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HomeMy WebLinkAbout01-1024 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 MASON RODERICK F MASON FINANCIAL SERVICES 246 OAK GROVE COURT MECHANICSBURG, PA 17055-9702 n__n__ fold ESTATE INFORMATION: SSN: 166-14-3779 FILE NUMBER: 21 - 2001 - 1 024 DECEDENT NAME: HOMMEL HELEN P DA TE OF PAYMENT: 11/07/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/14/2001 NO. CD 000494 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $7,368.82 I I I I I I I I TOTAL AMOUNT PAID: $7,368.82 REMARKS: LINDA L DEIBERT CHECK# 521 SEAL INITIALS: DO RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS / 7-/'l-P *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE . BUREA'tJ OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ReCOrC1C:;o!:€ of Repi" ",~ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-24-2001 HOMMEL 09-14-2001 21 01-1024 CUMBERLAND 101 .02 JAN -4 PI 2 :36 RODERICK F MASON MASON FINANCIAL SE~~~_:.>, 246 OAK GROVE CT Ct,mb{;;qlq, MECHANICSBURG PlC171f5S <..<, , / )" C' IlEY-1547 EX iFP (12-00) HELEN P A.ount Reid tted p,- j! t. r"'\ 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 ~ REY=is4-j-EX--AFP--fi'2=oll1--NCfficE--OF-i-tiHEiiifANCi-yAX-APpi;risEiiENT~--Ail-oNAirci-oR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HOMMEL HELEN P FILE NO. 21 01-1024 ACN 101 DATE 12-24-2001 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE 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. Hortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ll) (2) (3) (4) (S) (6) (7) .00 .00 .00 .00 .00 .00 187.034.38 APPROVED DEDUCTIONS AND EXEMPTIONS: ~ 9. Funeral Expenses/AdM. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GovernMental Bequestsi Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) llO) 9,398.08 . 5.266.27 llll ll2) ll3) ll4) NOTE: To insure proper credit to your account, subMit the upper portion of this forM with your tax paYMent. (8) 187,034.38 14.664 35 172,370.03 .00 172,370.03 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. AMount of Line 14 at Spousal rate 16. AMount of Line 14 taxable at Lineel/Class A rate 17. A.ount of Line 14 at Sibling rate 18. AMount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due (IS) .00 X 00 = .00 ll6) 172,370.03 X 045 = 7,756.66 ll7) .00 X 12 = .00 (18) .00 X 15 = .00 ll9)= 7,756.66 TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-07-2001 CDOO0494 387.83 7,368.82 TOTAL TAX CREDIT 7,756.65 BALANCE OF TAX DUE .01 INTEREST AND PEN. .00 TOTAL DUE .01 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) REV-1470 ~X (6-88) , . '* INHERITANCE TAX EXPLANA TION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Helen P. Hommel 2101-1024 REVIEWED BY ACN Sandra J Eslinger 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES G 1 Total on Schedule G was not correctly carried forward to recapitulation page. , . ROW Page 1 R::\{'500 EX (6J(jI # J;l -/4 - I;L...J REV-1500 LJSE: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER Z I - 0 / COUNTY CODE YEAR _lO~!J. NUMBER I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITlAL) Hommel, Helen P DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) September 14, 2001 August 4, 1907 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 166 - 14 3779 w .... lo::$Ul uO::lo:: wa.u :%:00 uO::...J a. III a. ~ [!] 1. Original Return D 4. limited Estate [X] 6. Decedent Died Testate (Attaell copy of Will) D 9. litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of dealh after 12.12-82) [X] 7. Decedent Maintained a living Trust (Attach copy ofTrust) -of D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death poor to 12-13-82) D 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attaell Sch OJ COMPLETE MAILING ADDRESS 246 Oak Grove Court Mechanicsburg, PA 17055-9702. ... -n"d" -7?-.." .J",' ;X; ...))"t4e.t;.A'~ { ~r ",,/dc,- ,J ~ ~/t: <.;:,~ jr'fJC,. .... z W Q Z o a. Ul w 0:: 0:: o U NAME Roderick F. Mason FIRM NAME (~Applicable' Mason Financial Services TELEPHONE NUMBER 717 766-6375 z o ~ ...I ::;) !:: Q. <( o w ~ 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) D 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) 9.398.08 5,266.27 (1) (2) (3) (4) (5) (6) (7) 187,083.38 (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) 14. Net Value Subject to Tax (line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::;) a. :!: o o X ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0_ (15) 45 (16) x.O_ x .12 (17) x .15 (18) (19) 16_ Amount of Line 14 taxable at lineal rate 172,370.03 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT -;::) .I"'Jf<- Ji('#.""lL- i OFFICIAL USE ONLY I I I i I I I I l...