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Home My WebLink About01-1129 PETITION FOR PROBATE and GRANT OF LETTERS Estate of FLORENCE E. ROMIG also known as No. To: 21-01-1129 Register of Wills for the , Deceased. County of Cumberland in the Social Security No. 194-16-1422 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 rix in the last will of the above decedent, dated September 16, and codicil(s) dated None named ,19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with ~ er last family or RrinciRal residence at 304 East Elmwood Avenue. ROrOllp)1 of echanicsburg, PA 17055 (list street, number and muncipality) Decendent then 92. years of age, died December 3 ,){19 2001 at Borough of Mechanlcsburg, Cumberland County, Pennsylvania. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of ttJe will offered for probate; was not the victim of a killing and was never adjudicated incompetent: one 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: $ Unestimated $ $ $ None WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c. La.; administration d.b.n.c. La.) theron. '" " u C " ~3 " .... e<:" c -00 ":';:: ro.';:: 3~ " '- 50 ;;j ,,: OJ) (j) ~;(.7 tuitlff 304 East Elmwood Avenue Mechanicsburg, PA 17055 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I s~ 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 u administer the estate according to law. Sworn to or affirmed and before me this 13 th Decem VJ ~. ::s l:::l .... l::: ~ ~ 1?-c2b - I ~o. 21-01-1129 Estate of FLORENCE E. ROMIG , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW December 13 x~:i in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated September 16, 1983 described therein be admitted to probate and filed of record as the last will of FLORENCE E ROMIG and Letters Testamentary are hereby granted to Shirley Lou Shoff FEES SPARE, P. C. Probate, Letters, Etc. ......... Short Certificates( ).......... ~-pages KenurrcIation JCP $ 50.00 $ 9.00 . . . . . . . . . . . . . . .. $ 6.00 $ 5.00 TOTAL $ 70.00 ilc.... Ja.,. .~.,............. B . , Sne1bak~;O~~~h~ag.&DS~%~e, P. C. 44 West Main Street, Mechanicsburg, PA 178jis ADDRESS Filed (717) 697-8528 PHONE OD ,.. ...'.... =(1) ::1 ~. tT " r" d - :XJ~ <1/0 r,I'""" 0 .. ;:.;, ,."'-[ ,"\", c:> C'"J --- ........ ;t:::: Q:) N 0'\ oc ". _... =(0 :;$ 7-, IT " if, ... n. ....1 (~. d - :o~ coo i{:~. g, CI) C. E:~ .:'1" c:::J c-:J - VJ ::t::> co N 0\ Q,~ (~ . "\) ~ ," ~ '~ " LAW OFFICES SNELBAKER. McCALEB & ELICKER 21-01-1129 LAST WILL AND TESTAMENT I, FLORENCE E. ROMIG, 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 or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give and bequeath the sum of Five Thousand ($5,000.00) Dollars unto my grand-daughter, namely, ANNE E. SHOFF, absolutely. THIRD. I glve, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my daughter, namely, SHIRLEY LOU SHOFF, absolutely and in fee simple, if she survives me. If my said daughter, SHIRLEY LOU SHOFF, does not survlve me, then and only in that event, I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my grand-daughter, namely, ANNE E. SHOFF, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my daughter, SHIRLEY LOU SHOFF, 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 son-in-law, DONALD A. SHOFF, to be the Executor hereof, each and both to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, FLORENCE E. ROMIG, 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 I t:,!!!-day of~i~~t.-".--, A.D., One Thousand Nine Hundred Eighty-three (1983). i' ,{~U!-~C-.-/--- v t. ~~pm1' ( 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 FLORENCE E. ROMIG, the Testatrix therein named, as and for her Last will and Testament, in the presence of us, who, at her request, in her presence, a~/_' in the presence of each othe / names as ~..4J V~-N,-fL,t/1/\ . d ~? have subscribed our LAW OFFICES SNELBAKER. McCALEB & ELICKER CO~WONWEALTH OF PENNSYLVANIA SSe COUNTY OF CUMBERLAND We, FLORENCE E. ROMIG, RICHARD C. SNELBAKER and JANET M. FORRY, 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 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. //) L \A --1J L/....cv.-,JI...) . /Vi . L::,L {!)-JJ-'-^;r ~'1ltness Subscribed, sworn to and acknowledged before me by FLORENCE E. ROMIG, the Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANET M. FORRY, witnesses, this I~~~ Ii 1 day of ,,/.e4_:tLC'7Jl-IJv /.f v' , 1983. d ~. ---- .....1 - , - ,,~i.--'{. -t-t.~<--__-i ~- (" ?~..J... <.e__~_"V" Notary tPublic HORHI::E 8. l03CHER. NOTARY PUBLIC MECHM,iCSlli:RG IJO!lO. CUM2HilArilJ COUNTY MY COIJilIHSS1ON n:Ptlm APRIL 6. 1'386 Mcmhrr.. Pi:-'r!J1$,J\!~n;a A~~.o.(',ja-tjo.!} 4"'1 !ier!,u4-fi$ LAW OFFICES SNELBAKER. McCALEB & ELICKER r Vl Z ::::: tTl I"Ij 111 l' t-I n tp 0 :r: )> ::0 ~ ~ tI:l :> tTl Z n ~ ~ (j n S e tI:l {Jl o . ~ , tJ:j (5 ." c:: l!! ~~ tI:l ...... ' ~ to m ~ V> o n Cl '"i ~ (J "U ~ 111 ::0 111 :- ~ n )> 0 Z Z ~ ~ l' :s: Z V> H ~ 'U tTl (Jl ~ tJj G) -< m ,. ~ m ~ g ~ ~ '"i Z > tT1 t: :;:j n 0 ()l fA; ()l tTl (j on f ,.. ..1 d :0 ~~ - (l) 0-' c.~ C (I) '''""-I 6S. ..., -'oJ; Q -- ,,) ~. - i;;T':< (;:, " n ......, C.' "',,~ .. - \oN ."' , .. , ;r~ i~.} ;x:,. '. 