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Home My WebLink About07-01-15 (2) � pennsylvania 1505614105 �i....�.mmrurcv E%(03-10)IFl) REV-1500 OFFIGIAL 119E ONLT Bureau of Indivitlual Taxes CountyCotle Vear FileNu�mbeIr Po eox 28a6ai INHERITANCE TAX RETURN n � ,. I 3 � � (� I I O � Harrisbur , PA ll128-0601 RESIDENT DECEDENT d" ENTER DECEDENT INFORMATION BELOW Social SeCOtlty NumbE� Date of D¢alh IAMDOYYYY Da�¢of BihM1 MMDOYYVY � � 06162013 10081939 DecetlenYs�ast Name Su1(x �. Oecetlents Firs[Name .. M� .Godfrey .... . . . .. Judith . . ... ..�A Qf Appllcable)Enter Survivin9 SPouse's In7arma[ion Below .. . ... .. . .......... Spouse's Lasl Name .. . Suflix Spouse s Firsl Name M� THIS RETURN MUST BE FILEU IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW p 1.Original ReWm � 2 Supplemental ReWrn O 3. Remainder ReNm(da�e of tleath pnor l0 12-1182) p 4.Agncuflure Exemption(date of p & FUWre Interest Compromise(Cate ot p 6. Fetleral Es�ate Tax ReWm Required dea��on or afte�]-0-2012) tlea�h aker 1242$2) � ].Decetlent Dietl Testate O e�Decetlent Mainlainetl a Living Tmsl 0 9. Total Number of Safe DeOosit Boxes (Atlech wpy ot will.) (Avach copY of imsl) p 10. Liligation Pmceetls Receivca O ��' �ScbeEu eaF ntl G Asses Ooly� � 12' DeterrallElection of Spousal Tmsts O 13. Business Assets � 14. Spouse Is Sole Beneficiary (NO 1N6�IOVOIV2d) CORRESPONOENT- THIS SECTION MUST BE COMVLETEU.RLL CORRESPONDENCE AND CONFI�ENTIAL TA%INFORMATION SMOIIL�BE DIREGiE�t0: Name Daytime Telephone Number �Tricia D. Naylor, Esquire� � �� (717)249-6873 � First Line o(Atltlress ...... .... .... . .... ...... 19 West South Street�� SecontlLineofAddress �� . Ciry or Post Offme Sta[e ZIP Code .._... _._.. ..� Cadisle PA 17013 � .r, � m � . .... _ c o m n tna lor baricscherer.com -� �� r�-- -`-' � CorrespontlenYs email adtlress: y � - r ;;� J� � _� REGISTER OF WILLS USE ON�:Y� IT - -' r ,o 0 REGiSTEROFWILL5U5E0Nd , O � . � �.ppTE FILEU MMUUYYVY� �.�'. � �� '�l T . . � ".'1 � � � w r m _'� � o � N � oare ri�eo sr� PLEASE USEORIGINALFORM ONLV Side 1 L I��I�I�'�'I�I�I��III�I��II�4�II��II��I��II�� 1505614105 � s 1 La J 1505614205 REV45W EX(Fl) DecetlenYs Social Sewrity Number oeoeae�r:r+ame�. JudithA. Godfiey � � RECAPITULATION .. . .. ....... ... . ....... . ... . 1. Real Es�ate(Schetlule A). � .. . ... ... . ... . .... . .. . ... .. 1 _.._ . . _.. .... . .... . .. ... ... ... ... 2. Stocks and Bonds(Schedule B) . . .. . .. . .. .... ... . ... .... .... . .. . ... 2 ...._.. _ .... . ��... 3. Closety Heltl Gorpora�ion, Parinership or Sole-Pmprietorship(SCM1edule C) .. . 3 _ , ,... .._... 4. Mortgages and Notes Receivable(Schetlule D) . . .... ... . ... ..... ... . 4 _ . ... _ .._... 22 186.93 5. Cash, Bank Deposi�s antl Miscellaneous Personal Property(Schedule E). . .. . 5 . . ._,__ 6. Jointly Owned Property(Schedule F) O Separate Billing Reques�e7 .. . .. 6 .. . .___�. ]. Inter-Uvos Tans�ers&Miscellaneous Non-Probate Pmperty 552 48 (Schedule G) O Separate Billing Requestetl..... . 7 . .. . 8. TOWI Gross Asse[s(�oWl Lines 1 Ihrough]).. . ... . ...... . _._ .._ . a .�_. .._._. 22�739.41 .... . .. ... . s 2 525.00 �. 9. Poneral Expenses antl Adminishative Cos[s(Schedule H). . ... . ., . _ . . 10. Deb[s oi Decetlen[,Mortgage liabillties and Liens(Schetlule I)... .... . . . . .. 