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Home My WebLink About09-27-13 (2) � 15�561�140 REV-1504 Ex '°,.'°> OFFICIAL USE ONLY PA Department of Revenue Caun Code Year File Num6er Bureav of Individual Taxes �Y ao aox 2aosa� INHERlTANCE T1�C RETURN � 1 � 3 Q 5 7 8 Harrisbur9,PA 1 7 9 28-060 7 RESIDENT DECEDEN7 ENTER DECEDENT INFORMA710N BELqW Social Security Number Date of Death MMDDYYYY Date of Blrth MMODYYW � 4 3 0 2 � 1 3 fl 5 2 3 1 9 3 7 DecedenYs Last Name Suffix DecedenPs First Name MI C 0 U L S 4 N t1 A R T H A t1 pf Applicable)Enter Surviving Spouse's Informatian Below Spouse's Last Name SuKx Spause's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLtCATE WITH TME REGISTER OF WIl�S FILL IN APPROPRIATE OVALS BELdW Q t.Original fteWm � 2.Supplemental Retum � 3.Remalnder Refum(defe of death prtor to 12-13-8F} � 4.limited Estate � qa,FuWre interest Compromise(date of � 5.Federal Estate Tax Return Required death after 12-12-82) QX 6. Decedent Died 7estata � 7. pecedent Maintained a Living Trust _ 8.Total Number of 5afe Deposit Boxes {Attach Copy of Wi11) {Attach Gopy of 7rust) � 9.Litigation Proceeds Received � t0.Spousal Poverty Credit(date of death � 1 i.Election to tax under Sec.9i 13(A} between 72-31-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTIpN MUSt BE CQMPIETED.A!i CORRESPONDENCE AN�CONFIQENTtAL 7AX INf4RMATWN SNOifID BE DIRECTEO T4: Name Daykime�iephoneNumber � � �� J A N L B R 0 W N 7 1 � =!5 4 1 _ 5 5 ,� 0 �„�t _:� _ � i rtqw��R,.s�F uv��i `8�}isE ow�v- I z�. ;.: - _. ,.:, .. First line of addre5s -� � = ` � J A N � 8 R d W N 8 A S S 4 C I Second line of address ' i.., 4.. ; �I 1 - �, I 8 4 5 S I R T H 0 M A S C T S T E Z 2 City Of POSt OffICB St2iB ZIP COdB I_.— ___.... ,AATE PILEO _ J N A R R I S B U R G P A 1 7 L 0 9 correspondenes e-mau addreas: BRENDAJLB@_VERIZON.NET Under penatt�es W perjury,I Ceciare that i have e�mtneQ Nis return,inciutling aaompenying schetlNes antl staieme�iGa,and to ihe best of my knowledge and belieF, d is hue,ca�ect and campie�.Oeclara6an of preperer other ihan the personai repreeentapye is baseG on aii infortnatlon of wirich preparer has atry krKKWedge. NATURE OF RSpN RESPONSI E FOR FILING RETURN DATE (�d�yy� �"��.Gq;� �•_ 9/26/2013 ADQRE S 3[3t] MAR ST T CAMP HI�L PA 1?�11 SIGNATURE Of P ARER O T R-'RESEN7ATIVE DATE 9/26/2013 ADQRESS 845 SI Ot1AS GT STE 12 HARRZT$URG PA 171�4 PLEA8E USE ORI6INAL FORM ONLY Side 1 � 1505610140 1505610140 � �� J 1505610Z40 REV-1500 EX DecedenPs Social Security Number oecedenraName: MARTHA M • COUL$ON RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 2. 5 7 6 1 3 , 8 9 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. 1 7 8 , � 0 6. Jointly Owned Property(SChedule F) ❑ Separate Billing Requested . . . . . . . 6. 8 4 4 3 , 2 9 7. Inter-Vivos Transfers&Miscellaneous N -Probate Property (scnedwe G) � Separete Billing Requested . . . . . . . 7. 3 3 9 9 4 0 , 0 8 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 4 � 6 1 7 5 , 2 6 9. Funeral Expenses and Administrative Costs(SChedule H) . . . . . . . . . . . . . . . . . . 9. 1 � 8 0 5 . 7 7 10. Debts of Decedent, Mortgage Liabilities, and Liens(SChedule p . . . . . . . . . . . . . 10. 2 3 3 6 . 4 3 11. ToWI Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 3 1 4 2 . 2 0 12. Net Value of Estate(Line 8 minus Line �t) . . . . . . . . . . . . . . . . . . . . . . . . . . . . �2. 3 9 3 0 3 3 . 0 6 13. Charitable and Governmental Bequests/Sec 9N 3 Tmsts for which an election to taz has not been matle(SChedule J) . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 3 9 3 0 3 3 . 0 6 TAX CALCULATION-SEE INSTRUCTIONS POR APPLICABLE RATES 75. Amount of Line 14 taxable at the spousal tax rete,or transfers under Sec.9116 (a)(12)X.0 _ � . � � 15. � . � � 16. Amount of Line 14 taxable at�inea�rate x.oae 4 4 1 7 3 . 6 7 �g. 1 9 8 7 . 8 2 17. Amount of Line 14 taxable atsiblingrate x.iz 3 4 B 8 5 9 . 3 9 ��. 4 1 8 6 3 . 1 3 18. Amount of Line 14 taxable atcol�atera�rate X.t5 0 . 0 0 �g, 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 4 3 8 5 0 . 9 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505610240 1505610240 J REV-1500 EX Pa9e 3 Flle Number DecedenYs Complete Address: 29 13 o5�s DECE6EMPS NAPAE MARTHA M. COULSON - - -- _ _ _ _ ___— __. .---— — STREE7ADDftESS - ------- �------. _._--..__.. ----------.—. 30Q2 Market St,Apt 1__ Cam�_Mili_Barough_ __ — _ _—.—____.—._— ---- -- ----_ -- --- -- GITY . . ,�STATE ZIP Camp Hiii PA �17011 Tax Payments and Credits: z. Tax Due{Page 2,�ne 1$} ji) 43,850.95 2. Credits/Payments A.Prior Payments 41 $92.42 e.piscount 2,192.55 7otal Credits(A+8) {2) 44,084.97 3. Inierest t3) 4. If Line 2 is greater then Line 1+une 3,enter ihe difference.This is the OYERPAYMENT. FII In oval on Page 2,�ine 20 to request a refund. (4) 234.02 5. If�ine 1+Line 3 is greater than Line 2,enter the difFerence,This is the TAX DUE. i5) 0.00 Make check payable to: REGISTER 4F WILLS, AGENT � m, _ r..,�. . r . � .:;- .�� =�� =� � _ _ x _ _ _� ��.� . _ _ = _��y PLEASE ANSWER THE FOLtOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decederrt make a transfer and: Yes No a. retain the use flr incpme of the prop�tY ir�tsferred7 ........._........................................................... ❑ 0 b. retain the right to designate who shall use the property transfeved or its income: ............................... ❑ � c, retain a reversionary interest�or ................................................................................................ ❑ � d. receive the promise for life of either payments,be�eflts or aare? ....................................................... ❑ �X 2. If death occurred aiter pecember 12,1982,did decedant trans(er propedy within one year of death without receiving adequate consideraUO�? ....................................................................................... ❑ [X] 3. Did decedent own an"in trust for"or payable-upontieath bank account or security at his or her death? ......... ❑ � d. Did d�edent a�m an ir�dividual refirement�count,�nuity or other non-probate property,which co�tains a benefiaiary designatioa?.................................................................................................. � ❑ IF TNE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SGHEDULE G AND fiLE IT AS PAftT dF THE RETURN. _ �,- =��:�=� ,.�� _. �r�;:- �.�_ , '� ��'�:k . ? ��=�+ _�..._ ��=':v _ ��:�x for dates of death on or after Ju(y 1, 4994,and before Jan. 1,1995,the tax rate imposed on the net vaiue of transfers to or for the use of the surviving spouse 3 percent[72 P.S.