HomeMy WebLinkAbout08-19-15 J � peq�sylaania
1505618403
�x(03-04)
REV-1500 OFFICIAL IISE ONLY
counrycoee vear Fuervumce�
Bureau otintlivitlual Taxes MHERITANCE TAX RETURN
POBOX280601 21 15 0461
Harrisbur PA t�128-0607 RESIDENTDECEDENT
ENTER DECE�ENT INFORMATION BELOW
Sotial Sewrity Number Date of DeaN MMoorrW Oate of Birth MMDOwvv
04 03 2n15 OS 11 1943
Decedenfs Last Name Suffx DecetlenPs Firs�Name MI
FLAGLE DONALD �
(If Applicable)Enter Surviving Spouse's Informa�ion Below
SpousesLas[Name SuPox Spouse'sFirsiName MI
THIS RETURN MUST BE FILED IN UUPLICATE WITH THE
REGISTER OF WILLS
FILI IN APPROPRIATE OVALS BELOW
O t OriginalReWm � 2. SupplemenlalReWm � 3. RemainderReWm(tlateolaeat�
pnortol2-13.82)
� 4. A9�iculWtal Exemplion(tlate ol � 5. FUWre Interest Compmmise(da�e o� � 6. Federal Esta�e Tax Relum Requiretl
�ea�h on or aHer]-t20i21 Oealh after 1242-82)
O Z Decetlen��ietl Testa�e � 9 Decetlent Malnlainetl a Living Trusl 1 9. To�al NumDer o�Sa�e�eposit Boxes
�A�lac�mpyofwlll) (A�[acM1copyof�mslJ
� ID. Li�iga�lon Pmceetls Receivea � t1. NorvProbate Transteree Re�urn � 12. De(erraVElection of Spousal Tmsts
(ScheOule F antl G Assa�s Only)
� t3. BusinessAsse�s � 14. Spouse Is Sole Beneficiary
(Na Vusl inv0lvBtl)
CORRESPONDENT�TH65ECilON MOST BE LOMPLETEO.ALL CORRESPONOENLE ANO CONFIOENtIAL TA%MFOFMAiION SHOUlO BE DIRECTEO TO'
Name Drytime Telephone Number
ROGER B IRWIN ESQ 717 249 6333
First Line ol Atldress
354 ALEXANDER SPRING RO
Secontl Line oi Address
CiryorPos�OHice SWte ZIPCotle
CARLISLE PA 17015
CorrespontlenPsemailatldress: b' ' Cd I h h
A
REGI ER OF WILLSS5�SE ON6j' 7
— 0 =� -' O
RECIsiEFOFwILLsuSEorvLv ��� = C7 �J
DATE FILEO MMDDYYYY ' ��
- t� Il
� CJ
� p
—O -,1 1
3 -1
DATEFILE�STAMP = �
O co �
CO
Side 1
L I IIIIII IIIII IIIII illll IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII
1505618403 1505618403 � �� j
�%�l
/
J 3505638411
REV-0500 EX Demtlenfs Social Sewrity Number
ceaam'sname� FIa01e, Donald G
RECAPITULATION
t aeaiEstatefscheau�en)._.............._.........................................................._....... 1. 193,500. 00
P. sacksenaBories(Scheaube)......................................................_..................... z. 654 . 08
3. Cloeely HeH Corywalion,PaMenhip or Sole-Propnetorship(SCMEuIe C)......... 3.
E. Moet9a9es eM NolaS RaceiveGla(Schetluk D1_..._...._._..__.._....................._._ 4.
5, Cesn,Benk DeposBs entl M'scNlaneous Personal Proparty(Schetluk E).......... 5. 7 9,7 91•5 5
8. Joinlly OwneE Praperty(Schetlule F) ❑ Separele BiINn9 Reques�etl._......... 8.
]. InterYrvos Tramfars d Mhcelaneoua NoinProbele Grupaity
�Scnetlu�eG) ❑ SeparateBinhgRepaeatetl...._.._. �. 1,126.990 •93
8. TotelGroseAssel9(�otalLi�resllMau9h�...................._....._.._..._....._.......... 8. 1�400.936. 56
9. FuneraiE�penseseMAOmino�retrveCostsfScheduleH).....................__...___.. 5. 47�212. 92
10. Debts of Decetlen�,Moitgage LlaGlilbs antl Liere(ScheCuk 1).............._........._. 10. 72 8• 5 2
it. Total Datluctlom(to�al Lines9 antl 10I...................._..._.__...._...............___..... 11. 47 ,941- 44
ii. NetvaivaofEsbte0.ineeminuslinei�l........_.............._.............__......._...... 12. 1.352.995-12
13- Charilable aM Governmental Bepuests/Sec 9113 T�usls M�w1iIW
en elec�ion Io tex�as rwt been me0e(StliMule JI.............................._......._...... 13.
14. NetValueSubJectmTaz(Linel2minusLinei3)_._................_........._............. 1a. 3,352.995 . 12
TAX CALCULATION-SEE INSTHUCTIONS FOR APPIICABLE MTES
15. Amourrt o(Line 14 taxabk
at ine spousal tax rete,or
lrena(ers aMer Sea 9118
rox,.z�x.00 ,s. o-o0
18. Amoun�M Line 10 tazaDle
atlinealrareX .045 1�352,995• 12 �e. 60.884 • 78
1]. AmouM W li�re 14 texabk
atsibliegrateX.12 0- U0 iZ 0-00
18. Amounl o(Line 14 ta�Dle
a�wllaterel�'d1eX.15 � •00 �8. Q-00
19. TAXDUE............_._............_.........................._._....................._..._........___........ 18. 60.884 . 78
20. FILL IN THE OVAL IF VOU ME RE�UESTING A REFUND OF AN OVERPAYMENT �
UMer PaN��dPe�hrY.I Miia�e I lw�e manMred N's relum.iirAtl'rq xmniW�W ecMM�le�eM s�ekmer�is,mN IONa Dvet W mY km�MtlOa aM Eeliel.
i�it bue.wrred eN mnpeh.0etlbalun dpc0am din Nm On VIN��esW�*idefu MnB tle�aWrn o OeeeO m eY Inbimaliori d xV�itli MeYa�a 1w
am xmMeaye.
