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Home My WebLink About02-19-09 (2)•~r fn ~1 1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county coda rear File Numbar Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 8 12 7 3 PO BOX.260601 Harrisburg, PA 17126-0601 ~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Dale of Death Date of Birth 193 24 0149 11 19 2008 10 07 1937 Decedent's Last Name MCKAY (If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. limited Estate ~~ 6 Decedent Diea Testate l^ (Attach Copy of Wll) 9. Litigation Proceeds Received Suffix Decedent's First Name MI MARY E Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum U 3. Remainder Relum (date of death prior to 12-13-82) qa Future Interest Compromise ~~ 5. Federal Estate Tax Return Requir=_d (tlate al tleath after 12-12A2) ~ Decedent Maintained a LiNng Tmst S. Total Numher of Safe De osit Boxes ' (Attach Copy of Tmst) p 10 spousal Poverty Crean (data of deam [~ 11 Election to tax under Sec. 9113(A) bahveen 12-11-91 and i-1-e5) (gryach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDEr;TIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MICHAEL L. BANGS 717 730 7310 Finn Name (If Applicable) First line of address 429 SOUTH 18TH STREET Second line of address CIty or Post Office CAMP HILL Corcespondent's a-mail address: State ZIP Code PA 17011 REGISTER OLS USE '(SLY _l7 -1-I e n-- ~ r ~ r `,•.m ._ ~~~ sD _ ~~ - ~':7 N I DBE F ILED ,. r1, ~naer pens nes or pequ i eeaare mar I n e examinee [ms return, mcluemg accompanying schetlules antl statements, and to the best of my knowletlge: and belief, it is lr~le, ey) and c plete.~edara~n f prgparer other than the personal representative Is based on all information of which preparer has any knowL=dge. Michael M. Graham a 519 Market Street, Lemoyne, PA 17043 SIG TUBE OF PREPAR THER THAN REPRESENTATIVE DATE Z ':~ Michael L. Bangs a ~~~ 429 South PA 17011 Side 1 1505607120 1505607120 V '~ ~, '- ~, J 1505607220 REV-1500 EX oeceaa~rs Hama Mary E. McKay RECAPITULATION 1. Real Estate (Schedule A) ........................................................................................ .. 1. 2. Stocks and Bands (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 Properly (Schedule E) ............... . 5. 6. Jointly Owned Property (Schedule F) [~ Separate Billing Requested ............ . 6. 7. Inter-Vivos Transfers 8 Miscellaneous No n-Probate Property _ (Schedule G) ~, ~ Separate Billing Requested ............ . 7, 8. Total Gross Assets (total Lines 1-7) ...................................................................... . 8. Decedent's Social Security Number 193 24 0149 9. Funeral Expenses & Administrative Costs (Schedule H) ................................. ........ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ....................... ......... 10. 11. Total Deductions (total Lines 9 8 10) ............................................................. ......... 11. 12. Net Value of Esfate (line 8 minus Line 11) .................................................... ......... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ......................................... ........ 13, 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................................ ......... 14. 2,525.30 27,940.70 30,466.00 6,541.52 396.21 6,939.73 23,526.,27 23,526.27 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 .00 0 . 0 0 15. 16. Amount of Line 14 taxable 2 3 , 5 2 6 . 2 7 1s at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 . 17. 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18. 19. Tax Due ........................._._.._...____._... ..._.................................._............._.__.... . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 0.00 1,058.68 0.00 0.00 1,058.68 Side 2 L 1505607220 1505607220 REV-1500 EX Page 3 File Number 21-08-1 273 Decedent's Complete Address: DECEDENT'S NAME Mary E. McKay STREET ADDRESS - - - ~- -- -- _- -- _- - -- -~- - - Loyalton of Creekview 1100 Crandon Road CITY ~ - -. -_ - STATE IZIP _. Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 1 ,058.88 2. Credits/Payments - - A. Spousal Poverty Credit B. Prior Payments 1,005.75 C. Discount 52.93 Total Credits (A+g+C) 3. InteresVPenalty if applicable (2) 1 058.68 _~_ p. Interest E. Penalty _ Total InteresVPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (q) Check box on Page 2 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. (5) 0.00 A. Enter the interest on the tax due. (5A) _ - B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) 0 p Q Make Check Payable to: REGISTER OF W/LLS, AGENT ~.~ ~...~ ., ~ ,. R ~ ~~ _ ~ ~. - .~ _ ~~ 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 :.................................... J ~ c. retain a reversionary interest; or ..............................................................................._.......... ... ................_ ~~ L~ d. receive the promise for life of either payments, benefits or care? ......................._.................. L ~ ~ i 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?......... I ~ I ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which - contains a benefcary designatlon? ...................................................................................................................._ ~~ ~, ~ _J 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 taz return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The taz 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 o(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-halt (4.5) percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1508 E%+ (6-a8) SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY COMaIONW£gLTM OF RENNSYLVANIA INHERITgNCE Tq%RETURN RESIDENT DECEDENT ESTATE OF E. ILE NUMBER 21-08-1273 InGUtle Ue proceeds of litigation antl the tlate the proceetls were received by the estate. All pmparty jointly-owned with the right of suMVOnhlp must ba dlaclosatl on schedule F. L„ ,,,o,e ~pe~e rs neeueu, acmoonal pages or the same size) Copyright (c) 2D02 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) ~ ~ ~ ~ Rev~i609 E%~ IB-99) COAMONWEFLTH OF PENNSYLVFNIp INXERITPNCE Tp%nENRN RESIDENT pECEpENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER McKay, Mary E. _ 21-08-1273 k an asset was matla Iolnt wkhln one year of the tlacetlent'a tlete of tleNh, I[ moat he reportatl on schetlula G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Michael M. Graham 519 Market Street Son Lemoyne, PA 17043 B. Jay D. Graham 250 Sam Snead Circle Son Etters, PA 17319 C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCwoe NAME oR FINpNapL INSnrunoN pNO epN%pccouNr NL)MRER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR downy-nEio REp~ESrprE. DATE OF DEATH VALUE OF ASSET ~o OF DECD~S INTEREST ogre of oEprH VAI-0E GF oeceoervrs lNrEREST 1 A 8/10/1987 Members 1st Federal Credit Union - 125.73 50.000% 62 87 Savings Account 73317-00 . 2 A 7/7/2003 Members 1st Federal Credit Union - 2,216.04 50.000°/p 1 108 02 Supplemental Savings #73317-01 , . 3 A 8/2/2007 Members 1st Federal Credit Union - 54.82 50.000% 27 41 Money Management Account #73317-OS . 4 A 6/12/2007 Members 1st Federal Credit Union - 10,696.96 50.000% 5 348 48 Certificate of Deposit #73317-47 , . 5 A 6/12/2007 Members 1st Federal Credit Union - 10,696.96 50.000% 5 348.48 Certificate of Deposit #733178 , 6 B 6/12/2007 Members 1st Federal Credit Union - 10,696.96 50.000% !5,348.48 Certificate of Deposit #73317-50 7 B 6/12/2007 Members 1st Federal Credit Union - 10,696.96 50.000% :5 348.48 Certificate of Deposit #73317-51 , 8 B 6/12/2007 Members 1st Federal Credit Union - 10,696.96 50.000% 5,348.48 Certificate of Deposit #73317-52 TOTAL (Also enter on Line 6, Recapitulation) I :!7,940.70 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) REVd191 E%~ (tb991 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & Art\Ar\OG~TPf\Tni~ ww~~_ ESTATE OF FILE NUMBER McKay, Mary E. 21-08-1273 ueors or aeceaent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. ~ c1~uCOAL En°ENuE~: - See continuation schedule(s) attached I 3,646.82 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State PA Zip 17043 Year(s) Commission paid 2. I Attorney's Fees Michael L. Bangs I 2,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. I Probate Fees 5. ~ Accountant's Fees 6. I Tax Return Preparer's