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HomeMy WebLinkAbout10-07-05 . REV-1500 EX.+ (6-00) '* COMMONWEALTH OF , PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT l' OFFICIAL USE ONLY FilE NUMBER 21 -0 5 0 0 1 07 COuN1YCOOE -VEAR- - - NiiMBeR- - I- Z W C W (J W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) LIS ROBERT J. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER 3 5 9 - 2 8 - 1 699 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ~:!!;(/) ott::~ wo.o :1:00 ott::...J :till <I: 01/08/2005 03/01/1937 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Lis Barbara J. [Xl 1. Original Return o 4. Limited Estate [Xl 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (date 01 death aner 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy oITrus!) o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95) o 3. Remainder Return (date 01 death prior to 12-13-82) o 5. Federal Estate Tax Return Required Q... 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION. MUST. BE COMPLETED.. All'CORRESPO.NOENCE.ANO:CONFIDENTIAl..rAXINFORMATIONSHOUlO.SE.:/J). REC'rEO'TO: NAME COMPLETE MAILING ADDRESS David H. Radcliff Es . 20 Erford Road FIRM NAME (If Applicable) Radcliff Law Office P.C. Suite 200 TELEPHONE NUMBER 717236-9318 Lema ne _ PA 17043 I- Z W C Z o 0. (/) W tt:: tt:: o o (1) (2) (3) (4) (5) z o i= ~ ...J :J l- n:: ~ (J 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) 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) OPF~IAL USE,Q \ . '. ') ) -'2\ .::J c.-:-:> I -.J 0.00 200.00 ::'~:"' (6) (,.) --l 362,962.00 X ~(15) 0.00 0.00 X _(16) 0.00 0.00 X .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 0.00 (7) (9) (10) 14. Net Value Subject to Tax (line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= ~ I- :J a.. :! o (J >< ~ I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 423,025.83 (8) 423,225.83 16. Amount of Line 14 taxable at lineal rate 4,266.99 55,996.84 (11) (12) (13) 60,263.83 362,962.00 0.00 17. Amount of Line 14 taxable at sibling rate (14) 362,962.00 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 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < . Decedent's Complete Address: I' STREET ADDRESS 3818 Hearthstone Road CITY I STATE T ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 0.00 Total Credits (A + 8 + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( 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. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 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 transferred; ........................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 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 non-probate property which t . b f" d' t' ? I)(l con alns a ene IClary eSlgna Ion. ....................................................................................................... ~ No 00 00 l&l 00 l&l 00 o 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 all information of which preparer has any knowledge. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE /(1 7. ()~- PA 17011 DA E /t> 7 t7) ADDRESS PA 17043 i \ 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 The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requiremer 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 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 benefi The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 1 individual who has at least one parent in common with the decedent, whether by blood or adoption. NAPD I4t{St l2 P.S. ~9116 (a) (1.1) (ii)]. .urn are still applicable even if ural parent, an adoptive parent, 3116(1.2) [72 P.S. 99116(a)(1)). ed, under Section 9102, as an REV-1507 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF LIS. ROBERT J. FILE NUMBER 21 05 00107 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Demand Note dated 12/19/2003 (Balance due $9500 plus interest and costs, no value to Estate as debtor closed business & inventory repossessed by bank under line of credit & debtor evicted from rental real estate at Cumberland County Court Docket No. 05-1479 VALUE AT DATE OF DEATH 0.00 2. $120,000 Note dated 9/8/1999 due 9/8/2004 in default on or before 12/19/2003 (Balance due $68,254 plus interest & penalties; No value to estate as debtor closed business & inventory repossessed by bank under line of credit & debtor evicted from rental real estate at Cumberland County Court Docket No. 05-1479 0.00 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 I' . REV-150a EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIS. ROBERT J SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 05 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with right of survivorship must be disclosed on Schedule F. 00107 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 200.00 Cash TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 200.00 I' . REV-150!l EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF LIS. ROBERT J. FILE NUMBER 21 05 00107 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Barbara J. Lis 3818 Hearthstone Road Camp Hill, PA 17011 Spouse B c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. All other property not separately listed on this return was held jointly with Barbara J. Lis, surviving spouse TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) . REV-151()EX + (6-98) . SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I' FILE NUMBER 21 05 00107 ESTATE OF LIS. ROBERT J. 