HomeMy WebLinkAbout12-08-11 (2)1505610105
-J REV-1500 a tO2.1,, t~
Of'FICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes ~~~ .E~.~ INHERITANCE TAX RETURN I I O
Po Box 280601. RESIDENT DECEDENT l ~J
Harrisburg PA a.~1,z8-o601 ~ I
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
209-12-1945 09/13/2011 10/27/1924
Decedent's Last Name Suffix Decedent's First Name MI
DAVIS E. RUTH
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Retum O 2. Supplemental Retum O 3. Remainder Retum (Date of Death
Prior to 12-13-82)
O 4. limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required
death after 12-12-82)
~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
DONALD J. MCCUEN 1;772) 664-5050
First Line of Address
9777 RIVERVIEW DRIVE
Second Line of Address
City or Post Office
MICCO
State ZIP Code
PA 32976
REGISTE~ WILLS USE ~ LY
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Correspondent's e-mail address: mCCUetI bellsouth.net
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Under penalties of perjury, 1 declare that I have examined this return, including accompanying schedules and statenx:r>ts, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal represerttative is based on all Informatbn of which preparer has any knowledge.
SIGNATURE OF PERSON SPONSIBLE FOR FILING RETURN DATE
~ ~cf-/r
ADDRESS
9777 RIVERVI W DRIVE, MICO, FL. 32976
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
J 1505610205
REV-1500 EX (FI) Decedent's Social Security Number
Decedent's Name: E. RUTH DAVIS 209-12-1945
RECAPITULATION
1. Real Estate (Schedule A) ............................................ . 1.
2.
......................................
Stocks and Bonds (Schedule B) 2,
. 20,796.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3.
4. Mortgages and Notes Receivable (Schedule D) .......................... . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5. 45,757.62
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... . 6. 49,850.46
7. Inter-Vvos Transfers 8~ Miscellaneous Non-Probate Property
168
59
65
(Schedule G) O Separate Billing Requested....... . 7. ,
.
8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 181,572.67
9. Funeral Expenses and Administrative Costs (Schedule H) .................. . 9. 2,933.71
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) .............. . 10. 3,376.25
11. Total Deductions (total Lines 9 and 10) ................................ . 11. 6,309.96
12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 175,262.71
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) ...................... .. 13.
14.
1 ( ) ......................
Net Value Sub'ect to Tax Line 12 minus Line 13 14.
.. 175,262.71
TAX CALCULATION -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_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 4.50
1g,
7,886.82
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE ....................................................... .. 19. 7,886.82
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610205 1505610205
REV-1500 EX (FI) Page 3
~lsisrlen~~~ ~`mm~le+O Af'IfIPpCC•
File Number
DECEDENTS NAME
E. RUTH DAVIS
STREET ADDRESS
104 WINCHESTER GARDENS
CITY STATE: ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
B. Discount
3. Interest
5.26
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.
(1)
Total Credits (A. + B) (2)
(3)
(4)
(5)
7,886.82
415.08
7,471.74
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 .............................................................................................................................. ^
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate considerafion? .............................................................................................................. ^
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or Fler 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 ~ AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1,1994, and before Jan.1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 0 percent [72 P.S. §9116(a)(1.2)].
e The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefirtiaries is 4.5 percent, except as noted in p2 P.S. §9116(a)(1)].
e The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 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-1503 FJC+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEp1~LE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
E. RUTH DAVIS 2011-00993
All orooerW ipintly.ownsd with right of survhrorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
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REV-i5o8 EX+ (ii-1o)
Pennsylvania
DEPARTMENT OF REVENUE
1NNFRiTANfF TAY RFTI IRN
SCHEDULE E
CASH, BANK DEPOSITS 8r MISC.
n-cocnwe~ DDnDCDTV
ESTATE OF: FILE NUMBER:
E. RUTH DAVIS 2011-00993
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 _ Household goods & Furnishings 1,425.00
2. Cash on hand 40.05
3. Sovereign Premier Checking 2891040082 1,414.23
4, Sovereign Money Market 1694060071 3,165.47
5. Sovereign Stmt. Savings Account 1694300490 0.18
g, Members 1st FCU Checking 382472-0011 130.07
7_ Members 1st FCU Savings 382472-0000 7.17
g. Members 1st FCU Money Management 382472-0005 12,694.51
g, Members 1st FCU 19 month CD 382472-0041 25,405.94
10. Jewelry 1,475.00
TOTAL (Also enter on Line 5, Recapitulation) $ I 45,757.62
If more space is needed, use additional sheets of paper of the sanne size.
