HomeMy WebLinkAbout07-03-06
REV-'500 EX (6-00)
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~L
COUN1Y CODE
~~ 0662 ___
YEAR NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Marshall Andrea
DATE OF DEJ\TH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
7/4/2005 3/23/1949
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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SOCIAL SECURITY NUMBER
208-38-7162
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ lXJ 1. Original Retum
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(J D::li:: 4. Limited Estate
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(J D::...J L../I.J 6. De03dent Died Testate (Attach copy of Will)
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~ D 9. Litigation Proceeds Received
D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82)
D 4a. Future Interest Compromise (date of death after 12.12.82) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
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Vick Ann Trimmer, Es ire
FIRM NAME (If Applicable)
Mette, Evans & Woodside
TELEPHONE NUMBER
717-232-5000
3401 N. Front Street
PO Box 5950
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Harrisburg, PA 17110-0950
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6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
15,000.00
0.00
0.00
0.00
5,300.00
593.51
OFFICIAL USE ONLY .
1. Real Estate (Schedule A)
(1)
2. Stocks and Bonds (Schedule B)
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortga~les & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
(4)
, \
(5)
.)
0.00
8. Total Gross Assets (total Lines 1-7)
(8)
11,391. 69
7,780.76
20,893.51
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
(13)
19,172.45
1,721.06
0.00
11. Total O,eductions (total Lines 9 & 10)
(11)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(12)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
1,721.06
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1 .2)
18. Amount of Line 14 taxable at collateral rate
0.00
1,721.06
0.00
0.00
x .0 ~(15)
x .0 ~(16)
x .12 (17)
x .15 (18)
(19)
0.00
77.45
0.00
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16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
19. Tax Due
0.00
77.45
20.01
HECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALLQUESTIONSON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
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ece en lS omple e ress:
S1REET ADDRESS
4184 CO'ITe Court Apt #109
Cumberland
CI1Y I STA1E I ZIP
Mechani'~sburq FA 17055-
Tax Payml:mts and Credits:
1. Tax Due {page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
77.45
0.00
77.45
0.00
Total Credits (A + 8 + C) (2)
77.45
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
TotallnteresUPenalty (0 + E) (3)
0.00
4. If Line 2 liS 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)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
A. Enter the interest on the tax due. (5A)
0.00
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check to: REGISTER OF
(58)
0.00
AGENT
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;. . . . . . . . . . . . . . . D
b. retain the right to designate who shall use the property transferred or its income; . D
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. 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 [1a
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 elf perjury, 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 compl~e
Declaration of prE~parer other than the personal rep~ lve is based on al informatjon of which preparer has any knowledge. ,I
~('jt=1t: "'''' ;;: DA'E
\)~Ianei. Farnsler f Executor 7067 Carlisle Pike, 1/7, Carlisle, PA/ 17013
SIGNA R. F PREPAR OTHER N REPRESENTAllVE IDlv.TE
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ADDRESS
Yes
No
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Vicky Ann Trimmer f Esquire 3401 N. Front St., Harrisburg, PA 17110-0950
Ii. .lRl_1 i~!IIl1If~&J.A_~1 _ ~____dlllllll JRil~.n_~,,,",,,~f,,,,__~,.~
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.99916 (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. 13 9116 (a) (1.1) (ii)]
The statute dOI~s 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 dE,ath on or after July 1,2000:
The tax rate im posed 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. 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 4.5%. except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(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. 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, vmether by blood or adoption.
3W46461.000
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
REV-1502 EX + (6-98)
ESTATE OF
FILE NUMBER
Andrea C. Harshall
21 05 0662
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 'ooIhlich 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
Real estate in Hampden
Township, Cumberland County,
known as tax parcel
#10-20-1848-146B, Deed book
247, page 2399 - Under
Contract
15,000.00
TOTAL (Also enter on line 1, Recapitulation)
$
15,000.00
3W46951.000
(If more space is needed, insert additional sheets of the same size)
REV.1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Andrea C. Marshall
FILE NUMBER
21 05 0662
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
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
2003 Kia Rio
Sale price by finance company
afte:t" repossession
4,800.00
2
Hous4ehold furnishings and personal
prop4erty - estimate
500.00
3W46AD 1.000
TOTAL (Also enter on line 5 Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
5,300.00
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDEJ\rr DECEDENT
ESTATE OF
Andrea C. l-farshall
SCHEDULE F
JOINTL V-OWNED PROPERTY
FILE NUMBER
21 05 0662
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINTTENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
Farnsle]~, Dylan K
7067 Carlisle Pike, #7, Carlisle,
PA 17013
Son
B.
c.
