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Home My WebLink About07-26-06 (2) REV-1500 EX + (6-00) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 -05 0 8 9 1 CQ'l"j'N:-yCQ5E --vEA~ - - NUMBER- - ~ Z W C W U w C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) BARRETT, JEAN M. DATE OF DEATH (MM-DD- Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER 3 3 0 - 5 0 - 7 629 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ~~en u o:~ w g,u :I:o:S Ua.m a. <l: 09/28/2005 03/19/1928 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [X] 1. Original Return D 4. Limited Estate [X] 6. Decedent Died Testate (Attach copy otWiII) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (da!e otdeath after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrus!) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [J 3. Remainder Return (date of death priorto 12-13-82) [J 5. Federal Estate Tax Return Required !L 8. Total Number of Safe Deposit Boxes [J 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE ANDCONFIQENTIAL TAXINFORMATIONiSHOULDBE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Jered L. Hock, Es uire 3211 N. Front Street FIRM NAME (If Applicable) Metz er, Wickersham, Knauss & Erb, P.C. TELEPHONE NUMBER 717 238-8187 z o ~ <( ..J ::::> !:: a. <( U w e::: I- Z W Cl Z o a. en w 0: 0: o U P.O. Box 5300 Harrisbur PA 17110-0300 I 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) OFFICIAL USE ONLY - , 3. Closely Held Corporation, Partnership or Sole-Proprietorship 286,567.78 I 30,821.69l I -----~ 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 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) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (8) 317,389.47 33,393.21 555.99 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ <( ~ ::::> a.. :E o U X <( ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 19. Tax Due 0.00 X _ (15) 283,440.27 X .045 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) (11) (12) (13) 33,949.20 283,440.27 16. Amount of Line 14 taxable at lineal rate (14) 283,440.27 17. Amount of Line 14 taxable at sibling rate 0.00 12,754.81 0.00 0.00 12,754.81 18. Amount of Line 14 taxable at collateral rate 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 355 South Sportinq Hill Road CITY Mechanicsburg I STATE PA ZIP 17050- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 12,754.81 11.400.00 599.98 Total Credits (A + B + C) (2) 11,999.98 3. Interest/Penalty if applicable D. Interest E. Penalty T otallnterestlPenalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due, (5A) B. Enter the total of Line 5 + 5A, This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 754.83 754.83 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 [Xl 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? ...................................................................................................... 0 [Xl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including 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 per~onal representative is based on all information of which preparer has any knowledge. S ATURE OF PERS S LE FOR FILING RETURN DATE ! / .-)~ ~/J({c~' . A DRESS 10 Canterbury Court Mechanicsbur ~~ OF PREPARER OTHER TH~E , "-! 6..,-{.~'/\' .c ADDR 3211 North Front Street, PO Box 5300 Harrisburq PA 17050 rTE 7 LLj J tJ J:. I I PA 17110-0300 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 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 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 PS ~9116(1.2) [72 P.S. ~9116(a)(1)J. 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. REV-15G8 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 05 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 Schedulle F. ESTATE OF BARRETT. JEAN M. ITEM NUMBER 1 . 2. 3. 4. 5. 6. 7. 8. 9. 10. 