HomeMy WebLinkAbout05-09-13 � 15�5611185
REV-1500 EX(02-11)(FI)
PA Depatlmenl of Revenue OFF�CIAL USE ONLY
Bureau of Individual Tazes County Cotle Vear File Number
ao aox zaoeoi INHERITANCE TAX RETURN 2y 12 0950
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
SOCi01$BCUfiIy NUmbEf Date of Death MMD�YYYV Date of Birth MMDDYVVY
Suffix DecedenPS First Name M I
HODGDON CELIA M
.(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name . Suffix Spouse's First Name MI
Spouse's Sociai Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
- - REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
� 1. Original Return � 2. Supplemental Return � 3. Remainder Return(Date oi Death
Priorto 12-13-82)
❑ 4 Limited Estate ❑ 4a. Future Inferest Compromise(tlale of ❑ 5. Federal Eslale Tax Return Required
death after 12-12-82)
� 6. Decetlent Died Testate � 7. Decedent Maintainetl a Living Trust � 8: Total Number ot Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of TrustJ
❑ 9. Litigation Proceetls Receivetl ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax untler Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule0)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALl CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHWLD BE DIRECTEO TO:
Name Daylime�elephone Nu�Der
'�
KEITH 0 • BRENNEMAN 717��?-85� !?a Q
�REQJ�T@�pOF NIfC£5 USf✓AN
.'q --' _
r � � ��i ^r
First Line of Address Z � � � r� ��
� Q �
� � �� T 1 �"i
44 WEST MAIN STREET �'' ° ` � - -n
"_' `_ �-• _: cs
Secontl Line of Address ' � N � ;r1
� F--. Cn O
D � �
City or Post Office State ZIP Code DATE FILED
MECHANICSBURG PA 17055
CorrespondenTS e-mail adtlress:
Under penallies of perjury, I declare thal I have examined this retum,inGuding accompanying schetlules and sfatements,antl to lhe best of my knowledge antl Eelief,
it is Ima,correct antl complete. Declaration of preparer other than the pereonal representative is based on all intortnalion of which preparer has any knaMatlge.
SIGNLAr OF PERSON RE,�SPION,S�{IBL1E FORI FILING RETURN.�— D/qTE
Il AD ala � (�i�J LN. J e / �.et�. l A. \Yi/ �o/� �i
ADDRESS �T�� / �
VALERIE C • H ��tITE , EXECUTRIX 304 WIDDERS DRIVE, MECHANICSBURG PA
SIGNA�PREPARER OTHER THAN REPRESENTATIVE TE 17055
[
ADDRESS S 7��
KEITH 0 . BRENNEMAN, ESQUIRE 44 WEST MAIN STREET, MECHANICSBURG
PLEASE USE ORIGINAL FORM ONLY PA
Side 1
� 15�5611185 oMasa�a000 1505611185 J
J 1505611285
REV-1500 EX(F'I)
DecetlenTS Social Searity Number
oeced r t�ame HODGD�N CELIA. I'1
RECAPITULATION
1. Reai Estate iSChetlute A} . . . . . . . . . . . . . . . . . . . . . . . . . . . . t. � •d�
� 2 Stooks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . �. � . 0 0
3. Clnseiy Heid Corporation.P2rtrx.vship or Sflie-Proprietaship{ScheduSe C}. . . . . 3. � .��
4. Mor�gages 2ntl Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , q, [f .�0
s. casn,aantc aeaosi+s and Misc��ane«,s Persona!property{scneau�e Ey . . . . , 5. 783,572 �fl 8
6. JoinUy Owned Property(Schedule F) � Separate Billing Requested , , , , g, ��,0 37 � 11
7, inter-Yivos Transfers S Miaceilar3ewas NarProbate Property
(5cheduVe G) � Sepa�ate Biiling Requested . . . . 7. � ���
8. 7ota1 Gross Asseu(total I.ines 1 ihrough 7) . . . . . . . . . . . . . . . . . . g, BIaO�609 •�9
9. Funerai Expenses and Adminisi�ative Costs(SCheduie H}. . . . . . . . . . . . . g, L�,2?3�8 5
10. Debts oi Deoedent, Mortgage Liabilitfes,and liens(Schedule p , _ _ , , , . _ , �p, �,57? �74
