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HomeMy WebLinkAbout04-26-06 (2) -.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT ~/-O&,-{)13 Date of Birth 174-20-3376 01/27/2006 03/02/1928 Decedent's Last Name Suffix Decedent's First Name MI Davidson D. J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Davidson Jay Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS FILL IN APPROPRIATE OVALS BELOW . 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 4. Limited Estate . 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8. Total Number of Safe Deposit Boxes Richard L. Placey, Esq. Firm Name (If Applicable) (717) 236-9577 Placey & Wright REGISTER O~ILLS USE o~ F;: 0 2;~ -) I) -;:2 3631 North Front Street f'1 ') 1'-'-.) \-;; 1 =0 fTl c-") ;"""j ') .~o '.-:J f1 !::J .JCl ."'::-1 ~T1 ('-j . :Tj First line of address Second line of address -;~)~ City or Post Office State ZIP Code DA}E;,F~LED r~,.) Harrisburg PA 17110-1533 ~,) -..0 Correspondent's e-mail address:pwlaw@epix.net Side 1 L 15056051058 15056051058 -.J .. . REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME D. J Davidson STREET ADDRESS 1411 Longfellow Court File Number 21-D&.013Q DECEDENT'S SOCIAL SECURITY NUMBER 174-20-3376 .- CITY New Cumberland I STATE PA 1zIP I 17070 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,289.32 0.00 0.00 278.40 Total Credits ( A + B + C ) (2) 287.40 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty ( 0 + E ) (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) A. Enter the interest on the tax due. (5A) (58) 0.00 5,010.92 5,010.92 0.00 5,010.92 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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;.......................................................................................... 0 [i] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [i] c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [i] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [i] 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent[72 P.S. 99116'(a) (1.1) (i)]. " .. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot 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 twenty-one years of age or younger at death to ~ adoptive parent, or a stepparent of the child is zero (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 decedent's lineal beneficiaries is four and one- '^, / 11 pi /,/1 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)). I v n L/ The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9 ~ Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. . d C,., 1,DI,'l1A- REV-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF D. JANE DAVIDSON, a/k/a D. JANE DECKMAN DAVIDSON FILE NUMBER 21-06-0139 All properly jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Smith Barney Citigroup Account 639-01661-11 VALUE AT DATE OF DEATH 2,438.3364 shares Blackrock Insured Municipal Income (Hi-14.15; Lo-14.06 - Valued @ $14.105/share) 34,392.73 410.172 shares Smith Barney Aggressive Growth Fund B valued @ $100.62/share 41,271.51 48,000 shares Tennessee Valley Authority Fed BK 0% 11/01/2012 valued @ 72.189% Money Market Account 34,650.72 6,427.18 (See Smith Barney valuation letter attached) ".' TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 116,742.14 ,--=. SMITH BARNEY.... cltlgroupJ February 16,2006 Placey & Wright Attorneys at Law 3631 North Front Street Harrisburg, PA 17110-1533 RE: D. Jane Deckman Davidson Date of Death Account Information Account 639-01661-11 As ofJanuary 27,2006 Dear Mr. Placey: Enclosed please find the information you requested for D. Jane Deckman Davidson. Prices are as of January 27,2006. Ouantitv Name of Security Hil!h Low Close 2,438.3364 410.172 48,000 6,427.18 Blackrock Insured Muni Income Smith Barney Aggressive Growth Fund B Tennessee Valley Auth Fed Bk 0% 11/01/2012 Money Market 14.15 14.06 14.15 100.62 72.189% 1.00 If! can be of additional service to you, please call me at 717-264-5901. Sincerely, (C~~~/1 v:"/'L "--.--c' __ _J"- Lisa Morris Registered Client Service Assistant The above information is being provided to you per your request. This does not supersede or replace the monthly SmithBarney monthly statement. The above prices have been obtained from sources we deem reliable but we cannot guarantee its accuracy or completeness. Citigroup Global Markets Inc. 446 Stouffer Avenue Chambersburg. PA 1720] TeI717-264-5901 Fax 717-264-6483 Toll Free 800-842-7076 THE INFORMATION SET FORTH WAS OBTAINED FROM SOURCES WHICH WE BELIEVE RELIABLE BUT WE DO NOT GUARANTEE ITS ACCURACY OR COMPLETENESS. NEITHER THE INFORMATION NOR ANY OPINION EXPRESSED CONSTITUTES A SOLlClTATION BY US OF THE PURCHASE OR SALE OF ANY SECURITIES. REV-15G8 EX+ (6-98) ~ .