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Home My WebLink About02-09-11 (3)~ REW-1300 PA Department of Revenue Bureau of Individual Taxes PO 60X.280601 Harrisburg, PA 17128-0601 155610143 EX (01-10) OFFICIAL Pennsylvania county cod oawara-roe eevoue INHERITANCE TAX RETURN 21 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death D tif' f B'rtl Y 0980 a o I 172 Ol 1590 09 02 2010 05 05 1908 Decedent's Last Name Suffix Decedent's First Name ~, Mt BREIGHNER MAYBELLE I B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI i Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLIC T WVITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remai 'der 3 t~1 (date of death 1 }} q. Limited Estate ~ 48 Future Interest Co~romise 5, Federal E to (date oideath enerl2-12-82) ^ ~ Tax Return R cared ~ . 8 Decedent Died Testate ~ 7 ~t~i~jr ~)a Living Trust g, Total Nur~t (Attach Copy of Will) ofi Safe Deposit Boxes g. litigation Proceeds Received ~ 10. pgg°",1~-3191 T-1-95 mss' ~ 11. ~ n ~ rider Sec. 9113(A) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFOR TI SHOULD BE DIRECTED TO: Name Daytime Tel Number MICHAEL L BANGS 717 73 7310 t~~ REGISTER LS USE~6pILY T )~ First line of address f t t7 W [ ~ 1 " p ,-~ , m 42 9 SOUTH 18TH STREET I -~ . ~: ; -- a Second line of address II - n U ~. -n . . ' , ~ !'!'1 D N FILED ~j Cit or Post Office y State ZIP Code I CAi~ HILL PA 17011 I Correspondent's e-mail address: ~ Under penaltos of perjury, I declare that I have examined this velum, ' axo ac~sdides and statements, and t0 R is true oared and com Declaraltl rt ote f th th th F~I ~ my knowledge and belief, , p . o preparer o o er an e represen is basetl on all informatbn of which has any knowledge. TORE OF PERSON RESPONSIBLE FOR FILING RETURN I ATE Connie L. Gruber ~ ADDRESS 204 Market Street Lelwisber PA 17339 SI R OF P PARER OTHEJ;'11jfAN REPRESENTATIVE ' / ~ D V Z ~ Michael L. Bangs ~. ADDRESS 429 South 18th Street Cam Hill PA 17011 Side 1 1505610143 15C15611~0 43 III I J REV-1500 EX o.ced~n~. Nom: Brsighner, Maybelle B. Decedents So 'al Security Number 172 ql~ 1590 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Hekl Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................................................ 4. '22 64.92 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. , 6. Jointly Owned Property (Schedule F) ^ Separate Bitting Requested............ 6. 13 , 33 Sr . 2 0 7. Inter-Vrvos Transfers 8~ Miscellaneous ton,-Probate Property Billi S t R h t d S d G 6 S 4 3 . 4 7 epara e ng eques ............ ) (~J e ( c e ule 7. , ~ 8. Total Gross Assets (total Lines 1-7) ..................................................................... 6. ~04 , 42 .59 ' 6 , 17 . 5 7 9. Funeral Expenses 8 Administrative Costs (Schedule H) ....................................... , 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10. 51 . 3 9 11. Total Osductlons (total Lines 9 810) ................................................................... ' 11. 6 , 6 9 . 9 6 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12, 97 , 73 . 63 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Nst Value Subjsctto Tax (Line 12 minus Line 13) ............................................... 14, 97 , 73 . 63 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ~, 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0 0 (a)(1.2) X .00 . . 16. Amount of Line 14 taxable q 0 0 16 0 0 . at lineal rate X .045 . . 17. Amount of Line 14 taxable 0 00 17 00 . at sibling rate X .12 . . 16. Amount of Line 14 taxable 97 '731.63 at collateral rate x .15 . 16. 14 6 , 5 . 