HomeMy WebLinkAbout05-09-13 1505610105
REV-1500 a(02-11"R'
lvantd OFFICIAL USE ONLY
PA Department of Revenue P arms,m Y County Code Year File Number
75
Bureau of Individual Taxes INHERITANCE TAX RETURN 77
PO BOX 28o6o1 �....
Harrisburg PA 17128-0601 RESIDENT DECEDENT �� 13
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
_ : 02/10/2013 03/2011930
Decedent's Last Name Suffix Decedent's First Name MI
DAVIDSON CATHERINE V
(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
m 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
CMD 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 TO:
Name Daytime Telephone Number
'Thomas P. Gleason (717) 53233270
REGISTER OF WILLS U$ ONLe
r -1 F
First Line of Address _ _ �➢ r'j co r,i C:r
49 W. Orange St.
Second Line of Address
c-
._a r-
-....._......-- GATE FILED-'. C1 -
City or Post Office State ZIP Code
Shippensburg PA 17257
Correspondent's e-mall address:tomgleason @tomgleasonlaw.com
Under penalties 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.
SIG T,IIURE O PE RES ONSIBLF-F?R FILING RETURN r DATE Y�
!U w ` aam,&(7
ADDRESS
447 W. Main St.,Walnut Bottom, PA 17266
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: '
RECAPITULATION
1. Real Estate(Schedule A). ............... ..... ...... ................... 1. 135,000.00
i
2. Stocks and Bonds(Schedule B) ... ........ .......................... .. 2. j 13,502.46
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. ' 0.00
4. Mortgages and Notes Receivable Schedule D 4.1 0.00 1
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)..... .. 5. ( 154,246.12 ',
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. ! 0.00
7. (Schedule Transfers&Miscellaneous Non-Probate Properly ( 30,299.04
(Schedule G) OD Separate Billing Requested........ 7. i
8. Total Gross Assets(total Lines 1 through 7)....................... ...... 8.
� 333,047.62 '
9. Funeral Expenses and Administrative Costs(Schedule H)................ ... 9. 22,576.56
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)... ............ 10. 4,848.40
11. Total Deductions(total Lines 9 and 10).................... ............. 11. 27,424.96
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 305,622.66
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ................. ....... 13. 0.00
14. Net Value Subject to Tax(Line 12 minus Line 13) ...... ........... ... .... 14. 305,622.66
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 000
(a)(1.2)X.0- . 15.1 0.00
16. Amount of Line 14 taxable
at lineal rate X.0 45 305,622.66 16.', 13,753.02
17. Amount of Line 14 taxable
at sibling rate X.12 0.00 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X AS 0.00 � 18. 0.00
19. TAX DUE............ ................ ..... ........................ 19.':� 13,753.02
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Catherine V. Davidson
STREETADDRESS
50 Water Street
CITY STATE ZIP
Walnut Bottom PA 17266
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 13,753.02
2. Credits/Payments
A.Prior Payments
B.Discount 687.65
Total Credits(A+B) (2) 687.65
3. Interest
(3) 0.00
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. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 13,065.37
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.......................................................................................... ❑ nX
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?...................................................................... ❑ IN
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ X
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 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)(11)(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)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[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 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-1502 IX+(12-12)
Topennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DEDEDENr
ESTATE OF: FILE NUMBER:
CATHERINE V. DAVIDSON
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 exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that Is Jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
REM Include a copy of the deed showing decedent's Interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION [+
Real estate located at 50 Water Street in Walnut Bottom,PA 17266-Parcel#41-31-2232-002. , Y135,000.00
L ! _
i
' 135,000.00 s
TOTAL(Also enter on Line 1,Recapitulation.) _
If more space is needed,use additional sheets of paper of the same size.
REAL ESTATE
AGREEMENT OF SALE
THIS AGREEMENT OF SALE ("Agreement") is made this day of
April, 2013, by and between the ESTATE OF CATHERINE V. DAVIDSON, by
ROBERT ALLEN DAVIDSON, Executor, of Cumberland County, Pennsylvania
(hereinafter referred to as "Seller"), and RYAN A. DAVIDSON, single, (hereinafter
referred to as"Buyer").