~,!;{~:& -~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF D. JANE DAVIDSON, a/k/a D. JANE DECKMAN DAVIDSON FILE NUMBER 21-06-0139 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 NUMBER DESCRIPTION 1 . 1992 Lincoln Automobile VALUE AT DATE OF DEATH 1,000.00 2. Miscellaneous Personal Effects 0.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,000.00 .. REV-1509 EX+ (6-98) .~bl& ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF D. JANE DAVIDSON, alk/a D. JANE DECKMAN DAVIDSON FILE NUMBER 21-06-0139 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME I ADDRESS I RELATIONSHIP TO DECEDENT A. Deborah Zentmeyer 613 Somerset Drive Mechanicsburg, PA 17055 Daughter B, Denise Wade 2815 Oakwood Drive Harrisburg, PA 17110 Daughter C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1, A. 1. AlB 07/22/96 Members 1st Federal Credit Union Savings Account 160425-00 Principall-$2,267.00; Interest-$1.63 2,268.63 33% 756.21 2. NB 07/22/96 Members 1st Federal Credit Union Checking Account 160425-11 Principal-$2,756.16; Interest-$.58 2,756.74 33% 918.91 3. AlB 09/22/04 Members 1st Federal Credit Union CD 160425-44 Principal-$5,240.80; Interest-$13.78 5,254.58 33% 1,751.53 4. AlB 04/14/05 Members 1st Federal Credit Union CD 160425-45 Principal-$1,035.66; Interest-$3.61 1,039.27 1,039.27 5. NB 05/10/05 Members 1st Federal Credit Union CD 160425-46 Principal-$10,403.60; Interest-$26.60 10,430.20 10,430.20 Exclusion per 1707(c)(3) of Inheritance and Estates Tax Act $3,000.00 per transferree -6,000.00 (See credit union valuation letter attached) TOTAL (Also enter on line 6, Recapitulation) $ 8,896.12 (If more space is needed, insert additional sheets of the same size) REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/ Suffix Date Account Established Principal. Balance atDate of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CERTIFICATE OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CERTIFICATE OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established ~1~ MEMBERS 1st FEDERAL CREDIT UNION 160425 -00 07/22/1996 $2,267.00 $1.63 $2,268.63 Deborah J Zentmeyer, Denise J Wade 07/22/1996 160425 -11 07/22/1996 $2,756.16 $.58 $2,756.16 Deborah J Zentmeyer, Denise J Wade 07/22/1996 160425 -44 09/22/2004 $5,240.80 $13.78 $5,254.58 Deborah J Zentmeyer Denise J Wade 09/22/2004 160425 -46 05/10/2005 $10,403.60 $26.60 $10,430.20 Deborah J Zentmeyer Denise J Wade 05/10/2005 * All certificates purchased by transfer of funds from 160425-00 Estate of: D. JANE DAVIDSON Date of Death: January 27, 2006 Social Security Number: 174-20-3376 160425 -45 04/14/2005 $1,035.66 $3.61 $1,039.27 Deborah J Zentmeyer Denise J Wade 04/14/2005 ~~RS 1A)ERAL CREDIT UNION ~ttd( atJek D nise A. Wolfe I Insurance Services Supervisor March 28,2006 5000 Louise Drive · P. 0. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1st.org REV-1511 EX+ (12-99>. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-06-0139 ESTATE OF D. JANE DAVIDSON, a/k/a D. JANE DECKMAN DAVIDSON Debts of decedent must be reported on Schedule 1. ITEM NUMBER A. B. 1. 10. 11. 12. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Grace United Methodist Church - funeral luncheon 419.31 ADMINISTRATIVE COSTS: Personal Representative's Commissions 0.00 Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City . State Zip Year(s) Commission Paid: 2. Attorney Fees 5,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State .Zip Relationship of Claimant to Decedent 4. Probate Fees 302.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Highmark Retirement Plan - refund direct deposit February pension Members 1 st Federal Credit Union - refund direct deposit February Social Security Patriot-News Company - estate advertising Placey & Wright - reimbursement Cumberland Law Journal re estate advertising Wachovia Bank - estate check order Reserve for future costs, taxes and expenses 186.58 1,354.00 110.16 75.00 27.00 1,000.00 8. 9. 