HomeMy WebLinkAbout06-14-06
lL
(,.~; L./-j
LLi =
( -,
--".-'
c::..
L:____ l .
( ,
E' -
(.-1
C_L'
~~--~::
L I i _
L.:..__
IN RE the Estate of Howard W. Clayton : IN THE COURT OF COMMON PLEAS
: OF CUMBERLAND COUNTY,
:PENNSYLVAN~,ORPHANS'COURT
: DIVISION
en
C"J
l"'"
: No. 21-05-00820
CL
l~_
C,')\_.
_:1"
FAMILY SETTLEMENT AND FINAL RELEASE
ESTATE OF HOWARD W. CLAYTON
(); ,-
-.1
I
C..;
\.J"'~,
C "
c::.;~:
'--.)
L)
KNOW ALL MEN BY THESE PRESENTS, that Howard W. Clayton, late of
Carlisle, Cumberland County, Pennsylvania, deceased, died testate on September 1st,
2005, having first made her Last Will and Testament, which was duly executed on
November 26th, 1991 and probated in the Office of the Register of Wills of Cumberland
County County, on September 14th, 2005.
WHEREAS, the said Howard W. Clayton, by the aforesaid Last Will and
Testament, named Karen A. Slusser as Executrix of said Last Will and Testament;
WHEREAS, Letters Testamentary on the Estate of the said decedent were duly
issued by the Register of Wills of Cumberland County, Pennsylvania, to the said
Executrix, hereinafter called personal representative;
WHEREAS, the personal representative has gathered the assets of the Estate of
the said decedent and the assets consist of personal and real property with the total
value of $81,996.60 as set forth in Exhibit "A", which is a copy of the Pennsylvania
Inheritance Tax Return filed and approved by said personal representative, and which is
attached hereto and made a part hereof, and marked Exhibit "A";
WHEREAS, the debts and deductions, including the payment of inheritance tax
in the said Estate, which have now been paid, leave a balance for distribution of
$58,508.64;
WHEREAS, the balance for distribution has been reduced to cash and has been
distributed as herein indicated in accordance with the terms of the Last Will and
Testament of the said Decedent;
Q;
NOW, THEREFORE, Karen A. Slusser being the only heir under the Last Will
and Testament of the said decedent, and being that person entitled to inherit under said
Last Will and Testament, does hereby acknowledge that she has this day had and
received from the aforesaid personal representative, in full satisfaction and payment of
all sums of money, legacies, bequests, and devises as are given, devised and
bequeathed to her by the said Last Will and Testament, the amounts due her under said
Last Will and Testament, which amounts she has received this day or prior to this day;
and, she does hereby stipulate that in order to avoid the expense and time involved in
the filing of a formal account and schedule of distribution, she agrees that no account is
necessary and he does hereby agree that she does consent to distribution being made
without the filing of an account and schedule of distribution, the same to be with the
same force and effect as if they had been filed and confirmed by the Orphan's Court
Division of the Court of Common Pleas of Cumberland County, Pennsylvania.
THEREFORE, she does hereby remise, release, quitclaim and forever discharge
the said personal representative, Karen A. Slusser, her heirs, executors, administrators
and assigned, of and from the said estate and from all actions, suits, payments,
accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for
any other use, matter, cause or thing whatsoever, touching upon the Estate of the said
decedent, and she does further hereby covenant and agree that should any liability
come due to the estate of the said decedent after the signing of this Agreement, she
does hereby covenant and agree with each other and the aforesaid personal
representative, that she will contribute pro-rata our share of the Estate to satisfy any
and all claims, demands, suits or causes of action which may be successfully
prosecuted against the said Estate or the aforesaid personal representative after the
signing, sealing and delivery of this Family Settlement Agreement and Final Release.
IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and
year noted below.
S}26/0b
, .
