HomeMy WebLinkAbout09-26-13 (2) • . �� .• � 1505610101
� REY-1500 �`�°'-'°, "�1
OFFIC7AL USE ONLY
PA Department of Revenue P?�$Y�V�� CouMy Code Year file Number
Bureau ottndivtdualTaxes �NHERITANCE TAX RETURN
Po sox zsosai
Harrisburg,PA i7iz8-o6os RESIDENT DECEDENT � � � �
ENTEft DECEDENT INF4RMAT14N BE�OW � ��
Socia�8ecurity Number Date of Death MMDDYYYY Date of Birth MMDDYYVY
� b "L��t�3 G+ `� __► _l � a `f�
DecedenPs last Name 3uffiz DecedenYs First Name MI
� o � G � u ►' � 4�D(��� 1�
{If Applicabte)Enter Surviving Spause's Mfarmatlon Below
Spouse's Last Name Sufix Spouse's First iJame MI
� ���� ❑
Spousa's Social Security Number
THIS RETURN MU5T BE FILED IN DUPLICATE WITH THE
��� REGISTER OF WILLS
FlLL IN APPR4PRIATE 6VA�$BELOW
� i.Originai Retum p 2.5uppiementai Return O 3. Remainder Retum(date of deatM1
priortp 12-13-82)
p 4. Limited Estate Q 4a.Future Interes!Compromise(date of p 5. Federai Estate T�ftetum Requlred
� tleath after 12-12-82}
� 6.Decedeni Oied Testate p 7. Decedent Mairitained a Living Tmst _ 8. Tolal Number of Safe Deposit Bpxes
(Attaeh Copy of Will) (Attach Copy af Trust)
p 9. Litigation Proceeds Received p 10.Spousal Poverty Credit{date of rleath O '11. Efection to tax undsr Sea 9ft3(A}
4eiween 12-31-91 and t-1•95} (Attach Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRE$PONDENCE AND CONFIDENTIAL TAX INFpRI/ATION SHOUL6 BE UIREGTWrtO;
Name Da e�elephone Number .. '��'�
�! � � ( � ��k�Tt('w}�,7� � � �
r....�.�,.
�TRfi'.I:fTER OIEYWLL$�t136 QNLY
,. Ui ..
4.- ' t
First line of address ;,-�a �. � ;_.J , ; i
ZN �4 � + , �; , :
-•c:� "-� ' , . . , .,
c-:) O� +:::>
Se�wnd iine of address 'v ;� -,�
Ciry or Post Otfice State ZIP Code DATE FILED
� 5 +a f N t� A t 1�2. �
� ,{
Cnnespo�denYs e�mai!address: �(.( fJ�{�(D(� �.p^y�(aSP.Yt t �
Under penalties of perjury,I tleclare the�I have examined this retum,induding accompanying schedules and statemen�s,and to tha best of my knpwledge antl beliet,
it is Irue.correct antl complete.Declaration ot preparer other than the perspnal represenWtive is based on all informatlon ot which preparer has any knowledge.
SIGNAj'}1 Eg OP PER30i RES NSIBtE FOR�y'LI`NG RETURN F�4TE��—��1
..(t)1 Al3di� V-j j� 7
ADDRESS—r
�y�l- 1�� SF �tS�en.�„� l�oe 24� ! z.-2..
SIGNATURE OF PREPRRER OTNER THAN REPRESENTATNE DATE
ADDRESS
P�EASE USE ORIGINAI.FORM ON�Y
Side 1
� b50561�1�1 1505610101 J
�,
J 1505610105
REV-1500 EX DecedenPs Social Security Number
�d.d,, < �
�h��� }� ��al� <°� �
Decetlents Name
RECAPITWLATION � �,�� .. ��s =� '�n
t. Reai Estate{Sdieduie A). ..... .. ....... ...... ... 1. ' . : „ � ' 1 S, t} f1 x
...... ._... ... � ..
