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REV. 1500 EX + (6.00)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
o 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after
12-12-82)
o 7. Decedent Maintained a Living Trust (Attach
copy of Trust)
o 10. Spousal Poverty Credit (date of death between
12-31-91 and 1-1-95
THIS SECTION MUSTBECOMPLETED'ALLCORRESPONDENCEAND::CONFIDENTIAPT AXiINFORMATIONii$HOULD BE DIRECTED TO:
AME COMPLETE MAILING ADDRESS
Ivo V. Otto III, Esquire
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
HERTZLER, JEAN H.
FILE NUMBER
21 05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
01039
NUMBER
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
072-18-2152
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
177-16-1252
o 3. Remainder Return (date of death prior to 12-13-82)
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5. Federal Estate Tax Return Required
8. Totai Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
Ten East High Street
Carlisle, PA 17013
(1 ) None
(2) 690,077.76
(3) None
(4) None
(5) 54,733.70
(6) None -
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(7) None
(8) 744,811.46
(9) 8,968.00
(10)
(11 )
8,968.00
11/12/2005
12/11/1918
(12)
735,843.46
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE iNITIAL)
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HERTZLER, WILLIAM T.
QSI 1. Original Return
o 4. Limited Estate
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13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
735,843.46
6. Decedent Died Testate (Attach copy
of Will)
9. Litigation Proceeds Received
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Q.
IRM NAME (If applicable)
Martson Deardorff Williams & Otto
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, 735,843.46 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
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Q. 17.Amount of Line 14 taxable at sibling rate x .12 (17)
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~ 18, Amount of Line 14 taxable at collateral rate x .15 (18)
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19. Tax Due (19)
20. 0
ELEPHONE NUMBER
717/243-3341
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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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)
0.00
0.00
Copyright 2000 form software only The Lackner Group, Inc.
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<.
Form REV-1500 EX (Rev. 6-00)
pJ.
Decedent's Complete Address:
STREET ADDRESS
1 000 West South Street
CITY
Carlisle
I STATE PA
I ZIP 17013
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
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
0.00
TotallnteresUPenalty (D + E)
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
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(3) 0.00
(4)
(5) 0.00
(5A)
(58) 0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
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?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adeq uate consideration?................................................................................................................. .....
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ............................ ................. ............................... ... .......................... .............
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Janice E. Hertzler
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ATURE OF PERSON RESPONSIBLE FO
246 Glendale Street
Carlisle, P A 17013
DATE
I .~/;l.i /()~
DATE
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
IVOV.O~~
ADDRESS
DATE
Ten East High Street
Carlisle, P A 17013
J )1 'I( 0,"
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. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax 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 or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116
1.2) [72 P.S. 99116 (a) (1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERTZLER, JEAN H.
I FILE NUMBER
21 - 05 - 01039
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 29322.1679 shares USAA Tax-Exempt Short-Term Fund 10.62 311,401.42
2 30000 Chester Upland Sch Auth PA Sch Rev RefB (1 66327DC7) 103.0675 30,920.25
3 4370.881 Evergreen PA Tax-Free Fd-B (300326204) 11.26 49,216.12
4 5908.419 Oppenheimer Multi St Muni PA MUll Fd-A (683940100) 12.58 74,327.91
5 108 P A Insd Muns Incm Tr Unit 296 (70884G488) 950.335 102,636.18
6 85 P A Insd MUllS Incm Tr Unit 292 (70884G405) 955.290 81,199.65
7 6 PA Insd Muns Inc Tr Unit Ser 241 (70884FI42) 995.370 5,972.22
8 9 P A Insd Muns Incm Tr Unit 284 (70884G249) 964.620 8,681.58
9 Accrued carryover & Daily Interest on above items 1,218.85
10 476 Nuveen Tax Exempt Unit Tr 796 PA Ins Series 196 50.81 24,185.56
11 Accrued interest on Item 10 318.02
TOTAL (Also enter on line 2, Recapitulation) 690,077.76
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERTZLER, JEAN H.
I FILE NUMBER
21 - 05 - 01039
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorshIp must be disclosed on schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
4,527.45
Wachovia Securities Account 4094-8628, cash
2
Remic Multiclass CMO, Redemption value and accrued interest
50,206.25
TOTAL (Also enter on Line 5, Recapitulation)
54,733.70
SCHEDULE H
FUNERAL EXPENSES &
ADMINIS1RATIVE COS1S
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERTZLER, JEAN H.
I FILE NUMBER
21 - 05 - 01039
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State
Zip
2.
Attorney's Fees
Martson Deardorff Williams & Otto (estimated)
5,000.00
3,500.00
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant William T. Hertzler
Street Address 1000 West South Street
City Carlisle
Relationship of Claimant to Decedent
State Pa
Spouse
Zip
17013
4.
Probate Fees
453.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Register of Wills, filing fee, Inheritance Tax Return
15.00
TOTAL (Also enter on line 9, Recapitulation)
8,968.00
REV.1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HERTZLER, JEAN H.