00 &1' 0 f c: N - .,.:J> ~::~ 0'\ f ----- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Florence E. Romig, Deceased Date of Death: December 3,2001 No. 2001-01129 PA No. 2101-1129 To the Register: I certify that notice of beneficial interest 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 or about December 17, 2001 : Name Address Shirley Lou Shoff 304 East Elmwood Avenue Mechanicsburg, P A 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE. Date: December 17,2001 ichard C. Snelbaker, Esquire 44 West Main Street Mechanicsburg, P A 17055-0318 (717) 697-8528 .. 1'~L r-- 9 N a::: 0\ - c:...:l c:::l p :1) .,' ..0 c:j:: .:)) ::; ." ..~ ..,ill ~ ..)C.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SNELBAKER BRENNEMAN SPARE PC C/O KEITH 0 BRENNEMAN 44 W MAIN STREET MECHANICSBURG, PA 17055 ____un fold ESTATE INFORMATION: SSN: 194-16-1422 FILE NUMBER: 2101-1129 DECEDENT NAME: ROMIG FLORENCE E DATE OF PAYMENT: 02/08/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/03/2001 NO. CD 000838 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,000.00 I I I I I I I I TOTAL AMOUNT PAID: $2,000.00 REMARKS: SHIRLEY L SHOFF C/O SNELBAKER BRENNEMAN SPARE CHECK# 100 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS \,.. /~-~6- /~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRIS8URG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* NOTICE OF INHERITANCE TAX APPRAISEKENTL ALLOHANCE OR DISALLOHANCE OF DEDUCTION5, AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1S48 EX AFP C01-02) '02 i\PH -1 :C2 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 03-25-2002 ROMIG 12-03-2001 21 01-1129 CUMBERLAND 194-16-1422 02101309 FLORENCE E SHIRLEY R SHOFF 304 E ELMWOOD AVE MECHANICSBURG PA 1~&55 (~t:lr!L; Amount Remitted 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 ~ ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP eOl-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-25-2002 ESTATE OF ROMIG FLORENCE E DATE OF DEATH 12-03-2001 COUNTY CUMBERLAND FILE NO. 21 01-1129 TAX RETURN WAS: S.S/D.C. NO. 194-16-1422 eX) ACCEPTED AS FILED e) CHANGED JOINT OR TRUST ASSET INFORMATION ACN 02101309 FINANCIAL INSTITUTION: CITIZENS BANK ACCOUNT NO. 140-052636-C TYPE OF ACCOUNT: DATE ESTABLISHED e ) SAVINGS e ) CHECKING e ) TRUST e X> TIME CERTIFICATE 07-22-1997 X 7,039.80 0.500 3,519.90 .00 3,519.90 .15 527.99 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X TAX CREDITS: PAYMENT RECEIPT DISCOUNT e+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 09-04-2002*. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE 527.99 INTEREST AND PEN. .00 TOTAL DUE 527.99 * IF PAID AFTER THIS DATE. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. * ( IF TOTAL DUE IS LESS THAN $1, 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. ) PURPOSE OF NOTICE, PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT, PENALTY, INTEREST, To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion reverse side. -- Make check or money of this Notice and submit with your payment to the Register of Wills printed on the order payable to: REGISTER OF WILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13I3). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or by calling the special 24-hour answering service for forms ordering, 1-800-362-2050; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (inCluding discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by, --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Depart~ent of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA l7l2B-060l Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice4 Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19B2 through 2002 are, Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 19B2 20% .000548 1992 . .000247 1983 16% .000438 1993-1994 ~ .000192 1984 11% .000301 1995-1998 . .000247 1985 13% .000356 1999 ~ .000192 1986 lU .000274 2000 ~ .000219 1987 . .000247 2001 . .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. 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 SNELBAKER RICHARD C ESQUIRE 44 W MAIN STREET MECHANICSBURG, PA 17055 __h_h_ fold ESTATE INFORMATION: SSN: 1 94-1 6-1422 FILE NUMBER: 2101-1129 DECEDENT NAME: ROMIG FLORENCE E DA TE OF PAYMENT: 08/26/2002 POSTMARK DATE: 0010010000 COUNTY: CUMBERLAND DATE OF DEATH: 12/03/2001 NO. CD 001556 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $343.02 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: RICHARD C SNELBAKER ESQUIRE (NO CHECK #) SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $343.02 MARY C. LEWIS REGISTER OF WILLS /;?-c26- /c:v \, BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT w REV-1UT EX AFP [01-02) RICHARD C SNELBAKER SNELBAKER HAL 44 W MAIN ST MECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-15-2002 ROMIG 12-03-2001 21 01-1129 CUMBERLAND 101 FLORENCE E Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=ic,'ifj-EX--AFP--foY:02Y------...--ZNifERITANC'E--fAX--STA-fEM'E-rif-o-F'-A'irCouiff--.-..---------------- - - --- ESTATE OF ROMIG FLORENCE E FILE NO.21 01-1129 ACN 101 DATE 10-15-2002 THIS STATEMENT 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 DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-30-2002 P R I NC I PAL TAX DU E : ...................................................................................................................................................................... 