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Home My WebLink About07-10-08'J REV-1500 EX (06-05 PA Department of Revenue Bureau of Individual Taxes PO Box 280601 Harrisburg, PA 17128-0601 15D56D41169 OFFICIAL USE ONLY County Code Year File Number IN R SIDENTEDECEDENTRN ~ ~ n ~ ~ ~~~~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 195-07-9125 10092007 Decedent's Last Name HUGHES (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL INAPPROPRIATE BOXES BELOW ® 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Wifl) 9. Litigation Proceeds Received Date of Birth 06231917 Suffix Decedent's First Name ZELDA Suffix Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 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 between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) MI I MI I.vKKtJruNlJtN 1 -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number KEVIN M. SCOTT 717-257-7551 Firm Name (If Applicable) SAUL EWING LLP First line of address 2 N. 2ND STREET, 7TH FLOOR Second line of address City or Post Office HARRISBURG State ZIP Code PA 17101 REGISTER OF WILL~,JbSE ONLY C7 °~ - Cp ' m ~ ~ _ c. ~. :;~~ ~ ~. . ' . j a '. ~ _ _ c~.~ ~. :. _' ~~ c . . -~ c _:x ' ~TE FILE -_ ~ 1 D - , w Co espondent's a-mail address: KSC TQSAUL . COM Un r penalt es of perjury, I declare tha have amined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is rue, co ect and complete. Declarati of pr arer o er than the personal representative is based on all information of which preparer has any knowledge. SI NATU E OF PERSON RESPDNSIBL Fr1R II Inl IzFnIRti _ __ 6/jb/o8 2 N. ~jD STREET, 7TH SBURG, PA 17101 6,(j()/08 2 N. 2ND STREET, 7TH FLOOR, HARRISBURG, PA 17101 PLEASE USE ORIGINAL FORM ONLY Side 1 ~, 15D56D41169 15D56041169 J 15056042160 REV-1500 EX Decedent's Social Security Number Decedent's Name: ZELDA I HUGHES 19 5 - 0 7 - 912 5 RECAPITULATION 1. Real estate (Schedule A) .......................................... ... 1. 0 2. Stocks and Bonds (Schedule B) ..................................... ... 2. 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 3 , 4 8 2 . 2 7 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested .... ... 6. 3 7 7.92 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested .... ... 7. 16 , 9 6 9 . 9 5 8. Total Gross Assets (total Lines 1 - 7) ................................ ... 8. 2 0 , 8 3 0.14 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 2 , 5 5 2 . 6 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. .. 10. 3 , 513.91 11. Total Deductions (total Lines 9 & 10) ................................ .. 11. 6 , 0 6 6 . 5 7 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 14 , 7 6 3 . 5 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 14 , 7 6 3 . 5 7 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_ 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .04 5 14 , 7 6 3. 5 7 16. 6 6 4. 3 6 17. Amount of Line 14 taxable at sibling rate x .12 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate x .15 0 18. 0. 0 0 19. TAX DUE ...................................................... .. 19. 6 6 4. 3 6 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042160 15056042160 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21- 0 7 -10 0 6 DECEDENT'S NAME ZELDA IONE HUGHES STREETADDRESS 824 LISBURN ROAD CITY STATE Zlp CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 6 64.3 6 2. Credits/Payments A. Spousal Poverty Credit 0 B. Prior Payments 6 2 7. 0 8 C. Discount 0 Total Credits (A + B + C) 3. InteresUPenalty if applicable (2) 6 2 7 . 0 8 D. Interest 0 E. Penalty 0 Total InterestlPenalty (D + Ej 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3j 0 . 0 0 Fill in box on Page 2, Line 20 to request a refund. (q) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3 7 . 2 8 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 3 7 . 2 8 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 : ..................................... ..... 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? ............................................... ..... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ..... [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..................................................... . . ... 