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Home My WebLink About08-10-06 --.J 15056041125 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes . INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 6 File Number o 4 4 5 Date of Birth 184203896 o 312 2 006 09211923 HENNIGH PAULINE MI V Decedent's last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 00 1. Original Return o 4. limited Estate 00 o 2. Supplemental Return o o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULR~E DIRECTED TO: Name Daytime Telephone Number; 6. Decedent Died Testate (Attach Copy of Will) 9. litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes GERALDJBRINSER 7 1 7 838 ..." ~ 3;]4 ;~S City or Post Office ZIP Code ;, ( ) '7':: REGISTER OF WILL~EONiY-=] I ell i -.';-l; -~ ~;~ "_, ) r._ { , I i ! Firm Name (If Applicable) B R INS E R WAG N E R Z I M MER First line of address 6 E M A INS T R E E T ~- -") Second line of address c...J P 0 BOX 323 State DA!~-"I~~~_._____ __.1 PALMYRA P A 17078 Correspondent's e-mail address: w.crawford@choiceonemail.com 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 preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGI;jATU OF P RSON RESPONSI E FOR FILING TURN OAT t/ 0(, DILLSBURG PA 17019 DATE ADDRESS - 6 E. MAIN STREET, P.O. BOX 323 PALMYRA PLEASE USE ORIGINAL FORM ONLY PA 17078 Side 1 c; 15056041125 .--J L 15056041125 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME PAULINE V. HENNIGH --- . -- -. STREET ADDRESS 375 CLAREMONT ROAD File Number 0445 CITY CARLISLE STATE i PA . ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 99.71 0.00 Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestiPenalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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) 0.00 0.00 99.71 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 99.71 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; ...................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 !Xl c. retain a reversionary interest; or ................................................................................................ 0 !Xl d. receive the promise for life of either payments, benefits or care? ....................................................... 0 !Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 !Xl 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 !Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 00 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. 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 three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (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 zero (0) percent [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. !l9116(a)(1 i). The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV.1508 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PAULINE V. HENNIGH FilE NUMBER 0445 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION FULTON BANK - CHECKING ACCOUNT #3622-74036 VALUE AT DATE OF DEATH 7,389.50 2. HIGHMARK BLUE SHIELD - MEDICAL REIMBURSEMENT 180.81 3. CLAREMONT NURSING REHAB - BALANCE PERSONAL ACCOUNT 49.57 4. CASH ON HAND 500.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 8119.88 1057 0064 20166 Y Fulton Bank LISTENING. STATEMENT OF ACCOUNTS 3622-74036 STATEMENT PERIOD FROM THROUGH x I... III... III" ....111 .1..1.1....11..1.1.1.1..11....1.1....111 PAULINE V HENNIGH ESTHER E HENNIGH POA 505 S BALTIMORE ST DILLSBURG PA 17019-9359 3-28-06 PAGE 4-27-06 1 OF o 1 o ENCLOSURES o TRUE BLUE BANKING PREVIOUS DEPOSITS/ STATEMENT BALANCE CREDITS 7,389.50 CHECKS/ 1 DEBITS 3.45 ACCOUNT: 3622-74036 SERVICE o FEES .00 .00 ENDING BALANCE 7,392.95 INTEREST PAID THIS YEAR ACCOUNT/INTEREST INFORMATION 14.00 DATE ACTIVITY DESCRIPTION REFERENCE 03-28 BEGINNING BALANCE 04-27 INTEREST CREDIT 04-27 ENDING BALANCE DEPOSITS/ CHECKS/ CREDITS DEBITS 3 . 45 ../ BALANCE 7,389.50 7,392.95 7,392.95 *** ANNUAL PERCENTAGE YIELD EARNED DISCLOSURE FROM 3-28-06 THROUGH 4-27-06 *** ANNUAL PERCENTAGE YIELD EARNED .55% AVERAGE DAILY COLLECTED BALANCE 7,389.50 INTEREST EARNED 3.45 SERVICE FEE BALANCE INFORMATION FROM 3-28-06 THROUGH 4-27-06 AVERAGE LEDGER BALANCE 7,389.50 AVERAGE COLLECTED BALANCE MINIMUM LEDGER BALANCE 7,389.50 MINIMUM COLLECTED BALANCE 7,389.50 7,389.50 CONGRESS HAS RAISED THE LIMIT ON FDIC COVERAGE THAT PROTECTS YOUR RETIREMENT SAVINGS! THE NEW LAW PROVIDES UP TO $250~000 OF DEPOSIT INSURANCE FOR YOUR RETIREMENT ACCOUNTS! PLEASE FEEL FREE TO CALL US AT 1-800-FULTON-4 OR YOUR BRANCH OFFICE FOR INFORMATION. DIRECT INQUIRIES TO: FULTON BANK DIRECT BANKING CENTER PO BOX 504 EAST PETERSBURG. PA 17520-0504 717-581-3000 OR 1-800-FULTON4 Member F.D.I.C. fultonbank.com REV:1510 EX + (6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PAULINE V. HENNIGH FILE NUMBER 0445 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 ITEM INClUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER AT'TACHA COPV Of THE DEED FOR REAl. ESTATE. VALUE OF ASSET INTEREST (IF APPliCABlE) VALUE 1. FULTON BANK - C.D. #064-0236722 - PUT IN JOINT NAME 700.00 50. 