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Home My WebLink About12-04-06 --.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW ~_~_~I Se~~._t:'!,~'"!.".!>.~___"_,_,,,___,__,,__,,___. Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth 1191-18-6589 OS/25/2006 08/24/1923 Decedent's Last Name Suffix OFFICIAL USE ONLY County Code Year zl"j ;6La File Number {)S~ James Decedent's First Name M Jones (If Applicable) Enter Surviving Spouse's Information Below Spouse's_~~st Nam~_, "'"",,-, Suffix : Jones MI Spouse's First Name MI ["___".__,,_._..,.,._m._.,_,_,,,,_ '.'...'_._.'.'.....'...'."._'m_._".'._."""; I Edith I K L-____________j Spouse's Social Sec~~.,t:'!~I!'~~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS <=> 4a. Future Interest Compromise (date of death after 12-12-82) <=> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) <=> 10. Spousal Poverty Credit (date of death 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 Daytime Telephone Number r.'.'.'..,..,.....,.,',.....,",...,"""",.".,"""". , I,~?~,?~,~,?~:~~~~-- FILL IN APPROPRIATE OVALS BELOW ca> 1. Original Return c:> 2. Supplemental Return c:> 4. Limited Estate C8> 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received c:> First line of address 1551 Inverness Drive Second line of address or Post Office State ZIP Code 17050 Correspondent's e-mail address: c:> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:> _,0,_ 8. Total Number of Safe Deposit Boxes REGISTER OF WILLS USE ON~ o g ~O 0"\ :=0""::0 C t./J-o fT1 ;YJ;r:O n ,..".. ~r;; I ::~; 0:) ~ .&'" "-00 > (.-)0." ::E D :Op=! rn '- -' G)C) D'5 ::0 --10 r-qrn ::OCJ C) c..., n --n ~~ c....)C) -Tl U1 CT\ Under penalties of perjury, I declare that I have examined this retum, induding 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. SIGNA RE OF PERSON RESPONSIBLE FOR FILING RETURN DATE t ?~-tf.-e>lo ADORE S 20 Conway Drive, Mechanicsburg, PA 17055 S"';RE!~n;E~1l;Ftp,.tITATM ADDR S I 516 W. Main Street, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 dJl1/oC 15056051058 --.J .-J 15056052059 REV-1500 EX Decedent's Name: James M Jones : 191-18-6589 RECAPITULATION 1. Real estate (Schedule A). ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. i 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. I 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. I 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. I 6. Jointly Owned Property (Schedule F) c::> Separate Billing Requested .. . . . .. 6. i 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. I 11. Total Deductions (total Lines 9 & 10)................ ...... ............. 11. ! 12. Net Value of Estate (Line 8 minus Line 11) .. . . . . . .. . . . .. . . ... .. .. .. . . ... 12. i 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. I 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 .0JL 255,937.89 16. Amount of Line 14 taxable at lineal rate X.O _ 0.00 17. Amount of Line 14 taxable at sibling rate X .12 0.00 18. Amount of Line 14 taxable at collateral rate X .15 0.00 i 15. 16. 17. 18. 19. TAX DUE. ..................... ................ ................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social Security Number ...................... .. mmmmmmmmmmmm_..._.._..-.__m._h........._m.._h._.........h.._.hh..... . . . ..... . ... ..... . . . . . .. . _nomm..nm..........hmm.................... 161,220.00 , 0.00 ! 0.00 I 0.00 , 95,592.09 , 0.00 i 0.00 i 256,812.09 ! 874.20 ! 0.00 ! 874.20 I 255,937.89 : 0.00 255,937.89 ! 0.00 0.00 0.00 0.00 0.00 c::> 15056052059 --.J REV-1500 EX Page 3 File Number Decedent's Complete Address: DD[" .........."..."_....."..nn....~~ n._n_"_" "J DECEDENTS NAME DECEDENfS SOCIAL SECURITY NUMBER James M Jones 191-18-6589 STREET ADDRESS 2810 Warren Way CITY I STATE I ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 0.00 0.00 0.00 Total Credits ( A + B + C ) (2) 0.00 3. InterestJPenalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnterestJPenalty ( 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, Une 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. (58) 0.00 0.00 0.00 0.00 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... D [iJ 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 [i] 4. Did decedent own an Individual Retirement Account annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D [!g 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. REV-I502 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER James M. Jones, Jr. 21-06-0586 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 wilting buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is jolntly-owned with right of survivorship must be disclosed on Schedule F. seMIDULI A REAL ESTATE ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. I "'<>VII'" residence, 20 Conway Drive, Mechanicsburg, PA 17055 Map#42-27 -1888-11 O,Lot 6E 161,220j~gwl i . . . . . . . . . .. . i . . . . .... ! TOTAL (Also enter on line 1, Recapitulation) $ 161,220.00 (If more space is needed, insert additional sheets of the same size) RE\l-l508 EX+ (6-98) .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF James M. Jones, Jr. FILE NUMBER 21-06-0586 ITEM NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION Federal Credit Union, Checking account #846204 Federal Credit Union, Savings account #846204 Federal Credit Union, Certificate of Deposit account #846204 Pension Plan Federal Credit Union, Certificate of Deposit account #846204 Items/Clothing TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH REV-'S" EX.11H9lW COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-06-0586 ESTATE OF James M. Jones, Jr. ITEM NUMBER A. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT 1. Memorial 7 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address Year(s) Commission 2. Attomey Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees 1 7. TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 06-07 SCHOOL REAL ESTATE TAX NOTICE ECHANICSBURG SCH DIST -lJ.A. TWP tABLE MARLIN A. YOHN. SR.. TREASURER 6 HICKORY LN MECHANICSBURG PA 17055 PHONE 766-4238 * OFFICE AT U.A.TWP. MUNICIPAL BLDG. 100 GETTYSBURG PIKE sc: MAP NO: 42-27-1888-110 LOT 6-E Residential Building KIMBERLY MEADOWS 006594 x ~ONES. ~AMES M ~R YER: EDITH K ..JONES 20 CONWAY DRIVE MECHANICSBURG PA 17055 IA^"'~IC.