Date
~k~~~
Witness -
REV . 1500 EX + (t-tO)
*'
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
',r-'
I llSE
I
I'FllE NUMBER
21 05
i COUN1Y CODE YEAR
1
I
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 1 SOCIAL SECURITY NUMBER
Clayton, Howard W. 142-22-4315
...
z DATE OF DEATH (MM-OD-YEAR) \ DATE OF BIRTH (MM-DO-YEAR) I THIS RETURN MUST BE AlED IN DUPLICATE WITH THE
w
C
w 09/01/2005 12/21/1927 REGISTER OF WILLS
0
w
C (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) I SOCIAL SECURITY NUMBER
I
~ 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date at death prior to 12-13-82)
w
... 0 4. Limited Estate 0 4a. Future Interest Compromise (date at death after 0 5. Federal Estate Tax Return Required
lO:~U)
~~8 12-12-ll2)
611:.... ~ 6. Decedent Died Testate (AItach copy 0 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes
tal at Win) copy at Trust) -
<l 0 9. litigation Proceeds Received 0 10. Spousal Poverty Credit (date at death between 0 11. Election to tax under Sec. 9113(A) (AItach Sch 0)
12-31-91 and 1-1.95)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
~AME COMPLETE MAILING ADDRESS
:Il!z Michael M. Jerominski
"'w FIRM NAME (If applicable)
l!ic 28 S. Pitt St.
o~ Turo Law Offices Carlisle, P A 17013
lEPHONE NUMBER
717/245-9688
Cot.NONWEALTH OF PENNSYLVANIA
OEPARThlENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
00820
NUMBER
r
None
-. "
I
\
I
I
, I
I
I
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
z o Separate Billing Requested
0
;:: 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
S
~ (Schedule G or L)
il: 8. Total Gross Assets (total Lines 1-7)
<l
ld 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
D:
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
62,000.00
OFFICIAL USE ONLY
None
None
19,996.60
None
I
l____
None
(8)
81,996;60
I I I
3,245.00
9,661.68
~ "
(12)
12,906.68
69,089.92
(11)
113. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
I made (Schedule J)
~ 14. Net Value Subjectto Tax (Line 12 minus Line 13)
-- SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
II 15.Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
[,6. Amo""' of Li". 14 taxable 01 "".al ....
[17. Amount of Line 14 taxable at sibling rate
I 18. Amount of Line 14 taxable at collateral rate
(13)
(14)
69,089.92
x .00
(15)
z
o
;::
<(
...
:::J
D.
:IE
o
o
~
...
x .045
(16)
x .12
(17)
69,089.92
x .15
(18)
10,363.49
19. Tax Due
(19)
10,363.49
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT,
>> BE SURE TO ANSWER ALL QUESnONS ON REVERSE SIDE AND RECHECK MATH <<
Copyright 2000 form software only The Lackner Group, Inc.
I
EXHIBIT
A
Form Rf
Decedent's Complete Address:
STREET ADDRESS
80 Fairview Street
I STATE PA
CITY
Carlisle
[ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
10,363.49
Total Credits (A + B + C)
(2)
0.00
3. InterestlPenalty if applicable
D. Interest
E. Penalty
(3) 0.00
(4)
(5) 10,363.49
(5A)
(5B) 10,363.49
Total Interest/Penalty (0 + 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 Une 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
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;.................................................................................. ~ ;
~: ~:::~ :h;e~;:i~~~~s:~~~=s~~..~~.~.I~.~~~.~~~.:.~.~~~.~~~~~~~~~~~..~.~.~.~~~:~~::::::::::::::::::::::::::::::::::::
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?.......... .......................... ................ ................................................................... 0 181
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 181
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation'?..............................................................................................................-....... 0 181
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 complete. Declaration of
prepare.- other than the personal representetive is based on aft information of which preparer has any knowledge_
SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS
Ka Slusser
DATE
61 Marilyn Drive
Carlisle, ]> A 17013
;]~ ~ CJ/:
__~_~__ ~/7610@
DATE
URN
ADDRESS
ADDRESS
28 S. Pitt St.
Carlisle, P A 17013
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)l. The statute does not exemDt 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. ~116
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.
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIOENf DECEDENT
ESTATE OF
I FILE NUMBER
21 - 05 - 00820
All real propefW 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.
Clayton, Howard W.
ITEM
NUMBER
I
DESCRIPTION
VALUE AT DATE OF
DEATH
62,000.00
80 Fairview Street
Carlisle, P A 17013
------.-
TOTAL (Also enter on Line 1, Recapitulation)
62,000.00
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAL lH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
21 - 05 - 00820
ESTATE OF
Clayton, Howard W.