7 4 19. Tax Due .................................................................................................................. 19. Z 4 , 65 .7 4 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15D5610243 15D561p ~3 15C]5610243 !~ Rw•1508 EXa 16-981 $CHL~-~lLL ~ CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY ~ colYatoNwEAUN of PENNSnvANu INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE BER Brei hner Ma belle B. 21- 0 80 Indude the proceeds of Ift'pation and the dots the proceeds were received by the sable. All property Jo Mli yownsd rvftl~ !M ripM of eurvivophip must be ~ecloesd on seMdule F. ', I i ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 JP Morgan Chase ! 10.107.54 2 Members 1st Federal Credit Union -Savings Account ' 5,013.45 3 Members 1st Federal Credit Union -Checking Account ', i 7,402.08 4 SERS Benefit ' I i I 126.85 TOTAL (Also enter on Line 5, Recapitulatio 1 22,649.92 (If more space is needed, additional pages of the same size) i Copyright (c) 2002 form software only The Lackner Group, Inc. Form F~ ~I A- 500 Schedule E (Rev. 6-98) Rav-tliOY t:X+ 1a-9a1 _ A SCFr~D~L~ F coMMONweAUNOFPENNSnvANU JOINTLY-OWNED PROPERTY INHERRANCE TAX RETURN ', RESIDENT DECEDENT ESTATE OF FILE AMBER Brei hner Ma belle B. 21- 0 0 Man aasat was made J °int wNhin ores ywW the dacedsnCs date of death, It must bs rspoRad on SURVIVING JOINT TENANT(S) NAME ADDRESS RE IbNSHIP TO DECEDENT A. Connie L. Gruber 204 Market Street Nis e Lewisberry, PA 17339 i B, Leanna B. Worley 1700 Market Street Sis~er Camp Hill, PA 17011 i C. I JOINTLY OWNED PROPERTY: ITEM LETTER FOR JOI DATE MADE DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCUIL INSTITUTION AND BANK ACCOUNT DATE OF DEATH ° C~F DA ~O~ O TH ~ ' NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR ALUE OF ASSE INT FREST DECED NT S INTEREST JOINTLY-HELD REAL ESTATE. 1 B Bank of America 12,765.41 5 .000°~ 6,382.71 2 A 3/1/1880 Wachovia Bank -Checking Account #7489 21,080.28 3 .000°h 6,956.49 8 ~~ ~~ ~~ ~~ ',I ~I'i ~,, ~~~ ~, '~~I ~~ '~, i TOTAL (Also enter on Line 6, Recapltula~on) ~ ' 13,339.20 (M more space is needed, additbnal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form i~A-'~5b0 Schedule F (Rev. 6-98) I Rw-1510 EX+ 1B-961 '~ INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY '~ col,auoN~uEr~rnof: PENNSr~v~Nw INF~iITANCE rAX RETURN RESIDENT DECEDENT ESTATE OF FILE N AMBER Brei liner Ma belle B. 21- 0 0 This schedule must be Wlrlpkted and filed it the answer to eny or questions 1 through 4 on Die reverse aide of the REV-1500 COVER SHEET is I s. I ITEM NUMBER DESCRIPTION OF PROPERTY TME DATE~OF~ETROANF SFE~R.SATT~ACIi A COPY OFTTHE DElED FOOREREEA~L ES7AT~E. DATE OF DEATH VALUE OF ASSET x of oeco~s INTEREST (IF P $$ tl¢ABLE) T ALUEE 1 Wachovia Bank -Checking Account 1592 88,435.47 100.000% I I I 'i I I ~, ~ ', b.00 68,435.47 TOTAL (Also enter on Line 7, Recapitulation) ', ',88,435.47 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form P~1-15Q0 Scheduled (Rev. 6-98) i aEV.~~a~ ~rar~o-0a~ _ ~ . $cw~~u~.~ N ~ oti„ ,,,,,,p, FUNERAL EXPENSES ~ ~~~~ ' ADMINISTRATIVE COSTS ESTATE OF FILE U DER Brei hner, Ma belle B. 21-1 0 0 Debts of decedent must be reported on Schedule L ~~ ITEM DESCRIPTION '~ AMOUNIT A, FUNERAL EXPENSES: Ses continuation schedule(s) attached I 1,155.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ', Name of Personal Representative(s) i Street Address City State ZiD ~' Year(sl Commission paid 2. Attomev's Fees Michael L. Bangs 4,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ', Claimant Street Address C~tY State ZID Relationship of Claimant to Decedent 4. Probate Fees 269.50 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 249.07 See continuation schedule(s) attached __ TOTAL (Also enter on line 9, Recapitulation) !