2,443.02 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-08-2002 CDOO0838 105.26 2,000.00 08-26-2002 CDOO1556 .00 343.02 09-30-2002 REFUND .00 5.26- TOTAL TAX CREDIT 2,443.02 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J PAVMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. If NON-RESIDENT DECEDENT make check or money order payable to: COHHONWEAL TH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13l3). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLV TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTV: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a dailY rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Vear Interest Rate Daily Interest Factor Vear Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 n .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 n .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. /?-d 6-/c2/ \. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 . HARRISBURG, PA '1'28-0:0: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ". SHIRLEY R SHOFF 304 E ELMWOOD AVE MECHANICSBURG PA 17055-0000 INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY .SSN.lDC ACN REV-1604 EX AFP <12-001 10-31-2002 ROMIG 12-03-2001 21 01-1129 CUMBERLAND 194-16-1422 02101309 FLORENCE E Allount Rellitted 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 ~ ---------------------------------------------------------------------------------------------------------------- REV-1604 EX AFP (12-00) -- INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS __ DATE 10-31-2002 ESTATE OF ROMIG FLORENCE E DATE OF DEATH 12-03-2001 COUNTY CUMBERLAND FILE NO. 21 01-1129 ADJUSTMENT BASED ON: S.S/D.C. NO. 194-16-1422 ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION ACN 02101309 FINANCIAL INSTITUTION: CITIZENS BANK ACCOUNT NO. 140-052636-C TYPE OF ACCOUNT: () SAVINGS () CHECKING () TRUST (X) TIME CERTIFICATE DATE ESTABLISHED 07-22-1997 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due .00 0.500 .00 .00 .00 .15 .00 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ADDRESS SHOWN ABOVE. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .on · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, 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.) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. __ Make check or money order payable to: REGISTER OF WILLS, AGENT. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REY-1313). Applications are available at the Dffice of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency or nine (9) months and one (1) day from the date of death to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2001 are: Year Interest Rate Daily Interest Factor ~ Interest Rate DailY Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7Z .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7Z .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 -- Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. REV-1470 EX (6-68) COMMONWEAL-A; OF PF:NNSYLVANIA DEPARTM~NT OF--'{~VEN U E BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME INHERITANCE TAX EXPLANATION OF CHANGES Romig Florence FILE NUMBER Emerson Luciano ACN 2101-1129 02101309 REVIEWED BY SCHEDULE ITEM NO. EXPLANATION OF CHANGES The above referenced ACN has been reduced to zero, as this account was reported on the probate return. Paqe 1 /?-026- /~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 'v COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RICHARD C SNELBAKER SNELBAKER ETAL 44 W MAIN ST MECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER '}COUNTY ACN 10-07-2002 ROMIG 12-03-2001 21 01-1129 CUMBERLAND 101 '* REY-1547 EX AFP (01-02) FlORENCE E Amount Remitted 4 I 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 ~ REV :i5'4-j-E3f-AFP--foY:02Y-NoYicE--oF-YNHEifiTANcE-YA'x-A-PPRirisEi'-ENT~--AL.rowAifcE-(rR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ROMIG FlORENCE E FILE NO. 21 01-1129 ACN 101 DATE 10-07-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED 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: 15. Amount of Line 14 at Spousal rate (15) 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 TAX CREDITS: .00 X 00 = .00 54,289.28 X 045 = 2,443.02 .00 X 12 = .00 .00 X 15 = .00 (9)= 2,443.02 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 (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) .00 1,416.48 .00 .00 21,546.37 46,244.30 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 14,802.67 115.20 Ul) (2) (3) (4) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 69,207.15 14.9]7 87 54,289.28 .00 54,289.28 . ~...