SIGNFNREOFPERSONFESPONSIBLEFORFttklGRENRH �¢LClever �
��,L,.^^,��J � �,_ l��n -E�// S
RDDRESS
4144 Enola Road,Newville,PA 17241
SIGNRTUREOFPREPPREROT T�.IIREPftESENSA/; RogerB.IrwinEsq. °PTE
�LN �'J C�il.�..� g l9 / S
ADORE55
354 Alexander Sprinq Road uite 7 Carlisle PA
I����������I�IIII�IIII�I����II��I��II�II�����II���I��II��� Sitle2
L 1505638411 150561B411 �
PA Inheritance Tax Return
Signature of Additlonal Fiduciaries
ESTATE OF FILE NUMBER
Flagle, Donaltl G 21•15-0461
UrWer peneHies ot pefjury.I OeGare Ihat I have eraminetl th's retum,iridWing exompem/irg schetluks eM stelemenls,a(k lo Ihe best of
my knowle0ga anC beliaf,X Ia We,co�recl antl cromplete.Declaration of preparer ollter Nen Me personal repeseritative Is baSeE on all
in(ormatbn of whirh preperer has eny knaNeAge.
Signature#2 ��— �� � ' , —EXP� .
Name P+��a K Yorleb
Addressi bb Fast Maln Strwt
Adtlress2
City,State,Zip �'�ilb PA 7]]A1
Date g 1 q I$�
REV-0500 EX Page 3 File NumEer 2'145-0461
Decedent's Complete Address:
DECEDENT'SNAME
Flagle, Donald G _ .
_. —. _ . .- —. _—_. _—_ _
STREETA�DRESS
295 Fairview Stree[
. . - .. _ __._—_ ._ ._ __—_..
CITV � � �� STATE ZIP
Carlisle PA 17015
Tax Paymen[s and Credi[s:
L Tax Due(Pa9e 2. Line 19) (1) . .. 60.88478
2 CretlitslPaymenls
A. Prior Paymen�s 55,000.00
B. �iscount � 3,044.24�
Total Cretlits(A .B) (Z) 58,044.24
3. Interes� (3)
Q_ If Line 2 is grea�erthan line 1 +Llne 3,enter the difference. This is ihe OVERPAYMENT. (4) _ _ _
Check 4ox on Page 2,line 2010 request a refuntl
5, If Line 1 t Line 3 is grea�er�M1an Line 2,enter the tliHerence. This is the TAX�UE (5) 2�84�.$4
Make Check Payabte to: REGISTER OF WILLS, AGENT.
Tr�i � i � � � mm�rm�T '"
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Oid tlecetlent make a transfer antl'. Yes Nol
a. re�ainlheuseorincomeotthep�opertytransfe�retl ._...... .__ __ � � �J
b. re�ain the right�o designate who shall use the pmpeRy Iransferred or LLs mcome . .. ❑ L.�
c. relainareversionaryinleres[or ....._..... .._ ._. _. � . Iz�
d. receive lhe pmmise for li(e ot ei�her payments,�enefLLs or care�__. ._. ._ i I ❑+
2. If death occurred afler Dec. 12, 1982 tl tl decedenl bansfer propetly w Ih n one year o( tlealh wilM1out �
receivingadequateconsitleralion2.._ ____. _.._... __._... ._...... �J z.
3. Did decetlent own an"in Uust for" or payable upon death bank acmunt or security a�his or her death2_.... ', '�,x.
4. Did decetlent own an ndrvitlual retirement accounl,annu ty or other non pmbate pmpeRy whmh I. .. r
con�ainsabeneticiarytlesignationP._. ._.__. ._...._ _....... ........._ �x'� LJ
IF THE ANSWER TO ANV OF TME A60VE pUESTI0N5 IS YES,VOU MlIST COMPLETE SCHEOULE G ANO FILE IT AS PART OF THE RETURN.
Por detes of death on or eHer Joly 1.1994 and belare Jan.1,1995.Ihe tax rate lmposad on the net value of ironslers to or br ihe use of iha surviving spouse
is 3 percenl P2 P.S.§9116Ia)(t t)Ii)l
For tlates of tlealh on or after January 1,1995,ihe tax rate imposetl on Ihe net value of�rans(ers lo or for the use of ihe surviving spouse is 0 percent
�72PB.§9116(a)�1.1J(1�f. Theslaluledoesnotexemp�alransierloasurvlvingspousetromlax,antl�hesteWtoryrequiremeNsfortllsdosureolesselsand
fling a Wx relum are still apP�icable even if�M1e surviving spouse is t�e only beneficiary.
For dates of dealh on or afler July 1,2000'
• The lax rate imposed on ihe nel value o(Vansters irom a tlewased chlld 21 years ot age or younger al deaN lo or tor the use of a naWral parent,an
a�apl'rve peren�,ore stepperent of the chiltl Is 0 percant�/2 PS.§9116(e)(12)�.
• The tex ale im0osetl on IM1e nel velue ot Vans(ers to orlor iM1e use ol Ne tlecedenfs linaal bene(cieries is 4b percent,except as noted in[]2 P_5-§9116(a)(t)�.
. TM1etaxre�elmposedon�henetvalueolians(erstoorfor�heuseoft�etlacetlent'ssiblingsisIIpercentl��PS-§9116(a)(iJ)� Asiblingistlafnad,
under Seciion 9102,as an Indivlduel wM10 has at leasl one paren�ln common wi�h Ne deczAenl,whelhar by blood or etloption.
.. aevsas�.��a<�
SAFE DEPOSIT BOX �
co�.iMor��.ven�rNorvEHHsv�vArvin INVENTORY
PTRTMENT OF REV ENUE
INHERITANLE TA%ONISION
�EaT 280601
HFlaaiseuac,anniae-osoi Please Print or Type
MOST BE COMPLETE�BY REPRESENTATIVE OF FINHNCIAL INSTITUTION WHEFE SAFE DEPOSIT BOX IS LOCATEO AND RETURYE�TO ABOVE HO�RE55
—_.. �. _ . __ _ _ .—..