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 exempt 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 childtwenty-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)]. Asibling 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-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ZELDA IONE HUGHES 21-07-1006 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 exchange between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant farts t~~ nivro space is neeaea, insert aaanional sheets of the same size) REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS ~ BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT t:~ lA I t yr FILE NUMBER ZELDA IONE HUGHES ~-1_n~_-Inn~ All property jointly-owned with right of survivorship must be disclosed oo Srharlii~e F ~u a wi c aNat,c m nccuCU, msen aaamonai sneers or the same size) REV-1504 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP t~ IAI t ur FILE NUMBER ZELDA IONE HUGHES 71 - n ~ _ -t n n ~ ~~~ iovv~c ~- ~ v. ~-~ tuiuuvmy an supponmg mrormauon) must ae attachetl for each closely-held corporationlpartnershipinterest ofthe decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted fnr c~la_nrnnriolnrehinc i~~ nivic space is neeaea, insert aaamonal sneers of the same size) REV-1505 EX+(6-98) SCHEDULE C-1 CLOSELY-HELD CORPORATE COMMONWEALTH OF PENNSYLVANIA STOCK INFORMATION REPORT INHERITANCE TAX RETURN RESIDENT DECEDENT _ ESTATE OF ~ FILE NUMBER ZELDA IONE HUGHES 21-07-1006 1. Name of Corporation State of Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Employer I.D. Number Business Reporting Year 3. Type of Business Product/Service 4. 6. Was the Corporation indebted to the decedent? .........................................[]Yes ~No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ............ Yes If yes, Cash Surrender Value $ Net proceeds payable $ _ Owner of the policy 8. Did the decedent sell or transfer any stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? Yes ~No If yes, Transfer []Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....... []Yes ~No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? .................................... . .................QYes ~No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? ......................[]Yes ~No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? .................... Yes ~ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. ~ • ~' • ~ • A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete addressles and estimated fair market valueis. It real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. No (If more space is needed, insert additional sheets of the same size) Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? ........................................QYes ~No If yes, Position Annual Salary $ Time Devoted to Business REV-1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER ZELDA IONE HUGHES 21-07-1006 1. Name of Partnership Address City 2. Federal Employer I.D. Number 3. Type of Business Product/Service Date Business Commenced Business Reporting Year State Zip Code 4. Decedent was a []General ~ Limited partner. If decedent was a limited partner, provide initial investment $ 5. 7. Was the Partnership indebted to the decedent? ......................................... Yes ~No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ............ DYes ~No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? Yes ~No If yes, (]Transfer Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ......... Yes ~ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? .......................................... []Yes []No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ...................... []Yes ~ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ........................................ []Yes ~ No If yes, explain 14. Did the partnership have an interest in other corporatipns or partnerships? .................... []Yes ~No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. 