'I t Totai Deduetlons{iotai lines 9 and 10}, , , , , , , , , , , , , , , , , , , , , y�, ti��851 . $9
12. Net Value of Estate(Line 9 minus Line t 1) . . . . . . . . . . . . . . . . . . . 12. 8 4�,757•6�
13. Charitabie and Governmenfai BequeststSec 9173 Trusts f�which
an�lection to tax has no�been matle(Schedule J), , , , , , , , , , , , , , , , 13. Q .Q 0
14. Net Valve Subject to Tax(Line 12 minus tine S3} , . 14, �t}Ia i 757•6�
TAX CAlCttlAT16N-SEE INSTRUCTIONS FOR APPLICAB6E RATES
75. Amqunt of Line 14 ta�ble
at ihe spousal�ax rate,or
transfers urKi�Sec.9tt6
t�)t�s}X.o� � ��Il a5. Cl•��
16. Amount of Line 14 i xable
atnneairetex .o4� 846�757 •6� ts. 3��1Q4 ��9
1 Z AmouM of Line 14 ta�cable
atsibiingrateX.t2 � ,(�� �� Q •�Q
18. Amount of Line 14 taxable
at collateral rate X.75 � ,{]� �g. �.��
19. TA% DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 38,104 •�9
20. fl�l!N TNE BOX IF YOU ARE REQUESTING A REPUND OF AN OVERPAYMENT X❑
Side 2
� 1505611285 15�5611285 �
OM4&aA 3 W4
REV4500 EX(Fp Page 3 File Numbe�
DecedenYsCom IeteAddress: 21 12 �95�
DECEDENT'S NAME �
HODGDON CELIA M
STREETADDRESS
PENNSBORO TOWNSHIP
C MBERLAND
CIN STATE ZIP
CARLISLE PA 17�15-
Tax Payments and Credits:
t 7axDue(Page2,�ine�9� (t) 38 �104 •�9
2. Credits/Payments
A. Prior Paymen[s 3 6,3 2 2 •0 0
B. Discount 1�816 •10
7otalCredits(A+g) �z� 38,138 •10
3 Interest
(3) 0 • ��
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in box on Page 2, Line 20[o request a refund. (4) 3 4 •O 1
5. If Line 1 + Line 3 is greater[han Line 2,enter the difference.This is the TAX DUE. (5) Q •��
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 Ihe property transferred . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑X
b. retain the right to tlesignate who shall use the property transterretl or its income . . . . . . . . . . ❑ 0
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ �
d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . ❑ �
2. If tleath occurred after Dec 12, 1962, did decedent transier property wiihin one year of tleath
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑X
3. Did decedent own an"in trust for"or payable-upon-tleath bank account or security at his or her tleath? . ❑ �
4. Did decedent own an individual retirement account, annuity, or other non-probate property,which
contains a beneficiary tlesignation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ �
IF THE ANSWER TO ANY OF THE ABOVE pUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For tlates of death on or after July 1, 1994, and before Jan. 1, 1995, the taz rate imposed on the net value of transfers to or for the use of the surviving spouse
Is 3 petcent(72 P_S.§9116(a)(1.1)(i)�,
Fa dates of tleath on or after Jan. 1, 1995, the tax rate imposed on the net value of iransfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116 (a) (1.1)(ii)�. The statu[e does not exempt a Vansfer[o a surviving spouse from tax, and the statutory requiremenis fw disclosure o(assels antl
filing a taz return are still applicable even if the surviving spouse is the only beneficiary.
For dates of tleath on or after July 1,2000�.
• The tax rate imposed on the net value of transfers from a tleceased chiltl 21 years of age or younger at death to or for Ihe use of a natural parent, an
adoptive parent or a stepparent of the chiltl is 0 peroent�72 P.S.§9116(a)(1.2�).