JOINTL V-OWNED PROPERTY:
lETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
N...MBER OR SIMILAR IDENTIFYING NUMBER. ATTACH oeeD FOR
NUMBER TENAf\.'T JOINT JOINTLY-rELDREAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A
1 A 5/14/2001 Members 1st Checking
Account #188235-11 1,162.02 50.0000 581. 01
2 A 5/14/2001 Members 1st Savings Account
#188235-00 25.00 50.0000 12.50
TOTAL (Also enter on line 6 Recapitulation) $ 593.51
3W46AE 1.000
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Andrea C. l~rshall
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 05 0662
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A.
FUINERAL EXPENSES:
1.
~rers Funeral Home
3,400.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
!\ttorney Fees
4,000.00
3. Family Exemption: (If decedent's address is not the same as ciaimant's, attach explanation)
Claimant
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
F'robate Fees
114.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Closing Costs for sale of real
estate on Schedule A
3,150.00
2
Cumberland Law Journal - Legal
Advertising
75.00
Total from continuation schedules
652.69
3W46AG 1.000
TOT AL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
11 391.69
Estate of: Andrea C. Marshall
208-38-7162
Schedule H Part 7 (Page 2)
3
ME~tte, Evans & Woodside - Costs
19.47
4
The Sentinel - Legal Advertising
129.77
5
WFS Financial - costs & fees for
rE~possession and sale of vehicle
503.45
Total (Carry forward to main schedule)
652.69
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RE1URN
RESlm,NT DECEDENT
ESTATE OF
Andrea C.Marshall
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 05 0662
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
ComcaLst - final cable bill
20.35
2 CommE!rcial Accceptance Company
(collection for Mountain View
VillcLge - balance due for
apart:ment rent)
655.00
3 Hampden Township Ambulance - final
illnElss expense
375.00
4 PA AIllerican Water Co. - water bill
201. 84
5 Powell, Rogers & Speaks Collectin
Agency for PP&L - electric bill
63.89
6 UGI -- gas bill
35.54
7 Veri~:on Account
#71 7--728-8998-554-34 - past due
telephone bill
821.62
8 Veri~:on Account
#71 7--728-8998-555-06 - past due
telephone bill
147.09
9 Veri~~on Account
#717-728-8998-553-57
72.07
10 WFS Financial - Date of death
balance for car loan for 2003 Kia
Rio. Balance due after
repol3session and sale is
$1,091. 81.
5,388.36
3W46AH 2.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
7,780.76
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Andrea CMarshall
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DI STR I BUTIO NS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Dylan K. Farnsler
7067 Carlisle Pike, #7
Carlisle, PA 17013
1
100% of Residue to Dylan K.
Farnsler
7067 Carlisle Pike, #7
C;arlisle, PA17013: 1,721.06
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21 05 0662
AMOUNT OR SHARE
OF ESTATE
Son
1,721.06
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
3W46AI 1.000
TOTAL OF PART 11- 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)
$
0.00
~
Last Will and T <estalll<ent
OF
ANDREA C. MARSHALL
I, ANDREA C. MARSHALL, of Camp Hill, Cumberland County,
Pennsylvania, do make, publish and declare this to be my Last Will and Testament,
hereby revoking all Wills and Codicils by me at any time made.
ITEM I: I direct that all inheritance and estate
taxes becoming due by reason of my death, whether payable by my estate or by any
recipient of any property, shall be paid by the Executor out of the residue of my
estate, as an expense and cost of administration of my estate. The Executor shall
have no duty or obligation to obtain reimbursement for any such tax so paid, even
though on proceeds of insurance or other property not passing under this Will.