~ ""'''''''.u {+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-08-2002 CDOO0838 105.26 2,000.00 08-26-2002 CDOO1556 .00 343.02 09-30-2002 REFUND .00 5.26- TOTAL TAX CREDIT 2,443.02 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, 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.) RESERVATION: Estates of decedents dying on or before Oecember lZ, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Com.onwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUNO (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Zl40 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (7Z P.S. Section 9140). Oetach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS. AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Oept. Z810Z1, Harrisburg, PA 171Z8-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z8060l, Harrisburg, PA l7lZ8-060l Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (57-) discount of the tax paid is allowed. The 157- tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (67-) percent per annum calculated at a dailY rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 198Z Z07- .000548 199Z 97- .000Z47 1983 167- .000438 1993-1994 n .00019Z 1984 117- .000301 1995-1998 97- .000Z47 1985 137- .000356 1999 n .00019Z 1986 107- .000Z74 ZOOO 87- .000Z19 1987 97- .000Z47 ZOOl 97- .000Z47 1988-1991 117- .000301 ZOOZ 67- .000164 -- Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BARTELL SHERRIE M 712 ALISON AVE MECHANICSBURG, PA 17055 n_n_h fold ESTATE INFORMATION: SSN: 107-52-5089 FILE NUMBER: 2102-1129 DECEDENT NAME: MYERS JEAN DATE OF PAYMENT: 03/27/2003 POSTMARK DATE: 03/26/2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/20/2002 NO. CD 002348 ACN ASSESSMENT CONTROL NUMBER AMOUNT 03103881 I $20.62 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: SHERRIE M BARTELL CHECK# 3115 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $20.62 DONNA M. OTTO DEPUTY REGISTER OF WILLS LAW OFFICES SNELBAKER BRENNEMAN & SPARE RECEIPT AND RELEASE WHEREAS, Florence E. Romig, late of Mechanicsburg Borough, County of Cumberland and Commonwealth of Pennsylvania, died on December 3, 2001, having first made her Last Will and Testament in writing probated before the Register of Wills of said Cumberland County on December 13, 2001, and Letters Testamentary were issued on the same date to Shirley Lou Shoff, the Executrix named in the Last Will and Testament of said Decedent; and WHEREAS, said Executrix has entered upon and completed her administration of said Decedent's Estate as set forth in her First and Final Account attached hereto, and intends to distribute the net balance of the assets of said Estate to the person named in the Statement of Proposed Distribution also attached hereto, both of said documents being incorporated herein by reference thereto; and NOW KNOW ALL MEN BY THESE PRESENTS, that I, Shirley Lou Shoff, being the principal legatee and distributee named in the Will of said Decedent and the person entitled to share in the residuary distribution of the Estate of said Decedent, do hereby declare and say that I have examined the attached Account and Statement of Proposed Distribution, and find the same to be true and correct, and in strict accordance with the terms and 1 provisions of said Will, and I do hereby acknowledge that I, this day have, had and received of and from Shirley Lou Shoff, the Executrix of the Estate of Florence E. Romig, the cash, personalty and/or real estate set opposite my name in the above Statement of Proposed Distribution, in full satisfaction, payment and discharge of all such sum or sums of money, legacies and bequests, share or shares, purports and dividends which were due, owing and payable and belonging to me, by any means whatsoever, for or on account of my full share, part or dividend of the Estate of Florence E. Romig, Deceased. NOW, THEREFORE, I, the said Shirley Lou Shoff, do by these presents, remise, release, quit-claim and forever discharge the said Shirley Lou Shoff, her heirs, executors and administrators, of and from my said shares or dividends of the Estate aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any act, matter, cause or thing whatsoever, from the beginning of the world to the day and date of these presents. AND, desiring to avoid the delay and expense of the settlement of said Estate by filing the foregoing Account of said administration in the Office of the Register of Wills of said Cumberland County and by having the balance in the hands of the Executrix, as shown by said Account, distributed by the Court of Cornmon Pleas of Cumberland County - Orphans' Court Division, I do LAW OFFICES SNELBAKER BRENNEMAN & SPARE hereby agree that the foregoing Account and Statement concerning 2 the matter of settlement may be recorded with the same effect upon me, as if the same had been reported upon by said Court, In a decree of distribution made on such proposed Statement of Distribution by the said Court of Common Pleas - Orphans' Court Division. AND in consideration of the aforesaid settlement being made without the aid of such Court of Common Pleas - Orphans' Court Division, that I Shirley Lou Shoff, do hereby agree that if any debts or demands other than those included in the above referenced First and Final Account, as hereinbefore set forth, shall be hereafter recovered against the Estate of said Decedent and be legally payable out of the same, that I will return to the said Executrix such amounts thereof as may be necessary to pay such debts or demands. IN WITNESS WHEREOF, we have hereunto set our hands and seals this ~.J{ day of ~ 2003. -d~L~fp (SEAL) LAW OFFICES SNELBAKER. BRENNEMAN & SPARE 3 LAW OFFICES SNELBAKER BRENNEMAN & SPARE COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) On this the C?t!:L day of /1/7 2003, before me, a Notary Public in and for said State and County, the undersigned officer, personally appeared Shirley Lou Shoff, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~ Mdtec .j(Jkl.l)~ Notary Public N~ajSeru l Sandra K. Showers, Notary Public 'I MectIar1Icsbum Boro, CUmberland County My CommIssTon Expires Nov. 22, 2003 Member, Pennsvlva<!la AS!;OC!