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Home My WebLink About11-15-06 ~---- ...J 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue '* County Code Year Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisbur ,PA 17128-0001 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~~ Suffix Decedent's First Name Imm] It File Number MI ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI o Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return c:::::> 2. Supplemental Return c:::::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required c:::::> c:::::> 4a. Future Interest Compromise (date of death after 12-12-82) c:::::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::::> 10. Spousal Poverty Credit (date of death c:::::> 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 SHOULD BE DIRECTED TO: Name Da ime Tele hone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received Q 8. Total Number of Safe Deposit Boxes 4. Limited Estate c:::::> c:::::> c:::::> REGIST~F WILLS U8J!PNLY S; 0 0"\ _'. ~>-:rJ Z rr :U"D 0 '.!j I ("") ...::: c',- }; F;; ~ ::rJ c..n (/)7"- 00 -0 (:-:l 0 " :J:: ()C o' ::xJ ~A11 FILED c..n Correspondent's e-mail address: mOm q't ()003 @ o..ol,C-tlW\. 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. SIGNATU OF PERSON RESPONSIBLE FOR FILING RETURN DATE /I Iy oc' ADDRESS I.? "1(1 Cocfcl...."i. ~j-I ffp~i(J~lr\('1J lij1- '70~J SIGNATURE OF PREPARER OTHER THAN 'REPRESENTATIVE . ..It DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ...J ~ -.J REV-1500 EX Decedent's Name: RECAPITULATION 15056052048 Decedent's Social Security Number 1. Real estate (Schedule A). .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c::) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::) Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 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). .... .. .. ...... ... .. ...... ...... .. . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ... . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES ) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 ta"ble at lineal rate X.O!:iS.. 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE....... ... ... .. ..... .. . ... ... .. .. ....... ...... .... .. ..... 19. 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052048 Side 2 c::) 15056052048 -.J 1_____ REV-1511o EX Pall'! 3 File Number STAT :4- ZIP 17o~S- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) &:2.J. r 7 Total Credits ( A + 8 + C ) (2) CJ,o~ J ,{ 9, 3. Interest/Penalty if applicable D. Interest E. Penalty ~- Total Interest/Penalty ( 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) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) CJ I 00 ~2/. ~9 ~:2/. 99 0.00 ro~/.99 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) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did d~nt make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D IZl 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 D(I 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D l8J 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 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. ~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 zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot 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. ~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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [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. _..~."'" . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF ~~ m t{ V 1 E - ~( se Y\.. All property jointly-owned with right of sUI'li'lorshlp must be disclosed on Schedule F. ITEM NUMBER 1. FILE NUMBER DESCRIPTION SQV\~()V~ C o.....~+, ~.eve.lo?~eVl.t COYf- lVOO'h.~ocA~~ sb ~-1s8'r ~tPi+a.J s+vck -- ;2 S h.Qr-es I Va / kQ "lcJO ~ .eaci. VALUE AT DATE OF DEATH <:t :200 Cl-o TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) sJ()o.()O -'~~."'" .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 1111/1 I 1'1 a V'1 E , 'f-tVJ,.f2rSRV'- Include the proceedS of litigation and the date the proceedS were received by the estate, All property jolntly-owned with the right of survivorship must be dilclosed on Schedule F. ITEM VALUE A T DATE NUMBER DESCRIPTION OF DEATH 1. .2. 