HomeMy WebLinkAbout06-05-07
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lSDSbDIfl.lIf7
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes .~
PO BOX.280601 ~
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code v..,.
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 6
File Number
0988
Date of Birth
206323868
11042006
02251909
Decedent's Last Name
SuffIx
Decedent's First Name
DAV:IES
MARY
MI
L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
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 D 2. Supplemental Return D 3. Remainder Return (date of death
prior to 12-13-82)
D 4. Limited Estate D 4a. Future Interut Compromise D 5. Federal Estate Tax Return Required
(date at de8lh eft... 12-12-62)
[!] 8. Deceder1t DIed THlIIle D 7 Decedent M8InI8Ined e Uvlng Trust 1 8. Total Number of Safe Deposit Boxes
(All8CII Copy at WII) . (AtllIch Copy of Trust)
D 9. LItIgation Proceeds Racelved D 10 SpouNJ p~ Credk ~date of de8lh D 11. Election to tax under See. 9113(A)
. b8\ween 12-31 1 end -1-1lS) (Attach Sch. 0)
iORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
.me D.ytlme Telephone Number
BAM:IL~ON C. DAV:IS 7175325713
Firm N.me (If Applicable)
ZOLL:INGER-DAV:IS, PC
First line of .dd.....
REGISTER O~ USE QNLY
~(:) (--:
~~
, ,
----: ~ '1
I
G
P.O. BOX 40
Second line of .dd.....
City or Post OffIce
SB:IPPENSBORG
State
PA
DATI5f:ILED
CJl
ZIP Code
17257-0040
Correspondent's e-m.II .dd.....: hamlltondavlslaw@comcast.net
Under penaltlel of P.8t'lury, I declare that I have examined this return, Including accompanY.ing schedules and statements, and to the best of my ~ and belief,
It Is true, correct and complete. Declaretlon of preparer othar than the personal representative Is based on all Information of which preparer has any knOWledge.
SIGNATURE RSON RESPONS FOR FILING RETURN DATE
ELEANOR F. HADLEY
DATE
Hamilton C. Davis
5
'7
P.O. BOX 40, Shlppensburg, PA 17257-0040
L
Side 1
lSDSbDlf111f7
1SDSbDlf111f7
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1505b04214t.
REV-1500 EX
Dececlent'. Nlllne: MAR Y L. D A V I E S
RECAPITULATION
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) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D 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. N.t Valu. of Estate (Line 8 minus Line 11)............................................................. 12.
13. Charitable and Govemmental BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
14. Net Valu. 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, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line fii8X8ble
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
125,311.64
16.
0.00
17.
125,311.64
18.
19. Tax Du.... .... ......................................................................... ............ .................... ..... 19
.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
1505bD4214t.
Decedent's Social Security Number
206323868
12,891.48
250,032.18
5,972.77
268,896.43
16,351.67
1,921.48
18,273.15
250,623.28
250,623.28
0.00
5,639.02
0.00
18,796.75
24,435.77
[!]
1505b042148
-.J
REV-15oo EX Page 3
Decedent'. Complete Add.....:
File Number 21-06-0988
DECEDENTS NAME
MARY L. DAVIES
STREET ADDRESS
17 RIDGE LANE, GREEN RIDGE VILLAGE
CITY I STATE IZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditsJPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
24,435.77
24,500.00
1,221.79
Total Credits (A + B + C)
(2)
25,721.79
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty (0 + 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)
(4)
(5)
(5A)
(5B)
1,286.02
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 [!]
d. receive the promise for life of either payments, benefits or care?............................................................. D [!]
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. Old decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.................................... ................................... ...... ... ..................................... D [!]
IF THE ANSWER TO ANV 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. fi9116 (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. fi9116 (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 retum 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. fi9116 (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. fi9116 1.2) [72 P.S. fi9116 (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. fi9116 (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.1MS EX+ (....,
*'
SCHEDULE B
STOCKS & BONDS
COIMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE8IDENT DECEDENT
DAVIES, MARY L.
