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REV.1500 EX + (6-00)
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OFFICIAL USE ONLY
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
II
0807
05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
NUMBER .. ___
201-16-0646
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Retum (date of death prior to 12-13-82)
[J 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
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NAME
George F. Douglas III
FIRM NAME (If applicable)
Said is, Shuff, Flower & Lindsay
TELEPHONE NUMBER
(717) 243-6222
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
COMPLETE MAILING ADDRESS
26 West High Street
Carlisle, PA 17013
(1 ) None
(2) None
(3) None
(4) None
(5) 9,296.48
----~.~-_._--_.._-_.~
(6) 22,057.93
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(7) None
(9)
(10)
2,172.33
358.86
OFFICIA,b.)USE ONLY
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
I DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
.... I Natcher, Viola P
~ DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
~ ~(1:08_21_2005 01-31-1911
~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
w [!J 1. Original Return [] 2. Supplemental Return
t- .--
~ ~ ~ I J 4. Limited Estate 4a. Future Interest Compromise (date of death after
~ & g I 12-12-82)
n f ~ [!J 6. Decedent Died Testate (Attach 7. Decedent Maintained a Living Trust (Attach
Q. ~cl~ ~clfu~
<C 9. Litigation Proceeds Received 10 Spousal Poverty Credit (date of death between
. 12-31-91 and 1-1-95)
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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)
LJ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) [J 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)
13. Charitable and Governmental Bequests/Sec 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)
......-~,
.....=r)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
:J~ ro,_..)
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CO
(8)
31,354.41
(11 )
2,531.19
28,823.22
(12)
(13)
0.00
(14)
28,823.22
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15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
0.00
x .00 (15) 0 . 00
! 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
28,823.22
x .045 (16) 1 ,297.04
0.00
0.00
x .12 (17) 0.00
x .15 (18) 0.00
(19) 1,297.04
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00;
. 1
Decedent's Complete Address:
STREET ADDRESS
C.M.E. Lot 104
I STATE PA
IZ'P1~7 2 41
CITY
Newville
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
900.00
0.00
Total Credits (A + 8 + C)
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (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.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
1,297.04
900.00
397.04
397.04
D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ................ .................................... ................................................................. D [!]
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 retum, 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Theresa P. Miller
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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
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167 Amy Drive
Carlisle, PA 17013
SIGNATURE OF PERSON RESPONSIBLE FO Fill ETURN
~^C-,=~€
'SIGNATURE PREPARER OTHER N REPRESENTATIVE
George F. Douglas III
ADDRESS
ADDRESS
26 West High Street
Carlisle, PA 17013
No
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DATE
tj'1?jo?
DATE
5/~"3 /0'
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 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 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 .5. ~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.
R~v.1508 EX+ (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONW~THOFPENNSYlVAN~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Natcher, Viola P
FILE NUMBER
21-05-0807
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property JolnUy-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 cash on hand 120.00
2 Comcast, refund 60.31
3 Highmark Insurance refund 578.55
4 insurance premium refund 150.00
5 The Sentinel, refund 87.62
6.
7.
Household furnishings and personal property
300.00
mobile home, value based on sale price
8.000.00
TOTAL (Also enter on Line 5, Recapitulation)
9.296.48
(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.1509 EX+ (6-98)
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
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
21-05-0807
Natcher, Viola P
SURVIVING JOINT TENANT(S) NAME
A. Theresa P Miller
ADDRESS
RELATIONSHIP TO DECEDENT
167 Amy Drive
Carlisle, PA 17013
Daughter
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 6/12/1997 M&T Bank, certificate of deposit, 20,014.85 50.0000/0 10,007.43
#031003910071362
2 A 10/31/1985 M&T Bank, checking acct. #2674055708 _ 7,563.00 50.000% 3,781.50
joint acct. with Theresa Miller, opened
10/31/85
3 A 7/13/2001 M&T Bank, savings acct. 16,537.99 50.000% 8,269.00
#015004198282219 - joint acct. with
Theresa Miller, opened 7/31/2001
TOTAL (Also enter on Line 6, Recapitulation) 22,057.93
(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-1151 EX+ (12.99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Natcher, Viola P
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-0807
ITEM DESCRIPTION AMOUNT
NUMBER
A FUNERAL EXPENSES:
See continuation schedule(s) attached 335.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees 1,500.00
See continuation schedule(s) attached
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
See continuation schedule(s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 275.33
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 2,172.33
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
R~v-1502 EX+ (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Natcher, Viola P
FILE NUMBER
21-05-0807
ITEM
NUMBER DESCRIPTION AMOUNT
1 clergy 50.00
2 clothing 100.00
3 funeral flowers 150.00
4 hair stylist 35.00
Subtotal
335.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-82
ATTORNEY'S FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Natcher, Viola P
FILE NUMBER
21-05-0807
ITEM
NUMBER DESCRIPTION
1 Saidis, Shuff, Flower & Lindsay
AMOUNT
1.500.00
Subtotal
1.500.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
Rev-1502 EX+ (6-98)
.
