HomeMy WebLinkAbout01-0889
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of' C;u S {~n/7d- T EbelhM~ )!Ul17fe. No. / B' J- J:; J:-:).,3 ~/-o}-W,
also known as To:
Register of Wills fOf the
Deceased. County of (', u m h (J r l;y n rJ in the
Social Security No. / ~ ,) -:A), - 't; 7 23 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut r~/r/~ 'J r (J~ tJ~.A()/)! named
in the last will of the above decedent, dated -::J u ~ :2? :1l 10' q I J, 19_
and codicil(s) dated I '
(state reievant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in CUm,
residence ~t
(. F" ,/_? j )
(list )street, number and muncipality)
Decendent, then R
at . c (-) h J
Except as follows, decede id not marry, was not divorced and'did not have a child born or dopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ <ff lfJj {" 0 (;>
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters lESTAMENTARY
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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OATH OF-PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I ss
COUNTY OF CUMBERLAND J
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn (0 '?' affi'Ill'i% and subscribed ~/Uac- [' tI ~~.' . !:,-t< '}h'<; Ii:!
before me this day of ~ / ~
~
'dd. ~
~
MARY c. ~
/7- /C)..3 1/'
~o. 21-2001-889
Estate of SUSANNA T. EBERHARr- HUMER
, Deceased
DECREE OF PROBATE A~D GRANT OF LETTERS
AND NOW SEPI'EMBER 22i"ltl:L-.._.___.._.._ ~nt-2.QQ1, in consideration c" ;I"~ De:iti(w. 'In
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated JULY 29TH. 1991
described therein be admitted to probate and filed of record as the last will of
SUSANNA T. EBERHART mTMF.~
and Letters TESTAMENTARY
are hereby granted to PATRICIA E. VOGELSONG
'A-) tf~
y c. LEWIS ~
FEES
5 115.00
5 3.00
5
S
TOTAL _ $ 12q nn
Filed SEPTEMBER. '27.lB1,.2001 . . . . . . . . . . . .
Probate, Letters, Etc. .........
Short Certificates( 1) . . . . . . . . . .
Renunciation ................
X-PAGES (2)
JCP
A TIORNEY (Sup. Ct. 1.D. No.)
6.00
ADDRESS
PHONE
MAILED LETTERS AND ORDER EXECUTRIX
05.805 REV 9/86
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Recor~s Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7742131
No.
21-2001-889
a<Ar/ 71: ~r
Local Registrar
SEP 2 1 zoot
Date
....2187
COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH · VITAL RECOROS
CERTIFICATE OF DEATH
NAME OF DECEDENT If".. MOM. U_I
1. Su..6a.nna. E. HWJIVl
AGE II... ~ UNDER 1 YEAR
MGnItIe o.y.
SEX
l ema1.e.
STAlE FU_R
SOCiAl SECURITY NUMBER
3. 782 22 - 4723
DATE Of'OEAlH.MoiWI. Oa). '_,
9-20-2007
..
8IRTHPUCI ~C"Y and
SlIle 01 FCfeogn CounuYl
Ai..toona,PA
1.
FACLlTY NAME (lIl1Clllnlil'l\Alcf\. gNe .... anlI numlle..
PlACE OF OEA'H iC1>ecI< ""'" IN'e ..... ."s"UCl.tln4 on lllhet _I
HOSl'\lAL;
Inpelienl 0 IEM)ulpaI_ 0
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DECEDENT'S USUAl 0CCUMl0N
.. I~-=:";:'C::':::;.l:r
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SUAVMNG SPOUSE
II ...... gAIe"- NIlI1IIl
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::...... 24-ae III1IIllle ~ by wr.s CASE AEFEAAED TO MEOlCAl ElWollNERlCOAONER?
~"'-wha"--ClNIh. 24. tZ"l~ E M. H. O?-/5IO-~L .. -liilFb' NoD
~21. HIlT I: e-...............OI ~ wflidtCllUMClIhe dUlh. 00 ....._..... made 01 dying.lUCtlaacarCIiK 01 ..ap;ralOly arresl.1hclcIt III """ 1alIure. I AppIoJcinIeIe PART II: 0Uw aigniIlc8nt_____~lOdeIIII.lIul
liII cw, _ __ on eldlline. ! =--= ............ ift...lIIllIedWing _..... ift PART I.
