HomeMy WebLinkAbout09-21-09Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau First
Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOfCE
Bill To: InvoiceNo: 2637
DONALD F DAVIS ESQ Invoice Date: 9/10/2009
Estate of THELMA P RICHARDSON
PO BOX 205 Estate No: 21-09-0152
SAP
NEW KINGSTON, PA 17072-
_ Qty Fee Description Fee Total
1 Additional Probate 240.00 $240.00
Total: $240.00
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Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
DONALD F. DAMS, ESQ.
Attorney and Counselor at Law
P.O. Box 205
New Kingstown, PA 17072 ~ Phone: (717) 909-2339
Fax: (717) 774-1919
September 14, 2009
Re ister of Wills
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Re: Estate of Thelma P. Richardson {r,Q
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File No. 21 09 O l 52 ~
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Dear Sir:
Enclosed find an original and two copies of an amended Inheritance Tax Return for the
above referred to estate.
The decedent owned two assets that were non-probate property. I included the non-
probate property on Schedule "E" which was incorrect. I have removed the non-probate
property from Schedule "E" and listed it on Schedule "G".
The new return shows that the inheritance tax is the same amount as on the original
return. I am filing the amended return to show that the probate fees should be based upon
$4,327.25 instead of $130,865.02.
If you have any questions, please call me at (717) 909-2479.
Sincerely,
Nancy L. Anderson, Paralegal
to Donald F. Davis, Esq.
.~ ,r
J 15056071,2],
REV-15 0 0 EX
(OS-05)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes
Po Box 28oso1 County Code Year File Number
INHERITANCE TAX RETURN
Harrisbu PA 17128-0601 RESIDENT DECEDENT 2 1, 0 9 0 1, 5 2
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
Date of Birth
0 0 9 0 1 7 9 1 2 0 1 1 9 2 0 0 9 0 6 2 7 1 9 2 0
Decedent's Last Name Suffix
Decedent's First Name
R I C H A R D S O N MI
T H E L M A
P
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
N O T A P P L I C A B MI
L E
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER QF IIUILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return
0
2. Supplemental Return ~ 3. Remainder Return (date of death
4. Limited Estate ~ prior to 12-13-82)
4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
d
^X s. Decedent Died Testate ~
A eath after 12-12-82)
7. Decedent Maintained a Livin Trust
g
(
ttach Copy of Will)
9
Liti
ti
P -.--. 8. Total Number of Safe Deposit Boxes
(Attach Copy of Trust)
.
ga
on
roceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec
9113 A
b
t
( )
.
e
ween 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED
A
Name .
LL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
D O N A L D F Daytime Telephone Number
- D A
Firm Name (If Applicable) V I S E S Q 7 1 7 9 0 9 2 3 3 9
r•a
REGISTE~F WILLS US LY -~
First line of address ~ -p ~„; ;~ C ,..7
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P O B O X 2 0 5 ~ ~, rya- r:. _
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Second line of address ~
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City or Post Office ~,p - ~
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State ZIP Code D
~E FILED Q -.
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N E W K I N G S T O W N P A 1, 7 0 7 2
Correspondent's a-mail address:
Under penal8es of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
G RE OF PERS R NSIBLE FOR FILING RETURN
DATE
i
ADDRESS _/~ -~
322 VALLEY ROAD, ETTERS, PA 17319
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
L 1505607121
Side 1
1505607121
J
1505607221
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: THELMA P• RICHARDSON 0 0 9 0 1 7 9 1 2
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 8~ Notes Receivable (Schedule D) ........................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 4 3 2 7 . 2 5
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ....... 7. 1 2 6 5 3 7, 7 7
8. Total Gross Assets (total Lines 1-7) ........................... g. 1 3 0 8 6 5. 0 2
9. Funeral Expenses 8 Administrative Costs (Schedule H) ................ 9. 2 9 6 9 . 4 7
10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ..... ....:.. 10.