~ ,",\Jrl "UL.' I ':UUO PIli ''1V. "U"'Nr TAX AMOUNT DUE -> Due Date If taxes are in escrow. forward 1hIs blI to yoor mortgage company. If oopaid by 12129106 taxes will be turned over tl CUmberland Co. Tax CIairn &neu. Retlm BII with payrnenl For a Receipt. rellm both copies with a-self Addressed Stamped Envelope. $1.00 fee for addiIionaI recelpts requested. OFFICE WED & THJRS 10 AM TO 2 PM ALSO HOURS: WED 6-9 PM KE-€P #1 COPY-RETURN #2 COPY WITH PAYMENT. FOR RECEIPT RETURN BOTH WITH STAMPEO ENVELOPE. 02b~920701200b00020270800020b8~5000227530~23 106-07 SCHOOL REAL ESTATE TAX NOTICE ECHANICSBURG SCH DIST-lJ.A. TWP YABLE MARLIN A. YOHN. SR., TREASURER 6 HICKORY LN MECHANICSBURG PA 17055 PHONE 766-4238 * OFFICE AT U.A.TWP. MUNICIPAL BLDG, 100 GETTYSBURG PIKE sc: MAP NO: 42~27-1888-110 LOT 6-E Residential Building KIMBERLY MEADOWS 006594 x ..JONES. ..JAMES M ..JR YER: EDITH K ..JONES 20 CONWAY DRIVE MECHANICSBURG"PA 17055 TAX COLLECTOR COPY JULY 1 2006 Bill No: 2649 TAX AMOUNT DUE -> Due Date JULY-A GUS SEPT -OCT NOV-DEC If taxes are in escrow. forward this blI to your mortgage company. If unpaid by :t 2129106 taxes will be ILmed over " Cunmert8nd Co. Tax ClaIm Bl.neu.Ret1m BlI with payment. For a Receipl. return both copies with a Self Addressed Stamped Envelope. $1.00 fee tor adI:ItIonaI receipts requested. OFFICE WED & THURS 10 AM TO 2 PM ALSO HOURS: WED 6-9 PM KEEP #1 COPY-RETURN #2 COpy WITH PAYMENT. FOR RECEIPT RETURN BOTH WITH STAMPED ENVELOPE. 02b~920701200b00020270800020b8~5000227530~23 (71- 2]" - 711- ~ BELCO .. CommunityCreditUnion _ L getting you there 0601 0607 0613 0630 0630 0601 0601 - 0605 0605 0612 0619 0620 0621 0531 - 0630 THE THE THE 0630 ~601 J630 STATEMENT OF ACCOUNT MAIN OFFICE: 401 N. 2. S1nIet P.O. Box 82 1fa..bNg. PA 111 08 JOIIIT OWIERS I.. .111.. .111... .1.1.11. ..I.. .1. .1.11.. .1.1.1.. ..1111....1.1.1 JAMES M. JONES, JR 2810 WARREN WAY MECHANICSBURG PA 17050 ~:~:~~~~R~~~~N~~T~R~vi~0095~~" COHCAST CENTRAL CENTRAL PA IVISA TRANSACTION DIVIDEND THE ANNUAL PERCENTAGE RATE IS 1.00 THE ANNUAL PERCENTAGE YIELD IS 1.00 THE AN~UAL PERCENTAGE YIELD EARNED IS 1. 1 NEW BALANCE PREVIOUS BALANCE .l!t ::. Ca.~. PREAUTHORIZED WITHDRAWAL ~~:"')925 BRNIBLES . TOWNHOU ACif ENTRY PREAUTHORIZED WITHDRAWAL 9783397101 VERIZON PAYHENTREC DRAFT PAID 1130 DRAFT PAID 1128 PREAUTHORIZED WITHDRAWAL 3231174060 UGI UTILITIES UBI BILL PREAUTHORIZED WITHDRAWAL 1008096660 PAWC PAYMENT PREAUTHORIZED WITHDRAWAL 1230959590 PP ELEC BILL DIVIDEND ADJUSTMENT DIVIDEND ANNUAL PERCENTAGE RATE IS 0.50 ANNUAL PERCENTAGE YIELD IS 0.50 ANNUAL PERCENTAGE YIELD EARNED IS 0 NEW BALANCE ------------------------ CLEARED DRAF 1128 .... 1130 ------------------------------------ P~EVIOUS IlALANCE ~T,[FI~=T~4Z2 CERTIFICATE EARNI .. ..CONTINUED__ TOTAL DMDEND YEAR- TO-DATE far II SIVings ID:ept IRA. p. 1 -71 10206 9491 9469 -6 -3 9409, 9379' 937 -1 935 . 933 1 0276 ~ 10311 mAL RrwICE CHAlICE YEAR- TO-DATE .. II .... THE THE THE 0630 0601 0630 THE THE THE 0630 J1!