a;�
2. Stocks and Boods(Schedule B) . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . .. Y + �� � � U '*
3. Glcme�Y Neid Carparation,Partnership or Sole-Proprietorship{Schedu�C} .... 3 � . ' ��� '� V
4 a . « r ,
' x
4. Mortgages and No1es Receivable(Schedule D) . . . . . . . . . . . . . . . . . . � s .. ,
s '� � �3 �, o t� t��
5. Cash,Bank Bepo�Ets and Misceitaneous Personal Praperty{Schedu(e E)..-.._ ..
�
6. JoinNy Owned Property(Schedule F) p Separate Billing Requested . . . . 6 :�.
7. IrtervViros Transiers&Miscefianeous Non-Probate Properky ry ;
(Schedule G) O Separate 8itting Re9uested...._... 7. !, ' ° _ � � � � �� 1 .
. �
- 8. Total Gross Assab(total Lines 1 through 7). . .. ... . . .. . . . . . . . . . . . . . . $ ( �� .. � ��.: . �u�1�.(� t �.' � �'.
9. Funeral Expenses and,4dministrative Costs{Schedute H}... . ... ... .... .. . 9. �� . ' � �- t� "T��p�.�
10. DebtG of Decedent,Mortgage LiabiliNes,and Liens(Schedule I) . . . . . . . .. . . 10 �` � � �. �',1 � �1 �
10. Totai Deductlans(totai lines 9 and 10). . . .... . . . ...... .. ..... . ......... 11. z ��� ,���. D �D �
12. Nst Value of Eatate{Line 8 minus Line it) ... . .. . . .. . � .. . . 1�. ' " ` �< ���. � V � �
13. Charitab:e and Govemmentai 8equeststSec 9113 T�usts for whiCh �J , � x� � � �
an slectioh to tax has not been made(Schedule J) . . . . . . .. . .. . . ' � ��
�� f
44. Net Value SubJeet to Tax(Une 12 minus Line 43) ... ... ... . ..... .. .. ..... 14. �... � . � , ����w�...2 (D �D :
7AX GAICULATION�SEE INSTRUC'f1�IS FOR APPk.�CABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rete,or � ,..
trensfers under Sea 911$ � '�"� . =i" � „r"_� ��s� 1fi.'.•�� � .
(a}(LZ}X A� � '
16. Amount of Line 14 taxable �, �, �°�; ? 16 e
. at lineal rate X ,0_ � `� ��
57. Amount of line 1A t�able -��� # � � �
�: c rt � 17.'" ta
� at sibiing rate X.52 ; '��. -
18. Amount of Line 14 taxable , � U D- C7
at Collateral rate X.15 Y`�Pr a� n��� V . .� �. 18. ..
. . .. . .�.. .. 19.� , .m.�� �: � 1 1.� tt C7
�9. TAX OUE .. . .. . .. . . .. . . . . .. . . .. . . . . ... ........_ . ... .. .. .. .
2D. F4�1 IN TNE OVAE 1F YOU ARE REQUESTiNG A REfUNO OF AN OYERPAYtAEN7 �
SIdB 2 �
L 15CI561tl105 150561C1105
REV-150q�X Page 3 File Number
Dec'edenYs Camplete Address: �0 13— � �a o �
DEGEDENT'S'tJ(A�tutE� ( (y { {��
__
... ......._�O�Mpl.lt3� �+... 1.-_�� �__.-----. __— ....
'___. .'—__ --_ ___.- . _ .
STREETApDRESS (� ���,,., (
�1 `aUri'�'C� �1{t�- T-�"FA'4�G'S..
ueW���1-e.
_ _ _ __----- ---- --_ _ -- _ ___— ---- _ _ _
cirr _ sTnT zia
� 1�1 o t{�
Tax Payments and Credits:
i. Tax Due{Page 2,line i9} {1) 2�p*'�,C}{}
2. CreditslPayments
A.Pnor Payments -----—._---_—_-._...._
B.�iswunt 5`70 ---- 'l a_�_=3�_.._---
raai creaits t�t�} �2) '�� •'.�3
3. Interest
�3� O. U O
4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. �
Filt in oval on Page 2,Lit�e 24 M request a refund, {9) '"'
5. If Line 1 +Line 3 is greater than Line 2,eNer the diRerence.This is the TAX DUE. (5) � � '�b 2• �u O
Make check payable to: REGISTER OF WILLS,AGENT.