SCHEDULE H-B4
PROBATE FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Natcher, Viola P
IFILE NUMBER
21-05-0807
ITEM
NUMBER DESCRIPTION
1 Register of Wills of Cumberland Co.
AMOUNT
62.00
Subtotal
62.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B4 (Rev. 6-98)
~ev-1502 EX+ (6-98)
*'
SCHEDULE H.B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Natcher, Viola P
FILE NUMBER
21-05-0807
ITEM
NUMBER DESCRIPTION AMOUNT
1 Cumberland Law Journal, estate notice 75.00
2 Register of Wills - short certificates 12.00
3 Register of Wills, filing fee for tax return 15.00
4 The Sentinel, estate notice 173.33
Subtotal
275.33
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Natcher, Viola P
FILE NUMBER
21-05-0807
Include unrelmbursed medical expenses.
ITEM
NUMBER OESeRI PTION
1 bank fee
VALUE AT DATE
OF DEATH
18.00
2 electric bill
50.86
3 lot rent for mobile home
245.00
4 phone bill
45.00
TOTAL (Also enter on Line 10, Recapitulation)
358.86
(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 I (Rev. 6-98)
~V.1513 EX+ (9-00)
*'
SCHEDULE .-
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Natcher, Viola P
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
C1istributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
I.
1
Logan Chestnut
33 Foreman Mill Rd.
Shippensburg, PA 17257
great
granddaughter
2
Ashton Grove
5379 Roxbury Rd.
Shippensburg, PA 17257
great grandson
3
Ketra Grove
5379 Roxbury Rd.
Shippensburg, PA 17257
great
granddaughter
4
Mark E. Grove
5379 Roxbury Rd.
Shippensburg, PA 17257
grandson
5
Sarah E. Grove
33 Foreman Mill Rd.
Shippensburg, PA 17257
granddaughter
FILE NUMBER
21-05-0807
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
See continuation schedule attached Continuation
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Copyright (c) 2002 form software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Form PA-1500 Schedule J (Rev. 6-98)
0.00
300.00
300.00
300.00
300.00
300.00
1,800.00
3,300.00
SCHEDULE .J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Viola P Natcher 201-16-0646 08/21/2005
Item Name and Address of Person(s) Share of Estate Amount of Estate
Number Receiving Property Relationship (Words) ($$$)
6 Stacey L. Grove Granddaughter 300.00
431 Mountain Rd.
Newville, PA 17241
7 Tyric Grove great grandson 300.00
5379 Roxbury Rd.
Shippensburg, PA 17257
8 Theresa J. Hepler Granddaughter 300.00
4233 English Way
York, PA 17402
9 Keith R. Miller grandson 300.00
P.O. Box 116
Upperstrasburg, PA 17265
10 Theresa P. Miller daughter residue 0.00
167 Amy Drive
Carlisle, PA 17013
11 Audrey Trussell (Black g randdaug hter 300.00
1519 N. Front St., Apt. 20
Harrisburg, PA 17102
12 Rebecca Grove Varner great granddaughter 300.00
326 Dublin Gap Rd.
Newville, P A 17241
Total 1,800.00
1
f! M&fBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
October 28, 2005
Law Offices
Saidis, Shuff, Flower & Lindsay
2109 Market Street
Camp Hill, Pennsylvania 17011
Re: Estate of' Viola P Natcher
Social Securitv: 201-16-0646
Date of Death: August 21. 2005
Dear Sir or Madam:
Per your inquiry dated October 21, 2005, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
Type of Account
Checking Account
A ccount Number
2674055708
Ownership (Names of)
Theresa P Miller *
Viola P N atcher *
Opening Date
10/31/85
Balance on Date of Death
$7,562.57
Accrued Interest
$ 0.43
Total
$7,563.00
Interest Paid YTD
$ 3.94 (Accrued interest is not included)
2.