• The taz rate imposed on the net value of transfers to or for the use of the decetlenPS lineal beneficiaries is 4.5 percent,except as no�etl in(72 P.S.§9116(a)(1)].
• The tax rate imposed on the net value ot transfers to or for the use of the decedenCs siblings is 12 percent [72 P.S.�9116(a)(1.3j]. A sibling is defined,
under Sec[ion 9102, as an individual who has at least one parent in common with the decetlent,whether by blood or adoption.
OM46J1 2D00
__ _
RE�_,5�Ex.�o&,z,
pennsylvania SCHEDULE E
°EP"'T',�'�roF REV�""E CASH, BANK DEPOSITS 8 MISC.
�RESioEr�oECEOenrTURN PERSONAL PROPERTY
ES7ATE OF: FILE NUMBER:
Celia M. Hodadon 21 12 0950
Include the proceeds of litigation antl the tlate ihe proceetls were reca�etl Dy ihe estate.
All pro ert 'ointl owned with right of survivorship musl be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1� HD Vest Financial Services/Sniegocki Financial Services 672,463.75
investment account, #4162-6196
2 Household goods 429.00
retained in-kind
3 Member's lst Federal Credit Union 4,614.84
savings account, N34518-00
4 Member's lst Federal Credit Union 7,641.17
checking account, #34518-11
5 Member's lst Federal Credit Union 97,718.42
investment savings account, #34518-05
6 Refunds due the decedent as follows: 704.90
a. $20.00 from Cremation Society
b. $363.90 from Highmark Insurance
c. $321.00 from Homesite Insurance Company
TOTAL(Also enter on line 5,Recapitulation) S 783,572.08
zwasAO zDOO It more space is needed,use adtlRional sheets M paper of ihe same size.
.
REV�1509IX«(01-10) I .
pennsylvania SCHEDULE F
oEau<ruENroraEVervuE I
inHeRirnNCe rnx aeruRH JOINTLY-OWNED PROPERTY
aESioENroECEOENr
ESTATE OF: FILE NUMBER:
Celia M. Hodadon 21 12 0950
If an asset becamejointly avnetl within one year of the Oecetlen['s tlate of tlea[h,il must be reportetl on Schedule G
SURJNING JOIM T8�14M�5)N4M5S) AODRESS R6_AT70NSH'P TO�ECEDIN�
A Fite, Valerie C.H. 304 Widders Drive, Mechanicsburg,
PA 17055 Daughter
H Hodgdon, Jeffrey H 259 Red Tank Road, Hoiling
Springs, PA 17007 Son
JOINTLY OWNED PROPERN:
�,.ER aarE oESCwarroni oF aaoaaav %oF anrE oF oFan�
R� Foa�ae�r M40E mcwoEw�ariNnuuuixsri*�*iarinxoenxxnccwxrrvU.eeawsiMUx �TEQFDEATH p[��pQ'7I'S VALI�OF
NlRvH6i rENr.vr JqM �oExnnirvcH��ecA�**acroeEOrwaaxnrxEiowEUESrare. VALUEOFASSE7 IMBiEST DEC�BJI'SIMB7EST
1 A 1/26/2002 Member's lst Federal Credi
Union 1,649.06 50.0000 924.53
investment savings account,
#213515-OS
2 A 1/26/2002 Member's lst Federal Credi
Union 25.15 50.0200 12.58
savings account, #213515-00
3 BA 2/25/1987 Property known and numbere
as 152,200.00 50.0000 76,100.00
1634 Newville Road, West
Pennsboro Township,
Cumberland County,
Carlisle, PA 17015.
Property was owned with
Valerie C.H. Fite, Jeffrey
H. Hodgdon and the deceden
as joint tenants with righ
of survivorship.
Decedent's share was 508
with remaining 50'k to
Valerie & Je£frey.
TOTAL (Also enter on Line 6, RecapiWlation) S 77�037.11
swaeae z.000 If more space is needed, use additional sheets of paper of the same size.