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"-~ ANAUlOPSY
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DUE 10 ('OR AS A CONSEOUENCE Of}:
DUE lOCoA M A CONSEOUENCE Of}:
WERE AU10PSY FINDINGS
UlU8LE PfllClR 10
COUPlETIOH 0# CAUSE
OF OERH?
MANNER Of' DEATH
DATE OF INJURY
1_. Day. 'M_I
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Hamcide
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CoolId _lie deI_1Md
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c:srr..... ~ """ ClfleI
"CUlTFtlNG I'HYSIClAN (Ph\'llCflll'l ~er1IIyong cause d....... _ _.. pl\vslc4n "" ponounc:ed dealh an<1 ~0fIljlleled IIern 231
To..........""........... delllllllCCUmlOt........c.....c.,_.......... .._. ......................... ............. ........ ......
.ii
~ -PRONOUNCING AND CERTIFYING ~YStCtAN (PhystQiIfT boIh prOOOUOC"'i deaIh MKJ cet1llylnv to cause 01 daaIh~
.. To Ihe........y ....wlecIa.. de.th DCCurreclal _..... d.... .not pl""e. _ d...1o _ ..-..(al_ "'an"", .. ...1..... . . . . . . . . . . . . . . . . . . . . . . . .
;ij
:: -MEDICAL EXAMlNERlCORONEA
On the..... of ..amlnatlon 1IftdI<< ,,,,,......Ion. in my opinion. death OCCUl'f.d at the lima, da'.. and place, and due 10 the COMealand
31.~" ....eel... .. . . . . . . . . . . :.: . " . . . . .. . . . . . :.: . . . . . . .. . '.' . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . 0
REG.
U 1.1 t:J.. I~ ~ I
TIME OF INJURY
DESCMlE tfOW INJURY OCCURRED.
INJURY AT WOfIK?
_ 0 NoD
)4.
LAW OFFICES
.~
LAST WILL AND TESTAMENT
I, SUSANNA T. EBERHART HUMER, of the Township of Upper
Allen, County of Cumberland, and Commonwealth of Pennsylvania,
being of sound and disposing mind, memory and understanding, do
make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making void all former wills and
codicils by me at any time heretofore made.
FIRST. I order and direct that all my just debts and
funeral expenses be paid by my Executrix, hereinafter named, as
soon as conveniently may be done after my decease.
SECOND. I give, devise and bequeath all the rest, residue
and remainder of my Estate, whatsoever and wheresoever situated,
in equal shares unto my children, namely, ELIZABETH A. SHUNK,
DENNIS M. EBERHART, PATRICIA E. VOGELSONG, EDMUND S. EBERHART
and LYNN S. MICHELS, share and share alike, absolutely and in
fee simple. If any of my above-named children should predecease
me and leave lawful issue to survive me, I order and direct that
the share of such deceased child shall be distributed unto her
or his lawful issue per stirpes by representation and not per
capita, subject, however, to the protective trust provisions of
Item Third hereinbelow.
THIRD. I order and direct that the foregoing distributive
share of my residuary estate attributable to any beneficiary who
has not attained the age of twenty-five (25) years at the time
of my death shall be paid over and delivered unto my Executrix,
hereinafter named, as my testamentary Trustee, IN TRUST,
NEVERTHELESS, to hold, manage, invest, reinvest and accumulate
NELBAKER a ELICKER at which latter time said trust shall be terminated and the net
until the beneficiary attains the age of twenty-five (25) years,
proceeds thereof paid over and delivered unto the beneficiary
....~ .
absolutely. During the existence of said Trust, I authorize and
empower my said Trustee to use, consume, expend and apply from
time to time such amounts of income and principal as said
Trustee shall determine in the exercise of her sole discretion
to be necessary and proper for the beneficiary's education. The
term fteducationW shall be construed to mean college or other
post-highschool training which is intended to promote the
beneficiary's productivity as an adult or to enhance the quality
of his or her life.