I FILE NUMBER
21 - 05 - 01039
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
n_ ,'_.
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 William T. Hertzler Spouse Entire Residue
1000 West South Street, Carlisle
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
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F 'FILES\DA T AFllE\Esule Plaanin.\I01 50-2.... will
LAST WILL AND TEST AMENT
I, JEAN H. HERTZLER, of Carlisle Borough, Cumberland County, Pennsylvania,
being of sound and disposing mind and memory, do hereby make, publish and declare this
to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by
me made.
ITEM ONE
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses
and all inheritance taxes shall be paid to the extent possible from the assets held or passing
under ITEM FOUR hereof as soon as practicable after my decease and as part of the
administration of my estate.
ITEM TWO
Ifmy Spouse, WILLIAM T. HERTZLER, is living thirty (30) days after my death,
then I give, devise and bequeath all of my estate, both real and personal property, unto my
said spouse, absolutely. If my said spouse does not so survive me, then I give, devise and
bequeath all the rest, residue and remainder of my estate, both real and personal property,
unto my Trustee to be held or distributed by such Trustee under ITEM FOUR hereof.
ITEM THREE
In the event my said spouse shall disclaim all or any portion of any devise or bequest
made to my spouse under the foregoing ITEM TWO, then the amount otherwise payable
shall be held by my Trustee under ITEM FOUR hereof. For purposes of the Trust
established under ITEM FOUR hereof, my said Spouse shall not be deemed to have
predeceased me by virtue of my said spouse's exercise of the right to disclaim set forth
herein.
ITEM FOUR
RESIDUARY AND DISCLAIMER TRUST
My Trustee shall hold the assets received under ITEMS TWO and THREE hereof'/it
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If
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any, for the following purposes:
A. My Trustee shall pay the net income, at least quarter-annually, to my spouse,
WILLIAM T. HERTZLER, for life. In addition, my Trustee, in my Trustee's sole discretion,
may invade the principal of the Trust for the proper and adequate support of my said spouse.
B. My Trustee shall further pay to my said spouse, annually, such sum from the
principal of the Trust as my said spouse may request in writing, provided, however, that said
sum may not exceed the greater of Five Thousand Dollars ($5,000.00) or five percent (5%)
of the aggregate value, at the time of said request, of the principal of the Trust hereunder.
C. Upon the death of my said spouse, or upon my death if my spouse shall not
survive me by thirty (30) days, my Trustee shall distribute the principal of the Trust to my
daughter, JANICE E. HERTZLER, absolutely.
ITEM FIVE
POWERS OF EXECUTOR AND TRUSTEE
In addition to the powers conferred by case law, by statute, and by other provisions
hereof, my Executor and Trustee and their successors, shall have the following discretionary
powers applicable to all property held by them which powers shall be effective without order
of any court and shall exist until final distribution.
A. To retain any property of any nature recei ved by them for whatever period they
shall deem advisable;
B. To invest and reinvest all or any part of said property in such stocks, bonds,
common trust funds, securities, accounts, certificates of deposit (including, but not limited
to, stocks, bonds, common trust funds, securities, accounts or certificates of deposit of the
Trustee) or other property, real or personal, as in their discretion they shall deem proper,
without regard to statutes limiting the property which a fiduciary may purchase;
C. To sell, transfer, exchange or otherwise dispose of, any part of said property,
for cash or on terms, publicly or privately, or to lease, even for a term exceeding five (5) ,
Page 2 of 7 Pages
[Initials J
years or the duration of any trust herein, without liability on the purchasers or lessees to see
to the application of the proceeds, and to give options for these purchases without the
obligation to repudiate them in favor of a higher offer;
D. To execute and deliver any deeds, leases, assignments or other instruments as
may be necessary to carry out the provisions of any trust hereunder;
E. To borrow money, including the right to borrow money from any bank and to
mortgage or pledge any asset of the estate as security;
F. To assume continuance of the status of any beneficiary with regard to death,
marriage, divorce, illness, incapacity and the like in the absence of information deemed
reliable without liability for disbursements made on such assumption;
G. To pay from the trust, or the income therefrom, all debts or claims against my
estate, or any taxes or similar charges on my estate;
H. To make any distribution hereunder either in kind or in money, or partially in
kind and partially in money. Distribution in kind shall be made at the market value of the
property distributed, and my Trustee, in my Trustee's absolute discretion, may cause the
share distributed to any distributee to be composed of property similar to or different from
that distributed to any other distributee;
1. To exercise any subscription right in connection with any security held
hereunder, to consent to or participate in any recapitalization, reorganization, consolidation
or merger of any corporation, company or association, the securities of which may be held
hereunder, to delegate authority with respect thereto, to deposit investments under
agreements, to pay assessments, and generally to exercise all rights of investors;
1. To invest in endowment, insurance or annuity policies on the lives of
beneficiaries of any trust hereunder;
K. To continue in any partnership, joint venture, joint ownership or other business
enterprise of which I am a part at the time of my death; I. .r
Page 3 of 7 Pages
[Ini tials ]
L. To compromise claims;
M. To continue for whatever period of time as they shall deem necessary any
ownership as a tenant in common or as a partner, in real estate or other property and to act
as I could have done had I been living;
N. To lend money to my estate or to any trust created hereunder or to purchase
from the estate or from any trust created hereunder, at the market value thereof at the time
of purchase, any securities or other property tendered to them by my estate or any trust
created hereunder at any time and from time to time within a period of nine (9) months after
my death;
O. In the event that any amounts are payable hereunder or under any trust created
hereunder to a minor, or to a person otherwise under legal disability, or to a person not
adjudicated to be an incapacitated person, but who, by reason of illness or mental or physical
disability is, in the opinion of the fiduciary(ies) hereunder, unable to properly administer such
amounts, such amounts may be paid by the fiduciary(ies) hereunder in his, her or their sole
discretion in any of the following ways as he, she or they may deem best:
1. Directly to such beneficiary;
2. To a legally appointed guardian of such beneficiary for the benefit of
such beneficiary;
3. To a person having custody of such beneficiary for the benefit of such
beneficiary;
4. By the fiduciary(ies) hereunder using such amounts directly to the
benefit of such beneficiary.
