HomeMy WebLinkAbout10-20-06
I
. . .
COMt.I>NWEALTH OF
PENNSYLVANIA
OEPAR1't.I:NT OF REVENUE
DEPT. 28(6)1
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
REV-1500 EX {&lq
FILE NUMBER
21-06-Q078
cotN'Y COlE YE'M IUIIER
DECElENT'S NMt: (lAST, FRST, AI<<) MIIDLE N1W.) socw.. SECIRTY tfJMEER
I-
Z Murdock. Hannah 192-28-8880
W DATEa:DEATH~~ DATE a: BRTH (MM-QO.YEAR) TtIS RE1URN IIJSI' EE FLED IN 1lFUCA1E1M1HltE
Q
W 01-09-2006 10-31-1922 REGISTER OF WILLS
fd
(F APPU:ABLE) SUIM\ING SPOUSE'S NAf.E (lAST, FRST, N<<J MDOLE NITIAI..) SOCIAl.. SECURITY NU&R
C
none nla
w I!J 1. Qigi1aI Reb.rn 0 2. Sl4lpIemeriaI ReIIIn 0 3. R8mai1der Reb.rn.. III......1i1 tz,tH2)
~ 0 4. UriIBd EsIlIIe 0 4a. FWe taresI Canprcrnise (dIIe III dIIlh... tz.1U2) 0 5. Federal EsllII8 T. R8IIm Requi1d
~a:~
wD. ~ 0
:J;Oa 6. Decedlri DIed TesIIIIIlM8dl CllJI't 01 ~ 7. 0ecelJe1 MaiItined a Living Trust (AIIIIcIl ccpr III 1i'uIO _ 8. TeG! t-URler rI Sara Depcd ac..
u~ 0 9. LIig8licn Praceeds R8CIIvId 010. SpausaI PcMrly Credit_ III dIIlh.--1Ut-lt IIllI t-t-85) o 11. Election to laCllll1<< See. 9113(,6,) lMdlldl 0)
ffi ".::::::n.JJ~C110';UIUST:BI!~~.:ALL~PONDeNCE.A*f.':...:'.: :.'. :::rA)r~.flO'''J:U..:~:1.0r/:: :
HAM: COMPlETE IN.t.JG ADDRESS
Q SAMUEL L. ANDES
z
~ FIlA NAf.E (I~) P.O. Box 168
~ TElEPHONE fUllER lEMOYNE. PA 17043
8 717-761-5361
--
1. RelII EstIIIa (SchD* A) (1) 156,078.00 ~ICIAL!E O~Y,~5
2. SIocbIlld Bcnla (~B) (2) ~C)-O n ;:c!/~
, . 1:::C ('") --I . . .' "-,
3. CIaIlIfyHefd Ccrpcmim. PIIhntip<< SoIe-Propriefln (3) : J )>... __-' '..-
f. c_ Z rn N c;:; rn
.... -:0 0 _-_0
4. ~ & Nafes ReceIvabIlI(SchdM 0) (4) . ."~:"'. c/) ^ 0
~~J <, 0 ):310 -n
9,072.33 --)O-n :x -n
5. CaIh, Sri 0epcsIs & Msc8Inous PersCNI Property (5) ..)c (~
(Sc:hedtie E) :~ C!? In
Z ~./-) C:J
0 6. JDilfIy Owned PrqlIIty (SdlIdUeF) (6) :g N -r-;
- -oJ
~ o SeplnIaBa1g RequesIed
::;) 7. _.VIa Trnfers & Msc:elfncus NlIl-Prob8t8 Property (7)
I: (SCNcIWe G<< L)
~ 6. Total Grma AIIIII (fdaI LNs 1 .7) (8) 165,150.33
9. FIIWlII ExpneI & Adrrinisfr8IIve Costs (Sc:hecIUe Ii) (9) 19,928.21
~ 10. 0ebII d 0ecIdld, abtgage LiIllIIIII. & Uens (Sc:IIlldIE Q (10) 2,905.42
11. ToIII DIcIuctIant (fdaI LNs 9 & 10) (11) 22.833.63
12. NIt"*- ofEstala (liIe 8 mills Une 11) (12) 142.316.70
13. CIwIIIbfe IIld GcIvIrmlraI8equeslsISec 9113 Trusts far which En eIeclicn to fax.. not been (13) 0.00
made (Sc:hecUeJ)
14. NIt Will SUbJect to .... (liIe 12 mills Lile 13) (14) 142,316.70
SEE INS'IRUC1IONS FORAPPUCAII.E RATES
Z 15. Arnold d Une 1411ll11b1e 1& IwIlJClUllll fax
0
~ IlIIt, <<....1IIlIer See. 9118 (8)(1.2) X.O_ (15)
$142.316.70 x.O~ $6.404.25
5 16. Arnold d Lile 141ala1b1e at IilIlII rate (16)
D. 17. Arnold d Line 14 fBllabfe at ~ rate X .12 (17)
~
18. Arnal.R d Lile 14 fBllabfe aI coIIaIerII raIe X .15 (18)
~ 19. .... Due (19) $6,404.25
Zl. 0 I:~*RE:". '00" .~: ":Rl5filNDOFAM~'''ertl
. ..' .Y,.ME..... A... ..... ..' .. . .. ..' q ...
