HomeMy WebLinkAbout03-05-14 J 15056101�5
REV-1500°`�°�11'��" �
�FICiAL USE ONLY
PA Department of R�ue P���a
Bureau of Individuat Taxes �""""�"� "`�""` �ty Code Year Fil�Number
Po Box 28o6oi ��NHERITANCE TAX RETURN /)� �/� � ��
Harrisbu PA 1��.28-ofioi RESIDENT DECEDENT ��� �
ENTER DECEDENT INFORMATION BELOW
Soc�al Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
204-30-7583 06/16/2013 10/08/1939
DecedenYs Last Name Suffix DecedenYs First Name M�
Godfrey Judith q
(If Applicable)Eirter 5urviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M�
Spouse's Social Security Number
THIS RETURN MUST BE FlLED!N DUPLICATE WITH THE
REGISTER OF WILLS
FlLL IN APPROPRIATE OYALS BELOW
� 1.Original Retum p 2.Supplemental Retum p 3. Remainder Retum(Date of Oeath
Prior to 12-13-82)
O 4.Limited Estate p 4a.Future Interest Compromise(date of p 5. Federai Estate Tau 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 Wili) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Elec6on to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.Al.l CORRESPONDENCE AND CONFIDENTIAI TAX INFORMATION SHOULD BE DIRECTED T0;
Name Daytime Telephone Number
Debraa J Maugans (717)712�96
���:
�
REGISTER USE OLILY
.-, -�,',�, �r�
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First Line of Add�ss ,�„ _, � � .�
VS , � f.�J
28 Brentwood Rd f.. �a •�;
C��- � ,.
Secc�nnd Line of Address �� � �: �'-{
� � `••' t' n-►
City or Post Office State ZIP Code DATE FILED
� � �
Camp Hill PA 17011
correspondenes e-mayi adaress:debimaugans@comcast.net
Under penafties of perjury.I dedare that I have ew�minEd this retum,induding accompanying schedules and statemenis.and to the best of my knowledge and be�ief,
it is true,cortect a�d complete.DeGaration of preparer other than the personal representative is based on ali i�ortnation of which preparer has any knowledge.
SIGNA7U OF PE J2�SPONSIBLE FOR FILING RETURN q�
1 � .�1�-� li �f
ADDRESS �.-�
v'� �� I� r�r�> ><-�-��-I i��"'�I ���•���� fi�,�ll �� � ?c�r I
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE-� DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610105 150561�105 �
J 1505610205
REV-1500 EX(FI)
DecedenYs Social Security Number
oecedent's Name: Judith A GOdf►'ey
RECAPiTULATION
1. Real Estate(Schedule A). ............................................ 1. 180,000.00
2. Stocks and Bonds(Schedule B) ....................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3.
4. Mortgages and Notes Receivable(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellan�us Personal Property(Schedule E)....... 5. 58,943.07
6. JoinUy Owned Properly(Schedule F) O Separate Biiling Requested ....... 6.
7. Inter-Vvos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested...,.... 7.
8. Total Gross Assets(totai Lines 1 through 7).... ........... ..... ... ...... 8. 238,943.07
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 22,574.66
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 14,983.40
11. Total Deductions(total Lines 9 and 10)........................ .. . .. .... 11. $7,558.�6
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 201,385.01
13. Charitable and Govemmentai Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........................ 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. 201,385.01
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousai tax rate,or
transfers under Sec.9116
(a)(1.2)X.0_ 15.
16. Amount of Line 14 taxable
at Iineal rate x.0 45 9,062.33 �g,
17. Amount of line 14 taxabis
at sibling rate X.12 �7,
18. Amount of Line 14 taxable
at collateral rate X.15 �g,
19. TAX DUE......................................................... 19. 9,062.33
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
$ic1B 2
L 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 Fiie Number
Decedent's Complete Address:
DECEDENTS NAME
Judith A Godfrey
STREETADDRESS �
28 Brentwood Rd
CITY STATE Z�p
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1} 9,062.33
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2)
3. Interest
4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2,Lir�e 20 to request a refund. �4�
5. If Line 1 +�i�3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 9,062.33
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 transfeRed.......................................................................................... ❑ �
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 consideration?.............................................................................................................. ❑ �
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)(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}J,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 retum are still applicable even'rf 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 chitd is 0 percent[72 P.S.§9116(a)(1.2)J.
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal benefiaaries 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 decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)J.A sihling 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 EX+ (12-12)
� pennsylvania SCHEDULE A
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Judith A Godfrey 2013-0710
All reai property ovmed 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
wouid be exchanged between a willing buyer and a willing seiler,neither being compeiled to buy or sell,both having reasonable knowledge of the relevant facts.
Reai 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 soid.
�M Include a copy of the deed showing decede�Ys interest if owned as teaant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1• Reai Property 180,000.00
28 Brentwood Rd
Camp Hill Pa 17011
(see attached appraisel) �
TOTAL(Also enter on Line 1,Recapitulation.) $ 180,000.00
If more space is needed,use additional sheets of paper of the same size.
Fue No.28BRENTWOOD
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I GODFREY,JUDITH �
� 28 BRENTWiDOD RD �
CAMP HIIL,PA 170t 1
� File Number. 289RENTWOOD
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In acca�dance with your request, i have appraised the real property at: �
i28 BRENTWOOD RD
iCAMP HILL,PA 17011-2505
I,
� The purpose of this appraisal is to develop an opinion of the defined value of the subject property,as improved.
� The property rights appraised are the fee simple interest in the site and improvements.
In my opinion,the defined value aF the property as of Octobera,20�3 �5:
I I
$180,000
Qne Hundred Eighty Thousand pollars
I The attached report contains the description, anaiysis and supportive data for the conclusions,
I finai opinion of value,descriptive photographs,assignment conditions and appropriate certifications. I
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3TEVEN D.WOOF �
PA STATE CERT RESIDENTIAL R.E.APPRAISER I
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Restricted Use Residential Appraisai Report Fi�No. 28gRENT'WOOD
Thhreptr[lalimitedtothe sde mGeiclusiveuseattheclient tha�ppnisefsopknbnsandcmclueiameetforth in thisreponmey'atbeundwslooApoperlywYhau[addtWnel infametfan
in I 's flb.The eoflhi a l 1 t vWa cllentwi a n' v e s ' v fp�
C�ierrt GODFREY JUDITH E•mai� DEBIMAUGANS VERIZON.NET
C�iein Aedress 28 BRENTVI/OOD RD C' CAMP HILL State PA 2' 17011
�ncenaed use PERSONAL FINANCE D�CISION
Pro ert Address 28 BRENTWOOD RD CAMP HILL State PA z' 17011-2505
Other aescri on APN,L I,etc.,ita ' Me PARCEL NUMBER 09-19-1590-OBd/BOOK 159 PAGE 191
Pro Ri hts raisetl fea Sim Leasehold pq�
Subject propeny existi�g use: SINC3LE FAMILY RESIDENTIAL Use reeected in appraisal: 5lNGLE FAMtLY RESIDENTIAL
H'hest erb Use: Ez' pther:
research did did rqt reveal a ' S81es a transfers of ihe far ttie ltree ' to ttre�effective dale�pps a � 1.
Pria Sale/Transfer; Date Price Sour s
Anarysis of pria sale varafar histay d Me wtyect property(arM compar�le saks,i eppica�)
O(ferirgs,�ptions and carmxts as of the elFec We date oF the appraisal
Mar�etaWiiryCanments: MA K ONDITION ARE TA LE A OF TH DA F TFfI APPRAI ,SUPP Y AN ND AR IN
BALANCE.CONVENTfONAI FlNANCItdO IS PREDOAAINANT IN THE IOCAL MARKET AREA WITH SOME HELP FROM THE
SEILER TOWARDS THE BUYERS CLOSING GOST.
Site Commems: SITE AREA OF 0.31 ACRES WAS TAKEN FROM THE CUMB RIAND COUNIY T�1X ASS SSMENT DATABASE.
�mprovemernCommems: E APPRAIS D PROP RTY I CONSIDERED TO BE IN OVERALL AVERAGE C N ITION AN HAS BEEN
TYPICA LY MAINTAINED.UPDAT D LE TRIC.Nd FUN TI NAL OR E TERNAL INADE UAGES N TEp.
fEATURE SUBJECT COMPARABLE SALE N0.1 COMPARABLE SAIE N0.2 COMPARABLE SALE N0.3
28 BR£NTWOOD RD 2 BRENTWOOD RD 39 BRENTWOOD RD 35 BRENTWOOD RD
A aes CAMP HfLL PA 170Y1 CAMP HILL P 17011 CAMp HILL PA 1T011 CAMP HILL P 17011
� � 0.18 i W 0. 7 i s N E 0. 5 m'Ies N
�1e�"� s S 200 U00 8 185 000 8 165 000
Sa�e iv.Area E �.00 .ft. S 4.61 .tt. 104.64 .ft. f 114.42 .h.