0891 DESCRIPTION Wachovia - Certificate of Deposit #247402042329264 DOD Balance: $10,231.83 Accrued Interest: $3.09 VALUE AT DATE OF DEATH 10,234.92 Wachovia - Certificate of Deposit #247402302114379 DOD Balance: $10,195.83 Accrued Interest: $1.88 10,197.71 Wachovia - Checking Account #1014151125780 DOD Balance: $113,925.61 Accrued Interest: $11.44 113,937.05 Wachovia - Checking Account #1010083717354 DOD Balance: $71,784.47 Accrued Interest: $53.20 71,837.67 Prudential Insurance proceeds - payable on life of Stanley Barrett, decedent's husband, who predeceased decedent by 22 days 43,500.00 Barclay's Bank - 1,776.78 British Pounds Sterling @ exchange rate of $1.767'1 per Pound 3,139.75 SmithBarney citigroup, Account #44A-00493-18-220 NOTE: The Smith Barney citigroup portfolio included the ING Annuity, which is listed separately on the appropriate schedule. 30,550.79 Total is $30,550.79 and consists of the following three subparts. A. First Bank of Puerto Rico CD of $15,000, plus interest of $314.14 B. Banco Bilbao Viscaya CD of $14,790.90, plus accrued interest of $218.21 C. Bank deposits of $227.54 Proceeds from sale of furniture of decedent 875.00 British Social Security 510.89 Refund from IRS 1,784.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 286,567.78 REV-1510 EX + (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY 0891 ESTATE OF BARRETT. JEAN M. FILE NUMBER 21 05 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 DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST VALUE (IF APPLICABLE) 1. ING USA Annuity 30,821.69 100. 30,821.69 Policy #C012511-0M, administered through Smith Barney citigroup TOTAL (Also enter on line 7 Recapitulation) $ 30,821.69 (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 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF BARRETT. JEAN M. ITEM NUMBER A. 1. 2. 3. B. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 21 05 0891 Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT FUNERAL EXPENSES: Myers Funeral Home 4,504.84 Ida Sarago - funeral caterer 318.00 Gingrich Memorials - grave marker 1,900.00 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Amanda J. Herm itt Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 10 Canterbury Court City Mechanicsbur~ State PA Zip 17050 Year(s) Commission Paid: 2005 and 2006 Attorney Fees Metzger, Wickersham, Knauss & Erb, P.C. (taken 2005 and 2006) Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 12,521.00 12,521.00 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills 356.00 Accountant's Fees Tax Return Preparer's Fees H&R Block (paid $207) Metzger Wickersham (estimated reserve to pay $330) Chase Card Services - temporary checks 537.00 20.00 Dauphin County Register of Wills - fee for oath of Executrix 15.00 Amy M. Ewing - notary fees 15.00 Cumberland Law Journal - publication of Estate Notice 75.00 Patriot-News Co. - publication of Estate Notice 126.27 Metzger Wickersham - reimbursement for photocopy, postage, long distance calls 42.10 TOTAL (Also enter on line 9, Recapitulation) $ 33,393.21 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent BARRETT, JEAN M. Decedent's Name Page 1 21 05 0891 File Number Schedule H - Funeral Expenses & Administrative Costs - B7. ITEM NUMBER DESCRIPTION AMOUNT 13. Metzger Wickersham - reserve for further photocopy, postage, long distance calls, certified mailings, faxes 52.00 14. Reserve for filing Account 300.00 15. Reserve for filing Releases 25.00 16. Reserve for filing Inventory 15.00 17. Reserve for closing 50.00 SUBTOTAL SCHEDULE H-B? 442.00 REV-1512 EX + (6-98) . SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BARRETT. JEAN M. FILE NUMBER 21 05 0891 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. United Water - water service debt of decedent 18.79 2. Verizon - phone service debt of decedent 16.83 3. Comcast - cable service debt of decedent 4.37 4. Family Eye Care - debt of decedent 26.68 5. Joseph Hermitt - reimbursement for miscellaneous monies advanced to cover bills of decedent while she was still living 344.80 6. Kohls - debt of decedent 26.80 7. Country Meadows - debt of decedent 92.72 8. VISA - reserve for payment of debt of decedent 25.00 TOTAL (Also enter on line 10, Recapitulation) $ 555.99 (If more space is needed, insert additional sheets of the same size) """;'''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF BARRETT JEAN M FILE NUMBER 21 05 0891 RELATIONSHIP TO DI=CEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Amanda Jane Hermitt Lineal 92,480.09 10 Canterbury Court; Mechanicsburg, PA 17050 2. Karen Sally Szymanski Lineal 92,480.09 15 Fountain