Fees 173.00 7. Other Administrative Costs 221.70 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 6,541.52 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER McKay, Mary E. 21-08-1273 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Auer Cremation Services 1,526.30 2 Harrisburg Holiday Inn Hotel -funeral luncheon 1,654.02 3 Patriot News Co. -Obituary Notice 81.77 4 Peeler's Flower Shop -funeral flowers 384.73 H-A subtotal 3,646.82 Other Administrative Costs 5 Cumberland Law Journal -estate advertising 75.00 6 Register of Wills -Short Certificates 20.00 7 The Sentinel -estate advertising 126.70 H-B7 Subtotal 221.70 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule H (Rev. 6-98) ~, . Rav-1611 E%~ (8-gat SCHEDULE 1 DEBTS OF DECEDENT , MORTGAGE LIABILITIES, & LIENS C CM1TIONWEgLTM OF pENNSYLVANIN INHERITANCE TPII gETURN RESIDENT DECEDENT ESTATE OF McKay, Mary E. FILE NUMBER 21 08 1273 Inclutle unreimbureetl metllcal expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Camp Hill Emergency Physicians 31.97 2 Omicare Pharmacy Services 54 80 3 Premier Eye Care 19.41 4 Susquehanna Internal Medicine 6.35 5 Verizon 80.41 6 Visa 205.27 TOTAL (Also enter on Line 10, Recapitulation) I 398.21 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form FA-1500 Schedule 1 (Rev. 6-98) REV~161] EX~ 19-0a) I SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES - RESiOENT pECEOENT FILE NUMBER .,. ESTATE OF McKay, Mary E. NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do NOr Llai Trustees cr-vo-r SHARE OF ESTATE (WOfdS) cr~ AMOUNT OF ESTATE ($$$) Jay D. Graham Son 250 Sam Snead Circle Etters, PA 17319 Michael M. Graham Son 519 Market Street Lemoyne, PA 17043 Total Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri 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 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTERTOTAL 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) St MEMBERS lst FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT Account Number/Suffix 73317-00 Date Account Established D7/28/1987 Principal Balance at Date of Death $125 73 Accrued Interest to Date of Death $.O6 Total Principal and Accrued Interest to Date of Death $125.79 Interest Earned 0l/01/08-10/31/08 $2,79 Name of Joint Owner Michael Graham Date Joint Ownership Established 08/10/1987 SUPPLEMENTAL SAVINGS ACCOUNT Account Number/Suffix 73317-01 Date Account Established 07107/2003 Principal Balance at Date of Death $2,216.04 Accrued Interest to Date of Death $2.pg Interest Earned 01/01/08 - 10/31/08 $8.18 Total Principal and Accrued Interest to Date of Death $2,218.13 Name of Joint Owner Michael Graham Date Joint Ownership Established 07/07/2003 CHECKING ACCOUNT: Acccunt Number/Suffix 73317-11 Date Account Established 04/05/1988 Principal Balance at Date of Death $875.30 Accn~ed Interest to Date of Death $,Op Interest Earned 0l/01108-10/31/08 $.00 Total Principal and Accrued Interest to Date of Death $875.30 Name of Joint Owner None MOhIEY MANAGEMENT ACCOUNT• Acccunt Number/Suffix 73317-05 Date Account Established 03102/2007 Principal Balance at Date of Death $54.82 Accrued Interest to Date of Death $.01 Interest Earned 0l/01/08-10/31/08 $10 Total Principal and Accrued Interest to Date of Death $54.83 Name of Joint Owner Michael Graham Date Joint Ownership Established 03/02/2007 CERTIFICATES OF DEPOSIT Account Number/Suffix 73317.47 73317-08 Date Account Established 0 111 012 0 0 8' 01/10/2008" Principal Balance at Date of Death $10,696.96 $10 696 96 Accrued Interest to Date of Death $24.53 , . $24 53 Interest Earned 01/01/08 - 10/31/08 $395.14 . $395 14 Total Principal and Accrued Interest to Date of Death $10,721.49 . $10 721 49 Name of Joint Owner Date Joint Ownership Established Michael Graham , . Michael Graham 01/10/2008 01/10/2008 `Rollover from certificate 73317-45, originally established 06/12/2007 . "Rollover from certificate 73317-43, originally established 06/12/2007. 