HomeMy WebLinkAbout01-27-06
REV-15l)(lo EX + (6-00)
*
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
II 2005
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
HOFFMAN, Sterling M
DATE OF DEATH (MM-DD-YEAR)
060-18-1559
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
DATE OF BIRTH (MM-DD-YEAR)
11-04-2005
07 -10-1923
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
0968
NUMBER
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o 2. Supplemental Return
O 4a. Future Interest Compromise (date 01 death after
12-12-82)
o 7. Decedent Maintained a Living Trust (Attach
copy 01 Trust)
O 10 Spousal Povertv Credit (date 01 death between
. 12-31-91 and 1-1-~5)
tHIS SECTION MUST BE COMPLETED. ALL CORRESF'ONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD I3E DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
DAVID W DELUCE
01
04
06
09
Original Return
Limited Estate
o 3. Remainder Retum (date 01 death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
Decedent Died Testate (Attach
copy of Will)
Litigation Proceeds Received
o 11. Election to tax under Sec. 9113(A} (Attach Sch 0)
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FIRM NAME (If applicable)
Johnson, Duffie, Stewart & Weidner
301 Market Street
P.O Box 109
Lemoyne, PA 17043
(1) None
(2) None
(3) None
(4) None
(5) 242.45
(6) 9,987.25
(7) 92,142.73
(8)
(9) 11,269.59
(10) 50.00
TELEPHONE NUMBER
717-761-4540
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) 0 Separate Billing Requested
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15)
z or transfers under Sec. 9116(a)(1.2)
0 (16)
i= 16.Amount of Line 14 taxable at lineal rate 0.00 x .045
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Do 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0
0 18. Amount of Line 14 taxable at collateral rate 91,010.39 .15 (18)
x x
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t- 19. Tax Due
(19)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
>>BE;SURl: TO ANSWER ALL. QUESnONSONREVERSl: SlOe: AND RECHECK MATH<<
Copyright 2002 form software only The Lackner Group, Inc.
OFFICIAL~~SE ONLY I
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102,372.43
(11 )
11,319.59
91,052.84
42.45
(12)
(13)
(14)
91,010.39
0.00
0.00
0.00
13,651.56
13,651.56
Form REV-1500 EX (Rev. 6-00:
~
Decedent's Complete Address:
STREET ADDRESS
815 Windsor Place, Apartment 1
CITY Mechanicsburg
ISTATE PA
/ZIP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
13,651.56
682.58
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
682.58
TotallnteresVPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
12,968.98
12,968.98
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
D [!J
D [!J
D [!J
D [!J
D [!J
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ D [!J
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............... .......................... ............. .... ........................................... ................ D [!J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, 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
<;Clll1plete Declarali.o"-ofprep",e~9ther !~a"-,he~"rsOl1lllr~r,,sentatlv,,~.b!ls~edo."all inform-"t~onof whlchpre'pa!"rhas~~y know~<lgec .
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Ca Bergman
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 adequate consideration?,.,..."......,.....".,...... .....,......,..,... ......,....,."....."...."....""....."....".......,....,.....",
Yes
DATE
515 Gettysburg Pike
Mechanicsburg, PA 17055
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DATE
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ADDRESS
ADDRESS
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..............1.L
DATE
4
301 Market Street
Lemoyne, PA 17043
-~-,-_._-_.,.'.'..'m'..'~~,_.'--_1iiIlIII;~1_
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S, ~9116 (a) (1.1) (ii)]. The statute does not exempt 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. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S.
~9116 1.2) [72 P.S. ~9116 (a) (1)],
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P,S. ~9116 (a) (1.3)]. A sibling is
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1&08 'EX+ (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, Sterling M
FILE NUMBER
21-2005-0968
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1 AAA
Refund on Account
29.97
2 Verizon Telephone
Refund on Account
12.48
3 1995 Ford Contour 4 Door Sedan
Contracted Sale Price
200.00
TOTAL (Also enter on Line 5, Recapitulation)
242.45
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev.1609'EX+ (6-98) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
HOFFMAN, Sterling M
FILE NUMBER
21-2005-0968
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
A. Carl D Bergman
ADDRESS
RELATIONSHIP TO DECEDENT
Friend
515 Gettysburg Pike
Mechanicsburg, PA 17055
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENT'S INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 10/3/1966 New Cumberland Federal Credit Union 19.974.49 0.500% 9.987.25
Savings Account No. 2389
TOT AL (Also enter on Line 6, Recapitulation) 9.987.25
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
Rev-1610 l:X+ (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, Sterling M
FILE NUMBER
21-2005-0968
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
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DE CD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE,
1 PNC Bank Personal Checking Account No. 95,142.73 100.000 3,000.00 92,142.73
5140029668
Transferee: Carl Bergman, Friend of the
Decedent
Date of Transfer: 10/24/2005
TOTAL (Also enter on Line 7, Recapitulation) 92,142.73
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc,
Form PA-1500 Schedule G (Rev. 6-98)
REV-1161'EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, Sterling M
FILE NUMBER
21-2005-0968
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 6,735.22
B. ADMINISTRA TIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Johnson, Duffie, Stewart & Weidner 4,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 62.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 472.37
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 11,269.59
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1602 EX+ (6-88)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, Sterling M
FILE NUMBER
21-2005-0968
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Funeral Luncheon - Damon's Grill
125.22
2
Myers Funeral Home, Inc.