LASTLY. I nominate, constitute and appoint my daughter,
namely, PATRICIA E. VOGELSONG, to be the Executrix of this, my
Last Will and Testament, but if for any reason she should fail
to qualify as such Executrix or cease so to serve, then and in
that event, I nominate, constitute and appoint my daughter,
namely, LYNN S. MICHELS, to be the Executrix hereof, each and
both to serve without bond or other security as a condition of
qualification hereunder.
IN WITNESS WHEREOF, I, SUSANNA T. EBERHART HUMER, have
hereunto set my hand and seal to this, my Last Will and
Testament which consists of two (2) typewritten pages to each of
which I have affixed my signature this
~q~ day of July
A.D., One Thousand Nine Hundred Ninety-one (1991).
~~'1H~ j~pb1,tv:Ju~ 7iu~u.J
(SEAL)
The preceding instrument, consisting of this and one (1)
other typewritten page, each identified by the signature of the
Testatrix, was on the date thereof signed, sealed, published and
declared by SUSANNA T. EBERHART HUMER, the Testatrix therein
named, as and for her Last Will and Te~tament, in the presence
of us, who, at her request, in her pre'ence, and in the presence
of each other, have subscribed our n as 'tnesses hereto.
~
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-2-
LAW OFFICES
NEL8AKER Be ELICKER
~.
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY
OF
CUMBERLAND
We, SUSANNA T. EBERHART HUMER, RICHARD C. SNELBAKER and
JANET R. STEGNER, the Testatrix and the witnesses, respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the Testatrix signed and executed the instrument
as her Last Will and Testament and that she had signed
willingly, and that she executed it as her free and voluntary
act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed
the Will as a witness and that to the best of his or her
knowledge the Testatrix was at that time eighteen years of age
or older, of sound mind and under no constraint or undue
influence.
,j;,c.&I~~ J. ~~ t vi ccd ~{,-1.~'
~~
' Witness
-~R /
L. ,'~~
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Subscribed, sworn to and acknowledged before me by SUSANNA T.
EBERHART HUMER, the Testatrix, and subscribed and sworn to
before me by RICHARD C. SNELBAKER and JANET R. STEGNER,
witnesses, this v?9~4.. day of July, 1991.
LAW OFFICES
~ ~.?
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Notary Public
;NELBAKER Be ELICKER
I Notarial Seal .
C~'tv,,.;,r, '::. p.Qusum. Notary Public
-,,,I' "".. .c. Co. '- . I d C ')llnty
r t-y.hC""If'C""'P'O Eorougl1. Currbsr,2,n c_.
\I,J~j1y'C~;~~i::~ission Expires Feb. 27,1994 I
Member, Pennsyl'Jania AssociatiOn of Notaries
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Stt~ cV/)/J;!
~(2M
/
f. flu /7J 6e
d co /
Date of Death:
Will No.