§9116(a�{1.1)(ia]. For dates of death on or after Jan. 1, 1995,the ta�c 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}�.7he stafute does not exempt a transfer to a survlving spouse fran tax,and the statutory requirements for discipsure of assets and f ling a tax retum are still applicable even if the surviving spouse is the only benefiniary. For dates of death on or after Juiy 1,2000; • The tax rate imposed on fhe net value of transfers ftom a deceased child 21 years af age or younger at deatt�to or for the use of a nap�rai parenf,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(12)]. • The tax rate imposed on the net vaiue of fransfers to or fqr the use of the decedent's�inea�beneficiaries is 4,5 perceM,except as nated in 72 P.S.§9116{1.2)(72 P.S.§9116{a�{1)J. • The tax rate imposed an the net value of transfers to or for the use of the decedenPs siblings is 12 percent[72 P.S.§911fi{a)(1.3a1.A sibling is defined,unde Section 9102,as an individuai who has at least one parent in common with the decedent,whether by biood or adoption. REV-1503 EX+(&12) pennsylvania SCHEDULE B OEPARTMENT OF qEVENUE INHEPoTANCETAxRETURN STOCKS & BONDS RESIDENTDECEOENT ESTATE OF FILE NUMBER MAF2THA M. GOUISCiN 21 13 067$ All prqperty jointly owned with right of survivorship must be disclosed an Schetlule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Columbia High Yield Bond Fund; 10,996.019 shs @ $3.07/sh 33,789.59 2 Columbia Large Care Quantitative Fund; 3,2A0.605 shs r'(,,,D $7.23/sh 23,431.p2 3 United States Savings Bonds; Series E, Qty 2 393.28 TpTAt(Also enter on Line 2,Recapituletion} S 57 fi93.89 if more space is rreeded,insert adtlitionsl sheets of the same size REV-1508 EX+(08-12) pennsylvania SCHEDULE E QEPAR7MENTOFREVENt1E �ASH, BAP1K DEPOSITS 8� MISC. RESEOeriroECeoeNiTURN pERSONAL PROPERTY ESTATE OF: FICE NUMBER: MARTHAM. COU�S{7N Zq �3 pg7g Include the proceeds of litigadon and the date the proceeds were received by the estate. All prdparty jointly pwned with right of aurvivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER OESCWPTION OF DEATH 1. Essex Hause; refund �7$.qp TOTAL(Also enter on Line 5,Recapitulation) $ �78 04 If mare space is needed,use addhionai sheets of pager of the same size. REV-75tl9 EX+(01-itl) pennsylvania SCHEDULE F °E°`,�""E"TOFRE"E"°E JOINTLY-OWNED PROPERTY INHERITANCE T�LY ftETURN RESI6ENT DEGEDENT ESTATE 4F: FILE NUMBER: MARTHA M. COULSON 21 13 0578 If an asset was made Jointly owned within one year of tha deaedenPS date of dexth,it must be reparted on Schedule G. SURVIVING JQINT TENANT(S)NAME(5) ADORESS RELATIONSHIP TQ�ECEDENT A. Marlene K Lanza 3002 Market St Ap! 1 sister Camp Hili PA 17011 B. C. JOINTLY•OWNED PROP@RTY: LETTER DATE DESCRIPTIpN OF PROPERTY %OF pATE OF DEATH ITEM FORJOINT MADE INCLUDENAMEOFFINANCIALINSTITUTIONANDBANKACGOUNTNUMBERORSIMItRR DATEOF�EATN DECEDENT'S VALUEOf NUN�ER TENNd( JOINT IDENTlFYtNGNUMBER.AT7'ACHDEEDFORJOINiLY-HEi.DREALESTATE. VAlUEOPASSET IMEREST DECEDENT$INTEREST 1. A. 2Q10 Sovereign Bank Checki�g 2331431231 16,888.57 50. 8,4d3.29 TOTAL{Also enter on Line 6,Recapitulation} S $G43 29 If more space is needed,use add'Nonal sheets of paper ot the same aize. REV-1540 E7C+{0&-08} pennsylvania SCHE�ULE G �EPARTMENT Of REVENUE INTER•VIVQS TRANSFERS AND INHEWTANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIOENT DECEDEN7 ESTATE OF PILE NUMBER MARTNA M. GOUIS{}N 21 13 0578 This schedule must be completed and filed if ihe answer ta any of questians 1 through 4 on page threa of the REV-1500 is yes. DESCRtPTt�7�PROPER7Y ITEM �NCLU6ETHENPMEDiTHETRANSFEREE,THEIflftELATIONSHIPT06ECE0ENTAND DATEOFDEATH °kOFDECD'S EXCLUSION TAXABLE NUMBER THEDATEpFTRANSFER.AITACHACOPYOFTHE0EE0fORREALESTATE. VALUEOFASSET INTEREST oFUm�cnrxn VALUE t. Ameriprise Financial Non-Qualified Account 87,986.72 100.00 