HomeMy WebLinkAbout04-18-06 (2)
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
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COlMY CODE YEAR
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MJMBER
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STF PA42021F.1
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Clifford F. Schoole
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
SOCIAL SECURITY NUMBER
173.07.4735
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
06.12.05 03.22.1914
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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[1g 1. Original Return
o 4. Umited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Utigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Uving Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AltachSchO)
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NAME COMPLETE MAILING ADDRESS
Frank H. Kell , EA Kelly Financial services, Inc.
~~~-r'OfA'i~~ncial Services, Inc. 400 Bridge Street, Suite #4
TELEPHONE NUMBER New Cumberland, PA 1 7070
717.774.7536
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 ONned 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 Beql,lests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
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14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
(1 )
(2)
(3)
(4)
(5)
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56,556
OFFICIAL USE ONLY
(6)
1,971
(7)
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(9)
(8)
10,417
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58,527
(10)
(11)
(12)
(13)
10,417
48,110
1,000
(14)
47,110
X.O_ (15) 0
4 7 , 11 0 X .&=-.:2 (16) 1,884
X .12 (17) 0
X .15 (18) 0
(19) 1,884
pt.
Decedent's Complete Address:
STREET ADDRESS 2 4 5 Glenn Road
CITY . 11 I STATE PA I ZIP 1 7 0 7 0
Camp Hl
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
1,884
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C) (2)
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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)
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A. Enter the interest on the tax due.
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1,884
(5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,884
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................ 0 [XJ
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . . " 0 ~
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 0 [XJ
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 [XJ
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . . .. IX] 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompan~ng schedules and statemeris, and to the best of my kl10Nledge 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.
SIGN RE OF PERSON R PONSI8LE FOR FILING RETURN DATE
ADDRESS
245 Glenn Road, Camp Hill, PA 17011
SIGN RE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
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 oftransfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (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.
F or 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(aX1.3)]. 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.
STF PA42021F.2
REV-1502 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Clifford F. Schoole
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a
willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship
must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
None
STF PA42021F.3
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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I
REV-1503 EX + (1-97) (I)
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Clifford F. Schooley
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
FILE NUMBER
1.
None
VALUE AT DATE
OF DEATH
STF PA42021FA
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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REV-1504 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP or SOLE-PROPRIETORSHIP
ESTATE OF
Clifford F. Schooley
FILE NUMBER
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship.
See instructions for the supporting information to be submitted for Sole-proprietorships.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
None
STF PA42021F.5
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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REV-1505 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
Clifford F. Schooley
FILE NUMBER
1. Name of Corporation None
Address
City
2. Federal Employer 1.0. Number
3. Type of Business
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
Zip Code
State
ProducUService
4.
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common $
Preferred $
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? Dyes DNo
If yes, Position
6. Was the Corporation indebted to the decedent?
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent?
Dyes
Annual Salary $
DNo
Time Devoted to Business
If yes, Cash Surrender Value $
Owner of the policy
8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82?
Dyes DNo If yes, DTransfer DSale Number of Shares
Dyes DNo
Net proceeds payable $
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
Consideration $
Date
9. Was there a written shareholder's agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
Dyes DNo
10. Was the decedent's stock sold?
DYes DNo
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death?
Dyes DNo
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships?
Dyes DNo
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
STF PA42021F.6
REV-1506 EX + (1-97) (/)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
Clifford F. Schooley
FILE NUMBER
1. Name of Partnership None
Address
City
2. Federal Employer 1.0. Number
3. Type of Business Product/Service
4. Decedent was a D General D Limited partner. If decedent was a limited partner, provide initial investment $
Date Business Commenced
Business Reporting Year
State
Zip Code
5.
PERCENT OF PERCENT OF BALANCE OF
PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? 0 Yes 0 No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? Dyes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82?
Dyes D No If yes, D Transfer D Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? Dyes 0 No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death?
Dyes
DNo
Dyes
DNo
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners?
Dyes
DNa
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships?
Dyes
DNa
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
STF PA42021 F.7
REV-1507 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
Clifford F. Schooley
FILE NUMBER
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. None
VALUE AT DATE
OF DEATH
STF PA42021F.8
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
o
REV-1508 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Clifford F. Schooley
FILE NUMBER
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
2 .
Wachovia Bank - Burial Account
Annuity - Bankers Casualty & Life Insurance Company
benefit continued after death to Jerry Mattern _
son-in-law and Sandra mattern - daughter - both get
a monthly annuity check for $703 per month each.