COIINiYCO�E FILENIIM6ER
DECEOENT'S NAME(UST,FlRST,MIDOLE) OFTE OF OEATH �
I�i ' K 0/lal � � i� � 3r 1 Z�iS
• pDDRE550 DECE� NT (STREET) � (CITY) (STATE) (ZIPGO�E)
2`IS Fu� v �wsf �u� iisda �J} f7a;S'
NAME AN�FDORE55 Of PENSON REQUESTING THE OPENING OFTHE SNFE OEPOSIT BO% �
(fJ�ME) 1,
PGmCl4 �C�`^� lO�'C�S
�eraeErrvnme� (cm� �srnle; �nPcaoe7
6s Ea.r, r�u,_ sf hl�I.-,., it� �A i�zvl
NAME,AOORESSHNORELFT�ONSHIPQFANY�TODELEOENT,OFPERSON(S�PRESENTqTTHE00%OPENING �
a. (NAME) (RE�PTIONSHip) �
Pumelq lC.y vo-lift __ Dnu�t� �e�
(STREEiNAME) (CIT1� (STAiE) �ZIPCODE)
Gs c Mu:.. S+ n4�.�r�Ce Grl nzv�—
t. (NHME) (RELATIONSHIP)
(STREETNAME) (CITY) (STATE) (ZIPCO�Ef
c �NFMEJ (REI.ATIONSHIP)
I �STRPETNAME� �CITV� (STATE) (ZIPCO�E) �
NAME RND A�DRE55 OF FlNl�NCIAL INSTITUiION W HERE TXE SAFE oEPOSR BO%IS LOCATEO . �
(NHME) p
WZ��.) G✓�6 I1pn�G _—
(STREETNAME) (QTY) (STATE) (ZIPGO�E) I
6�Y /-- /d% h � Cvr�ii4 _pA l7a�3
1 NAME OF PERSON MFKIN IAST ENTRY DATE AND TME OF LNST ENTRY '
Do.a��� d G F /�/g '. lo z� / /z 'a3 /�M
DATE OF CONTRHCT TO RENT BOX NUM9Eg,OF BOX ' TITLE UNOER WHICH BOX IS NENTE�
7- - S6Y_ __. —Pa,�n�d C- F/�.�/e . _..
NAME pN�AOORE55 OF PERSON(5)HAVING hCCE55 TO BOX
i. (Nl�ME) b. (NAME)
Do.lzfd F�r+�
�sraeernooaess� �saee�r�oaess7
'Z9S Fri.r�r:... S9
(cirv� �srnTe) �zwcooe� (cnv� �srnre) �ziNcooe�
CcaiiSl� �h � >e� _ _
. NAMEANOiRLEOFEMPLOVEETRHINGTHEINVENiORY �
Da�id IZ �ie+cher - t�e�s�,ul 3u�Ke�
---.—_... _. .
WASBWILLMTHEBOX9 ] TES �JNO Ifyes� a. 0a�eolwill: _ .__ __
b. Name and atldress o!personal represenlalive�i�nam¢tl In the will
(NAME�
(STREETNANIE) (Grv) (SINE) (ZiPCODE)
. rvamea�aaaaressorairorney,rta�y �� —��- -
� Nnn�e�
—_.__ —.___ -- I
� (sraeerrvnme) (mrv� �sm1e) �zpcooq �
— _ . _ ___.. _ _—_.—_ __ .._ _ _ _ _". _ I
v vvr n ynl r.,ea��.rz _. —
SAFE DEPOSIT BOX INVENTORY Page�__ of_ L
� INSTRUCTIONS __.__ __ _ ___
The Department is authonzed untler federal law,42 U.S.Q §405(c),to use�he decedenfs Social Securiry number in
administering this state tax law.The Department uses Social Sewriry numbers to establish a tlecetlenPs identiry antl
ensure pmper cretlit for tax paymen�s.
I (1) Cash: Reporttotalonly.
(2) Stocks: List in tletail every common or preterred cetlifcate,warran�or olher rights Found in box.Smcks are to be
Idesigna�ed by name ot mmpany,certifrate number, date of certifca[e, name in which s�ock is regislered, and
� number of shares and class of stock.
(3) Obligations of 0.S. Government: Number of items, date of issuG face value, names in which registered antl
i type of ownership,i.e..jointty held, payable on death,etc.
(4) Bontls: Designate by name,amount,serial number,or other designatioa (Bearer 8ond5)
(5) Bank antl Savings and Loan Passbooks: State name of depositor, number of book, lasl date appearing in book,
name of bank antl branch, and balance.
, (fi) Jewelry,Coins,Stamps, Manuscripts,etc. List antl descnbe as fulty as possible.
�� (7) Deetls, Mortgages, Cvrrent Insurance Policies or other evidences of intlebtetlness. I.ist and describe as fully
I, as possible.
� (8) All other contents.
REM REM OESCRIPTION
NO.
I �ed �r ays �,•-uw s� cw i s4 -/+ �7�ed e��r� /+ ��, so H,y
z c-�-+� � �w 6 aa fi�s�. �� �«� � ,�-
� Qirrh Cvki .{ c•�le '�. on�.( ol l�i
y ��<� � c�� � Z n�� h��K � v�r . 3 � �'� `�do _
�1 -- - _
— —_ — - -- �
-- — '
�� ,
� — - _
_
--- -
ICERTII FYONUEXPENALiYOFPERJURYTHATTHEABWERECOROIS PERSONRECEIVINGCOPYOF
ICORRECTAN�COMPLETETOTHEBESTOFMTKNOWLEDGEANOHELIER SAFEDEPOSITBO%INVENTORY: ___
� Sl�n �q pa[ r� / . ✓
�L�---� ��_-�-- C —_
�aiH.0. v�'�i IZ_ ��F�e.- � Am£ o�crce � ei eoaxG�� �.� — _ _ �
Frcwrnn� � -- onr- c c . ,in-rmx
� N� (il ❑ � � .r.. .
o,�i�.
i �e��o�c.l l3a F'« I ��Z3��S ❑e.�iau•.��,���u�o ❑�m�io..ro,or.a�s�e��meo. I
��
___ — _ —_ __ . .�,
_—._
NOTE:Attach additional H'l:"x 11" sheet(s) if necessary or use duplicates of this page of form
�r.., ,.r�,.n��.��..��i.
Rav-05@ E%��R-II)
SCFIEDULE A
s'� pennsylvania REAL ESTATE
� DEPARTMENTOi REVENUE
INHFRrtANCETPXRETURu
reesmEHroEceoervr
ESTA7E OF FILE NUMBER
Flagle Donald G 21-15-0461
an,�ai prop.ny owo.e.mmy o�:..�.o.m�i�=ommo�mo.i ee�.e�nae,�i.n m.ne�..m.ra�,ma�xai.awe�i.aar��aa e:me on�a��.n�m o,e eny.oma ee
a�aoqea eaµeeoe w�w�p e�yar a�o a wuer�s aeuer.�aune�oei�r.�veiiemo wy or�u,oo�n na�i�e rea:o�aeie x�o.neaee oune reie�am�a:
ne.i pron.nv ma�.i��mp.o.m.e wnn nem or.�rvroonnio m�.�e.a�,�i%ea on.cn.aw.F.
AXac��copy ol iM1e aenlemmt s�vel i�IM1e pmpeny�aa Oaen ealE
m�wa..�opy or m.a..e.no.n�y e.�.a.m�.m�e.�.rr o.,�ee.n.�.oi m oommo�.
