be paid, directly, all income from
. the Trust. Upon such child's attaining the age of
twenty-five (25) years, he or she shall be paid
one-half (1/2) of the then assets of the Trust. Upon
such child�s attaining the age of thirty (30) years, he
or she shall be paid all of the remaining assets of the
Trust. (If, at the establishment of the Trust, said
child has already attained an age at which he or she
would have been entitled to one or more distributions
of assets, as above provided, the portion(s) which
would have been distributed at such prior age(s) shall
be paid to such child forthwith.) Should such child of
mine die before final distribution of the assets of
said Trust, but be 'survived by then living issue, the
Page 2 of 8
Trustee shall quarterly pay the net income from said
Trust to or for the benefit of said issue, per stirpes,
living at each time of quarterly distribution. TwentX
(20) years following the death of such child, all then
remaining assets of said Trust shall be paid to the
then recipients of the income, in the proportion by
which they are then entitled to the income. Should
such child die before final distribution and not be
survived by then living issue, the provisions of Item
III(d) herein shall obtain.
(c) In each Trust established for the benefit of
the issue of a deceased child of mine, the Trustee
shall have, hold, manage, invest and reinvest the
principal thereof and shall quarterly pay the net
income to or for the benefit of the issue of such
deceased child of mine, per stirpes, living at the time
� of each quarterly distribution. Twenty (20) years
following my death, the Trustee shall pay over all of
the then assets in the Trust to the then recipients of
the income in the proportions by which they are then
entitled to the income.
• (d) If, at any time before final distribution•of
the assets of the Trusts established for my children or
the issue of any deceased children of mine, there are
no living beneficiaries of a Trust, that Trust shall
terminate, and its assets shall be divided into as many
equal shares as there are then existing Trusts created
• under this Item III, and one such share shall
be added to each such then existing Trust, provided
that if any of said Trusts herein created has
previously been terminated by payment of all of its
principal to its beneficiaries, said beneficiaries who
received payment of the principal of that Trust shall
collectively be considered an "existing Trust" for the
purposes of this Item III(d) , and one such equal share
Paqe 3 of 8
� ._ � i
• shall be paid directly to each beneficiary in the same
proportion by which he received the principal• of the
Trust or, if deceased, to his issue, per stirpes. If,
at the time of termination described in this Item
III(d) , there is no then existing Trust, or if at any
time before final distribution of assets under this
Item, none of my issue is living, the Trust shall
terminate, then all of my property, real, personal and
mixed, not disposed of by the preceding portions of
this Will, shall be distributed one half to my parents,
Donald D. Harbert and Mary E. Harbert of Atco, New
• Jersey, or the survivor; and one half to my wife's
parents, Roy E. Coombs, Jr. and Frances T. Coombs of
Berkeley Heights, New Jersey, or the survivor. If both
of my parents predecease me, then one half share of my
property shall be distributed, in equal shares, to my
brothers, James M. Harbert of Taylor, Pennsylvania, and
David L. Harbert of Atco, New Jersey, or the survivor.
If I am not survived by either of my wife's parents,
then one half share of my property shall be distributed
to my sister-in-law, Martha C. Parvis. If all of the
above persons do not survive me, then all of my
. property, real, personal and mixed, not disposed of by
the proceeding portions of this will, shall be
distributed as if 2 had died intestate, a resident of
the Commonwealth of Pennsylvania.
(e) In the event of the death, resignation,
refusal or inability of my sister-in-law, Martha C.
Parvis, to serve as Trustee (and Successor Executor)
hereunder, I nominate, constitute and appoint my
brother, James M. Harbert of Taylor, Pennsylvania, to
serve.
ITEM IV: In the settlement of my Estate and during the
continued existence of the foregoing Trusts, my Executor and
Trustee of each Trust shall possess, among others, the following
Page 4 of 8
. , i
powers to be exercised for the best interests of the
beneficiaries:
(a) To retain any investment 2 may •have at my
death, so long as my Executor or Trustee may deem it
advisable to my Estate or Trusts to do so.