The present value of the funds as calculated equals
the taxable amount listed.
Calculatin as follows:
Monthly Check 703 x 2 = 1406 x 36 months = 50616
a present value calculation at 5% - 46912
9/644
46/912
STF PA42021F.9
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
56/556
REV-1509 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Clifford F. Schooley
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Sandra Mattern
245 Glenn Road
Camp Hill PA 17011
Daughter
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Inclt..de name of financial instibiion and bank accolllt flJrOOer or similar ideriifying runber. DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT Attach deed for joirily-t'eld real estate. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. Commerce Bank account 3,942 50 1,971
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL (Also enter on line 6, Recapitulation) $ 1,971
STF PA42021 F.1 0
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Clifford F. Schooley
FILE NUMBER
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 %OF
ITEM It-.CLUDE HE NAME OF H-E TRANSFEREE, H-EIR RELATIONSHIP TO DECEDENT AND H-E DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER OF TRANSFER. ATTACH A COPY OF HE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
1. None 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL (Also enter on line 7, Recapitulation) $ 0
STF PA42021 F.11
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Clifford F. Schooley
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Betzer Funeral Horne, Muncy PA
9,022
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative( s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
2.
3.
City
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
State
Zip
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
5.
Accountant's Fees
1,170
6.
Tax Return Preparer's Fees
225
7.
STF PA42021F12
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10 417
REV-1512 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Clifford F. Schooley
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1. None
STF PA42021 F.13
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
o
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Clifford F Schooley
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)J
Tammi Geraci
1.
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
2. Jerry Mattern, Jr
Granddaughter
5,000
3. Joseph Geraci
Grandson
5,000
4. Nicholas Geraci
Great Grandchild
1,000
5. Sandra Mattern
Great Grandchild
1,000
Daughter
balance of funds
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. St. Andrew Evangelical Ltheran Church
Muncy PA
1,000
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)
1,000
STFPA42021F.14
REV-1514 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
(Check Box 4 on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
Clifford F. Schooley
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89.
Indicate the type of instrument which created the future interest below and attach a to the tax return.
NAME(S) OF
LIFE TENANT(S)
DATE OF BIRTH
NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS
DATE OF DEATH PAYABLE
None
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate - 03 1/2% 06% 0 10%
3. Value of life estate (Line 1 multiplied by Line 2)
o Life or o Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
$
o Variable Rate
%
NAME(S) OF
ANNUITANT(S)
DATE OF BIRTH
NEAREST AGE AT
DATE OF DEATH
TERM OF YEARS
ANNUITY IS PAYABLE
1. Value of fund from which annuity is payable
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - o Weekly (52) D Bi-weekly (26)
o Quarterly (4) 0 Semi-annually (2) o Annually (1)
3. Amount of payout per period
4. Aggregate annual payment, Line 2 mu~iplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate 03 1/2% D 6% 0 10%
6. Adjustment Factor (see instructions)
7. Value of annuity -If using 3 1/2%,6%, 10%, or if variable rate and period payout is at end of period,
calculation is: Line 4 x Line 5 x Line 6
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
o Life or 0 Term of Years
$
o Monthly (12)
DOther ( )
$
o
o Variable Rate
%
$
$
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax return. The resuning life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13,
15, 16 and 17.
STF PA42021 F.15
(If more space is needed, insert additional sheets of the same size)
REV-1647 EX + (9-00)
SCHEDULE M
FUTURE INTEREST COMPROMISE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(Check Box 4a on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
Clifford F. Schooley
This schedule is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment
cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
o Will 0 Trust 0 Other
I. Beneficiaries
NAME OF BENEFICIARY
RELATIONSHIP
DATE OF BIRTH
AGE TO
NEAREST BIRTHDAY
1. None
2.
3.
4.
5.
n. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months
of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such
withdrawal right.
o Unlimited right of withdrawal
m. Explanation of Compromise Offer:
D Limited right of withdrawal
~ Summary of Compromise Offer:
1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) ........... $
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 06%, 03%, 00%.......................... $
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One 06%, 04.5%................................. $
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 Taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) ........... $
6. Value of Line 1 Taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) ........... $
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. $
(If more space is needed, insert additional sheets of the same size)
o
STF PA42021 F.16
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REV-1649 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
ESTATE OF FILE NUMBER
Clifford F. Schoole
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113 (A) of the Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113 (A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust
or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule
0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arangement. The numerator of this fraction is
equal to the amount of the trust or simila- arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar
arrangement.