REV-1$O9 EX+ (Ol-SO)
i~; Pennsylvania
DEPARTMENT OF REVENUE
SCNEp1~LE F
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
E. RUTH DAVIS 2011-00993
Deborah S. Davis (unmarried name)
e' E. Fred Davis
If an asset became jointly owned within one year of the decedent's date of death, it must be resorted on Sdiedule G.
SURVMNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A• Deborah S. Johnson 1417 Pine Ave., Vorhees, N.J. 08043 Daughter
C.
1584 Newville Rd, Carlisle, Pa. 17015
Son
ITEM
NUMBER LETTER
FDR ]DINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % of
DECEDENT'S
1NTERESi DATE OF DEATH
VALUE Of
DECEDENTS INTEREST
1. A. Members 1st FCU 15 mo. CD 382472-0042 ITF Deborah D. Johnson 10,066.63 100 10,066.63
2. B Members 1st FCU 19 mo CD 382472-0040 or E. Fred Davis 10,234.86 50 5,117.43
3. A $1000 I Savings Bond M0019753861 or Deborah S. Davis 1,839.60 50 919.80
4. A $1000 EE Savings Bond M25226190EE or Deborah S. Davis 1,603.20 50 801.60
5. A $1000 EE Savings Bond M34394750EE or Deborah S. Davis 1,540.80 50 770.40
6. A $1000 EE Savings Bond M28278198EE or Deborah S. Davis 1,571.60 50 785.80
7. A $1000 EE Savings Bond M27987890EE or Deborah S. Davis 1,603.20 50 801.60
8 A $10000 I Sevings Bond X0018424511 or Deborah S. Davis 13,484.00 50 6,742.00
9 A $5000 I Savings Bond V0012592351 or Deborah S. Davis 9,168.00 50 4,584.00
10 A $5000 I Savings Bond V0012514011 or Deborah S. Davis 9,198.00 50 4,599.00
11 B $1000 EE Savings Bond M27987889EE or E. Fred Davis 819.60 50 409.80
12 B $1000 EE Savings Bond M25226189EE or E. Fred Davis 1,603.20 50 801.60
13 B $1000 EE Savings Bond M23528679EE or E. Fred Davis 1,668.00 50 834.00
14 B $1000 EE Savings Bond M19463130EE or E. Fred Davis 1,854.80 50 927.40
15 B $5000 I Savings Bond V0012514001 or E. Fred Davis 9,198.00 50 4,599.00
16 B $1000 I Savings Bond M0019753871 or E. Fred Davis 1,839.60 50 919.80
JOINTLY OWNED PROPERTY:
TOTAL (Also enter on Line 6, Recapitulation) I; 43,679.86
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+ (o1-io)
Pennsylvania
~~ DEPARTMENT OF REVENUE
3WHERITANCE TAX RETURN
RESIDENT DECEDENT
SCEIEp~1LE F
70INTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
E. RUTH DAVIS 2011-00993
Deborah S. Davis (unmarried name)
e' E. Fred Davis
A• Deborah S Johnson 1417 Pine Ave., Vorhees, N.J. 08043 Daughter
If an asset became jointly owned within one year of the decedents date of death, it must be reported on Schedule G.
SURVMNG JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
c.
1584 Newville Rd, Carlisle, Pa. 17015
Son
ITEM
NUMBER LETTER
FOR ]DINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECEDENTS
INTEREST DATE OF DEATH
VALUE OF
DKEDENIS INTEREST
1' '¢ 1509 PAGE TWO
14 B $1000 HH Savings Bond M6523090HH or E. Fred Davis 1,000.00 50 500.00
15 B $10000 HH Savings Bond X887942HH or E. Fred Davis 10,000.00 50 5,000.00
16 B $1000 EE Savings Bond M45754496EE or E. Fred Davis 1,341.20 50 670.60
JOINTLY OWNED PROPERTY:
TOTAL (Also enter on Line 6, Recapitulation) I # 6,170.60
If more space is needed, use additional sheets of paper of the same size.