6. Value of the decedent's interest $ REV-1507 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER ZELDA IONE HUGHES ~~-n~_~nn~ Au property ~omny-owned with right of survivorship must be disclosed on Srhedu~n F ~~~ nwi c aNaw ~a nceucu, niSCll d00100n81 Sflee[S OT [ne Seme SIZe~ REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY t~ IAt t or FILE NUMBER ZELDA IONE HUGHES 21-07-1006 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with rtaht of survivorship must tip d~~~i~eo,a ,,., c,.Mea„~~ ~ ~~~ ~~~~~ ~ ~Na~~ ~~ naauea, msen aoamonai sneers or the same size) REV-1509 EX+ (6-98) SCHEDULEF COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ZELDA IONE HUGHES 21-07-1006 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule tx SURVIVING JOINTTENANT(S) NAME ADDRESS RELATIONSHIPTO DECED A.TIMOHTY HUGHES B. C. JOINTLY-OWNED PROPERTY: 7024 TERRANN DRIVE HARRISBURG, PA 17112 ENT SON LETTER DATE DESCRIPTION OF PROPER ITEM NUMBER FOR JOINT TENANT MADE JOINT TY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEEDFORJOINTLY-HELD REALESTATE. DATE OF DEATH VALUE OFASSET h OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~ A. 1990 M&T BANK CHECKING ACCOUNT 755.83 50% 377.92 TOTAL (Also enter on line 6 Recapitulation) I$ 3 7 7 9 2 (If more space Is needed, Insert addltlonal sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER ZELDA IONE HUGHES 21-07-1006 This schedule must be completed and filed if the answer to any ofquestions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIPTO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OFASSET INTEREST (IF APPLICABLE) ~. HARTFORD ANNUITY ##245878 16,969.95 TAXABLE VALUE 16,969.95 _ TOTAL (Also enter on line 7 Recapitulation) I $ 16 , 9 6 9 9 5 (If more space Is needed, Insert addltlonal sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ZELDA IONE HUGHES FILE NUMBER 21-07-1006 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 1, 0 4 0. 0 0 Name of Personal Representative(s) Marorie t t a F . Mi 11 e r StreetAddress 2 N. 2nd Street, 7th Floor ciry_Harrisburq state PA zIP 17003 Year(s) Commission Paid: 2. Attorney Fees 1, 0 4 0. 0 0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant StreetAddress City State ZIP Relationship of Claimant to Decedent 4. Probate Fees 118.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. CUMBERLAND LAW JOURNAL 75.00 8. CARLISLE SENTINEL 142.66 9 • Saul Ewing LLP - advance costs, copies, postage, mileage 137.00 TOTAL (Also enter on line 9 Recapitulation) I$ 2, 5 5 2 6 6 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT f ca iH i c yr FILE NUMBER ZELDA IONE HUGHES 21-07-1006 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUEATDATE OF DEATH ~ CAMP HILL EMERGENCY PHYSICIANS 22.95 2. SPIRIT PHYSICIAN SERVICES 37.76 3. PHYSICIANS REHAB 17.94 4. WEST SHORE EMS 846.30 5. HOLY SPIRIT HOSPITAL 992.00 6 TIMOTHY HUGHES-reimburse for 2007 mileage and 2006 tax preparer fee 1 4 3 5 0 7. KATHY STAHL -reimburse for 2007 mileage 98.46 8. SAUL EWING LLP 500.00 9• KATHY STAHL - reimburse for 52 hours-POA-for 2007 8 5 5.0 0 TOTAL (Also enter on line 10 Recapitulation) I $ 3 , 513 91 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF - ZELDA IONE HUGHES NUMBER NAMEANDADDRESS OF PERSON(S) RECEIVING PROPERTY 1 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] A. TIMOTHY HUGHES B. ~ DALES HUGHES C. ~ KATHY STAHL D. ~ MARIE HUGHES FILE NUMBER 21-07-1006 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE SON 1/4 SON I 1/4 DAUGHTER I 1/4 DAUGHTER-IN-LAW I 1/C~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWNABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET 11 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS SCHEDULE) BENEFICIARIES TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ZELDA IONE HUGHES 21-07-1006 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable .............................................. $ 2. Actuarial factor per appropriate table ..................................................... . Interest table rate- ^3 1/2% ^6% ^10% ^Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) ........................................... $ ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ................................................ $ 2. Check appropriate block below and enter corresponding (number) ............................. . Frequency of payout - ^Weekly (52) ^Bi-weekly (26) ^Monthly (12) ^Quarterly (4) ^Semi-annually (2) ^Annually (1) ^Other ( ) 3. Amount of payout per period ............................................................ $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ...................................... . 5. Annuity Factor (see instructions) Interest table rate-^31/2% ^6% ^10% ^VariableRate 6. Adjustment Factor (see instructions) ............................................ . 