The URL can be used to link to this page

Home My WebLink About01-20-15 � 1505610140 REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 4 2 4 Harrisburq PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 4 2 4 2 0 1 4 0 8 0 3 1 9 3 4 DecedenYs Last Name Suffix Decedent's First Name MI MADDEN RAYMOND L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 1.Original Return � 2.Supplemental Return � 3. Remainder Return(Date of Death Prior to 12-13-82) � 4.Limited Estate � 4a.Future Interest Compromise(date of � 5. Federal Estate Tax Return Required death after 12-12-82) Q 6.Decedent Died Testate � 7. Decedent Maintained a Living Trust � 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) � 9.Litigation Proceeds Reczived � 10.Spousal Poverty Credit(Date of Death � 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number SUSAN H . CONFAI R 71 7 763 1 383� �" � RE�'s1�STER OF WIL��.1SE Q�L'� C_e r7 �"'�' �,� � _ �,7 C_ C�7 � First Line of Address � `,:,� ��a r,,.� � �:-> � . � :-� 2 3 3 1 MA RKET ST REET �� '�-, `�' � � `'' �._. . c� ;.a �:.� , ,a Second Line of Address " � . . •""� �-"' , '., - � =� `r.y 'S'1 � ! , � � > _t� _ . ..._ •DATE FI " � City or Post Office State ZIP Code - -- -• �g " " �- CAMP HI L L PA 1 7 0 1 1 � ,`� "' �n Correspondent's e-mail address: SCONFAIR _REAGERADLERPC.COM Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and beiief; it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG RE OF ERSON RES/�O BIrE� FILiNG RET�IRN �DATE � L �� ADDRESS 46 WILLOW WAY DRIVE ENOLA PA 17025 �_ SIGNATURE OF PREPAR 0 HER THAN REPRESENTATIVE DATE ��-��-�=-�-- � //�'�/.a ADDRESS ! 2331 MARKET STREET CAMP HILL PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610140 1505610140 �r \�a ; i � 1505610240 REV-1500 EX(FI) DecedenYs Social Security Number DecedenPSName: RAYMOND L. MADDEN RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. • 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 5 $ 7 5 4 3 , 5 3 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. � 2 5 7 6 6 , 7 6 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. • 7. Inter-Vivos Transfers 8�Miscellaneous N n-Probate Property 7 9 $ 3 � 4 � (Schedule G) � Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 7 2 1 2 9 3 � 6 9 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9� 2 � 2 3 2 . 6 6 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . .. . 10. � 7 6 9 . 6 1 ��. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 2 0 � 2 . 2 7 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 6 9 9 2 9 � . 4 2 13. Charitable and Governmental 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. 6 9 $ 2 9 � . 4 2 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 _ � . � � 15. � . � � 16. Amount of Line 14 taxable at�inea�rate X.045 6 9 8 2 9 1 . 4 2 �6. 3 1 4 2 3 . 1 1 17. Amount of Line 14 taxable at sibiing rate X.12 � . � � 17. � . � � 18. Amount of Line 14 taxable at collateral rate X.15 0 • � � 1 g. � • � � 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 3 1 4 2 3 . 1 1 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT QX Side 2 � 1505610240 1505610240 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 2� 14 0424 DECEDENT'S NAME RAYMOND L. MADDEN __ _ STREET ADDRESS 46 WILLOW WAY DRIVE _ CITY STATE ZIP ENOLA PA 17025 Tax Payments and Credits: �• Tax Due(Page 2,Line 19) (1) 31,423.11 2. Credits/Payments A.Prior Payments 29,856.00 B.Discount 1,571.16 Total Credits(A+B) (2) 31,427.16 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 4.05 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred ...................................................................... ❑❑ � b. retain the right to designate who shall use the property transferred or its income ............................... c. retain a reversionary interest ..................................................................................................... ❑ ❑X d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... � 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ❑X ❑ 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 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)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in p2 P.s.