--,....__.~____~_,~~~_-=_~,.~._..._...__<. (8) 187,034.38 (11) (12) (13) 14,664.35 172,370.03 (14) 172,370.03 7,756.66 7,756.66 Decedent~s Complete Address: STREET ADDRESS CITY 24 Butternut Lane Mechanicsburg I STATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 387.83 3. InterestlPenalty if applicable D. Interest E. Penalty Total Credits ( A + 8 + C ) (2) TotallnterestlPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) (5A) A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT I ZIP 17055 7,756.66 387.83 7,1hR R? 7,368.82 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property lransferred;.......................................................................................... ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ ~ c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 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? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other noo-probate property which contains a beneficiary designation? ........................................................................................................................ 00 No o o ~ IKJ fKI ~ o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of peljuly. I declafe that I have examined this relum. ipckKling accompanying schedules and statements, and to the best of my knowledge and belief, tl is true. correct and complete. Declaration of preparer other than the personal representative is on aI infonnation of which preparer has any knowledge. SIGNATURE ~~-'~ERSO .ES.PONSIB~~~ ~ ADDR~/ rI~ ..-'. < 24 Butternut Lane Mechanicsburg, PA 17055 )tTE // &JS/o/ / EPARER OTHER THAN REPRESENTATIVE ~1 ~,'-- DATE /1 .$ ()/ ADDRESS 246 Oak Grove Court Mechanicsburg, PA 17055-9702 For dates of death 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 3% [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 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 child is 0% [72 P.S. ~9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)). The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)). A sibling is defined, under Section 9102, as an . . .. .. ..... . I. ... I '" I ," REV-IS10 EX. (1-97) SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hommel, Helen P This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE DF TRANSfER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COPY QF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE \ ~UMBER 1. Helen P Hommel Living Trust 187,034.38 187,034.38 Listing of assets and values provided to the Department of Revenue under separate cover TOTAL (Also enter on line 7, Recapitulation) $ 187,034.38 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hommel, Helen P SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Rolling Green - interment 760.00 2. Myers Funeral Home 8,160.00 3. Giant Foods - meal following service 138 . 58 4. Romberger Memorials 90.00 5. Linda Deibert - clothing for deceased 49.50 B. ADMINISTRATIVE COSTS: 1. 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 sarne as claimant's, attach explanation) Claimant Street Address City State ~ Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 200.00 7. TOTAL (Also enter on line 9, Recapitulation) $ 9.398.08 (If more space is needed, insert additional sheets of the same size) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ~{. COMMONWEALTH OF PENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hommel, Helen P Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 2. 3. 4. Buffalo Valley Nursing Home Guardian Health Services - Nurses Continuing Care Rx - Medicine Albright Care Services 4 , 519. '1J2 297.00 445.15 5.00 TOTAL (Also enter on line 10, Recapitulation) $ 5,266.27 (If more space is needed, insert additional sheets of the same size) ~m-..~ '~. SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hommel, Helen P RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. Beneficiaries are listed in the Living Trust which has been provided to the Department of Revenue under separate cover 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 11- 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) LAST WILL AND TEST AMENT OF HELEN P. HOMMEL IDENTITY I, Helen P. Hommel, residing in the County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other and former Wills and Codicils to Wills heretofore made by me. My child is Betty Jean Book. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to my Living Trust as a result of the "ASSIGNMENT OF FURNITURE. FURNISHINGS AND PERSONAL EFFECTS" signed this date. Ifthere is any question regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Living Trust in accordance with the provisions of the section titled "Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devises), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me, which is known as "The Hommel Trust, dated December 1,1998, Helen P. Hommel, Trustor and/or Trustee." The Trustee shall add the property bequeathed and devised by this Item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before my death. If for any reason the said Trust shall not be in existence at the time of my death, or iffor any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said Tmst as it exists at the time of my death to be invalid, then I give all of my estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their substitutes and successors under the Trust, described hereinabove, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms, trusts and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, Hommel Last Will and Testament @Copyright The Estate Plan@ 1998 All Rights Reserved. Page 1 hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. PRIV ACY OF TRUST No Clerk of Court, Commissioner of Accounts, or other party (except my Executor, Personal Representative, or other Fiduciary of my Estate, and a Beneficiary of my Estate or Guardian or Fiduciary of such Beneficiary), dealing with a Trustee in relation to The Hommel Trust, dated December 1, 1998, Helen P. Hommel, Trustor and/or Trustee, will be obligated or privileged to see that the terms of the Trust have been complied with, to inquire into the authority, necessity or expediency of any act of a Trustee, or to inquire into any of the temlS of the Trust, except when permitted by the Trustee. EXECUTOR I hereby nominate and appoint Linda L. Deibert, as Executor ofthis my Last Will and Testament to serve without bond. In the event the first named Executor shall predecease me, or is unable or unwilling to act as my Executor for any reason whatsoever, then and in that event I hereby nominate and appoint Christine L. Lemke to serve without bond as Executor (Co-Executors if more than one person). In the event the second named Executor shall predecease me, or is unable or unwilling to act as my Executor for any reason whatsoever, then and in that event I hereby nominate and appoint Dennis S. Deibert to serve without bond as Executor (Co-Executors if more than one person). When more than one person is named with others to act as Co-Executors and one of the named persons is unable or unwilling for any reason to serve or to continue to serve, and no additional persons are named herein to take the place of such declining or retiring Executor, I hereby direct that the remaining named Co-Executor(s) shall continue to serve as Co-Executors (or ifone only remains, Executor) hereof without the approval of any court. Whenever the word "Executor" or any modifying or substituted pronoun therefor is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor or substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers and duties, authority and responsibility conferred upon the Executor originally named herein. Hommel Last Will and Testament @ Copyright The Estate Plan@ 1998 All Rights Reserved. Page 2 EXECUTOR POWERS By way of illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to Executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind or partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purposes of this my Will, without being limited in any way by the specific grants of power made, and without the necessity of a court order. My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my Executor believes has had the effect, directly. or indirectly, of preferring one beneficiary or group of beneficiaries over others. In determining the federal estate and income tax liabilities of my estate, my Executor shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my estate shall be used as federal estate tax deductions or as federal income tax deductions. GLOSSARY OF TERMS For the purposes of this my Will, "children" means the lawful blood descendants in the first degree ofthe parent designated; and "issue" and "descendants" mean the lawful blood descendants in any degree of the ancestor designated; provided, however, that if a person has been adopted, that person shall be considered a child of such adopting parent and such adopted child and his issue shall be