1� , . ._. . ,'. ... . . .... . �� 2,525.00 11. To[al DetlucHons(btal Lines 9 and 10). .. . ... ... . .... .. .. . .. . �2. Nel Value of Estate(Line 8 minus Line 11) . . . .. . ... . .. . 12 2� 214.41 .. ... . .. . .... . . 13. Chan[able and Govemmental Beques�sl5ea 9113 Tmsts for which '� an eleclion lo lax has not been matle(Schetlule J) .... .... . .... ... . .. 13 . . . .. . � , .._ . . . ... 14. 20�214.41 14. Net Value Subjec�ro Tax(Line 12 minus Line 13) . .... . ... . .. - TAX CALCULATION-SEE INSTRUCTIONS FOR APPLIGABLE RATES 15. Amount of Line 14 taxable at ihe spousal tax rate,or _. _ . .... . . ... .. . Vansfers underSen 9116 �� 15 . (aJ11 2)%A— ..... . ..._ ... . . . .. . ..... 16. Amount of Line 14 taxable �� 20,214.41 i6. ��. 909.65 at lineal rete %0 45 . . __._ ..... ._... . 1]. Amount of Line 141axable �� .. al sibling rate X.12 � .... .. ..... . . �� ._. .. _._ _. ._. .. 18. Amount of Line 14 taxable �� a�collaterel rale X A5 ..... . . 18 -- � - . ....... .__...._.. 909.65 19. TAX DUE . .... .. . ... . ... .. . .. . .... . .. . 19 . _.. . . ..... . . .. ... . ... . . .. � 20. FILL IN THE OVAL IF YOU ARE REOUESTING A REFUNO OF AN OVERPAVMENT 0 UnOer penalties o�perlury.I Oedare I M1ave examinetl Nls reWrn,induding accompanying scheUule�s antl sWlemenK,and lo Uie�est ot my knowleUgD�QOareM1as II 15 Vue, 2c�en0 complele.Declare�lon o�prepe�a�olM1e�I�an I�a pe5on responslble lo�tJln I�e reWm is besed on all Informatlon ot wM1ICM1 eny kno tl9e_ SIGN RE F P i ON `�aN518LE PoR FI)NG RETURN �AtE/ /O .��l�S ADD E55 28 rentw Rd., Cam ill, PA 17011 51G E OF PR ER THAN ERSON RESPONSIBLE FOR FlLING THE RETURN � �0�� S � ADORE S 19 est South Street, , PA 17013 I��'I�I��I�II��II�II�4�II��I�'ll��l��ll�� Side2 y505614205 J L 1 561 2 5 REV-05W EX (FI) Page3 FilaNumbe� Decedent's Complete Address: DECE�ENT'SNAME Judith A. GodfreY .... ... . .._.. ..._ .._. . .____ . �STREETADD0.E55 ___ .. .. _—.. ._._. . � 28 Brenlwood Rd. __. . ..._ . ...... . .... .... .... ._.. ._.. .__. . . .. _—. . . I STATE . _ ._._. ZIP __. ._. cirv . PA �'� 17011 Camp Hill Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 909.65 2. Credils/Paymen�s A.PriorPaymen�s —. .—_.. .-- B.Diswunt _ _. --- � - Total Credits(A a B) (2) (Seelnstrudians.) 3. Interes� (3) 4. If Line 2 is greater than Line 7 +Line 3,en�er the diRerence. This is�he OVERPAYMENi (4) FIII in aval on Page 1,Line IO to request a refund. 5. If Line 1 t Line 3 is greater lhan Line 2,en�er the dlRerence.ihis is�he TAX DUE. (5) 909.65 Make check payable to: REGISTER OF WILLS, AGENT. � PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedenl make a�ronsfer and'. Yes No a. relainfheuseorincomeoRhepropertytransferred .,...._. .--�� ----- �-""'-' � � b. reWin�he rightto Oesignate who shall use the properly transtened or ils income ................_.........,._...._,...... ❑ � c. re�ainareversionarym�erest ....... . ._........... ..........._.... .__......... ................. ❑ � d. receive�he promise for Ilfe of either paymenis,benefifs or care'+ ............... ........,..,,.. ................,. � � 2. If dea�h ocarted aRer Dec. 12, 1982,did decedenl Uansfer propetly within one year of death ■ ❑ wi�hou�receiving a0equate considera�ion? _ . .............. ........