~2. .'.,' L~youthere . ..... .' .... . " ~...OFFJCE: · ~.~..o.... ZRIIl:SIniIt P :0. Box 82 ~ PA 17108 t;,-. '. '.' STATEMENT OF ACCOUNT PIlI 2 JOIIT OWNERS JAMES M. JONES~ JR ANNUAL PERCENTAGE RATE IS 4.15 ANNUAL PERCENTAGE YIELD IS 4.230 ANNUAL PERCENTAGE YIELD EARNED IS NEW BALANCE (MATURES 080406)4.150~ PREVIOUS DALAHC~~T~ 42921 CERTIFICATE EARNINGS ~9 ANNUAL PERCENTAGE RATE IS 3.40 ANNUAL PERCENTAGE YIELD IS 3.450 ANNUAL PERCENTAGE YIELD EARNED IS 3. 6 NEW 8ALANCE (MATURES 091906)3.400~ 10311 09 253 254 254 TOTAl. DlVIDEIID YEAR- TO-DATE far . snInp uapt IRA. 300.55 TlTAl. RNAftCE CHAII&E YEAR- TD;.IMTE ,. . ..... 0.00 -. VERIZON'S BENEFITS CENTER 100 HALF DAY AD LINCOLNSHIRE lL 60069 Retum Servt ce Requested EDITH K "'ONES BENE OF "'AMES M ,",ONES ,",R 20 CONWAY DR MECHANICSBURG PA 17055-&135 ~ veftlOn 0480184750 Page 1 of 1 0044129 For info.....tion call Vert zon Benef i ts Center 1-877-Ask-VzHR (1-877-275-89.7) 111111111I11111111.1111.1.1111111I111111111.111I1.11111111.111 PAY ON: 08/01/2006 MGMT REG PENSION PLAN VERIZON EDITH K ,",ONES BA 028823800M1 7829T 01 atECK ..-ER: 0480184750 DESCRIPTION CASH DISTRIBUTION FEDERAL INC TAX - US NET PAVMENT AMOUNT THIS PAY sa.t"GOO.OO t"t2 . 200.00 $48.800.00 6{J vir ,/ 'J v '!> REGISTER OF WillS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS No. 2006- 00586 PA No. 21- 06- 0586 Es ta te of: JAMES M JONES JR IFht. Middle. UIstJ Late Of: HAMPDEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 191-18-6589 "y"CJ January 9th ~989 was admi tted to probate as the last will of JAMES M JONES JR (Fbt, Mlddlt, UIstJ late of HAMPDEN TOWNSHIP, CUMBERLAND County, who died on the 25th day of May 2006 and, WHEREAS; a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Conunonweal-th of Pennsylvania, hereby certify that- I have this day granted Letters TESTAMENTARYto: EDITH K JONES who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I bave hereunto set my band and affixed the,,~, of my office on the 3fd day Df JlJly2006~ "",.>"N jjJMtb.~f1<kJ1I- ~~~ . .... ........ a",,, .. ro"TTT:I "nnT.l7\ n (PTDC!"" MTnnT.J:i' T.n!:!'T' I LAST WILL AD DSTAHER'l OF .JAHES H. JORES. .lB.. _!!_.-!~ H. .JODS!-~. ,~~.__~~~_!~wnship _C?~_ Uppe~~~~~_~~_~?~!._____ _.._ of Cumberland and State of Pennsylvania. being of sound and disposing mind, memory and understanding. do make, publish and declare this my ~'''2 ~...., -.:::--..) ~ c:...... hereby 1. ~: .J ~ :~::?~ ;._rn (j') n ~1'j: w I direct the payment of all my just debts and funeral expens"i"s .> as soon after my decease as tbe same can be conveniently done. 2. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my wife, EDIT.R K. .JOBES, absolutely and uncon- ditiona1ly. 3, In the event that my wife, EDItH K. .JOlES, should predecease me, or should she die at about the same time as I do, such as in an accident common to both of us, then in either such event, I give, de- vise and pequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever the same may be situate, to my four -1- ,...",', ".".""",,- ..........,..,.""......- "'_.~- .' "--, ..\-~,o!,,,,,..~~.