Data Source s CPMIMLS#10230141 CPMlMLS#10230384 CPMLMiS#10223744
Veritkation Sarce s ASSESSMENT/COUNTY 3TEB ASSESSMENT/COUNTY S7E8 AS3ESSMENT/COUNTY STEB
VA N CRIPTION DES RIPTI N .sna'. DESCRIPTION p C IP ION .-s
Sa�ewFinancing FHAYES/HELP -6,870 VAYES/HELP -1,550 CASH NO/HELP
Concessbns 84 UOM 128 bOM 358 DOM
DateM a�eRime s5l13'c1/1 34h3'C3/13 35l13'C5/13
�ocatbn RESIDENTIAL RESIDENTIAL RESIDENTIAL REStDENTlAL
LeaseholdlFee Si Fee Sim e Fee Sim le Fee Sim le Fee Sim le
S¢e 0.31 ACRES 0.24 ACRES 1 000 0.25 ACRES 1 OQO 0.27 ACRES 0
View R IDENTIA RESID NTIAI RESIDENTIAL RESI NTIAL
Des S �e SPLlT-LEVEL SPLIT-LEVEL Bf-LEVEL 0 BI-LEVEL 0
Rua�' ofCu�wctlon AVERAGE AVERAGE AVERAGE AVERAGE
Acwe� 58 57 � 52 0 55 0
Condition AVERAGE AB.AVERAGE -10 000 AB.AVERAGE -10 000 AVERAGE
Above Graae Taa� eerms ee�ns raa� emms eans ra�i eams. eans Taw emms arns
RoomCaun 7 3 2 6 3 1.1 4 000 8 3 1.1 4 600 7 3 2
Gross Ar�30.00 1 888 ft. 2 114 ,n. -8 780 7 788 a 3 800 1 442 .ft 13 380
Bassrrem&Firristred FULL BASEM}N7 PARTIAL 0 PUIL BASEMNT FULL BAS�WINT
Rooms Bdow ED QOM GAM OOM FAMtLY ROOM D FAMILY 0
functlona�lhll AVERAGE AVERAGE AVERAGE AVERAGE
Heaci Coai FWA C/Air FWA C/Air FWA C/Afr FWA ClAir
Ener Etficiemitems NONE NONE NONE NONE
Gara Ca NONE 1 Car Gara e -1 000 2 Car Gar e -2 000 2 C r t3 e -2 000
PorcnlParid k Dedc Patio 0 Patio 0
N� �� + 4 19 650 . f 4 950 + f 11 380
/MJusted Sele Price Net Adj. -9.8% Net Mj. -2.796 N�Adj. 6.9%
� a�s c�ross . 14.8% E 180 350 cross 72.0% f 180 050 Gross . .3% S 178 380
Summa af Sales Co rison A h Se@ AtFdCh6d Adtleffdum
� r HodaadugngAClmAwae.800271.e777xww�.tan T16imnCapyqto2p753010AC10ivi.varoi50ClalmsServlxs.Irc.NIRigMSRU•saveed
��� . . .. . . Page 1 d 3 (9VAR'")Geireral Purposep�p�g�gg�{jppp�0112008
'GPARFE52_OROBtIN08
Restricted Use Residential Appraisal Report Fi�No. 288RENTWOOD
MethodserMtechni esem : x SalesCom arisonA roach CoSt eh IncomeA pech pther;
Discussron of inethods and techniques e�loyed,irrcludirg reawn fa ezcluding an approach to value: S E C p
Recaxi�iation commems: MARKET DATA APPROACH WA UTI IZED.
Based on the staopedwork assaxr�ptfor�s,limi[ing caMkions erkJ appraiser's certifmatia�,mY(a+�)opinion of tF+e dei'x�ed value dthe real property that is
the subjeu afmis repa�e as c� 10/04/2013 ,which is v+e ertective daee of mis appraisal,is:
�X sing�epoint i i80 000 Range S w S O Greaterthan �Lessman S
Tfris appraisal a�de 'as is; subject to completiai per plans and spec�catans on the basis of a Ilypothedcal condrtion tliat the qnprcnremems Ireve been compicted,
�s�bjecc m me�o�bwin9 repais a aher�on ihe basis ot a hypothe4kal carqRfan tAa!the repairs a atteratiais have been completed [� s�m me r�ow�g:
APPRAfSED"AS-15"
appraiser�s certificaeion
'fhpsppaisarts>certirKS u,et,maie eestoru,e,ppwser�s knnw�.Age m,a naier:
i.The xtaTements d taa corcained in this report are true a�axrect,
2.'tBe reported analyses,opimons,aM conclusians are IimiCed ordy by the reported a,sumptions aM fimitlng conditiws and are tice appraiser's personal,imp�sru�,and unbiased
prMessbnal ar�etyses,opinions,and concluspns.
3.Unless otAerwise stated,tlie apprai�t hss rro presem or prpspecwe iM�est in the proPerry ihat is tlie subject of this repat and Aes ra perwnal i�rterest wBh respect m tbe peroes
invoNed.
4.The ap�xaiser has no das wRh respect to the prope�ty thyt is the subject of this report or to the parUes inwived with tNS assignment.
5.The appraiser's engagement in ttiis assignment was not comirgem upon developing or repating pretletermined resuhs.
6.The appraisers compensation for compietlng this assignment is na conangern upon the eevebpmeert a repati�g of a preeetetmi�d value or Airecdon in value mat favors the cause ot
the clie�rt.tlre amamt of ihe value oqroon.the aaairanem d a stipulatetl resulC or the ocairtence M a subseqt�eM everrt direary related to the irtten�d use of uris appraisai.
7.The appr0�sar's anatyses,opinions,and conGusions were developed,arM this report has been prepered,in cordormiry whh the Unitorm Standards o(ProfessionsJRppraisal Practice.
8.UNess ott�erwise naed,the app�aiser has ma0e a personal inspecUOn of the property that is the su6ject of Ihis repat.
9.Unless ro[ed,rro pne prrnitleA sigmficam teal prbperty appraisal assistance to the aqxaiset signing this certification. Signi(icarn real properly appraisal assistance ptovideA by:
.___°.-----------_�__.._._._.__-._-------- —_....---------------_._._----..._.----------•------------`-----
_...-------------------
tbnalCertitfcations:
THE/�PPRAISER 15 NOT A HOME INSPECTOR,THE APPRAISER ONLY PERFORMED A VISUAL INSPECTION OF THE
___�___._._._...____.__-----___�._._.--�_.______Y_.--°___._._.__._.___«_.�_,-------...___._._.__,..__..__�__.___w_.____T______.__�_---
ACCES5IBLE AREAS ANO THE APPRAISAL GANNOT BE RHL,IED_UPON TO DISCIOSE CONDITIONS ANlD/0R QEFECTS IN 1'HE _
PROP�RTY. — — — .—
.._,_.w ,__�_ M�,...._ �_,�.� �.�.. ..,_.._.
__�....._.....,y_. ..__._�_,�. ..._�.. ..� . ___v_. � ..,... ... ,_�. __. ._._._.
Type of Value. O Merlcet Value ��Other Value.
SarcceorDennhion: ��q�,�STAT�APPRAfSl1 TERMtNOLOGY
�ernaion ot Vawe:THE MOST PROBABLE PRICE WHlCH A PROPERTY SHOULD BRING IN A COMPE7'fTNE AND OPEN MARKET
UNDER ALL CONOITIONS RE UISITE TO A FAIR SALE THE BUYER AND SELLER EACH ACTiNG PRUDENTLY
KNOWLED(;�AgLY ANO A UMWG THE PRICE IS NOT AFFEC7E0 BY UNn E S7IMULUS.