<!'ion of N!1'tanl:3 4 ESTATE NO. 21-01-1129 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY SHIRLEY LOU SHOFF, EXECUTRIX OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF FLORENCE E. ROMIG, DECEASED, LATE OF MECHANICSBURG BOROUGH, CUMBERLAND COUNTY, PENNSYLVANIA Shirley Lou Shoff, Executrix as aforesaid and Accountant herein, avers as follows: DATE OF DECEDENT'S DEATH: DATE LETTERS TESTAMENTARY ISSUED: December 3, 2001 December 13, 2001 DATES EXECUTOR NOTICE ADVERTISED: Cumberland Law Journal Patriot-News December 28, 2001, January 4, 11, 2002 December 25, 2001, January 1, 8, 2002 FIRST AND FINAL ACCOUNT PERSONALTY - PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of the following items of Decedent's Personalty valued as of the date of Decedent's death: 1. MetLife, 52 shares of common stock valued at $27.24 per share 2. Citizens Bank, checking account #142-109-7708 3. Consolidated Railroad Co., final pension payment 4. Commonwealth of Pennsylvania, overpayment of Inheritance Tax TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: $ 1,416.48 21,475.08 71.29 5.26 $ 22,968.11 PERSONALTY - PRINCIPAL ACCOUNT CREDITS LAW OFFICES SN ELBAKER BRENNEMAN & SPARE The Accountant claims credit for the payment of the following items from Decedent's Personalty Account: 1. Malpezzi Funeral Home, funeral services 2. Peggy Hammaker, gift by Executrix 3. Central PA Oncology, medical services 4. Dl Hayhurst Engraving, inscription on marker 5. Pinnacle Health Hospitals, medical services 6. Anne E. Shoff, payment of bequest as per Item Second of Will 7. Register of Wills, estimated tax payment 8. Donald Shoff, reimbursement for honorium 9. Register of Wills, Inheritance Tax 10. Register of Wills, filing fee for Inheritance Tax Return 11. Weis Pharmacy, perscription expenses 12. West Shore Medical Emergency Service, ambulance service 13. Snelbaker, Brenneman & Spare, P.C., attorney services $ 9,950.00 500.00 91.20 85.00 24.00 5,000.00 2,000.00 250.00 343.02 15.00 15.25 151.50 500.00 Page 1 14. Snelbaker, Brenneman & Spare, P.C., costs advanced: a. Cumberland Law Journal, adverising Executor's notice b. Patriot-News, advertising Executor's notice c. Register of Wills, probate fees 15. Register of Wills, filing fee for Receipt & Release and Inventory TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: 252.67 75.00 107.67 70.00 38.00 $ 19,215.64 PERSONALTY - INCOME ACCOUNT DEBITS The Accountant charges herself with the receipt of the following income from the investment of Personalty Principal: 1. Citizens Bank, checking account # 142-109-7708 TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: $ $ 2.95 2.95 PERSONALTY - INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from the Personalty Principal Account: TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS: $ $ NONE NONE REAL ESTATE - PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of Decedent's Real Estate as follows: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: $ $ NONE NONE REAL ESTATE - PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from Real Estate Principal Account: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: $ $ NONE NONE REAL ESTATE - INCOME ACCOUNT DEBITS he Accountant charges herself with the receipt of the income from the investment of Real Estate Principal Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: $ $ NONE NONE REAL ESTATE - INCOME ACCOUNT CREDITS LAW OFFICES SNELBAKER. BRENNEMAN & SPARE he Accountant claims credit for the payment of the following items from the Real Estate Income Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS: $ NONE $ NONE Page 2 RECAPITUlA TION PERSONAL TV: PRINCIPAL ACCOUNT: Debits $ 22,968.11 Credits $ 19,215.64 Balance $ 3,752.47 INCOME ACCOUNT: Debits $ 2.95 Credits $ NONE Balance $ 2.95 TOT Al PERSONALTY $ 3,755.42 REAL ESTATE: PRINCIPAL ACCOUNT: Debits $ NONE Credits $ NONE Balance $ NONE INCOME ACCOUNT: Debits $ NONE Credits $ NONE Balance $ NONE TOTAL REAL ESTATE: $ NONE TOTAL FOR DISTRIBUTION: $ 3,755.42 LAW OFFICES SNELBAKER. BRENNEMAN & SPARE Page 3 LAW OFFICES SNELBAKER BRENNEMAN & SPARE STATEMENT OF PROPOSED DISTRIBUTION Shirley Lou Shoff, Executrix and Accountant herein, proposes to distribute the balance of the Estate of Florence E. Romig, Deceased, to wit: $ 3,755.42 in accordance with the Last Will and Testament of said Decedent as follows: 1. Shirley Lou Shoff 100% of residue as per Item Third of Will a. MetLife, 52 shares of common stock, received in kind b. Cash $ 1,416.48 2,338.94 TOTAL FOR DISTRIBUTION: $ 3,755.42 Page 4 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Shirley