HomeMy WebLinkAbout08-09-06
REV. 1500 EX + (11.00)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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06
YEAR
00111
NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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IRM NAME (If applicable)
Martson Deardorff Williams & Otto
SOCIAL SECURITY NUMBER
189-18-5544
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
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o 3. Remainder Return (date of death prior to 12-13-82)
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SOCIAL SECURITY NUMBER
5, Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11, Election to tax under Sec. 9113(A) (Attach Sch 0)
Ten East High Street
Carlisle, P A 17013
(1 ) 283,000.00
(2) 62,185.14
(3) None
(4) None
(5) 166,827.57
(6) None
(7) 152,547.31
(9) 31,938.48
(10) 10,736.50
I DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
MYERS, RICHARD L
fDATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
101/29/2006 04/09/1923
I (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
~ 1. Original Return 0 2. Supplemental Return
D 4. Limited Estate D 4a, Future Interest Compromise (date of death after
12-12-82)
~ 6. Decedent Died Testate (Attach copy D 7. Decedent Maintained a Living Trust (Attach
of Will) copy of Trust)
D 9. Litigation Proceeds Received D 10, Spousal Poverty Credit (date of death between
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
Carl C. Risch, Esquire
ELEPHONE NUMBER
717/243-3341
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
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(8)
664,560.02
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(11 )
42,674.98
(12)
621,885.04
(13)
(14)
621,885.04
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)
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16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
118. Amount of Line 14 taxable at collateral rate
I 19. Tax Due
120. 0
x .00
621,885.04 x .045
x .12
x .15
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
(15)
(16)
27,984.83
(17)
(18)
(19)
27,984.83
Copyright 2000 form software only The Lackner Group, Inc.
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
105 Pine Street
CITY
Carlisle
i STATE PA
ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
27,984.83
20,000.00
----..-.-
1,052.63
Total Credits (A + B + C)
(2) 21,052.63
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 6,932.20
(5A)
(5B) 6,932.20
Make Check Payable to: REGISTER OF WILLS, AGENT
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?............................................................,.""..,.............................................. ..
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;.................................................................................. B I
b. retain the right to designate who shall use the property transferred or its income;....................................
c. retain a reversionary interest; or..................................................................................................................
d. receive the promise for life of either payments, benefits or care?.............................................................. 0 ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.. ....... ......... ..................... ......... .......................... ....,...,.......... ........... .............. 0 ~
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
35 Garland Court Two
Carlisle, PA 17013
OATE
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DATE
:5 /7 /Lo(~
DATE
117 It) Ie
ADDRESS
ADDRESS
511 Springfield Road
Shippensourg, P A 17257
Ten East High Street
Carlisle, PA 17013
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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. s9116 (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 l
[72 P.S. s9116 (a) (1.1) (ii)]. The statute does not exemDt a transfer to a surviving spouse from tax, and the sl
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
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~~~ ~=~er~~ :;~~z~ ~~ ~::~;~~ai~;~~~;ansfers from a deceased child twenty-one years of age or youngel & () /;)-vy q
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. s9116 (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 fJ tft /1/./
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..:>. ~_ ~ 9'( q / 61.,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoplloIJ.
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SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
II FILE NUMBER
21 - 06 - 00111
ESTATE OF
MYERS, RICHARD L
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 which property would be exchanged between a willing buyer and a wilflng 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
I
DESCRIPTION
VALUE AT DATE OF
DEATH
162,000.00
Real estate known as 124 & 126 Beech Street, Carlisle, South Middleton Township, Cumberland County,
PA, being part of parcel no. 40-22-0487-086, and being valued per appraisal attached, marked Schedule
A, Item I
2
Real estate known as 105 Pine Street, Carlisle, South Middleton Township, Cumberland County, P A,
being part of parcel no. 40-22-0487-086, and being valued per appraisal attached, marked Schedule A,
Item 2
121,000.00
TOTAL (Also enter on Line 1, Recapitulation)
283,000.00
*
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
21- 06 - 00111
ESTATE OF
MYERS, RICHARD L
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
378 shares PNC Financial (CDSIP 693475105)
~--
66.0625
VALUE AT DATE OF
DEATH
24,971.63
DESCRIPTION
UNIT VALUE
2
1123.968 shares Dryden Mun Ser Fd (CD SIP 74435M879)
10.05
11,295.88
3
1433.724 shares Blackrock Fds (CDSIP 091928366)
10.82
15,512.89
4
1354.784 shares Federated Income Secs Tr (CDSIP 314182106)
7.68
10,404.74
TOTAL (Also enter on line 2, Recapitulation)
62,185.14
..