3. 4. ~. ~. 1. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER CqS~ ~ k~~ D S S Ci u i""-.~ S b o->--4l Clotk~ J ~ I.\J t-I '('1 F\An'\~ +lAv.e.- 7''SV .J?) 't 37. 1'2- $' JOO, 00 ~.;LJ, 00 ij,S-O.OO Books, c'b's I ~f'er ])~+s ~totkc~ t~-r.oo .t;;J \{ d.... 9 , Co~- TOTAL (Also enter on line 5, Recapitulation) $ ~ 1/? 0 7 (If more space is needed, insert additional sheets of the same size) -'~~."'" . COMMONWEALTH OF PENNSh VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER t1J Q (1 f;, ~J.pr.s{J'A If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SCHEDULE F JOINTLY-OWNED PROPERTY SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. ~ lP1 ('1 jv\,)II. I e fir LIt! Cockl,~ r~ fi1ecNz"\l'C~ b~v~{ PA-11oJJ bkM-jtJ--Pv B. c. JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and balk account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointiy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. ~\:'OIolJ SOveveij~ ~I e'. OJ BOlC R,yc../<...ef1.chl1.j) $;;.S- ~(),fr S-O~ $'):( 90,'12- If'} 0 'fjt 1'1"2- 2~lf ~ A(c.~*I" ~/11 J, Sj-i:, wclc~ Ac,-~ TOTAL(Also enter on line 6. Recapitulation) $ I -::2 1 0 . <..f 2- (If more space is needed, insert additional sheets of the same size) ~,":"."", . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBATE PROPERTY ESTATE OF .1\ ~ 1f\ a. If 1 [, 't\V\{J/ p n;. e~ 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. FILE NUMBER DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IIF APPLICABLEl NUMBER 1. 1ht\lA.if, w" ~ VI a.~J bk' Y\fti (itt~ier: " 10(/% td.-O, "(1 ( . ~o 0{61 ~7/. 20 Ro~ An.J...trse-'\ , .so VI L or'''', AI-\.J.e{~.e~ I ~ 0'- Ah ~ c ~ ;\j ~ dJ ""t5tJ-.o- Wt.d~~ S~I s~ V,clc~ C l~/~ (&AAj/'.d-~Y ~~4 j ~'1 ~~1-..f~ ttTh~tP~ bJCiw/l(L- M Q &. ~ \\ ~~ 11\ \\MertCA (:'~ ",c;"'cI ~ L ~ { .e. 'S '" r \J\ (4/1'-~ a.....~ A~V1\.i.~ ~ ~. , TOTAL (Also enter on line 7, Recapitulation) $ t2 OJ f 7/ ,.2-0 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) . , , ~_O_ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. fo.rtk..tVtulU J:-1A/,\€(a) ~~/;~: -tz:; Q>1'~p"rq-H~(){: 6D4?~1 V'1C!.-W'1' ~V\UcJ 'S.tUviaJ +r'tjltt-C~ tl+ Vih-l.q'i'n..rJ e...G.r;kJ, to;1~'sf-.v bMk, mek1MeJ-t, I~.f/ CYl..~'vYt) to'-I'\) $r;~ ~ 3, CYl> ~ws;f~: :2.. p,o-o 1J]),cro D~m. C.uhC'i C~f J ~ ~o 'NW +-~ #-7.0-0 ~\Y &(.t{SQy '10, O'!l C(.H~~1 M.v...s ic'i~~ '1DO,CS"D 13Q>k.~~ r:l-I.ttMJl : (B~f~ I t\ S~ ~t{Jrolh.) Od ~lIe --C4~5, II~ s-oL!, C{o B. ADMINISTRATIVE COSTS: r I ih. ~ ~ ~ ' 1. Personal Representative's Commissions Name 01 Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship 01 Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 8- / 0 2,- ({ 0 Debts of decedent must be reported on Schedule I. (II more space is needed, insert additional sheets 01 the same size) REV-1513 EX+ (9-00) " *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT leNIDULI J BENEFICIARIES ESTATE OF , 1\ fIl a YI1 E.'fty\j~(s~ , NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a~~~.d.. . ~r 1. K\\~~(.s~ i') I ~ 4<t. 3 s-0 RJ $ o/2.'f 2) ts-fl~f" f'I, ~(T.}J '-I (,fh 3 Lf 11 '1,:J.C{ J, Lot"""'1 ~~ t~ g'S-~/'~f IS ry: d.-ClI ~ c..t /1V.2C{ c..Y1SWL~k~/rlt 5'01(3"2- 3. AJ~Lf9,Mr:klt~ {t t1j'l~~'I~;q 1: s;81.~K f\.f c.l~ ;C~ bll\v)1 PA- t?~-} 4. WtSl~ ~~SJz-- tr~? J.3 <j S-?1,6f 11"- kJak&ko........ AlI.A-. Sl.{/1V,21.{ (fro 11~t.L Kr 02.-<iorr I S, V,c-k(} crA~ il,'l..a~ls sJK/,{,i ~ tJ: ~ <f7fr, 9L ~() l. /=--. Co ""' .....we ,'JJ ,{ t $ l/ /71/, L 'I ~ ..e/ ~l..t~, WI -;-4911 ENTER DdLLll.R AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET FILE NUMBER NUMBER I RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE $ G Y\.. ~tl1 rr, 92 a <;'0 " .$ l.f 1 {r I C1l.- c9 ~JJ-~v $ c..r 7 f J/ <] 2 S' ()V\... '$L{7-J[,97- II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. ~HARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Ifjyc.:ku'v" J... 0 t- ~ )J q c(H' .t KL. &,/1 ,I,.~~t- )J,.w ~ "",b..cw 10.....) r A- \ 701D I . <[2-'110. .Lr- ,-. \j t.