ITEM VALUE PT DATE
NUMBER DESCRIPTION OFDEATH
1 Real Estate-locatetl at 295 Fairview Street,Carlisle-sold as per attachetl settlement sheet 193,500.00
TOTAL�Also enter on Line 1, Recapitulation) 193,500.00
p!more space Is neetleQ atltlilional Oages of 0e same size)
Copyright(W 2012 form software only The Lackner Gmup,Ina Form PA-0500 Schetlule A(Rev. 12-12�
', II II ' orno nvo��aivo.�sos-0za;
� � �. = aSettlement Statement (HUD-1)
'.II�IIIII
9. TypeolLoan _
G Fle NmnOer
N:ilga5e��ivra�a Case Nu.'n�e.
�. [�'Fw� z. �ans a. �co��.um.+z aos-aos�3s-smc �3000�aszF
n. [�vn s. �co�..i.++.
arvore: rx�:m:mi:m�mrnee�oq��,eyo�a:�a�ememo�ac�ai:e�vememmi�s. amo�m.a��am:�aeyme5e�oememase�i+re��o�.�.uer�maMea
.(a��7'w��a oa�a ows�ae me�msmg.mayare seow�eerem�mm�ma9o�ai a�ma�s e�a are�m mdmea m u:e miais
aanaare::meonowar. ervam�caea��:oixue.. .xamaeneare::miem,l
PauIL.Kean Est�ho/DonaltlGFlagle.OivneL �Pn'maiy ReSipenlialMortgage,lnc..
61iWe5(SWtlyLane CIP .CO�FS¢Culn'x 1d80Nort�230aV/es(
Enola,PA1�015 ]95Fa1 Slree( $allLak¢Ciiy,(lTB<i16
YckieLKean €3(bf201RibdEWC.FIagle.PamelaK.
611West5hatly Lane Yotl l.COExecuMx
Enola,PAA�PS 195Fai lewSbeef
ep
G.Pmpc�/Localion: H.Sclll•menlPgent I.SelllemenlDate
¢95Fairview5heet OETHLEFS�PYKOSHLAWGROI/P,LCL, 08/faY[Oi5
Catllsle�PF 1)015 �anell C.Uelh@!;Esqulie
Phone Numher:pAl9�&9<OG
Lum6nlantlCowfy 31J1MaBelSbeef
Camp Nill.FA POfl
PiecealSa�Aemen�t ]ishursemen�CaleAetlJ/1015
bJ$MaMe[Sbe (Gamp HIII.PA i>01f
J. Summaryo(6ormwer'sTransac�ion N.SummaryolSellelsTransaction
IDO.GrassAmount�ueFmmBormwe � 600, GrossAmount0u[ToSeller
IO1.Conbad5ale5pA<e $19J.500.00401.Loniteclselespr¢B 5393,So0.o
ID2Pesonalpmpetly 403.Pe6onalOmpeR.y
iosseaiemem�ne�e:meo�ro.,ar�n�eiaao� s+,soo.3< aaa.
m< aaa
ms <as
nai��nne�c:ror'im spa�oey:enermaa.a��e nai�:im=m:maie��:pa�aoy:enzrmaa.a�oe
me.c�ryno.��i�as aos_cnyrm.,��e.�s
i,
iozca,�qia..e: oe/iaisms � iv3a/zms sais.ozaw_c���yia.es oe�vaizoss m �v3vmvs szzn.oa
IDfi.As5e55Txn�5 96/3V2035 1 O6/30/1016 53,]<6,35 408.ASsessmeo�5 C9/34/3035 b 05/30/3036 51.1<6.]
109 4�9-
im. am. --.__._ .-..
m -_'" an
iiz <iz
130.GrossAmount�ueF�om9mmwe� 34IO.GmssAmounlDueToSeller 53g5.469.]
30�.AmounbPaldByO�lnBehal(OIBo�mwe� SOO.RetlucOonslnAmoun[OueioSeller
zm.oe�o:rtorear�e:�mo.�ey s3,000.00 sotemeisoeposi��:ee'i�:o-��:�o„z� _
202P(mtlpdamoc+�otnawloan(S 5363�500.00 503.SelllemenlcM1a�gesLo5e11erQIne110�] 535,�20.69
203 Eus Tg loen(s��aken sublecl'n SW.Ezls�ing loa��s)laken 5c��etl lo
2ae. S�C.PzyoSo'lrs�motlgageloan
zas. sos.aayoxm:e=a.,a moe�a�=ioa�
3C6. Se.ler Assis[ance ✓/Closing Costs 52,901. 0 5C'o.5ellea Ass-i<a�re w/Cloei.�g Ca..[ SZ,9CS.50
2L] SGI.
. _. .
dC9 50B
3C9. 5C3.
Adlus:men[Sb�l[emsunpai�byscf�er AOlus�men�s(oritemsunpaitlbyselle�
RID.Ciry/lown�euc _ SID.Ciry/lownlaxes _ __
t Coun'y I�e S i.Loun�y�ares
312,Assessne�^'s 512.Azssssmenls
]10. Sll
]10. � � 51<. __._
215 � 515_
21B. 515.
R9. _... ._ 5P.
HB. � 518.
213. " �� 513.
3IO.iotalPalOBylForBormwer 5!69�9:250530.io�alReEucOonAmoun[�ue5eller $36�E�3.!
]OO.CasM1AtSetllemen[FromRo9o�mv:e� 6CO.CasI�AlSe�tlemenlTolFmmSeller
]01.Gro5 Ounitlue�mmbo�mvrzl�1inx1A0) �_�_69_�601.Gro56>*mn�yu¢losellxr91nsp2'J �SLo5,169.3�
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Certification
��o�i���ea o-om Huo-i�
I have wrefwly raiewed the HUD-1 SeLL!emenl S�a[emen�antl lolhe best of my knowletlge antl'oeltof
II is a hue antl accura;o s�etenent o!all receipts and dlsbursements mede on my acmunt or by me in this
irensaction. I further certify that I have recelvetl a copy of tba HUo-1 Settlement Sle�emenL
./c� G, �Uc�
Selleror �y � A , �f!/�
Borrowec �-Q � �� Oate' �S-/`/-/5 Agenf Gr". Date
�i�
P ul L. Kean Diane .Clever,Co�ExecuVix
Estale o!Uonaltl G Flagle
61� West Shatly Lara 295 Falrvlew SVee�
Fnola, PA 1�025 Catllsle,PA 1]015
' - �p� ��" Selleror ��ie� '� Y"`�`�`
sorrower:`Jf.LU'CLC G� `U�CEl9 ozte: c� 14��IS n9ent ./.i /i.ct�u��bate�. e�K�s
Vickie L. Kean � � Pame K.Votlets,Co-Executnx
Esta:e of Donxld G.Flaole
fi11 Wes�Shatly Lane 295 Fairvlew Strea!