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
/~/;z;:;befA ,C::;hUI7K 5115 JfrlclA.kY't P/c;C1J }7}ecAfin/rfbu/'tj h /}oSJ'
J ) ~
De.I1I7/J Ih. J~b~rM;e/ jlljP7 V,4I)?;:JrlJ'fl TraIl jtfLfsv/Ji/I//~ /~/')C~ 3;)..)..~3
" I J J
f/:Hf'/u~ V!JeIsM1 (,31){'jlUhc/~dr! Ld/2/ 'fci/lI:1I'oh4rf ~ I)?'~
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Ed U/1JS E e,M ~/el'/ / J'l/lIf /J/2/d /;jl7'g~3i)
Lyg,,,,, m;c)c-/i) (;0,/:2 E: w4rd.f ";(jej ~('l9n/rj'6l{ 'I, ;!//9 / )05'0
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
~td~
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Signature
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Name J}.;J I'/ll a [~. 1/, fie 1st1/7~
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Address t '3 IS- C h () JH r DL lei ! d 17<
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Telephone (?/) ~ /_ 9 S ~ ::>
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Capacity: X- Personal Representative
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
VOGELSONG PATRICIA E
6315 CHESTERFIELD LANE
MECHANICSBURG, PA 17050
-------- fold
ESTATE INFORMATION: SSN: 182-22-4723
FILE NUMBER: 21-2001- 0889
DECEDENT NAME: HUMER SUSANNA T EBERHAR-
DA TE OF PAYMENT: 12/07/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 09/20/2001
NO. CD 000611
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,090.67
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: PATRICIA E VOGELSONG
CHECK# 8
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
$3,090.67
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
/ 7-/tJ -3
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRIS8URG~ PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
(,ATE
-ESTATE OF
DATE OF DEATH
FILE NUMBER
P 2 ~NTY
"ACN
01-21-2002
HUMER
09-20-2001
21 01-0889
CUMBERLAND
101
Amount R..litt.d
Recoro(:;
Regl:'V::
.02
JAN 25
PATRICIA E VOGELSONG
6315 CHESTERFIELD LN
MECHANICSBURG PA 17050CierK-;:
rAllnberJ Gn c
ESTATE OF
HUMER
DATE 01-21-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Sehedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Mise. Expenses (Sehedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deduetions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
NOTE:
*s~
IlEV-1547 EX AFP Cl2-DD)
SUSANNA
E
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
76~905.27
4.&08 89
72~296.38
.00
72,296.38
(19)=
.00
3~253.34
.00
.00
3,253.34
" ,.... ,,_" I
PA
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-Y=is'47-iic--A FP--f i'2-:olir-NoVici-oF-'rNHERITANCi-y- Aic-APPRA-isEMENT-;Aii.oWAifci-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
SUSANNA E FILE NO. 21 01-0889 ACN 101
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (IS)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
) CHANGED
(I)
(2)
(3)
(4)
(!iJ
(6)
(7)
.00
.00
.00
.00
76,905.27
.00
.00
(8)
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
PAYMENT MUST BE HADE BY 06-20-2002*. TOTAL TAX CREDIT .00
BALANCE OF TAX DUE 3~253.34
INTEREST AND PEN. .00
TOTAL DUE 3~253.34
. IF PAID AFTER DATE INDICATED~ SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(9)
(10)
1~010.00
( IF TOTAL DUE IS LESS THAN $l~ NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
3.598.89
(II)
(12)
(13)
(14)
(Schedule J)
.00 X 00 =
72,296.38 X 045=
.00 X 12 =
.00 X 15 =
/ "} - /L'> --"-.?
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRIS8URG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REV-U07 EX AFP (12-00)
Re~Jif.:;t()
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
P 1 :4 ~OUNTY
ACN
01-28-2002
HUMER
09-20-2001
21 01-0889
CUMBERLAND
101
SUSANNA
E
Recoro.:.:.
-02 FEB-1
PATRICIA E VOGELSONG
6315 CHESTERFIELD LN
MECHANICSBURG PA 1706ierk
Cmnbeik1
Allount Rellitted
-~Jr {
r) f-\
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=i6o-j-ix-AFP--fi'2-:oo1-------..ii-iNHERITANc'E-;:AX-STATEME-ti;:-OF-Accou'Nf--...---------------------
ESTATE OF HUMER SUSANNA E FILE NO. 21 01-0889 ACN 101 DATE 01-28-2002
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUEl APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE1 ANDI IF APPLICABLE1
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-14-2002
PR I NC I PAL TAX DU E : ...........................................................................................................................................................................................................................
31253.34
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
12-07-2001 CDOO0611 162.67 31090.67
TOTAL TAX CREDIT 31253.34
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
(/aI
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ,5USAn/7(J
Date of Death: ,)U2LJ:/ ;;to doo /
, I
Will No. :2/-01- O~g f
F
AI U /?? fUl
,
Admin. No. 20tJ/-(JtJ~f?'7J
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes~ No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes.. _ No ".-1'". ,
b. The separate orphaf(s" tourt No. (if any) for
the personal representative's account is:
c. Did the personal representative s~e an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
N
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s&cz(~ L V~j
Pf)lr;'cLa f'1l6"iehMQ
Name (Please type Qt print)/
t 3/ (J J.{ j ~d e
Address J'J1t'C ,41'J J( ({ (7~;-l ';l / /aJ6
(7/;) ~9)- CjS-~)
Tel. No.
