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Home My WebLink About12-21-06 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 ~L COUNTY CODE ~L 0322 ___ YEAR NUMBER ~ Z W o w o w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Hertzler Jeannette DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 3/30/2006 2/17/1932 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I SOCIAL SECURITY NUMBER 168-26-2730 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- :.:~ U D..U Woo ::z::: 0::.... U D..IO D.. . [X] 1. Original Retum D 4. Limited Estate [X] 6. Decedent Died Testate (Attach copy of WII) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (date of deeth between 12-31-91 Ind 1-1-95) D 11. Election to tax under Sec. 9113(A) (AllleIl Sch 0) I- Z W o Z o 11. tJ) W a::: a::: o u THIS SECTION MUST 8E. COMPLETED. ALI.CO~RESPONDENe. AN~QON~f~EN'rw..'r~ INF()RMATIONSHOUI.DB~DI~~(:TEOTO: NAME COMPLETE MAILING ADDRESS Richard C. Snelbaker 44 West Main Street FIRM NAME (If Applicable) Snelbaker & Brenneman, P.C. Mechanicsburg, PA 17055 TELEPHONE NUMBER 717-697-8528 1. Real Estate (Schedule A) 2. S10cks and Bonds (Schedule B) (1 ) (2) 78,000.00 0.00 0.00 0.00 219,413.36 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) z o i= ~ ::::;) ~ ii: c( o w IX 4. Mortgages & Notes Receivable (Schedule D) (4) 5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly OYot"led Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 53,530.60 8. Total Gross Assets (total Lines 1-7) (8) 26,643.78 397.93 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) 13. Charitable and Governmental Bequests/See 9113 Trusts forv.tlich an election to tax has not been made (Schedule J) (12) (13) .:::;t (") OFFICIAL USE ~ Co C? ~ ::0 rn ,}, -0 0 ("') )j :r:. r: I'> c:- ~ fT\ -c-._ ..<:-:: ':0 .> Cf) 7' -~) () 0 -) (-:) -n >,C '; --' :P - --1 "'0 J.::>' - ~ ce e,..) \.D 350,943.96 27,041. 71 323,902.25 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 15. Amount of Line 14 taxable at the spousal tax z rate, or transfers under See. 9116 (a)(1.2) o ~ 16. Amount of Line 14 taxable at lineal rate I- ;:) ~ 17. Amount ofLine 14 taxable at sibling rate o u 18. Amount of Line 14 taxable at collateral rate )( ~ 19. Tax Due 20. ~ x.O L (15) x .0 45 (16) 0.00 0.00 0.00 323,902.25 x .12 (17) x .15 (18) (19) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 323,902.25 0.00 0.00 0.00 48,585.34 48,585.34 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 Decedent's Complete Address: STREET AOORESS '492 Glenn Street, Boro of Mechanicsbura . Cumberland County CllY I STAlE I ZIP Mechanicsburg PA 17055- 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . 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? . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year Of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] 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. Under penalties of perjury. I dedare that I have examined this return, Indudlng accompanying schedules and statements, and to the best of my knowledge and belief, It is true, correct end complete. Declaration of preparer other than the personal representatlwls based on a1llnfonnation of which preparer has any knowledge. .~~~~~BtE~A~~~ AOORESS ". o ky trix SENTAllVE Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 45,000.00 2,250.00 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 TotallnterestlPenalty (D + 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. (SA) PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS /;2 -11-0 h . 48,585.34 47,250.00 0.00 0.00 1,335.34 0.00 1,335.34 Yes No D D D D [Jg [Jg og ~ ~ []I DATE 4 Conway Drive, Mechanicsburg, PA 17055 A~fo AOORESS Richard C. Snelbaker, Esquire 44 West Main Street, Mechanicsburg, PA 17055 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. ~ 9916 (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 ct 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 ct assets and filing a tax natum are still applicable ellen 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 ct age or yollnger at death to or for the use ct a natural parent, an adoptiw 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 ctthe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~ 9116(1.2) [72 P.S. ~9116(a)(1)]. Th,: ~ax rate imposed on the net value ~transfers to?r 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 mdlVldual who has at least one parent m common WIth the decedent. whether by blood or adoption. 3W46461.000 REV-~502 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE FILE NUMBER Jeannette I. Hertzler 21 06 0322 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 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. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Property located at 492 Glenn Street, Boro of Mechanicsburg, Cumberland County, Pennsylvania, sale value (see attached settlement sheet) 78,000.00 3W46951.000 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 78,000.00 . Conestoga Title Insurance Co. Settlement Statement u.s. Department of Labor and Urban Development 123 East King Street, Lancaster PA 17602 Phone 1-800-732-3555 In Lancaster 299-4805 FAX 717-295-7155 OMB No. 2502-0265 A. HUD-1 UNIFORM SETTLEMENT STATEMENT B. Type of Loan 1. [ ] FHA 2. [ ] FmHA 3. [ ] Conv. Unins. 16. File Number: r Loan Number: 18. Mortgage Insurance Case Number: 4. [ ] VA 5. [ ] Conv. Ins. C. NOTE: This form furnishes a statement of settlement costs. Amouts paid to and by the settlement agent are shown. Items marked "(p.o. c)" were paid outside the closing; they are shown for informational purposes and are not included in the totals. D. Name & Address of Borrower: E. Name, Address and TIN of Seller: F. Name & Address of Lender: Lester T. Sheely and Aida M. Sheely Estate of Jeannette I. Hertzler None 222 Old York road clo Rose M. Levosky, Executrix DiIIsburg, PA 17019 TIN of Seller: 120-6908977 G. Property Location: Place of Settlement: H. Settlement Agent: 492 Glen Street, Borough of Mechanicsburg, 44 West Main Street Cumberland County, Pennsylvania Mechanicsburg, Pennsylvania 17055 Keith O. Brenneman Phone: (717) 697-8528; FAX: (717) 697-7681 Date of Settlement: lJuly 6,2006 J. Summary of Borrower's Transaction K. Summary of Seller's Transaction 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contract sales price $78,000.00 401. Contract sales price $78,000.00 102. Personal property 402. Personal property 103. Borrower's settlement charges (line 1400) $1,545.25 403 104. Mortgage Payoff 404 105 405 Adjustments for Items paid by seller In advance Adjustments for items paid by seller In advance 106. City/town taxes 07/06/06 to 12/31106 $107.16 406. Cityltown taxes 07/06/06 to 12/31/06 $107.16 107. County taxes to 407. County taxes to 108. 'Assessments to 408. Assessments to 109. School Taxes to 409. School Taxes to 110 410 111 411 112 412 113 413 120. Gross Amount Due From Borrower $79,652.41 420. Gross Amount Due to Seller $78,107.16 200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amount Due to Seller 201. Deposits or earnest money $5,000.00 501. Excess deposit (see instructions) $5,000.00 202. Principal amount of new loan(s): 502. Settlement charges to seller (line 1400) $785.00 203 503. Existing loan(s) taken subject to 204 504. Payoff of first mortgage 205 505. Payoff of second mortgage 206 506 $0.00 207 507 208 508 209 509 Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210. City/town taxes to 510. City/town taxes to 211. County taxes to 511. County taxes to 212. Assessments to 512. Assessments to 213. School Tax 07/01/06 to 07/06/06 $10.06 513. School Tax 07/01/06 to 07/06/06 $10.06 214. Sewer Charges 07/01/06 to 07/06/06 $5.66 514. Sewer Charges 07/01/06 to 07/06/06 $5.66 215 515 216 516 217 517 218 519 220. Total Paid By/for Borrower $5,015.72 520. Total Reduction of Amount Due to Seller $5,800.72 300. Cash at Settlement From/to Borrower 600. Cash at Settlement To/from Seller 301. Gross amount due from borrower (line 120) $79,652.41 601. Gross amount due to seller (line 420) $78,107.16 302. Less amounts paid by/for borrower (line 220) $5,015.72 602. Less reductions in amount due seller (line 520) $5,800.72 303. Cash [X] from [ ) to Borrower $74,636.69 603. Cash [X] to [ ) from Seller $72,306.44 Substitute Form 1099 Seller Statement The information in Blocks E, G,'H, I & line 401 (or if line 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. If this real estate is your principal residence, file FORM 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or Schedule 0 (Form 1040). You are required to provide the Settlement Agent (named above) with your taxpayer identification number. If you do not provide the Settlement Agent with your taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number. Seller Seller L. Settlement Charges 700. T,')tal Sales/Broker's Commission: (based on price) @ Paid from Paid from Division of Commission (line 700) as follows: Borrower's Seller's Funds at 701 Funds at 702 Settlement Settlement 703. Commission paid at Settlement 704 800. Items Payable in Connection with Loan 801. Loan Origination Fee 802. Loan Discount 803. Appraisal Fee 804. Credit Report to 805. Lender's Inspection Fee 806. Mortgage Insurance Application Fee 807. Flood Certification Fee to 808. Tax Service Fee to 809. Document Preparation Fee 810. Plan Review to 811. Assumption Fee to 812 813 814 900. Items Required by Lender to Be Paid In Advance 901. Interest from to @ per day 0.00 902. Mortgage Insurance Premium for 903. Hazard Insurance Premium for 904 905 1000. Reserves Deposited with Lender 1001. Hazard Insurance months @ per month 0.00 1002. Mortgage