PLEA3E ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"" IN THE APPROPRIATE BLOCKS
1. Did c�Cedent make a Uansfer and: Yss Na
a. retain the use or income of the property transierred:.......................................................................................... ❑ �
b. retain the right to designate who shall use the properry transfarced or its income:............................................ ❑ �
a retain a reversionary interesk or..........................................................................._.................._.............._......... ❑ �
d. receive the promise(or life of eiM�er paymerrts,benefits or care?..........._..................._.................................... ❑ �
2. If death occurced after Dec.12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?...................................................................:.......................................... ❑ �
3. Did decedent owrr an'i�trust for'�payabEe-upat�death bank acctsunt or Sacurity at his ot her death?............_ ❑ (�
4. Did decedent nwn an individual retirement account,annuiry or athsr non-probate propedy,which
contains a beneficiary designation? .............................................._.................._.................................................... ❑ �
IF THE ANSWER T4 ANY 4F THE ABOVE QUESTIpNS iS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF TNE RETURN.
Fa dates of death on w after Juiy 1, 19�1,and before Jan. 1, 1995,the tax rate imposed on the�et vafue of trensfers to or fw the use of the sun+iving spouse is
a perc��r�r2�.s.§st�s{a}ti.��{���.
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.§91f6(a}{1.tj{ii}].The statute does not ea�empt a transfer to a survivir�g spouse hom tax,and the statutory requirarr�nts for disciosure of assets and
fiiirrg a tax retum are s81i applieable even if the s�riving spause is the onty 6er�efiaary.
For dates of death on ar after July 1,2000:
• The tax rate imposed on the net value ot transfe�s frwn a deceased cMid 21 ysars of age or younger at death to or for the use of a natural parent, an
adaptive parer��a stepparent of t#�e d�ild is 0 percent[72 PS.§9116(a}(12}j.
r The tax rate imposed on the net value of transfers to or for the use of the decedenYS lineal beneficiaries is 4.5 perceni, except as noted in
72 P.S.§9116(12)[72 P.S.§9116(a)(1)l.
• The tax rate impased on the t�ef vaiue af transfers#o w for the use of ttie decedenYs sibiings is 12 perce�[72 P.S.§9N$(a){1.3}].A sibling is defined,under
Section 9102,as an individuai who has at least one parent in common with the decedent,whether by biood or adap6on.
I
aEV-isoz Ex+ �oi-io�
• � pennsylvania SCHEDULE A
OEPAIiTMENT OFREVENUE
�NHER�TANCETa�RET�RN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
1�onald L. �qol � �ot� - a rao3
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is tlefined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being wmpelled 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[he property has been sold.
ITEM Indude a mpy of the tleed showing tlecedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER
DESCRIPTION OF DEATH
�. 19q5 S..�Qt��0. l �f��l{. I���dt i�t X �� N�b�(z 1�4��.c, ► i � 5csn. o a
TOTAL (Also enter on Line 1, Recapitulation.) $ �(� J'—U0.00
If more space is needed,use additional sheets of paper of the same size.
aEV-isos Ex+�ii-ia)
� . � pennsylvania SCNEDYLE E
oeaaarMeNloFAeveNUe CASH� BANK DEPOSITS & MISC.
�""ER�TQ"cE v"`R�r�R" PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF:
'��Q1 I � t V'� FILENUMBER:
�� a
��C3 — O l UG 3
Indude 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
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
!, �ooa C'k�vrof�ef S� IrtracEo 1560
4+ovstl�ol�.� �ewe�ry � Cldt-6.�v.� �� BSd.o�
noQ. a o
TOTAL (Also enter on Line 5, Recapitulation) $ 3(oDb. 00
If more space is needed, use additional sheets of paper of the same size.