-.... - � 3. Oiddecedentownan"inVuslfor'orpayableupondeathbankacwuntorsecunNathisorherdeatM ....._ ❑ 4. Did decedenl own an individual retiremenl accoun�,annuity or other non-probale propetly,which contains a 6eneficiary designa�ion? ...._.. ----- -"""'- """""""" � ■ .............. 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 da�es of dealh on or afler July 1, 1994,and 6efore Jan.i 1995 the taz rete imposetl on the net value of transfers to orfor the use of the surviving spouse Is 3 percen�[72 P.S.§9118(e)(1.1)(I)]. For dates of death on or afler Jan. 1, 1995, �he tax rete imposed on the net value of transfers �o or for the use of �he surviving spouse is 0 percent �72 P.S.§9116(a)(1.1)(ii)].The statWe does not exempt a Uansfer to a surviving spouse hom tax,and ihe statutory requiremenis for tlisclosure of assels and filing a tax reWrn are still applicable even if the surviving spouse is Ihe only beneficiary Por dates of death on or afler July 1,2000: • The�ax ra�e imposed on Ihe net value of Vansfers fmm a deceased child 21 years o(age or younger at dea�h to or for the use of a nalural parent, an adoptive parent ar a step-Darent ot the chiltl is o percent(72 P.S.§91t6(a)(12)�. • The�axra�eimposedonihenetvalueofiransferstoorforiheuseofihedecedenfslinealbeneficianesis45percent,exceptasnotedin[72P.S.§9116(a)(i)�. • The tax rate imposed on lhe net value of Vansfers to or for the use of the decedenfs siblings is 12 perceN[/2 P.S.§9116(a)(1.3)�.A sibling is defned, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. pEViyoeEx��o813� SCHEDULE E � pennsylvania `17 oePnnrmervroFnevcrvue CASH� BANK DEPO5IT5 & MISC. mrewrorvce+�aer�nrv pER50NALPROPERTY aEsmerv*oEceocrvr FILE NUMBER: ESTATE OF: 2�-13-0710 Judith A. Godfrey IncWde Ihe pmceetls of litigation anE[M1e da[c IM1e Omceetls were mceive�by[he estate. All property)oin[ly owned with right af survivorohip must be tlisclosed on ScheEule F VALUE AT DATE IIEM pESCRIP�tON OF DEATH NOMBER �. Cash ReNnd of(ee hom Debra Maugan 4,448.00 p. Cash Refund o(school Wxes(rom Dehra Maugan 2 285.86 g, Cash Refund of credit card payment from Debra Maugan 7,990.07 q 2013federalincometaxrefund 1,713.00 5, SleepNumberBed 1,200.00 g Hummelscollection 4,500.00 7. Cash 50.00 TOTAL(Also enter on Line 5, RecaD��ula[ion) $ 22�186.93 I(more space is neeEed,use atld[ional sheets of pa0er of IM1e same size. REV-]510 FA+ (OB-09) � pennsyLvania SCHEDULEG �� oevaernervroraevcnue INTER-VIVOS TRANSPERS AND �r�Neana+cer�ne*uae� MISC. NON-PROBATE PROPERTY aEsme'rt oEceoerv* ESTATE OF FILE NUMBER Judith A. Godfrey 21-13-0710 TCIs schetlule murt be mmpletetl an0 filetl If Me answer to any af questlans l thraugh 4 on page three ol Ne REU�1500 is yu. �ESCRIPTION OF PROPERIY pATP OF DEATH %Oi�ECD'S E%CLUSION TA%ABLE I�EM �xcur cexnneavmemwueee*��unoxsrvmraoec�rvrwo VAWEOiA55ET WTERE4 �uuvuee� VAWE NUMBER N[onrzttmwstx. nn��[cwoiTMtof[oraxw[srarz. �. Gifl of Miscellaneous Personal Property,Debra Maugans,tlaughter,O6R014 3,55248 100 3,000.00 55248 2 GiftofmusiclessonstoJertodMaugans,grandwn06/2014 80000 100 800.00 0.00 TOTAL(Alsa en[er on Line 7, RecaOitulation) ; 552.48 If mare space Is neetletl,ose atltlltlonal sheefs of paper of Ihe same slze. aev-�s�i ex—(oe-i3) � pennsylvania SCHEDULE H j1J oEvnrrrnerv*ovREVErvuE FUNERAL EXPENSES AND rvnevrnrvcernxae.oan ADMINISTRATIVE COSTS aesmErn oecEoervr ESTATE OF FILE NUMBER Judith A. Godfrey 21-13-0710 UecedmPs debts mus[be reported on ScheOule I. ITEM pESCRIPTION AMOUM NUMBER a, fUNERALEXPEN5E5: 1. B. ADMIN[STRATIVE COSTS: 1. Penonal Representative Commissions�. Name(s)ot versonal Representative(s) __ _._ — � � -- StreetAOdress . ._ ._—. .. .. — . _— .