Insurance months @ per month 0.00 1003. City property taxes months @ per month 0.00 1004. County property taxes months @ per month 0.00 1005. Annual assessments months @ per month 0.00 1006. School taxes months @ per month 0.00 1007 1008 1009. Aggregate Accounting Adjustment 1100. Title Charges 1101. Settlement/closing fee 1102. Abstract/title fee 1103. Title examination 1104. Title insurance binder 1105. Document preparation 1106. Notary fees 1107 Attorney's fees to (includes above item numbers 1108. Title insurance to Keith O. Brenneman, Agent, Conestoga Title Insurance Company 726.75 (includes above item numbers 1101-1106) 1109. Lender's coverage: 1110 Owner's coverage: 1111. Insured Closing Letter 1112. Endorsements 1113 1200. Government Recording and Transfer Charges 1201. Recording Fees: Deed: $38.50 Mortgage: MIL Stip: 38.50 1202. City/county tax/stamps Deed: $780.00 Mortgage: 780.00 1203. State tax/stamps Deed: $780.00 Mortgage: 780.00 1204 1205 1206 . 1300. Additional Settlement Charges 1301. Survey 1302. Pest Inspection 1303. Courier Fee to 1304. Tax Certification Fee to Barry L. Heckard, Tax Collector 5.00 1305 1306 1307 1308 1400. Total Settlement Charges (This number transfers to Lines 103 & 502 Above) 1,545.25 785.00 Certification I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all reciepts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement . ' $J ~~~.4:- Purchaser Estate of Jeannette t Herlzler Lester~)~IY~. p /~. By ~~ 7fI . ~ ~ Lf4 ~ Purchaser Rose M. Levosky, Executrix Aida M. Sheely Seller To the best 0 my knowledge the HUD-1 Settlement Statement which" I have prepared is true and accurate account ofthe funds which were received and hav,be n r will be disfj sed by the undersigned as part of the settlement of this transaction. t Settlement Agent Date: July 6, 2006 Keith O. Brenneman WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. REV-T508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INI-ERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Jeannette I. Hertzler FILE NUMBER 21 06 0322 Include the proceeds of litigation and the date the proceeds were receiYed by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1990 Chevrolet Lumina Sedan Kelly Blue Book value 525.00 2 Capital Blue Cross refund unused premium on health insurance policy 409.20 3 Donegal Insurance Co. refund unused premium on homeowners insurance 190.00 4 Household goods sold at public auction by Bricker's Auction 3,044.25 5 Patriot-News refund unused portion of newspaper subscription 179.50 6 Pennsylvania State Bank Money Market, account #21403019 87,893.21 7 PNC Bank, N.A. Certificate of Deposit, account #31800261650 51,650.98 8 PNC Bank, N.A. Checking, account #5080487746 2,121. 01 9 PNC Bank, N.A. Savings, account #5030122159 29,553.25 10 Safe co refund unused premium on auto insurance 34.77 11 Sovereign Bank Money Market, account #1681733358 43,718.19 12 United States Treasury refund due on 2005 income tax return 94.00 3W46AD 1.000 TOTAL (Also enter on line 5 RecaDitulation) $ (If more space is needed, insert additional sheets of the same size) 219,413.36 REV.'510 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jeannette I. Hertzler FILE NUMBER 21 06 0322 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 IN:l..Ll:E TI-E NI\ME OF TI-E TRANSFEREE, TI-EIR RELA TIONSHP TO DECEDENT IWJ DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER Tl-EDATEOFTRANSFER. ATTPCHACOPY OF T1-E DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF .APPUCABLEI VALUE 1. Symetra Financial 53,530.60 100.0000 0.00 53,530.60 Annuity, account * VOOO033484 TOTAL (Also enter on line 7, Recapitulation) $ 53.530.60 (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 REV-1511 EX + (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA 1Nt-ERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jeannette I. Hertzler ITEM NUMBER A. B. 3W46AG 1.000 Debts of decedent must be reported on Schedule I. DESCRIPTION 1. FUNERAL EXPENSES: Gingrich Memorials grave marker Total from continuation schedules 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip 2. Year(s) Commission Paid: Attorney Fees Snelbaker &. Brenneman, P. c. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach e>eplanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Bricker's Auction commission paid on sale of household goods 2 Cumberland Law Journal advertising Executrix Notice Total from continuation schedules FILE NUMBER 21 06 0322 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) AMOUNT 870.00 8,570.00 11,685.33 360.00 2,400.00 75.00 2,683.45 26,643.78 Estate of: Jeannette I. Hertzler 168-26-2730 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Myers Funeral Home, Inc. funeral services 8,570.00 Total (Carry forward to main schedule) 8,570.00 Estate of: Jeannette I. Hertzler 168-26-2730 Schedule H Part 7 (Page 2) 3 PPL Electric electric service 58.48 4 Patriot News advertising Executrix Notice 129.69 5 RSR Appraisers & Analysts appraisal fee for real estate 300.00 6 Register of Wills short certificates 16.00 7 Register of Wills filing fee for Inheritance Tax Return 15.00 8 Settlement charges associated with the sale of property as follows: a. transfer tax $780.00 b. Tax certification $5.00 785.00 9 Skip's Hauling Service removal of debris from property 350.00 10 United Water Pennsylvania water service 20.28 11 Vital Records death certificate for Emma M. Hertzler 9.00 12 Reserve for filing fees, accounting costs and other miscellaneous expenses associated with the administation of Decedent's estate 1,000.00 Total (Carry forward to main schedule) 2,683.45 . REV.l'S12 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA 1tfl:RITANCE:TAX RETURN RESIDENT DECEDENT ESTATE OF Jeannette I. Hertzler SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 06 0322 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NlJJIBER 1. EESCRIPTION VALUE AT DATE OF DEATH Barry L. Heckard, Tax Collector real estate taxes 229.54 2 Borough of Mechanicsburg sewer/refuse service 86.80 3 Holy Spirit Hospital medical expense 25.00 4 PPL Electric electric service 34.47 5 United Water Pennsylvania water service 15.41 6 Verizon phone service (21.66 - 14.95 refund = $6.71) 6.71 3W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 397.93 REV-~513 EX+ (<9-00) SCHEDULE J BENEFICIARIES COMMONWEAL 1H OF PENNSYLVANIA II+lERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jeannette I Hertzler FILE NUMBER 21 06 0322 NUMBER I 1 NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERlY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Rose M. Levosky 4 Conway Drive Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 100% of Residue: 323,902.25 None 323,902.25 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET " 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 1\ - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 3W46AI 1000 (If more space IS needed, Insert additional sheets of the same size) $ 0.00 LAW OFFICES SNELBAKER. BRENNEMAN 8: SPARE ~-===- ,- , LAST WILL AND TESTAMENT I, JEANNETTE I. HERTZLER, of the Borough of Mechanics burg, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real personal and mixed, whatsoever and wheresoever situated unto my friend, namely, ROSE M. LEVOSKY, absolutely and in fee simple if she survives me. If the said ROSE M. LEVOSKY should predecease me, then and in that event, I give devise and bequeath my said residuary estate unto her husband, namely, BERYL LEVOSKY, absolutely and in fee simple, ifhe survives me. Ifboth of the above-named persons shall predecease me, then and in that ultimate event, I give, devise and bequeath my said residuary estate unto the issue of ROSE M. LEVOSKY and BERYL LEVOSKY, per stirpes, by representation and not per capita. LASTLY. I nominate, constitute and appoint my friend, ROSE M. LEVOSKY, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint her husband, namely, BERYL LEVOSKY, to be the Executor hereof, In the event that both of the above-named persons should fail to qualify as my personal representative hereunder or cease so to serve, then and in that ultimate event, I nominate, constifute and appoint THOMAS LEVOSKY and PATTI BETHEL (two of the children of Rose and Beryl Levosky) to be the Executors hereof. I order and direct that none of the above-named persons shall be required to post bond or other security as a condition of qualification hereunder. " . IN WITNESS WHEREOF, I, JEANNETTE I. HERTZLER, have hereunto set my hand and seal to this my Last Will and Testament, which consists of two (2)) typewritten pages to each of which I have affixed my signature this 4th day November, A.D., Two Thousand Three (2003). }"'- _-;tJ:;: > ..} ~ (SEAL) JEANNETTE I. RTZLER The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, se'aled, published and declared by JEANNETTE I. HERTZLER, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her re s in her presence and in the presence of each other, have subscribed our names as witnesse e !{~ COMMONWEALTH OF PENNSYLVANIA) : SS. COUNTY OF CUMBERLAND ) We, JEANNETTE I. HERTZLER, RICHARD C. SNELBAKER and JANE J. COONEY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. . -~~ Witness LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE f~e~ Subscribed, sworn to and acknowledged before me by JEANNETTE I. HERTZLER, the Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. COONEY, the witnesses, this 4th day of November, 2003. NaImtaI Seal 88ndJa. It ShoweIa,.H9BY.NIIc ~~ ~...Cwnb..1faI14 ~ ~'7 VVlIR1JUStjlO1l '-^fJJres Nov. 22, 2003 fr'.. .:=;~ [";~:~~.~., ~_.~.;..... ;":" .:-:-..>: .~~,~,~_........./ ~J".:' ..._,._.~- ,..~.~~