8,974.05 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF D. JANE DAVIDSON, a/k/a D. JANE DECKMAN DAVIDSON FILE NUMBER 21-06-0139 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Bixler's Flowers and Gifts - debt of decedent 23.32 2. Progress Energy Florida, Inc. - debt of decedent 25.66 3. Hospital Telephone & Telecom - debt of decedent 12.00 4. Internists of Central PA - debt of decedent 32.87 5. Riverside Anesthesia Associates - debt of decedent 29.97 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 123.82 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF D. JANE DAVIDSON, a/kJa D. JANE DECKMAN DAVIDSON FILE NUMBER 21-06-0139 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 outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)1 1. Deborah Zentmeyer, 613 Somerset Drive, Mechanicsburg, PA 17055 Daughter One-Half Resi 2. Denise Wade, 2815 Oakwood Drive, Harrisburg, PA 17110 Daughter One-Half Resi ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 due due (If more space is needed, insert additional sheets of the same size) , LAST WILL AND TESTAMENT OF D. JANE DAVIDSON a/k/a D. JANE DECKMAN DAVIDSON I, D. JANE DAVIDSON, a/kla D. Jane Deckman Davidson, now of Lower Allen Township, Cumberland County, Pennsylvania, do hereby declare this to be my Last Will and Testament and hereby revoke all prior Wills and Codicils made by me. ITEM I. I direct that all of my just debts and funeral expenses, including the cost of my gravemarker, if any, shall be paid from my residuary estate as soon as practical after my decease as a part of the administrative expenses of my estate. ITEM II. I give and devise all of my estate of every nature and wherever situate in equal shares to my daughters, DEBORAH ZENTMEYER and DENISE WADE, or their respective issue, per stirpes. Should either of my daughters predecease me and die without issue, such daughter's share shall be paid to my surviving daughter, or her respective issue, per stirpes, as the case may be. ITEM III. If any income or principal shall be payable to any person who shall be under the age of twenty-five (25) or who shall be incapacitated for any reason, my personal representative, as trustee, shall such income and principal for such beneficiary until the age of twenty-five (25) or during incapacity (whichever event occurs first) and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person after considering other resources available to such person for those needs without the ~, t)~ b~ D. Jane Davidson, a/k/a D. Jane Deckman Davidson appointment of any guardian or committee or any authority of court, and shall be entitled to make direct application hereunder or to make application by payment thereof to the parent or other person in charge of such person, or to his or her guardian or to a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be paid and distributed to such person upon attaining the age of twenty-five (25) or upon the termination of incapacity. ITEM IV. I appoint my daughters, DEBORAH ZENTMEYER and DENISE WADE, Co-Executrices, or the survivor of them Executrix, of this my Last Will and Testament. No bond shall be required by my personal representative(s) in any jurisdiction. ITEM V. In addition to the powers given by law to my personal representative(s) and trustee(s) [hereinafter fiduciaries] in the administration of my estate and of any trust(s) created herein, they shall have the following discretionary powers applicable to all real and personal property held by them, including property held for minors, effective without court order until actual distribution. A. To retain any property owned by me at my death and to invest any funds held by them in any stocks, bonds, notes or other securities or property, real or personal, including common trust funds, mutual funds and money market deposit accounts operated or offered by my corporate trustee, if any, or any affiliate of it. B. To sell or otherwise dispose of any property, real or personal, at any time forming a part of my estate or the trust estate, for cash or upon credit, in such manner and on ~ of} 1 o. ~1 ~ ~f.I D. Ja e DavIdson, alkla D. Jane Deckman Davidson ,., ... such terms as they see fit, and no one dealing with the fiduciaries shall be bound to see to the application of any monies paid. C. To manage, operate, repair, improve, mortgage or lease for any term [even if beyond the duration of the trust(s)] any real estate at any time held or owned by them as fiduciaries. D. To hold investments in the name of a nominee and exercise and dispose of warrants. E. To engage in litigation and compromise, arbitrate or abandon claims and property . F. To conduct any business in which I am engaged or in which I have an interest at the time of my death for such period as the fiduciaries deem advisable, with the power to borrow money and to pledge the assets of the business and to do all other acts which I, in my lifetime, could have done, or to delegate such powers to a partner, manager or employee without liability for any loss occurring therein. G. To allocate items of receipt or disbursement between principal and income as the fiduciaries deem equitable regardless of the character given such items by law; to distribute in cash or kind or partly in each at valuations fixed by the fiduciaries H. To borrow money, including the right to borrow from any corporate trustee, if any, and to mortgage or pledge as security or to hold its own stock if a corporate trustee. 