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
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OFFICIAL USE ONLY
FilE NUMBER
21 -0 5 0 0 1 07
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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
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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
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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 \
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0.00
200.00
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(6)
(,.)
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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
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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:
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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
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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
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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
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. 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
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. 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
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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
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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)
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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
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HARRISBURG. P A, '17108
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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
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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:
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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
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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
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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
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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
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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