ESTATE OF
'.
SCHEDULE E I
CASH, BANK DEPOSITS, & MIS.C..~I
PERSONAL PROPERTY
I FILE NUMBER
I 21-06-00111
MYERS, RICHARD L
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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
---
I
DESCRIPTION
Sovereign Bank, Checking #3381139657, principal and accrued interest
2
Sovereign Bank, Certificate of Deposit #2895377352, principal and accrued interest
3
Presbyterian Homes, refund
4
The Sentinel, refund
5
PNC 1/24/06 dividend
6
Prudential Financial, Dryden Fund 1/25/06 dividend
7
Prudential Annuity No. A2011801, January annuity (final payment)
8
$50 Series EE U.S. Savings Bond, issued 1/1992
9
Jackson National Life Insurance Co., Annuity No. 0059348290 (principal $38,177.63 + accrued interest
$744.48); beneficiary: estate
10
U.S. Treasury, 2005 income tax refund
11
Household goods, appraised value
TOTAL (Also enter on Line 5, Recapitulation)
VALUE AT DATE OF
DEATH
97,471.44
26,080.38
361.89
145.74
189.00
32.95
86.04
55.02
38,922.11
288.00
3,195.00
166,827.57
"
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MYERS, RICHARD L
FILE NUMBER
21 - 06 - 00111
I
This schedule must be com I.eted and filed if the answer to an of uestions 1 th!OUl4 on page 2 is yes.
DESCRIPTION OF PROPERTY I DA I % OF
Include 'he name of the 'ransferee. the" re'at,onsh,p '0 decedent and the da'e of 'ransfer TE OF DEATH DECO'S ,EXCLUSION TAXABLE VALUE
Atlach a copy of the deed for real estate VALUE OF ASSET: I (IF APPLICABLE)
. . INTEREST ,
ITEM
NUMBER
2
3
4
5
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_J
Prudential, Annuity No. A2011801, no proceeds payable on
death
0.00
0%
0.00
19,033.18
67,428.53
49,058.45
17,027.15
152,547.31
Allstate Life Ins. Co., Annuity No. GA0596120;
beneficiary: Richard L. Myers, Jr., son
19,033.18
Allstate Life Ins. Co., Annuity No. GA0583343;
beneficiary: Richard L. Myers, Jr., son
67,428.53
MetLife Ser L Annuity No. 3200644142; beneficiary:
Richard L. Myers, Jr., son
49,058,45
Hartford IRA Annuity No. 710302117; beneficiary:
Richard L. Myers, Jr., son
17,027.15
TOTAL (Also enter on line 7, Recapitulation)
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ESTATE OF
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
MYERS, RlCHARD L
SCHEDULE H
FUNERAl EXPENSES &
ADMINISTRATIVE COSTS
! FILE NUMBER
I 21-06-00111
Debts of decedent must be reported on Schedule I.
ITEM I
NUMBER
A.
B.
FUNERAL EXPENSES:
Ronan Funeral Home, Carlisle, P A
2
St. John's Lutheran Church, reception
DESCRIPTION
AMOUNT
Social Security Number{s) I EIN Number of Personal Representative{s):
City
Relationship of Claimant to Decedent
4.
Register of Wills
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
State
Zip
Street Address
City
Year(s) Commission paid
2.
Attorney's Fees
Martson Deardorff Williams & Otto (estimated)
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
State
Zip
Probate Fees
5. Accountant's Fees
6.
Tax Return Pre parer's Fees
Boyer & Ritter, 2005 income tax returns
7.
1
Other Administrative Costs
PPL, electric service pending disposition of property
2
South Middleton Township Municipal Authority, water/sewer service pending disposition of
property
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
5,368.50
100.00
20,000.00
414.00
300.00
360.00
132.00
5,263.98
31,938.48
*'
Schedule H
FWlElIaI Expenses &
MninDbcl~ve Costs continued
ESTATE OF
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESID~NT DECEDENT
MYERS, RICHARD L
3
Cumberland Law Journal, advertising Letters Testamentary
4
The Sentinel, advertising Letters Testamentary
5
Co/Twp. Real estate taxes pending disposition of property
6
School real estate taxes pending disposition of property
7
Recorder of Deeds, copies
8
EVP Systems, Stock valuation reports
9
Certified Mail
10
Register of Wills, filing fee, inheritance tax return
11
Register of Wills, filing fee, additional probate fee
12
Register of Wills, filing fee, account
13
I FILE NUMBER
I 21-06-00111
I
I
I
Miscellaneous expenses for mowing, snow removal, trash removal and maintenance, personal
property appraisal
14
Diversified Appraisal Services, appraisal of real estate
15
Reserved for filing and closing expenses
Page 2 of Schedule H
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1_-
75.00
144.29
486.31
2,094.16
3.50
6.20
9.52
15.00
100.00
330.00
500.00
500.00
1,000.00
'.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANlA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MYERS, RICHARD L
I FILE NUMBER
I 21-06-00111
Include unreimbursed medical expenses.