Type of Account
Savings Account
Account Number
015004198282219
Ownership (Names oj)
Theresa P Miller *
Viola P Natcher *
Opening Date
07/13/01 Closed 09/15/05
Balance on Date of Death
$16,531.91
Accrued Interest
$
6.08
Total
$16,537.99
Interest Paid YTD
$ 95.64 (Accrued interest is not included)
3.
Type of Account
Certificate of Deposit
A ccount Number
031003910071362
Ownership (Names oj)
Theresa P Natcher *
Viola P Natcher *
Opening Date
06/12/97 Closed 09/15/05
Balance on Date of Death
Total
$20,000.00
$ 14.85
.....$20:0"J-;{85..............................._-_.._._...................................................................-........................................
Accrued Interest
Interest Paid YTD
.-.-..- ...--......-.............-.. ,.- ..-.........--...............-.........-.............-..-...-..-...-........-..,....-. .......... ...-.............-.......- .._-......... -- ........- ,--.
$ 361.24 (Accrued interest is not included)
* For further account information or to locate the existence of a safe deposit box, or regarding ownership and
any changes, closures and/or reimbursement of funds, please contact our High Street Carlisle Branch at One
West High Street, Carlisle, PA 17013, phone # 717-240-4536.
Sincerely,
~(J~
Nancy Clagett
Records Management
LAST WILL AND TESTAMENT
I, Viola P. Natcher, of Newville, Cumberland County, Pennsylvania,
being of sound and disposing mind, memory and understanding, declare the
following to be my last will and testament, hereby revoking any and all wills
heretofore made by me. (
Item I. I direct my executrix hereinafter named to pay all my debts and
funeral expenses.
Item II. I give, devise and bequeath the sum of Three Hundred
($300.00) Dollars each to my grandchildren:
-Audrey Black
-==-Theresa Hefler ~
Stacey Grove \:.J
Sarah Grove
Keith Miller
Mark Grove.
Item IV. I give, devise and bequeath the sum of Three Hundred
($300.00) Dollars to each of my great grandchildren:~ and
Rebecca Grove Varner, L~an Chestn~t, Ketra Grove and Pyric Grove. If any
of my great grandchildren should be under the age of 18 at the time of my
death, I appoint Farmers Trust Company, Carlisle, P A, as trustee. I give my
trustee the right to invest as it sees fit and expend principal as it sees fit. The
trust will terminate when each of my great grandchildren reaches age 18, at
which time the balance of his or her share shall be given to them.
Item V. I give, devise and bequeath all the rest, residue and remainder
of my estate to my daughter, Theresa P. Miller.
(C(O)[Pl[
Item V. I appoint my daughter)' Theresa P. Miller)' of Carlisle)' PA. as my
executrix)' and I direct that she should serve without bond.
-1Ldayof
IN WITNESS WHEREOF)' I have hereunto set my hand and seal this
~.
)'2001
\u;4 P ..9?~
Viola P. Natcher
Signed)' sealed)' published and declared by the above named
testatrix)' as and for her last will and testament)' who at her
request)' in her presence)' in our presence)' and in
the presence of each other have hereunto subscribed
our names as attesting witnesses:
~C.~OA-~
~Q.~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We ~~ J.A~ -' I and whose names are
signed to Ute attached;i&,;;;:g ins~m~nt, being d y qualified according
to law, do depose and say that we were present and saw testatrix sign and
execute the instrument as her last will, and that she signed willingly and that
she executed it as her free and voluntary act for the purposes therein
contained, that each of us in the hearing and sight of the testatrix signed the
will as witnesses; and that to the best of our knowledge, the testatrix was at
that time 18 or more years of age, of sound mind and under no constraint or
undue influence.
Sworn te and subscribed before
me this 1-, day of ~ ' 2001
~~ G -"..f-oNotary
Notanal Seal
Anne M. Cox. Notary Public
Carlisle Borough. Cumberland County
My commISSIOn expIres July 14, 200S
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
I, Viola P. Natcher, 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 the
purposes therein expressed.
~f1;~_
Viola P. Natcher
Sworn to and subscribed ~
before me this the r L day of
~ Notary
, 2001.
Notarial Seal \
Anne M. Cox. Notary Public
Carlisle Borough, Cumberland count,lY<' .
My commiSSIon expIres July 14. 200..,..,