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ................... . If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................... $ SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN :heck Box 4 on REV-1500 Cover Shee NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A Through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 EX+ t3_04) INHERITANCE TAX SCHEDULEL COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT INHERITANCE TAX RETURN OR INVASION OF TRUST PRINCIPAL RESIDENT DECEDENT I. II. III. FILE NUMBER 21- 0 7 -10 0 6 is r A I t ~F - ------- HUGHES ZELDA I (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate .............................. $ 2. Stocks and Bonds ........................ $ 3. Closely Held Stock/Partnership .............. $ 4. Mortgages and Notes ...................... $ 5. Cash/Misc. Personal Property ............... $ 6. Total from Schedule L-1 .................... ................................ $ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities ......................... $ 2. Unpaid Bequests ................. . ....... $ 3. Value of Unincludable Assets ................ $ 4. Total from Schedule L-2 .................... ........ . ....................... $ E. Total Value of trust assets (Line C-6 minus Line D-4) ............................... $ F. Remainder factor (see Table I or Table II in Instruction Booklet) ....................... . G. Taxable Remainder value (Line E x Line F) .. ..... (Also enter on Line 7, Recapitulation) .............. . ................ $ rrvvH~IVrv Ut GpRPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpus consumed .......................................................... $ D. Remainder factor (see Table I or Table II in Instruction Booklet) ....................... . E. Taxable value of corpus consumed (Line C x Line D) .............................. $ (Also enter on Line 7, Recapitulation) REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet FILE NUMBER ZELDA IONE HUGHES 21-07-1006 This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries II. III. I V. NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal Explanation of Compromise Offer: ...,~~~~~~a~y ~~ a.vrnprvmrse ~n'er: 1. Amount of Future Interest ...................................................... $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) .. $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6%, ^ 3%, ^ 0% $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) .. $ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) .. $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) .................. $ (If more space is needed, insert additional sheets oithe same size) REV-1648 EX (11-99)(I) SCHEDULE N SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH 011011927012131194) INHERITANCE TAX DIVISION ESTATE OF FILE NUMBER ZELDA IONE HUGHES 21-07-1006 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. 1. Taxable Assets total from line 8 (cover sheet) ... . ............................... ............ 1. 2. Insurance Proceeds on Life of Decedent ....................................... ............ 2. 3. Retirement Benefits ....................................................... ............ 3. 4. Joint Assets with Spouse ................................................... ............ 4. 5. PA Lottery Winnings ....................................................... ............ 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary) ... 6a. 6b, 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ........................................................ . .. ~6 7. Total Gross Assets (Add lines 1 thru 6) ........ . ..................... . ..................... 7. 8. Total Actual Liabilities .................................................................. 8. 9. Net Value of Estate (Subtract line 8 from line 7) .......................................... . .. 9. if line 9 is greater than $200, 000 -STOP. The estate is not eligible to Claim the credit. If not, continue to Part !!. Income: 1. TAX YEAR: 19 2. TAX YEAR; 19 3. a. Spouse ............ 1a. 2a. 3a. b. Decedent .......... 1b. 2b. 3b. c. Joint .............. 1c. 2c. 3c. d. Tax Exempt Income .. 1d. 2d. 3d. e. Other Income not listed above ........ 1 e. 2e. 3e. f. Total .............. 1f. 2f. 3f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1 f) + (2f) + (3f) _ 4b. Average Joint Exemption Income ........................................................... _ If line 4(b} is greater than $40, 000 -STOP. The estate is not eligible fo claim the credit. If not, continue to Part !