��5� C0.APPRAI5ER
r+��'
$ignature: �"� Signalwe:
Name: S7EVEN D. Name:
state Certificat+on a RL003822 state cen;r�cation M
or License! a license N
a Otl�er(desaibel: State 8: State:
Siete:PA Expiration Date of CenRcation a License:
Expiration Date of Cenifm,ation or lice�e: 06/30/2015 Date of Signature:
Date of Signat�ue and Repat: 10/OS/2013 Date of Property Viewing:
Date M Property Viewing: 10J04/2Q13 De�ee of�xoperty viewing:
Oegree of ptoperty viewin4: �� D Irrterior and Exterror Exteria On
�Interia and Ezteria ❑ Ezteria Onl � h ❑�d not personany vieva
Y ❑ Did not personalty vitKv
""` ,,, ctro��a��yaa�,�e.�o.zxemw�,+�.n�a� m>mmc�pgrcomos�mionao�-�,eisocb�n9xwr�.iz..nnwqaae�n
7agn 2 W 3 (9P�"")�nmel P�a{nse isal Re 01/2008
Appraisinp PA "°�`eaaecsfmae„moe
Fae No.2ggR�N7VVOOD
Scope of Work.Assurnptiau and Limiting Caiditions
� ScopeofworkisdeflrredintheUniform5tendardsMProfessfonalAppraiselPraeticeas"tt�etypeandexternofresearcAarNaralysesinenassiy�meM.'Mshort,xoped
worklswhattheeppraiserdldenddidnotdoduAngthecourseottheasslgnment ki�ciwles.butisrrotlimitadto:theeztpKtowhfehthoprvpertyisidenti8edanyinypected,
thetypeende�tento/detara9earchad,thetypeende#erROfanalysesnppliatltoartiveatopinionsorconclusibns.
� Thescopeotthisepprai5elandenwingdlscussionlnthtsreportarespeciflcrotheneedsottlieclientsndWtheir�tenntleduseoftherepat,thisreportvwspreparedfortheyole
antl exelusfve use Mthe client ta tM WenWied fMended use antl its uae by any olher psrcies is prohibited.Tlie spproisa is not responylWefa wuuthoritedusedthe report.
Ttw appraisar'a r�rNfidtlon�pparing in Ws apprafsal repor[is subJe�tto the followirg conditions andto wcA o(Fwr specpkcondlNpr�say arayp�(nr�by�e y�e{�M ry�
r�wt.NI eztraordinary oasumpdom arM hypothdkal conditio�s are stated in the report ana might haveaHected the assignment�wWrs.
1.The appraiser assumes no responsibility fa matters M a Iega1 naWre aftectlng ihe property appraised or title thereto,na does the appraiser render arry opinion as to tlie title,wluch is
aswrned ta 6e good and ma�etabie.The property is sp{�aised as Vrough under respor5ible ownership.
T.My 9ce[cA in ffiis repan may slaw appro�timate dimer�sia�s and is inchWed oNy to assist the reader in visualizing the propetry.Tbe appraiser has made m suvey dih¢prq�t.y.
3.The a{�praiser is mt�uireAro give tesUnxiryl a appear in cart because of havirg matle q�e appraisal with reference w the qoperty in�n,u�ess artarp�emerqs t�ave pcen
�. previ0osly made tl�er¢[o.
4.Ne'ther aN,na any pat of�he ca�d tks repart,copy a dher media tl�ereaf(inclu6rg conclusrorts as ro the property vaNie,the iderrt�r d tl�e aq�prahEr,professin�l desiqiafiwis,
efhe fkm wbh wlid�the appr8iser is conn.�,ShaN be useU fM arry WrPoses bY enyone MH the Cliertt and oU�er iMended usws as klenl�ied in UiS repbrl,mr shal d be mnveYed bY
"1'�"e��a���.n�relauats.news,sales.a oa�er media,vwman me written co�rsem at u�e appraiser.
5.The appraisei wid not�tM�o/ttps appraisaf repat unkss reqiwed�Y aPRlicabie'law a as sped(�eU in ttie Urdtorm Standaids ot Rdessionel Appraisal P�tice.
6.IMarmatlan.esumaaes.an�l opimo�Grr�ishm w the appraiser.a�mrtsined in me repat,wue oarained from saxces considered reNSde an0 be6evee to be true and carea.
Howei'er,�a respn�i6ddy for acwacy of such items(urnishe0 ro the appraiser is assumed by the ap�aiser.
7.The appralser asst�nes thet Ihere are rro hidden or unapparent condHions of Fhe prpperty,subsoil,or suucnre5,which wouW rerMer it mae w less vshiable.The 8ppreuer assumes
rro resporaibiNty fa such condilians,or(or eigir�ering or testing,which mgM be require0 to discover such fadors.Ttds appaisai is not a twme inspection or ern'ronmental asseavnerrt
O(the prop0rty aM 5hould rat be wnsidoretl 8s such.
8.The ap{xaiser specializes in the vaqiation of real propgrty am1 is not a home inspectw,buitdng convactor,SGUCtusl emjreer,a similer expe�t unless otheiwise rwted.Ttie a(pxaisa
did not conduct the imensive rype ot freltl o6servations of the kintl fMended to seek and discover property defeds.The viewing o/the propeny arrcf airy improvemems is fw purposes d
devebpirg an opinion of q��ned value of the property,given the imendst use of this assignmerrc.Statemems rega�ding conditio�are basetl on surface observatio�s ony.The
appraiser claims no special expertise regardinq iswes includirg,but not Ilmited to:foundadon settlemen6 6asement moisture problems,vrood destroying(or other)insects,pest irdestatlon,
tatlon gas,lead based paim,motd pr errvironmeMal issues.Unless otherwise indicated,mechanical systems were nm activated or tested.
� This appraiset report shoWd no[be used w discbse the condition of the property as it relates to the presencelgbsence of d2tects.The client is invited and encauraged w emp�py quaiified
experts ro ir�spect and atldress areas of cor�cem.If riegaGVe corxiitbns are Oiscovered the opinion of vaN�e may�affected.
UNeas othe�wfee noced,tly apprel3erassumes thecamponenCS that cor�stitute the suQJect property Improvement(s)are�tundamentalty sourMandin wwkingorder.
My viewirg of the properry by the appraiser was limited to readAy observaWe areas.Uniess otherwise noted,attks and crewl space areas were rwt accessed.The appraixv did rrot move
hunA�re.flaa covwi�gs a other items that may resvlct the viexdng M me propetty.
9.Appraisals irnolving hypothetical cnrMrtions related ro canpletion oi new consuuction,repairs or attera6on are based on ttie assumption Nat such completion,alteration or repai�s will
be wmpe[er�Y pnfamed.
10.UMess the iMentled use W this ap(xaisal specificaNy inckWes issues p/property insurar�ce coveryye.Nis appraisai should rat be used ia such purposes.Reproduction w
Rep�acemeM oost fu�wes usetl in the cost approech are fa vahiation puposes oNy,given tf�e intende0 use of the assignmem.The Definmon of Va1ue used in Vds assignmem is not
�o�istem wrth tl�tlefinrtian of Medcet Value for propeny insiaarce coveragefuse unless otherwise stated by the appraiser.
AddtlorW Cdnrt�NS Related io Swpe Of Work,pswrt�pqons�nd IJmiti�g Con07Nons
STATEMENT OF ADDRIONAL LIMITINC'a CONOITIONS AND ASSUMPTIONS
THt8 AWPRAISAI R�PORT HAS BEEN PERFQRMED FOR THE CLIENT INDICATED!N THE PRECEDIN(i,WITH WHOM
PROFESS'10NAL STANDARDS REQUIRES ME 70 MAINTAIN A STRICT REQUIREMEN7 OF CONFIDENi'IALITY.
I.�Y i2�ASON OF YHIS R�POR1',AM NOT f2EQU112ED 70 GtV�TES7IM�NY IN COUF27 WI'T'H REF�R�NCE Tb 7HIS
APPRAISAL.IF ANYONE WFSHES MY APPEARANCE,IT CAN BE ARRANGED ONLY 8Y PRI�R ARRANGEMENT BEING MADE
WITH ME.SUCH APPEARANCES SHALL BE MADE AS AN EXPERT WITNESS AND THE FEE FOR SUCH APPE4RANCE3
SHALL BE A7 7HE tiATE C1F$125MOUR PORtAI TO POR7Al,pLUS ANY REASONABLE CQST INCURRED BY ME.
PURP0.SE:
THE PURPOSE OF TWIS APPRAISAI IS TO ESTIMATE 7HE MARKET VAIUE OF TIiE FEE SIMPLE INTEREST IN THE TITLE OF
THE PROPERTY.
SIGNATURE:
THE fiI�BCTRONIC SIGNATWRE USED IN THIS REPORT ARE PROTECTEp BY THE APPRAI3ER AND ON4Y THE APPRAISER
HAS COMPLETE CONTROL OF THE SIGNATURE.
ADDiTIONAL CER7IFICATION:
THE INTENDED USER OF THIS APPRAISAL REPORT IS THE CUENT.THE INTENDED USER IS TO EVALUATE THE
PROPERTY THAT IS THE SUBJECt OF THIS RPPRAISAL FQR A PERSONAL FINANCE DECISI�N,SUBJEGTTO 71iE S7ATED
SCOPE OF WORK,PURPOSE OP THE APPRAISAL,REPORTING REQUIREMENTS OF THIS APPRAISAL REPORT FORM,AND
DEFiNiTfON OF MARKET VALUE. NO ADdiTiONAL INTENDED U&ERS ARE IDENTIFIED BY THE APPRAfSER.