FILE NUMBER
21-06-0988
ESTATE OF
All property joInl1y.owned with right of eurvlvorahlp muet be clecl~ on 8c1Mclul. F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 149 shares of PRUDENTIAL STOCK 86.52 12.891.48
TOTAL (Also enter on Line 2, Recapitulation) 12.891.48
(If mom space Is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rft'-1101 EX+ (1-_'
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COh'MONWEAL. TH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RE8I~ DECEDENT
ESTATE OF
DAVIES, MARY L.
FILE NUMBER
21-06-0988
Include the proceedI of IIlIg8lIon .1Id the dill. the procHCla MIW r8ClIlwd by the HIM.
All property joIftUy-..cl wIttI tIMI right of MlMVOrM'P muM .. d1.:1oHcI on Kheclul. F.
ITEM
NUMBER DESCRIPTION
1 NATIONWIDE INSURANCE REFUND
VALUE AT DATE
OF DEATH
4.00
2 SAVINGS ACCOUNT - FARMERS NATIONAL BANK - ACCOUNT NO. 9159029 - SEE
ATTACHED VALUATION LETTER
245.937.38
Accrued Interest on Item 2 through date of death
16.16
3
CARLISLE REGIONAL MEDICAL CENTER REFUND
952.00
4
INCOME TAX REFUND FOR 2006
3.094.00
5
INCOME TAX REFUND FOR YEAR 2003
28.64
TOTAL (Also enter on Line S,Recapltulatlon)
250.032.18
(If more apace Is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rft'.1101 EX+ (....)
*'
SCHEDULE F
JOINTLY -OWNED PROPERTY
COMMONWEALTH OF PENNlIYlVANIA
INHERITANCE TAX RETURN
REIlIllENT DECEDENT
ESTATE OF
DAVIES, MARY L.
FILE NUMBER
21-08-0988
" 1ft .... WlIS msde Jolnt within _ yur of ths clececlent's d.. of dNth, It must be reportH on schldule G.
SURVIVING JOINT TENANT(S) NAME
A. Gall E. Fisher
ADDRESS
1047 Woodpecker Way
Afton, VA 22920-2845
RELATIONSHIP TO DECEDENT
Stepchild
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT ~ATEOFDEA~ DECO'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR ALUE OF ASS INTEREST DECEDENrs INTEREST
JOINTL Y-HELD REAL ESTATE.
1 A CHECKING ACCOUNT - FARMERS 11.944.89 50.000% 5.972.45
NATIONAL BANK - ACCOUNT NO.
220930 - SEE ATTACHED VALUATION
LETTER
2 A Accrued Interest on Item 1 0.84 50.000% 0.32
TOTAL (Also enter on Line &, Recapitulation) 5.972.77
(If more space I. neecled, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule F (Rev. 6-98)
REV.1111 EX+ (12-11'
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DAVIES, MARY L.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-0988
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 6,030.80
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees 9,700.00
See continuation schedule(s) attached
3. Family Exemption: (If decedenf. address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountanfs Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs 620.87
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 16,351.67
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H (Rev. 6-98)
Rev-1H2 EX+ (....,
*'
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE8lOENT DECEDENT
ESTATE OF
DAVIES, MARY L.
FILE NUMBER
21-06-0988
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
EGGER FUNERAL HOME
6.030.80
Subtotal
6.030.80
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H-A (Rev. 6-98)
Rev.1M2 EX+ (,..)
.
SCHEDULE H.82
ATTORNEY'S FEES
continued
COMIIlONWEALTH 01' PENNSYLVANIA
INHERITNICl! TAX RE'I1JRN
REIIIlENT DECEDENT
ESTATE OF
DAVIES, MARY L.
FILE NUMBER
21-06-0988
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
HAMILTON C. DAVIS, ESQUIRE
9.700.00
Subtotal
9.700.00
Copyright (c) 2002 fonn software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
Rev.1HZ EX. (.....,
.
SCHEDULE H.B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEAL1l1 OF PEHNlM.VANIA
INHERITANCE TAX RETURN
RE8lDl!NT D1!ceoeNT
ESTATE OF
DAVIES, MARY L.
FILE NUMBER
21-06-0988
ITEM
NUMBER DESCRIPTION
AMOUNT
1
LEGAL ADVERTISING - THE NEWS CHRONICLE
79.25
2
LEGAL ADVERTISING - CUMBERLAND COUNTY LEGAL JOURNAL
75.00
3
PP&L UTILITIES
86.62
4
REGISTER OF WILLS - PROBATE FEE
380.00
Subtotal
620.87
Copyright (c) 2002 fonn software only The Lackner Group, Inc.