... . . . .' .. :).)::~'~:BE:SURE tOAHSVIlERAU." :ON' . :SlDE ANJ.REcHECifliATH:<=<:: ..
. . .. . . .. .
STFPM2021F.1
".... ",., ,.".~~ ~~W;"."", <...,."_...,,.,....,-
'. 'f \
Decedenfs Complete Address:
STREET ADDRESS 1020 Swarthmore Road
CITY New Cumberland I STATE PA I ZP 17070
Tax Payments and Credits:
1. Tax Due (Page 1 Une19)
2. 0'editsIPayment
A. SpousiiI Povarty Crecit
B. PrIor payments
C. Discotri
3. IntenlstJPenaIty If appIcabIe
O. Interest
E. Per8ty
(1) $6,404.25
Total Cndts (A + B + C) (2)
TotaIlnterestlPerdy (0 + E) (3)
4. If Une 2 is grcBer than Une 1 + line 3. enter the ciInnce. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
5. If Line 1 + Une 3 is lJealer than Una 2. emr the dfl8rence. This Is the TAX DUE. (5)
A. Enter the iIUresl CIlthe tax due. (SA)
B. ErUrthetolalofUne5+5A. TtialstheBALANCEDUE. (58) $6,404.25
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER 1HE FOLLOlMNG QUESllONS BY PLACING AN ur IN THE APPROPRIAlE BLOCKS
1. ad deceda't make a InI1sir ant: Yes No
a relain the use orJnccme of the propertyblllSfemld; ........................................ 0 ~
b. retain the riglt fo designlte who shall use the prqH!Ity tnrlsI'erred or its inccme; . . . . . . . . . . . . . . . . . .. 0 ~
c. retain al8WllSioray InIenlst; or . ........................ ........... ........ .... ... .... 0
d. I8CIliva the promise ilr life of eilher payrI'HIU. bEnefits or en? ............................... 0
2. If dIBh ocr::tmId BIer December 12, 1982, del decedent tnI'IsB' property v.flIin one ye;Jl of deah
lIlithol.t receNIng ~consIderaIlon? .... ................ ... ........................... 0 1!1
3. ad decedert l1M1 an 1n trust fa" or payabJe l..,on deBIh bank lICClJlri or secuily at tis or her deah? . . . .. 0 ~
4. Did deceda't l1M1 an JrdviduaI ReIInment Accold,IIVIity, or other ~ property which
codainsabsllllclay . ? ....................................................... 0 lEI
IFnEANSWER TO AN( OFllE QlES110NS IS YOU MUST COMPLETE SCtEDlI.E G AN) FILE IT AS PART OF llE RETlM
lhIIr...... d pIIjq I dIclnhlll hM nUn, iI1l:kIh ~ ICMd&M 1IllI.......lIllIlDlhe bell d my knowledge lIlll belief. lis WI, carect lIlll ~
<<*lW .. II"'ClIIllfWall'llllllldwNch his
UNG RETURN ~
t!>
SlGNA1\JlE~~~.rrisburg, PA 17112
Ames s.- - I~l:~' .0. Box 168. le_. PA 17043
DATE
1<6' nq-.2qb
For dales cI dBaIh CIl or after JIJy 1, 1994 and bebe JarIJlIIy 1, 1995, the tax rate imposed CIlthe net vaue ct transfers to or for the use c1the IIII\'ivq spouse Is 3%
[72 P.S. pt16 (8) (1.1) (I)].