+-t'fC(I/',cS A~~; V1irhr,d..;~ R~I('V\ 0+ l~rt ~fklS VA- ~flJ14J~ ~~lif $1lfS", U7J " TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ "3"3 r 5 ( U' (If more space is needed, insert additional sheets of the same size) Register of Wills Cumberland County Pennsylvania In regard to: Inheritance Tax Decedent: Mary E. Andersen Please note: I have included my mother's will, but I did not fill ova16 on the cover page of REV -1500, because I did not submit the will for probate. It was not submitted for probate as per a conversation I had with your office on May 24, 2006, in which I was told I did not need to have it probated unless I was expecting someone to request a "Short Certificate". She did not have any outstanding bills, and I was not expecting anyone to seek payment from the estate. tt Sovereign Bank- STATEMENT OF ACCOUNTS 1-877-S0V-BANK (1-877-768-2265) www.sovereignbank.com GENERATION CHECKING GENERATION CHECKING -. '.'" :-.~ -:. ~ ,-. _ ~ . _,: MARY E ANDERSEN NANCY M MYERS Account # 1681716356 Former Account # 1800009722 Deposits/Credits + $1,429.12 Average Daily Balance $2,977.27 - - Earned this Period :p~t(nY.ea $ 0.12 Paid Last Year $1.65 === - - - = - ~ = ~ ~ . . . .~ - - - -= - - ;;;; Interest i *The interest earned and the interest paid may differ depending on when interest is credited to YOt.l,..:~~qotJfJi. ., Additions ~... ..' DELAWARE ~~ Medallion Allmerica financial Ufe Insurance and Annuity Company VeraVest Investments, Inc. TRANSACTION CONFIRMATION Confirmation Date: 06/15/2006 Transaction Type: Death Benefit Transaction Date: 06/15/2006 Variable Annuity Case/Contract Nuaber MN417266 Date of Issue 07/27/1999 Type of Plan Non-Qualified Annui tant MARY E ANDERSEN MARY E AADERSEN 417 COCICUN ST MEOtANICSBURG PA 17055 Your Financial Representative HARRY E RADCLIFFE ROYAL AlliANCE ASSOCIATES 930 RED ROSE CT STE 200 LANCASTER PA 17601 is: 5827 IN 0250 I ill - . = - - ii !! - - - - = ~ !!! Delaware VIP $8,087.~- $3.334345 2,425.4296- 2,425.4296- NONE Value Series ;; Delaware VIP Trend Series $2,771.21- $3.886516 $4,406.48- $1.971121 897.8445- 897.8445- NONE Delaware VIP Balanced Series 2,235.5191- 2,235.5191- NONE TOTAL DEATH BENEFIT $20,871.20 We confin. to you as agent for the Principal Underwriter, VeraVest Investments, Inc. Values are as of the transaction date. Your current value may differ. IMPORTANT: Please review this Transaction Confirmation carefully. Report any discrepancy within 10 days of receipt to Customer Service. 85-08541 2 OF 2 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX[11-96j RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NANCY MYERS 417 COCKLIN STREET MECHANICSBURG, PA 17055 h___n_ fold ESTATE INFORMATION: SSN: 471-12-9507 FILE NUMBER: 2106-1010 DECEDENT NAME: ANDERSEN MARY E DATE OF PAYMENT: 11/15/2006 POSTMARK DATE: 11/14/2006 COUNTY: CUMBERLAND DATE OF DEATH: 04/29/2006 NO. CD 007438 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $621.99 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 555 SEAL INITIALS: CJ RECEIVED BY: REGISTER OF WILLS $621.99 GLENDA FARNER STRASBAUGH REGISTER OF WILLS saw testatrix sign and execute signed willingly and that she executed it as her free purposes therein expressed; that each of us in the hearing and sight of testattix was at that time eighteen or lIIOre years of age, of sound mind under DO constraint or undue influence. (\ 71i" 2/ / !.o, ~ J~ YJ~ ;,e)!~--LJ- before me by ~/J. :A,~i~,'j;~~~t~l::~~i~e~y of (~/'df~' N~tary Public ' , ,,v :....~...~_.~.::>.~-~.~.--. A"M __. TONE. STONE ttorneya et Law 14 BrIdge S_ ~' Cumberland. Pe. 17070 -, - .", ,._'~"' -c. Page 4 elf' 4 SIGNED, SEALED,PUBLISBED, and DECLAlED by MARY ELIZABETH ANDERSEN, the i ! Testatrix above named, as and for ber Last Will and Testament, and in the pre- ( 'sence of us, who at bet: request, in her presence and in the presence of each subscribed our names as witnesses. I 'I (j f'&(~iIh u..(ic$uj &. Address li~'/'" " " , """"~,,'. '"" " It ~ <7f" ~ ATZ;':)Gt,:)::Z~:; ~.'