700.00 0.00 NAMES WITH SISTER, ESTHER HENNIGH, IN OCTOBER 2005 (see attached) 2. FULTON BANK - C.D #064-0236686 - PUT IN JOINT NAME 1,100.00 50. 550.00 0.00 NAMES WITH SISTER, ESTHER HEN NIGH, IN OCTOBER 2005 (see attached) TOTAL (Also enter on line 7 Recapitulation) $ 0.00 (If more spaoe is needed, insert additional sheets of the same size) : ., 'COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *' INFORMATION NOTICE AND TAXPAYER RESPONSE NO. 67 06123867 05-22-2006 REY-1545 EX AFP (D9-DOl FILE ACN DATE EST. OF PAULINE V HENNIGH S.S. NO. 184-20-3896 DATE OF DEATH 03-12-2006 COUNTY YORK TYPE OF ACCOUNT o SAVINGS o CHECKING o TRUST [Xl CERTIF. ESTHER E HENNIGH 505 S BALTIMORE ST DlllSBURG PA 17019 ~@~~ REHIT PAYHENT AND FORHS TO: REGISTER OF WILLS YORK CO COURT HOUSE YORK, PA 17401 FULTON BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of PennsYlvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 064-0236722 Dats 10-12-2005 Established Account Balance Percent Taxable AMount Subject to Tax Rate Potential Tax Due x .00 100.00 .00 .12 .00 TAXPAYER RESPONSE Tax x PART [!] To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". NOTE: If tax payments are made within three (3) months of the decedent.s date of death, you may deduct a 57. discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. [CHECK ] ONE BLOCK ONLY I A. tJThe above information and tax due is correct. , ~. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain ; a discount or avoid interest, or you may check box nAn and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. ~The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ~ to be filed by the decedent.s representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION lINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. AMount Subject to Tax 5. Debts and Deductions 6. AMount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 TAX ON JOINT/TRUST ACCOUNTS x x PART [!J DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL CEnter on line 5 of Tax COMPutation) I $ Under penalties of perjury, I declare that the comPle~e~f my knowledge and belief. TAX~R SIGNATURE' il~ facts I have reported above are tru., correct and HOME ( WORK ( TElEPHONE p'/I Joto DATE ) ) NUMBER 'COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 '* INFORMATION NOTICE AND TAXPAYER RESPONSE FILE ACN DATE NO. 67 06123868 05-22-2006 REV-1543 EX AFP (D9-DDl (G @ WY")f EST. OF PAULINE V HENNIGH S.S. NO. 184-20-3896 DATE OF DEATH 03-12-2006 COUNTY YORK TYPE OF ACCOUNT D SAVINGS D CHECKING D TRUST 00 CERTIF. ESTHER E HENNIGH 505 S BALTIMORE ST DILLSBURG PA 17019 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS YORK CO COURT HOUSE YORK, PA 17401 FUL TON BANK has provided the Departllent with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you fael this inforllation is incorrect, please obtain written correction froll the financial institution, attach a copy to this for. and return it to the abova address. This account is taxable in accordance with the Inheritance Tax Laws of the COllmonwealth of Pennsylvania. Questions lIay be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 064-0236686 Date 10-04-2005 Established Account Balance Percent Taxable A.ount Subject to Tax Rate Potential Tax Due x .00 100.00 .00 .12 .00 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice lIust accollpany your paYllent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) lIonths of the decedent's date of death, you lIay deduct a 5% discount of the tax due. Any inheritance tax due will becolle delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. r=J The above inforllation and tax due is correct. 1. You lIay choose to rBllit paYlIBnt to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you lIay check box "An and return this notice to the Register of Wills and an official assessllent will be issued by the PA Department of Revenue. ~'The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ~o be filed by the decedent's representative. r=J The above inforllation is incorrect and/or debts and deductions were paid by you. You lIust cOllplete PART ~ and/or PART ~ below. PART ~ TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. A.ount Taxable 7. Tax Rate 8. Tax Due TAX ON JOINT/TRUST ACCOUNTS If you indicate a different tax rate, please state your relationship to decedent: OF I 2 3 4 5 6 7 8 x x PART @] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Co.putation) I $ that the facts I heve reported above are true, correct end belief. HOME ( ) tJ~Jot WORK ( ) Tel PHONE NUMBER ---- -------- REV-1511 EX + (12-99) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PAULINE V. HENNIGH FILE NUMBER 0445 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. 