ITEM
NUMBER
1
2
3
4
5
6
7
DESCRIPTION
AMOUNT
South Middleton Township Municipal Authority, outstanding check on date of death
Green Ridge Village, outstanding check on date of death
PPL, account payable
PA Dept. of Revenue, 2005 income tax, balance due
Sprint, final payment
Continuing Care RX, account payable
Green Ridge Village, account payable
TOTAL (Also enter on Line 10, Recapitulation)
239.00
9,776.35
40.76
337.91
1.06
338.20
3.22
10,736.50
,REY'1513 EX'" (9.00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MYERS, RICHARD L
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I.
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Richard 1. Myers, Ir.
511 Springfield Road, Shippensburg, P A 17257
2
Donald 1. Steinour
35 Garland Court Two, Carlisle, PA 17013
3
Richard 1. Myers, Ir.
4
Trustees for benefit of Ketha M. Ranck, Erica R. Ranck and Paul A.R.
Ranck
I FILE NUMBER
! 21-06-00111
RELATIONSHIP TO
DECEDENT
Do Not L lid TrII!d_~Il)
Son
Stepson
Son
Granddaughter,
great-granddaughter and
great-grandson
Enter dollar amounts for distributions shown above on lines 15 through 18. as appropriate, on Rev 1500 cover sheet
AMOUNT OR SHARE
OF ESTATE
$152,547.31 (Sch. G,
Items 2-5)
1/3 estate residue
1/3 estate residue
1/3 estate residue
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
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
. .
F: \FILES\DA T AFILE\Estnte Planning' 7108-3, H. WILL.2004
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LAST WILL AND TESTAMENT
I, RICHARD ,L. MYERS, of South Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils made
by me.
1.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and
all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any
property) shall be paid from my residuary estate as soon as practicable after my decease and as part
of the administration of my estate. My Executors 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.
2.
Ifmy wife shall survive me by thirty (30) days, then I give, devise and bequeath all of my
estate, both real and personal property, unto my wife, RHODA S. MYERS, absolutely.
3.
In the event my said wife shall predecease or fail to survive me by more than thirty (30) days,
then I give, devise and bequeath all of my estate, both real and personal property, in the following
manner:
a. One-third (1/3) thereof unto my stepson, DONALD J. STEINOUR In the event he
shall predecease or fail to survive me by thirty (30) days, then I give his share unto his wife, A.
JANE STEINOUR.
b. One-third (1/3) thereofunto my son, RICHARD L. MYERS, JR In the event he shall
predecease or fail to survive me by thirty (30) days, then I give his share as follows:
(1) One-half(1/2) thereof unto his wife, CORRlNE L. MYERS; and
(2) One-half (1/2) thereof unto his stepson, TRAVIS A. MYERS.
c. One-third (1/3) thereof in the following manner:
,"'f L 11
RL.M.
Page 1 of 5 Pages
, .
(1) One-third (1/3) thereof unto my Trustees to be held in trust for the benefit of
my granddaughter, KETHA M. RANCK. I direct that my Trustees shall hold, invest and
reinvest the same, collect the income arising therefrom, and after paying all expenses
incident to the management of the trust, to use and apply as much of the income and
principal as may be necessary in the sole discretion of my Trustees for the support, health,
well-being and maintenance of my said granddaughter.
Upon the death of my said granddaughter my Trustees shall continue to hold
t~e income and principal of such trust for the benefit of her children, ERICA RHODA
RANCK and PAUL ANTHONY RICHARD RANCK, in equal shares, in accordance
with the terms of this Item 3.
(2) One-third (1/3) thereof unto my great-granddaughter, ERICA RHODA
RANCK; and
(3) One-third (1/3) thereof unto my great-grandson, PAUL ANTHONY
RICHARD RANCK.