PART A: Enter the deSCription and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement.
DESCRIPTION
None
VALUE
Part A Total $ 0
PART B: Enter the description and value of all interests included in Part A for which the Section 9113 tAl election to tax is being made.
DESCRIPTION VALUE
STF PA42021 F.17
Part 8 Total $
(If more space is needed, insert additional sheets of the same size)
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105.805 REV 1/05
This is to certify that the information here given is correctly copied from an original certificate of death duly filed wi th me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
-
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
p
11396622
No.
~~
JUN 18 2005
Date
----------~-------._------~."-~--_.........._-~._._.......,,,..-----,..~,~~
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H105.143 Rev. 2187
TYPE/PRINT
IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICA TEOF DEATH
1.
AGE (Last Birthday)
5.
COUNTY OF DEATH
91 Yrs.
. lib.
CumhPrland
17d.1i] ~~hi:=:i~~ at
Iwp
MOTHER'S NAME (Firs!. Middle, Malden Surname)
CItYlboro
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27. PART I: Ent... the di...os.., inIu.... 0< comp'icetions which c..._ the d..... Do not eM... the -.... 0' dying. Such .. canliK or raplratory wrest, shock 0< heart tal...... . Approximate
li.t only on. cau.. on each lin.. : inlerval betwee
: onset and death
Sequentially list conditions b
it any, leading 10 immediate I c.'
cause. Enter UNDERLYING
CAUSE (Disease or injury
- fhal initialed events
resulting on death) LAST d.
WAS AN AUTOPSY VVERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY
PERFORMED? ~6~~~~i~R6~~~~SE Natural.f] Homicide 0 (Month. Day. Vo",)
OF DEATH? Accidenl 0 Pending Investigation 0 Yes 0 NoB
r;l{ n/ 0 30a. 3Ob. M. 30e. 30e1.
'~O No 't' ,., 0 No '+- s..D" Coo" """. ,,,....,..., 0 PlACE O""JUR' . ^' _. _. ,.." _,. ,"', L"""""" "..... c,."_. S.",
bUIlding, ole. (Sped"") ,_ .
28a. 28b. 29. 30.. 3Of.
CERTIFIER (Check only one) ,/ SIGNATURE AND TITLE OF CERTIFIER ?'
'yg~~F,J~~t~r.';tnl;J~~~s~~:1h ~g~~a~J: t':! n.e:~h,.~;:~(:r~~';g~~~~a~s h~~r:~~~~.~.~~.l~ ~~ ,~~~.I~.i.I~.~~) ............. ...0 3ib. ,~ it L
'PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death and certifying to calJse of death) LICENSE NUMBER. ~ . '"C':" "J A L DATE SIGNEp (Month, Day. Year)
To the best ot my knowledge, death Occurred at the time, date. and place, and due to the causes(s) and manner as stated.. .. 0 3ic. C:.?":::. C\c:.>.J j".., 3id. 6 '-/1- I'-- c ~:;--..
NAME AND ADDRESS OF p~.. ~. Mrt:n~i~~:p 0
(Item 27) Type or Print I.J'.f.:ICU- n. CMI.::JAn I "U:H. "
........... .......... ................................. 0 32 '6'?..~7c 1:~7:,C(.~.I-fr .
DIITE FILED (Month. Day, Year)
34. ~ t)f ;;;{ t~~
DUE TO (OR AS A CONSEQUENCE OF)
Other significant CXlnditions contributing to death, but
nol resulting in the undertying cause given In PART I
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DUE TO (OR AS A CONSEQUENCE OF):
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
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Commerce
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Commerce Bank/Harrisburg N.A
100 Senate Avenue
Camp Hill Pa 17011
888-937 -0004
Page 1 of 2
CLIFFORD F SCHOOLEY
SANDRA L MATTERN
245 GLENN ROAD
CAMP HILL PA 17011
STATEMENT DA'J'E
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ACCOUNT NO.
,
3
*** CHECKING *** 50 PLUS CLUB
ACCOUNT NUMBER 0512093428
PREVIOUS STATEMENT BALANCE AS OF 06/03/05 . .......................
. PLUS 4 DEPOSITS AND OTHER CREDITS ...................
LESS 3 CHECKS AND OTHER DEBITS.. ..... ...............
CURRENT STATEMENT ~CE AS OF 07/05/05 .... ........ .............
NUMBER OF DAYS IN THIS STATEMENT PERIOD 32
CYCLE-001
-----------------------------------------------------------------------------------
4",476.22
1,890.79
\:!..5..~~~.....