2. 3. 4. 5. FUNERAL EXPENSES: COCKLIN FUNERAL HOME INC. MAYS MEMORIAL - CARVE HEADSTONE FUNERAL LUNCHEON BLOSSOM SHOP - FLOWERS HONORARIUMS 29.86 90.00 156.64 50.00 190.00 B. 1. 750.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 505 S. BALTIMORE STREET City DILLSBURG State P A Zip 17019-9359 Year(s) Commission Paid: 2006 2. 3. Attomey Fees BRINSER, WAGNER & ZIMMERMAN 1,000.00 Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees REGISTER OF WILLS 88.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2 354.50 REV-1512 EX + (12-03) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PAULINE V. HENNIGH FILE NUMBER 0445 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. PHARMERICA - PRESCRIPTION DRUGS VALUE AT DATE OF DEATH 165.87 2. PA DEPT. OF PUBLIC WELFARE - CLASS 3 CLAIM 4,772.09 3. CLAREMONT NURSING REHAB 36.07 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4974.03 ~ *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 May 23, 2006 BRINSER WAGNER & ZIMMERMAN GERALD J BRINSER ESQUIRE 6 EAST MAIN ST - 2ND FLR PO BOX 323 PALMYRA PA 17078 Re: PAULINE HENNIGH CIS #: 890179746 SSN: 184-20-3896 Date of Death: 03/12/2006 Dear Attorney Brinser: Please be advised that the Department of Public Welfare maintains a claim in the amount of $4,772.09 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $4,772.09, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $.00, is to be entered as a priority Class 6 claim against the estate. ---- Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, 1~/lc-fv:::1 Karen P. Matvey Claims Investigation Agent 717-214-1283 717-705-8150 FAX Enclosure RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. LOIS M. HENNIGH Sibling 158.27 214 E. 5TH AVENUE, BELLEFONTE, PA 16823 2. RONALD W. HENNIIGH Collateral 158.27 35033 LAKE ROAD, CENTERVILLE, PA 16404 3. ORPHA R. THUMA Sibling 158.27 1839 RIVER ROAD, MARIETTA, PA 17547-9319 4. ESTHER E. HENNIGH Sibling 158.27 505 S. BALTIMORE STREET, DILLSBURG, PA 17019-9359 5. RACHEL A. HENNIGH Sibling 158.27 505 S. BALTIMORE STREET, DILLSBURG, PA 17019-9359 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIA TE, 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. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ",VO""""'. COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF PAULINE V HEN NIGH SCHEDULE J BENEFICIARIES FILE NUMBER 0445 (If more space is needed, insert additional sheets of the same size) , @(Q)[?):yr WILL OF PAULINE V. HENNIGH I, PAULINE V. HENNIGH, currently of the Borough of Dillsburg, York County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out ofthe principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof III. All the rest, residue and remainder of my estate, of whatever nature and wherever situate, including property over which I hold a power of appointment, I devise and bequeath equally unto the following persons who survive me, namely, Lois M. Hennigh, Ronald W. Hennigh, Orpha Thuma, Esther E. Hennigh and Rachel Hennigh. IV. I appoint my sister, Lois M. Hennigh, Executrix of this my Will. In the event that she fails to qualifY or ceases to act as Executrix, I appoint my sister, Esther E. Hennigh, Executrix of this my Will. V. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, PAULINE V. HENNIGH, herewith set my hand to this my Last Will, typewritten on two (2) sheets of paper including the attestation clause and signatures of witnesses, this q+h day of ~ .2002. . . e~v,~ (SEAL) PAULINE V. HENNIGH 0()1 ~~ -1- . Signed by, PAULINE V. HENNIGH, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this qtvl day of 9-fJ!vJ ' 2002. /~,(/~ residingat ~ J/ f? ~null~ residing at :lUll-ill ~ tA I -2- ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF LEBANON WE, PAULINE V. HENNIGH, GERALD J. BRINSER and ~\t\"\L't~ \l. ~E. \ F\=(~ , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. - 2--4- - ~~'~I;W^ Subscribed, sworn or affirmed and acknowledged before me by PAULINE V. HENNIGH, ther1e~.!atrix, GERALI? 1. BRINSER and \'{\~~\l'\N '{.... iE.\FFE~ witnesses, this u.rrv I day of Q..phJ ,2002. NOTARiAL. SEAL WENDY L CRA~ORO, Notary Public Palmyra Boro., LebanOn County My Commission Expires 10.2005 (SEAL) -3-