~~~~~"::-:.,....__,.<.,..'-,....'..~.~'_.,. (4) children, to wit, ltA1tER AD STETTLER, DANIEL R. JOBES, lIARK D. JOlES and CHRISTOPHER R. JOBES, share arid share alike, per stirpes. -4';" --.---.----..--.- LAStLy, I nomdnate, constitute and appoint my wife, EDIT:H K. JOBES, Executrix. of this t my Last Will and Testament, and in the event, I nominate, constitute and appoint my daughter, KAlER ARK STETTLER, and my son, DARIEL ll. JOBES, Co-Executors of this, my Last Will and Testament, in her place and stead. Ilf WITRESS liIRRRlMp, I have hereunto set my hand and seal this 9th day of January, A. D. 1989. (SEAL) .JAHES H. presence presence nesses. '" " , 't~M.~,.;f:~\,;'~~~/: ~ Signed, ~eaiecf, published and declared by the above-named .JOBES, JR., as and for his Last Will and Testament, in the of us, who, at his request and in his presence, and in the of each other, have hereunto subscribed our names as wit- .' ,...'.':;,~.~~~~~~~ -2- ~~{\1:B~~FJ;';C~'-:-"""""'C':C- ,-- .. ---- ~. OF PQN;YLVANIA) )ss: JtNl"i OF CUMB~ ) I, JAKES II. JOBES. JR.. , the testat or , whose name is signed :> the attached or foregoing instrunent, having been duly qualified accord:i.rlg to law, => hereby ackxlcMledge that 1 signed and executed the inso:unent as my Last Will and ast:.ament;-that-.I J::; F kwi.l.l.i.Dgly;. _aIlct~that~_Lsi.gnecli.t~as]JJY-_fr.e~L~m,tY01YntarY~__ ::t and deed for the purposes therein expressed. Sworn aId affirmed to and ackrx:Mledged before me, the 9th day of January , A. D., 19.!2.-. :l-K>L~ OF PENNSYLVANIA) )ss: :xNIY OF . CUMBERLAND ) We, the undersigned, J. 'RI\1lRR'l" STADI'I'EIl and 1fAULD11CAY 1l..41CT11 , the witnesses whose names are signed to the attached or oregoing instrUnent, being ch1ly qualified according to law. do depose and say that e were present and saw the testator JAKES H. JOBES. .JR.. ign and execute the instrllDent as his/bee last 'nll aIXi Testament; that the said estator JAlfR~ K. JOlIES. .D.. ..' signed the same willingly and bat the said .JAlOl~ II. J'ODS. .JR.. , . executed it as his/1raer free and ol\.mtary act for the purposes therein expressed; that each of us, in the hearing and ight of the testator ,signed the Will as witnesses; and that to the best of our oowledge the testat~_. was, at the time, 18 or m:>re years of age; of sound mind; nd under no constraint. duress or 1 II)TARIAl SEAL MMY S. all5Ol. IOTARY PlaIC JEaIMIICSd8 IORO. QI8lIUIID m. Rr eo-tsston bptres Sept. 21. '1991 ~m and subscribed to before me this 9th day of JanUATV , 1989 . IDTARtAl. SEAl 1WlY s. ROaltSll. aMY PUIlIC MECHMICS8UIG IOIlO- QIIIE1I.AIO co. My ta.1ss1Oft Expires Sept. 21. 1991 --.:-""'"'""',....~~~b;.:J'I"f_~JRJ.~~"!f-~{';;O~0_-:;Ti'~.;:n..~_ :~~~~"':~,~__ ___JlIl!ITIlI!lr Tn:,~"'!l>~~JW I105.805 REV 1/05 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. /J . 1-"'~'1 (/;~L/~ ~ '( /~..~. (j Fee for this certificate, $6.00 Local Registrar MAY 312006 p 12623535 Date \Ul2I2OO6 IINTIH :r 1130 -250 ,. -ofDoc.-t(Fnl. niddIt.IaIl.....) James 5..(IaI~) 82 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (CORONER) 6. OIlIofM 7. STATE FILE NUMBER ~. 