—. —� � -- CitY—.—. � .. . . State ._ZIP_._ _ _— Year(s)Commission Paid:_._ . . - --- --� --- - - -� �— 2,500.00 2. Attorney Fees: }. Fdmlly E%PRIpb0111 (1(dPCEtlP�I�S dddfP5515 OOIIhP SdRIE d5 CIdIlOd0I�5�dlfdth Q%pldfldl100.) �131Rid0[ . , . _.— . _ . - .— . . _ Stree[AOOress. _. __... ..... ._. _ _... ... _.... Cry .._ . ._._ . ... . . Sta[e ._.. ZIP .. ..... RelationshipofClaiman[foDecedert _._ . _.. ._ ... _ ... 4. Prabate fees: 5. Hcmuntant Fees: 6. Tax fteturn Preparer Fees'. 10.00 �. Copies-Belco b. FilingFee-RegisterofWills 15.00 TOTAL(Also enter on Line 9, Recapitulation) $ 2,525.00 II more space is neeGe4 use addi[ional shee6 ofDaOer oF[he same size. REVi513 E%+ (O1�10) �� pennsylvania SCHEDULE J o`°"a�"`"`°`"`°F"°` gENEFICIARIES INNERITNICE TPN PEfO0.H 0.ESIDEM�E�DENi FILE NUMBER: ESTATE OF: Judith A. Godfre 21-13-0710 0.EUTIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AN�AD�RE55 OF PERSON(5)RECEIVING P0.0PERiY Do Not list Trustee(s) OF ESTATE 1 TA%NBLE DISTRIBUTIONS[IntluOe ou[nght spausal GisMbutions and tmnsfers untler Sec.9116(a)(1.l),] �. �ebra J.Maugans,28 BrenN;ood Rd.,Camp Hill,PA 17011 daughter ��2 2. Richard A.God6ey,Sc,26910 White Plains Way,Leeshurg,FL 34748 son ��2 ENTER DOLUR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18 OF REV4504 COVER SHEE[AS APGROGRIATE. 31 NON-TA%ABLE DISTRIBUTIONS A. SPOUSAL�[STAIBUTIONS IIN�ER SEQION 9113 FOR WHICH AN ELEQION TO TA%IS NOT TAKEN: 1. B, CHARITABLE AflD GOVERNMENTAL�ISTRIBUTIONS: 1. TOTPI OF PART II- ENTE0.TOTAL NON-TA%ABLE DISTRIBU�IONS ON LME 13 OF REV-150�COVER SHEET. S I(more space is neeEed,use atltlitianal sheets of pa0er of Ihe same size. i�� io Will of Judith A.Godfrey Part I. Pereonal Information I,3udiih A.Godfrey,a resident of the Stete of Peonsylvanie,Cumberlen�aunty, e�el az� m � U�atthisismywill. m�� z y y mi � _� o . � ar rv mm Par12.Revceallon of Provious Wills a y � '�^ � o z . �c o 0 i rewke all wills and codicils that I k�ave previously made. � o � 3 " � c = � z r r m Part3.Ch0drea ? ~ � (ri,,�; .. . (have the following children now living:Debra J. Maugens and Richard A,GodCrey,Sc A Part 4.Grandchildren I have the following grandchildren now living: Shaw¢D.Malvin,Derek R Maugans, Jecrod M. Maugaus,Adam S. Maugans, Amanda Msrquis,Tiffini M.Howell,W illiam C. Godfrey,ltichard A. Godfrey,Jc and Allison Godfrey. Part 5.Disposition ot Property A beneficiary must survive me for at least 45 days W receive property uoder llvs wi1L As used in tltis will,the phtase"sim�ive me"means to be alive or in e�cis[e¢ce aS an organization oa t6e 45th day after my death. If I leave property to be shered by hvo or more beneficiaties,and any of them does not survive me,i leave his or Mc share to the othe:s equally unless this will provides otherwise. My residuazy estate is all propar[y[own at my death thaz is subject to this will tLat does not pass tmder a general or specific beques[,including all failed or lapsed bequesfs. I leave my dwelling at 28 Brentwood Rofltl, Camp Hill,PA 170ll ro Debm J.Maugens.If Debra J.Maugazis does not