11. Total Deductions (total Lines 9 8~ 10) .................... ....... 11. 2 9 6 9 . 4 7
12. Net Value of Estate (Line 8 minus Line 11) .................. ....... 12. 1 2 7 8 9 5. 5 5
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. 1 2 7 8 9 5. 5 5
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. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 1 2 7 8 9 5. 5 5 1 s. 5 7 5 5. 3 0
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18. 0. 0 0
19. Tax Due ......................................... ....... 19. 5 7 5 5. 3 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
1505607221 1505607221
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 09 0152
DECEDENTS NAME
THELMA P. RICHARDSON
STREET ADDRESS
1700 MARKET STREET
CITY STATE Zlp
CAMP HILL PA 17011
Tax Payments and Credits:
~• Tax Due (Page 2 Line 19) (1) 5,755.30
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 5,271.21
C. Discount 263.56
Total Credits (A + B + C) (2) 5, 534.77
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval 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.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4) 0.00
(5)
(5A)
220.53
(56) 220.53
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 : ...................................................................... ^ X^
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ 0
c. retain a reversionary interest; or ................................................................................................
d. receive the promise for life of either payments, benefits or care? ....................................................... ^
^ 0
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? ......... ^
Q
^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 0 ^
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 child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)j. 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-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RESIDENT DECEDENTRN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
THELMA P. RICHARDSON 21 09 0152
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, Integrity Bank checking account #203006659 (see attached letter, marked Exhibit "3" 1,482.25
and incorporated herein by reference)
2. Refund from Manor Care 2,717.00
3. Refund from Pennsylvania Income Tax 128.00
4. Assorted clothing - no value
TOTAL (Also enter on line 5, Recapitulation) I $ 4,327 25
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
COM NH RI~ cE AX RETURN ANIA MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THELMA P. RICHARDSON 21 09 0152
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST
(IF APPLICABLE) VALUE
1, Manning & Napier Fund, Inc. (see attached facsimile dated 48,218.72 100. 48,218.72
February 20, 2009, marked Exhibit "1"and incorporated
herein by reference)
2. ABWE Foundation Inc. WGA #1319 (see attached letter 78,319.05 100.
dated January 19, 2009, marked Exhibit "2" and incorporated
herein by reference
TOTAL (Also enter on line 7
(If more space is needed, insert additional sheets of the same size)
78,319.05
126,537.77
REV-1511 EX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
THELMA P. RICHARDSON
SCHED!!LE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
~1 n4 n~,
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
A• FUNERAL EXPENSES:
~• Pathemore Funeral Home & Cremation Services, Inc.
2• Anair Memorials (grave marker)
3• Lyndon Center, Lydonville, Vermont (internment)
AMOUNT
408.17
1,166.00
300.00
B• ADMINISTRATIVE COSTS:
~ • Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State
Zip
Year(s) Commission Paid:
2. Attorney Fees Donald F. Davis, Esq.
3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation)
Claimant
Street Address
Cry State
Zip
Relationship of Claimant to Decedent
4• Probate Fees Cumberland County Register of Wills
5, Accountants Fees
6• Tax Return Preparer's Fees
~• Cumberland Law Journal
8• The Sentinel
9. Pamela Purrington (reimbursement for flowers for internment)
10. Pamela Purrington (reimburesementfnr pastor and pianist at funeral)
11. Benjamin Barrett - (preparation of DVD of funeral service)
500.00
54.00
75.00
166.30
50.00
200.00
50.00
TOTAL (Also enter on line 9, Recapitulation) ~ s
(If more space is needed, insert additional sheets of the same size)
2,969.47
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
THELMA P. RICHARDSON 21 09 0152
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Pamela R. Purrington Lineal 40,786.93
322 Valley Road
Etters, PA 17319
2 Gregory N. Richardson Lineal ~ 40,786.93
5641 Bidwell Pkwy #102
Sarasota, FL 34233
3 Jeffrey L. Richardson Lineal 40
786.93
66757 Reilly Road ,
Gregory MI 48137
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)
,Feb 20 2009 3:33PM HP LRSERJET FAlt
PQ BaX 182454 • COLUMBUS, OH 43218
p. ($OC}j 466-3863 f. (614) 428-3390
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ing
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Tor Parn Farrington Fromm lCmberiy M. Woof!
Eruct 717-774-1919 ~lil~ ~
p Dotb: 0~l20109
RrM: Accout:t VaN.ie Verification ~~
^ tJr~snt D por Roview D PMrao Contt~nt ^ Pl~wso R.oply D Plartros R~ycfa
Ms. Farrington.
Please let this fax serve as cvr:firmation of Thelma Richardson's TOD account vale as of her date of
death on 1N 9109. The avcamt vedue as of 1!19/09 was $48,218.72. The price per share was $10.04.