considered as issue of the adopting parent or parents and of anyone who is by blood or adoption an ancestor of the adopting parent or either ofthe adopting parents. The terms "child," "children," "issue," "descenda,nt" and "descendants" or those terms preceded by the terms "living" or "then living" shall include the lawful blood descendant in the first degree of the parent designated even though such descendant is born after the death of such parent. Hommel Last Will and Testament @Copyright The Estate Plan@ 1998 All Rights Reserved. Page 3 SPECIFIC OMISSIONS I have intentionally omitted any and all persons and entities from this, my Last Will and Testament, except those persons and entities specifically named herein, and I have also intentionally omitted any and all persons and entities from this, my Last Will and Testament, who are not persons or entities specifically named in The Hommel Trust, dated December 1, 1998. It is my intention that any and all persons and entities, whether or not named in this Will or said Trust, shall have an interest in my estate and property, including the said Trust, if and only to the extent that I have provided for them in this Will and in the said Trust. If any person or entity shall challenge this Will or any term or condition hereof, or of the Living Trust to which I have herein made reference, or any term or condition thereof, then, to that person or entity I give and bequeath the sum of one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that person or interest may have in my general and Probate Estate or the Living Trust and its Estate. I specitically disinherit any person or persons claiming an interest in my estate through this, my Last Will and Testament, or through the previously named Trust, as my child, the issue of my body, who are born more than nine and one-half months after my death. SIMULTANEOUS DEATH Ifany beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed for the purposes of this my Will that said beneficiary predeceased me. IN WITNESS WHEREOF, I have hereunto set my hand and declared this to be my Last Will and Testament this 1st day of December, 1998. ;1 ~~A~ -' P )~" Helen P. Hommel SIGNED, SEALED, PUBLISHED and DECLARED by the above testator as and for her last will. in the presence of us, who thereupon at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses: \\~~~ ~ " "\: ~~ tness t~()A ~fP/f1 (0/1.11 Witness residing at 246 Oak: Grove Court Mechanicsburg, Pennsylvania residing at 246 Oak: Grove Court Mechanicsburg, Pennsylvania Hommel Last Will and Testament @ Copyright The Estate Plan@ 1998 All Rights Reserved. Page 4 SELF-PROOF OF WILL COMMONWEALTH OF PENNSYLVANIA ) ) ss. COUNTY OF CUMBERLAND ) We Helen P. Hommel, J!)\..^ P. f, ~f o~-' , 1)~-Ili(...J tMeR... and ~ab~r.l:: l..U(!j4-Jli) , the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being 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 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 witness and that to the best of each witness's knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ! LJ~ ^~ Ip ~~-U V Helen P. Hommel /\ ~,\ ~ ~.I\~ ~~ v, ,~ "tness /, 7 /d; (J( -{fJ1l/11 C1/l/l Witness 7 ./' J II I / Wit ess S SCRl$ED, ORN TO AND ACKNOWLEDGED before me, by Helen P. Hommel, the Test~ and subscribed and sworn to before me by J 0\...," ~ . r f ~ t . ~r , J)", ../.,....-.1 CM!L and~"k.:uJ 1..1.1(;.#1:0 , witnesses, this 1st day of December, 1998. "' J~')~// a Y ULI.\ NOTARY SEAL My Commission EXPires/-/(i I.~ ;k2.~;/ / ...../'- llol11nll:1 Last Will and Testament @Copyright The Estate Plan@ 1'198 All Rights Reserved. Page 5 '"Glar!af Seal . '.~a~:\l'-,:. ~~!~yl1eld. Notary Public ..;>, ::;pm,,;;' ~':.. CUmberland County . .':~:;;O' ,',...res Dec. 17,2001 . , '/.,rt" ;\ssociatlon of Notaries CERTIFICATE OF ACKNOWLEDGMENT COMMONWEAL TH OF PENNSYLVANIA ) ) ss. COUNTY OF CUMBERLAND ) \ On this 1st day of December, 1998, before me,&IJvRh ~ / II~~,L:::" V", (here insert name of notary) a Notary Public, personally appeared en P. Hommel, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her authorized capacity, and that by her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instmment. WITNESS my hand and official seal. /) \ S. .J<J-/~/ A Ignatlu:~ '~YA{;,~1:Y / 'I (~ ;.' / .,// (Seal) Nolanal Seal I , Bunnie L MayfIeld. Notary Public I Silver Spring Twp., Cumberland County My Commission ExpIres Dec, 17, 2001 I Member. Pennsylvania Associallon of N:;taries Hommel Last \Vill and Testament !0 Copyright The Estale Plan@ 191)8 All RighlS Reserved,