(b) To vary investments, when deemed desirable by
my Executor or Trustee, and to invest in such bonds,
stocks, notes, money markets, real estate mortgages or
other securities other than options or futures, and in
such other real or personal property as my Executor or
Trustee shall deem wise, without being restricted to
so-called "leqal investments."
(c) In order to effect a division of the
principal of my Estate or a Trust or for any other
purpose, including any final distribution of my Estate
or any Trust, my Executor or Trustee are authorized to
make said divisions or distributions of the personalty
and realty, partly or wholly in kind. If such division
or distribution is made in kind, said assets are
required to be divided or distributed at their
respective values on the date(s) of their division or
distribution.
(d) To sell, either at public or private sale,
and upon such terms and conditions as my Executor or
Trustee may deem advantageous to my Estate or Trusts,
any or all real or personal estate or interest ttierein
owned by my Estate or Trusts, severally or in
conjunction with other persons, or acquired after my
death by my Executor or Trustee, and to consummate said
sale(s) by sufficient deeds or other instruments to the
purchaser(s) conveying a fee simple title, free and
clear of all Trust, and without obligation or liability
of the purchaser(s) to see to the application of the
purchase money or to make inquiry into the validity of
said sale(s) ; also, to make, execute, acknowledge and
Page 5 of 8
. ' ' i
deliver any and all deeds, assignments, options or
other writings which may be necessary or desirable to
effect any oP the bequests or devises made in my Will
or in carrying out any of the powers conferred upon my
Executor or Trustee in this Item IV(d) or elsewhere in
my Will.
(e) To mortgage real estate and to make leases of
real estate. .
(f) To borrow money from any party to pay
indebtedness of mine or of my Estate or Trusts,
expenses of administration, or inheritance, legacy,
estate and other taxes.
(g) To pay all costs, taxes, expenses and
� charges�, except as herein noted, in connection with the
� administration of my Estate or a Trust. My Executor
shall pay expenses of my last illness and funeral
expenses.
(h) To vote any shares of stock which form a part
of my Estate or a Trust and otherwise to exercise all
the powers incident to the ownership of such stock.
(i) To assign to and hold in a Trust an undivided
portion of any asset.
(j) In the discretion of my Trustee, if the size
of any Trust herein established shall become so small
� , that it is impractical or uneconomical to continue said
Trust, my Trustee may distribute all accumulated income
and principal to the then income beneficiaries in
proportion to their income interests.
(k) The right and discretion to elect the most
appropriate settlement options for any pension plans,
individual retirement accounts or other employee
benefit options payable to my Estate or any Trust,
assuming such election shall be in accordance with
procedures established by the plan's administrative
committee or administrator, as the case may be.
Page 6 of 8
' �
(1) The right to engage accountants, attorneys,
appraisers and other agents, as deemed necessary by my
Executor or Trustee, to render advice to and/or to
represent my Executor or Trustee, as my Executor or
Trustee deem necessary or appropriate to the
administration and preservation of my Estate or the
assets of any Trust.
ITEM V: If at any time, any minor child or mentally .
� incapacitated person shall be entitled to receive any assets
hereunder, my Trustee shall act as Guardians of the assets
payable to such minor child or mentally incapacitated person and
shall have full authority to use such assets in any manner as
such Guardians shall deem advisable for the best interests of
such minor child� or mentally incapacitated person, including
proper support, maintenance, medical, hospital, nursing and
nursing home care and high school, vocational, college,
university, post-graduate or other education, without securing
court order.
ITEM VI: Any person who shall have died at the same
. time as Testator, or in a common disaster with him, or under
such circumstances that it is difficult or impossible to
determine who died first, or who shall fail to survive Testator
. by ninety (90) days, shall be deemed to have predeceased him.
ITEM VII: I hereby nominate, constitute and appoint my
wife, Cynthia C. Harbert, to be my Executrix (herein referred to
as "Executor") . In the event of the death, resignation, refusal
or inability of my said wife to serve as Executor, 2 nominate,
constitute and appoint my Trustee to serve as Executor in her
place. My Executor, Trustee and Guardian are specifically
relieved from the duty or obligation of filing any bond or other
security.