Enola,PA�9025 Catlisle, PA 1]015
The HU0.1 Settlenent vdF.lch I M1ave prepared Is e�me antl accurate accouct of this hen Gon. I have
aosed orwiA causa ihe funds ro be tlisbursadin ecwrdaoce wilM1 Ihis sta[emenL �
Date SeWementAgent Date' � �y �
�arrell Q ethleis,Esquire
WARNING: I�15 a crime to knowing:y make false s�atamen�s�olhe Unitetl Sta[es on�his o�any oNer �
mllar form. PenelG�cpom m�Ndion can inclutle a 9ne antl ImpnsocmenL For tletails
sae:Title 18 U S Code Secllon 1001 ana Section 1010.
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SCHEDULE B
�# pennsylvania STOCKS & BONDS
��� I]EPARiMFNTOFREVENUF
INHERIlANCE TA%RETURN
AesioeN*oEceoervr
ESTA7E OF FILE NUMBER
Flagle Donald G 21-15-0461
an vroP�nvlmnOpownee wun nem o�eunmonnla mu.�ee ebnos.e on sm.aN.i.
ITEM CUSIP VHWEAT�ATE
NUMBER NUMBEF2 DESCRIPTION UNITVALUE OFOEATH
1 US Savings Bontls-Four Series EE-5100 face value each 400.00
p US Savings Bontls Interest-accrued to tlate of death 254.08
TOTAL(Also enter on Line 2. Recapitulation) 654.08
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Copyright(c)2012 torm soflware anly The Leckne�Group, Inu Form PA-1500 Schetlule B(Rev. 08�12)
c� I 1 Y, —v�n�w�����+•ve��ani SERIES EE
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..��1 �Ta--19S F0.IRVLEM STf��'ET., , �' . ..
.�r���GA0.LISLE ' F � 'r PA 1T013 � FIS[R?6TxUS} I
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SCHEDULE E
s� pennsylvania CASH, BANK DEPOSITS, & MISC.
��y oePAarMer�rorAe�eN�e pERSONAL PROPERTY
INHERITANLE iP%REiI1RN
RESIOENi�ECE�ENT
ESTATE OF FILE NUMBER
Flagle Donald G 21-15-0461
mu�ae me o.o�am mrnaano�a�a ino aam me v�«<em.rere r���oa ey�ne e:iaie
PII p�opeM�e���lyowneE wll�Me tlgM ol survlvoMip mml b ElfcloaeE an¢�etlule F.
ITEM VALUE AT�ATE
NUMBER DESCRIPTION OF DEATH
1 Allianz-paymentfrompolicy#00070880379 307.75
2 Fahrney Bus Company-DecedenYs final paycheck 329.4�
7 Real Estate Ta:es-pro-rated credit as shown on settlement sheet 1.969.37
4 RelianceSWndard -PaymenlforPolityNumberK5U0001608 334.40
5 WeIlsFargoBankCheckingAccount#1000324154903-dateofdeathbalance 43,784.00
6 Personal Property, Householtl Goods antl Vehicle-appraised at 30,520.00
7 AAP.-refuntl from cancelation of service 84.OU
8 Comcast Cable-refund 28.66
9 Erielnsurence-carinsurencecancelationrefund 85.00
10 Humana -refund 398.40
�1 MetlicolnsuranceCompany-Refundo(premiumforpolicyG000M00U20611 184.56
12 USTreasury-20141RSWxrefund 2.372.00
TOTAL IAlso enter on Line 5, Recapitulation) 79,791.55
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Copyrigh[(c)2012 form software only The Lackner Gmup. Inc Form PA-1500 Schetlule E(Rev.OB-12)
Crown Classic Banking° �
Acmunt num6ec 1000324159903 � March 1,2015-March 31,2015 � Page 1 of 4 �
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I I II III� I I I I I I I I Questions?
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k- < DONALDGFLAGLE Availablebyphonel4hoursaday,ldoysaweek�
" Telecommunications Relay Services calls accepted
'� DOLORES K FLAGLE
295 FAIRVIEW ST 1-800-742-4932
CARLISLE PA 17015-4358 TIl': 1-eoo-en-4e33
En espanol: 1-877-027-2932
'1�0 1-600-26&2288(6amfo7pmP7,M-f)
Online: wellsfargnmm
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Vartland,OR 9R28-6995
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SCHEDULE G
�4 pennsylvania lNTER-VIVOS TRANSFERS AND
[�� oePnarMer��oFaeveHue MISC. NON-PROBATE PROPERTY
INHERITANCETA%RENRN
RESI�ENTOECE�ENT
ESTATE OF FILE NUMBER
Flagle Donald G 21-15-0461
m�::�necwa m�:�o.wmv�e�ee a�e rnee n ma a�:�.rena aov o�a�emo�5 i mro�en a o�case mre.onne aev-isoo��.ye..