survive me,I leave ihis property to Randal Scott Maugans. I lesve my residnary estate to my children Debra 1. Maun�ne and Richard A.Godfrey,Sr. in equa]sLaccs. if Debra J.Maugans does not survive me, f leave her share of my residuary estate to Sha.vu D. Malvin,DerekR.Maugans,Jertod M.Maugens aadAdam S. Maugans in equal shares.If Richard A. Godfrey, Sr. does not survive me,I leave his share of my residuary estate to Amaada Mazquis, Williazn C. Godfrey,Richazd A. Godfrey, Jr.,Tiffini M. Howel]aud Allison Godfrey in equal sha�es. All personal and real property�hat I leave in this will shall pass subject to any encumbrences or liens placed on the properiy as securiry for Ihe repayment of a loan or Page 1 of i Initiels: � � � Dnh: //�y/13 Will of Judith A.Godfrey debt. Part 6.E:ecutor I name Debra 7. Meugans to serve as my executor. No executor sfiall be required W pos[bond. � Pert 7.Executor's Powers I direct my executor to take all ac6ons legally p�xnussible to have the probate of my will done as simply and as free of court supervision es possible under the laws of the state having j�aisdiction over ihis will,includiag Sling a pe6Hon in the approprtate court for the independent admivisnafion of my estate. I�rant to my executor the following powers,to he exercised as she deems to be in She best imerests of my eshate: L To retain property without tiabiliry for loss or depreciarioa 2. To dispose of property by public or private sale,or exchange,or otherwise,and receive azd administer the proceeds es a part of my estate. 3. To vore stock;to exercise any opfion or privilege ro convert bonds,iwtes,stocks or ottier secmities belonging to my estate into other bonds,notes,stceks or other seciuities;and to exe�cise all other rights and privileges of a person owning similaz propecty. 4. To lease any real property in my estate. 5. To abandon,adjust,azbitrate,compromise,sue on or defend and othe�wise deal with end senle claims in favor of or against mg estaze. 6. 1'o continue or participate in any business wUich is a pa[[of my estate,and[o incolporate, dissolve or othenvise change Ihe form of organization of the business. These powers,authority end discretion are intended to be in addition to the powers, authority and discretion vested in her by operation of law by virtue of her office,and may be exercised as often as is deemed necessary or advisable, withovt application to or � approval by any court. Part 8.Payment of Deb[s Except for liens and encumbiances plac:ed ou properiy u secucity for the repayment of a Page 2 of4lnitids: � � � I)ete:� w�u ora�a�cn n.coarrey loan or deb41 direct that all debts and expenses owed by my estate be paid in the manner provided for by the laws of Pennsylvanie. Part 9. Peymeot of Tases 1 d"uect that ail estate taxes assessed againsl property in my esfate or against my beneficiaries be paid using tt�e fotlowing asse[s in the order listed: my savings account at Belco Community Credit Union;my checking accounl at Belco Commwiry Cledit Union. Part 10. NaContest Provision If any 6eneficiary under this will contests this will or any of its provisions,any share or interest in my estate given ro the contesung beneficiary under tlus will is revoked and shall be disposed of es if that contesting beneficiary t�ad not survived me. Part 11.Severa6ility If a court