FCI' dales cI dBaIh CIl CI' after JanJIIY 1, 1995, the tax rate inDOSed CIl the net vaJue of transin to or for the use cI the SIniW1I ~ Is 0% [72 P.5. 19= 1) (Ji)~
The __ does not .~ a InnIfir to a SlIViving spouse iom tax, lI1d the statutory reqUl8l'leIU for dIscIosu8 cI asseIs lIid 1iIlng a tax rellm 118 sill even
if the 8IftMrG spouse . friI btnlIciay.
FCI'dates cI deIIh CIl CI' after JIJy 1, 2000:
The tax nH ImpoIed CIlthe net __ ct Iransin from a deceased ctiId twenty-one yeas cI age or ycuvI' at death to or for the use of a natlnI .... an .q,tive
Il8'ri. or a aleppaie.t c1the ctid Is 0% (72 P.S. 59116(aX1.2)].
The tax nH Imposed on the net vaJue ct Iransin to or for the use of the decederts UneaI beneficiaries Is 4.5%, a:ept as noted In 72 P.S. fi')116(1.2) (72 P.S. fi')116(a)(1)].
The tax nH Imposed CIl the net VBIue of IransfIlrs to or for the use ctthe decedelfs sIllIir9 is 12% (72 P.S. fi')116(aX1.3)). A sibling Is defined, lJlder Section 9102, as an
individual who has at least one JB8i In CCIIlmon with the decederl, wheIher by blood or ldopIIon.
STF PM2lI21F.2
.
. . ,
REV-1li02 EX + (1.e7) (Q
~CEPENNSYIWM
IIERITANCE TAX AE'RIlN
RESllBTDECEIDT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Murdock. Hannah 21-06-0078
AD !'III P"lI*Ir....wr tit. a tInR In cammon nut be IIpClrtad It fIIr.....VIIue. F8lr nwk8t... dIIIned ... price Itwlic:h JI"lI*lYwUI be~ belweIn I
wIq _lI1lIa .-..1IIar...... being compeIed to buy,.... boll having I'8ISClIllIbIe knaMedgedthe relevaltfacll. RIll JIRlI*Irwhlch IaJoInIIyoCMllld wIlh_ dllftlvcnNp
......~anll:hdNF.
ITEM VAUEAT DATE
NUt.eER DESCRIPTION OF DEATH
1.
Single-family residence at 1020 Swarthmore Road, New Cumberland Borough,
Cumberland County, Pennsylvania.
$156.078.00
Value based upon county tax assessment of land ($30,000.00) and improvements
($106.910.00) multiplied by the common level ratio for Cumberland County (1.14)
TOTAL (Also ..... on Una 1, RecapltuIaIion) $ 156.078.00
(If more space Is needed, Insert adlItionaI &heels of the SIIne size)
SlF PM:2Il21F.3
.
. , ,
REV-15118 EX + (1-87) (I)
lDIotOtWtEAl]lf OF PENNSVlWM
IHIIWI:E TAX RETURN
REBIBn' IECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Murdock, Hannah
FIlE NUMBER
21-06-0078
ESTATE OF
h:Ule.. pnlCll8ds dlllgallcllllld" dale.. ~ Went IlIClIived by" esllD. All pnlIBly JoInIy-owned wllhthe IIPt ~ IlniWlraNpnutbe cIICIaIId III ScMduIIF.
ITEM VALLE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
Checking account No. 0771031742 with Sovereign Bank
$5,029.81
NOTE: This account had been owned jointly with decedent's late husband,
Leonard A. Murdock, who predeceased her death and so the entire account
belonged to the decedent on the date of her death.
2.
1990 Chevrolet Caprice automobile in fair condition
$1,200.00
3.
Household furnishings, appliances, and other household contents
$2,500.00
4.
Checking account No. 610068-248-7 with Citizens Bank
$342.52
NOTE 1: This account had been titled in the name of decedent's late husband,
Leonard A. Murdock, who died shortly prior to decedent. At the time of decedent's
death, the funds in that account were in the process of being withdrawn and paid to
her and, therefore, we have inluded the date of death value in the account as an
asset of the decedent.