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
1
DESCRIPTION
VALUE AT DATE OF
DEATH
152.09
Geico
Insurance Refund
2
Checking Account
12,263.08
3
1994 Saturn SLl
VIN# IG8ZH5594RZ250073
2,500.00
4
Members 1 st Federal Credit Union Savings Account # 51227
79.70
5
Cash
139.38
6
Federal Income Tax Refund
974.00
7
Console Color Television
25.00
8
Miscellaneous Used Furnishings
100.00
9
Miscellaneous Kitchen Items
75.00
10
Yard and Garden Tools
25.00
II
Jewelry
50.00
12
Compact Discs and VHS Tapes
500.00
13
Washer and Dryer
100.00
14
Comfort Mobility Adjustable Bed
3,013.35
----- '----
TOTAL (Also enter on Line 5, Recapitulation)
19,996.60
*'
SCI-EDlI.E H
R.N:RAI.. EXPENSES &
ArMNSlRAT1VECOSlS
I
I
I
I FILE NUMBER
21 - 05 - 00820
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clayton, Howard W.
Debts of decedent must be reported on Schedule I.
ITEM
DESCRIPTION I AMOUNT
NUMBER
A. FUNERAL EXPENSES:
1 Auer Memorial Home and Cremation Services 85.00
I
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
i
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State - Zip
Year(s) Commission paid
2. Attorney's Fees Turo Law Offices 3,000.00
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
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Central Penn Business Journal 85.00
Advertise Estate
I
I
,
i
_____L______.____
Total of Continuation Schedule(s) I 75.00
----~~.---.~. . .--~--..~.-.__r_____-~..--~.--.-
TOTAL (Also enter on line 9, Recapitulation) I 3,245.00
*'
Sct&kde H
FweraI Expenses &
Pd'T1i"MdtiwCosts continued
COMMONWEALTH OF PENNSYLVANIA
INHERrrANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clayton, Howard W.
I FILE NUMBER
21 - 05 - 00820
2
Cumberland Law Journal
Advertise Estate
75.00
Page 2 of Schedule H
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
21 - 05 - 00820
ESTATE OF
Clayton, Howard W.
Include un reimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
Geico
Insurance
73.00
2 Comfort Mobility 3,013.35
Adjustable Bed
3 PPL Electric 102.35
4 South Middleton Township 99.00
Water and Sewer
5 Comcast Cable 125.96
6 Sprint 12.04
Long Distance
7 Sprint 120.56
Local
8 Waste Management 42.39
9 PPL Electric 48.35
10 Speedy Rooter, Inc. 273.00
Plumber
11 Dauphin Oil Co. 120.45
12 PPL Electric 41.13
13 H&RBlock 90.00
14 Speedy Rooter, Inc. 249.00
Plumber
15 Karen Slusser 24.00
Extra Short Certificates (paid out-of-pocket)
Total of Continuation Schedule(s)
TOTAL (Also enter on Line 10, Recapitulation)
5,022.10
9,661.68
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clayton, Howard W.
I FILE NUMBER
21 - 05 - 00820
Include unreimbursed medical expenses.
ITEM
NUMBER
16
DESCRIPTION
~
AMOUNT
205.00
Karen Slusser
Register of Wills fees (paid out-of-pocket)
17
Settlement Charges
80 Fairview Street
Carlisle, P A 17013
5,022.10
I
I
I
I
I
I
I
I.
Page 2 of Schedule 1
i
I
I
I
I
I
~..__._L.______~~.
-I
LAST WILL AND TESTAME~T
OF
~:--!
<-)
"r'"i
-: (~S
n___- '-11
HOWARD W. CLAYTON
" ,
I
.~.}
r',_1
I, HOWARD W. CLAYTON, Social Security Number 142-22-4315, of the
state of Pennsylvania, declare that this is my LAST WILL AND TESTAMENT
and I revoke all other wills and codicils previously made by me.