~ ~ 6,173.57 Copyright (c) 2009 form software ony The Lackner Group, Inc. Form P/~-1 ~00 Schedule H (Rev. 10-06) ......__ _ I._-~ I SCHEDULE 1~1 FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE IN MBER Brei hner Ma belle B. 21- 0 80 ITEM NUMBER DESCRIPTION '~, AMOUNT Funeral Expenses 1 Parthermore Funeral Home ', 1,155.00 H-A 1,155.00 Other Administrative Costs 2 Cumberland Law Journal -estate advertising ' 75.00 3 The Sentinel -estate advertising I' 174.07 H-B7 ' 249.07 Copyright (c) 2002 form software only The Lackner Group, Inc. Fonn I~A-1'~ Schedule H (Rev. 6-98) Rev-1512 t:X+(12-06) SCHEDU4E~ 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS coraroNwEA~TrIOFaENNSrwANw INIiERRANCE TAX RETURN ~ RESIDENT DECEDENT ESTATE OF FILE MIBER Brei hner Ma belle B. 21- 0 0 Report debt ineumd by Ufe decedent prior to death tMt nmalned unpaW at tM date of death, Ineludinp unraimbureed ITEM VALUE AT DATE NUMBER DESCRIPTION I OF DEATH 1 Heartland Pharmacy I 18.00 2 Heartland Pharmacy ~'~ 27.00 3 HRC Manor Care ~ i 356.00 4 SERS -refund of unearned benefit I I i i 118.39 TOTAL (Also enter on Line 10, Recapitulati n) 519.39 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software ony The Lackner Group, Inc. Form P ~i i A-1 i 5b0 Schedule 1(Rev. 12-08) REV-1513 EX+H1-0dl SCHEDULE J CON1~~!'R~~~~~-E"Y""'" BENEFICIARIES ESTATE OF FIL N ItABER Brei hner Ma belle B. 21- 0 80 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ES AT AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (words) (a$a> I TAXABLE DISTRIBUTIONS [include outright spousal • d~stnbutions, and transfers under Sec. 9116 a 1.2 Connie L. Gruber Niece 97,731.63 204 Market Street Lewisberry, PA 17339 I i I I, ~i I i I I I ~I I Total 7,731.63 Enter dollar amounts for distributions shown above on lines 15 thro h 18 on Rev 150 0 co r sheet a a riate. NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NO T I KEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS i I III illll I I TOT P T II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1 00 COVE S E Copyright (c) 2009 form software only The Lackner Group, Inc. Form P~--1~f0~0 Schedule J (Rev. 11-08) I II --- - _ I ; BankofM~elr~ca'~' December 9, 2010 Bangs Law Office 479 South 18~' Street Camp Hill Pa 17011 Dear Michael L Bangs: Bank of America received your request regarding the Estate of Maybelle B. Breighn~, pate of Death 09/02/2010. Below find the financial information requested on accounts held i t~e name of the decedent: avin s Account Number: 8639 ate of Death Balance: 12,765.41 ccrued Interest: 0.73 tatus: LOSED 12/03/2010 ltle: YBELL B BREIGHNER OR LEEANNA B RLEY Comments: No Safe Deposit Box found. ' ', Should you need additional assistance regarding the above named Estate such as obt~.ir~ir-g statement copies or closing accounts, please direct requests to the address noted below: Bank of America Legal Correspondence R.S. & S. Center BankofAmelrica'°' FL1-300-01-29 4109 Gandy Blvd II Tampa, FL 33611 'document lease contact e I arty listed For questions regarding the information contained in this , p ~ j below. ~~ Sincerely, ', Bank of America Account Validation 54ST ' '' 803-832-7770, Option 7 I'dX li dtlJlitlaJiVll tV/ GG/ GV1V 1l : YJ JG H!'1 Y`f'1lIC, t/ VVG i'd~Xi ~t51 VII ~1~. ~a~ee m: 3140727 Wachovia Bank I~ Balance Canfim~aticn 3ervioes P O Boa 40028 Roanoke, VA 24022 ' October 22, 2010 ', BANGS LAW OFFICE . ** I , SiJBIECf; V ~ C,an~wdoa afaooou~aE ~Hemeoc ~io~sadba prw;clod br: Caaka~er:llfAYBY.Li~ B H~I($N~~ (551wF~cX ~ ]59~) Date of DeatL: Septeasb~er ?,, 20i® li ~, ~c ~w.a DdaafDe.16 w.mDeH.ta~e Dale ~, I~ot YTD Dale ~ N~obQ i~ op~ ~ g.ae >~ rr..,c i~ cso.