ITEM II: I direct the Executor to pay the expenses
of my last illness and funeral expenses from the residue of my estate as an expense
and cost of administration of my estate.
ITEM III: I give all of my household furniture and
furnishings, books, pictures, jewelry, silverware, automobiles, wearing apparel and all
other articles of household or personal use or adornment and all policies of insurance
thereon to my son, DYLAN K. F ARNSLER, if he survives me. If he does not survive
me, I make this gift to my brother, WILLIAM H. BLAND.
ITEM IV: I give the residue of my estate, not
disposed of in the preceding portions of this Will, to my son, DYLAN K. F ARNSLER,
Page 1
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ifhe survives me. Ifhe does not survive me, I give the residue to my brother,
WILLIAM H. BLAND.
ITEM V: The Executor shall possess the following
powers, exercisable without court approval and in a fiduciary capacity only:
(a) To retain any investments I have at my death, including
specifically those consisting of stock of any bank even if I have named
that bank as the Executor.
(b) To vary investments and to invest in bonds, stocks, notes,
real estate mortgages or other securities or in other property, real or
personal, without being restricted to so-called "legal investments," and
without being limited by any statute or rule of law regarding
investments by fiduciaries.
(c) In order to divide the principal of my estate or make
distributions, the Executor is authorized to distribute personal property
and real property partly or wholly in kind, and to allocate specific assets
among beneficiaries so long as the total market value of each share is
not affected by the division, distribution or allocation in kind. The
Executor is authorized to make, join in and consummate partitions of
lands, voluntarily or involuntarily, including giving of mutual deeds, or
other obligations, with as wide powers as an individual owner in fee
simple.
(d) To sell either at public or private sale any or all real or
.personal property severally or in conjunction with other persons, and to
consummate sale(s) by deed(s) or other instrument(s) to the
purchaser(s), conveying a fee simple title. No purchaser shall be
Page 2
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"
obligated to see to the application of the purchase money or to make
inquiry into the validity of any sale. The Executor is authorized to
make, execute, acknowledge and deliver deeds, assignments, options or
other writings as necessary or convenient to carry out the powers
conferred upon the Executor.
(e) To mortgage real estate, and to make leases of real estate.
(D To borrow money from any person, including the Executor,
to pay indebtedness of mine or of my estate, expenses of administration
or inheritance, legacy, estate and other taxes, and to assign and pledge
assets of my estate.
(g) To pay all costs, taxes, expenses and charges in connection
with the administration of my estate.
(h) To make distributions of income and of principal to the
proper beneficiaries, during the administration of my estate, with or
without court order, in such manner and in such amounts as my
Executor deems prudent and appropriate.
(i) To vote shares of stock which form a part of my estate, and
to exercise all the powers incident to the ownership of stock.
(j) To unite with other owners of property similar to property
in my estate to carry out any plans for the reorganization of any
company whose securities form a part of my estate.
(k) To disclaim any interest in property which would devolve
to me or my estate by whatever means, including but not limited to the
Page 3
G-Uvvr\
following means: as beneficiary under a will, as an appointee under the
exercise of a power of appointment, as a person entitled to take by
intestacy, as a donee of an inter vivos transfer, and as a donee under a
third-party beneficiary contract.
CD To prepare, execute and file tax returns of any type
required by applicable law, and to make all tax elections authorized by
law.
(m) To allocate administrative expenses to income or to
principal, as the Executor deems appropriate. However, no allocation to
income shall be made if the effect of the allocation is to cause a
reduction in the amount of any estate tax marital deduction or estate
tax charitable deduction.
(n) To employ custodians of property, investment or business
advisors, accountants and attorneys as the Executor deems appropriate,
and to compensate these persons from assets of my estate, without
affecting the compensation to which the Executor is entitled.
(0) To do all other acts in the Executor's judgment deemed
necessary or desirable for the proper and advantageous management,
investment and distribution of the estate.
ITEM VI: Any person who has died within thirty
(30) days of my death, or under such circumstances that the order of our deaths
c:annot be established by proof, shall be deemed to have predeceased me. Any person
.(other...than myself) who has died at the same time as any beneficiary under this Will,
or in a common disaster with that beneficiary, or under such circumstances that the
Page 4
~
order of deaths cannot be established by proof, shall be deemed to have predeceased
that beneficiary.