REV-0511 EX�(1608)
pennsylvania SCHEDULE H
oEar.��r,nenROF ReveNUe FUNERAL EXPENSES AND
,N„ER,rAN�Er.�REr„RN ADMINISTRATIVE COSTS
aesoENroECEOENr
ESTATE OF FILE NUMBER
Celia M Hodgdon 21 12 0950
DecedenYS tlebts mus[be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
� None
B. ADMINISTRATIVE COSTS:
1. PersonalRepresentativeCommissions:
Name(s)ot Personal Representative(s)
Street Address
Ciry State ZIP
Year(s)Commission Paid:
z. n�torneyFees: Snelbaker & Brenneman, P.C. (Estimated) 7,500.00
3. Famiry Ezemption: (If decedenfs address is not the same as claimanPs,attach e�lanation.)
Claimant
S[reet Address
City State ZIP
Relationship o(Claimant to Decedent
4. Probate Fees: 323.50
5. Accountant Fees: 50.00
6. TarzReWm Preparer Fees:
7.
1 Cumberland Law Journal
advertising Executrix Notice 75.00
Total £rom continuation schedules . . . . . . . . . 2,325.35
TOTAL(Also enter on Line 9,Recapitulation) $ 10 273.85
swnenc z o0o If more space is neetled,use atltlitional sheets of paper of the same size.
Estate of: Celia M. Hodgdon . 21 12 0950
Schedule H Part 7 (Page 2)
2 Member's lst Federal Credit Union
check printing charge 13. 95
3 Ray D. Gottshall, Auctioneer
appraisal fee 60.00
4 Register o£ Wills
filing fee for Inheritance Tax return and Inventory 30.00
5 The Sentinel
advertising Executrix Notice 221.40
6 Reserve
. for filing fees, accountant fees and other
miscellaneous costs associated with the
administration of the decedent's estate 2,000.00
Total (Carry forward to main schedule) 2,325.35
REV-t512[X+(12AB7
pennsylvania SCHEDULE I
c�aurrn�rrr oF�evEr�ue DEBTS OF DECEDEt�IT,
— '""ER'T""cE T,�REr"R" MORTGAGE liABtLITiES & LIENS
RESI�EM DECF.OENT
ESTATE OF FILE NUMBER �
Celia M. Hodqdon� 21 12 0950
Report debts incurred by the depedent prior to tleath[hat remained unpaid at the da[e o(death,inclutling Unreimbursed medical expenses.
�7eM � VALUE AT DATE
t�aAeER .___.__ __ �SCRIPTIOFf OFDEATH
- ____ ._....
�� Century Link �
phone service �.yq
2 Member's lst Federal Credit Union
checks written by the decedent £rom account #34518-11
(which cleared hank after death as follows:
1. #1210 $64.38
2. #1149 $90.p0
3. #120A $257.00
4. #1201 $299.99
5. #12p6 $366.00
6. #1204 $29,31
7. #12p5 $255.00
B. #1208 $80.00 .
4. #1207 $95.04
14. #1211 $1,?25.42 � 3,264.60
3 PA Department o£ Revenue
tax due on 2012 Final Individual Znnome ta�ces 307.00
,,,_ __ ,.___ T07AL Also enter on Line 10,Recapitulation) $ 3 577,79
awneaH z.000 I�more space is neetletl,insert etltlitional sheets of the s2me size.
REV-15t3EX*(Dt-10) SCHEDULE J �
pennsylvania
�P�T�"`°`R"E"UE BENEFICIARIES
INtiERITANGE TAX RETURN �
RESIDENT DECEDEM
....�' " .. ..... .�
ESTATE OF: FILE NUMBER:
Celia M. Hodgflon _ _ � 21 12 0954
RELATIONSHIP TO DECEDEfJi AMOUNT pR SHARE
NUMBER hLAME ANU ADDRESS OF PERSON(5)RECEIVING PROPERTY Do Nat List Truatae(s) OF ESTATE
� TAXAe�E DISTRIBUTIQNS(inGUtle outnqht spous�i distnbufions and Vansters under �
SsG.9178{aj(L2}.]