§s��s(a)(��. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENTOFREVENUE STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND L. MADDEN 21 14 0424 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CENTURYLINK INC. (CTL) -61 SHARES VALUED AT$34.63 PER SHARE 2,112.43 2. AT&T, INC. (T)-3,159 SHARES VALUED AT$34.50 PER SHARE 108,985.50 3. FRONTIER COMMUNICATIONS (FTR) - 176 SHARES VALUED AT$5.81 PER SHARE 1,022.56 4. METLIFE, INC. (MET) -38 SHARES VALUED AT$51.95 PER SHARE 1,974.10 5. THE PNC FINANCIAL SERVICES GROUP (PNC)-3,960 SHARES VALUED AT 333,669.60 $84.26 PER SHARE 6. TERADATA CORP (TDC) -64 SHARES VALUED AT$46.00 PER SHARE 2,944.00 7. VERIZON COMMUNICATIONS (VZ) -853 SHARES VALUED AT$46.28 PER 39,476.84 SHARE 8. VODAFONE GROUP PLC (VOD) -248 SHARES VALUED AT$36.42 PER SHARE 9,032.16 9. AMERICAN INTERNATIONAL GROUP, INC. (AIG)- 10 SHARES VALUED AT 524.90 $52.49 PER SHARE 10. COMCAST CORPORATION (CMCSA) -532 SHARES VALUED AT$51.37 27,328.84 PER SHARE 11. EXELON CORPORATION (EXC) - 1,256 SHARES VALUED AT$36.01 PER SHARE 45,228.56 12. NCR CORPORATION (NCR) -32 SHARES VALUED AT$34.190 PER SHARE 2,188.16 13. TE CONNECTIVITY(TEL) - 10 SHARES VALUED AT$60.76 PER SHARE 607.90 14. TE CONNECTIVITY LTD. (TEL) - 10 SHARES VALUED AT$60.76 PER SHARE 607.90 15. PRUDENTIAL FINANCIAL, INC. -CUSIP -744320102 - 138 SHARES VALUED AT 11,303.58 $81.91 PER SHARE 16. AIG (WS)-5.339 SHARES VALUED AT$21.27 PER SHARE 113.56 TOTAL(Also enter on Line 2,Recapitulation) $ 587 543.53 If more space is needed,insert additional sheets of the same size Continuation of REV-1500 Inheritance Tax Return Resident Decedent RAYMOND L. MADDEN 21 14 0424 DecedenYs Name Page 1 File Number Schedule B-Stocks& Bonds ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. LSI -38 SHARES VALUED AT$11.13 PER SHARE 422.94 SUBTOTAL SCHEDULE B 422.94 GRAND TOTAL SCHEDULE B $ 587,543.53 REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: RAYMOND L. MADDEN 21 14 0424 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. UNION COMMUNITY BANK-SAVINGS CLUB -#1700105643 700.00 570 LAUSCH LANE LANCASTER, PA 17601 2. UNION COMMUNITY BANK- INTEREST CHECKING -#806218 344.79 570 LAUSCH LANE LANCASTER, PA 17601 3. UNION COMMUNITY BANK-CLASSIC CLUB CHECKING -#10116427 75,037.00 570 LAUSCH LANE LANCASTER, PA 17601 4. THE FEDERATED FUNDS - MONEY MARKET-#00642744 2,059.89 PO BOX 8600 BOSTON, MA 02266-8600 5. PERSONAL PROPERTY 200.00 6. COMCAST- DIVIDEND CHECK, DATED 4/23/14 119.70 7. EMERITUS REFUND 590.00 8. HIGHMARK REFUND 26.16 9. PRUDENTIAL LIFE INSURANCE ON LIFE OF DAVID MADDEN 6,904.42 10. PRUDENTIAL LIFE INSURANCE ON LIFE OF DAVID MADDEN 3,696.10 11. VANGUARD BROKERAGE SERVICES 35,895.81 12. DISCOVER CARD REFUND 13.98 13. CAPITAL ONE REFUND 22.50 14. PA DEPARTMENT OF REVENUE -2013 TAX REFUND 156.41 TOTAL(Also enter on Line 5,Recapitulation) $ 125 766.76 If more space is needed, use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND L. MADDEN 21 14 0424 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDETNENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND DATEOFDEATH %OFDECD�S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATfACH ACOPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICABLE) VALUE 1. VANGUARD- ROLLOVER IRA 7,983.40 50.00 3,991.70 CHRISTINA M. DUTTRY- DAUGHTER 2. VANGUARD- ROLLOVER IRA 7,983.40 50.00 3,991.70 DAVID R. MADDEN -SON TOTAL (Also enter on Line 7,Recapitulation) $ 7 983.40 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(OB-13) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND L. MADDEN 21 14 0424 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, DIOCESE OF HARRISBURG - BASE FOR MARKER 450.