Capacity: ~personal Representative
Counsel for personal
representative
Date:
~-J 6 -0 i..
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~r..
C,,",.
, \.0
....-
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(MAH:rmf/AM3)
'EV-1500 EX (~O)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEP1280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
c:lL-OL eBq.
COUNTY CODE YEAR - NUMBER - ,
REV-1500
OFFICIAL USE ONLY
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SOCIAL SECURITY NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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04. Limited Estate
[?6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (dale of death atter 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31.91 and 1-1-95)
o 3. Remainder Return (dale of death prior to 12-13-82)
I.XJ 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sell 0)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
\ 5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
'10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x .0_ (15)
x .0 'i.5:j(16)
x .12 (17)
x .15 (18)
16. Amount of Line 14 taxable at lineal rate
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17. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF S
Lt_ r- rJ,h /? r7
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
II fA p7 8f'
FilE NUMBER
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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
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
th~c R/I?J f/)r)
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36-' / /.J...20
t. D.
5/700:20'/30
3,;{ 7//.;2 I
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TOTAL (Also enter on line 5, Recapitulation) $ 7 6 CJ tJ <;. ~ '")
(If more space is needed, insert additional sheets of the same size)
REV-1q11 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OSF. .
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
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Debts of decedent must be reported on Schedule I.
FILE NUMBER
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ITEM
NUMBER
A.
B.
1.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
trem/.l.ho,."g- Memorial ?/)C)!~
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7
Personal Representative's Commissions
Name of Personal Representative(s}
Social Security Number(s}/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4.
Probate Fees
/~ C;'.OO
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ /01 d. (J 0
(If more space is needed, insert additional sheets of the same size)
MedIcal documents I couner ree
Nationwide guarantee program
Worldwide travel protection program
Private family identification and/or witnessing cremation
at crematory (includes cremation container)
FINAL DISPOSrrrON
Packaging and forwarding cremated remains
Express mail
Arranging with a cemetery for burial of cremated
remalOS
Arranging, packaging and forwarding cremated remains
to a national or private cemetery for burial
Scattering of cremated remains over land or sea
Burial of cremated remains at sea
MERCHANDISE
Register book
Memorial folders/prayer cards
Thank you cards
Do-It-Yourself Memorial strvice i
cardOoara con~a ner
Urn #
Cremation container
Urn burial vault
CASH AnY ANCES (We charge you for our services in buying these items)
Cemetery charges
Honorarium
Certified copies of the death certificate
County coroner cremation approval fee
Flowers
Newspaper placement fee
Newspaper charges:
Ha~~lsburg PAT 116
If a cremation container, urn, burial vault or
embalming'is required this is why:
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$25.00
SALE PRICE
DOWN PAYMENT
UNPAID BALANCE
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$ts9 t> . flJ0
$45.00
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For ar-netl ~W"~ces only: ! hereby agree rhat J have examined the above stated items and found them to be correct and according to the arrangements requested and J
hereby acknmMMge receipt of a copy of this statement, J hereby represent that I have sufficient assetS legally fvailby 2'%P"yment of the cash price ani Ig'if,by agtee and .
covenant JOIntly and severally to make payme'T of $ within days. A late charge ot per month amounting to pet year IS
applied to the unpaid balance beginning days from the dare of rhis agreement. Any additional services or merchandise ordeted or requested after the date of
this agreement will be considered parr of t IS agreement and the cOSt thereof will be reflected on Ihe final statement.
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Crematio/J Society of Pe/J/Jsytvania
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MEMORIALS
ORDER NO.
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"A Tribute to Life"
5243 Simpson Ferry Road, Mechanicsburg, PA 17055 · (717) 766-5622
CEMETERY I)) (' C /"i, ::) /"; j ( \~
NAME OF DECEASED "
LETTERING REQUIRED:
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RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Receipt Date
Receipt Time
Receipt No.