...J
.-..,-"'--,......~ ...-....-....-........'
*** CHECK TRANSACTIONS ***
SERIAL DATE
894 06/08
895 06/10
AMOUNT
41.2~
492.73.---
SERIAL
896
DATE
06/16
AMOUNT
444.33---
-----------------------------------------------------------------------------------
. .
***CHECKING ACCOUNT TRANSACTIONS ***
DATE DESCRIPTION
06/14 AC-BANKERs LIFE AND-BO OPERTNG
07/01 AC-THE TRAVELERS -PENS PMT
07/01 AC-LTV STEEL (REPUB-PN PMTS/BG
07/05 INTEREST PArMENT
DEBITS
CREDITS
1,411.01-
11. OJ--
468.12'-
. 63-- "
-----------------------------------------------------------------------------------
*** BALANCE BY DATE ***
06/03 4,476.22, 06/08
06/16 4,908.92 07/01
4,434.97 06/10
5,388.07 07/05
[:;.... 942.241 06/14
5,388.70
23-2324730
2.47
5,353.25
. PAYER FEDERAL 10 NUMBER
INTEREST PAID YEAR TO DATE
----------------------------------------------------
*** INTEREST EARNED THIS STATEMENT PERIOD
DAY S IN PERIOD .........................
INTEREST EARNED .... .... ...... ... .......
ANNuAL PERCENTAGE YIELD EARNED (APY)....
***
----------------------------------------------------
32
.63
0.15%
Mornhar en.,...
NOTE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION
Check~w
-
Page 2 of 2
Date
7/05/05
Account
512093428
CUFFORD F. SCHOOlEY 894-
c.::. ~~:::Il ~"' 5 - 0 1 - n1:> - .'IO/J::
~~~ /#~~;~~
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.~os -~~~Gf?" ~~~-h1~
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CUFFORD F. SCHOOLEY
245 GLEHH ROAD .
CAMP HIU.. PA 11011
895
Check 894, Amou nt $41.25 Date Presented 6/8/2005
D4rr'("")~ !rj,nS
. ::,~\,\\~.~,,,i,,^, ~~ J $4~:r'
~~"::~~:I~~ ;:'.' N~;-,... '61~~
"BanIc__.._~_
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':01 BD 18" t.': 5. i!O q:l.. 2 8''- DB q 5 ,"DOCil:W" 11 i? ? 3."
Check 895, Amount $492.73 Date Presented 6/10/2005
""114/3'3
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ClJFfORD F. SCHOOLEY . 896
24G GLENN RCMO I .
CAMP HILL. PA 11011 . ~TF h - I () _ OS 1IO-1W3::
~:~C: l~t:-~~:\ :' $~'I~.33 .
~- -'< -,~_'<I-CJ g _J.t~,... ol\ S:-
"BankAm'_"_~_" ~. .
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':O:U30.BI.f,.: 5. 2OQ31.2 au- OBcif, ...00000......33.'.
Check 896, Amount $444.33 Date Presented 6/16/2005
-
Investment Calculator
Name: Clifford Schoolev deceased - Jerry Mattern
Assumptions:
Desired payment amount ............................... $
Number of payments per year ..........................
Payments will be made at the End of Period
Number of years of the annuity ............................
I nterest rate ........................................
Interest is compounded ..............................
703.00
12
3
5.000 %
Monthly
Results:
With 3 years of payments, at an effective annual rate of 5.116%, and making 12 payments each year
of $703.00, you will have accumulated $27,243.59 (future value of annuity).
The present value of the annuity is $23,456.09.
Prepared By:
Kelly Financial Services, Inc.
400 Bridge St. , Suite 4
New Cumberland PA 17070
Tel: (717) 774-7536 Fax: (717) 774-4802
03-27 -2006
II
Investment Calculator
Name: Clifford Schooley deceased - Sandra Mattern
Assumptions:
Desired payment amount ............................... $
Number of payments per year ..........................
Payments will be made at the End of Period
Number of years of the annuity ............................
I nte rest rate ........................................
Interest is compounded ..............................
703.00
12
3
5.000%
Monthly
Results:
With 3 years of payments, at an effective annual rate of 5.116%, and making 12 payments each year
of $703.00, you will have accumulated $27,243.59 (future value of annuity).
The present value of the annuity is $23,456.09.
Prepared By:
Kelly Financial Services, Inc.