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)ofPersonalRepresentative(s) CHRISTINA M. DUTTRY 15,000.00 StreetAddress 46 WILLOW WAY DRIVE City ENOLA State PA Z�p 17025 Year(s)Commission Paid: 2014 2, AttomeyFees: REAGER &ADLER, PC 3,050.00 3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. ProbateFees: CUMBERLAND COUNTY REGISTER OF WILLS 583.50 5 Accountant Fees: 6. Tax Retum PreparerFees: GOODLING TAX SERVICE 188.00 7, EXECUTOR EXPENSES -CHRISTINA M. DUTTRY 961.16 TOTAL(Also enter on Line 9,Recapitulation) $ 20 232.66 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER RAYMOND L. MADDEN 21 14 0424 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CLAIR DALE DDS- DOCTOR 142.00 2. DISCOVER CARD -CREDIT CARD 13.98 3. OMNICARE PHARMACY- MEDICATION 7.00 4. CAPITAL ONE-CREDIT CARD 22.50 5. TE CONNECTIVITY- RETURN PENISON 461.96 6. EPPU - REPLACEMENT OF UNCASHED CHECK 1,000.00 7. ATT 58.46 8. CAPITAL CARDIOVASCULAR ASSOCIATES- MEDICAL 2.3� 9. POSTAGE- UNITED STATED POST OFFICE 61.34 TOTAL(Also enter on Line 10,Recapitulation) $ 1 769.61 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RAYMOND L. MADDEN 21 14 0424 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include ouUight spousal distributions and transfers under Sec.9116(a)(1.2).] 1. CHRISTINA M. DUTTRY Lineal 343,845.45 46 WILLOW WAY DRIVE ENOLA, PA 17025 2. DAVID R. MADDEN Lineal 354,445.97 38 S. LEHIGH GORGE DRIVE WEATHERLY, PA 18255 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. ST, THERESA OF THE INFANT JESUS PARISH OF THE 1,000.00 ROMAN CATHOLIC DIOCESE OF HARRISBURG, PA 1300 BRIDGE STREET NEW CUMBERLAND, PA 17070 TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 1 000.00 If more space is needed,use additional sheets of paper of the same size. . LAST WILL AND TESTAP�JIENT OF RAYMOND L. MADDEN I,RAYMOND L. MADDEN, of Susquehanna Township, Dauphin County,Pennsylvania, being of sound and disposing mind,memory and understanding, do make,publish and declare this to be my Last Will and Testament,hereby revolcing and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses, expenses involved or connected with the administration of my estate, and all federal, state, or other death taxes payable because of my death with respect to the property forming my gross estate whether or not passing under this Will as soon after my death as is reasonably possible. However,my personal representative need not accelerate and pay those unmatured obligations which, in his, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not own a burial plot or a grave marker at the time of my death, I authorize my personal representative, in his,her, or its sole Page 1 of 6 Pages discretion,to purchase a burial plot and to erect a suitable marker at my grave, and to expend sums from my estate for this purpose. SECOND I give, devise, and bequeath the sum of One Thousand and 00/100 ($1,000.00) Dollars to St. Theresa of the Infant Jesus Parish of the Roman Catholic Diocese of Harrisburg, Pennsylvania, or its successor. THIRD I give, devise, and bequeath the entire rest and remainder of my entire estate together with all insurance proceeds thereon of whatever nature and wheresoever situate in equal shares to my children, CHRISTINA M. DUTTRY and DAVID R. MADDEN,who survive me by sixty(60) days,per stirpes. FOURTH If, at the time of my death, any beneficiary of this my Last Will and Testament is under the age of eighteen (18)years or is, in the judgment of my personal representative,mentally disabled, I give,devise and bequeath said beneficiary's share to my Trustee, CHRISTINA M. DUTTRY, in Trust for said beneficiary,in accordance with the paragraphs below. If CHRISTINA M. DUTTRY is unwilling or unable to serve for any reason, I appoint ROBERT P. KLINE to serve instead. FIFTH During the terms of any trust created pursuant to this Will the Trustee is authorized to expend and apply so much of the net income and principal of each such trust as the Tnistee shall consider advisable for the health,maintenance, support, and education(including college education,undergraduate and graduate) of each such beneficiary until he or she attains eighteen Page 2 of 6 Pages (18)years of age, or until all such amounts are paid out of the Trust. When the