THIS APPRAISAL REPORT HAS BEEN PERFORMED FOR THE CLIENT INDICATED IN THE PREGEDING,WHIT WHOM
PftOFESSIOlVAL STANDARDS REQUIRES ME TO MAINTAIN A S7RICT REQUIREMENT OF GONFIOENTIALITY.
���iv ... ... RaLaCUSngAClsaRwrre.BOD.271.8R7www,acn+eh.mn 7taWrmCqyigao70.5.d110AGOw�isimqlSOCle'sns5avipce�x.Irc�..MReyppbtRe�avM
Vass 3 d 3 �9P��)�°g�� 'GvaRRESt OB�ii71�p8
Restricted Use Residential Appraisal Report Fi�No.288REN'IWOOD
FEAT R SUBJECT COMPARABLESALEN0.4 COMPARABL ALEN0.5 COMPARABLESALEN0.6
28 BRENTVWOb RD 851 POPLAR CHURCH RD
A ess CAAAP HiLL PA 17011 CAMP MILL. PA 17011
Proxi ' rosub' 0.28 miles WSW
Se�e Price S E 17S 000 E S
s��c��g u,,.n� s o.00 .h. s �zs.3o .h. s e. a ft.
Data s GPMLML�t0238440
Verification Sourc s /iSSESSAAENTlCOUN7Y STEB
L N E RIPTI RIPTI N pE �
Sa�eaP�nancing CONV NO/HELP
Concessions 25 DOM
Oate of Sa�elTime s7/13'c6/13
��eovn F�E IDEhI'11AL R�SIbEN71AL
�eese�wxu�eesi F im FeeSim le
Site U.31 ACRES 0.69 ACRES -4 000
��ew R InENTIAI B SY ROAb 5 b06
5 �e SRLIT-LEVEL RANCH p
otC«snui.tion AV�RAGE Ai/ERAGE
Actual 88 g3 p
Comlitian AVERAGE AB.AVERAGE -10 U00
Above Grade raai eam,s s Ta i ea�ms eem rae� eams e�+s Taai emms ea�
Room Coum 7 3 2 5 3 2 p
Gmss Area30.00 i 888 .ft. 1 415 .h. 14190 R, h
easementBFirnshed FULL BASEMNT PARTIAI p
Rooms Below de BE ROOM N NE '1 pp
Funcnana�UUr AVERAGE AVERAGE
Heatin Coolin FWA C/Air A C/A�ir
En EAiciem ttems NONE NONE
Ga NONE 2 C r Qara e -2 Od0
ParchlPa6WDeck eCk qeck POrCh -1 0�0
Net 'us�ment omi + S 3190 � ; , s
AtljustetlSalePnce NetAdJ. 1.$% NetAtlj. % NetAdj. %
of Com ar os 20.8% S 182 190 Gmss '. % E Gross . %
Sum of Sales Com arison A oach
� iw F1'�OusnpAClsollwere,Ipp27�B7y7xxw.anwm.can TlpslpmCopyqc=1005.2p70ACIq�yiuia115PGaImsSm�n,�es.Inc..MRyFbReseteLL
�0^��a^Par�s (9PAR"'1 Gen�-al Pwposep�anal R�art O1RW8
.... . . . . . 'GonnRE52 OemnzWB
ADDErDUIYI
Client GOOFREY.JUDITH File No� 2�REN'MbOD
P�Address. 28 8RENIVVOOD RD C��.
Cdy CAMP FNLL
State: PA zip: 17011-2505
Comments an Saies Comparison
MARKET DATA OF CLOSED SALES WERE LIMITED BUT STILL CONSIDERED SUFFICIENT T1D ARRFVE AT AN
OPINION OF VALUE.THE INITIAL&EARCH PARAMETERS INCLUDEQ SIMILAR STYLE HOMES IN THE SUBJECT
hiEiGHBdRH00D OF NORTHWOOD HiLLS V4ATHIN THE LAST 12 MONTHS.
NO AGE ADJUSTMENT WAS WARRANTED DUE t0 TME SUBJECT BEING IN SIMILAR CONDITION AND HAVfNG A
SIMILAR EFFEC7IVE AGE AS THE COMPARABLE SALES.
AlL SALES WERE CLOSED 1tWTFF MOST WEIGHT PLACED ON COMRARABLE SALE AF2 DUE TO THE LEAST NET
ADJUSTMENTS WMEN ARRIVING AT AN OPINION MARKET VALUE.
SITE RREA ADJUSI`ED AT$t0,00U PER ACRE.
nda�nam aaae�a�
E&O DEC PAGE
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P Ad ss:2 BREN OD Rn No.:
Ci : P HIlL taUe:PA Zi :17011-2505
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Sqte:PA Zi :1701t-2505
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REV-i5o8 IX+(p8-�2)
pennsylvania SCHEDt/LE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8�MISC.
INHER]TANCE TAX RENRN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Judith A Godfrey 2013-0710
Indude the proceeds of litigation and the date the proceeds we�-e received by the estate.
��ProP�Y laMhr uwned with right of survivorship must be disdosed on Schedule F.
IfEM
NUMBER VALUE AT DA7E
DESCRIPTlON OF DEATH
1. Savings Account#38901 Belco Community Credit Union on June 16,2013 3,187.96
Checking Account#38904 Belco Community Credit Union on June 16,2013 38,050.31
Deposits 2,418.31
Dividends
32.49
2 2008 Town and Country Limited/Good Condition 15,254.00
TOTAL(Also enter on Line 5, Recapitulation) $ 58,943.07
If more space is needed,use additional sheetr of paper of the same size.
'� BELCQ
CUMMUNI7Y CRF,DIT UNIUN
BELCO CONIlr![JNITY CREDIT UNION
CAMP HILL BRANCH
3500 TRINDLE RD Inquiries Ca11:800-642-4482
CAMP HILL PA 17011-4439
Account XXX�IX�IX89p GODFREy,JUDITH A Effect: 06/26/13 Post: 06/26/13 Tlr: 1278
ID DUE DATE PRINCIPAL INTEREST FEES BALANCE TRAN AMOUNT SEQ
Withdraw from SAVINGS 0001 Prev Bal: 3,187 . 96
0001 3,182 . 96- 0 .00 0 . 00 5.00 3,182 . 96 #214787
Withdraw from CHECKING 0040 Prev Bal: 39,212 .20
0040 34,212 .20- 0 .00 0 . 00 5,000 . 00 34,212 .20 #214788
Account X��X�IXggp
Available Balance: 50001 0.00
Available Balance: 50040 5,000 .00
Check Disbursed 00 25255 ESTATE OF JUDITH A GODFREY 37,395. 16-
Authorized by
Need extra vacation cash? Did you know you can skip a Belco loan payment once
pe year, to free up funds when you need them most? Go to belco.org, then ?Loan
Products,? then ?Consumer, ? and look for the Skip-a-Payment page.