400 Bridge St. , Suite 4
New Cumberland PA 17070
Tel: (717) 774-7536 Fax: (717) 774-4802
03-27-2006
I
TZER
FUNERAL SERVICE
Tuesday, June 28, 2005
Mrs. Sandra L. Mattern
245 Glenn Road
Camp Hill, PA 17011
Dear Mrs. Mattern,
Thank you for selecting our funeral home to provide services for your family during recent your
bereavement. I hope that you found our services to be of the highest standards and that they met your
needs and those of your family and friends.
The following is an itemization of the service charges for the services for Clifford F. Schooley and are
herein indicated as PAID-IN-FULL.
CHARGES FOR MERCHANDISE SELECTED
Casket: Batesville Woodbridge Pecan
Outer Burial Container: Eagle Sentinal T op-SeallLiner
80
$2,603.95
$885.00
ALTERNATIVE SELECTION
Standard Traditional Funeral
TOTAL MERCHANDISE
$3,488.95
$ 3428.00
CASH DISBURSEMENTS
Cemetery Charges
Vault Service at Cemetery
Newspaper Notices - Obituary
Clergy Honorarium
Flowers
Engraving of Monument
Certified Copies of Death Certificate:
Rental of Church Social Hall
Catered Funeral Meal
TOTAL SPECIAL CHARGES
$3,428.00
(Weekday)
(Weekday)
Sun-Gazette & Patriot
12
$ 375.00
$ 100.00
$ 379.24
$ 100.00
$ 326.48
$ 75.00
$72.00
$ 75.00
$ 601.97
TOTAL CASH DISBURSEMENTS
$2,104.69
TOTAL OF SERVICES
LESS: Credits granted
Casket & Vault Package
LESS: Total Payments
6/27/2005 Wachovia Bank
LESS: Refund of Overpayment
$9,021.64
$250.00
$250.00
$9,643.61
9643.61
$871.97
PAID IN FULL $0.00
Enclosed you will find a check in the amount of $ 871.97. This represents excess funeral trust funds.
Please do not hesitate to contact me if you have any questions concerning this statement or if I may be of
further assistance.
Sincerely,
~ e-J.- .( . l'i..-'~-""
Galen R. Betzer
Director
PHONE (570) 546-8119 - 1 08 NORTH MAIN STREET - MUNCY, PENNSYLVANIA 1 7756
PHONE (570) 547-2491 - 40 EAST HOUSTON AVENUE - MONTGOMERY, PENNSYLVANIA 17752 _ KIRK E. NAUGLE, SUPERVISOR
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PATRICK F. LAUER, JR..
Attorney at Law
2 J 08 Market Street
Aztec Building
Camp HIli, PA 170J 1
(717) 763-1800
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LAST WILL AND TESTAMENT
OF
CLIFFORD F. SCHOOLEY
I, CLIFFORD F. SCHOOLEY, of 245 Glenn Road, Cumberland County,
Camp Hill, Commonwealth of Pennsylvania 17011, being of sound mind
and memory, hereby revoke and declare null and void any and all
Wills and Codicils heretofore made by me, and do make, publish, and
'declare this to be my Last Will and Testament.
FIRST
I direct my Executor or Executrix to pay my just debts, the
expenses of my last illness, and my funeral expenses from the
property passing under this Will as an expense and cost of
administering my estate, as soon after my death as may be found
convenient.
SECOND
I give, devise, and bequeath the following specific legacies:
(a) The sum of $5,000.00 to my granddaughter, Tammy Geraci;
(b) The sum of $5,000.00 to my grandson, Jerry Mattern, Jr.;
(c) The sum of $1,000.00, each, to Joseph Geraci, Nicholas Geraci,
and any natural born greatgrandchildren of mine hereafter; and
(d) The sum of $1,000.00 to Saint Andrew Evangelical Lutheran
Church of Muncy, Pennsylvania.
THIRD
I give, devise, and bequeath the rest, residue, and remainder
of my estate of every nature and wherever situate, of all that I
own to my daughter, Sandra L. Mattern, provided that my daughter
survives me by thirty (30) days. Should my daughter predecea$e me
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or fail to survive me by thirty (30) days, I direct that the
remainder of my estate be given in equal shares to her issue (and
their descendants) per capita by generation.