Court; Wilmington, DE 19808 3. Trudy Ann Apple Lineal 92,480.09 816 Woodsdale Rd.; Bellevue Manor; Wilmington, DE 19809 4. Charles William Apple Lineal 1,000.00 816 Woodsdale Rd.; Bellevue Manor; Wilmington, DE 19809 5. Tanya Victoria Apple Lineal 1,000.00 5514 Park Ave., 2nd Fir; West New York, NJ 07093 6. Elijah Jude Hermitt, c/o Joseph Hermitt Lineal 1,000.00 10 Canterbury Court; Mechanicsburg, PA 17050 7. Serena Eve Hermitt, c/o Joseph Hermitt Lineal 1,000.00 10 Canterbury Court; Mechanicsburg, PA 17050 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 BEINC" 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 $ (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent BARRETT, JEAN M. Decedent's Name Page 2 21 05 0891 File Number Schedule J - Beneficiaries - 1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trusltee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. Robin Jean Szymanski, c/o Steve Szymanski Lineal 1,000.00 15 Fountain Court; Wilmington, DE 19808 9. Julia Marie Szymanski, c/o Steve Szymanski Lineal 1,000.00 15 Fountain Court; Wilmington, DE 19808 """"'" I , I I ! I I '~~ I I, JEAN MARY BARRETT, of 140 Easterly Drive, Mechanicsburg Post Office, Silver I . I -, Spring township, Cumberland County, Pennsylvania, revoke any prior Wills and Codicils and i I I (.) I give my automobiles, furniture, and household and personal ef~cts LAST WILL AND TESTAMENT OF JEAN MARY BARRETT -1 -.1 I , >-:\ -.-:J , -. ) : :1 ~:) declare this to be my Will. _ J ) ITEM 1. (a) and other tangible personalty oflike nature, together with any existing insurance thereon, to my husband, STANLEY BARRETT, ifhe survives me by thirty days. (b) If my husband, STANLEY BARRETT, is not living on the thirtyj-- first day after my death, I give the items which would have gone to my spouse under this Item or my Will in as nearly equal shares as practicable to my children, AMANDA JANE HERMITT, I KAREN SALLY SZYMANSKI, and TRUDY ANN APPLE, subject to the survival provisions bf I this Will. i I give One Thousand Dollars ($1,000) each to my six grandchil~en, (c) CHARLES WILLIAM APPLE, TANYA VICTORIA APPLE, ELUAH JUDE HERMITT, I I SERENA EVE HERMITT, ROBIN JEAN SZYMANSKI, and JULIA MARIE SZYMANSKI, ! subject to the trust provisions of this Will. If any of my six aforesaid grandchildren does not sJive I me by thirty days, the gift to him or her shall lapse. ITEM 2. I give all the rest, residue, and remainder of my estate to my husband, STANLEY BARRETT, if he survives me by thirty days. 309543-1 ~. ITEM 3. I , If my husband, STANLEY BARRETT, is not living on the thirty-first d~y after my death, then I give all the rest, residue, and remainder of my estate in ,equal shares to m~ I children, AMANDA JANE HERMITT, KAREN SALLY SZYMANSKI, and TRUDY ANN . APPLE, subject to the survival provisions of this Will. ITEM 4. If any of my three aforesaid children does not survive me by thirty days, II I give that child's share to her issue per stirpes who survive me by thirty days, subject to the trust I I , I provisions of this Will for any beneficiary under twenty-one (21) years of age:. If any of my thr~e I aforesaid children does not survive me by thirty days and leaves no issue who survive me by thirty I days, that child's share shall lapse and be given instead to my other heirs under this Will, in I I I I proportion as they otherwise take shares of my estate. i I ITEM 5. I direct that all my just debts and the expenses of my last illness and i disposition of my remains shall be paid from my residuary estate as soon as practicable after m~ death and as part of the expense of the administration of my estate. I also din::ct that any and all I I i inheritance tax, estate tax, or other tax occasioned by my death be paid from my residuary estatd as I part of the expense of administration of my estate. I ITEM 6. Notwithstanding any other provision of this Will, I direct that if any , beneficiary is under twenty-one (21) years of age at the time of my death, his or her share sh~ll I be held in trust, with the Trustees to be empowered to expend both income and principal for the I beneficiary's health and maintenance and for the beneficiary's education beyond high schood I whether the same be education in college, trade school, business school, vocational school, 04 other forms of post-high school education. Any sums remaining in the trust shall be distributbd ! outright to the beneficiary upon the beneficiary's attainment of age twenty-one (21). 