NOTE 2: At some point shortly prior to decedenfs death, the balance in the
account was $3,363.52. However, $3,021.00 of that balance was withdrawn by the
United States Civil Service System and the United States Social Security
Administration because they represented over-payments by those agencies to
Leonard A. Murdock. The result of that transaction was that the balance on the date
of death, and received by the decedent or her estate, was the amount shown above.
SlFPA42D21F.ll
lOTAl. {Also enteron line 5, Recap/tUation) $ 9,072.33
(If I1lOI8 spa:e Is needed, Insert lKkIIIonaI sheets of the SIIIl8 size)
.
~..~"i~.
lIII~1l4
Court Ordered Processing / MAl MB3 02-10
P.O. Box 841005
Boston, MA 02284
January 31, 2006
Samuel L. Andes
Attorney at Law
P.O. Box 168
Lemoyne, P A 17043
RE: Estate of: Hannah Murdock
Date of Death: January 9, 2006
Dear Mr. Andes:
Per your request, enclosed please find the account information as of date of death for the
above-named decedent. Please note the balances do not include accrued interest.
If you should have any further questions, please do not hesitate to call.
Very truly yours,
\ /) "
!)J(~ce\~__"___
Linda Spavento
OAG Team Leader
(617) 533-1789
(617) 533-1931-fax
Sovereign Bank
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Hannah Murdock
192-28-8880
January 9, 2006
Account #: 0771031742 Type: Checking
In the name of: Hannah Murdock or Leonard A Murdock
Date of Death Balance: $5,029.81
Int.(YTD) from 1/1/2006 to 1/9/2006
Accrued interest to date of death: $0.10
Other Info:
Open date: 6/5/1997
$0.00
Page 1 of 1
II Citizens Bank
1-888-910-4100
Call Citizens' Phone Bank anytime for account information.
current rates and answers to your questions.
US259 BR290
15
LEONARD A MURDOCK
1020 SWARTHMORERD
NEW CUMBERLND PA 17070-1707
Circle Summary
Account
Account Numller
DEPOSIT BALANCE
Checldng
Circle Checking
610068-258-7
Monthly combined balance to waive monthly fee is
Your monthly combined balance this statement period is
Member FDIC @Equal Housing Lender
1
Balana
Last Statement
3,363.53
5,000.00
2,083.89
Balance
this Statellent
342.52
Circle
Account Statement
o OF 5
Beginning December IS, 2005
through January 17, 2006
Contents
Summary Page 1
Checking Page 2
Check Images Page 4
LEONARDA MURDOCK
HANNAH MURDOCK
Circle Checking
610068-258-7
e
e
Total Deposit lalana
342.52
Total Relationship Batanu
342.52
REV-1S11 EX + (1.w) (I)
<DIIOfMEAIJH OF JIENHSYI.\MIA
IIEII1MCETAXREMN
RESlElfTlECEIEHT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRAnvE COSTS
ESTATE OF
AlE NUMBER
Murdock, Hannah
21-06-0078
DlbCaddadlntnut be rIplIItId on8d1edule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. $1,123.00
Stone and Murray (funeral services)
Rolling Green Cemetary (burial expenses) $1,673.90
B. ADt.tNISTRATIVE COSTS:
1. PnlI1II RepI..-.....s Con.lisslollS
N8ne II PtnonlII RepnlserDtive(s)
SocIIIII Secuity Nlmber(s) I Eftl tQnber rI PtnonlII RIlprISlllUlNe(S)
SlreeIAd*-
City Stale Zip
.s) ConmIssIcI1 Paid:
2. Nmrtt Fees SAMUEL L. ANDES $5,000.00
3. FIII1Iy Elempl/on: (f dececlelts address is rd the SlIllIa cllirnris, lIIIach expInIion)
CIairrlad
SIreet Address
CIy Stale Zip
ReIatIcrlsI1p rI CIaImart 10 Oecedert
4. Pnlb&Ia Fees Register of Wills $337.00
5. AI:coInIrfs Fees
6. TIKRelIrn Pnlprn's Fees $95.00
7.