Please let me know if you have any questions or need anyth~g ®Isa. Thenk you.
Best Regards,
~~~ ~~
C?
Kimberly M. Wood
Fund Servkes Assacia~e
Distributed by Manning 8~ Napier Inaes~r Services, Inc.
ne
ASSOCIATION OF BAPTISTS FOR WORLD EVANGELISM
January 19, 2009
To Whom It May Concern:
This letter is to confirm that on this day of January 19, 2009, the date of death of Thelma P.
Richardson, there was an account balance of $78,319.05 with the ABWE Foundation, Inc.
Sinc ly,
tit '
Larry D. Inskeep
Director of Accounting
ABWE Foundation, Inc.
P.O. Box 8585
Harrisburg, PA 17105-8585
Phone: 717-909-2335
MAIL P.O.Box 8585, Harrisburg, PA 17105-8585 PHONE 717-7747000 FAX 717-7741919 WEB www.abwe.org
DELIVERIES 522 Lewisberry Road, New Cumberland, PA 17070
CANADA OFFICE 980 Adelaide Street South, Suite 34, London, Ontario, CANADA N6E 1 R3 PHONE 519-690-1009
(~ ((r ~~ ft !- 1
WITHDRAWABLE GIFT AGREEMENT # 1319 , _~ , ~
THIS AGREEMENT, prepared in duplicate, entered into this 16th day of August, 2007
between THELMA P. RICHARDSON (Donor), now residing at 322 Valley Road, Etters, PA 17319
and the ABWE FOUNDATION, INC., a Pennsylvania nonprofit corporation ("FOUNDATION"),
provides as follows:
The FOUNDATION acknowledges receipt of SEVENTY-FIVE THOUSAND
DOLLARS ($75,000.00) as the initial withdrawable gift made by Donor for the purpose of establishing
this Withdrawable Gift Agreement. This amount and any further additions which the FOUNDATION
shall accept from the Donor shall be held under the conditions set forth in this agreement.
1. DEPOSITS AND WITHDRAWALS. Donor reserves the right from time to
time, to make withdrawals from, and deposits to this Withdrawable Gift Agreement in amounts not
less than five hundred dollars ($500.00), except that reinvestments of income may be made in any
amount. The FOUNDATION agrees to make payment of withdrawal within ten (10) days of receipt of
a written request.
2. INTEREST. The FOUNDATION agrees to pay interest on balances credited to
this account from the date received until the date of withdrawal payment. Interest will be paid or
credited to on the last day of each calendar quarter this agreement is in effect. The rate of interest shall
be set by the Board of Directors of FOUNDATION annually. The current rate is four and two-tenths
percent (4.20%) per annum.
3. TERMINATION. Upon the death of Donor, the remaining balance, less interest
accrued from the last interest payment date preceding the Donor's death, shall be distributed, in equal
shares, to Pamela R. Purrington, Jeffrey L. Richardson, Gregory N. Richardson, children of Donor.
4. RIGHT TO CANCEL. The Donor reserves the right to terminate this agreement
or request withdrawal of the entire balance upon thirty (30) days of receipt of written notice to the
FOUNDATION by registered mail.
The FOUNDATION reserves the right to cancel this agreement at any time by paying
the balance to the Donor together with any unpaid accrued interest.
5 OTHER CONDITIONS. This agreement shall be binding on and inure to the
benefit of the parties, their heirs, executors, administrators, legal representatives, successors and
assigns.
/yF ., ^ 4
7 ~..
THELMA P. RICHARDS fi~1(Donor)
ABWE FOUNDATION, INC.
By: William on, President
~,
Attest: ce . Jac s ,Director
Planned Giving Minis 'es
EXHIBIT "3"
03/ l l f 2005 14:34
7179015501
INTEGRITY BANK
~rregxiry
B I1 N K
On the day of January 19~' 2009, Thelma R.ichardson's checking account
number 203006659, had an account balance of $X482.25. This balance
reflects any and all transactions and interest payments up to that date.
PAGE 02f 82
Si»cere~y,
~ ~
Toseph Ritter
Customer Service Rep.