5000 Louise Drive PO. Box 40 Mechanicsburg, Pennsylvania ]7055 (500) 253-2328 wmrw.menl6etslsLOrg CERTIFICATES OF DEPOSIT Account Number/Suffix Date ACceunt Established 73317-50 73317-51 Principal Balance at Date of Death 01/10/2008' 01/10/2008" Accrued Interest to Date of Death $10,696.96 $10,696.96 Interest Earned 01/01/08 - 10/31/08 $24.53 $395 14 $24.53 Total Principal and Accrued Interest to Date of Death . $10 721 49 $395.14 Name of Joint Owner ' ' $10,721.49 Date Joint Ownership Established Jay Graham Jay Graham ovlolzooa ovlo/zooa 'Rollover from certificate 73317-40, originally established 06/12/2007 "` Rollover from certificate 73317-42, originall . y established 06112/2007. CERTIFICATES OF DEPOSIT: Account Number/Suffix 73317-52 Date Account Established 01/10/2008• Principal Balance at Date of Dealh $10 696 96 Accrued Interest to Date of Death , . $24 53 Interest Earned 0l/01/08-10131/08 . $395 14 Total Principal and Accrued Interest to Date of Death . $10 721 49 Name of Joint Owner , . Jay Graham Date Joint Ownership Established 01/1012008 'Rollover from certificate 73317-44, originally established 06/12/2007. M BERS 1sT FEDE L CR UNION Danielle A. Kline Insurance Services Specialist December 31, 2008 Estote oL MARY MCKAY Date of Death: November 19, 2008 Social Secur(ty Number: 193-24.0749 ~ ~~~~ ~ ~j~%e~/l~ 1 I, MARY E. McKAY, of the Borough of Wormleyburg, Cumberland County, ~ Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker ;~ and all expenses of my last illness, and any and all taxes and assessments imposed by any ~~-. governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a ~; ~ 1 part of the expense of the administration of my estate. °\~V `~, ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and adl other articles of household and personal use, equipment and ornament, together with all U ~~~ insurance thereon and relating thereto, in equal shares to my sons, MICHAEL M. GRAHAM and -?~ JAY D. GRAHAM, or to the survivor of them, provided they survives my death by thirty (301 c-' '~ days. ~'_~ ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my _,._., possessions and estate of every nature and wherever situate in equal shares to my sons, MICHAEL M. GRAHAM and JAY D. GRAHAM, or to the survivor of them, provided they survives my death by thirty (30) days. ITEM IV. All of the interests of the beneficiazies hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM V. I appoint my son MICHAEL M. GRAHAM executor of this my last will. Should my son predecease me or otherwise fail to qualify or cease to serve as executor of this my v last will, I appoint my son JAY D. GRAHAM executor of this my last will. ~ ITEM VI. In addition to the other powers and authorities granted to my personal Cx representatives by Pennsylvania law and by the other terms and provisions of this will, I hereb}~ give to my personal representatives the following powers and authorities effective without court ~~ .( ~ approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or v ~~ diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM VII. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. 2 ru ,, ~ IN WITNESS WHEREOF, I have hereunto set my hand this ~ -~ da of Y Lk~~" ~ ? t E ,~ , 2007. ~ ~- -; ~~- MARY t;. McK~(Y ---~ ~~`-- +t• .• The preceding instrument, consisting of this and THREE other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by MARY E. McKAY, the testatrix therein named, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. 4 cti• <t '.r COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) The undersigned, being the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acl.nowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Swarn o: affirmed to and acknowledged ber .rc ~*.e by the t tatrix named above this ;~~f dayof~ %~)'JCI(C,lt X007. ll~...„1 ~r ;~ deYU H i c ~. r ,. .~ COMMONWEALTH OF PENNSYLVANIA ~~ ~' ;~, MAR . McKA _ ~- ~ /~c lC ~'`, I (SS: WF„ i ~i~Jv.. / 4 /,4.v'~S and ~ ~ '~ ,the witnesses whose names are signed to the attached or foregoing instrument, bein 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 will; that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. i f~~ ~ r<~ Y? ~ or/ ~ ~~ ~.. 1~`~ ,~ ~ ~ 1--J~~.~ COUNTY OF CUMBERLAND affirmed do and acknowledged us ' ~" day of ~ ~ f _(. 1- , 2007. RK3T,~i~i, S1uRL 1R,EPfDY S. CHl_S,~3tU, P;a:~q F~hs'e Lous~r,~lNSn 7wp., Cutn4~nnd~.~r pAy Corrornlsc?o:t E.t~kgc play 10, 2fld1'