REM DESCRIPTION OF PROPERTV DATE OF DEATH �aFoeco's ExcwsioH TPXA9LE
NUMBER }nE�onrior?aA sRea"SniRncNa"coPvoFi°oE�Eo°o°aaEa°iE'sini�. VALUEOFHSSET ��TEAEsi �1P^PP°c^a�E� VAWE
1 Allianz Annuity Policy#70677491 -nametl 108,542.% 108,542.54
beneficaries are decedenPs two step-daughters
2 Allianz AnnuiTy Policy#70880319 -named 715,087.49 115,087.49
beneticaries are decetlent's two step-daughters
� FitlelitylnvestmentsAnnuityAccount#01481294898 - 67,7fi9.39 67,'169.39
nametl beneficiaries are decedent's hvo step-
daughters
4 JacksonNationallRAAccountp10132'Ii'I55-nametl 13,752.41 13,752.41
beneficiaries are decedent's lwo step-daughters
5 Jackson National IRA Account#1013212097 �named 39,422.47 39.422.47
beneficiaries are decetlenYs two step-daughlers
6 LincolnFinancialAnnuityAccount#35-7142349- 43,740.91 43,740.91
nametl beneficiaries are decedent's hvo s[ep-
daughters
7 LincolnFinanciallRAAccount#35-7142348-named 6,173.45 6,173.45
beneficiaries are decedenYs lwo step-daughlers
e LincolnFinanciallRAAccount#F�709390'I -named 46,379.40 46,379.40
beneficiaries are decedent's two step-daughters
9 RelianceSWntlardAnnuityAccount#ATMG003749- 26,016.00 26,016.00
named beneficiaries are decedenCs lwo step-
daughtere
10 RelianceStantlartlAnnuityAccountpK500001608- 109,048.18 709,048A8
named beneficiaries are decedenPs two step�
dau9htere
Total of Continuation Schedules See attachetl
a es
TOTAL(Also enter on Line 7, Recapitulation� 1,126,990.93
(It more space Is neetleQ atlaitional vages ot tne same size)
Copyright(W 2009 form sokware ony The Lackner Group,Inc. Fortn PA-0500 Schetlule G(Rev. 08-09)
Pw9510 EX��OBL9�
SCHEDULE G
t�f pennsylvania lNTER-VIVOS TRANSFERS AND
`�J oEvnarMEN*araEvenue
iHHeairaxce�rxaer�R� MISC. NON-PROBATE PROPERTY
aesmEur oECEoervr continued
ESTATE OF FILE NUMBER
Flagle Donald G 21-15-0461
ITEM DESCRIPTIONOFPROPERTY OATEOFDEATH woFoecos excwsioa TAXABLE
NUMBER �^'c�uoEuaMEoriwausrEaEErneiAaE�nlioe�sHiarooEceoE�urauo in*EaEsr iiFqpp�icqe�E� VALUE
lnconlEorrRarvsFen nnacHacovroFrnEOEEoroaa�n�cs*nrE. VALUEOFASSET
17 RelianceStandardAnnuityAccount#K500004994- 171.56L78 111.561A8
named beneficiaries are decedent's two step-
daughters
12 Reliance Standard IRA Accounl#ATMG002510 - 47.955.70 47,955.70
named beneFciaries are decetlent's lwo step-
dau9hlers
13 Reliance Standartl IRA Account#K500001298-named 23.294.35 23194.35
beneficiaries are decedenPs two step-daughlere
14 Reliance5tandardlRAAccounttlK500007326 -nametl 7'1,941.86 71.947.86
bene�iciaries are decedenYs two step-daughters
15 Reliance Standard IRA Account#K500001327-nametl 96,971.52 96,971.52
beneficiaries are tlecedenPs two step-daughters
'16 RelianreStandardlRAAccount#K500003150-nametl 12.489.09 12.489.09
benef ciaries are decedenYs two step-0aughters
17 Reliance Standard IRA Account#K500003158-named 16,833.41 16,833.47
beneficiaries are decetlenPs two step-daughters
18 RelianceSlantlardlRAAccounl#K500004632-named 61,08922 61,08922
beneficiaries are decedent's lwo step-daughters
19 RelianceStandardlRAAccount#K500005075-named 9,915.67 9,915.67
beneficiaries are decetlenYs hvo step-daughters
20 Reliance Standard IRA Account#K500005076-named 10,022.50 10,022.50
beneficiaries are decedent's two step-dau9hlers
2i VoyaIRAAccountN90438146-namedbeneficiaries 89,584.19 89,584.19
are tlecedenPs lv+o slep-daughtere
Copyright(c)2009 Porm soflware only The Lackner Group,Ina Form PA-1500 Schadule G(Rev. 0&09)
Troy H.Laodis,CFP
LANAIS & CO.F7NANCIAI. SETtVICES,LLC
74 Wavt�'omfret Street
Carlisle�PA 17013
(71'n 245-9522
Fax('71'�249-029fi
Apri122, 2015
Accounts of Donald G. FIa�1e
Comuanv Acct.No. Avorox. Value
Allianz 70580319 $ 1J5,087.49 Non-Qvalified
Allianz 70877491 $ ]08,5425A Non-Qual�ed
Lincoln Fiozncial FQ7093901 $ 46,379-40 IRA
Lincoln Financial 35-714234$ $ 6,173.45 IRA
Lincoln Financial 35-7142349 $ A3,740.91 Non-Qnalified
Reliance SWndard K500003158 B 16,833.41 iRA
Relianee Standard K500003159 $ 12,489.09 IRA
Reliaace Standard K500005075 $ 9,915.67 TRA
Reliance Siandazd K500005076 $ 10,022.50 R2A
Reliance Standard K500004632 $ 67,089.22 TRA
Reliance Standazd K500001326 $ 71,941.86 IRA
Reliance Standard K500001327 $ 96,971.52 llLA
Reliance Standard K500001298 $ 23,29435 IRA
ReGance Standard ATMG002510 $ 47,955.70 IRA
Reliance Stsndnrd ATMG003749 $ 26,016.00 Non•Qualified
Reliance Standard K500001608 $ 109,048.18 Non-Qual.ified
Relipnce Standard K500004994 $ 111,56718 Non- QitaliFed
Voya 90438146 $ 89,584.19 IRA
FidelityInves[ments 01481294898 $ 67,169.39 Non-Qual.ified
Jackson National 1013211155 $ 13,752.41 IRA
IacksonNational 1013212097 $ 39,422.47 LRA
IRA Total A 545,825.24
Non-Qvali6ed Total S 581165.69
Total $1,126,990.93
Regis�ered Rapresentative of and Securities ot7ered thro�gh Voys Financial Advisors, Inc,Member 54PC.
l,endis�@ Co. I'inancial Services,LLC is nol a subsidiary of nor conholied by Voya Pinuncial Advisors.