1. To join in any merger, reorganization, voting trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto. ~.~~~ D. Jan DaVIdson, alk/a D. Jane Deckman Davidson 3 1. Should the principal of any trust herein provided for be or become too small in trustee's opinion so as to make establishment or continuance of the trust inadvisable, my trustee(s) may make immediate distribution of the then remaining principal and any accumulated or undistributed income outright to the person or persons and in the proportion they are then entitled to income. Upon such termination, the rights of all beneficiary(ies) who might otherwise have an interest as succeeding income beneficiary(ies) or in remainder shall cease. K. In general, to exercise all powers in the management of the assets of my estate or the trust estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as the fiduciaries may deem best, and to execute and deliver all instruments and to do all acts which the fiduciaries may deem necessary or proper to carry out the purposes of this will or any trust( s) created herein. L. To apply income or principal to which any beneficiary is entitled, directly for his or her comfort, maintenance and support, should the fiduciaries deem such beneficiary incapable of receiving the same by reason of age, illness, infirmity or incapacity, or to pay the same to such person or persons as the fiduciaries select to disburse it, whose receipt shall be a complete acquittance therefore without the intervention of any guardian. M. To assume continuance of the status of any beneficiary with reference to death, marriage, divorce, illness, incapacity or other change in the absence of information deemed reliable without liability for disbursements made on such assumptions. N. All principal and income shall, until actual distribution to any beneficiary, be free of the debts, contracts, alienations and anticipations of any beneficiary, and the same may ~ ~ .4- ,~ . /..J ~ D. Jan DaVIdson, a/kla D. Jane Deckman Davidson 4 . not be liable for any levy, attachment, execution or sequestration while in the hands of any fiduciaries. Provided, however, any beneficiary may assign any part or all of the beneficiary's interest in my estate or the trust(s) to anyone or more of the beneficiaries or my descendant~ IN WITNESS WHEREOF, I have hereunto set my hand and seal this H day of 6?lcJv /2005. ~.~'LJ ~~ D. Ja e DavIdson, alkla D. Jane Deckman Davidson The preceding instrument, consisting of this and four other pages, identified by the signature of the testatrix, was on the day and date thereof signed, published and declared by D. Jane Davidson, a/k/a D. Jane Deckman Davidson, the testatrix therein named, as and for her last Will, in the presenc of us, wh?,_~ r request, in her presence, and in the presence of each other, ;cbSCrib,~(!j} /BWitnes~.3 tP3 ( f'0 r;.~ d ~fJA,1~r4hC/nrr!- .~---- ~L~ ~ .61.n;~ 31.>3/ 71 .:;z;,~d .-dl-,/ .jL~1 /U 5 . ACKNOWLEDGMENT COMMONWEAL TH OF PENNSYLVANIA : SS. COUNTY OF DAUPHIN I, D. JANE DAVIDSON, alk/a D. Jane Deckman Davidson, testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. '.~~~ ~e Davidson, alk/a D. Jane Deckman Davidson Sworn or affirmed to and acknowledged be Jane Deckman Davidson, testatrix, this / qi'rl day of . ~ XJ kul No ry Public My Commission E tes' NOTARIAL SEAL -----, HOLLY S. KIRK, NotaryP,ublic Susquehanna Twp., Dauphin County My Commission Expires Feb. 15,2007 AFFIDA VIT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF DAUPHIN and ~ClndllQ L '/3vnCtw/, the witnesses whose names are signed to the attach or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight ofthe testatrix signed the Will as witnesses; and that to the best of our knowledge' 'e. testa . :'\~wa that time 18 or more years of age, of sound mind and under no constraip.t~Q e in enc;/ , /'/ / . .-- . :,;/~ ~~ _ ~4",~~; Sworn to and subscribed before me this I q 1n day of g G I1UCI"J ,2005. We, ,ChClfoL L, PIc'