//. 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less 2. Multiply by credit percentage (see instructions) ............................................. . 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet .................................. . 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ............................................................... . 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet....... . TAX YEAR: 19 REV-1649 EX+ (6-98) SCHEDULE O COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN (SPOUSAL DISTRIBUTIONS) RESIDENT DECEDENT ESTATE OF FILE NUMBER ZELDA IONE HUGHES 21-07-1006 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the Total value of the truss or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving soouse sz• c)nline Banking w ® MBER 1, 2007 ~. ACCOUNT SUMMARY Welcome, TIMOTHY K HUGHES • Your last login was Oc;tob~r 31, 2007 at 6:03 PM • contact Us Accounts Transfers Bill Pay ~i w~P 4USTbfAiZE TMf; PAflE >} DepOSit ACCOUntS Account# Total Balance Available Balance (last 4 digits) Checking, Savings, and CDs M8T Classic Ghecknq vvflnterest 9248 $755.86 $755.86 Total Deposits $755.86 $755.86 Related Links: Transfers & Loan Payments ~ Pia Bill ~ Statements ~ Cleared Checks Statement View Account (Select Acc,~~unt) GQ Related Links: Statement CORV Reguest ~ View Cleared Checks Check View Page 1 of 1 Sign Off Customer Service View your checks and statements online... View recent acco_u_nt statements, View checks that have Gearedyour account in the last 90 days View checks or statements rjQht from this pie Account (Select Account) ar Check Number GQ r Related Links: Order Copies of Cleared Checks 4 Place a S#op Payment -~"j~)j~~ ~'~~~~7~J ~j;'~ ~,~~' CC,,~~? ~e~~>~~ #~~ ~ ~~~ To add an account, please contact an M8T Online Customer Service Representative at 1-800-790-9130, {Mon.-Fri. Gam-9pm, Sat.-Sun. gam-Spm EST). Q Ms~TBat~ ® 2007 Manufacturers and Traders Trust Company. Users of this web site agree to be bound by the provisions of the M&T Web Banking Terms and Conditions. View the Te ~ and Conditions, Privacy Policy or Security Information. https://onlinebanking.mandtbank.com/summary/AccotuitSummary.aspx 11 /112007 Received 11/07/2007 03.53PM ;n n~•~n ~n i:~~ ~,~., t__ ~~~~ ~ ~ .._ Received 11/07/2007 03:53PM in 03.30 nn line r~~i f~~ znco * ~_ ~.~ NOV-n7- Received 17/07/2007 03:53PM in 03:30 on line [14] for 3069 * Pg 3/3 ~ Ull B-/UI. TSAJ/A nr?nnrm nnr. _ PA Hartford Mutual Funds Online /~~ ~ ~ %' /`~`~~ ~~ Page 1 of 1 ~ ~ b<-[ JL-~<-- ~ ! ~'~ ~l . .~:~1~~ Portfolio Summary ~ ~,~ - ~1 ~'~'~'~~ Portfolio Yaiue: S 16,993.20 ¢ ~~ ~ y -."~_ ~ Fund Distribution W .~ ~ 1 ~, ~ >> o ~ ~ ,~ ~ r p33 ~~ ~TFIB HARTFORD US GOV SBCURZTIBS - Y {1637y 45.841 ~~ ~`~~ /' / j ~7H8 HARTFORD FIIGH YIHLD - A {316) 45.OB~ l7//(j/ ~TFiH HARTFORD HOABY 17ARKBT - B ;940) 9.08 !.!~ By Fund ,~ ~ By Account Number Select to Purchase Into Multiple Funds » e. ~- Account Summary ~ \ ~ n Account Value Collapse Atl_Accounts Z ZONE HUGHES TOD ~~~''~ ~~ ` ~ S 16,993.20 Hide Account Details TIMOTHY K HUGHES POA Jv ` ( ~~~ 245878 \ J Z ZONE HUGHES TOD ~~'C C~ TIMOTHY K HUGHES POA `~ f 7024 TERRANN DR HARRISBURG PA 1714?-RAO~ Fund THE HARTFORD US GOV SECURITIES - E UnitsiShares UniUShare Price Fund Value (1~) 0•~ S 9.14 ; 0.00 Ticker: FIUGX Establish Date: 07/12/1994 Select Action As of February 9, 2007, The Hartford Mutual Fund shareholders voted to approve the reclassification whereby Class [E, Z) shares of the fund have been reclassified into the Class Y share of the same fund name. Please select the Class Y share of the same fund name to com late our transaction. Fund Units/Shares UniUShare Price Fund Yalue THE HARTFORD HIGH YIELD - A (316) 967.279 S 7.92 S 7,660.85 Ticker: HAHAX Establish Date: 07/12/1994 Select Action Fund Units/Shares Unit/Share Price Fund Value THE HARTFORD MONEY MARKET - A (940) 1,542.850 ; 1.00 ; 1,542.65 Ticker: IHAXX Establish Date: 0 711 211 9 94 Select Action ;,~ Fund Units/Shares Unit/Share Price Fund Value THE HARTFORD US GOV SEGURITIES - Y 857 674 (1637) S 9.08 S 7,789.50 Ticker: HUSYX Establish Date: 0210912007 Select Action This fund is closed to new investors. Purchases into this fund are only allowed if you currentty