9/27/2001
10:48:03
1026991
RUMER SUSANNA T EBERHART
File Number 2001-00889
Remarks VOGELSONG PATRICIA E
SK .
------------------------ Distribution Of Receipt ------------------------
Transaction Description PaYment Amount Payee Name
PETITION FOR PROBA
SHORT CERTIFICATE
EXTRA PAGES
JCP FEE
115.00
3.00
6.00
5.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
Check# 149
Total Received..... ....
$129.00
$129.00
--
11/15/131
10:14
REGISTER OF WILLS -+ 717'7834295
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COMMONWEALTk OF PENHSYL\lANIA
lNl'l~RI1'AN~ 'TAlC RETURN
. DENT DECiDE
eST^no OF
SCHEDULE I
DEBTS OF DECEDENT, I
MORTGAGE LIABILITIES & LIENS
E.
Include ulltelmbuRed !Melle.1 expanse".
ITEM
NUMBER
oeSCRIPTION
AMOUNT
1.
JjeSS1aJ, l/r//~
1<.ofJtI1 p/-J 'j tr)t" /) I - 1/ r) J /
<]I '3 Ol/cJ, () 25
/
:2
V e f1 J 2- On
FII7/l/ je /~h/)/7(l 8/1/
11 Ie;. PD
;J
:J
P hflr fr;uj CCl
7 e j; C-4hoa./'
3/53 C;or
i
I
i
!
. i
TOTAL (A inter on line '0,
(II more space I. needid, insen acIdlUonlll &heet, Ill. lame Size)
I
ladon) $ '3
,
09/01/2001
09/12/2001
(, {{1
\/ \ N
t:3eginnlng Balance
ROOM & BOARD ~ SEMI-PVT
19 DAYS AT 160.00 PER DAY
PAYMENT RECEIVED - THANK YOU!
3,040.00
rp~y(!eY1 ;
~ OO/}1 h J \ II PeY
CJ Sl'd, ! 11)0 r
'\0~ ~)O
Op\ (
\
Current
61-90 Days
91-120 Days
Over 120
31-60 Days
0.00
0.00
0.00
Statement End Date:
-3,500.00
Total Due
3,040.00
09/30/2001
3,50LJ.vv
6,540.00
3,040.00
SUSANNA E
UMER
I' ,.,....
l~
I verlzglJ
I Please make payment to Verizon
I and return thi s Qage wi th y-our p-ay-ment
Page 1 of 7
717 766-9689-210 72Y
September 19, 2q01
Due Date October 15, 2001 . . . . . . . . . . . . .
$19.80
Fill in Amount Paid
. . . I
;ciii,@;Ji;i.0i;'1
'. i
!
SUSANNA E HUMER
c-o MESSIAH VILLIAGE
PO BOX 2015
MCHNCSBRG PA 17055-2015
111111111.11111111.1111.111111111111111111111111.111111 d 11111
$ [2] [1J . [m[Q]
PO Box 28000
Lehigh Yly PA 18002-8000
10971707669689210202802139000006000000000000000001980200000
R21 028
f'.'1;-,,"~
. If~
. r.-
.:I
G.EORGE L VOGELSONG
PATRiCIA-E. VOGELSONG
6315 CHESTERFIELD LANE
MECHANICSBURG, PA 17050-2821
162
~.
JlAU01.HE I / II r /'---;J /'lV'1
~ORDEROF V t::... ~, /
l~~~ Ch,c1~
J:
U
/11 ;l L ') / 60-811.1/2313
LY cr .J. 0<-06 DATE
/
~I. $/~~~
r:~
ARMERICA <Il~
For Comments and lor Concerns:
111 RUTHAR DRIVE
NEWARK, DE 19711-
For Payment:
PO Box 6176
Carol Stream, IL 60197-6176
IF YOU HAVE ANY QUESTIONS CONCERNING THIS STATEMENT OR WISH TO PAY WITH YOUR VISA, MASTERCARD,
AMERICAN EXPRESS, OR DISCOVER PLEASE CALL A BILLING REPRESENTATIVE AT 800-352-9161
PHYSICIAN NAME
ZIMMERMAN LAWRENCE B
STATEMENT
DATE
09/30/01
ACCT. NO.