6.610.00
Subtotal
6.735.22
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1602'EX+ (6-98)
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, Sterling M
IFILE NUMBER
21-2005-0968
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Cumberland County Register of Wills Office
Filing fees for Inheritance Tax Return ($15.00) and Inventory ($15.00)
30.00
2 Cumberland Law Journal 75.00
Notice of Estate Administration
3 Reserves -Additional Close Out Costs 200.00
Preparation of Decedent's Final Income Tax Return
4 The Patriot News 132.60
Notice of Estate Administration
5 United States Post Office 18.57
6 United States Post Office 16.20
Subtotal
472.37
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
R.v-1612 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, Sterling M
FILE NUMBER
21-2005-0968
Includ. unr.lmbur..d m.dlcal ..p.n....
ITEM
NUMBER DESCRIPTION
1 Cumberland County Orphan's Court
Filing Fee for Petition prior to Death
VALUE AT DATE
OF DEATH
50.00
TOTAL (Also enter on Line 10, Recapitulation)
50.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule' (Rev. 6-98)
REV.1613' EX+ (9.00)
.
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
HOFFMAN, Sterling M
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trust..ls)
FILE NUMBER
21-2005-0968
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
Carl D Bergman
515 Gettysburg Pike
Mechanicsburg, PA 17055
Friend
Personal
Property
Total
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
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
Rev-1602 'EX+ (6-98)
.
SCHEDULE .I-liB
CHARITABLE AND GOVERNMENTAL
DISTRIBUTIONS
continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOFFMAN, Sterling M
FILE NUMBER
21-2005-0968
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
World Wide Church of God
300 West Green Street, pasadena, CA 91123
42.45
Subtotal
42.45
Copyright (c) 2002 form software only The La~kner Group, Inc.
Form PA-1500 Schedule J-IIB (Rev. 6-98)
EXHIBIT A
:267658
LISTING OF EXHIBITS FOR
ESTATE OF STERLING M. HOFFMAN
LAST WILL AND TESTAMENT FOR STERLING M. HOFFMAN
SIGNED AND DATED SEPTEMBER 2lh, 1981.
EXHIBIT A
1fiast ~HI anD mtstamcm of
STERLING M. HOFFMAN
>:115 w',,-IP S'lJ f r L =ill
M. HOFFMAN, Of1l1810 Market Street,
Iv! ~1I/fd:::;56vI(6,ffr I, STERLING
Camp Hill, Cumberland
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County, Pennsylvania, beina of sound and
disposing mind, memory and understanding, do hereby make, publish
and declare this my Last Will and Testament, hereby revoking any
and all prior wills and codicils thereto by me at any time hereto-
fore made.
FIRST
I direct that all my just debts and the expenses of my
last illness and funeral shall be paid from tne assets of my
estate as soon as practicable after my decease.
)\ I authorize my personal representatjve to expend funds
from my estate, in such amounts as my personal representative
shall consider necessary and desirable, for the purchase, erection
and inscription of a suitable marker for my grave.
SECOND
I give and bequeath all automobiles, household effects
and other tangible personal property, not including cash or
securities, owned by me at my death, together with all policies
of insurance thereon, plus Five Hundr~ DOllarS'($500.~ to
.5 j 5 GY:f1161J~6- {1/ XI:::- fttecJI4tVC '5B~G- I'll
CARL BERGMAN, O~007 Dougias Drive, Carlisle, Pennsylvania,
and to his heirs.
THIRD
I.
I give,
devise and bequeath
the residue of my estate,
fJ I tv if (J//,J liitllA t5 J/ fiN' if!;. 1 S:tI ~
to THE WORLDWIDE eHURCH OF v
if S5oct&f'1(j1J
/11) IV IV 1:: !ljlC/'L-! <' . ,
, ./ .41/10
S,;l if If (; '~(J.t 7'7'"
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of every nature and wherever situate,
GOD,
Box Ill, Pasadena,
California, 91123.
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FOURTH
All principal and income, until actual distribution to
the beneficiaries, shall be free of the debts, contracts, assign-
ments, alienations and anticipations of any beneficiary, and the
same shall not be subject to any levy, attachment, execution or
sequestration.
FTFTH
I direct that all taxes that may be assessed in conse-
quence of my death, of whatever nature and by whatever jurisdic-
tion imposed, shall be paid from my residuary estate as a part of
the expenses of the administration of the estate.