0IlI of Dutl lMonfl. dIy. ~ May 25, 2006 M Jones, Jr. alii atIIlI or Aug. 24, 1923 Allentown, Pa. 8<1. FacIIy NaN (I not -..on. ghe _ alii runborl 2810 Warren Way Rooidence 0 ClIIlor. Specify. 10. RIce: Ameltcan 1_.IIack. Wlilo. H:. (SjIdy) Whi t e _of ".Donot_lIIfId. I<Ird of Iluei-../IrDIAy Ma"ha er Communications 18. 0ecIdertt IIIIIv AddnllIs (5noI. c:lIy 1_. _. ~ Illllle) 2810 Warren Way Mechanicsburg, Pa. 17050 12. Wa Doc.-t _ in Ihe U.S. AImed "-1 lily. oNo lJocedert. AcUlI Rooidence 171. Slale PeunsvlvJ!.Ini.. 17b.COtIlIy Cuaberland Heller 17e.:EJ Y..Doc.-tlMdin H::Imprlpn 17d. 0 ~~oflMd- T"",. cay, 80m 19, MoIhor'. NaN (Filii. niddIt. maklen uname) Anna C. Hillegas n. Inbmant'a MaIIng __ (Staet. dIy 1_. _. Zip Illllle) 20 Conwa Drive, Mechanicsbur 21e. Place of llIapoaiton (NaN of c:emo4ery. CNmlIIory or oller place) Cremation Society of Pa. 221:. NlI11IlI1dAddlaacfFocIIty Aller Memorial Home & Cremation Services. Inc. L --.Barriabura_ r&.~~~._~.Ihe"'_alIIpIace~.~II1d.) _______ r4r_~7700APr~: M. 25.0IlI~~~7"~~ I CAUSE OF DEATH ("'IM~"'" ......,..) IIIlm 27. PART t e..1he cIIiIil.ltJlIDL.-.~, orcanplicalionl.INldir8cfyClUlld lledulll. 00 NOT __....Is such II cardiacatllSl, ....,....... or __lIIrIoIim witIlout oIlaooing lie etlllIogy. lisl only one CIUII an each line. ~~~~ Gunshot to Head Due to (or.. . coneequence of) Sr. , Pa. 17055 21d. l.oc:aIIon(CltyI_._.ZipIllllle) Harrisburg, Pa. 230. Lic:anae Number 230. Dale Signed (Month. day, year) 26. w. c.. Roferllld 10 __ E_I Ccmnor lot 1 Rlla!on ClIIlor \tlan CIomaIion IJI DonaIion? II Yes 0 No o Y. jJJlo o Y. 0 No 31. _oIDoaI1 32a. Dateal ~fMonf1. day."" 32b. llescrIlo Haw 1n;lIy0clunld: oNIIlLnl 0- May 25, 2006 Self-inflicted ,-~Accident DPendng~ 'J2sJApl~ ASuicide 0 Could Not be DeIIInnined 11 : 00 P M. Par111: EnIor oller -.... mvllIiMo............1o -. 28. Dif Tobacctl Ute ConIribulllIo Dealh1 but not IllIUiIng in Ihe underlying CIUII ghion in Plitt 0 Ves 0 ~ o No 0 Unknown 29. lFem&le: o Not pragnanI wilhin PlBI year o f>I8gnant. limo cf dealh o Not ~ant, butlllllgllMl wiIhin ~2 daya of death o :".::-. but pr&gnlI1t 43 daya 10 1 year o u........ W ~1111 wIt1in Iho PlBIIU' 320. Place allnjury: Home. Farm, sn.t, FacIofy, guns ho t - hand gun 0IIice Bulking. e4c, (SjIdy) Home 32g. LocaIIan alln;lIy (sn.t. c:lIy 'WI. _) Warre Way, Mechanicsburg, PA -5:mIial-.."", = Io__onlno.. - EnIIr UIlllERI. YIIG CAUSE i (...... or ~....1riIIalId lie ._~"_llAST, Due"(or_I_O~: OueIa(or.._aF). . . . 3Oa. _.. AuIopay = -.nod? . Jell. _Aa*lpIyF'~ ...._ Prior 10 CompIotion of Calso aI DoaII? 33a. CodWI_oniYonel . ~~('~'==~:::::"":=;':.~~::~_-::~)________________n..o Coroner . =:::,o:::=.~:.:= =.::::::.~=::-...:.~-'-' __ otaIatL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _..0 :nl. 0IlI Signed (Monlh.day. year) . _~/ear- May 30, 2006 -On". of~a"d~.1n ""0flInI0rI' ~ -.....-.............. and duo...... CIUH(a).... -- - alalpj, _..0 34. ~~"t":' WRBm~tIMlmIF","/PriI' ~~D9I'D~~ 1-<.' 1/ I~ 1/ 1/ 1 3601l1;~.;;C A~~~a~i~~g~~~, R~ld178~bte III (S.. Instructions and .xamples on rev......)