invalidates any provision of this will, [hat shall not effect other provisions ifiet can be given efTect without the ittvalid provisioa Signature c I,3udith A.Godfiey,the testator, sign my name to[his document,this 2 y - day of oi u.wr Z �i3 ,et Ln �/c /�/�] (city � or couriry,and state). I declare thet I sign and execute Uus document as my last will,that I sign it willingly and that I cxecute it as my free and voLmtary act. I decia�e that I am of t6e age of majoriry or othecwise legally empowereA to meke a will,and under no consuaint or undue influence. Signaturc:_��.r��'6[E'Zi9 W'1[OC89C9 We,the wimesses,siga our names to this document,and declare tLat We testatoc willingly signed and�ecuud this document as the testator's last will. In the presence otthe testator,and in the presence of each otGer,we sign this wi11 as witnesses to the testator's signing. /// //// //// //// //U Poge3otalnitiah: /,[ U Dete: d� � � �_ — Will of Judit6 A.Godtrey To ihe best of our knowledge,the testator is of the age of majority or olhecwise legally empowered ro meke e wiq,is of sound mind and is wder no consKaint or uvdue - influence. We declare uodec penalty of pepury thatthe foregoing is tcue and coRect,tltis ,2 N� day of .�a� zn � 3 at Ei1d�� Pu— . (city or couoty,and stete). Firs( �tnas Si�yo�r neme: ��w�� 0. _ � �`.�...�.� Primyourname: VJPno�Phn J Crist Address: � y l� �!'on Sf Ciry, State:�i n P �u / ��y3 Secottd Wirnus /� Sign yow name: �2Lr�z f.d3,n�v� �� Print your name: �J' Y/Id N �/�C 0/3 J' Addmss:�o�9�0 k STG? l�7I C C �/J City, State:�/�p7p �/2L�, �/� �7��1 Page0of/lnitiels: Q U� 4/ . Date:� V Affidavit ACKNOWLEDCMENT $tate ofPennsylvania CountyoF. C U•., �,�� Ic...�.Z I, .,�.� �`�1-� A (,�d �e-� the testator whose neme is signed to the attached . or foregoing insawnent,having�ly qual�ed according to law,do hereby aclmowledge thaz I signed and executed the instrument as my Last Will;and t6at f signed it witlingly and as my frce and vol�mtary act for the pivposes therein expressed. Testator� ,�.Cl��'<°� �d'�'��«J Officer: __4�— COMMONWF.ALTH OF PQJNSYLVANIA NIXnNaISNI T�M.IlobMwn,Na4 ry Pudk �aa�m�o iwo.,amxcam caMy My Canmlss�in bprea Ibv.15,i015 . MEMBFl�iFNNSttVNl1AhS50OAT4YCF�IOTppIlS Attidxvit--Page 1 of2 Affidavit AFFIDAVIT State of Pennsyhania �OIIIII}'Of: l � iMb r�4n We,�llen�v� v. J C��S�' ynd E�� Q�/U �� _ the wimesses whose names are signed to the attached or foregoing instrument,having 6een duly qualified according to law,do depose and say thet we were present aud saw the testaror sign and execute the inshument as his/her Last Will;that ihe teststor sigaed willingly and executed it as his/her free and voluntary ac[forthe putposes iherein expmssed;that each.subscribing wilness in the hearing and sight of the testator signed the will as a wimess;aad that to N�e best of our knowledge ihe testator was at thet time 18 or more years of agq of sound mind and under no wnstraint or undue inHuence. Swom to or atiirmed and subscri6ed to.before me by Win�cl,n � (.'� ir and 13.� ron ,c,c� �5 ,wiMeSSes, this_�,dey of��, Witness:��,.,.� /1 �'�..a,7` Witr�ess: �_�Y�7��.C^J OtGcer:��{�_�/(/" " cowr�or+w�un�ov r�nnmvanu MMxat 4al Tlna H.Roba�hwn,Notnry Public E tPenrtiCwoTwO"NmUdlaidCauMy Ny(pmilSYbn Evpl?5 Nw.15�30I5 MFN6FA PBIIISYLVPM\RS'A[]IIICM Cf HOT FS �drvit—P�ge2 0[2