5711-01-01156
DOLLAR
QTY. CODE AMOUNT
415.81
AMOUNT DUE UPON RECEIPT
=CONVERT TR=TRANSFER CR=CREDIT RX T=TAXABLE D=DISCOUNTED N=NON-COVERED
PLEASE RETURN BOTTOM PORTION WITH PAYMENT - Retain top portion for your records
435
REV-1513 EX+ (9-00)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
, Sec. 9116 (a) (1.2)]
1. t //?-Abaih /} Shu/J~
5J1S Er:5hfon P /JJU
1Yjechlln/(J!ur1. Pc? /70>-[
:2. Di!,.,n Ie; fn Che/M.<el
/,/. 'fIn V f}/pqrJ S'''ff/.l, /
T/lc)lSC/? (-"//1', .~/COr!d '3 ))..).]
'3 )'1q.fr;("/<J C IJOj(~,6-'f}r"l5
&3/S ChPJ!-er{>;dJ L (Jrv
Yrje eh It:} 11;0 bLUJ. 1,tJ /70)7
Ij r J )17 (J n r.f )- [ be i AAe/
/Cf_'i'i Mu./ bN'j Dri()-P
H/1h 4/(/) (J:;!' j)rnl.? 9 3,),30
L1ttN >>7/ c/'p). . DfJ uJ ~f~ I ~ yL,
&o'!') [' cI t.v./?rrfj PI'I (/(1 / ..)
YntC/'Ah:O hVio fljJ j7() )'-0
ENTER DOLLAR AMOUNTS'FOR DISTRiBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NUMBER
I
5
RELATIONSHIP TO DECEDENT
Do Not ListTrustee(s}
AMOUNT OR SHARE
OF ESTATE
DIi")A-fe?
js~
5 tl~
/5" y-i,
J) f)lrJi,iee
Is tt:
Sot-,
/5 y4
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 additional sheets of the same size)
WHEREAS,
dated July
on
the 27th
29th 1991
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
No. 2001-00889
PA No. 21-01-0889
ESTATE OF HUMER SUSANNA T EBERHART
(LA~'l', .b'l!{t)'l' , [vlllJlJL.l:!;)
Late of UPPER ALLEN TOWNSHIP
CUM~.l:!;!{LANlJ CUUN 1'1: ,
Deceased
Social Security No. 182-22-4723
day of September
2001 an instrument
was admitted to probate as the last will of HUMER SUSANNA T EBERHART
(LAt)'l' , .b'l!{~'l', MllJlJL.l:!;)
late of UPPER ALLEN TOWNSHIP
CUMBERLAND County, who died on the
20th day of September 2001 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to VOGELSONG PATRICIA E
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, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 27th day of September 2001.
* * NOTE * * ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
......-~
LAW OFFICES
LAST WILL AND TESTAMENT
21-2001-889
I, SUSANNA T. EBERHART HUMER, of the Township of upper
Allen, County of Cumberland, and Commonwealth of Pennsylvania,
being of sound and disposing mind, memory and understanding, do
make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making void all former wills and
codicils by me at any time heretofore made.
FIRST. I order and direct that all my just debts and
funeral expenses be paid by my Executrix, hereinafter named, as
soon as conveniently may be done after my decease.
SECOND. I give, devise and bequeath all the rest, residue
and remainder of my Estate, whatsoever and wheresoever situated,
in equal shares unto my children, namely, ELIZABETH A. SHUNK,
DENNIS M. EBERHART, PATRICIA E. VOGELSONG, EDMUND S. EBERHART
and LYNN S. MICHELS, share and share alike, absolutely and in
fee simple. If any of my above-named children should predecease
me and leave lawful issue to survive me, I order and direct that
the share of such deceased child shall be distributed unto her
or his lawful issue per stirpes by representation and not per
capita, subject, however, to the protective trust provisions of
Item Third hereinbelow.