WITNES SETH,that in consideration of the mutual covenants and agreements
hereinafter contained,the parties, intending to be legally bound hereby agree as follows:
1. Seller shall sell to the Buyer and Buyer shall buy from Seller real estate lying
and being situate in South Newton Township, Cumberland County, PA. Said
parcel is known and identified as Parcel ID No. 41-31-2232-002 and is more
particularly described in a deed filed in the Office of the Recorder of Deeds
for Cumberland County, Pennsylvania in Deed Book Volume 250, Page 928.
2. Buyer shall pay to Seller as the total purchase price for the above-described
property pursuant to this Agreement the sum of One Hundred Thirty-Five
Thousand ($135,000.00)Dollars. The Buyer did not make an earnest money
down payment at the time of signing this agreement and the.purchase price is
to be paid in full to the Seller at the time of settlement.
3. The property shall be conveyed by special warranty deed and title to the
Property shall be good and marketable and free from all liens and
encumbrances, easements, conditions, reservations, rights-of-way and
restrictions of record. Seller shall be responsible for the cost of preparation of
the deed for this conveyance.
4. Property is being sold"as is".
5. All county,municipal, and school taxes as well as rents, water rents, and
sewer rents, if any, shall be prorated as of the date of settlement.
Apportionment shall be based upon the calendar of the fiscal years of the
taxing authorities for which the subject taxes are levied.
6. The Pennsylvania realty transfer tax of two percent shall be borne equally
with one percent being paid by Seller and one percent being paid by Buyer.
7. Seller will provide a seller's assistance of 3%of purchase price toward
Buyer's costs, as permitted by the Buyer's lender. Seller is only obligated to
pay up to the percentage approved by lender if less than 3%.
8. Settlement shall be held within ninety (90) days of executing this agreement, at
such time and place chosen by Parties.
9. Risk of loss for the property shall remain with the Seller until
Settlement.
10. All times fixed for performance in this Agreement by any of the parties
hereto shall be of the essence.
11. The parties represent that no broker was involved in this transaction
and the parties save and hold each other harmless and indemnify each
other for any broker's commission.
12. This Agreement is the final and entire agreement between the
Buyer and the Seller and the parties shall not be bound by any terms,
conditions, statements,warranties, or representations, oral or written, express
or implied, not expressly set forth herein.
13. Seller warrants that the premises do not contain any environmental
contamination or other environmental hazardous substances of any kind
whatsoever and that Seller shall indemnify and hold Buyer harmless from any
and all environmental liability whatsoever which resulted from any actions,
inactions or omissions by Seller to the Property prior to the date of settlement.
This warranty shall survive settlement.
14. Buyer may at his option, within thirty (45) days of the date of this
Agreement, order from a reputable Pest Control Operation certified by the
Pennsylvania Department of Agriculture, a written"Wood Destroying Insect .
hifestation, and Resultant Damage Report" and shall present said report to
Seller before settlement. The expense for said report shall be bome by Buyer.
If the inspection reveals evidence of active infestations,previous infestation,
and/or resultant damage which has not been corrected, Seller hereby agrees, at
Seller's expense, to have the structure treated for such infestation.
15. Any changes or additions to this Agreement must be made in writing
and executed by the parties hereto.
16. This Agreement is binding on the parties hereto,their heirs, personal
representatives, successors and assigns.
17. In the event any part of this Agreement is construed as unenforceable, the
remaining provisions of this Agreement shall be in full force and effect and
enforceable as though the unenforceable part or parts were not included.
18. In the event that either party waives any right or remedy contained
herein or otherwise provided by law with respect to a breach or
violation by the other party of any of the terms and conditions of this
Agreement, such waiver shall not operate as a waiver as to any future
violation or breach by said other party.
19. This Agreement shall be construed under the laws of Pennsylvania.
IN WITNESS WHEREOF, and intending to be legally bound,the parties hereto
have executed this Agreement the day and year first above written.