REUd510 EXa (08-09)
� . �pennsylvania SCHEDULE G
oEPAa�MeNTOFRE�eNUe INTER—VIVOS TRANSFERS AND
�NNeR�TaNCeTnxaEruaN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
�ati,atoQ �. �'qo�� �o13— � IUO �
This schedule must be completed antl filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPER7Y
ITEM mcwoerhENnneaF�rveraarvsreaee,the�aaeunoNSwerooeceoeNrnNO DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER rheonTeormaNSrea, nrrncnncoevoFmeoeeovoaneaiesTaTe VAWEOFASSET INTEREST prnPVUCneie� VALUE
i. Tror4-Fere�e — �-ac-c.� lu . S �ll� uqh °exwt �� i%nia,
,I��Y I�enK CkecK��� a8'43 � � � ��i�,
M�7 Sa� �n�l IStrou -a.� �lu54 '�S
C�tcki�c1 Io$�{�.22 SD`�v 34a.1• � I
�,, ,n�s a24 X`I.v3 �7� ���z.Uo
TOTAL(Also enter on Line 7, Recapitulation) $ y ��3, � �
If more space is needed, use additional sheets of paper of the same size.
REV-;s>> ex+t�aos>
. � SCNEDULE M
� GQMMONWEALTH QF PENNSY�VANIA FUNERAI EXPEN5E5 &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RE910ENT DECEDENT
ESTATE OF FILE NUMBER
�e�,a�c� �-, �c�v'�� � �ai3— OlCJG '�
Debts of deeedent must be reportetl pn Schedule L
ITEM
NUMBER DESCRIPTI4N AMOUNT
A. FUNERAIEXPENSE�S^: `1
1. ��1DVh SOh Y�lYrQYa� ttdM(� �L.�i4vl.oi�l �4 •
�r»�tsstona.� S�rv tc Y'S ""�,�is. o p
�ranS�f f -�-d ��n�tru.� ��^+'�- �.-9 5.G�U
hewEh C,e� ���Ca�-C � �vricel ��trn��-4- tz5.od
(""��t�M,,�2!��Mr�'( �- C�ra1�^Gfr �C' PS '3G0 ,�j�
llc�^�VZ �f.t�'t�zttT G� jGp tj G
S�n,Q�u:cy o� Gt�...airti.'s �o.OG
!b�
B. ADMINISTRATIVE COSTS:
L Personai Representative's C�nmission5
Name qf Personal Representaiive(5} ,
StreetAddress
City --- ---- -- _State Zip _ . .
Year(s)Commissian Paid _ . __ .. ____ .__,,,,.
�o o. tr�
2. Attomey Feea
3. Femiiy Exemptian:(!f decedenYs address+s nat the same as ciaimanYs,ettach axplanation)
Claimant
SireetAddress
� ._ . .. .__. ___. .. _..__ _ .... .____ ..__ . __._. .. .
City.__—_w�.� _ ___ _..State 2iP ......_ ....