Fonn PA-1500 Schedule H-B7 (Rev. 6-98)
"-".1'12 EX+ (....)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALlli OF PENNSYLVANIA
INHERITANCE TAX RETURN
REIlDENT DECEDENT
ESTATE OF
DAVIES, MARY L.
FILE NUMBER
21-06-0988
Include urnllllllurud medlcal.~.
ITEM
NUMBER DESCRIPTION
1 CARLISLE REGIONAL MEDICAL CENTER
VALUE AT DATE
OF DEATH
952.00
2 CONTINUING CARE
15.60
3 LANCASTER HMA
436.00
4 PRESBYTERIAN HOMES. INDEPENDENT LIVING
423.93
5 PRESYBERTIAN HOMES
61.43
6 PRESYBERTIAN HOMES
32.52
TOTAL (Also enter on LIne 10, Recapitulation)
1,921.48
(If more apace is needed, additional pages of the ..me size)
Copyright (c) 2002 fonn software only The Lackner Group, Inc.
Fonn PA-1500 Schedule I (Rev. 6-98)
REV 1113 EX+ (1-00)
.
SCHEDULE -I
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
DAVIES, MARY L.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS Onclude outright spousal
Cfistributions.l and transfers
under Sec. lf116(a)(1.2)]
RELATIONSHIP TO
DECE~E~ _ _
Do Not Uet T..-.,
FILE NUMBER
21-06-0988
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
1
Lynn H. Bailey
292 Woodpecker Way
Afton, VA 22920-2645
Gall E. Fisher
1047 Woodpecker Way
Afton, VA 22920-2645
Stepchild
25% OF
RESIDUE
62,655.82
2
Stepchild
25% OF
RESIDUE
62,655.82
3
Eleanor F. Hadley
70 The Fenway
Apartment 46
Boston, MA 02115
Niece
50% OF
RESIDUE
125,311.64
Total 250,623.28
Enter dollar amounts for distributions shown above on lines 5 throuah 18, aa aDprop ate, on Rev 1500 cover sheet
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 II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule J (Rev. 6-98)
""'.1112 EX+ ('-11)
*'
SCHEDULE Y-19A
Inheritance Tax
Paid @ 5% Discount
COMMllNWI!AI. TH 01' PENN8YLVANIA
INHEIllTANCI! TAX RETURN
R!lIIDENT DECEDENT
ESTATE OF
DAVIES, MARY L.
FILE NUMBER
21-06-0988
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
REGISTER OF WILLS
24.500.00
TOTAL (Also enter on Line 10, Recapitulation)
24.500.00
(If more ~ 18 needed. addltion.1 pllgel of the same size)
Copyright (c) 2002 fonn softw8... only The Lackner Group, Inc.
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LA~T WILL AND TESTA~~NT
~
I Mary Lewis He"rlett Davies, resiclin~ in ~(5Vill~ - ~ ~
C b 1 d C .:?:::o 0 c.,-) c.~
urn er a.n ounty, Pennsylvania, make the fOlij.. .~ L"fst mn
. ,..- z i:+\ co -". J '0
and Testament hereby revokin~ all prior wills ~~di~lS~~
mad e by me: oOe-n :x ~ C)
c:> - ,"- [11
. ,:0 t)? I;
".... -o:-t (~ ) C)
FIHST: My .family consists of' my niece, Ele'anor~orsht ,4fitdle;~' ,:
her children Qavid and Anne Hadley and their children(my great
grand' nephews and great ~rand nieces) and my husband,Charles
O. Davies his children Gail.E. Fisher, Lynn H. Bailey and
their children.
SECOND: I give to persons named in separate memoranda in my
safe deposit box in Farmers National Bank in Newville, Pa.
signed by me, certain articles of personal property of' family
and sentimental si~ificance including such other items to
others,as I may identify. To Eleanor Forsht Hadley I ~ive
such articles of personal orooerty including household
furnishings and articles of family or sentimental significance
to her, excluding such oroperty as may be owned by my husband
Charles,O. Davies, or owned jointly by me with him, as she
shall select ana not in conflict with any list or tangible
personal property as specified in above or other sections of
this will. My wishes will be known to my Executor by memoranda.