Lou Shoff, being duly sworn according to law deposes and says: that she is the Executrix of the Estate and under the Last Will and Testament of Florence E. Romig, Deceased, and the Accountant herein; that there are no unpaid creditors or claimants of said Estate; that there are no persons interested in the distribution of said Estate other than as stated in the foregoing Statement of Proposed Distribution; and that the facts set forth in the foreqoing First and Final Account and Statement of Proposed Distribution are true and correct to the best of her knowledge, information and belief. /~4v'rf-,L-~ Executrix and Accountant Sworn to and subscribed before me this ~+h day of m~ 2003 ~ f<~J Notary Public Notarial Seal Sandra K. soowelS,.NotarY ~_ ~ Boro. ~ ~2003 My CommIsS1OO expires Nm.22. MemOOf, p.mllS',4vanl9 AS$!Y"-!ro!OO ot LAW OFFICES SNELBAKER BRENNEMAN & SPARE Page 5 0(':: S (f' :::s:: () , ('1" s ;:g; ~ --" 01 ;D \0 o N ::n (D ('~l ? T COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND L J 55: Shirley Lou Shoff being duly according to law, deposes and says that she ; ~ t- hp F,XPf"llt- r; x of the Estate of Florence E. Rorniq late of ----.Me.chanir. Shll rg.._B.D.ro~_ , Cumberland County, Pa., deceased and that the within is an inventory made by Shirley Lou Shof f ., the said Executrix of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. s wn rn Sworn and subscribed before me, ~~~~....t., ;f;2L: 1-1 sJ4J;: 2003 Shirley Lou Shoff 304 East Elmwood Avenue Mechanicsburg, PA 17055 Date of Death Notanal Seal ~ Showers, Notary Public My "'''''''':;'::',2 Born, Cumberland VUOID'1l5S1OI'l expires Nov. 22, 2 3 Member, Pennsv~/.'!I'1L1 A",.t::ld.1l'1~ of r'r~[lrft>~ 3rd De~ernber Day Month Address 2001 Year INSTRUCTIONS I. An inventory mi.lst be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. . U P-l .. Q) H eel 0.. Q") >- "tl N al ~ W '" rl >- ~ ~ III H ~ rl W -< '.-1 Gl I c::: a.. ~ S u 0 Q) eel 0 VI Q) ~ &.. rl 0 C 0\ W ~ W 0 III eel ~ 0 l- I a.. p:; a.. ..0 I ~ ..J L1. Z III rl ! rl L1. ..J -< 0 . a.. Q) N W 0 -< w 1'4' >. > ~ ~ Z - U) Z 0 Q) c C :3 0 VI Z C) 0 . .. ~ ~ U Z w -< - U H a.. Q) :s "tl Q) H c '"d ..81 III - -.:: H 0 Q) eel ~i ..c ""0 ~ ..c: I Q) E - al 0 C) I III :3 0 ..-1 ..J U u: all p:; Inventory of the real and personal estate of FLORENCE E. ROMIG, Deceased PERSONALTY: 1 MetLife, 52 shares of common stock valued at $27.24 per share 2 Citizens Bank, checking account #142-109-7708 3 Consolidated Railroad Co., final pension payment TOTAL PERSONALTY: REAL ESTATE: 1 Decedent owned no Real Estate at the time of her death TOTAL PERSONALTY AND REAL ESTATE: ,') ;,1'-1 C, ';i:, u (1~ a.lO: ex: N 9 '" c:::r:: \D ...- ~ :::c rt""\ P :3 {~) /.0 ,;:~ .l) = .....- ~ :';U Page 1 $ 1 ,4 1 6.48 21,475.08 71.29 $ 22,962.85 $ 0.00 $ 22,962.85 C~)~< L/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: FLORENCE E. ROMIG Date of Death: 12/3/2001 Will No. 21-01-1129 Admin. No. 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 X 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, ~tate the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts y b lIed with the Cerk of the Orphans' Court and may be -t ed his report. Date: s-/ pluj Si e N 9 .0\ c:::r: \"oJ Richard C. Sne1baker Name (Please type or print) 44 West Main Street Mechanicsburg. PA 17055 Address t_: ct , f \D --J >- d:: ::r:: i:1J C) .,....., . () ..j) () Q) Q)a:: ex: p ".'.. !J) ~.o ....s= m= :JU (717) 697-8528 Tel. No. Capacity: Personal Representative X Counsel for personal representative (MAH:rmf/AM3) ./ REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 /'? ,;?? DEPARTMENT OF REVENUE /0:;- DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 1129 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Romio, Florence E. ~ 194-16-1422 DECE- DATE OF DEATH (MM-DD YEAR) I DATEOFBIR"~D YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 12/03/01 06/24/1909 . WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~ ,. Original Return ~' Supplemental Return B (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. FuturelntEuestCompromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Maintained aLivingTrlJst 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach acopyofTrust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between 0 11. Election to tax under Sec. 9113(A) 12-31-91andl-1-95) (Attach Soh 0) Tl-iIliSEPTIQ~MQ$'tj:ll$rp~LS-mQ;)I\C4qq!jjje~Np"N,q~al:;Qf.jfi6l$I'WIAti:AXjNfi:jIlMA'tIONSIld1.l4tfi:ltulaeCTEbtQ; NAME COMPLETE MAILING ADDRESS COR- Richard C. Snelbaker 44 West Main Street RE- FIRM NAME (II Applicable) Mechanicsburg, PA 17055 SPON & Spare, DENT Snelbaker, Brenneman P.C. TELEPHONE NUMBER 717-697-8528 None>- OFFICIAL USE ONLY ,. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 1,416.48 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 21,546.37 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested (6) 46,244.30 RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) None 8. Total Gross Assets (total Lines 1-7) (8) 69,207.15 9. Funeral Expenses & Administrative Costs (Schedule H}(9) 14,802.67 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 115.20 11. Total Deductions (total Lines 9 & 10) (11) 14,917.87 12. Net Value of Estate (Line 8 minus Line 11) (12) 54,289.28 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value SubJect to Tax (line 12 minus line 13) (14) 54,289.28 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amountof Line 14taxableatthespousaltax rate, or transfers under Sec. 9116(a)(1.2) X.O (15) TAX 16. Amount of Line 14 taxable at lineal rate 54,289.28 X.O 45 (16) 2,443.02 - COMPU- 17. Amountof Line 14 taxable at sibling rate 0.00 x.12 (17) 0.00 TATION 18. Amountof Line 14 taxableat collateral rate 0.00 X .15 (18) 0.00 19. Tax Due (19) 2,443.02 20. ex I CHECK IiEFlE'ii\YOll AllE Fll:;Ql.leS"l"lNG Al!$1llNIiO#AI'IQVER!'A'tMl:;r#1 >> BE. SURE TO:ANSWERALIL. QUESTIONS ON. PAGE 2' AND RECHECK MATH~< . o PA15001 NTF 29755 Copyright 2000 GreatlandlNelco LP- Forms Software Only - PA REV-1500 EX (6-00) Decedent's Com lete Address: STREET ADDRESS 304 East Elmwood Avenue Page 2 Boro of Mechanics CITY Mechanicsb Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount , Curnterland Ct STATE PA ZIP 17055 (1) 2,443.02 2,000.00 100.00 3. Interest/Penalty jf applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 2,100.00 Total Interest/Penalty (0 + 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) A. Enter the interest on the tax due. (SA) ::~t~;t:;..t:t~l;f~I::::::::I.:':t::~~~~~~~~~Y(~I{l~~~~':I~~gi~:~~;'~~7~~(::) PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "x" IN THE APPROPRIATE BLOCKS 0.00 343.02 0.00 343.02 2. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; c. retain a reversionary interest; or. . . . . . . . . . d. receive the promise for life of either payments, benefits or care? .. . . . . . . . . . . . . . . . . . If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~ I B ~ 3. 4. [jg Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on information of which preparer has any knowledqe. SIGNATUR~OF PERSON RESPON)3IBLE FOR FILING RETURN DATE ./ . .;}7~ .r/:2 .Y,J 2- ~0o;;~;'A- 26~1 /, ~ 1..-'1 See c ed ttached SI E PR P ER OTHER THAN REPRESENTATIVE DATE 2-3/0"2- '" [72 P.S. g 9116(a)(1.1)(i)]. For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S.!3 9116 (a}(T.1)(ii}J. The statute nnp<; nnt p.xpmnt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age oryoungerat death to orforthe use of a natural parent, an adoptive parent, or a stepparent of the child isO% [72 P.S.!39116(a)(1.2)). The tax rate imposed on the net value of transfers to orforthe use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72.P.S.!i 9116(1.2) [72 P.S.!39116(a)(T)]. The tax rate imposed on the net value of transfers to orforthe use of the decedent's siblings is 12% [72 P.S. !i9116(a)(1.3)). Asibling is defined, under Section 9102, as an individual who has at least one parent In common wllh the decedent, whether by blood oradoption. o PA15002 NTF 29756 Copyright 2000 Greatlano/Nelco LP - Forms Software Only - Estate of: Florence E. Romig 21-2001-1129 'The following person (s) are signing the return as representative (s) of the estate: Shirley Lou Shoff 304 E. Elmwccd Avenue Mechanicsburg, PA 17055 -- REVC1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Florence E. Romiq SCHEDULE B STOCKS & BONDS FILE NUMBER 21-2001-1129 All property Jointly-owned with right 01 survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 MetLife, 52 shares of common stock valued at $27.24 per share 1,416.48 7 CPA31 NTF 10905 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,416.48 ""n~",i"'ht F"r"'~ o;n1'\.01;>r" n"l" jqq7 Npl"" I"" ----- REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Florence E. Romiq SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include proceeds of litigation & date proceeds were received by the estate. All proo. Jointly-owned with rlaht of survlvorshlJJ must be disclosed on Sch. F. 21-2001-1129 ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 Citizens Bank, Checking account #142-109-7708 21,475.08 2 Consolidated Railroad CO., final pension benefit 71. 29 7 CPA81 NTF 10908 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 21,546.37 '-~"""n~t "",.....~ <::~..,""" nnl" <<:"'7 ~I"'~n I~~ --- REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Florence E. Romig SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21-2001-1129 SURVIVING JOINT TENANT(S) NAME A Shirley lou Shoff If an asset was made JoInt withIn one year of the decedent's date of death, It must be reported on Schedule G. ADDRESS 304 E. Elrrwood Avenue Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Daughter JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR MADE Include name of financial institution and bank DATE OF DEATH JOINT account number or similar identifying number. DECO'S VALUE OF NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A inceptio Fulton Bank, Certificate of 10,018.71 50.00 5,009.35 Deposit #400-0998064 2 A inceptio Citizens Bank, Certificate of 12,348.41 50.00 6,174.20 Deposit # 00273672 3 A inceptio Citizens Bank, Certificate of 7,039.80 50.00 3,519.90 Deposit #140-052636-C 4 A inceptio Citizens Bank, Certificate of 56,078.57 50.00 28,039.28 Deposit #140-079132-C 5 A inceptio Citizens Bank, Certificate of 7,003.14 50.00 