Page 1 of 4
Belco Community Credit Union
BELCO COMMUNITY CREDIT UNION
CAMP HILL BRANCH
3500 TRINDLE RD
CAMP HILI, PA 17011-4439
800-642-4482
Close�isplay �
Activity for Account ******3890 from 06/41i2013 through 06I30/2013
Judith A Godfrey
28 Brentwood Rd
Camp Hill, PA 17011
POST EFF TRANSACTION DESCRIPTION AMOUNT NEW BALANCE
ID 0001-SAVINGS
06/01 Beginning Balance: , 3,187.96
06/26 06/26 Withdrawal 3,182.96- 5.00
06/30 06/30 Deposit Dividend: 0.150% 0.33 5.33
06/30 06/30 %%APY Earned 0.15% 06/01/13 to 06/30/13
06/30 06/30 %%APYE Avg Daily Bal 2,657.47
06/30 Ending Balance: 5.33
ID 0040-CHECKING
06/01 Beginning Balance: 37,19429
06/02 06/02 Withdrawal by Cred/Deb-Card (SubAction=P): SIGNATURE DEBIT 98.70- 37,095.59
06/02 06/02 KARNS PRIME & FOOD LEMOYNE PA
06/02 06/02 Date 06/01/13 24427333152720003911558 5411
06/02 06/02 %% Card 10#8227
06/02 06/02 %% MCC 5411
06/06 06/06 Withdrawal by Cred/Deb-Card (SubAction=P): SIGNATURE DEBIT 33.60- 37,061.99
06/06 06/06 THE HOME DEPOT 4120 MECHANICSBURG PA
06/06 06/06 Date 06/05/13 24610433157010182028766 5200
06/06 06/06 %% Card 10#8227
06/06 06/06 %% MCC 5200
06/06 06/06 Withdrawal by Cred/Deb-Card (SubAction=P): SIGNATURE DEBIT 1121- 37,050.78
06/06 06/06 ARBY'S#1172 00011726 CAMP HILL PA
06/06 06/06 Date 06/05/13 24164073157945712933841 5814
06/06 06/06 %% Card 10#8227
06/06 06/06 %% MCC 5814
06/07 06/06 Withdrawal by Cred/Deb-Card (SubAction=P): SIGNATURE DEBIT 24.07- 37,026.71
06/07 06/06 SMOKER'S EXPRESS#1401 MECHANICSBURG PA
06/07 06/06 Date 06/05/13 24258023157980001759112 5993
file://C:\Documents and Settings�All Users\Application Data\Jack Henry and Associates\E... 11/7/2013
CLOSE SHARE/ACCOLJNT Page 1 of 1
Closing Account: 0000023890
2 Card(s) expired
Dividend for$ 7.42 on Share 0040
0 EFT Transfers Expired for EFT: 23
0 EFT Transfers Expired for EFT: 24
0 EFT Transfers Expired for EFT: 25
0 EFT Transfers Expired for EFT: 26
0 EFT Transfers Expired for EFT: 27
0 EFT Transfers Expired for EFT: 28
0 EFT Transfers Expired for EFT: 29
0 EFT Transfers Expired for EFT: 30
0 EFT Transfers Expired for EFT: 31
0 EFT Transfers Expired for EFT: 32
0 EFT Transfers Expired for EFT: 33
Transfered $ 6045.76 from Share 0040 to Share ID: 0001
Check#00-0000027552 issued FOR 6,051.09
Share 0040 closed
Share 0001 closed
Tracking record created with reason closure reason of:
Deceased
Account 0000023890 closed
file://C:\Documents and Settings\All Users\Application Data\Jack Henry and Associates\Epi... 8/6/2013
Page 2 of 4
06/07 06/06 %% Card 10#8227
06/07 06/06 %% MCC 5993
06/10 06/12 Deposit ACH: SSA TREAS 310 1,522.00 38,548.71
06/10 06/12 TYPE: XXSOC SEC ID: 9031036030
06/10 06/12 CO: SSA TREAS 310
06/10 06/12 PPD-Prearranged Payment or Deposit
06/10 06l12 %%ACH Trace 031036033733152 Unexpected Transaction Type
06/12 06/12 Withdrawal ACH: VERIZON WIRELESS 166.57- 38,382.14
06/12 06/12 TYPE: PAYMENTS ID: 1223344794
06/12 06/12 CO: VERIZON WIRELESS
06/12 06/12 PPD-Prearranged Payment or Deposit
06/12 06/12 %%ACH Trace 021000023066991 Unexpected Transaction Type
06/12 06/12 Withdrawal Draft: 005995 125.00- 38,257.14
06/13 06/13 Withdrawal by Cred/Deb-Card (SubAction=P): SIGNATURE DEBIT 57.72- 38,199.42
06/13 06/13 GIANT 6263 ENOLA PA
06/13 06/13 Date 06/12/13 24692163163000679693459 5411
06/13 06/13 %% Card 10#8227
06/13 06/13 %% MCC 5411
06/13 06/13 Withdrawal by Cred/Deb-Card (SubAction=P): SIGNATURE DEBIT 7.73- 38,191.69
06/13 06/13 MCDONALD'S F7928 LEMOYNE PA
06/13 06/13 Date 06/12/13 24427333163720058694569 5814
06/13 06/13 %% Card 10#8227
06/13 06/13 %% MCC 5814
06/13 06/13 Withdrawal by Cred/Deb-Card (SubAction=P): SIGNATURE DEBIT 7.29- 38,184.40
06/13 06/13 MCDONALD'S F1816 CARLISLE PA
06/13 06/13 Date 06/12/13 24427333163720061359010 5814
06/13 06/13 %% Card 10#8227
06/13 06/13 %% MCC 5814
06/13 06/13 Withdrawal Draft: 005993 40.00- 38,144.40
06/13 06/13 Withdrawal by Cred/Deb-Card (SubAction=P): SIGNATURE DEBIT 44.09- 38,100.31
06/13 06/13 GIANT 6263 ENOLA PA
06/13 06/13 Date 06/12/13 24692163164000861931328 5542
06/13 06/13 %% Card 10#8227
06/13 06/13 %% MCC 5542 jy�.��4 �
� 06/14 06/14 Withdrawal Draft: 005994 50.00- 38,050.31 ��,, ����
06/22 06/22 Withdrawal by Cred/Deb-Card (SubAction=P): SIGNATURE DEBIT 82.10- 37,968.21 �.i�����^ �
06/22 06/22 SMOKER'S EXPRESS#1401 MECHANICSBURG PA
06/22 06/22 Date 06/20/13 24258023172980001759196 5993
06/22 06/22 %% Card 10#8227
06/22 06/22 %% MCC 5993
file://C:\Documents and Settings�All Users\Application Data\Jack Henry and Associates\E... 11/7/2013
�-��.x��, . �.:y� ��Y ��,,�z�� _� } - _ �. � �,��
. Page: 1
Enclosures: 0
Integrity
B A N K
Statement Date: 12/31/2013
33as n�arker sr,-eer,camp H�t�nA r�olt Account Number: 2201034687
(717)910-4900
CYCLE-031
*********AUTO**SCH 5-DIGIT 17011
114 0.4650 AV 0.360 1 1 114
��I�I������I�I'����I'�I11�11�1�1�1���"��11�1�1�1����1���1�1���1�
ESTATE OF]UDITH A GODFREY
28 BRENTWOOD RD
CAMP HILL PA 17011-2505
Checking
� BUSINESS INTEREST
ACCOUNT NUNIBER 2201039687
PREVIOUS STATEI�NT nnr.suCE AS OF 11/30/13 . . . . . . . . . . . . . . . . . . . . . . . . 6,330.26
PLUS 1 DEPOSITS AND OTHER CREDITS . . . . . . . . . . . . . . . . . . . 1.05
LESS 1 CHECKS AND OTHER DEBITS . . . . . . . . . . . . . . . . . . . . . . 141.12
CURRENT STATEMENT BALANCE AS OF 12/31/13 . . . . . . . . . . . . . . . . . . . . . . . . . 6,190.21
NUMBER OF DAYS IN THIS STATEMENT PERIOD 31
• Account Transactions
DATE DESCRIPTION DEBITS CREDITS
12/02 AC-LibertyMutualIns-INSPayment 141.12
CHECK#-1057
12/31 INTEREST PAYMENT 1.05
• Balance By Date
11/30 6,330.28 12/02 6,189.16 12/31 6,190.21
PAYER FEDERAL ID NUMBER. . . . . . . . . . . . . . . . . 52-2389022
INTEREST PAID YEAR TO DATE. . . . . . . . . . . . . . 11.41
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1 of 3 8/21/2013 8:53 FM
REV-1511 EX+(08-13)
� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Judith A Godfrey 2013-0710
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUPfT
A. FUNERAL EXPENSES:
1' Shalonis Funeral Home 6,537.17
2 Rich Memorial Works Monument Etching 175.00
3 Pamela's Flowe�s 730.92
a Reception 820.07
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 10,168.00
Name(s)of Personai Representative(s) D2bf8.1 M8Ug8t1S
Street Address_28 Brentwood Rd
City Camp Hilf State PA ZIp 17011
Year(s)Commission Paid: 2013
2• Attomey Fees:
3 500.00
3• Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.) '
ciaimant Debra J Maugans
Street Address 28 BrentWOOd Rd _
city Camp Hill _state pA ztP 17011
Relationship of Claimant to Decedent d8ught2f
4• Probate Fees: 293.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
�• Steven Woof-Home Appraisal 300.00
8 Advance Publications 50.00
TOTAL(Also enter on Line 9, Recapitulation) $ 22,574.66
IF more space is needed,use additional sheets of paper of the same size.
� ,.��.,�.�.� ����._ ___
_ _ � ���__. n,�,.��. :���
Michael J. Shalonis Funeral Home
206 Maple Avenue
Marysvil�e, Pennsylvania 17053
Fax(717)-957-2077 Michael J. Shalonis, Owner Phone (717) 957-3451
We Care About Service To You
Tuesday,July 2,2013
Mrs. Debi J. Maugans
28 Brentwood Road
Camp Hill,PA 17011
Dear Debi,
Thank you for selecting our funeral home to provide services for your family during your time of bereavement. I hope that you found
our services,so far,to be of the highest standards that we always try to achieve. The following is a summary of the service charges as
previously explained and provided in written form on the services for.