THIRD. I order and direct that the foregoing distributive
share of my residuary estate attributable to any beneficiary who
has not attained the age of twenty-five (25) years at the time
of my death shall be paid over and delivered unto my Executrix,
hereinafter named, as my testamentary Trustee, IN TRUST,
NEVERTHELESS, to hold, manage, invest, reinvest and accumulate
5NELBAKER Be ELICKER at which latter time said trust shall be terminated and the net
until the beneficiary attains the age of twenty-five (25) years,
proceeds thereof paid over ann delivered unto the beneficiary
absolutely. During the existence of said Trust, I authorize and
empower my said Trustee to use, consume, expend and apply from
time to time such amounts of income and principal as said
Trustee shall determine in the exercise of her sole discretion
to be necessary and proper for the beneficiary's education. The
term "education" shall be construed to mean college or other
post-highschool training which is intended to promote the
beneficiary's productivity as an adult or to enhance the quality
of his or her life.
LASTLY. I nominate, constitute and appoint my daughter,
namely, PATRICIA E. VOGELSONG, to be the Executrix of this, my
Last Will and Testament, but if for any reason she should fail
to qualify as such Executrix or cease so to serve, then and in
that event, I nominate, constitute and appoint my daughter,
namely, LYNN S. MICHELS, to be the Executrix hereof, each and
both to serve without bond or other security as a condition of
qualification hereunder.
IN WITNESS WHEREOF, I, SUSANNA T. EBERHART HUMER, have
hereunto set my hand and seal to this, my Last Will and
Testament which consists of two (2) typewritten pages to each of
which I have affixed my signature this ~q~ day of JUly
A.D., One Thousand Nine Hundred Ninety-one (1991).
.-J'U4-tltILH~l j ~ fJ t..'/...l,l'C!I.--L..? 7k ~7"L;'t./
(SEAL)
The preceding instrument, consisting of this and one (1)
other typewritten page, each identified by the signature of the
Testatrix, was on the date thereof signed, sealed, published and
declared by SUSANNA T. EBERHART HUMER, the Testatrix therein
named, as and for her Last Will and Teytament, in the presence
of us, who, at her request, in her pre ence, and in the presence
of each other, have subscribed our n as 'tnesses hereto.
,...--:1
_AW OFFICES
AKER Be ELICKER
/~..') /'7, /'
".. '--"-iC"~H_,,,..::r-JA-< .' i---r::::<~~~-
/ '.../ ,j
-2-
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY
OF
CUMBERLAND
We, SUSANNA T. EBERHART HUMER, RICHARD C. SNELBAKER and
JANET R. STEGNER, the Testatrix and the witnesses, respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
"
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authority that the Testatrix signed and executed the instrument
as her Last Will and Testament and that she had signed
willingly, and that she executed it as her free and voluntary
act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed
the Will as a witness and that to the best of his or her
knowledge the Testatrix was at that time eighteen years of age
or older, of sound mind and under no constraint or undue
influence.
~c:...rdrY7~ J. :?:~ r "'..;c<.../.--,I'.: 7L{.t~~".e.v"
~. . ....... est~
Witness
/.} /) /...;f7
~/~~I ~.)""'~
..' .' 1 tnes . .
:/ '
Subscribed, sworn to and acknowledged before me by SUSANNA T.
EBERHART HUMER, the Testatrix, and subscribed and sworn to
before me by RICHARD C. SNELBAKER and JANET R. STEGNER,
witnesses, this
v? '?' -,.ct( day of July, 1991.
/-:.~ . ~.",;?
( ..':' /?/---w!! (.,.~
Notary Public
LAW OFFICES
3AKER a. ELICKER
r'- .T\:otar~3! Sf~al
I ""':'0',"':-. ~;!':,.olisuln. Notary Public
\! ....:...,.!,:';;~,"~::~:,,:,0~::~~~;~~~?~:~~~ ~~~lnty_
L________,-. - I '. '--XI-lion at Notanes
r\.~e~.nbor, Penn~"',y '/an~Lt !~-" a