3,501.57 Deposit #145-096313-C TOTAL (Also enter on line 6, Recapitulation) $ 46,244.30 7 CPA91 NTF 10909 (If more space is needed, insert additional sheets of the same size) Cooyrlght Forms Software Only, 1997 Nelco, Inc. -- REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Florence E. Romiq SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FilE NUMBER 21-2001-1129 Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Dr Hayhurst Engraving, inscription on marker 85.00 2 Malpezzi Funeral Home, funeral services 9,950.00 B. ADMINISTRATIVE COSTS: ,. Personal Representative's Commissions 0.00 Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Name: Snelbaker, Brermeman & Spare 500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Shirley Lou Shoff Street Address 304 East Elrrw:::x::x:l Avenue City Mechanicsburq State PA Zip 17055 Relationship of Claimant to Decedent Dauqhter 4. Probate Fees 70.00 5. Accou ntant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 Register of Wills, filing fee for Inheritance Tax Return 15.00 8 The Patriot News, advertising Executrix notice 107.67 9 Cumberland Law Journal, advertising Executrix notice 75.00 10 Reserve for filing fees, accountant fee and other costs 500.00 associated with the administration of Decedent's Estate TOTAL (Also enter on line 9, Recapitulation) $ 14,802.67 7 CPA11 NTF 10911 (If more space is needed, insert additional sheets of the same size) - '-",,~.... ;:~"~- CO.,H.".,,,, nrl" '''07 ~Ic,i~.~ I~c' ------ REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Florence E. Rami Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2001-1129 DESCRIPTION AMOUNT 1 Central PA Oncology, medical services, account payable 91. 20 2 Pinnacle Health Hospitals, medical services, account payable 24.00 7 CPA12 NTF 10912 TOTAL (Also enter on tine 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 115.20 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Florence E. Romiq No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Shirley LDu Shoff 304 E. Elmwood Avenue Mechanicsburg, PA 17055 2 Arme E. Shoff Mechanicsburg, PA 17055 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not LIst Trustee(s) Daughter Granddaughter 21-2001-1129 AMOUNT OR SHARE OF ESTATE 49,289.28 5,000.00 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 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 None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 7 CPA13 NTF 10913 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) Copyright Forms Software Only, 1997 Nelco, Inc. ------ 0.00 'J ~-. l ~ '\ ~ ~ .. LAW OFFICES SNELBAKER. McCALEB 8= E~rCKER LAST WILL AND TESTAMENT I, FLORENCE E. ROMIG, 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 or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give and bequeath the sum of Five Thousand ($5,000.00) Dollars unto my grand-daughter, namely, ANNE E. SHOFF, absolutely. THIRD. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my daughter, namely, SHIRLEY LOU SHOFF, absolutely and in fee simple, if she survives me. If my said daughter, SHIRLEY LOU SHOFF, does not survive me, then and only in that event, I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my grand-daughter, namely, ANNE E. SHOFF, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my daughter, SHIRLEY LOU SHOFF, 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 son-in-law, DONALD A. SHOFF, to be the Executor hereof, each and both to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, FLORENCE E. ROMIG, 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 / 0~day ofA...L-r~' A.D., One Thousand Nine Hundred Eighty-three (1983). !?~U!fl-C..L- c e. /) . k[~/YYU-r (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 FLORENCE E. ROMIG, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence, ~.n i.n the presence of each our names as Wi;n;~~~ ~ -{~h&b~.k.ua..,~ '-... {/-::a N,~ t- IVI \ -:f ,,-^--"-J- othe have subscribed LAW OFFICES SNEL8AKER. CALEB a ELICKER COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. We, FLORENCE E. ROMIG, RICHARD C. SNELBAKER and JANET M. FORRY, the Testatrix and the witnesses, respectively, whose names the Testatrix signed and executed the instrument as her Last Will duly Sworn, do hereby declare to the undersigned authority that are signed to the attached Or foregoing instrument, being first 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 witness and that to eighteen years of age or older, of sound mind and under no the best of his or her knowledge the Testatrix was at that time constraint or undue influence. /- . 0 ;>-;t-'0J- ' l.. rJ.x .' f ~~</: . c4tE,d~/C/ --Wi tness 9~."J. )11 . ,,:;I ~/ Wltness Subscribed, sworn to and acknowledged before me by FLORENCE E. ROMIG, the Testatrix, and subscribed and sworn to before me by //"'<, RICHARD C. SNELBAKER and JANET M. FORRY, witnesses, this I~ :/ ._,"" ;7 of ;4--1:?/:..-CI11'-tLev / i/ , 1983. day d ~. ~.- -7 ; :~- ~'--{'-n_.c.-I ~_, ~_-:.~~ Notary ,PubllC FlO~ENCE 8. LO!CHER. NOTMY PUOllC MECH,\NICSBiJRG OORO. CUMBrRlAHD COUNTY MY COMMISSION EXPIRES APRil 6. 1985 lAemhAr, P(>ruls,lv~nid Ihsor,i2:tiO!I of 1/o1u-.wt. LAW Oi'"FIC.c:,s SNELBAKER. =ALE9 & ELICKER