FIRST: I appoint KAREN A. SLUSSER as my Personal Representative
concerning this Will.
a. I request that my Personal Representative be permitted to
serve without bond or surety thereon and without the intervention of
any court, except as required by law. I direct that my Personal
Representative act in unsupervised administration so as to administer
my estate with a minimum of court supervision. If it becomes necessary
to have ancillary administration of my estate in any jurisdiction where
my Personal Representative is unable or does not desire to qualify ao
ancillary legal representative, I appoint as such ancillary legal
representative such individual or corporation as my Personal
Representative shall designate, in writing_
b. I direct my Personal Representative to pay the expenses
of my last illness, the expenses of a funeral appropriate to my station
in life and custom of living (including a suitable monument or marker
for my grave), and written charitable pledges which I have made. I
grant my Personal Representative the power to extend or renew any debt
for such time as my Personal Representative shall deem appropriate.
c. All estate, inheritance, succession and other death taxes
with respect to all property passing under this my Will shall be paid
from and borne by- the principal of my residuary estate, without regard
to reimbursement, as if such taxes were administration expenses. My
Pe~sonal Representative may pay such taxes at any time deemed
advisable, whether or not then due and payable.
d. My Personal Representative is requested to settle my
estate as soen after my death as may be practicable~ and to payor
deliver every legacy or bequest to my beneficiaries without waiting
time that may be believed to be customary in p~obate m&tte~8.
~Y'lt.1
---..;
) !"" /'IJ ~-
I "', "0", , / Iff I II ~ ' 'I
/ i VU;/ (,/jL() UV, LA vvY)~A))"......
--------------~------~-----
[j
PAGE 1
}
\"~~
-~,~--
'"
-JU---
/J j u/
Df/ftf/l ,
OF 4 PAGES
e. I have served In the Armed Forces of the United States.
Therefore, I direct my Personal Representative to consult with a Legal
Assistance Attorney at the nearest military installation and with the
Department of Veterans Affairs and the Social Security Administration
to ascertain if there are any benefits to which my family members are
entitled by virtue of my military service.
SECOND: I give, devise and bequeath, absolutely and forever, all
of my estate and property of which I may be seized or possessed, or to
which I may be entitled, at the time of my death, wherever situated or
of whatever nature, be it real, personal, or mixed, to KAREN A. SLUSSER
as her sole and absolute property if she shall survive me.
THIRD: Except as otherwise provided in this Will, I have
intentionally failed to provide for any other relatives or other /
persons, whether claiming to be an heir of mine or not. Insofar as I
have failed to provide in this Will for any of my issue now living or
later born or adopted, such failure is intentional and not occasioned
by accident or mistake.
FOURTH: Any beneficiary who fails to survive until one hundred
twenty (120) hours after my death shall be deemed to have predeceased
me, and the gift to that beneficiary shall be disposed of accordingly.
FIFTH:
Definitions:
a. The term "children" as used in this Will includes adopted
and afterborn persons. The term "children" as used in this will shall
also include step-children, the natural born or adopted children of a
person's spouse. A relationship by or through legal adoption shall be
treated the same as a relationship by or through blood for purpose of
succession to property under this Will.
b. The term "descendants. as used in this Will means the
immediate and remote lawful, lineal descendants by blood or adoption of
the person referred to who are in being at the time they must be
ascertained in order to give effect to the reference to them.
c. The term "issue" as used in this Will means all persons
who are descended from the person referred to either by legitimate
birth to or legal adoption by that person, or any of that descendant's
legitimately born or legally adopted descendants.
d. The term "Personal Representative" as used in this Will
means EAecuto~F Executpix; Independent EAecutor~ O~ any other title of
like impo~t which is used to de8c~ibe such a fiducia~y.
~, .-L--
,~r" , j-: I! f /( ,.-'.--' " r /1
1--1 61 { I /1 I} /1 Ii! I V I't-' A A' J.;cy.
___~L~~~~~~y_~~~~_~~~~L~__
U
P A(jE 2
.17
~r--,.
V~
A
--J1.~--
/)411/
c.1/P~ ,
OF 4 PAGES
e. The term "per stirpes" as used in this Will means that
whenevep a dist~ibution is to be made to the descendants of any person,
the property to be distributed shall be divided into as many shares as
there are (1) living children of the person, and (2) deceased children,
who left descenda.nts who. are then living, of the person. Each living
child (if any) shall take one share and the share of each deceased
child shall be divided among his then living descendants in the same
manneI".