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 ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE (IF APPLICABLE) 1. Merrill Lynch Custodian for Robert J. Lis, IRA 423,025.83 100. 423,025.83 (Barbara J. Lis, surviving spouse, is the sole beneficiary) (Account # 872-77933) I TOTAL (Also enter on line 7 Recapitulation) $ 423 025.83 (If more space is needed, insert additional sheets of the same size) . REV-1511- EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS I' FILE NUMBER ESTATE OF LIS ROBERT J. Debts of decedent must be reported on Schedule I. 21 05 00107 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 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 Radcliff Law Office, P.C. 4,000.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 50.00 5. Accountanfs Fees 6. Tax Return Prepare~s Fees 7. Legal advertising - The Sentinel 107.99 8. Legal advertising - Cumberland Law Journal 75.00 9. Additional short certificates 4.00 10. Filing fees - inventory and inheritance return 30.00 TOTAL (Also enter on line 9, Recapitulation) $ 4.266.99 (If more space is needed, insert additional sheets of the same size) l' REV-1512 EX + (6-98) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LIS. ROBERT J. FILE NUMBER 21 05 00107 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Pennsylvania State Bank (Note Number 500470002) for debt of Nauti-Lis, Inc., guaranteed by decedent VALUE AT DATE OF DEATH 55,996.84 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 55 996.84 "~'''''~'I'' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF liS ROF:FRT.I. SCHEDULE J BENEFICIARIES NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Barbara J. Lis 3818 Hearthstone Road Camp Hill, PA 17011 FILE NUMBER 21 05 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Spousal nn1n7 AMOUNT OR SHARE OF ESTATE 362,962.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) $ 0.00 f:-;,:'\F.f?,i;;<" -, . .' ,~-<, " ECKE~i'SEAMX~s CHERlN&MELLOO "P.o:oox 1248,"; , HARRISBURG. P A, '17108 . ,,' (717) Z37~ ,." .,....'..i, .." ",~. "c., '-" .' ; c; "1~-.. ".'.' ','-"" .'.'... WILL OF ROBERT J. LIS I, ROBERT J. LIS, of Cumberland County, Pennsylvania, make this my Last Will, hereby revoking any and all former wills or codicils made by me. ,._ ARTICLE ONE Payment of Last Expenses I direct my Personal Representative to pay the expenses of my last illness and my funeral expenses as soon as may be convenient after my death. ARTICLE TWO Ta~lPble Personal Property I give my automobiles, household and personal effects, and other tangible personal property of like nature (not including cash or securities), together with any existing insurance thereon, as I may have provided in a memorandum kept with the original of this Will, or to the extent not so provided, to my Wife, BARBARA J. LIS, provided she survives me by thirty (30) days. If she does not so survive me, I give all such property to such of my children as are living on the sixty-ftrst (61st) day after my death in such shares or by such items as they may agree upon or, if they are unable to agree, then in such shares or by such items of approximately equal value as my Personal Representative shall determine, after consulting the wishes of such children. Any such property no so distributed shall be sold and the proceeds added to my residuary estate and pass under Article Three thereof. ARTICLE THREE Residue Section 1. Distribution to Trustees. All of the residue of my estate, excluding any property over which I have a power of appointment, I give to the Trustees under the ROBERT J. LIS REVOCABLE TRUST dated today as amended at any time prior to my death, (hereinafter, the "Revocable Trust") to be added to and to form a part of the Trust Estate held under said Revocable Trust, or, if said Revocable Trust is not in effect at the time of my death, to be held in trust on the same terms and conditions specifted in the instrument(s) governing said I'. t:: Revocable Trust as it existed at the time of the execution of this Will or of the last codicil hereto, with like effect as if said terms and conditions were set forth herein verbatim. Section 2. Ultimate Distribution of Certain Reversions. In the event that any portion of my residue originally distributed by Section I of this Article Three reverts to my estate by virtue of the terms of the Revocable Trust, then such assets should be distributed toi such persons who would have been entitled thereto if I had died at the time intestate, unmatried, without children surviving, and domiciled in the Commonwealth of Pennsylvania. ARTICLE FOUR Personal Representative I appoint my Wife, B~ARA J. LIS, as my Personal Representative under this Will. My said spouse, or any successor Personal Representative, shall have the authority, in his or her sole discretion, to appoint another individual or bank as an additional or successor Personal Representative, or to renounce his or her appointment in favor of another individual or a baul<:. If my above named Personal Representative is unable or unwilling to act or to continue to act as