Relationship of Cla+mant ro Decedent , _ ,_ . ,
4. probaleFees �`{`�,SQ ��� '��
5. AccountanYs�ees 1�"y{?,(}{} . (�p, Q {'}
8. Tac Return Preparer's Fees — (,7 — q i, q b
7. �}t4�sPu�tC � �1"�f �rt��ntrt��af ���tt �� ��.'S-��t � ��y '25:t} (9
�d. C�**�tier k�►�al L,� u� �'�uv�o�e� � �.5�� e� � 3d��5
�. ��-� o� r+�tn-�-atnq� lZ �ioun�lr� �txtw _�b'�-e5 uo i t �59,t� o
��Pot�- �3"7bn � 'T'c�ct54'l7-l�� U-���iEt�'s :2ZJ,.`
1�. �'�s� oSs -�vz� �o �a �u�t �3r+�an•4�`� �-��1�#r�? Ste{ '�`1Stll`J
-�ot 1-c�¢1 �'-c�scm5 ��o'C es-�a-E c
TOTAL(Also enter on line 9, Recapitulation) $ ���g'��(!1
(tl more space is needed,insen additional sheeis of the same sizej
REV-1512 E%+ (12-OS)
� . �pennsylvania SCHEDULE I
��� �EPAqTMENTOFpEVENUE DEBTS OF DECEDENT,
rNHea�raNCeTnxaeruaN MORTGAGE LIABILITIES & LIENS
RESIOENT DECEDENT
ESTATE OF FILE NUMBER
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
REM VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
i. �} rtn-! , z-� C"o��ny�� V�e� Es��es, laewvill-e_ P4 (��n,c �`t�t.oC�
�an�.S �I ec�cr �c. � ���•t 2u13 . 1 10 • O o
1���;,.� � D�ck c�� z� ���n+�,� U��w ks�n,��5 3i5.oc
C—r-0.ss c�ri-4��9 , J',n,t �-v �3 t tl o , a o
`R-e �r5 �. 7�02 C�nevro �,c`� S��vcra�o (� 5S,U0
�t���� ��Ycl�s� �az Ch2vro�� Si�tvu�o 32y.U0
TOTAL(Also enter on Line 10, Recapitulation) ; t�q'3�V�
[f more space is needed, insert atlditional sheets of the same size.
,REV-1513 EX+{01-10)
• `�i� pennsylvania SCHEDULE J
�7 DEPARTMENTOFREVENUE
INHERITNNCE TAX RENRN BEMEFICIARIES
RE5IDENT DECEDENT
ESTATE 0�� FILE NUb18ER:
j`�m�lc�, L. �c���� 2a1`3 - O 1 Gr� 3
RElATIONSHIP TO DECEDENT AMOUNi OR SHARE
NUMBER NAME AND AbDRESS OF GERSON(5)RECEIV]NG PROPER7Y Do Not LfstTruslee{sj OF ESTATE
S 7AXABlE DISTftI6U40N5�tnclude outright spousal distributians and Cransfers under
Sec.911b(a)(1.2).] ^ .
f. `LL�ac2� 1.0 . �,�11 �var P_k-wi � e �va��
a��- ��.-�, �� :
1��y�2 e� l� 2 t �z.`�-
�
ENTER 60Li_4R AMOUNTS FOR DISTRIBUTI4NS SHOWN A80VE ON LINES SS THROUGH I$Of REVdSQQ WVER SHEET,AS APPROPRIATE.
Y= NON-TA7(pBLE DISTRIBUT[ONS
A, SPOUSAL DISTRIBUTIONS UNDER 5ECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHAR[TABLE AND GOVERNMENTAL DISTRI9UT10NS:
1.
TOTAL OF PART II - ENTER TOTAL NQN-TAXA6LE DISTRIBUTtONS ON LINE 13 OF REV-1500 COVER SHEET, $ G I
If more space is needed,use additional=_t+eets af paper of ihe same size. '��..
I
C.7 '..J . ,,..�
LAST WILL AND TESTAMENT � � ,11 '
r., _:; , ,
OF � � : -.
� � ' ,�
�. �
RONALD LEE EGOLF .
I, Ronald L. Egolf, of 27 Country View Bstatea, Newville, Cumberland County,
Pennsylvania 17241, being of sound and disposing mind, memory and nnderstazrding. da here6��
make, publish and declare this as and far my L.ast ��'iil and Testament_ l�erehc re� -�k[n� 3?l o;'t��.
icil!. and c„�t;e:t: hzY.t�'�i-e*..��t .....
FIRST: T direct that all my just debts and funeral expenses,inclndirng my,grave mazker,shall
be paid &om the assets of my estate as soon as practicable after my deoease.
SECOND: I give, devise anfl bequeath the residue af my estate, of every nature and
wherever situate, to my friend, Stacey W. Sultivan, providing she shall survive me by thirty(30)
days. Should my friend, Stacey W. Snllivan, predecease rne or die on or before the thirtieth day
followrng my death, I give, devise and beqixeath the residue of my estate, of eaery nature and
wherever situate,to my friend's daughters, Samantha M. SuiIivan and Jessica D.Suliivan,eqnally.