Withess I Robert Allen Davidson, Executor for
The Estate of Catherine V. Davidson(Seller)
Witness yan . Davidson (Buyer)
REV-1503 EX.(&iz)
pennsylvania SCHEDULE B
DUMTMINfOFREVENUE
INHERIrANCETAXRETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CATHERINE V. DAVIDSON
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. United States Series HH Savings Bond 8,000.00
2 United States Series E Savings Bond 3,996.48
i 3; Orrslovm Bank Stock (102 shares redeemed at$14.7646 per share) 1,505.98
I 1
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TOTAL(Also enter on Line 2, Recapitulation) $�._ 13,50246
If more space is needed,Insert additional sheets of the same size
REV-15o8 E%+(oB-a)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHEWANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CATHERINE V. DAVIDSON
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
L 1. Citizens Bank Checking Account#610080-023-7 54,409.13 k
L _ I _
2.' ICitaens Bank Performance Money Market Account#623134A89-8 78,539.99 ;
3 2002 Buick Lasabre _F — 5,900.00
4.• 1989 GMC S15 3,100.00
5,. Refund from Erie Insurance for car insurance 297.001
6, i Miscellaneous personal property and effects 2,000.00
7.1 (Citizens Bank CD#6140-871638 10,000.00
I �
A
1
I 1 i
I
I
I
TOTAL(Also enter on Line 5, Recapitulation) $ 154,246.12
If more space is needed,use additional sheets of paper of the same size.
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REV-1510 EX+(08-09)
a pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INNEWANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CATHERINE V. DAVIDSON
This schedule must be completed and riled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY .
INDICE THE NAME OF THE TRNBaH,THEIR RaA00410 TO DMENT AND DATE OF DEATH % DEWS EXCLUSION TAXABLE
NUMBER neaTEOFTwaara.ATUaAOrraTrED®roR REAL ESTATE VALUE OF ASSET INTEREST (FAAMUCASUD VALUE
1 !Citizens Bank CD#6140-751993 in trust for decedent's daughter,Diane L. 1 ,277.54 1001 10,277.54
Free(February 10,2013). _�
�) Citizens Bank CD#6148-823966 in trust for decedent's son,Robert A. 7 jf�-�'
j LDavidson(February 10,2013. 10,021.50 1001 10,021.50]
3 �itizens Bank CD#6140-897505 in trust for decedent's grandaughter,Stacy I 10,000.001 ( 100; 10,000.00
J.Pattillo(February 10,2013)
i
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TOTAL(Also enter on Line 7, Recapitulation) $ .sue 30,299.04
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
Q7pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHEWANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CATHERINE V. DAVIDSON
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Duggan Funeral Home 10,771.56
1
f
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 3,000.00
Name(s)of Personal Representative(s) Robert A. Davidson —
Street Address 447 W. Main Street
City Walnut Bottom State PA ZIP 17266
Years)Commission Paid: 2013
2. Attorney Fees: 2,800.001
3. Family Exemption:(If decedent's address is not the same as daimant's,attach explanation.) �-
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 433.50
5. Accountant Fees: —
6. Tax Return Preparer Fees:
7• Estate Publication in Cumberland Law Journal 75.00
8. Estate Publication in Shippensburg News Chronicle _ 96.50
s. Realty Transfer Tax for Sale of 50 Water Street,Walnut Bottom,PA. 1,350.00
10. Sellers assitance to buyer of 50 Water Street,Walnut Bottom,PA for closing costs. —4,050.00
TOTAL(Also enter on Line 9, Recapitulation) $ 22,576.56
If more space is needed,use additional sheets of paper of the same size.
REV-1512 Ex+(12.12)
pennsytvania SCHEDULE I
12 DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CATHERINE V. DAVIDSON
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' Green Ridge Village Nursing Home I I! 3,443.85
2. 'Erie insurance for insurance on cars and home f~� 647.00 -
EDonna Brobst,Tax Collector for property taxes on 50 Water Street,Walnut Bottom,PA 331.7
5 �M IlennmmiPharmacy to 50 Water Street,Walnut Bottom,PA from DOD until closing 16 8 66
C6', TlRuth Mooney,Tax Preparer for 2012 personal tax return preparation fee 50 00 +
I 7.E �Chambersburg Hospital � 7.01 p
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'-� �raa.._=-�.:saw•-....-•.-s�._s.R_.-rr--:._-__--cx=-=_=c•cW==—.._.:,c__-._ .�� 1 .s,,,}' �-_�---•�4
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TOTAL(Also enter on Line 10,Recapitulation) g 1 4,848.40
If more space is needed,Insert additional sheets of the same site.