Evidence of the application of payment of an amount in such a manner shall be a full and
complete discharge of the fiduciary(ies) hereunder to the extent of such payment or
application. This paragraph shall be applicable to payments of income as well as principal.
P. To employ agents, attorneys and proxies and to delegate to them such J1P~er;J -< .
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Page 4 of 7 Pages
[Initials)
as my personal representatives and Trustees consider desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys and proxies;
Q . To conduct an inventory of any safe deposit box necessary to the administration
of my estate.
R. To do all other acts in their judgment necessary or desirable for the proper
management, investment and distribution of my Estate.
ITEM SIX
PROTECTIVE PROVISIONS
All income or principal held for the use and benefit of the beneficiaries of any trust
hereunder shall not be in any way or manner subject to anticipation, assignment, pledge, sale
or transfer, nor shall any such interest, while in the possession of my Trustee, be liable for
or subject to the debts, contracts, obligations, liabilities or torts of any beneficiary, or to
attachments, executions or sequestrations under process of law.
ITEM SEVEN
APPOINTMENT OF EXECUTOR AND TRUSTEE
I nominate, constitute and appoint my spouse, WILLIAM T. HERTZLER, as Executor
of my estate. In the event that my said Spouse shall predecease me or fail to act as Executor,
then I appoint my daughter, JANICE E. HERTZLER, as Executrix of my estate.
I nominate, constitute and appoint my spouse, WILLIAM H. HERTZLER, as Trustee
of any trust created hereunder. In the event that my said spouse shall fail or be unwilling to
continue to act as Trustee, then I appoint my daughter, JANICE E. HERTZLER, as Trustee
of any trust created hereunder.
ITEM EIGHT
WAIVER OF BOND
I direct that neither my Executor nor my Trustee or their successors shall be required
to file any bond in any jurisdiction to secure the faithful performance of their duties, nor shall
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Page 5 of7 Pages
[Initials]
they be required to obtain any order or approval of any court for the exercise of any power
or discretion set forth in this Will.
IN WITNESS WHEREOF I have hereunto set my hand and seal thi~. - /C'utray of
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~6..:i'RV"..q/c'/ ' c.-:;C03. < ,,( .' /'f .
.t'.
Jean H. Hertzler
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix,
as and for her Last Will and Testament, in the presence of us, who at her request, have
hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and
of each other.
~~~/
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Page 6 of 7 Pages
COMMONWEAL TH OF PENNSYL VANIA )
: SS.
COUNTY OF CUMBERLAND )
We, Jean H. Hertzler, r-, '-<.v.A L . ;'/1 .'.. and -J.;... i '., (~ ;:.='. I.k ,-I- ') 1(', _
If
the Teslatrix and the witnesses, respectively, whose names are signed to the 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 that the T eslatrix has signed
willingly, and that the Testatrix executed it as her free and voluntary act for the purposes
therein expressed, and that each of the wi tnesses, in the presence and hearing of the T eSlatrix,
signed the Will as a witness and that to the best ofhislher knowledge the Testatrix was at that
time eighteen years of age or older, of sound mind and under no constraint or undue
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influence.,; -I' ''J: ·
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Jean H. Hertzler, Testatrix
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WItness
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ess
Subscribed, sworn to and acknowledged before me by Jean H. Hertzler, the Testatrix,
and subscribed and sworn to before me by ~t {c ',., .t<-./ ''J ('1 L , I', > and
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) - , "" - . z. I.;, , f ,'. / " , the witnesses, this /, hday of !--. -L _ ._ )
--(t. I j .
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Notary Public
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NOT ARiAL SEAl
CORRINE L. MYERS, Notary Public
Carlisi.) Bora. ~,.inh','rlar1dCounry
L l.1y C r: 'T1~_~:',.0 5:.~ ~'_~' lY.,::X:.. 2003
Page 7 of 7 Pages