R�151E%.,��," gCHEDULE H
� pennsylvania
oEPnRrmeN*orr+EVEHUE FUNERAL EXPENSES AND
'""Eq'�"""'"�RE�"a" pDMINISTRATIVE COSTS
AEs oervr oECEOExr
ESTATE OF FILE NUMBER
Flagle Donald G 21-15-0461
Decedent's tlebts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
R
q, Fl1NERALEXPENSES:
See continuation schedule�s) attached 1,790.00
B. ADMINISTRATIVE COSTS:
1. PersonalRepresen�a�ive'sCommissions
Name of Personal Representalive(s)
Diane L. Clever Pamela K Yorlets
SlreetAtltlress 65 East Main Street
City Newville State PA Zio 77241
Vear(s)Commission Paid Waivetl
p. nuomey's Fees Salzmann Hughes, P.C. 23,23828
3. Famity Exemption: Qf�ecetlenfs atldress is nol Ne same as claimanCs,aLLach explanation)
Claimant
Street Atldress
Ci1y State Zio
Relatiorehio of Claimant to Decedent
4. Pmba�e Fees 815.50
5. AccountanfsFees
6. Tax ReNm Preparer s Fees
]. Other Adm'misVative Cosis 21,369A4
See continua[ion schedule�s)attached
TOTAL(Also enter on line 9, Recapitulation) 47,2'12.92
CoOY��gh1(c)2013 torm so(twere only TM1e Lackner Gmup,Ina Form PA-1500 Schetlule H(Rev_OB-13)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Flagle Donald G 21-15-0461
ITEM
NUMBER DESCRIPTION AMOUNT
��
1 Hollinger Funerel Home 8 Crematory,Inc. -cremation services '1.790.00
H-A 1.790.00
Other Administra[ive Costs
2 AtivanceDisposal -garba9eservice 42.09
3 CenturyLink-telephoneservice�3/25/15-04124H5 28���
4 CenturyLink-telephaneservice05/25/15-O6/24/15 28.81
5 CenturyLink-telephoneservice06/25115-07/24115 30.21
fi CenturyLink-felephoneservice04125/1 5-05/24H5 Z8�8�
7 Cumberlantl Law Journal-legal advertising fee 75.00
8 Met-Ed -eleclricservice4H4/i5-5/11/15 3�.49
9 Me4Etl-electricservice5N2H5-6/11115 99�39
�0 Met-Ed -electricservicefill2/75-7H3/�5 �6���8
17 Reserve-to be held(or final lite income tax returns,(itluciary income Wx returns antl 1,400.00
miscellaneous contingencies in ortler to adminisler[he estate
t4 Roy Gottshall -personal property appraisal fee 175.00
13 Settlement Expenses for Sale ot Real Estate-as shown on settlement sheet 18,623.19
CopyngM(c)2002(orm soflware only Tha Lackner Group, Inc Form PA-1500 Schadule H(Rev_Fi98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Flagle Donald G 21-15-0461
ITEM
NUMBER DESCRIPTION AMOUNT
ib SW Barrett Real ESWte and Appreisal Service-real estate appraisal fee 375.00
15 TheSentinel-legaladvertising 201.16
16 UGIUtilities-gasservice3l20/75-4/21/15 Z�.49
17 UGIUtilities-9asservice4121/15-5/20/i5 13.50
18 UGIUtilities-gasservice5/20/15-6122/15 '14.49
19 UGI Utilities-gas service 6/22/15-7121115 �3.49
20 Unitetl Stales Post OHice-certified mailing fee for safe tleposil box invenlory 6.48
H-67 21.369.14
CoOYrigM(c)2002 torm sollware only The Lackner Gwup, Inc. Portn PA-1500 Schetlule H(Rev.6-98)
Ren15II EX�I��-��)
SCHEDULE 1
d�6 pennsylvania DEBTS OF DECEDENT,
p�� °E"�fTNENTOFtEVENOE MORTGAGE LIABILITIES AND LIENS
INIIERIiANCE iA%RETORN
RESIOENi OECE�ENT
ESTA7E OF FILE NUMBER
Flaqle Donald G 21-15-0461
R.von a.oi.ma�..a ey m.e.�.a.m v�or m e..m mn rem:mee��o.ia a m.aa.o�oenn.m=wm�y��ra�me�a.a m.oma.:v.�..s.
ITEM VALUE AT OATE
NUMBER DESCRIPTION OF DEATH
1 Metlicolnsurance-premiumpayment 205.06
2 Met-Etl-electricservice3/72H5-4/73/15 �BZ.ZZ
7 SouthMiddletownTownshipMunicipalAuthority-water/sewerservice01/01/15-03/31/15 147.32
4 SouthMiddletownTownshipMunicipalAuthoriTy-waler/sewerservice04/07/i5-06/30/15 147.32
5 UGIUtilities-gasservice2/19/75-3/20/75 46.fi0
TOTAL(Also enter on Line 10, Recapitulation) 728.52
pr more spece is neeaee,aeelnonal pages or ine same ske)
Gopyngh�(c7 2012 form soflware only Tha lackner Group, Ina Porm PA-1500 Schetlule I(Rev. 12-12)
0.EV�15ll E%���t-00�
�. pennsylvania SCNEDULE J
�)' OEPPRTMENT OFPEVENVE
�HNEA�,a��E.,�AE.�R� BENEFICIARIES
FNTOECEDENT
ESTATE OF FILE NUMBER
Fla le, Donald G 21-15-04fi1
NAMEAN�ADDRESSOF RELATIONSHIPTO SHAREOFESTATEAMOUNTOFESTATE
NUMBER PERSONfS1RECEIVINGPROPERTV �ECEDENT (Wortls) (3$$)
TA%ABLEDISTRIBUTIONS �'mclutleoulrighlspousal
I• disMibutions,antltransfers
untler Sec.9116 a 12
Diane L Clever Steptlaughter 50%of residue
4744 Enola 2oatl plus
Newville, PA 17241 annuities/IRAs
DeborahAHeckendorn �aughter None
228 Richland Roatl
Carlisle, PA 77015
Pamela K Vorlets Stepdaughter 50%of residue
65 East Main Street plus
Newville,PA 17241 annuities/IRAs
To[al
Enter dollar amounls for tlls�ributions shown above on lines 15 throu h i6 on Rev 1500 wver sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TA%IS NOT THKEN
B.CHARITABLE AN�GOVERNMENTAL OISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE OISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form soflware only The Lackner Gmup. Inc. Form PA-0500 Schedule J(Rev. 01-10)
LAST WILL AND TESTAMENT
I, DONALD G. FLAGLF„ of Soutli Middleton Township, Cumbcda�d County,
Pennsylvania, being of sound mind, disposing memory and flill legal agc, do hereby make,
publish and declace this to be my Last Will and Testamen[, hereby rewking all Wills and
Codicils heretofore made by me.
ONE. I direct my Executor or Executrix, as the case may be, to pay all of my
debts, fimcral and administrative expenses as soon as convenient after my decease. Furthermore,
I direct that all state, inheritance, succession and other death taxes imposed or payable by reason
of my death and interest aod penalties thereon with respect to all pmperiy composing of my
gross estate for death tnx purposes, whether o� not such property passes mider this Will, shall be
paid by the Executo� or Executrix of my estate. Further, to 8ie extent that su�cient assets exist ,
in my estnte, any and all inheritance or other estate taxes, whether to non-charitable or charitable
beneficiaries, shall be paid by my Executor or Executrix from the residuary of my estate prior to
distriUution and no part of the taxas paid shall be prorated or apportioned among the persons or
beneficiories reeeiving the tnxable property regardless of tax rate applica6le by law to caeh such
persans or beneficiaries'.
"C�VO. My Exewtor or Rxeeutrix may, at his or her discretioq compromise
cloims, bon�ow money, rc[ain propeiTy for such length of [ime as he or shc may dccm proper,
lease end sell property for such prices, on such terms, at public or private sales, ns he or she may
deein proper, and invest eslate property and income �vithout restriction to legal investments
unless othcrwise pmvided hereunder. I authorize and cinpower my Execu[or or Execuhix to sell
any realty and/or person�lty owned by me at my deatl� end not specifically dcvised or
bequeathed herein, at public or priv�te sale or sales and to givc gootl and sufficient dceds ,md/or
bills of sale tlicrefor, in fee simplc, as I could do if living. My Executor oc Executrix is
authorized and empowered to engage in any business in which I may be engaged at my death, foe
such period of time after my death as seems expedient to said 8xecumr or Executrix.