87,986.72 Mariene K�anza, sister, beneficiary Coiumbia Equity Value Fund = $14,862.03 Columbia Diversified Equity Income Fund = $13,440.62 Golumbia large Gore Gtua�fitative Fund=$13,627.13 Columbia lntermediate Bond Fund =$23,013.5d Columbia Multi-Adv International Equity Fund = $4,149.58 Columbia Small Cap lndex Fund = $1&,933.86 2 Ameriprise Financiai Qualified IRA Account 207,779.69 100.00 207,779.69 Marlene K Lanza, sister, beneficiary Gofumbia tntermediate Bond Fund 3 RVS�ife Rate Bonus Fixed Annuity 4d,173.67 1D0.00 44,173.67 Russell Coulson, stepson, beneficiary 4 Ameriprise Fixed Retirement Annuity; NOT TAXABt�E This contract was annuitized. DecedenYs only rights were to designate a beneficiary (the estate)and to receive reguiar monthly payments. As such, this annuitized contract has nat been inciuded in the inheritance tax calculation. TO7AL(Also enter on Line l,Recapitulation) 5 339 940.0$ If rcrore space is rweded,use adGit�mai sheets of paper of U�same size. ftEV-1811 IX+{td-06} pennsylvania SCHEDULE H �EPARTMEN70F ftEVENUE FUNERAI.EXPENSES AND INHERIiANCETAXRETURN ADMINISTRATIVE COSTS RESIpENT�ECEDENT ESTATE OF FILE NUMBER MARTHA M. C4ULSON 21 13 0578 Oecedents AeMa must he reported on Schedule]. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. Neiii FuneraE Home Inc 3,150.57 2 Biaoms By Vickrey; funerai fiowers 106.00 3 Minister honorarium 200.p0 4 Funeralluncheon 885.92 e. ADMtNlSTRATIVE COSTS: 1. Personai Representative Commissions: Name(s)ot Persona�Represenrative(s) Street Address City State ZIP Year(s}Commi,s9ion Paid: 2, Anomey�ees: Jan L Brown &Associetes 5,500.Qp 3, Famity Exemplion:(!t decedenPS atldress is notihe same as c�imanYs,attaoh er.pianatiar.} Ciaimant StreetAddress City St&te ZIP Relationship qf Claimant W Decedent 4. procatepees: Cumberiand County Register of Wiiis 248.5d 5 nccoun�sncFees: Waggoner, Frutiger& Daub LLP and/or Parks&Company 625.00 8. Tax Rahtm Preparer Fees: 7. Pennsylvania Vitai Records; death certificata for Leroy A Couison 37.04 8 Soversign Bank; bank charge 34.96 8 USPS; registered mail charge 17.82 1 OTAL(Alsp enter on Line 8,Recapitulation) S 10 805.77 H rrwre space is needed,use addiGaiai sheeb W paper of the same srze. REV.t 512 EX+(12-12) pennsylvania SCHEDULE I �EPARTMENT Of REVENUE pEBTS OF dECEDENTt iNNeeirnNCErnxReruRN MORTGAGE UABILITIES&LIENS RESIDENT OECEDENT ESTATE OF PICE NU#BER MARTHA M. COULSdN 21 13 p578 Repod debts incuned by the decedent prio�to death that remained unpaid at the date of death,including unreimhuraed medicai expensea. ITEM VALUE AT DATE NUMBER DESCRIP710N OF pEATH t. Naward Ray Cohen MQ 2$3.73 2 Snoke Pamily Practice 52,7p 3 Bureau of Account Management, agent for Select Medicai Corp 2,OOp.00 T4TAL(Also enier on Lina 10,Recapitulation) $ Q 336.43 If mo�e apace is needed,insert additional sheets of the same size. REV45i3 EX+(0�-10) pennsylvania SCHEDULE J DEPARiMENT OF REVENUE BENEFICIARIES INHEWTANGE TAX RETURN RESIpENT DECEDENT E57ATE OF: FILE NUMBER: MARTHA M. CQULBON 21 13 0578 RELATIONSHIP TO DECEDENT AMqUNT pR SHARE NUMBER NAME AND ADdRESS 4F PERSON{S}REGEIVING PROPERTY Do Nat List 7rustee{s} pF ESTA7E I TAXABLE pISTRIBUTIONS Qnclude ou�' htspousal disVidutions and bansters under Sec.9t f6(a}{t.2}.] 1. Russell Coulson, stepson Linea! 