have money invested in the fund. A full redemption or exchange from a Class L or Y share of this fund will prevent future investments into this fund and share class. v `-' _ 1 https://www3.financialtrans. com/tf/FANWeb Account Vaiue: 5 76,993.20 Portfolio Value: s 16,993.20 ~ Q _~ ~a-v ___ -- .J~~~~"'."7 ~-~m 2007 The Hartford Financial Services Group. Inc. Atl Rights Reserved 1111 /2007 LAST WILL AND TESTAMENT OF ZELDA IONE HUGHES Introductory Clause. I, Zelda Ione Hughes, a resident of and domiciled in the Borough of Camp Hill, County of Cumberland and Commonwealth of Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking alI Wills and Codicils at any time heretofore made by me. I have three living children: Dale W. Hughes; Kathy S. Stahl; and Timothy K. Hughes. I have one deceased child, G. Randall Hughes, who died December 14, 1966. I have two grandchildren from my deceased child: Sherry D. Hughes and Darryl 5. Hughes. ITEM I Direction to Pay Debts. I direct that all my legally enforceable debts, secured and unsecured, be paid as soon as practicable after my death. ITEM II Direction to Pay All Taxes from Residuary Estate. I direct that all estate, inheritance, succession, death or similar taxes (except generation-skipping transfer fazes) assessed with respect to my estate herein disposed of, or any part thereof, or on any bequest or devise contained in this my Last Will (which term wherever used herein shall include any Codicil hereto), or on any insurance upon my life or on any property held jointly by me with another or on any transfer made by me during my lifetime or on any other property or interests in property included in my estate for such tax purposes be paid out of my residuary estate and shall not be charged to or against any recipient, beneficiary, transferee or owner of any such property or interests in property included in my estate for such tax purposes. ITEM III Outri¢ht Gift of All Property to Children Contingent Gift to Named Beneficiary. I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devises) wherever situate and whether acquired before or after the execution of this Will, absolutely in fee simple to my surviving children and Eo the widow of my deceased son, Marie J. Hughes, in equal shares, per stirpes. ITEM IV Namine the Personal Representative Personal Representative Succession Personal Representative's Fees and Other Matters. The provisions for naming the Personal Representative, Personal Representative succession, Personal Representative's fees and other matters are set forth below: (1) Naming an Individual Personal Representative. Ihereby nominate, constitute, and appoint as Personal Representative of this my Last Will and Testament Dale W. Hughes and Donn L. Snyder, Esquire and direct that he shall serve without bond. (2) Fee Schedule for Individual Personal Representative. For its services as Personal Representative, the individual Personal Representative shall receive reasonable compensation for the services rendered and reimbursement for reasonable expenses. ITEM V Definition of Personal Representative. Whenever the word "Personal Representative" or any modifying or substituted pronoun therefor is used in this my Will, such words and respective pronouns shall include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Personal Representative named herein and to any successor or substitute Personal Representative acting hereunder, and such successor or substitute Personal Representative shall possess all the rights, powers and duties, authority and responsibility conferred upon the Personal Representative originally named herein. ITEM VI Powers for Personal Representative. Byway of illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to Personal Representatives generally, my Personal Representative is speCifcally authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, to make distributions or divisions in cash or in kind or partly in each without regard to the income tax basis of such asset, and in general, to exercise all the powers in the management of my Estate which any individual could exercise in the management of similar property owned in his or her own right, upon such terms and conditions as to my Personal Representative may seem best, and to execute and deliver any and all instruments and to do all acts which my Personal Representative may 2 ,., , deem