ITEM VII:
I appoint my son, DYLAN K. F ARNSLER,
to be the Executor. In the event of his death, inability or refusal to serve, I appoint
my mother, DOROTHY M. BLAND, and my brother, WILLIAM H. BLAND, to be the
Executor. The Executor is specifically relieved from the obligation of filing bond or
entering security.
IN WITNESS WHEREOF, I have set my hand and seal to this, my Last
'Will and Testament, consisting of this and the preceding four (4) pages, at the end of
each page of which I have also set my initials for greater security and better
- Y\1}\ ^. \
identification this ~ day of /1 p~\ \ ' 2005.
Q~t. f/J~~EAL)
NDREA C. MARSHALL
We, the undersigned, hereby certify that the foregoing Will was signed,
sealed, published and declared by the above-named Testatrix as and for her Last Will
and Testament, in the presence of us, who, at her request and in her presence and in
the presence of each other, have hereunto set our hands and s~als the day and year
first above written, and we certify that at the time of the execution thereof, the said
Testatrix was of sound and disposing mind and memory.
tUf4~
/
(SEAL)
Ji~-r:R ()PO./V) !. 6' 7/0.1 I! (SEAL)
i[)]U,~ ~\~;}/(SEAL)
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Residing at / I J (~-'t, i Y/~7" U
~rc-l.A~i/'.7 ;If. 17()J7-
Residing at 1JO~y(6/nC() ldu Clu-l.
(~~of)A., PH /1{J;J~
Residing at 5 f\. 3 ) ~ S{ .
_t-tlY nS H~ J)y ) l) {)(7
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTYOF O~
)
) SS:
)
I, ANDREA C. MARSHALL, Testatrix, 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 and
Testament; that I signed it willingly; and that I signed it as my free and voluntary act
for the purposes therein expressed.
.a~v L~(SEAL)
NDREA C. MARSHALL
Sworn to and subscribed
before me this~ day
of a~ ' 2005.
)1f~L~
j Nota ublic
My Commission Expires:
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Monica J. Bald, Notary Public
Susquehanna Twp., Dauphin County
My Commission Expires July 12, 2008
Member, Pennsylvama Allsoci"lion of Notariee
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
O /) . . ./JJ.,;N'l
COUNTY OF ~vv..
)
) SS:
)
~ . We, i<f) IItv;! (lI/l.c'M.v ,;WA/if'AJ mJY /Jeil/ and
~(~U \L . \--V2 / \C(C !~, 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 Testatrix, ANDREA C. MARSHALL, sign and execute the
instrument as her Last Will and Testament; that Testatrix signed willingly and that
she executed said Will as her free and voluntary act for the purposes therein
expressed; 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
eighteen (18) or more years of age, of sound mind and under no constraint or undue
influence.
I /7;1 ~ I) .. r '. '77) 1 0/ }/I . n ~.
.J.~' .. ~-<---- c-- !- '\ 6 uJ () .(,OJ0 '. ' -I-- 0 i jI (/
Witness _____ Witness
/ "" ' ,
( 111~~ 1~;t\O(J)~
\ Witness
Sworn to and subscribed
be+:hiS JOTh day
of ,2005.
~
Nota ubhc
My Commission Expires:
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Monica J. Bald, Notary Public
Susquehanna Twp., Dauphin County
My Commission Expires July 12, 2008
Member, Pennsylvania Associalion of Notaries
4:21987vl
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
Estate of: ANDREA C. MARSHALL
Date of Death: 07/04/2005
Social Security Number: 208-38-7162
~lst
MEMBERS 1st
FEDERAL CREDIT UNION
188235 -00
10/07/1999
$25.00
$.00
$25.00
Dylan K. Farnsler
05/14/2001
188235 -11
10/07/1999
$1,162.02
$.00
$1,162.02
Dylan K. Farnsler
05/14/2001
ldBERS 1ST FE~ERAL CREDIT UNION
. ~ at@td1L
o nise A. Wolfe T
Insurance Services Supervisor
September 21,2005
5000 Louise Drive. po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.memberslst.org