my Personal Representative under this Will, and a successor has not been appointed, I appoint my son, DAVID LIS, as successor Personal Representative. If my successor Personal Representlative is unable or unwilling to act as my Personal Representative I appoint JENNIFER SMYTH as successor Personal Representative. ;.In addition to the powers conferred by law, my Per~onal Representative shall have the following discretionary powers, exercisable without the need to obtain court approval: :,,' , -:,T, Section 1. Power to Retain Assets. To retain as part of my estate any property received hereunder, without any duty of diversification. Section 2. Power to Invest. To invest and reinvest the principal of my estate in such stocks, bonds, mortgages, securities or other property, real or personal, without being limited to the classes of securities or investments in which fiduciaries are by law authorized to invest funds. Section 3. Power to Deal With Assets. To sell, exchange, lease, encumber, option or otherwise dispose of all or any portion of my estate, real or personal in such ma:tmer and upon such terms and conditions as are deemed advisable, and to make, execute and deliver any documents necessary to effectuate any powers herein granted. Section 4. Tax Powers. In connection with the making and fIling of all income tax, estate, inheritance and other death tax, gift tax and other tax returns and the paying of such taxes, to make such elections, decisions, concessions and settlements, including extensions of ~ime for the payment of any Federal estate taxes or other taxes due, as may be deemed proper, without liability to any person thereby affected, and without the necessity of making compensating adjustments. 2 I' Section 5. Power to Distribute in Kind. To make distributions of my estate in cash, in kind, or partly in cash and partly in kind; and to make non-pro rata distributions in kind without consideration of the income tax basis of the assets distributed. Section 6. Advance Distributions. To make advance distributions ill an estinlated amount to fund the respective Trusts established under my Revocable Trust. Section 7. Allocation of Generation-Skippin~ Exemption. I expressly authorize my Personal Representative to allocate, pursuant to Section 2631(a) of the Internal Revenue Code of 1986, as amended, any unused Federal generation-skipping transfer tax exemption which may be available as of the date of my death to any property with respect to which I am the transferor for generation-skipping tax purposes, whether or not such property passes under this WiU or otherwise and whether or not such 'property was transferred during my lifetime or by reason of my death; provided, however, that it is my desire, but not my direction, that my Personal Representative allocate said exemptIon in the following order of priority: (a) To all direct skips other than any direct skips resulting from a disclaimer; (b) to property distributed to the Family Trust established under Article Four of my Revocable Trust, unless my Personal Representative shall determine otherwise for good reason. My Personal Representative also shall be authorized to exclude any property \ with respect to which I am the transferor from any such allocation of such exemption. My Personal Representative shall be authorized to make any election relating to the allocation of such exemption. Any such allocation or election made by my Personal Representative shall be made without the necessity of obtaining court approval and shall be binding on the transferee of any inter vivos generation-skipping transfer I may have made and on all persons interested in my estate or in any trust established or to be established therefrom. Any good faith exercise, partial exercise or failure to exercise the authority granted to my Personal Representative hereunder shall not be subject to complaint or appeal by any party, and I hereby indemnify my Personal Representative against any and all such claims and costs (including attorneys' fees) associated therewith. Section 8. Business Powers. My Personal Representative may carry on any business owned and operated by me or my estate as a sole proprietorship or any business conducted by a limited or general partnership of which I or my estate was a partner for whatever period of time my Personal Representative may deem advisable, and to that end my Personal Representative shall have the power to do any and all things deemed necessary or appropriate, including the power to pay any negative cash flow, the power to incorporate any such business or hold the stock as an investment, the power to borrow and pledge assets held in trust as security for such borrowing, the power to liquidate or sell any such business or such interests therein at public or private sale and at such times and upon such terms as my Personal Representative detims advisable, and the power to employ agents to manage and operate such business without liability 3 II ; ~ for the actions of any such agents, or for any loss, liability, or indebtedness of such business, if the management is selected or retained with reasonable care. Section 9. Real Estate and Proceeds. I do not wish to have the value of my estate reduced by the forced sale of any