~/']hatever articles Are not acr.enter toe:ether with my furniture
I
I' and t.he rest of mv useful t:an~ib]e <.ersonal prouerty or
I
,
1
I
proceeds thereof, I ~iVf
rnv husnr3n~ 9harles.O. Davies; but
if he not be livtn~,thpn
MV g.:<r~cut,or
in his sole 0iscretion
11 th 0 off~r ~h~m ~s a ~1.'ft to Green Rid~e
may se e samE: r "., ~ 1l.. :>,- C c-, ...,
village, a unit of Presbyterian Homes Inco at Newville, Pao
\
II
<<
.' .., -,
. ~ / .... -I.--+- .1 'A; -'
: / ; ....... <_J... _ __ . /"~':_'_, ,_./:.:..u _r-.::.Y (SEAt-r-
Mar~tewis Hewlett Davies
-
~,
~
THIRD: Assets which I hold jointly with my husband, Uharles o.
Davies, shall become his sole property; but if he not be living,
I! then I give such assets held jointly with my husband Charles 0.1.
j
!
Davies, in equal shares: Une eoual part to Eleanor F'. Hadley,mr
niece} and One eoual part to be divided in two equal narts: one,;
to Charles'dau~hter Gail E. Fish~r; and the balance to CharIest
daughter Lynn H. Bailey or to the survivors of them.
FOURTH: With respect to the gifts made in above Articles
"Second" and "Thirdft, in the event any of the persons there
.~.
I named should not be living; at my death, I give the share of
I
I deceased beneficiary, the personal representative of
: that to
I
" I that deceased beneficiary, to be disposed of as part of the
,
estate of that deceased beneficiary.
I FIFTH: Any property not disposed of under the above provision:~,
I give in two equal shares Cne to Eleanor F. Hadlev, my niece:
~ne &q'..lal P3:rt to .he.....di-v-id'ed in ~equ:a~ portia:: to Ch~:::: /. ,I
OC!UF.ntp.T!'} Ga i--l-E. ~iE:her and ~rnn T..L !Llle~ He__p- "T my ____tP- -
. residue shall be divided appropriately to
~ ~ i
I /-1/\ ..' : ' " j ~ - (I
. f l' t I I. ({J IA.'''. -"" '\.--. ....-t.. ...~---~. - . 0-'~
I 0 equa 1 Yo d ij
I }\\(A'l(t
effect my intention
/"~ }~ j '-I, J 1'1
(\
,fl,-- C)~..... .,...--Y----
SIXTH: Any pronerty that may become payable to a minor
beneficiary may be administered by an Executor or Executrix":wt~o
may be named as first or successor custodiRn under applicable
I .
I
law.
2
'" __~. '-,.. /' ., H . J
" j. J . .. / , "
")'1 .2 I" ; .J,:" '.. '_., ~: '- '-1 ,- / -..- ..
MARl LEWIS HEWLETT DAVIES,
!- -.-:.:...:..)....
SEVENTH
Any state or feceral taxes nayable by my Executor
or Executrix sh~ll be paic from the estAte residue and shall
not be charl?'ed to the benefi.ciClry of any share.
EIGHTH : I appoint my husband Charles o. Davies, as Executor
hereof; and, as his sllbstitute or successor for any reason
includin~ a lack of reSDonse to perform as Executor or cease
to act as Executor, I appoint my niece Eleanor F.Hadley;as
a substitute Executrix; as a. substitute or successor to the.m
I aPDoint my Erand nephew David Hadley, o~ such person or
fiduciary institu.tion as tile survivor of the above named
persons shall desi~nClte i.n aDDroDriate form. The fiduciaries
named shall serve without bond in any jurisdiction. I give
them authority to exercise all. common law an~ statutory powers
including power to sell Mnv nronerty and to cistribute my
estate in kind or partly so on W~11ver of ju~ical anoroval
thereof anc by receint, releDse 2nd refund bond.