ITEM VIII: If I survive my spouse, Cynthia C. Harbert,
and am survived by minor children, I nominate, constitute and
appoint my sister-in-law, Martha C. Parvis, of Newtown,
Connecticut to be the Guardian of the person of each such minor
Page 7 of 8
;
COMMONWEALTH OF PENNSYLVANIA :
. SS..
COUNTY OF DAUPHIN .
I, Thomas M. Harb�xt, th� '���t�'�Q�' Wh9se tl�]ile �,s ��.g;IgSl
to the attached or foregoing ins�rumeri�, having been duly
qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will; and that I signed
it willingly and as my free and voluntary act for the purposes
therein expressed.
Sworn to or affirmed and acknowledged before me by ,
Thomas M. Harbert, the Testator, this ist day of July, 1994.
���.���'�...
Thomas M. Harbert, Testator
��C� �� • �C`\1C1-�
Notary Public
My Commission Expires:
(SEAL)
NOTARIAL SEAL
LISA M.LONG,Notary Public
Ciry o(Harrisburg,Dauphin Counly
M Commission Ex ires A ril 28.1997
- � _ i
child. In the event of the death, resignation, refusal or
inability of my sister-in-law, Martha C. Parvis to serve as
guardian hereunder, I nominate, constitute and appoint my
brother, James M. Harbert of Taylor, Pennsylvania, to serve.
IN WITNESS WHEREOF, I have hereunto set my hand and
� seal to this, my Last Will and.Testament, consisting of this
page and the preceding seven (7) pages, this ist day of July,
1994.
�,�.�.�� ��.��..,,�
Thomas M. Fiarbert
SIGNED, SEALED, PUBLISIiED AND DECLARED by the above-
named Testator, Thomas M. Harbert, as and fo.r his Will, in the
. presence of us, �aho, at his •request, in his presence and in the
presence of each other, have hereunto subscribed our names as
witnesses in attestation thereof.
�� � �"1�Address 350� �1� I'C� �
NIeL��,.:t�(��- P.4- c-�.s-s
. / ^ P�Jn � Address l�� a�� �� �C�.
�S'��m rH�./.�[� � i)�9v
,C/' l.• Y,(%1�/f%�. Address 1'��,37 ; IL7S1'�//l.Q }�Q(��
� {�'1�,t,c.r�-�•.��1 , �f�f 17.�5�
TMHARBERT.u1L DRG14 July 7, 1994
Page 8 of 8 .
. • . - ,
. - . �
COMMONWEALTH OF PENNSYLVANIA :
• . SS. .
COUNTY OF DAUPHIN .
We, 1�'-�.r',C� I� . �.1E�1 z. , \I ;c`K� �=1 . 2�:•1•,,it,,c!/
and "�rc�.�cti=� C' ��r-�,�•��._. , 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 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.
Sworn to or affirmed and subscribed to before me by
�y�;cti�Z • �1C-1 2. , _ �t.c �<; �1 i�����:-,n-r� and
,�����r� C• ��r�.<x�. , witnesses, this lst day of July,
1994.
_�I, ��//`.'/I
Witness
c � l�
witn `s
.� �- /.�: � �.
iG7itness
� v')C` �Yvl . ('iri�
Notary Public
My Commission Expires:
(SEAL)
NOTARIAL SEAL
USA M.LONG,Notary Public
Ciry of Harrisburg,Dauphin County
M Commission Ex ires A ril 28.1997
� �d: �
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April 14, 2015
WIX, WENGER & WEIDNER
508 North�Second Street
Harrisburg, PA 17101
Re: Estate of Thomas M. Harbert
To Whom It May Concern:
This notice serves to inform you of the deposit account Mr. Harbert held at
UNB bank. At the time of his death, there was only one open account: a checking
account, account #0205542501, titled in the name of Thomas M. Harbert (single
owner), the date of death balance being $1,855.37. (This was a non-interest
bearing checking account.) If I can be of any further assistance, please do not
hesitate to contact me at (570)799-0176. Thank you.
erely,
����
ebecca Gross
Assistant Branch Manager
ZI1vB Bank
1 North Oak Street 1071 Numidia Drive
P0.Box 367 P.O.Box 98
Mount Carmel,PA 17851-0367 Numidia,PA 17858
Phone 570-339-1040 Phone 570-799-0176