Car1isle Sentinel (advertising) $138.30
Cumber1andLaw Journal (advertising) $75.00
Costs to repair and maintain home (see Schedule attached) $11,486.01
TOTAL (Also erier on line 9, RecapiluJaIion) $ 19,928.21
SlFPM:1021F.12
(If more space Is needed, insert adcitionaI sheets of the sane size)
& .
Schedule H Estate of Hannah Murdock No. 21-06-0078
Expenses to maintain home until distribution
Real Estate taxes
Municipal and County $667.77
School $1,328.00
PPL - electric service $705.93
UOI - gas service $803.00
P A WC - water service $134.22
Sewer and trash bills $129.60
Homeowners insurance $231.00
Granulawn - lawn service and maintenance $706.49
Joseph Hawthorn - painting, supplies, repairs, and utilities to prepare $6.780.00
house for sale
TOTAL $11,486.01
REV-1512 EX + (1.en (I)
COMlNWEALlHOF PEIlIlSYI.WM
NEIlITAI<<:E TAl RETURN
RESlENTDB:EDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABlUTIES, & UENS
ESTATE OF
FIlE NUMBER
Murdock, Hannah
21-Q6-0078
Indudllmllmbul-.l.-lal-
ITEM
tUeER
DESCRIPTION
AMOUNT
1. Quantum Imaging
2. Prescription SelVices
3. Healthsouth Nursing Home
4. Mutual of Omaha - insurance premium
5. Boscov's Department Store
6. New Cumbertand Fire Department
7. Magazine selVice
8. Capital One Credit Card
9. Chase Credit Card
10. Verizo- phone bill
11. AT&T - phone bill
12. QVC Channel
$4.93
$53.00
$21.20
$267.00
$50.37
$25.00
$18.48
$1,833.33
I
$375.45
$159.34
$27.32
$70.00
TOTAL (Also en... an line 10. RecapituISion) $ 2,905.42
(If more splD is needed, i1sert adcItIonaI sheets d the same size)
81'FPAA2021F.13
REV-1513 EX + (8000)
C<IIMlJIIrEAl.l OFPENNSYlWM
IIHNIM:E W REl'1JlN
IE8IlEHTDECEDENT
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-06-0078
ESTATE OF
Murdock, Hannah
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAt.E At-[) AOORESS OF PERSON(S) RECEMNG PROPERTY Do Not list TruslIe(s) OF ESTATE
1 TAXABLE D1STR1BU1lONS rlflCl\de outrIgtt spousal dstributials, lI1d trcI1sfers
lI1der Sec. 9116 (a) (1.2)1
1. Steven A. Murdock son 50%
510 Toms Road
Harrisburg, PA 17112
2 Arlene F. Orsinger
1005 Swarthmore Road daughter 50%
New Cumberland, PA 17070
ENTER OOlLARAMOUNTS FOR DlSTRJBUnONS SHOWN ABOVE ON UNES 15llROUGH 18. AS APPROPRIATE, ONREV-1500 CCNERSI-EET
n. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSALDlSTRIBUTICN)UNOERSECTION 9113 FOR WHICH AN ElEcnONTO TAX ISNOTBBNGMAOE
1.
none
B. awm"ABlE AND GOVERNMENTAL DISTRIBUTIONS
1. none
TOTAL OF PARl'n - ENTER TOTAL NON-TAXABLE DlSTRlBunCN) ON UNE 13 OF REV-1500 COVER SI-EET $ 0.00
STFPM2021F.14
Of mare space Is needed, Insert IIIcIIIonaI sheela of the l8l'l6 size)
I, HANNAH MURDOCK, of the Borough of New Cumberland, Cumberland County"
Pennsylvania, declare this to be my last will and revoke any will previously made by me. ;
ITEM I. I direct that all my just ~ebts .and funeral expenses, including my .grayemarker and
all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary ,estate as soon as practicable after my decease as a part
of the expense of the administration of my estate.
~ ITEM II. I give, devise, and bequeath all of my possessions and estate of every nature and
o wherever situate to my husband, LEONARD A. MURDOCK, provided he survives my death by sixty
(60) days.