THREE. I give, devise and bequeath all of my estate of whatever nature and
wherever situa[e to my spouse, DOLORES K. FLAGLE, absolute.
FOUR. If my spouse, DOLORES K. FLAGLE, does not survive me by a period of
a[ least sixty (60) days, then I give, devise and bequeath the rest, residue and remainder of my
estate in equal sha�es to my step-daughters, DIANE L. CLEVER and PAMELA K. YORLETS,
per stirpes, which provides that the child or children of any deceased beneficiary shall take the
share their parcnt would have taken if living.
A. My biological daughter, DEBORAH A. HECKENDORN, is specifically divestul,
prohibited and excluded from taking any share of my estate under this Last Will and
Testament.
PNE. In the event of a commoii disaster causing thc death of myself, my spouse
2nd all of my children, without leaving surviving issue, all within a peiiod of sixry (60) days,
then I give, devise and bequeath the rest, residue and remainder of my estate pursuant ro the
inslestacy laws of the Commonwenith of Pen�sylvania.
SIX. If, under any of the provisions of[his Will, pny principal becomes vested
in a tninor, tny Execulor or Execu�rix, as the case mny bG including any adminishator c.t.a.,
shall have the disceelion cither to pay over sueh prineipal or any part [hereof to any parent of
such minor, uny ovardian of the person or estnte of such minor, or any person with wliom such
minor resides, or to re�ain the same ns h�istee of a powcr in trusl for the bencfit of such minor
during his or Iror minority. Any of the principal Otus retained, und any of the income tl�erefrom,
0
including the whole thereof, may bc paid to or applied for the benetit of such minor from time to
time in the diseretlon of the trustee of such power. When such miiior reaches majority, the funds
so held shall be paid over [o such person, or, if he or she shall sooner die, to his or her legal
�epresentatives. I� so holding any principal or income for a�y minor, the trustee of such power
shall have all the rights, powers, duties and discretimis confetted or imposed upon my fiduciaries
acting under this Will. I furtlier direct that no bond shall be reyuired fmm any person receiving a
payment hereunder and receipt from such peeson sliall be a fidl discharge to the trustee of such
powcr who shall not be bound to see to the application or use of such paymenL The trustee of
such power sl�all be entitled to commissions at the rates and in the manner payable to a
testamentary �rustee.
SEVEN. I nominate and appoint my spouse, DOLORES K. FLAGLE, [o be the
Executrix of this my Last Will and Testament. In the event that she has predeceased me, failed
m qualify or is not able or does not serve for wliatever reason, I then appoint my step-dauglzters,
DIANE M. CLBVER and PAMELA K. YORLETS, or the su�vivor of the two of them, ro be the
substitute Co-Executrixes of this my Last Will and Testament, whereby the said substitute
personal mpresentatives shall have the sa�ne powers as are given to the original F.xecuVix
hercunder.
EIGH'C. No person(s) shall bcnefi[ hereunder unless such beneficiaiy shall survive
me by sixty (60) days.
NINE. No 8xecutrix or Guardian ncting hercunder shall bc requircd to pos[ bond
or enter s-ecurity in this or any otherjurisdiction.
'I'PN. No beneficiary may assign, anticipate or plcdge his or her interest in any
inwme or principal held or disMbutable hereunder, tmd no beneficiaiy's creditors may Icvy,
ett�ch or othenvise reach any such interest.
i
ELEVEN. If any person or institu[ion enlitled to shace in any distribution under the
tenns of this my Last W ill and Testament becomes an adve�se party in any proceeding [o contest
the probate of this Last Will and Testament, such peiso� or institution shall forfeit his, he� o� its
entire interest inherited hereunder and all provisions in favor of such person or institution shall
be declared void and of no effect. The shace of such person or institu[ion so forfeited shall be
distributed as part of the residue hereof except that if such person or institution is entitled to
share in the said residue, that interest shall be distributed proportionately to the other residuary
distributees.
T�VELVE. This Last Will and Testament was made, published and declared in
accordanee with the First Amendment to Agreement for Reciprocal Wills which I enteced into
with my spouse, DOLORES K. FLAGLE, on March '�}'�, 2014, and shall be executed subject to
the provisions contained therein.
IN WITNESS W HEREOP, I have here�nto set my hand and seal this �T dxy of March,
2014.
,r//vr��+'� 2l �"h~/ /(SEAL)
DONALD G. FLAGLE
Signed, sealed, puUlished and declared by thc above-named person as and for T Last Will
and Testament, in our presence, who nt snid persods request, in snid person's presence ond in thc
presence of ench other have l�eeeunto set our names ns subscribing witnesses.
�/.f,_( .��'.��.Vi. CICi��'i�� .—
�
�����
Y_ , ,_
�
ACKNOWLEDCMENT AND AFFIDAVIT
WE, DONALD G. FLAGLE, tCANDY L. COYLE and JENNLFER M. NEGLEY,
the tcstator and witnesses respectively, whose names are signed to the foregoing instmment,
being first duly swom, do hereby declare to the undecsigned authority tliat the testator siovncd and
exewted the ii�strumei�t as his Last Will and Testament, and that lie had signed willingly, and
that lie executed it as his free and voluntary act for the purpose herein exp�essed, and that each of
the wiMesses, in Ihe presence and hearing of the tes[ator, signed the Will as a witness and thal to
the best of their knowledge the testator was, at that time, eighteen years of a�*e or older, of sound
mi�d and under no constrnint or undue influence.
,�,�.�.c�� �`� ���.`-,
DONALD G. FLAGLE �--
--�� .L �'t'� 'l " �r��
KANDY L. C ' YLE %
J NN�R M. NEGLE�Q �
�
COD4D10NWEALTHOFPENNSYLVANLA .
. S5:
COUNTY OF CUMBERI,AND �
Subscribed, swom to and ecknowledged before me by DONALD G. tLAGLE, the
testator herein and subscribed and sw� �fn to before me by JENNIFER M. NEGLEY and
KANDY L. COYLE, witnesscs, this `f��dny of March, 2014.
f���e��� � ,��,�>r����,,� � � l�n n�n
�o� �s a�
(a ela 5.Co r�a Notary Fubl� -�-
So t�N�dlcton Tnp.,Cu i Gerlond Couny
Nn'c�mm�a�exao-esnmez¢,mia Notar Public
� •nemn,r o�nrs.dva,.�anss�tia;odnruorarve- Y
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