beneficiary attains the age of eighteen (18) years or is in the judgment of my Trustee mentally sound whichever event occurs later, the Trust shall terminate and the remainder thereof shall be paid to said beneficiary. If said beneficiary shall die before the termination of said Trust,the Trust shall terminate and the remainder thereof shall be paid in accordance with the paragraphs above. I direct that no Trustee shall be required to give or post bond for the faithful performance of the Trustee's duties in this or any other jurisdiction. slxTx My Executor and Trustee are authorized and empowered to exercise from time to time in his,her or its sole discretion and without prior authority from any Court, in respect of any property forming part of any trust hereby created or otherwise in its possession hereunder, all powers conferred by law upon trustees or executors and I intend that such powers be construed in the broadest possible manner. SEVENTH No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner,nor shall any beneficiary have the power in any manner to charge or encumber his or her interest either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my personal representative for the liability of such beneficiary. EIGHTH I nominate, constitute and appoint my daughter, CHItISTINA M. DUTTRY, Executrix of this my Last Will and Testament. In the event CHRISTINA M. DUTTRY is deceased,unable or unwilling to serve or shall cease to serve for any reason whatsoever,then I nominate, constitute Page 3 of 6 Pages and appoint ROBERT P. KLINE,to serve instead. I direct that my personal representative shall not be required to give or post bond for the faithful performance of his, her or its duties in this or any other jurisdiction. NINTH I hereby declare it to be my expressed desire that my personal representative employ Kline Law Office of New Cumberland, Pennsylvania, for legal advice and assistance regarding this my Last Will and Testament, said attorneys having considerable knowledge of my affairs,views and wishes respecting any matters that may arise at the probate of this instrument,the administration of my estate, and the execution of the powers herein mentioned. IN WITNESS WHEREOF,I have hereunto set my hand to this my Last Will and Testament this day of '1�'Z��_,2013. ��-�-_ . . � Witness RAY � ND L. MADDEN �� C��/'�i, ��- Witness Page 4 of 6 Pages ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA . : SS COUNTY OF CUMBERLAND . I, RAYMOND L. MADDEN,the Testator whose name is signed to the attached or foregoing instrument,having been duly qualified according to the law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly,and that I signed it as my free and voluntary act for the purposes therein expressed. ' �� RAI' OND L. MADDEN Sworn or affirmed and acknowledged before me by RAYMOND L. MADDEN, the . Testator,this �� ` � day of,��f--� , 2013. � ` � -��-. _- �� .2Ly�_. C-�'-<�,.2G-ei?� i 1VOTARY PUBLIC COtv1�10NWEALTH CF PEN(dSYLVA�IA NOTARIAL 5EAL SNARON R.FEISTER, Notary'Public New�umberland Boro.,Cumberland Co. tJ,y Ccmmissian Expires April 15,2015 Page 5 of 6 Pages AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA . : SS COUNTY OF CUMBERLAND � We,�� -1� � � 7"l G��t,l c" and �iG�AfLc%� � �'1 r�l"1�'�t.��v� ,the witnesses whose names are attached to the foregoing document,being duly qualified according to the law,do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will and Testament;that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed;that each subscribing witness in the hearing and sight of the Testator signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. � � ��t�� Sworn or affirmed and subscribed before me by ��°-7 � �-�L/a'� and ��`'y�,v t'-�_ ��7�i��Sthis d�� day of �'I.��/ ,2013. � `�^ t.�`" �� . �� 'NOTARY PUBLIC COMMONWEALTH OF PENNSYLVA�IA NOTARIAL SERL SHARON R. rEISTER, Notar�r Public I�ew Cumbe�land Boro.,Cumbe�land Co. �,�y Commission Expires Aprii 15, 2D18 Page 6 of 6 Pages �� \ ` _�.� / `�'� \(\,� �� 1�� ` �� 4 � � �C� `� �o ��' ��