Integrity Bad
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3345 Man~rt Scnx4 C+~mj+ X;ll, ,F~ ,f7Cltl - ~i'rbs~: 7X7-91x0-490.87?- I-fIA1rF..F!'' • FRx: 7.17 ?10-~f7~ • wweu ~r~te~rrr,}~bwrt~r4xe.~o~x
URiGiNAL AT LRW OFFfCE OF
LEAHY & DEFAULT, LLP
178 BROAQ ST.; P.O. BOX 829
GLARE~iGNT, NH 03743-0829
(603a 543-3185
~Lagt t~C and ~C¢sfamettt
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of
~~jeCma ~. ~i~jarb~ott
. I, Thelma P. Richardson, of Claremont, in the County of Sullivan and State of New
Hampshire, do make this my last will, hereby revoking alI earlier ones,. and I dispose of my estate
in the following manner:
1. I direct the payment of all my just debts, funeral expenses and expenses of
administration of my estate.
2. I direct that any legacy and succession tax, inheritance, estate, transfer, or similar tax,
whether state or federal or foreign, which shall be imposed on my taxable estate, whether or not
passing under this will, or upon any beneficiary or other recipient thereof as a result of my death,
shall he paid out of the residue of my estate as an expense of adrnin.istration without proration.
3 . Mindful of any children and issue of deceased children of mine who may survive me
who are not named or referred to in this will, I make no specific provision for any one of them other
than as herein provided.
4. I may leave a memorandum stating my wishes with respect to the disposition of certain
articles of my tangible personal property, but such memorandum will be simply an expression of my
1
LEAHY 6t D.ENALfLT. LLP • ATTORNEYS AT LAW • 178 BROAD STREET • P.O. 80X 929 • CLAREMOIVT. tVH 03743-0829 • C503} 543-3185
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wishes and shall not create any trust or obligation, nor shall it be offered for probate as a part of this
will.
5. Ali the rest, residue and remainder of my estate, whether real or personal and
wherever situate, I give, devise and bequeath to my husband, C. Ross Richardson.
_In the event that my said husband should predecease me, or in the event that our deaths
should occur simultaneously, or approximately so, or in the same common~accident or calamity, or
under any circumstances causing doubt as to which of us survived the other, then I give, devise and .
bequeath all the rest, residue and remainder of my estate, whether real or personal and wherever
situate, to my children, Jeffrey Richardson, Pamela Farrington; and -Gregory Richardson, all in
t .~
equal shares share and share alike. If any of my said children shall have predeceased me said ..
deceased child's share shall pass to his or her issue, per s~irpes; and for lack of such issue tv my
children then living:
. b. An adapted ~ child in any generation and his issue, including adopted issue, shall have
the same rights under this instxwment as if born to the adopting parent and of the same blood. .
7. I naminate and appoint my daughter, Pamela Puritagton, as Executrix of this my last
will and testament. If she shall not be living at the tune of my decease, or if, for any reason, she
shall be unable or unwilling to accept this trust and act as Executrix of this my last will and testament,
I nominate and appoint my son, Gregory Richardson, as the. Executor hereof. Except as otherwise
specifically herein limited, my Executrix and her successors shall have all of the powers conferred
on trustees by New Hampshire RSA 564-A, the Uniform Trustees Powers Act, as it exists at the date
of this execution of this Will, which Statute is hereby incorporated by reference.
2
I~
IN WITNESS WHEREOF I have hereunto set my hand and seal this 27`h day of May 2005.
...-.
/~h ~l
! i' f ~~
Thelma P.
Signed, sealed, published and declared by the ~ above=named Thelma P. ~tichardson as her
Iast. will and testament in our presence who at her request ~n her presence ~ and in the presence of each
other have hereunto set our names as witnesses the year and date above written.
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STATE OF NEW HAMPSHIRE
COUNTY OF SULLIVAN
We, Thelma P. Richardson, Denise B .~ Saucier; and Debra Johnson-IVlelchex, 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 Iast will and that she had signed willingly or 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, at the request of the testatrix, in her presence, and in the presence of each
other, signed the will as witness and that to the best of their knowledge, the testatrix was at that time
IS or more years of age, of sound nand and under no constraint or undue influence.
. Thelma P. Richar on
Testatrix
.. t
Wi e s '
Witness
Subscribed, sworn to and acknowledged before me by Thelma P. Richardson, the testatrix
and subscribed and sworn to before me by Denise B. Saucier and Debra Johnson-Melcher, the
witnesses, this 27`~ day of May 205.
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