IN WITNESS WHEREOF, I sign, seal, publish and declare
the foregoin.E'; four typewritt,E:'n pap'es, the preceding pages first'
signed by me at the foot thereof, as my LAST WILL and "TESTAMENT
this:.;<yA day of April 1996.
in the presence of' the persons 'ditnessing it at my request on
'}n,).; L:!e.1 u-~ ~ ---l:Zir i. D ,vv
Ma~'Lewislrew~tt~avies
The foregoing instrument consisting of four ~ages , the
page. prior to pa~e two first signed by Mary Le~s Hewlett .
Davies was si~ned- sealed, published and declared by Mary ~
Lewis Hewlett 'Davies to be her LAST v.TILL and TESTAMENT in our
presence, who were p~esent at the same time and thereupon at:
her request and in her presence ahd in the presence of e!ch
other 'we have hereunto subscribed our names attesting WJ..tnesf'.~
this~day of April 1996.
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~~lTNESS SIGNATURE)._ . l ~). "7 r /' _
.f ,"',C-'/~ ;;::; 1/'> 4:. V tC: ~", .\... -1,' /r:" '(." J,!/ i 1,. I-
(PRINT ~ME AND ADDRESS). 3
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\Ill, ;-,' " :t{.~(")-.~~~, .' C.:
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.(~lTNES..;;:; SIG~ATUREJ r. . .'. -n ", " " _: .
I...\'ULf't.R 17 ~\,- ,_ ('1~ 1;\ ODh ,l... t.:..
(PRINT NAME AND ADDRESS), .
1.0 .7\; nC,c- . L 'P, J'v i: . ..
. .... -. ~ ..l\ ...... .-7 LI )'.
1''4 E \\i i, I;" L t_. /' n . . / . /.'r- r- . ".
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COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
, I, MARY LEWIS HEWLETT DAVIES, the testatrix whose name .ts
s~gn7d,to the attached or foregoing instrument, having been duly
qual~f~ed according to law, do hereby acknowledge that I signed and
e~ec~ted the instrument as my Last will; and that I signed it
w~ll~ngly and as my free and voluntary act for the purposes therein
expressed. .
.m (((1'1 ;(c;.t-^.~~ ~J~ ,J\) c~ -4 ./
Mary Lewis Hewlett Davies
Sworn to or affirmed and acknowledged
before me by MARY LEWI~ HEWLETT DAVIES,
then;,estatri ')(. t-.his ~ft,4, day of.
!::.!I:::::-r) I , 19 96 ,
~~~.~,1
I Notary Publ~
HELEN B. SHULENBE
Ct;w:tj~1\ J;A~ 09-3-02
21 W. E1I-'oJ Scr,ni.jAwn;e
N~'OO.?A 17241 .
ComrnJ3slon' $.1at
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
We, M~lford W:. Castrodale and Genevieve W.....CCi..st~odal.e, the
witnesses whos.e names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw the testatrix sign and execute the
instrument as her Last willi that the testatrix signed willingly
and executed it as her free and voluntary act for the pur~oses
therein expressed; that each subscribing witness in the hearing and
. sight of the testatrix signed the will as a witness; and that to
the best of our knowledge the testatrix was at that time eigh~een
(18) or more years of age and of sound mind and under no constraint
or undue influence.
~~ti x:~
-~~~~~
Sworn ,to 0:;:- affirmed and subscr~bed/to bef..ore1
me by i11i11-.6r"/ V. (J/.u-lr;dA-/<. and G~...<!: v;< ic.- ~'. (1.q.,SfyodR.......:
witnesses, this .;:)'-/11. day of f).;pr; I , 1996..
_6~l~'
I' Notary blic
HELEN B. SHULENBERGER
OIHictJustk:e ~
r1 W. Big Serino A~
HoWIe. "pA -'7241
CD.IU'4I11m
4
.'
. Computershare - Shareholder Services - Account Details
Page 1 of 1
.
Account Details
Certificates
Holding PRUDENTIAL FINANCIAL INC COMMON STOCK;Jiill
Company Name PRUDENTIAL FINANCIAL INC
Holder Name MARY L DAVIES
Prudential ~ Fin;
Category Issued Capital Stock
, Date 03 ]an 2007
ilW
Balance as of 03 ]an 2007
Select Date:
.'.'
~~_!