SIXTH: In addition to any powers granted by the laws of the state
in which this Will is probated, I hereby authorize and empower the
fiduciaries named in this Will, to the extent of the discretion herein
granted, to sell, exchange, convey, transfer, assign, mortgage, pledge,
lease or rent the whole or any part of my real or personal estate, to
invest, reinvest, or retain investments of my estate, to perform all
acts and to execute all documents which my fiduciaries may deem
necessary or proper in regard to my property. If any of my fiduciaries
elect to receive compensation for services, such compensation will be
that allowed by law.
SEVENTH: If any part of this Will shall be invalid, illegal, or-
inoperative for any reason, it is my intention that the remaining
parts, so far as possible and reasonable, shall be effective and fully
operative. My Personal Representative may seek and obtain court
instructions for the puppose of carrying out as nearly as may be
possible the intention of this Will as shown by the terms hereof,
including any terms held invalid, illegal, or- inoperative.
IN WITNESS ~~EREOF, I have at _~C~2J~7__8~~~s~L~~~~______, this
~_~' d~y of ~~~~~~C___, 193J____ set my hand and seal to this my
LAST WILL AND TESTAMENT, consisting of 4 typewritten pages, each page
beaping my handwritten signature.
__)l~4JLfM!L_~~____________(SEAL)
HOWARD W. CLAYTON
Il_, _ / I,I!(} _1--!-
j--ll"ri'U'J'l/' ((f {If{,'")1 &"\...,
? / v l./ t-c../ If; . /v.' '-_/1.... vV if /\._"':'_/ [ \....-
---~-----~-~-~------~~--~--
- (I
'~---'
PAGE 3
OF 4: PAGES
f)
l~
~ :?--
~
~--
;} ) )/1/'
CUj\! f.- ,
-------
. .
.... /'! ., D I
The foregoing inst~ument was, a~ -~~~S~T--l~~7J~~~L~______7
this _~~, day of t:J2.::'~Y~~'!:::_, 193-J_, signed, sealed, published and
declar-ed by HOWARD W. CLAYTON, the testator-, to be his LAST WILL AND
TESTAMENT in the presence of all of us at one time, and at the same
time we, at his r-equest and in his presence and in the presence of each
other, have hereunto subscribed our names as attesting witnesses, and
we do so verily believe that the said testator is of sound and
disposing mind and memory at the date hereof.
_~..1._~ ~"'tk-L!-L____- ---~-~~-iS7-.
OF ~~~~__________ OF _iJ2_L~Jl~_~_ OF ___~~~~_~_________
------?~------------_ --~1~~_-~8_________ _________~___________
1J",! i; /u / ! j j (i ?:i /!r--
-__1~~~~~~{_(~~_~((~0~fJ~__
1/
u
PAGE 4
OF 4 PAGES
__fk~~_
J .
~~-
/) J/.1/
_ !::f:::'1!! A ~
State of --\?~~ft20~'o~_--------------
County of _~~~~~~_______________
ACKNOWLEDGNI.EN"T
I, HOWARD W. CLAYTON, 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 the purposes therein expressed.
['
. ' / (YVJrwd 01/( Cf(/v{,Tt;;; ( SEAL)
HOW~D-W~-CLAYTON---~~~----------
AFFIDAVIT
We, _~v~~_~~~~~_______, _JPH~_l~~~_________, and
AL~~_~~~~__j(j~~______, the witnesses, sign our names to this
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 the testator signed willingly and
executed it as his free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the testator signed the will as a witness; and that to the best of our
knowledge the testator was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
__~....Q--L~ -1"=X-4--cJ,A_------
Witness Witrless
~A~~_l~_~__
Wi tness-r
Subscribed, sworn to and acknowledged before me by HOWARD W.
CLAYTON, the testator, and subscribed and sworn to before me by
~\..._~__~l~~~~______, ~7--t~-~---------, and
~~~Ji_~~~{5f_J(u{~, the witnesses, this ~____ day of _~~~_~~~~_~__,
19j1__
~;e~
NOTARY PUBLIC My Cow~ission Expi~es:________
-J
1\: _"'~ ,},;I~:aJ &'t~"".. Po ""'1,. -I:
" Via ...a r~ , .u., "e.l", ..'...c""';{. '-'.......
('.zrj\;)le 1301'0, Cumbeilan,j ~So/"
! t-~1yComm$slcn ExpresOct ;<:), i~ J
! i'!18~ltBr, p.""r;;:+,r;o:ni.::: P.ssojatlc,., of N72'oies