44,173.67 PO 8ox 296, Dauphin, PA 1701$ 2 Marlene K Lanza, sister Sibling 3402 Market St, Apt 1, Gamp Hitt, PA 17011 Sch F 8 G; 50°fo residue 3 John E Goyle, brother Sibling 2474 Hibiscus Ln, Kernersville, NC 27284 50°fo residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 pF REV-1600 COVER SHEET,AS APPROPRIATE, II. NON•TAXABLE DISTRIBUTipNS: A.SPOUSAL DISTRIBUT(ONS UNOER SEC710N 9473 FOR WHICH AN ELECTfON TO TAX!S NOT TAKEN: 1. B.GHARITABLE AND C�OVERNMENTAL DISTRIBUFIQNS: t. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ tf mara space is needed,use ac�itional streets of paper of the same size. LAST VYILL AND TESTAMEiVT QF NIARTHA M. COULSO�i I,MARTHA M.COULSUN,now domiciled in Cumberland Caunty,Pennsylvania,declaza � this to be my Last Will and Testazttent. I revoke all other witls and cadicils that I may have previausly made. Article I My just debts and expenses of my last illness, funeral,and administration of my estate shall be paid by my Executor frorn the principal of my residuary estate as soon as practicable after rny death. Article II AIl inheritance,estate,and succession taaces(including interest and penaities thereon,buE not including any generation skipping ta�t)payabte by reason af my deatt� shail be paid out af and be charged generally againsi the principai of my residuary estate withont reimhursement frorn any person. This provision is not a waiver of any right which my Executor has to claim reimbursement n -:: � for any such taacas whieh beeome payabte as the resnit of any property over whic��ve the�we� c � �: r� -c v`sxa of agpaintmeat. -� � �v = � -. L.y _ �-.' � � c:. "`' C+ 4 ' _ -� "! � : _ � �'y � .--� G'1 it5 �3 f_�7 `rl . Article III I give, devise and bequeath in accordance with any mernorandum which I have either _ handwritten or szgned,located with my will ar with my valuable papers and found within 30 days of the prabate of my wilL GiRs may oniy be to persons who survive me ar to organizatians which exist at my death, and if there is a conflict, the mamorandum having the tatest date shall gavem. Article N All the rest, residue and remainder of my estate, of whatsUevar nature and wheresoeuer sihtate,I give,devise and bequeath IN EQUAL SHARES to my sister,MARI,ENE K.LANZA,of Cumberland Counry,Perassy2vania, and to my brother,JOHN E.COYLE,of KernersvilIe,North Carolina. I request that my brother and my sisier share their inheritance with their children as rny brother and sister deem agpropriate. This request is not a directive,only a wish. if any of my beneficiaries predecemse me or fail to survive me by thirty {3tl) days, I give, devise and bequeath his ar her share to his or her issue who survive me,per stirpes,or if he or sha has na issue, the share(s)aze to be added equally to the other sttares. Article V I nominate,eonstitute,and appoint rny sister,MAI2LENE K LANZA Executrix of my Last Will and Testament. In the svent of the renunciatian, death, ar inability to act, for any reasan whatsoever of my Executrix,I naminate,constituke and appoinz my niece,JEIYPIIFER SILVET'TI, of CumberIand County, PennsyIvania as successor Executrix of my Last Will and Testament. T - 2- direct that my Executrix ar successor Executrix be permitted to serve without bond and in addition to those powers granted by law,I grant them pawer to distribute in cash or in kind in like or in unlike shares and to frle any quatified disclatmer T could have fited if living. My Executrix or successor Executrix shall receive reasanabte compensation for services rendered ta my estate. Articfe VI In addition to the powers canferred by law, I authorize rny Execntrix and successor Executrix, in