JUDITH A. GODFREY
PROFESSIONAL SERVICES
Basic service of funeral director and staff $ 1800.00
Embalming $625.00
Dressing,Casketing,and Cosmetology $385.00
Total Funeral Service Selected
TOTAL PROFESSIONAL SERVICES $2,810.00
FACILITIES,STAFF AND EQUIPMENT
Use of Facilities&Staff for Visitation $N/C
Use of Facilities&Staff for Ceremony at Funeral Home $450.00
FACILITIES,STAFF AND EQUIPMENT $450.00
AUTOMOTIVE EQUIPMENT
Transfer of Remains to Funeral Home $200.00
Hearse/Funeral Coach $250.00
TOTAL AUTOMOTIVE EQUIPMENT $450.00
OTHER MERCHANDISE SELECTED
Casket: Gemi Series White with Pink Int $1,195.00
Outer Burial Container Grave Liner $875.00
Acknowledgement Cards $included
Register Book $included
Memorial Folders 150 $included
TOTAL OTHER MERCHANDISE SELECTED $2,070.00
CASH ADVANCES
Grave Opening/Closing Charge $750.00
Certified Copies of Death Certificate $60.00
Newspaper Notice Patriot News $284 ��
Cemetery equipment $240.00
CASH ADVANCE TOTAL $1,335.17
LESS: Credits granted $578.00
30 Day payment discount $578.00
TOTAL OF SERVICES $6,537.17
BALANCE DUE $6,53'7.17
If there are any questions or concerns that remain unanswered,please call me.
Sincerely, '7�3 f l3 C�k '�/00� 7
/
-L'e dm ,OGd�' /y►�� Ns �6 5�7�
Michael J. Shalonis "�
OWrier j"S��f� Ci�� � �A/,pn.G �
pj1 cOl �'" '_ l�
//�/ .R71%✓'� �/
�
Rice Memorial Works
421 W. Main Street
New Bloomfield, PA 17068
(717) 582-2512
Judith A. Godfrey Estate I/�VO/Cl,°
c% Debi J. Maugans 10/8/2013
�8 �'�ea�WOOd le�{ i
Camp Hill, PA 17011
• . .
13-31472 8/2/2013 Judith Godfrey L nne Trace
Y
1
1 Cemetery Inscription
�iank you, your memorial or cemetery Order Total: $175.00
inscription is fir�ls�ied. Payments: �o.00
Balance Due: $175.00
�'� `�; 1
��� \�3
�����
A finance charge of 1'/z%per month (18%annually)will be added after 30 days
_ __ _ _
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH Receipt Date : 6/25/2013
Cumberland County - Register Of Wills Receipt Time : 11 :46 : 04
One Courthouse S uare Receipt No. : 1074643
Carlisle, PA 17�13
GODFREY JUDITH A
Estate File No. : 2013-00710
Paid By Remarks : DEBRA MAUGANS
WZ
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 210 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 1123 $293 . 50
Total Received. . . . . . . . . $293 . 50
File No. 286RENTWOOD
***''�*****INVOICE*"°*******
File Number: 28BRENTWOOD
Invoice#:
Order Date:
Reference/Case#:
PO Number:
28 BRENTWOOD RD
CAMP HILL, PA 17011
APPRAISAL $ 300.00
$
--------------
Invoice Total $ 300.00
State Sales Tax @ $ 0.00
Deposit ($ 300.00 )
Deposit ($ )
--------------
Amount Due $ 0.00
Terms: PAID IN FULL
Please Make Check Payable To: �
STEVEN D. WOOF DBAAPPRAISING PA �a/`� //3
302SOUTH FRONT STREET
WORMLEYSBURG, PA 17043
Fetl. I.D.#:
DLJ/lAIC7�771A OL.`04/CAV 74�74A C44A
ADVERTiSING INVOICE / STATEME 123
Advance Publications ' � ' • • ��
of Perry and�uniata Counties, Inc. 12/O1/13
P. O. Box 130 30 Day Terms
New Bloomfield, PA 17068
: � . �
: � � • � .
DEBRA MAUGANS 20525
DEBRA MAUGANS
28 BRENTWOOD ROAD . � ,
CAMP HILL, PA 17011
� � � ' �
. . � .
11/28/2013 802994 Godfrey Est. � � • � � � � '
Proof of publication
5.00 5.00
O1 Perry County Times - 3 1.00 x 2.10 2.10 in
0.0 5.00
02 The News-Sun - Godf 3 57 wd 0.26
45.00 50.00
03 Ducannon Record - G 3 1.00 x 2.10 2.10 in
0.0 50.00
REV-1512 EX+(12-12)
� pennsylvania SCHEDULE I
�EPARTMEIYTOFREVENUE pEgl'S OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIOEWT DECEDENT
ESTATE OF
Judith A Godfrey FILE NUMBER
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,inctuding unreimb�rsed medical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1. OF DEATH
School Taxes-East Pennsboro Township
2,285.86
real property @ 2g Brentwood Rd,Camp Hili,Pa 17011
2 Chase
12,409.67
account ending in 8763
3 Verizon Wireless account# 319617127-00001
184.43
4 Verizon Home account#717975-190805637Y
15.94
5 AAA Financial Services account#ending 4457
87.50
TOTAL{Also enter on Line 10,Recapitulation) $ 14,983.40
If more space is needed,insert additional sheets of the same size.
Account Number: 2201034687
Page: 2
' Cc�n�(l�d c.�,eG k �r s�11mv �
oxeeKino�mrNOn�ru ` '�•�, ,•. .. . ..
a4�:��•' ,• :.
CC ESTqTE OF JUDITH A OODFREY oexezo�a.�
9��'-^'�"'°" DEBRA J MAUQANS.F�( ��B]b3i3 �OOB T
5 �by� M0.UL�Q 28 BRENTWO00 RD �V p Q
;o�re ?('S�/3 /� � CAMP HILL,PA 17017 /�`iJ
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3 u+ouwr p'Yl,k 'E.:"W l,�,Q,q.r�ei\ ,h r..o-, � �. $s�d f S. �i/
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2zo�o3v-r�8�. s. i ooa o0
�f�r i479 � �
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N.ccrat.i.
,,;,,0313i87B7.: �20L034687��L00 �� --- r
07/05/2013 $1,000.00 .-�-.
ESTATE OFJVDRH A fi00FREY oaaa¢oia ��/24/2013 1006 $2,2B5.B6
DEBRA�MAUOANS,EX eo.ie�emo 1pp1
28 BAENTWOOD no ESTATE OF JUOITM A OODfREY 0678t0i3_•'
CAMP HI�L,PA 17017 �"3�� ' DEBRA J MAUOANS.EX � -----�--°P—,!'°_'010.._70p7_
'r 28 BRENTWOOp RD
' p:ei e`."�✓JA.s/�.. ',,i� CAMP HILL.PA 17011 7 Z3� .,.
,dd:�..��,�,�. �f � ,��� , ,;$Gsa7.'yM e;:�,� _ --- �-- , ..
�� �"'�—�-L3 6 L' � .�„ Ii�..w., .. � �.� , /��Z'��'�
�i �
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.A:D3131A7B7�, 2 20 10 3468 7�•�7 "
o�/os/2ois iooi •" . �
$6,537.17 Y ,.-.,p .:..,. ,
ES7ATE rOf~jUD17H A GODFREY ,oezsxo,a�� j'� �`'� � " ���26�2013 1007 $3,255.65
DEBRA J MAUGANS,EX a+ne.��� �1002
28 BRENTWOOD RD ESTATE OF JUDITH A OODFREY 06�830�3
CAMP HILI,Pp 77p�� 7/3 ' •. DEBRA J MAUOANS,EX �^ueuu tppg
28 BpENTW00D RD
. _ q � CAMP Hlll.GA 17011 u �3 ...
u�.Cta� �,y )'
t I $�U 5'�'• o.:. PGa.
J — . .ai` _ nn.
�...``'4..+r y' e -- i $Sa Y�.°�
CI_ 1 .. "L_:.�1_ � � ' /---�� fd :.
�� u °°«•..
r°" � ��l t�
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� 220iO3�687�10 000073092��' ai�) �=
' '�-•• - � :- .�L'03L31B787�t 22D103�687u.100
� , `. +^ 1 07/08/2013 1002 $730.92
ESTATE OF JUDITH A GODFREY osxsao�� ��' � 0�/25/2013 1008 $5,047.03
I DEBRA J MAUGANS,EX ^s�e�&�i3 1003
� CAMPFHILLV pA�17011
7/9/�3.
' ��_�1_����� $�93.�9',,.