i. Linda H. Myers (FOrmerly Morris)
326 D Street
�Carlisle, PA 17013
20� of Reeidue: 153,994.10 Aaughter 153,944.10
2 Jeffrey B. Hodgdoa
259 Red Tank Road
Hoiling Springs, PA 17007
Property known and numbered as
Inventory Value: 38,050.00
40$ of Residue: 307,888.20 Son 345,938.20
ENTER OOLLAR APd�Ot#vTS FOR DISTRIBUf16Ns SFK)WN A80VE 4N Lii�5 i57NR4UGH i8 OF REV-i500 COVER$HEET.AS APPRQPR{kT�.
�� NON-TAXABLEOISTRI6UTIONS � �
A.SpqUSAL DISTFiIBUT10NS UNDER SECiION 9i 13 FOR WNICH AN ELEGTION TO TAx IS NOT TAKEN:
i.
�
�e_CNARITABLEAt�GOVERNMENTA�DlSTftiBUTit7NS:
7
(
__'�_ .' ' ' '
___ TOTAL OF PART II-ENTER TOTAL NQN-TAXABLE pIS1RIBUTIdNS ON LINE 13 OF REV-1 S00 COVER SHEET. �S O.00
swasr+i z.000 If more spape is needetl, use additionai sheets of paper of the same size.
Estate o£: Celia M. Hodgdon 21 12 0950
Schedule J Part 1 (Page 2)
Item
No. Description Relation Amount
3 Valerie C.H. Fite
309 Widders Drive
Mechanicsburg, PA 17055
Member's lst Federal Credit Union
Inventory Value: 12.58
Member's lst Federal Credit Union
Inventory Value: 924.53
Property known and numbered as
Inventory Value: 38,050.00
40� of Residue: 307,888.20 Daughter 346,875.31
II
I LAST WILL AND TGSTAndENT
OF
� --
?.,� CELLA M.IiODGDON
� ._
��' � 1,CCLJA M. HODGDON,of West Pennsboro Tow��ship,Cmnberland Countv,
�
'�� �
, I Pcnnsyh�ama, being of sound and disposing mind, memory and understanding,do hzreby ntal:e,
\
�� �wnlish and deciare tliis as a�d for my Last Will nnd�fcslament,hereby revoking nnil m:d:in�, ��
I
.� ( void any and all wills by me at any time heretofore made.
��
l. I order and direct ihat all my just debts nnd funeral expenses be paid by my I:xecn�ris
or Executor, whichever the case may be,hereinafter named as snon as pr�cticable after my death. '
I diiect tlmt all taxes that may be assessed�s a eonsequence of my death shall he paid
from my residuery estate as part of ihe expenses of the aclminisRation of my estate.
2. 1 bequeath those articles of my l�ousehold fm�nishings,personal effe�cts and personal
propeity as set forth in a separate memorandum,which I intend to sign and keep with my copy of
this Will,�o the�ersons named in that memorandum.
�
3. I give, de�vise and bequeath the contents of my home to my children tn be divided
among them as the}�shall.igree with s�id disiribution to be ac equzl:�s possible. All reinnining
contents of my home which nre not chosen by my children shull be sold and the net proceeds
i
I shall be divided equ¢Ily among them.
4. I give, devise and bequeath my remaining onohalf'interest in the renl esie�te at 1614
Neville Road, West Pennsboro Township,Cumbedand Count}�, Pennsylvania in equal shnres io
my daugh�er, VALERIP. C. Il. C'iTi�nnd my so��,JGPFl2TY 6. I-IODGDON,�vilh ceich to
rcceive fifty (50°/�) pucent of s2id one-hnlf interest,[o be held bv�hem asjoint tenanis�vith right
nf survivorship.
i nw<�FFn-Es
SNe��arcek&
BnFNNEn�nN, P.C.
i I oive, devise and hequea�h the residue,of my est�te,of every nnture and whcrcver
I�
cituate to mv children in the slieres indicated as follows:
A_ To VALCRIE C. FL FITEe Forry(40%)percent ofse�id residae;
i3. To JftiFREY B. liODGDON, �orty(40%)percent of said residiie; and
� �� C. To LINDA H. M012RIS,Twenty(20°%)percent ol said residue. .