her absolute discretian: (a} to reGZin in the form received and ta sell either at public ar private sale,any real estate or personal praperty except that which I specifically bequeath herein, (b} to manage real estatc, (c} to invest and reinvest in all forms of property without bezng con£ined to legal investrnents, and withaut regazd to the prinoipal of diversi£eation, (d) to exercise any option or right arising&om the ownership af investments, {e) to compromise claims without court approval and without consent of any beneficiary, (f') ta file any federal income ia�c return for any year far which I have not filed such retum prior ta my deatti, {g'� t0 tI23ICE CIISCLI�}lltIOT1S F$C2SEt O7 121 ICIAd,or in bath,and ta detennine the value of any such property, (h} to employ any attomey, investment advisor, ar atlier agan# deamed necessary by my Executor; and to pay from my estate reasonahle compensation for all their services, (i) to conduct atane or with others, any business in which t am engaged in, or have an -3 - inierest in at time af my death, and {j)ta receive reasonable cornpensation in accordance with theic standard schedule of fess in affect while their services are performed. IN WITNESS V!TFiEREOF, I, MAFtTHA M. COULS4IY, hereby set my hand to this my Last Will and Testament,on_��1 ' � �2005. �.� ,��J�S�.—� MARTHA M.COULSOIY Tn aur presence,the above-named MAIiTHA M.COiT1.SON signed this and declazed this to be her Last Wili and Testament and now at har request,in her presence,and in the prasenoa of each other,we sign as witnesses. Name Address �-Q� �Q.. 845 SirThomas,�ourt. 3uite 12 Hazrisbure,,PA 17109 �� ,-,�_„_ 845 Sir Thomas Court.Suite l2.Harrisbure PA 17109_ -4- I,MARTHA M.COULSOi�t,Testatrix,who signed the faregoing instrument,having been duly qualified according to law,acknowledge that I signed and executed this instrument as my Wi21, and that I signed it willingly as my tree and voluntary act for the purposes therein expressed. Sworn to or a�rmed and acknowledged before rne by MARTHA M.CCt ON,the Testatrix . on �{' �� 2045. n - � ,�� `{ �. � l.C�.l`u .�1��, �. N tary P 61ic � � THA M.COULSON At1HOFl91N�t. ANU,�L�� 1ACQI�t�EA.iffitY IIOfiUlf Fli9tJC �Elf�l�iT tU� We, the undersigned witnesses who signed the foregoing instrument,being duly qualified according to taw, depose and say that we ware present and saw the Testatrix sign and execute this instnunent as her Wili;that she signed and executed it willingly as her free and vaTuniary act for the purposes therein expressed;that each of us in her sight and heariag signed the Wil(as wimesses,and that to the best of aur knowledge, that she was at that tirne eighteen (18) yeazs or rnore of age, af sound mind,and under no consh�aint or undue influence. Sworn to ar affirnied and subscribed ta befare e b� 1-�.�s��. ��.e�.�a.� l�� and J:;aFL�. �.� efsc� Wimess witnesses,an ��Z�, 2005. ,y,� UC'{.t� e��J�'�C � ' �jI^ W CSS I ,'1 �`kt� 1/ ''/ Ot3Y)' �J�IC �N�INal1N OF PEIINSY[MI4NYt �d�1E�AlS�l�MOtARYP{l�p,' � � - M1'l�IM44pOMEXPI�N17,20W y b C/� o ; a � y � O < � °; � c w � � a �, = n n o e � 0 4 C"' r � °- °- °' c 9 c n n+ z � � � � � � � w• a * 0 0 � c p c W ! Ib z y � a+' c,' _' °' w <' � D � � � � C � C � 2 C cn nD. o � v��, °' � Z A O C W o Q7 C� 4�° 07 m � m C� ='+ .c �O "` � Ca" � N O �'o '� O n c��o � � m .�' � Y a .. -1 -3 � a y °i 3 w �O a = t" � '�f D - D y ^' r -n r w �- � °: � _ � d .. 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