(4) In the event any ofthe foregoing beneficiaries shall be a minor at the time for
distribution, then I direct that his or her share shall be held by my Trustees, in trust, in the
following manner:
(a) I direct that my Trustees shall hold, invest and reinvest the same,
collect the income arising therefrom, and after paying all expenses incident to the
management of the trust, to use and apply as much of the income and principal as
may be necessary in the sole discretion of my Trustees for the support, well-being
and education of the beneficiary of such trust.
(b) I direct that such beneficiary shall have the right of withdrawal of the
principal and any accumulated income of such trust as he or she attains the age of
twenty-five (25) years.
(c) Prior to the distribution ofthe principal ofany share, my said Trustees
shall have the sole discretion to invade the principal of said share for the support,
maintenance and education of such beneficiary, regardless of age.
':{ J. f1
R.L.M.
Page 2 of 5 Pages
d. To the extent that the same is permitted by law, none of the beneficiaries hereunder
shall have any power to dispose of or to charge by way of anticipation any interest given to such
beneficiary; and all sums payable to such beneficiaries hereunder shall be free and clear of the debts,
contracts, alienations and anticipations of the beneficiaries, and all liabilities for levies and
attachments and proceedings of whatsoever kind, at law or in equity.
4.
I nominate, constitute and appoint DONALD 1. STEINOUR and RICHARD L. MYERS, JR.,
or the survivor ofthem, as Executor(s) of my estate.
5.
I nominate, constitute and appoint DONALD J. STEINOUR and RICHARD L. MYERS, JR.,
or the survivor ofthem, as Trustee(s) under the terms ofthis Last Will and Testament. Either of my
Trustees shall have the right at any time to resign and appoint a successor trustee to act in their stead.
6.
I direct that my Executor(s) and Trustee(s) shall not be required to file a bond to secure the
faithful performance of their duties in any jurisdiction.
7.
I authorize and empower my Executor( s) and Trustee( s), in their sole and absolute discretion,
to purchase or otherwise acquire and retain any investments of which I die seized or any real or
personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or
grant options in regard to any or all property of any kind forming a part of my estate for such terms
and such prices as they may deem advisable; to borrow money for any purposes connected with the
protection and preservation of my estate; to mortgage or pledge any real or personal property forming
a part of my estate or to join in or secure the partition of same; to compromise any claims or
demands of my estate against others or of others against my estate; to make distribution in kind and
to cause any share to be composed of cash, property or undivided fractional shares in property
different in kind from any other share; to employ agents, attorneys and proxies and to delegate to
them such power as my Executor(s) and Trustee(s) consider desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys and proxies; and to
R ~ f.-7
R.L.M.
Page 3 of 5 Pages
execute and deliver such instruments as may be necessary to carry out any of these powers. In
addition, I direct that my Executor(s) shall have the power to conduct an inventory of any safe
deposit box necessary to the administration of my estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this g T/l day of
JVLY
,2004.
. 4~r:;ttf'l1t1~A.V
Richard L. yers
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator, as and
for his Last Will and Testament, in the presence of us, who at his request, have hereunto subscribed
our names as witnesses thereto, in the presence of the said Testator and of each other.
d~"--'f ~'Vl~{L rr~.dl Dd:K
Page 4 of 5 Pages
, .
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
We, RichardL. Myers, J..A.u.,,,,-I-?- rVlA.....; J.(.{' ,and :[;\( [ /AL-{In", i..btcK..tu-,
the Testator and the witnesses, respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and
executed the instrument as his last Will and that the Testator has signed willingly, and that the
Testator executed it as his free and voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing ofthe Testator, signed the Will as a witness and that
to the best of his /her knowledge the Testator was at that time eighteen years of age or older, of sound
mind and under no constraint or undue influence.
~~Lw (), fbtf/-
Subscribed, sworn to and acknowledged before me by Richard L. Myers, the Testator, and
subscribed and sworn to before me by La. e'-ru... k. n l<< r t' \I j C. [, and
1C\(t~it:lltH' A. o (cLer , the witnesses, this ~-, day of ,J;.Ja ,ZCt;-Y.
il t t", C'<fl0,
Notary Public
NOTARIAl SEAL
VICTORIA L OTTO NOT ARf PUBliC
CARLISLE BORO:! CUMBERLAND COUNlY
MY COMMISSIOI1 EXPIRES DEe 2 2006
Page 5 of 5 Pages