REV-1513 EX+(01-10)
Mpennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RE UM BENEFICIARIES
RESIDENT DEMMT
ESTATE OF: FILE NUMBER:
CATHERINE V. DAVIDSON
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).]
I. Robert Allen Davidson,447 W.Main St.,Walnut Bottom,PA Son(Lineal) 7 X25%1
(Lawrence James Dav dson,437 W.Main St.,Walnut Bottom,PA (Son(Lineal) 25%
f 3., Diane Louise Free,160 Boyd's Hollow Road,Biglerville,PA I Daughter(Lineal) 25%1
J Stacy J.Pattillo 235 Whitley Drive,Chambersburg,PA Grandaughter(Lineal) 25% 1
(
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1B 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:
i�
L_ I
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
t ,, „_
TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $1 r
If more space Is needed,use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, CATHERINE V. DAVIDSON of
Pennsylvania being of sound and disposing mind, memory and understanding, do
make, publish and declare this my Last Will and Testament hereby revoking all prior
wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of all my legal debts, funeral expenses including
my grave marker and all expenses of my last illness, state, federal estate and
inheritance taxes and administration costs shall be paid as soon as may be
conveniently done following my decease leaving all specific bequests free of tax to
the legatee.
SECOND: I give, devise and bequeath all my property be it real, mixed or
personal, to my spouse, James W. Davidson.
THIRD: If my spouse should predecease me or if we should die in a
common disaster, then in either of those said events, I give, devise and bequeath
all of my estate, be it real mixed or personal in four equal shares, as follows:
a. One share to Lawrence James Davidson, per stirpes.
b. One share to Robert Allen Davidson, per stirpes.
C. One share to Diane Louise Free, per stirpes
d. One share to Tyler Hockenberry and Stacy Pattillo, the children of
Linda Marie Hockenberry, in equal shares; share and share alike, per
stirpes.
FOURTH: I nominate and appoint my spouse, James W. Davidson as
Executor of this my Last Will and Testament. If he should fail to serve or be unable
to serve, then in either of those said events, I nominate and appoint my children,
Lawrence James Davidson, Robert Allen Davidson and Diane Louise Free as the
Executors of this my Last Will and Testament. I direct that no executor named
herein shall be required to post bond in this or any jurisdiction.
IN WITNESS WHEREOF, I, CATHERINE V. DAVIDSON to this my Last Will
and Testament set my hand and official seal, this Iq day of _ /
2003.
(SEAL)
Catherine V. Davidson
Sworn to and subscribed, declared and
Published by Catherine V. Davidson as
Her Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at her request,
And in her presence, and in the presence
Of each other.
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
I, Catherine V. Davidson, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed it
willingly; and that I signed it as my free and voluntary act for the purpose therein
expressed.
Catherine V. Davidson
Sworn to and acknowledged, before me,
By Catherine V. Davidson, the Testatrix,
This day of J-�b 2003.
Notarial Seal
H. Anthony Adams, Notary Public
Shippensburg Boro, Cumberland Co
My Commission Expires May 15, 2 un[y
Member,Penta: vaniaassoCetMmNotMOS
Notary Public
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testatrix sign and execute the instrument
as her Last Will and Testament; that she signed 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 and belief the Testatrix was at the time at least eighteen
(18) or more years of age and of sound mind and under no constraint or undue
influence.
IER
Sworn to and subscribed before me by,
Darlene M. Bigler and Sharon Coleman Adams
The witnesses, this day of Lko,4 2003.
Notary Public
Notarial Seal -
H. Anthony Adams, Notary public
Shippensburg Boro, Cumberland County
My Commission Expires May I5, 2006
Member.pennsynaniaRSSrcia tionotMOtanes