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REV-1510 EX+ (OS-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
E. RUTH DAVIS 2011-00993
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, 7NEIR RELATIONSF4P TO DECEDENT AND
THE DATE OF TRANSFER. ATRCH A COPY OF THE DEED FT;tt REAL ESTATE. DATE OF DEATH
VALUE OF ASSh7 °/a OF DECD'S
INTEREST EXCLUSION
(IF aPPLICA~.EI TAXABLE
VALUE
1. Western National Life Insurance Co. SP Annuii XP220589. Issued 6130/05. 9,014.Ei9 100 9,014.59
Benefiaarys E. Fred Davis and Deborah S. Davis, Son & Daughter.
Also shown on Sovereign Bank Stmts. as AIG Bonus Flex 7, Acct. #1131803,
as it was purchased through their Investment Svcs. Dept.
2 Western National Life Insurance Co. SP Annuity XP215261. Issued 213106. 20 022.!30 100 20,022.80
Beneficiarys E. Fred Davis and Deborah S. Davis, Son & Daughter.
Also shown on Sovereign Bank Stmts. as AIG Bonus Flex 7, Acct. #1192484,
as it was puchased through their Investment Svcs. Dept.
3 $5,000 I Savings Bond V0014680731 Issued 0112003 POD Deborah Davis 7,210.00 100 7,210.00
4 $5000 EE Savings Bond V2349752EE Issued 0711992 POD E. Fred Davis 6,706.00 100 6,706.00
5 $10000 EE Savings Bond X2185078EE Issued 0711992 POD E. Fred Davis 13,412.1)0 100 13,412.00
6 $1000 EE Savings Bond M45754496EE Issued 08.1992 POD E. Fred Davis 1,341.20 100 1,341.20
7 $5000 I Savings Bond V0023534011 issued 0912002 POD E. Fred Davis 7,462 00 100 7,462.00
TOTAL (Also enter on Line 7, Recapitulation) ; I 65,168.59
If more space is needed, use additional sheets of paper of the same size.
WESTERN ~ NATIONAL
L i f e Insurance C o m p a n y
P.O. Box 871
Amarillo, Teicas 79105-0871
1.800.424.4990
November 28, 2011
DONALD J MCCUEN
9777 RIVERVIEW DR
MICCO FL 32976
Re: Annuity Contracts:
Contract Owner:
Dear Mr. McCuen:
BX202371, XP220589 and XP215261
E Ruth Davis, Deceased
Thank you for your recent inquiry regarding these annuity contracts. We would like to take this
opportunity to respond to your request.
The accumulated value of contract XP220589 as of September 13, 2011, the date of death is
$9,014.59.
The accumulated value of contract XP215261 as of September 13, 2011, the date of death is
$20,022.80.
Policy BX202371 was surrendered at an early date by E Ruth Davis, therefore there are no
benefits payable under this contract.
We appreciate the opportunity to assist you. Should you have any questions, please contact our
Client Care Center at 1-800-424-4990.
Sincerely,
Ange a Furlong
Annuity Claims Department
REV-1511 EX+ (10-09)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
E. RUTH DAVIS 2011-00993
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I' Hoffman-Roth Funeral Home, Direct Cremation, Service, Clergy, Coroner, Death Certificates 8~ Obituary 2,610.62
Estate Cks.1005 & 1008
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) Donald J. MCCuen
Street Address 9777 Riverview Drive
2.
3.
4.
5.
6.
7.
B.
s.
city Micco State FL ;zIP 32976
Year(s) Commission Paid:
Attorney Fees:
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
City _ State
Relationship of Claimant to Decedent
Probate Fees:
Accountant Fees:
Tax Return Preparer Fees:
Stringfellows Apartment Furnishings Valuation
Patriot News Legal Notice
Glenda Famer Strasbaugh, Register of Wills Fees
75.00
102.59
145.50
TOTAL (Also enter on Liine 9, Recapitulation) ; 2,933.71
ZIP
0.00
If more space is needed, use additional sheets of paper of the same size.