I
6. I hereby nominate, constitute and appoint my d<�ughter, VALERIF C H. FITH, us
Fxecuirix oCihis my Lnst Will and�iestament. 7 give unto sain Executrix ftiil power and
a���hority io disnibute the residue of my estate, in the percentages specified,by mal�ing
distributinn of assets in I<ind, in caeh,or in L<i��d and ii�casli,as she,in her sole discretioq
deems appropri�te. Tn the event of the renunciati'on,dea[h,resigna[ion or inability to act for
any reason�n�hatsoever of the sTid VALERIE C. H. F1TL, 1 nominste,constitule,and a��point
Ilfl�FREY R. HODGDON as Executor of lhis my Last Will and"1'estament I hcreby relieve
my 6xecutrix or her successor fi�om the necessity of posting seeiu-ity to eonnection with their
duties as such in nny jurisdiefion in whieh diey may be called upon to act, insofar as 1 am able
by la�v so to do.
M V✓ITNLSS WHEREOG,I l�ave hereunro set my hand nnd seal to this my Lxst ANill nnd
� Testament written on lwo(2)pages this 2�°i d�y of December,2007.
/r- �,i ],/� �/� �
�4LLS[—f'Ff�_.�`sL_"Z���R'� ISL.AL.)
i Celiu M. Hodgdon j
Signed,sealed,published and declared by CGLIA M. HODGDON,the Testalrix above
named,as and for her Last Will and Testament,in our presence, who,in her p�esence,at her
request,�nd in [he presence of each other,have hereunm subscribed our nemes ns attestii�g
�vit�esses.
�� � vv �--- .
isrnr.�
�w�,���.ts
sNE�askER�
e�FN�.EMAti_PC. ��—�–� . �C^-� rS1-:AL1
/` ---- --- -
i
_''
�
��CC�i�lA9ON L1�LAS.Ti�2 OF PLN?VSYL V A?tIA i �
SS.
� COUNTI'OP CUM13ERi.9NI) ) �
�
1Ve,CELIt\ M. HODCi17C}N.KFii�7�l O_13R61V1��EMAN and 7ANt3.1.C66Nf�Y,the �
Testanix�nd Uie �vlt'nes�es,rea���ectively,whuse uanrt�5 are sigrietl io the attnched or fnresoing
(
insirumant,heing (7rst duly sw4rn,do hereby dwlare tu lhe�undersigned authoriry thni the �
� 4 -Cestatrix si�iez!an�.i executed thc aistrument as her T,.n.st 1§�ill ai7d Testament and ihni s17e liad
E (
� signed willingly, nnd ihet she exeouted it t�s her fi�ee and voluntary act for ihe purposes Iherein �
� esp�essed,end ihat c�ch vftl�e ruitnesses,iit the�resence znd hearing oFthc'i'estalrix,signcd tl�e �
Witl as witness nnd that to the I�est ofhi9 m�her(oiowlecige the'1"esCatrix w�rs at thnt tiine �
� ei�(�tecn gesrs ot age<x older,of sound min�3 and imd'c no a�nstraini e�r i�nclue influance.
�l%��_;2��� �. ,,
L � t
"fe;'wtatris �;
�a�ZZ�u�.._,
---- ---
_--
w�tness
� �� �
� �-j---�------ -
���~ Witness
�
f
i
Subscribed,swori�to and acl;nowledged berore�me l�y GF.L[A M. ]]ODODON,Tesit�trix,and
suhscdhed and swm�n to befnr�me by Kl�ii'[`i�O.SRP�tJt�MAN and.iqNG.L COONti:l',
�vimes;es,this 271b day of Decembe�;20(17.
1
� I
J>
� _—r—fS�� •�_ _.�LfG ._.
Nofary 7 ub ic t. i
�
� �
COMMONWEALTH OF PFNN512VANtA
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