T�iIRD: T direct that ail ta�ces that may be assessed in consequence ofmy death,of whatever
nature and by whatever jurisdiction imposed,skt�ll be paid fram my residuary estaYe as a part of the
expense of the adrninistration of my estate.
FOURTHt I have faur sons,one has predeceased rne. I have intenrionaEly givezt them and
their issue nothing under this Wiit.
FIFTH: I naminate,constitute and appoint my friend.Stace}��`.Sullivan,Executrix�fthis
my Last Will and Testament. In the event my friend, Stacey W. Sullivan, is deceased, unabte to
unwilling to serve or sha11 cease to serve for any reason whatsoever,then I nominate,constiEixte and
appoint my friend's daughter,Samantha M.Sul3ivan,as personat representarive of this my Last Will
and Testarnent. I direct that my persona)rtpresentative shall not be required to give or post band for
the faithfui performance of his,her or its duties in this or any other juresdiction.
SIXTH: I direct rny Hxecutars and their succesaors sha11 not be reqnired to give band far the
faithful perf"ormance of their duties in this or any other jurisdiction.
SEVENTIi: I hereby dectare it to be my express desire that rny persanal representative
employ the law firm of Rominger and Associates, of Cumberland County, PennsyIvania, far legai
advice and assistance regarding this my LasY Will and Testament, they having considerable
knowiedge of my affairs, views and wishes respecting any matters that may arise at the probate af
this instnxinent,the administration of my estaYe,and the execution of the powers herein met�tioned.
Any mentzon of ftomin$er and Associates in this, my Last Wiil and Testament, is my free and
voluntary act and through no influence by any person.
IN WITNESS WHEItEdF,I have hereunto set myhand and seal to this.m.-Last Witlta
TesCament, consi�t�ns�>f't<<o!_',>t�pe�.rriczei�pa�es. esch ideisti,i�c�L�� m} sigs�azure.tius v'^iC�
day of�_ , 2013.
��.�t���
��� �
Ronald L. Egolf, Testat,b�����
Signed,sealed,published and decZared by the above-named Testator,Ronald L.Egolf,as and
for his I,ast Wi11 and Testament,in the presence of us,who,at his request,in his sight and presence,
and ia the sight and presence of each other,have hereunto subscribed our names as wimesses.
� _ ..
Wimess j - Wimess <.,,,�1;
COMMdNWEALTH OF PENNSYLVAI3IA }
: 5S.
COUNTY QF CLJMBBRLANI3 }
1,Ronaid L.Egolf,Testator,whose nazne is signed to the attached or faregoing instrument,
having been duty quaiified according to law,do hereby acknowledge that I signed and executed the
insirument as my Last Will and Testament;ihat I signed it willingly; and that I signed it as my free
and voluntary act for the purposes therein expressed.
Swom or affirmed to and acknowledged before me by Ranatd L. Egalf, the Testator, this
�"r� da1 cf �.�;�.,.��"� °�:'",
=�; �-- _
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�� ���
r�ot�r,��z;� �—
r+s aF a�NNmvuata
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a w ewo,�oun,q,na�nd Puti`
ComWObe 4�
v�wu
COMMONWEALTH OF PENN5YLVANIA )
: SS.
CQ(JNTY OF CUMBERLAND }
We,� and , the
�� � ,� � � �
witnesses whos'�e�na�me� signed to the ttached or foregoing i�nt, being duly qualified
according to law, do dzpose and say that we wers present and saw Testator sign and execute the
instnunent as his Last WiII and Testament;that he signed willingly and that he execu4ed ii as his free
and voluntary act far the purpose therein expressed; that each of us in#he hearing and sight of the
'Iestator signed the Will as witnesses;and that to the best of our knowledge the Testator was at that
rime 18 or mare years of age, of sound m'snd and under no constraint or undue influence.
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Swom or affrnned to and subscribed ta before me by�
and� ��,�"�U �?�� ,witnesses,this���day of �G.t,�(�', 13.
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