--D�—_____._ ` f e 8 .:._
_,._
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.°" �.�� -,�,,�.-.�
.
i 03i318787�C 220L034687��•L0�3��� —_
07/09/2013 1003 $893.50
! ESTATE OF JUDITH A GODFREY oezezoi3
DEBRA J MAUOqNS,EX e��man3 1004
28 BRENTWODD RD
CAMP HILL.PA 17011 � �
�,�^:_—"` �J e�✓__�_�T/"1�4r..�S � $•35Gb.�
��a'„�'nr-s=�_�i��,,�u.,ov(.,�.� � 8
�� � l.;i,.
rs�.��on3121'QiJ�Es�n�Cr .�� _
��— ���_�_
,�'03i318787C 220i0346B7r3004
���
�T�_07/09/2013 1004 $3,500.00
;ri.:,rt;,;.av�az•.. Sa+�a;;�'
ESTATE OF JUDITH A GODPREV 0626Y073 `eo�ieve�a�a 1005
DEBRA J MAUGANS,EX
28 BRENTWOOD RD �"' -- ' �—
CAMP HILL,PA 17p7 7
---------- � 3 ..
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�ks hi..��cd�F1t�P�cL&e,J -� � e C.�.
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i ���ry
e.GoOFQ d� _
„!R0333i6787�; 220iO3ti687��i00 -----___
07/30/2013t 005
$13B.00
Cardmember Service
Post Office Box 17281
Wilmington, DE 19850-7281
�H�►� �..
E
October 4, 2013 ��
Debra J Maugans
28 Brentwood Road
Camp Hill PA 17011
RE: Account ending in 87C3
Dear Debra J Maugans:
We are responding to your inquiry about a payment made to the credit card account noted above.
The $12,409.67 payment posted to the account on 8/6/13. This paid the account in full and currently
has a zero balance.
If we can help in any other way,please call us. Serving you is very important to us, and we
appreciate your business.
Sincerely,
�t vLa�N
Payment Research Specialist
Y
-:�.,����>��.,���.� _
� ,...:. . .:� �.�
� �° �,.�.� , � � _ � -� .
Page: 1
InregrltY Enclosures: 0
B A N K
339s Marker srYeer, cump H�rr.Pa ��o�t Statement Date: 08/31/2013
��I�J 9zo-avoo Account Number: 2201034687
CYCLE-031
*************AUTO**5-DIGIT 17011
48 0.4650 AV 0.360 1 1 48
���I�III�I��I�I�������I�II���i����lll�l�'ll�'��II�����I������I��I
ESTATE OF JUDITH A GODFREY
28 BRENTWOOD RD
CAMP HILL PA 17011-2505
Checking
� BUSINESS INTEREST
ACCOUNT NUNIBER 2201034687
PREVIOUS STATEh�NT gALANCE AS OF 07/31/13
PLUS 2 DEPOSITS AND OTHER CREDITS � " " " 14,387.13
LESS 1 CHECKS AND OTHER DEBITS . . . . � � � � � � � � � � � � � 6,052.70
CURRENT STATEMENT BALANCE AS OF 08/31/13 � � � � � � � � " " 12,409.67
NUNIBER OF DAYS IN THIS STATEMENT PERIOD 31. . . . � � � � " " $�030.16
• Account Transactions
DATE DESCRIPTION
/��,,C 08/06 DEPOSIT DEBITS CREDITS
�'`�'e -•� 08/07 AC-CHASE 6,051.09
'� 08/31 INTEREST PAYMENT -EPAY 12r409.67
P��� 1.61
• Balance Bv Date
07/31 14,387.13 08/06 20,438.22 08/07 8,028.55 08/31 8,030.16
PAYER FEDERAL ID NUI�ER. . . . . . . . . . . . . . . . . 52-2389022
INTEREST PAID YEAR TO DATE. . . . . . . . . . . . . .
6.87
�� .��
�.»� ,�
. - ���,-��, � -r�,�y_ _.
Page: 1
Integrity Enclosures: 4
B A N K
334s MQYker srreer, camp x,rr,aa ��ol� Statemer�t Date: 10/31/2013
��1��vzo-a9on Account Number: 2201034687
CYCLE-031
*************AUTO**5-DIGIT17011
50 0.6240 AV 0.360 1 1 50
��uillui��llll�il�ini�u��ll�ll�l�uh�n�l��lhl�li����������
ESTATE OF JUDITH A GODFREY
28 BRENTWOOD RD
CAMP HILL PA 17011-2505
Checking
� BUSINESS tNTEREST
ACCOUNT NUNIBER 2201034687
PREVIOUS STATEt�9;NT gALANCE AS OF 09/30/13 . . . . . . .
PLUS . . . . . . . . . . . . . . . . . 7,831.46
1 DEPOSITS AND OTHER CREDITS . . . . . . . . . . . . . . . . . . .
LESS 10 CHECKS AND OTHER DEBITS 1.15
CURRENT STATEMENT BALANCE AS OF 10/31/13 � � � � � � � � � � " ' 1,503.37
NUMBER OF DAYS IN THIS STATEMENT PERIOD 31 . • � � � � � � � " ' 6,329.24
• Account Transactions
DATE DESCRIPTION
10/02 CKCD DEBIT �EB� CREDITS
10/02 00:00 5.00
ONTRAVEL COM ACTIVITY 888 2 NV
10/02 CKCD DEBIT 10/02 00:00
ONETRAVEL COM AIR 888 239 3 NV 16.00
10/02 CKCD DEBIT 10/O1 00:00
PARK N FLY RESERVATIO 04042 GA 42•30
10/03 CKCD DEBIT 10/O1 00:00
USAIRWAY LAS VEGAS NV 539.20
� 10/18 AC-VERIZON FINANCIA-PAYMENTS
CHECK#-1054 15.94
� 10/18 AC-Verizon Wireless-Payment
CHECK#-1053 184.43
10/31 INTEREST PAYMENT
1.15
• Check Transa ions
SERIAL DATE AMOUNT SERIAL DATE
10 5 0 10/0 7 AMOUNT
1051 10/24 300.00 1052 10/18 138.00
175.00 1055* 10/21 87.50
• Balance By Date
09/30 7,831.46 10/02 7,768.16 10/03 7,228,96 10/07
10/18 6,590.59 10/21 6,503.09 10/24 6'928•96
6,328.09 10/31 6,329.24
PAYER FEDERAL ID NUMBER. . . . . . . . . . . . . . . . . 52-2389022
INTEREST PAID YEAR TO DATE. . . . . . . . . . . . . .
9.32
Account Number: 2201034687
Page: 2
Eatete of Judith A Godfrey
26 Brentwood Roatl - "��Bi�3+a 1050
Camp Hill,Pq 17p�7
ldlY�I3
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i S 3GY�.`�/,�y
� A�
~"^ 8 c�..
��' ---- �.. �..�
--,�03L3►8787�;-- 2 20 10 3468 7w105 - -- - - .
10/07/2013 1050 $300.00
Estete of Juditk A Godfiey - -
2B BientwooA Road ��+e�flreis 1057 r
� Cemp Hltl.PA t 701 i
- �U/iv/-i3 �
�;�.��,�cz. e,,n �
�� � $i7s�9"%
��r l3-3i€�To�. '��_r� 8 s�.�,�=
r.�.u�i-�'w��n(cri�_ -_ .
„en03L3i87g7r, 220303ti687riQ51
10/24/2013 1051 $175.00
Estate of Judlth A Godfrey
28 Brerrtwopd ROad e�.+everois 1�52
Camp Hilf,PA 17011
ID�i— ���—�
�.:'• EnS+ �e. �-,ro In�, �I ��p i $13g.°%
OrltaoCf�.. .J ..! �t�' '� i�n�ni°l un .._ �y -
.
, ---x�_^� 8 G:=
�'�.'sa.;.r aso.��k.k..,
.e.GoO F Qsn oa i
a;a3i3►a78��; 220L03L687�+105
__ 10/18/2013 1052 $138.00
_..::..,_..,. �--
Estate of Judkh A Godfrey ��-�'{
� 2B&entwood Road -..-.. - .. � ... .:eo�»yau �105$.
Camp Hili.PA 17011 --' . � -. ..._. ...
)d�/¢�---�3
o.:,a��� F� �� : � °' �4
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_ � _
,d;033318787�: . 2 20 10 3468 7r1055 =
� .. ., :. . . .. .�.:-. er—�+v .
10/21/2013 1055 $87.50
REV-1513 EX+(01-10)
�i pennsylvania SCHEDULE ,7
DEPARTMENT OF REVEPlUE
INHER7TANCE TqX RFRJRN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF:
Judith A Godfrey FILE NUMBER:
2113-0710
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
I TAXABLE DISTRIBUTIONS[Inciude outright spousal distributions and transfers under po Not List Trustee(s) OF ESTATE
Sec.9116(a)(1.2).]