~~ ti8:
2007
Share Class
Register
Balance
Price
COMMON STOCK
Book Entry
149
US$86.52
It I~, ~ql. Lf~
Account Details
Account Number
******01077
Category
Issued Capital Stock
Tax Certification
Form W9:Certified:***-**-3868
Payment Instructions
There are no Payment Instructions on File
GREENRIDGE VILLAGE
17 RIDGE LN
NEWVILLE PA 17241-9749
UNITED STATES
Address
Important Note: Market data from close of previous day. The above balance d,
any transaction in the course of processing. This balance is for information purp,
should not be relied upon to support any contemplated transactions. Please conI
require Information which predates the oldest information displayed, as only a CI
data is retained on our system.
@ Reuters Limited. Click for Restrictions.
Copyright @ 2006 Q>mPJJteJ"~h.fmL.wJIljted. All rights reserved. Reproduction in whole or in ~
medium without express written permissio-D of Computershare Limited is prohibited. Please v
Corrdltions and Priv~ policy.
https://www-us.computershare.com/Investor/Security/Summary.asp
1/3/2007
~ FARMERS NATIONAL BANK
NOV 2 1 2001
OF NEWVIllE A Division of Adams County National Bank
November 20, 2006
Hamilton C. Davis, Esquire
Zullinger - Davis P.C.
P. O. Box 40
Shippensburg, PA 17257
RE: Estate of Mary L. Davies
Dear Mr. Davis:
Mrs. Davies had a checking account #220930 in the names of Charles O.
Davies or Mary L. Davies which was openedJune 30, 2001 and the name of Gail
E. Fisher was added October 31, 2001 as a joint tenant. The date of death
balance was $11,944.89 plus .64c accrued interest~
There is also a savings account in the names of Charles O. Davies or
Mary L. Davies , !19159029 which was opened February 17, 2004 and had a balance
as of November 4, 2006 of $245,937.38 plus $16.16 accrued interest.
Sincerely YOu~~
~gh T-"
Executive Vice President
P.O. Box 156, Newville, PA 17241 . (717) 776-5312
NOV-29-2006 IO:55AM FROM- 1-968 P.OOI/OOI F-989
~Y~~Jnc.
15 Big Spring Avenue
NEWVIu.E, PENNSYLVANIA 17241
F. CHARLES EGGER, Supervisor 717.776.3414 FRANK C. EGGER, FunerolOirector
.:...
November 29, 2006
Funeral Bill for Mary Davies
Date of Death November 4, 2006
Professional Services $2.975.00
Cemetery Opening Charge S700.nO
Cemetery Sexton Charge Sloo.no
5 Death Cenificates $6.00 S30.00
Hairdresser S20.00
Patriot News Obituary SI40.:W
Sentinel Obituary $7S.6U
Casket $1,09:i.00
Burial Vault $895.00
T ota) $6,030.80
LAW OFFICES OF
J1 --5 h'l I: 5~ULLINGER _ DAVIS
("=
PROFESSIONAL CORPORATION
opr" j:'" ,'"
:;-.'i'- L''":'-" :-~
CL, .
r-,',
JOEL R. ZULLINGER
14 North Main Street
Suite 200
Chambersburg, P A 17201
717-264-6029
Fax: 717-264-1884
zulngrlaw@earthlink.net
Dale F. Shughart, Jr.
of counsel
HAMILTON c. DAVIS
20 East Burd Street, Suite 6
P.O. Box 40
Shippensburg, P A 17257
717-532-5713
Fax: 717-530-5222
hamiltondavislaw@comcast.net
May 31, 2007
Register of Wills
Cumberland County
One Courthouse Square
Carlisle, PA 17013
RE: Estate ofMaJ.Y L. Davies
Estate No. 21-06-0988
Dear Sir or Madam:
Please find enclosed for filing, in duplicate, the Pennsylvania Inheritance Tax Return for
the above estate, together with the filing fee check. A prepayment of inheritance tax has already
been made, and no tax is now due.
If there are any questions or concerns, please contact me at the Shippensburg office. Thank
you.
, .r, . ceIetyyO,urs,
~ (l J-:--
Hamilton C. Davis
for Zu1linger - Davis
Professional Corporation
HCD/njk
Enclosures
Reply to: Hamilton C. Davis
P.O. Box 40
Shippensburg, P A 17257
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