. ,~ ij COMMONWEALTH OF PENNSYLVANIA ) ) !i COUNTY OF CUMBERLAND ) I, MARY ELIZABETH ANDERSEN, testatrix whose name is signed to the attached 'i or foregoing instrument, having been duly qualified according to law, do here- :i by acknowledge that I signed and executed this instrument as my last will; ii that I signed it willingly and that I signed it as my free and voluntary act "for the purposes therein contained. >1~~~{;~~is,~D Ii STONE a. STONIE Attorneys .~ lAw 414 BrIdge Stte~ New Cumberlend. Pa. 17070 Sworn to or affirmed to and ~_1edged "ffore me by MARY ELIZABETH ANDERSEN, the testatrix this 10 day of "~~ i1989. /7 Vj"./--" ,','i' l~~O<^-~~~ Notary Public ' . " " Page 3 of 4 NOT ARfAl SEAl CONSTANCE L KARU. Notary Public New Cumbetland. PA C:Jmberland Co. M)' Ccnrnission Expires April 13. 1991 ITEM III: I appoint my Executrix and her successors guardian of any pro- perty which passes either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the 1Ilinor or to another for the minor's benefit. Such guar- dian shall have the power to use principal as well as income from time to time 1:/ 11 for the ~_nor' s support aftdeducat!()n (ineli!ding colle,g~ educ8:;_~~'b<>~'hg;a~ " Ii duate and uudergraduate) without regard to his or her parent's ability to pro- vide for such support and ~ucation, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM IV: The words "issue" and "children" as used in this my last will shall not be interpreted to include step-children. ITEM V: I appoint my daughter, NANCY M. MYERS, Executrix of this lilY last wi 11. Should my daughter, NANCY M. MYERS, fail to qualify or cease to act as Executrix, I appoint my son, WESLEY P. ANDERSEN, Executor of this my last will. ITEM VI: I direct that ~ Executrix and Guardian, and their successors, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. I: lit 1flTHSS tlllEUOl, I have hereunto set my hand and seal this JpZ,( day of~t~~-t (/ , 1989. STONE" STONE Attof'neYa at Law .,. Bridge Street New Cumberland. Pa. 17070 .,;;f;, _ j __,., Z~b-d_,tv&lL. ',i. 0 22 ~ . ./1 /~ Z; . ...,/1 ~C-W ..... . Y ELIZABETH ANDERSEN v (SEAL) Page 2 of 4 I ~ I , ~ . I I I .~ I STONE" STONI! Anorneya at LAw 414 Bridge Stree1; New Cumbef1ltnd. Pa. 17070 i I I I ! 1 I I I I I I i LAST WILL AND TESTAMENT OF MARY ELIZABETH ANDERSER 1, MARY ELIZABETH ANDERSEN, of the Borough of Mechanicsburg, Cumberland County, and Commonwealth of Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: 1 devise and bequeath all of my estate of every nature and situate as follows: Ten (iO!) perdefte thed~6ft6 th~'N~w eurtib~hirtd Church the 16th Street and Brandt Avenue, New Cumberland, Pennsylvania, for its purposes. B. Ninety (90%) percent thereof to be divided in equal shares to my children, ROY E. ANDERSEN, LORNY D. ANDERSEN, NANCY M. MYERS, WESLEY P. ANDERSEN, and VICKY J. CLAYTON, as survive me. Should any of my above named children fail to survive me, I devise the share of such child to issue per stirpes living at the time of my death; and should any such child of mine leave no such issue living at the time of my death, I devise and bequeath the share of such child to my issue per stirpes living at time of my death. ITEM II: I hereby dt!ciare and reaffirm that all savings, checking and money market accounts and Certificates of Deposit in the joint names of mysel and any other person, or in "P.O.D." form, have been put in such forms for convenience purposes only. To that end, the entire balance of ariy'such account or certificate shall be distributed as a part of my estate and shall not pass to the surviving joint owner, and the shares passing to all persons under this will shall be calculated as though such property had been part of my probate estate. Page 1 of 4 cf tc. -) LL() OO~ , :::s p t.n . EEz -l<t ulE 0: o G"-If'l ~ ~ .&)-; Ir. ~ ~-::>'f" l- ~ rO("l ~Cl \B.<t"~_ 0...... C)-toO Ir.'ur- .,.0';. .~""'"'''-':)d ~ \ ~.%O ~ $ \u; -: -: .. --= -=s =s :: -: ~\iel g~, t; '" 0 ::: ti~ : !~ -:.' Lt_ (:.) f~:~~ LLJ . C) tt L},", C>CI C~. W o cc c.:;; C) W-J CL "'-0 = c::> (--..J :it: 0- >- C) Z \~ ~ ~ ~ Q.- ......... ~~ ~ c.. ~ ~ v_ ~ 0-1 ~~ ~C~ --:2..';) -1 r ~ -Q ~ '-'\ ~ ('/\ ~~C/J 01, ~ ~ 3 J. ~ ~o -+-~ ~ lL 0 '> ,_ ~ - ~~ ~ J. ~ ~8 c) Gr'- - Q \"- - ~