1� Debra J Maugans
daughter 96.5%
28 Brentwood Rd.
Camp Hill,Pa 17011
2 Richard A Godirey
son 3.5%
26910 White Plains Way
Leesburg,FI 34748
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SNEET,
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 DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
'�I 4f 3udii�t�.�odf�
P�rt�.P���m�io�
I,J�:A.�d�nc�,a rc�c�t2�c Statie o��'��y�v�i�„G�b�rla�d Ccx�y decla�e .
th�t t�is i�my w�I. ,
�rt 2.R�v+err+�t�ra t�'��p�il�
I revolc�a�v�ri��d.c�di�iis#hat I�p�sri�ly m�e,
�t 3,C�
I�tav�the�o�c�vving c�6�id�n nc��v livirig:�br�J.11�auga�s�trni I�ich�'d A.C�odfi�y,Sx.
_�'" Part�C�m�
I have#�e follawiBg�dCbai�da;en�.ow livi.n�: Shawn,D.1VIalv�in,D�ek�t..A��g�ns,
T�r�d 11�f. l�sug�,�r�n�.iViaugans,�msnc�l�farqui�,Ti�ni l�t.�ovv�I,V�'�Ili�m C.
+�uc�e�',�tir�rd A.G�rey,3r. ar�d A,Uis€�n�y.
�'nrt 3.�i#�t a���"re��erty
A�cimy m�ust�v�me fc�r a�l�ast 4S da.ys�rec�ive P�+nPertY und�'tlus will.As
used itt tt�w�i,��"S�tve me"�s-k�b��ve c�ia elc�is��,9 an
car�a�ni�on an���xh clay after my death.
If I le,�r�Paro�rty#n}a�e�d�q tw4 c�r�b�fci�ir,s,�3�cy of't�n dcMes�
survive me,I�e�v�his ar h�share tc�i�e ot,��crs�I�r unt�s t�is w.�t�vis�s
vt�exwise.
�Y�'��'�is atl.prop�t,y I owa at m.y c�ath tha��s s�a�b3eact t,�th�vvit�th�t d�s
r�►t��r�ge�i o��fic�t,imclt�g a�I�e�er i��.
���ve mY$�1�g�t 28�tood Rr�d,Camp�i,PA 1'741I tci I�bra 3:1'It��t�s.3f
I�rr�3-���a�s does��ive me,I��ae�P��`�Y����tt 1Vi�,�s.
�I�a���ny res�d.uary est�t�tn my chilc�.I�b�ra J. 11�iarugans�nc�I�ichar�A.4�,►y,�.
ia�q�}sha�es. I£Debxa J.��ga�ts dQes i�ot st�rv�v�me,I�edve her�re of my
����'y��t�S�w�D.�atv�u,:l�rek�,.M��air�,��r�d 1M.�Vi�ug�ns�Arla�a�
�.It�isugans in eq�sh�res.If Richard A. C`saci�y,Sr.does nat sttrvive�,I 3ea;ve his !�
; sh�re�my resic�uary e�a��tci A�A��qz�s, W�ili�tn�.���,Ric�rd A.
C�odfrey,Jr.,fisffini 11�. Hc�we�l aa�d Adlison{"rodfrey in ec�ual sh�res.
�It persoz�l and reai p�perty that i leave in this wi1� shall p�ss��t tu any '
' enc��irances ar li�n.s p�ced cu�t�e Prop�rtY as s�cw�ity�c�r th�r�.yme�t Q�a loan or '
P�e 1 of��tts; � ��
_.�.:.,: .�_. v��:���3
_�t-�.. U�i
:;�:
VV"�Qf��A.�adfirey
�rt.
�t S�.�#�r
I n�e£�na I:M�u�to serve�s my e�tec�r.
N4�s��b��t�past t�aauc�.
�ar�k'�.��r*��
I�my exea�r�i#�he a�i acticr�s�ly Pe��le�a h�we t�pco�of my�vill
d+�e a,s si�p�y a�d as free of�supervi�aian�s pc�l��r th�e Iaws af the st�te
�a�$jwEisdis�ac>a c�#�is�ii�,ir�cluc�ing fi�ing�p�titi+em in t�,e appropri�c cxx�t for
���'��o�m3�e�tate.
����'��e;�trta�r t��ntIo�p��rs,to t�e�c�i�i�s�e cic�ms t�a be i�th�
best irtt�er.ests of my e�te:
1. T+o r�in pmp�rty ur�hout�„�b�ity for Zvss a�r cicp�+ciati+an.
2. �'o di�ofp�wert�'bY p�iC or priv�te s�le,or�x��ge,or a#Ii�se,a�
re�v�ar�d a�ni.ster t,h+�paroceeds as�p�rt of my esi�.te.
3. �"o v��;ta�ex�ise an.Y op�an cx'I�rivit�e��anv�bcinds,no�es,�ks or.
�'�e�betd�gin�ta my�a;te ix�tp trth�c�r�d�,�te�,:�s cxr a�x
�ec�►rit��s;�d to�ciss�1 ot�t ri�ktts��rivi#�Ses af a P�o�s��ar
�Y
�. TQ l�se a�ty real P�'�1�3'in�Y�.
g, Tt�ab�,aci3tist,arbi�raE'e,camp'Y�mi�s,sue an or�a�ct a#herw�se dtral
vvith a�se�tle cl�izt f�tvc�r crf'c�r a�my est�te,
fr. To�.�ae c�p�rt�i�iFate�n►aq�'hu�i�sa wb�i�h i�a�t of my e�cat�,�d ito
iucorpt��,dissc��ve ar tr�er�ise clk�ange i�e ftmn of org��„�an Qf the busi�s.
'��FQ'�s,�uthnr�tp aad.di�c�tion ar�intcnd�d tQ ta�in a�d:itian ta th�F,�w�,
�.urity a�rd ctis�rction vcst�ed in�r bp ope�ation of�sw by vird����r a�,artct may
be ex�r�i��,s ar�a�is d�n�d n�ess�ry�r�visable,,'t�t���►�c�an ta or
�Fproval bY�nY cxrt�rt.
F�#$.Pa���
EZCCept f�,�e�as a�,d�cumb�gl�c��pmpe�y�s sec�ty for the r�ym�e�t of a
I'��c�i'4 I�ak�: �� �'�:_�
�
�����A�.�r�y
�oa�t a�d�,�dit�e�t�t��c�s�t e��ed�sy���p�d i�t�mea�te�
�vi�fanr by t�c�ws Q���v�.
���fi�����i
Id�t��l�t�s �����y���g1y
���s be��tb�e fo�wit��a�ets im.t�e cx�er li�m���ae+at�mt at
.��a f`a��ity�r�it Ui�ia�;my d�c�ia��rw�a�Be#cb��aty � '
IJni�n,
�'x�t��.lY�+as�+est�rov�iuuaa
If any beracfic�ary�m�er�is wi`�cc��s this wiil o��ay csf its p�ovi�io�s,�Y�o�
in���in�y���,r�to t�cc�����r�is wil�i�r��nd
�I�be ciisgv�d c�f as if that cc�nt�stittg b�seficiary h�ttl sot sttrvives�m�.
P�rt�1.��'�'tt�y
If��'�i�s�Y l��aa Qf t�is w�]1,that sh�1�at af�'ect o�pm�rision�t�at
casi be give�t��vvit�t��irrv�2i�t pravfsion.
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I,3t�A.G+o�y,�t,���,�.�my��u ti�s dc�e�t,t�is ���
� <= ��' 2�%� ,�t L..�-.� �1�: ��� `�.3'
vr r,aunty,�ut�e}. f��
I d�lare t�t I sigrt a��x�tl�is c�c�ce�m.�t as m�l�st wl�l,�t��a it willi�;�y a�nd
th�t i�r.e�ute��s mg f�ee�d vaiu�.t�ry s�t.I c�e�e�I�of#��d��t�,vr
����egallX�vu�ed to�a�v�lt,�w��o co�s�fit�im ar�infl�
Si�: �...., ✓�, ����,��
f
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w����,�ou��s ta this dc�cumeztt,�ui d�c�tbat t,�t�stata�r willu�g�y
�t8�d�e��ih�s dc�cument as t�,e te,st�rEcir's tast vvi�.
Ia��ue�e af tl�test�tc�r,�ind in tMe gres�tLCe nf�h crther,v►r��ign t�ris will as
�vitr�sses t�o�t�tvr's s�iag,
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i�Ve�ect��r pc�ty+�fP'���'1�t th�fc�r�4i�g is tr�a�Go�rr�ct,�is
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