proper or necessary to carry out the purposes of this my Will, without being limited in any way by the specific grants of power made, and without the necessity of a court order. ITEM VII Provision for Personal Representative to Act as Trustee for Beneficiary Under Age Twenty-0ne. If any share or property hereunder becomes distributable to a beneficiary who has not attained the age of Twenty-one (21) years or if any real property shall be devised to a person who has not attained the age of Twenty-one (21) years at the date of my death, then such share or property shalt immediately vest in the beneficiary, but notwithstanding the provisions herein, my Personal Representative acting as Trustee shall retain possession of the share or property in trust for the beneficiary until the beneficiary attains the age of Twenty-one (21), using so much of the net income and principal of the share or property as my Personal Representative deems necessary to provide for the medical care, education, support and maintenance in reasonable comfort of the beneficiary, taking into consideration to the extent my Personal Representative deems advisable any other income or resources of the beneficiary or his or her parents known to my Personal Representative. Any income not so paid or applied shall be accumulated and added to principal. The beneficiary's share or property shall be paid over, distributed and conveyed to the beneficiary upon attaining age Twenty-one (21), or if he or she shall sooner die, to his or her personal representatives. Whenever my Personal Representative determines it appropriate to pay any money for the benefit of a beneficiary for whom a trust is created hereunder, then the amounts shall be paid out by my Personal Representative in such of the following ways as my Personal Representative deems best: (1) directly to the beneficiary; (2) to the legally appointed guardian of the beneficiary; (3) to some relative or friend for the care, support and education of the beneficiary; (4) by my Personal Representative using such amounts directly for the beneficiary's care, support and education. My Personal Representative as trustee shall have with respect to each share or property so retained all the powers and discretions conferred upon it as Personal Representative. ITEM VIII Discretion Granted to Personal Representative in Reference to Tax Matters. My Personal Representative as the fiduciary of my estate shall have the discretion, but shall not be required when allocating receipts of my estate between income and principal, to make adjustments is the rights of any beneficiaries, or among the principal and income accounts to compensate for the consequences of any tan decision or election, or of any investment or administrative decision, that my Personal Representative believes has had the effect, directly or indirectly, of preferring one beneficiary or group of beneficiaries over others; provided, however, my Personal Representative shall not exercise its discretion in a manner which would cause the loss or reduction of the marital deduction as maybe herein provided. In determining the state or federal estate and income tan liabilities of my estate, my Personal Representative shall have discretion to select the valuation date and to determine whether 3 1 ~ . any or all of the allowable administration expenses in my estate shall be used as state or federal estate tax deductions or as state or federal income tax deductions. ITEM IX Definition of Children. For purposes of this Will, "children" means the lawful blood descendants in the first degree of the parent designated; and "issue" and "descendants" mean the lawful blood descendants is any degree of the ancestor designated; provided, however, that if a person has been adopted, that person shall be considered a child of such adopting parent and such adopted child and his or her issue shall be considered as issue of the adopting parent or parents and of anyone who is by blood or adoption an ancestor of the adopting parent or either of the adopting parents. The terms "child," "children; "issue," "descendant" and "descendants" or those terms preceded by the terms "living" or "then living" shall include the lawful blood descendant in the first degree of the parent designated even though such descendant is born after the death of such parent. The term "per stirpes" as used herein has the identical meaning as the term "taking by representation" as defined in the Pennsylvania Probate Code. ITEM X Statement by Testatrix of Intent Not to Exercise Power of Appointment. I hereby refrain from exercising any power of appointment that I may have at the time of my death. Testimonium Clause. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this ,~ day of August, 1996. (SEAL) Z DA IONE H HES 4 ~ ~ Attestation Clause. The foregoing Will was this ~rday of Au st, 1996 si published and declared by the Testatnz as and for her Last Will and Testament in ourepresence, and we, at her request and in her presence, and in the presence of each other, have hereunto sub 'bed our names witnesses on the above date. of • of ~ ~7['n n Sl D ~~- 5 COMMONWEALTH OF PENNSYLVANIA : COUNTY OF DAUPHIN ss: We, Zelda Ione Hughes, and Donn L. ~nyder and Carol A. Garling & Sybil A. ;tiller ,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 that she had signed willingly (or willingly directed another to sign for her), 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, and in the presence of each other, signed the Will as witness and to the best of our knowledge the Testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. \ , Witness, Carol A. Garl' Subscribed, sworn to, and acknowledged before me by Zelda Ione Hughes, the Testatrix and subscribed and sworn to before me by Donn L. snyder and Carol A. Garling & Sybil A. Miller , witnessed; t#~ 6th day of Aggust~ 1996. (Seal) Public for Pen vlvania My Commission Expires: NOTARIAL SEAL Maronetta F. Miller, Notary Pudic Harrisburg, PA Dauphin County My Commission Expires Jan. il), ?fi00 6 W1tneS , ybil A. Miller t' 1' ' fn FIRST CODICIL TO WILL I, ZELDA I. HUGHES, of Cumberland County, Pennsylvania, declare this to be a Codicil to my Will dated August 6, 1996. FIRST: I hereby revoke subparagraph (t) of ITEM IV of my WiII in its entirety and in lieu thereof substitute the following: "(1) Naming an Individual Personal Representative. I hereby nominate, constitute, and appoint as Personal Representative of this my Last Will and Testament Donn L. Snyder and Maronetta Miller and direct that they serve without bond." SECOND: In all other respects I ratify, confirm and republish my Will dated August 6, 1996. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of ~ ~ ~ ~ ' , 2007. {'~'~-~~,~,,-,-c.c... ~ ~ - p~cJ (SEAL) Z~DA I. HUGHES SIGNED, SEALED, PUBLISHED AND DECLARED by the above named ZELDA I. HUGHES, the testator, as and for a Codicil to her last Will dated August 6, 1996, in the presence of us who, at the testator's request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. WITNESS 1~,,,: /' Y I ~ WITNESS ADDRESS ADDRESS /~ `~ COMMONWEALTH OF PENNSYLVANIA : COUNTY OF ss We, ZELDA I. HUGHES, the testator, and ~~ b ~: c~ h ~ ~ ~ Z and Cdr - s 1 ~ ~e ~ C' C l~ ,the witnesses, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declaze to the undersigned authority that the testator signed and executed the instrument as and for a Codicil to her last Will dated August 6, 1996, and that she 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 testator, signed the Codicil as a witness and that to the best of the witnesses' knowledge the testator was at that time over eighteen years of age, of sound mind and under no constraint or undue influence. ,A ZELDA ~. HUGHES Witness Witness ~ Subscribed, sworn to and acknowledged before me by ZELDA I. HUGHES, the testator, and subscribed and sworn to before me by ~ E'_ b 0 c 4 h K i ~ Z and C ~ f ~ S '~ i ~ ~ C ~ , witnesses, this ~ ~ day of ~ PC ,~ , 200?. .~~ ~ _ ~~~ KEVIN M. SCOTT Attorney I.D. # 70322 -2- ,' ~r COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF ~ L~ ~~ kj ~u n CF ; ~~ On this, they day of ~t ~ ~ , 2007, before me , L. SI~'(~/Ffie undersigned officer, personally appeared KEVIN M. SCOTT, known to me or satisfactorily proven to be a member of the bar of the highest court of Pennsylvania, and certified that she was personally present when the foregoing acknowledgement and affidavit were signed by ZELDA I. HUGHES and witnesses. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~ ~~~~ Notary Public Commonwealth of Pennsylvania My Commission Expires: ;(:~ Fy"F.~LTF~ CAF F~ii; --- --- tol.;~ai c~ FC ~thy L. S~i~. Nd2ry Put~lic: City QF Fk~cA~x~. Dauphin ('.~ mty L4•; :'sx:.~=~iort Ex~' tx Mar. %3. 7; ~' ; -3-