SIXTH
My personal representative shall have the following
powers in addition to those vested in him by law and by other
provisions of this Will:
f~ A.
To retain any or all assets of my estate, real
or personal, without regard to any principle
of diversification, risk or productivity.
B.
To invest in all forms of property (including
stock or other securities of my corporate
fiduciary or its successor, or of a holding
company controlling my corporate fiduciary
or its successor, and common trust funds and
mortgage investment funds, whether maintained
by my corporate fiduciary or its successor or
others), without restriction to legal invest-
- 2 -
ments, as he may deem proper, without regard
to any principle of diversification, risk or
productivity.
c. To purchase investments at a premium or dis-
count.
D. To exercise all rights of a security holder
or shareholder in any corporation; to give
proxies; to join in any merger, consolidation,
reorganization, voting trust plan, or other
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concerted action of security holders, and to
delegate discretionary duties with respect
thereto.
E. To sell at public or private sale, to exchange
or to lease, for any period of time, any real
or personal property, and to give options for
sales, exchanges or lease~ for such prices and
upon such terms or conditions as he deems
proper.
F. To allocate receipts and expenses to principal
v
or income, or partly to each, as my personal
representative thinks proper.
G. To borrow money from my corporate fiduciary or
others and to mortgage or pledge any real or
personal property as security therefor, in his
sole discretion.
H. To compromise any claim or controversy without
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order of court or consent of any beneficiary.
I. To exercise any option, right or privilege
granted in insurance policies or arising from
ownership of investments.
J. To make any distribution herein provided for in
cash, in kind, or partly in each, at valuations
fixed by my personal representative at the time
of distribution.
SEVENTH
I appoint CARL BERG~ffiN, Of;(2007 Douglas Drive, Carlisle,
Pennsylvania, Executor of this, my Last Will and Testament.
Should Carl Bergman predecease me or for any reason fail to
qualify as such Executor, or having qualified, fail to serve as
such Executor, then I nominate, constitute and apPoint~NB
Bank, N.A., of Lemoyne, Pennsylvania, as my surviving Executor of
this, my Last Will and Testament.
EIGHTH
My executor shall not be required to post security in
any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, consisting of five (5)
typewritten pages, the first four (4) of which bear my signature
- 4 -
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
STERLING M. HOFFMAN, THE TESTATOR, WHOSE NAME IS
SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALI-
FIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED
AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TESTAMENT;
THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS MY FREE
AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED.
SWORN OR AFFI RMED TO AND
~ STERLING M. HOFFMAN, THE TESTATOR,
A-€r~~ ' 1981.
ACKNOWLEDGED BEFORE ME BY
THI S ")!/-?, DAY OF
._-/lc~ ;;~ ~ -A? ~-I:~--rt~~_/ -- -
if Testator'
~""~~~'d C '~~~~N
No ry Public
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
C. K:.hbr, fJo~.:ry Public
. CC~ n!y
f"y 'on 18 IS"?
Momber, Pennsyi~arlla Assoc'j.llon 'of 'N(lt~ril!S
WE,/);M/( r/W/DorF AND ;~Y;!"L/S: /h, /l1/::~~L-L-
THE WITNESSES WHOSE NAMES ARE SIGNED TO THE FOREGOING INSTRU-
MENT, BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY
THAT WE WERE PRESENT AND SAW THE AFORESAID TESTATOR SIGN AND
EXECUTE THE INSTRUMENT AS HIS LAST WILL AND TESTAMENT; THAT
HE SIGNED WILLINGLY AND THAT HE EXECUTED IT AS HIS FREE AND
VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT EACH OF
US IN THE HEARING AND SIGHT OF THE TESTATOR SIGNED THE WILL
AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE
TESTATOR WAS AT THE TIME EIGHTEEN (18) OR MORE YEARS OF AGE,
OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE.
SWORN
THI S 2{//~ DAY
g:~ Z5;~~~~~I7?/:EroRE ME,
7//\ itness
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iV i;)f a~ {~n!.~Z;-A/~~
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~'''-~N;~'~ ~bl~~~~r~~
i'-1\'"
r'ij~n:~Jc: r ~je:nn:~;yit.<ir:iU /~~.Dc:j~titT: of Nt~LFf:S
r:. Y.:"h',?r, t-J(:tary Public
'jlU;~ty
; ~~L)
in the margin for the purpose of identification, this 2Y!?r day
of ~ti-~ ' 1981.
G
-X.-~~~SEAL)
Hoffman
Signed, sealed, published and declared by the above-
named Testator, STERLING M. HOFFMAN, as and for his Last Will and
Testament, in the sight and presence of us, who, at his request,
in his sight and presence of each other, have hereunto sub-
s.ccrr~,. e d ou...r names as witnesses.
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