ITEM III. Should my said husband, LEONARD A. MURDOCK, predecease me or be deceased
on the sixty-first day after my death, I give, devise, and bequeath all of my possessions and estate
of every nature and wherever situate as follows:
A. One-half thereof to my daughter, ARLENE F. ORSINGER, provided she
survive my death by sixty (60) days and, if she does not so survive my death, to
such of her issue, per stirpes, as survive my death by sixty (60) days and, if she,
leaves nci such issue, to the other person or persons taking under this Item III o~ ,this
my last will.
B. One-half thereof to my ~on, STEVEN A. MURDOCK, provided he survive
my death by sixty (60) days and, if he does not so survive my death, to such ot his
issue, per stirpes, as survive my death by sixty (60) days and, if he leaves no such
issue, to the other person or persons taking under this Item \II of this my last will.
ITEM IV. I appoint my son, STEVEN A. MURDOCK, executor of this my last will. Should my
'''',I ...
1"\
<J
0-..
"
(>
-
WILL
OF
HANNAH MURDOCK
.
said son predecease me or otherwise fail to qualify or cease to serve as executor of th.s my last
will, I appoint my daughter, ARLENE F. ORSINGER, executrix of this my last will.
Page ]. of 4
'. .
ITEM V. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM VI. In addition to the other powers and authorities granted to my personal
representative by Pennsylvania Law and by the other terms and provisions of this wiIJ, I ~erebY give
to my personal representative the following powers and authorities effective without court approval
and until actual distribution of all property: to compromise any claim or controversy; to make
distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my
personal representative may determine and at valuations finally to be fixed by them; to invest in all
forms of property, including any stock or other securities in any corporate fiduciary or its successor
without restriction to investments authorized for Pennsylvania fiduciaries, as my personal
representative deems proper, without regard to any principle of risk or diversification; to retain any
or all assets of my estate, real or personal, without regard to any principle of risk or diversification;
to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal
property and to give options for sales, exchanges, or leases, for such prices and upon such terms or
conditions as my personal representative deems proper; and to allocate receipts and expenses to
principal or income or partly to each as my personal representatives deem proper in their sole
discretion.
ITEM VII. I direct that my personal representatives and fiduciaries shall not be required to
give bond for the faithful performance of their duties in any jurisdiction. ~
.' IN.WITNESS WHEREOF, I have hereunto set my hand this 9 day of
Od' ~ ., 2003.
~ a.......J... ~J.,J...
HANNAH MURDOCK
Page 2 of 4
'.. -.
The preceding instrument, consisting of this and two other typewritten pages, each identified by
the signature of the testatrix was on the date thereof signed, published, and declared by HANNAH
,
MURDOCK, the testatrix therein named, as and for her last will, in the presence of us, who at her
request, in her presence, and in the presence of each other, have subscribed our names ~s
witnesses hereto. I
I
o
~
J
~
Page 3 of 4
'...
...
....,
~
COMMONWEALTH OF PENN5YL VANIA
COUNTY OF c.",-"^,b~rl",,...,J)
)
( 55.:
)
The undersigned, being the testatrix whose name is signed to the attached or foregoing'
instrument, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will, that I signed it willingly; and that I siqned it as
my free and voluntary act for the purposes therein expressed. . 1
5wQ.rr.t or a.tfirmed to and ~cknowledged
befdre m~by"the testatrix named above
'.tllis ,-~_ d~y of OC'l'be.~ I 2003.
-- ." "'. ......
oJ#'
C1ioJ ~J..
HANNAH MURDOCK
NOmr-JIOTMY PUBlIC
fa.. BORG CUIIBER1.AND CO.
. COMM1SS1Oft aPim AUG. 17 ·
COMMONWEALTH OF PENNSYLVANIA
C~
COUNTY OF
)
( 55.:
)
WE, S' AIV\~~l. L.. IrHOE"S and AMV H A-~K,,"S I the witnesses whose names
are signed to the attached or foregoing instrument, being duly qualified according to law, do depose
and say that we were present and saw the testatrix sign and execute the instrument as her last
will; that she signed it 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 of the testatrix sig,hed the will
as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or more years
of age, of sound mind, and under no constraint or undue influence.
Sworn or' s'ffirmed to and
. " dCk~owledge(j--before me this
-. ""--.. .'
l::: !t, aay.of:~C.1b&~, 2003.
~~
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