.,
REV-1512 EX+ (12-08)
Pennsylvania
DEPARTMENT Of REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES ~ LIENS
ESTATE OF FILE NUMBER
E. RUTH DAVIS 2011-00993
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 • Member's 1st FCU Visa cans 46720900 0037 2334 66.77
2. Central Link (phone co.) Estate Ck.1002 29.46
3. Stringfeltows Used Furniture valuation of apartment furnishings. Estate Ck.1003 75.00
4. Med Staffers. Estate Ck.1001 1,784.25
5. P.P. & L. Estate Ck.1004 54.24
6. Med Staffers, Estate Ck.1006 838.50
7. AOL. Estate Ck.1007 25.90
8 Med Staffers (final bill) Estate Ck.1009 502.13
TOTAL (Also enter on Line 10, Recapitulation) I; 3,376.25
If more space is needed, insert additional sheets of the same size.
.,
REV-1513 EX+ (01-10)
Pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
E. RUTH DAVIS 2011-00993
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustce(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. E. Fred Davis, 1584 Newville Rd., Carlisle, Pa. 1015 Son 50°~
2. Deborah S. Johnson,1417 Pine Ave., Vort~ees, N.J. 08043 Daughter 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
II NON TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON TAXABLE DISTRIBlTIONS ON LINE 13 OF REV-1500 COVER SHEET. I ¢
If more space is needed, use additional sheets of paper of the same size.
~,
LAST WILL AND TESTAMENT
I, E. RUTH DAMS, of 107 Winchester Gardens, Carlisle, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby declare this to be my last will, hereby revoking any
and all wills heretofore made by me.
Item I. I direct that I be cremated and that my ashes be thrown to
the mountain winds at the top of Waggoners Gap of Carlisle by my son Fred on
his Harley, if he is able to do this for me. I prefer no viewing, however, I leave
this decision to my children to make it as easy as possible for them. Throw away
any ashes a:~rd get on with your 1_~.ves. Remember only the good times we had.
Item II. I direct my executor hereinafter named to pay all my debts
and funeral expenses.
Item III. I give and bequeath all the rest, residue and remainder of
my estate to my two children, E. (Edward) Fred Davis and Deborah Susan Davis.
If one of them should predecease me, I direct their share to go to the surviving
child. If both should predecease me, I give and bequeath m;y entire estate to my
brother, Donald J. McCuen of Micco, Florida.
Item IV. I nominate, constitute, and appoint my brother, Donald J.
McCuen as executor, and I direct that he serve without bond. If my brother shall
predecease me or be unable to serve, I appoint my son, E. Fred Davis, as
substitute executor, and I direct he shall serve without bond ,also.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this the
/9'11 day of March 2008.
~ r
E. Ruth 1;'nV15
Signed, sealed, published and declared by the above-named testatrix, as and for
her last will and testament, who at her reques#, in her presence, in our presence,
and in the presence of each other, have hereunto subscribed our names as
attestir+rg witnesses:
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COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND
SS.
l~~~l f C~i ~~-~'
We, ~ and~.1 the
witnesses whose names are signed to the attached or foregoing ins ent, being
duly qualified according to law, do depose and say that we were present and
saw testatrix sign ar~d execute the instrument as her last-will, and that she signed
willingly and that she executed it as her free and voluntary act for the purposes
therein contained, that each of us in the hearing and sight of the testatrix signed
the w,~ill 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.
Sworn to and subscribed before me
this ~_day of March, 2008.
c
~;
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r.
Notary
illi'`t ~1' wldx3 uo~sm+w~o~
~ ~~
~jM,~C~Mr1rMC~4-
~eww1M ~s.IMr ~ ~N
' / ~.
COMMONWEALTH OF PENNSYLVANIA, ~
COUNTY OF CUMBERLAND ~ SS.
I, E. Ruth Davis, whose name is signed to the attached o
instrument; havin r foregoing
g been d'~Y qualified according to law, do hereb
acknowledge that I signed and executed the ' Y
signed it willin I instrument ~ n'Y last will, that I
~ g Y, and that I signed it as my free and voluntary act for the
p riposes tlle,-e±r exPrQSSed.
/~
1
E. Ruth Davis
Sworn to and subscribed before me
this -__~ ~ __ day of March, 2tlOg.
Notary
~~ ~dAet seal
~ otary ~'
SOf011gh, Ct~mberiei~cf i:cuMr
~wMMbn ExPiras June 3, ~