FOURTH
It is further my desire that my Executor or Executrix, after
consultation with any heir or heirs of mine who survive me, and in
his, her, or its own discretion, chOose such articles from my
tangible personal property (exclusive of cash, stock certificates,
bonds, and all other tangible evidences of intangible personal
property) as he, she, or it believes will be useful to such heir,
family member, friend, or personal acquaintance, or desirable for
such person to have, either from a sentimental point of view or
otherwise; and to deliver such articles to such person, or among
such heirs in equal or unequal shares as determined by the further
exercise of his, her, or its discretion, provided no heir objects
to the distribution after being given suitable opportunity to do
so. Any such distribution shall be taken into account at its
current fair market value in regards to the final disposition of
the assets of my estate.
FIFTH
I
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,/
~ ..~
Any devise or distribution under this, my Last Will and
Testament, which is payable to any beneficiary who may be under
twenty-one (21) years of age, shall be held in a separate trust by
my son-in-law, Gaspere (Gus) Geraci, and Tammy Geraci, or the
survivor of them, as Trustee until such beneficiary reaches twenty-
Page 2 of 6
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one
(21) years of age.
In the event neither Gaspere (Gus) Geraci
or Tammy Geraci is able or willing to serve as Trustee, I nominate
Jerry Mattern, Jr., to serve instead.
During the term of any trust created pursuant to this
paragraph, the trustee is authorized to expand and apply so much of
the net income and principal of each such trust as the trustee
shall consider it advisable for the health, maintenance, support,
education (including college education, graduate sChoOl), purchase
of a residence, or payment of debts preexisting my death for each
such beneficiary until he or she attains twenty-one (21) years of
age, or until all such amounts are paid out of trust.
I direct that no trustee shall be required to give or post
bond for the faithful performance of the trustee's duties in this
or any other juriSdiction.
SIXTH
estate.
I nominate SANDRA L. MATTERN to serve as Executrix of my
If she is unable or unwilling to perform her duties as
Executrix, then I hereby name JERRY A. MATTERN, JR., as First
Alternate Executor. In the event JERRY A. MATTERN, JR., is unable
lor unwilling to perform as First Alternate Executor, I then hereby
name JERRY A. MATTERN, SR., as Second Alternate Executor.
I I direct that no Executor/trix shall be required to give or
j
/post bond for the faithful performance of the Executor's duties in
IlthiS or any other juriSdiction.
II
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this
-L!t!!! day of MAflC 1-1 2000.
xr;l~~Jf~
C B RD/F. SCHOOLEY
SIGNED, SEALED, PUBLISHED, and DECLARED by the above-named
Testator, CLIFFORD F · SCHOOLEY, as and for his Last Will and
Testament, in the presence of us, who, at his request, in his
presence, and in the presence of each other, have hereunto
subscribed our names as witnesses.
~16~VU~1f1 (! If /!4-
ADDRESS
I' 'LJU1;/t JJ;Jj7j;L
V'fITNESS,
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DDRESS
Page 4 of 6
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AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
I, CLIFFORD F. SCHOOLEY, Testator, whose name is signed to
the attached or foregoing instrument, having been duly
qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my last Will, that I signed it
willingly, and that I signed it as my free and voluntary act
for purposes therein expressed.
set my hand and seal this
IN WITNESS WHEREOF, I, CLIFFORD F. SCHOOLEY, have hereunto
)l.j7f1 day of .fiAtH<.cH
;
2000.
{/~~ p:~?
C RD rF. SCHOOL Y
SWORN or affirmed to and acknowledged
the Testator, this
before me, and CLIFFORD F. SCHOOLEY,
L LOt!
- "L. day of
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2000.
Notarial Seal
Matthew J. Eshelman, Notary Publfc
~ Hm Boro, Cumber1and Countv
My COmmission expires Nov. 24, 2003
Mem6ii, ~
Page 5 of 6
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
: SS:
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.
We,
~vo ITI-I ;r k,?E;35
and &Cl~ A./'lf,IJAJ/C 1+
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the witnesses whose names are signed to the attached or
foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the Testator sign
and execute the instrument as his Last Will, that he signed
willingly, and that he executed it as his free and voluntary
act for the purpose 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 that
time eighteen (18) or more years of age, of sound mind, and
under no constraint or undue influence.
::.1-/
Sworn or affirmed to and subscribed efore me by
J~,Dl7fl A, kRE8S and (W-~l..{?yl..A1f"-MJ Ie fI
the witnesses, this I4.Trl day of M4t?CH 2000.
tMl~~v
Page 6 of 6
Notarial Seal
Matthew J. Eshelman, Notary Public
Camp Hili Bora, Cumberland County
My COmmission Expires Nov. 24, 2003
Mem6ir, PennijtVinia AasoaitiOii of NotaI1iS
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