~a ~'~c~ ancr+e4 ~at~oao.~ 3nn4ro ~ I sa46 4nirmio tl~c,+-1.Zr1i.E:1~ux~u. B Ba1$cinv~t '~ IEE ANNA H WOID,EY QONNIE LEB (1RL11~B Q.OBII~3 HAIANCE: 3'2107938 ' ~43~.a7 erc6noio Sla3o ~13_i2 912412010 rECU.~: iu~u. s B~c~avFx i oo~N~ 1.E8 ciBUBex '~ CYA6ING B+lIaNCE: X68473.51 ~~, ,~ ,. ~! ~I Pp~toF2 __ Transmiss:~a~. 1U/z2/LOIU 11:43:52 AM PAGE 2/G~02 Fax Server ZZe~Sasoe m: 31vo7Yt i « I~te ~ death oal.,ce dean not iadude aoaned imeamt. • if dataaf deatliaawm~mawealom+daa iolidajs atlo dde~6eheoedaesaatimludaa~rtooea~tioost6rw~emrdedrrio~il~ttm ~aiod kmtifcr Straub Srrvicenter ~~sutciaUe Nbona:(540)563-T323 )s;Jo Byam¢ig~iaiefot~,idrao~r.~..drp.e.r.astr~r.ubvw~.Fa~aae+.HA('Wa~FaBd~,u~tu.wopie~sa$aadbylw n~wiaeL~Hlyt~isdormrloR 1~nroeipieot~eee~ciwa~mctioiceelh~i.a~oana+a:dt~•de..e.~p~bdndawbl4Mr~a~tY~it.ils~Y:~rct~i' '154 «Yn~auit Welbfasodosmtc~aaetaedwma~tbaltl~i~mrEiae.i~+odaaoaaat<Theaei~itlafLred~arlrlpabtdrii><mitimar~>a~ ~O~e eLteliorMipWiaa~iomer audWelkFago.lleio6®atcasai~}~aalgr~twiltiwt>t>boabtla>.dpistl5ewga~ct~osloidmYj.~rla~LboliWa~FgaY~misim a~ti~a'reliiae~SomtAn diadeame and ws ofNfe a>Rrmiiea bf Itteraipi~tar tie@Ehe 6taaa- bl~~rl'+lees~ea . wleeaaNWm.ar wae~molaieed Mewin. waol~avia Heduri Wachws Bast of Demme sa diviaima of ViaUs Faso Ba.t. xl. F.os z ar 2 2~1r-Cct-~? Q4:2" P"~ Jr `"organ Chase 21Q-588-3263 JPMorganChase u Qdaber 27, ao~n AtoentMn: ta~cNael L saner 1i1 JPMorpatf Lhasa $enk, NA. Comer FdAln~f-Decsw~ed Proo~ing t+AaU Code:'tX3~TB14 P.O. Box BSOlS1E San Antonio, TX 7t~Z6b tom: e Soais! t3aux~rt~y Misr: 7~ t)ate~ ~ nawth: a TSear sir or laadam: please t.id rated t~wow th• ~ rated in your u~r cia~a: ta0ei~ta y~e~~c.~-r~dN o~ ~uat~s JPMorDan Ctww Ba-tlr, NA. a ~adsaalgt tc~utsd iai MslNudott, dub ~ocPoratsd aced ~Ilflsd m act as the Utli~ed t#~t ae Amaarice, by acrd through the utfdtra~nsd oiRar, harsby oerlM~as (a of sven d~ htarrad ~~ t~Y~e far tsw Calais of ttlsioilowing AxouncNumber OwMraRAo~tart Pdndpwt ~~ DataAc~out~t ~ a ~o~t U.O.D. D. XXX)OOE87T86/ MAY[3LlLB BREfC3HNER, SOLE-t1WNtBR 10,iD7.34 Q 't217A14D84 CQ Sato Daposfi Boot ,„~„Yas ,„~,,,No EaoOC Number C'1atK Tak~phons N~n~er dascripd~n of toanr it any; t 9hocdd you haws argt qussti~ in ttsierscx;s b dsposk acaotr~, pmts ooraad us ad 86d-6a3~0746, ar rapt If you Claws quaadrona on amy atha a types. please coartad approprids li<r of husinsss. JP Chase dank. N.F1. By Anna Apuilsra to 1~86b+tOQr3~t63, ___ __ ~ _, MEMBERS 1't PBDHAAL CR8D1T UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued interest Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Acxount Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accnaed Interest Name of Joint Owner Estate of: IMaybele B. Breighner Date of Death: September 2, 2010 Social Security Number: 172-01-1580 370428-00 10!26/2009 $5,013.45 $0.04 $5,013.49 None 370428-11 10/26/2009 $7,402.08 $.02 $7,402.10 None MEMBERS 1ST FEDERAL t Leigh- ne Stallings Lending Insurance Support October 8, 2010 IT ~. 5()00 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania .17055 (800) 283-2328 w~vx~vmemberslst.org ~_ ~~~' ~'` I, MAYBELL B. BREIGHNER, of the Borough of Camp Hill, Cumberland County, Pennsylvania, declaze 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 gravemazker and all expenses of my last illness, and any and all taxes and assessments imposed by any goven!imental 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 part of the expense of the administration of my estate. ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all other articles of household and personal use, equipment and ornament, together with all insurance thereon and relating thereto, to CONI~TIE L. GRUBER provided she survives my death by thirty (30) 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 to CONNIE L. GRUBER provided she survives my death by thirty (30) days. ITEM IV. All of the interests of the beneficiaries 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 CONIVIE L. GRUBER executrix of this my last will. 1 _ _ _ _ ,~ A~ ITEM VI. In addition to the other powers and authorities granted to m}~ ~{~rsonal representatives by Pennsylvania law and by the other terms and provisions of this v~ill, I hereby give to my personal representatives the following powers and authorities effective v~rithout 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 inn kind, and ~n ~uch manner as I my personal representatives may determine and at valuations finally to be fixed b~ them; to invest in all forms of property, including any stock or other securities in any co~porate fiduciary or its successor without restriction to investments authorized for Pennsylvania ~id~cparies, as my personal representatives deem proper, without regazd to any principle of risk or ~di~ersification; I to retain any or all assets of my estate, real or personal, without reg#trd to any pr~n~iple of risk or diversification; to sell at public or private sale, to exchange, or to lease for any ~er~ad of time, any real or personal property and to give options for sales, exchanges, or leases, f such prices and upon such terms or conditions as my personal representatives iieem proper; ~~an~l to allocate receipts and expenses to principal or income or partly to each as my personal deem proper in their sole discretion. ITEM VII. I direct that my personal representatives and fiduciaries to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WIi~REOF, I have h An/ ' , 2006. rat be required 2 I i l_, The preceding instrument, consisting of this and TWO other typewritten'pa~ges, each identified by the signature of the testatrix was on the date thereof sued, publish. ,and declared by MAYBELL B. BREIGHNER, the testatrix therein named, as ar~d for her lastl~~ 11, in the presence of us, who at her request, in her presence, and in the presence of each c}th r, have i subscribed our names as witnesses hereto. i 3 ,. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ( SS: The undersigned, being the testatrix whose name is signed to the attached or r gping instrument, having been duly qualified according to faw, does hereby acknowledge th t Signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I si ed it as my free and voluntary act for the purposes therein expressed. ,~ ,~ . MA ELL B. BREIG~N ,~ Sworn or affirmed to and acknowledged ', bef a by the t n ed above thi ~ ,day ~, 06. i Notary Public WBrdY S, p ~ pubic ill LaMrAMn Twp., Cu~nl~~ I My Gamn~ion.E~nea 10 T007 COMMONWEA ) COUNTY OF CUMBERLAND (SS: ii WE, Y~ ~~~we,~ L ~ ~ and ~{e ~,/A~. 1~4a Q, the witnesses whose names are signed to attached or foregoing instrument, being duly q ~ified according to law, do depose and say that we were present and saw the testatrix sign and execute a instrument as her last will; that she signed it willingly and that she executed it as her Fie and volun ~ for the purposes therein expressed; that. each of us in the hearing and sight of the. testatrix si ed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or m re yiears of age, of sound mind, and under no constraint or undue influence. 7/%i I Sv~Jrn or rmed and acknowledged U/ hefare me thi day of i 2006. I ~i ~~ II 'I Notary Publ I ~~ ~ pubic '~ ~ Con+~elo?I"'pam'b«le I Coin, I' ~y ,toot I i 4 ~ __ --_