real estate which I may own at my death. I therefore authorize my Personal Representative to retain such real estate until such time as it can be sold for its fair market value and, if necessary, in order to provide funds for the payment of any debts, expenses, estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death, I authorize my Personal Representative to borrow money and for that purpose to mortgage any such real estate and to execute and deliver all notes, bonds, mortgages, and other instruments and to perform all acts necessary, proper or convenient in connection therewith, any and all such loans and. mortgages to be made in the sole discretion of my Personal Representative and for such amounts and upon such terms as my Personal Representative.deems proper. I authorize my Personal Representative, without the necessity of petitioning any court for approval or confirmation, to sell at any time all or part of the real estate in my residuary estlate to anyone or more of my children or their issue for such price and upon such terms and conditions as all of my surviving children may agree. ARTICLE FIVE Waiver of Bond I direct that no Personal Representative or any other fiduciary named hereunder shall be required to give bond for the faithful performance of duty in any jurisdiction. ARTICLE SIX Source of Payment of Debts. Expenses and Taxes All estate taxes, inheritance taxes, transfer taxes and other taxes of similar nature, together with any interest and penalties thereon, payable by reason of my death upon the property constituting my gross estate for death tax purposes, whether or not such property passes under this Will, and all debts, costs of administration and other proper expenses, paid by my Personal Representative shall, except to the extent paid by my Trustees, be paid from the principal of my residuary estate passing under Article Three, without reimbursement from or apportionment among the legatees or devisees or persons having a beneficial interest in any such property. Assets sold by my Personal Representative to make payments hereunder shall be selected, to the extent advisable, so as to minimize the recognition by my estate of gain for income tax purposes. My Personal Representative may enter into such agreement to pay all or any part of the d~ath taxes on any future interest as may be deemed appropriate, and such agreement shall be binding upon all parties in interest. 4 I' ARTICLE SEVEN Interpretation of Will Section 1. Sineular and Plural: Use of Gender. Whenever used herein, the singular shall include the plural, the plural the singular and the use of any gender shall be applicable to all genders. Section 2. Defmition of Child. Children or Issue. Whenever the terms "child," "children" and "issue" are used herein, such terms shall be interpreted to include adopted children, regardless of the date of adoption, with full effect as if they were the natural children of the adopting parents. Such terms are also intended to include persons in gestation at any pertinent time under this Will, provided such persons survive birth by thirty (30) days. Section 3. Captions. The captions of articles and sections of this Will are for convenience of reference only and shall not affect the interpretation of this Will. Section 4. Governine Law. I hereby declare that I am a domiciliary of the Commonwealth of Pennsylvania and that the succession laws and other applicable laws of the Commonwealth of Pennsylvania shall control the interpretation of this Will and the ownership of any other property passing at the time of my death other than under this Will, and that no succession laws of any other nation or state shall have any applicability to this Will or the ownership of any other property passing at the time of my death other than under this Will. IN WITNESS WHEREOF, I have hereunto set my hand and seal to the original of this Will only this /3 day of ~y , 2000. ,1 JL" ~ (SEAL) ROBERT J. LI Signed, sealed, published and declared by the above-named Testator, as and for said person's Will in the presence of us and each of us, who, at said person's request, in said person's presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto e da d year last above written. 7J-- Residing at f/lA/ Ii :5 bJ J I A JO~J (~ Residing at ~(::v r ; ~h )J I f.(\ 5 II ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN ) ) ) SS: We, ROBERT J. LIS, ~ ~(bl;)..rCl. L. E.. ~-\~{) Inomo..~ 1'. G,~~~I and the Testator 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 Testator signed and executed the instrument as his Last Will and that he signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge the Testator was at that time"eighteen years of age or older, of sound mind and under no constraint or undue influence. &~.. ROBERT IP ~ TL . . A_I Witness ~~~ J C6lo~ Witness SUBSCRIBED, sworn to and acknowledge before me by ROBERT J. LIS, the Testator, and subscribed and sworn to before me by Ihcrn(:).~ r. C1t:\.c\-\. ,and ";po.i'oa..(~ J... fo.'\'ol'\ witnesses, this l'b+h day of :r a.. '" \) ~:r '1 ' 2000. ~Il). ~~~ Notary hc Notarial Seal . Judy M. Cadenhead, ~otary Pubhc Harrisburg, Dauphin County My Commissi0n Expires June 18, 2001 Member, Pennsylvania Association of Notaries (Notarial Seal) L0205478