309543-1 ITEM 7. In addition to the powers conferred by the common law, by statute, or any other provisions hereby, my Personal Representatives and Trustees are hereby empowered as follows: I (a) To sell at public or private sale, to exchange, to lease, to pledge, fO ! mortgage, to transfer, to convert, or otherwise dispose of, or grant options with respect tp, I any and all property, real, personal, or mixed, at any time forming a part of my probate hr trust estates, in such manner, at such time or times, for such purposes, for such price or I I I I , prices, and upon such terms, credits, and conditions as shall be deemed advisable or necessary under the circumstances; (b) I To make distribution in division of the probate estate in cash, in pnd, or partly in both; (c) To distribute articles to a minor or to his or her guardian or to an~ I person taking care ofthe minor to hold for the minor within the limits authorized by sta,ute or rule of law; (d) To compromise any claim or controversy; (e) To apportion between principal and income any receipts and disbursements and to ascenain income and principal in accordance with the statutes anJ I rules oflaw ofthe Commonwealth of Pennsylvania; I (f) To make, execute, acknowledge, and deliver ,my and all instrum~nts which may be deemed advisable or necessary to carry out any of the powers herein grJted I or provided by law; I I I I I I I 309543-1 ..__.-~ (g) To invest and reinvest the principal ofthe estate together with Jy accumulated income thereon in all forms of property without being limited by any statute or rule oflaw concerning investments by fiduciaries; (h) To disclaim inheritances and interests in prope:rty. i I I No bond shall be required of my Personal Representatives and Trustees, Ibut ifbond is nevertheless required, it shall be without surety. ITEM 8. ITEM 9. (a) I appoint my husband, STANLEY BARRETT, Executor. Ifhe does I I I I I appoint the father of any minor beneficiary as Trustee for that I I not qualifY or ceases to act, I appoint my daughter, AMANDA JANE HERM1TT, Executrix. (b) minor beneficiary. For the convenience of my alternate Executrix, I note that this Will has bben I prepared by Jered L. Hock, Esquire, and the law firm of Metzger, Wickersham, Knauss & Erb, f.e. I I ITEM 10. Executed on "ik. ~ 3 () tL V ,2004. , I I ~11 ~ ;J~1 I Signed, sealed, published and declared by the above named Testatrix, JEAN MAJRy BARRETT, as and for her Last Will and Testament, in the presence of us, who, at her request, iIt her sight and presence, and in the sight and presence of each other, have hereunto subscribed ou* ~ames as Wi~esse~ A A _ /1 _ "d( 0') A . "--~ Address ~ -J'\' I ~/~ ~ I ~, Address h..." ~_i,,~-/ # '" ., 309543-1 Commonwealth of Pennsylvania ss County of Ofutph;r-, We, JEAN MARY BARRETT, and ,7;'r"'d I fiN k , and i D.tv:d fl. m~,.....J.;.....a (I , the Testatrix and the witnesses, respectively, wllose names are signed to the attached or foregoing instrument, being fIrst duly sworn, do hereby dec1are to the undersigned authority that the Testatrix signed and executed the instrument as her Last ,m and that she had signed willingly (or willingly directed another to sign for her), and that she I executed it as her free and voluntary act for the purposes therein expressed, and that each ofthej witnesses, in the presence and hearing of the TestatIix, signed the Will as wilness and that to thy best of our knowledge the Testatrix was at that time eighteen years of age or older, of sound miM and under no constraint or undue influence. i I I f4~-11 I I I I ~, II{?~ Testatrix ~ ___0//~ Witness i I [ I I I ~ I ] ! Witness I SWORN to or affIrmed and acknowledged before me by the above named Testatrix and witnesses this ~ay of .~ fl! , 2004. II' I I I O~a. -ff} -(J1~i,j,^~ Notary Pu ic My Commission Expires: (SEAL) i I I [ Notarial Seal i Angela M.. Miller. Notary lfublic City of Hamsburg, Dauphin ~OUDty My Commission Expires Oct. 15. 2006 ! 309543- ]