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Home My WebLink About01-11-07 --.J 150560141046 REV-1500 EX (05-04) PA Department of Revenue . Bureau of Individual Taxes , Dept. 280601 Harrisburg, PA 17128-0601 ENTER D CEDENT INFORMAnONBELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (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 ... 1. Original Return c::> 2. Supplemental Return c::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::> 4. Limited Estate c::> - c::> 4a. Future Interest Compromise (date of death after 12-12-82) c::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::> 10. Spousal Poverty Credit (date of death c::> 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 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes c::> -:l-:l rr-l C-. C) 'I I C) S; t;i~ , ,,'-r>r- Correspondent's e-mail address::> ~ ~ r;__, 2:3 ~~der penalties of pe~ury, I declare that! have examined this return, including accompanyin~ s~hedules and s~tements, and to ~he be, $t ef~nowledge and ~~f 0(::-':-) It IS true, correct and complete. Declaration of preparer other than the personal representative IS based on all information of which prep~ ~ any ledge. ;-, '"l ~"1 SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN :'~ -. ATE ~:::.; (_:..) ~~~n4 {". S~"'I~D-I ;.-- r'Y"l ADORES J c::> -- "., .:' /, 8 ~"'/~~ 1'v'V ~ mt> 2.1 z/ 0' I' SIGNA~OF,P~JJflER OTHER TH EP ~~r'''' ADDRESS 1 DATE - z,.t:H ~ w.~.:(~_fA_;::2.D'~ a~4.4.'.r~~ ~ /P;9 ,. , PLEASE E ORIGINAL FORM ONL" /~~~ Side 1 L 15056041046 15056041046 .....J -.J REV-1500 EX Decedent's Name: RECAPITULATION , ' 150560 420 47 ( _," ~ ~.""'" -'I 1. Real estate (Schedule~A). . . ~. . . ~ :. . . . . . ':' . . . . . . . . . . . '.'. . . . . . ~. . . . . . . '!'.. -1. 2. Stocks and Bonds (Schedule B) . . . . . . . . '': ',' . ~ . . . . . . . . . . . . . . . . . . . . . . . .. 2. ii"" 3. Closely Held}:;orporation, Partnership or Sole-Proprietorship (Schedule C) . .. .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. . . 6. Jointly Owned Property (Schedule F) c::> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::> Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . .. . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . , . , . . .. , . . . .. 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . , . . . , . , , . . . . . . 12. 13. Charitable and Governmental Bequests/See 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. TAX COMPUTATION - 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_ 16. Amount of Line 14 ~Jx, at lineal rate X.O ~ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 '*' it.''';. \ 1i. .,..... ~ .,.t;" 15. 16. 17. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ \. ~ L 150560042047 ," ,:. "-",.. " ,..' -" Side 2 c::> .. #0' '\ ... ... . .. .... 15056042047 --' REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENTS NAME /Ii /74 V. STREET ADDRESS CITY /'l1oWeRY fA,1~.sr r'e",yN Sr. .s-/ .~/CL/.r~ CHv~ STATE ~,p ZIP I r~/$ Tax Payments and Credits: 1. . Tax Due (Page 2 Line 19) 2. CreditslPayment~ A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 10.A~;;'1- ~ 000.. Do 2-/eJJ,F3 Total Credits ( A + 8 + C ) (2) ~ 2./~ G3 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 j;" 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) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) 3/8: 11 5. If Line 1.t..Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax 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;.......................................................................................... D III b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D 5lI d. receive the promise for life of either payments, benefits or care? ...................................................................... D ill 2. If death occurred atter December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. KI D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 5(1 D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D Jl] 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. 99116 (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 or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(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-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. 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. 99116(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. '" .... ~ .' 15056042047 REV-1500EX Dec~dent'sSocial Security Number "/1."..... ".. ,.......,.,~..,.,;.......'. ..... "'4.. .~: ,[,.~ 'fJ.1~ ll/ >~ .:"2, ~ ~. ~" .: . 1""':.;;1 .:1I:It .;>,:' ;,_ r :' -. ~ i", ,,-' ,;' . .. _...:s,- '. _ '. t. ~ .... ..,.{." , .;\~ ".t ,,,..~,,".. Decedent's Name: RECAPITULATION . \ ("" . . ..', ... ~..' .' I . '. .: · f.";';:"j"..:f"\f'1...."'.,..."'''f...'T1; 1. Realestate(Schedule'A).....~...~..........~............:.......::......~......,. ;.. : .," r;. ..... .~.}:.~ ..* r _ 2. Stocks and Bonds (Schedule B) . . . . ',':' . .. y. . . . . . . . . . . . . . . . . . . . . . . . . . . . ~;X6i:(tA" /~ 1"'r'}.'~~, "-q" \ ; \ rO; . ~.t.>r~,"-;\:i\ \ .' , !! .~ t ., 3. Closely Held ~orporation, Partnership or Sole-Proprietorship (Schedule C) " ...:, '~"ii~t~iilk;";J ii, e:1v . . ~l te;' ~ \. tP~ 7fit;;f-~' ....~1;; ;:i'/tC!fl~~8!(:"'/'~ 1....:...r....-r_i9h9) ....A .... ;~I ,:. ::::ffi~fE~:::t~:::e~:~I::~:(:::~;ch:dUI~")........"". ,: ~, "?~'"~t:t~l~:?~ 11. Total Deductions (~'lin.. 9 & '0)............................. ........ 11. C;.~C<fJ':ft~;@~r.:f7 '.' .,~ .,...... '., n~~~V,m;.......:'i;2Ii. 12. Net Value.ofEstate ,(L.ine8 minus Line 11) ..... ........ ................. 12.~' ,] .:// :~~.?~O ~7~ 13. Charitable and Governmental Bequests/See 9113 Trusts for which ~~;.~' ',' r'.k"J..L;........ . ',~., . :an election'.totax'has nO,t been-made (Schedule J) . . . , . . . . . . .... ..... .0;..... : 1. ." ,1~.. ~ . ,;;'.,....<.--:;,... ~). ~o}Z1$fci~;qC3 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.l.a;;';~j';>.~';; ~ ~. i 7. fi';l&~ii~;.~~,~ 8.' ' ' 4. Mortgages & Notes Receivable: (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. ...' '- '. . ,'. 6. Jointly Owned Property (SchedLlle F)C? .Separate'BiUlng 'Requested. . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non~ProbatePro~rty (Schedule G) . <:::) Separate Billing Requested. . . . . . . . TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. A~ount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116t~;';i'''': tc....,""c.:-~;..".'f''"''''...... """;.''';. \ '6. ~~~l :;~ne 14 ~, 15. ~"'l"+'"1+1"ru"-~:'"r''''':"C at lineal rate X.O ~ 16. ~ " i .,~ ; :..J;;~'f.r~~ ...z....;:- :: :~!~~g:~~:x::::::: 17. ~:t},:t:r.~.'.~t",C::P;:l.~:,,:' '. at collateral rate X .15 . 18. t ,i' ..... . 'J...; , " ,.".' . 19. TAX DUE..................:............. ......................... 19. [:,J.~~~J~:~:::1":~)~.3,:r:.Ar- ~ . 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . ... . . . . . . . . . . . . . . . . . . 14. ~ " "i. ~.\ '\. \ _.". ;., :, ~. 't -' , 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c:> I "':~ .- "\~.. " 41. - ; -'~.t " ~, '" .., ....'- "" ~. . ~ - -~ , \'.~' ..'-' "...... _.. .!,.. ,.... ".... ,1I " , ...~, " ..~ ., -..-.. _: ",' ." .... - ". Side 2 L 15056.0420 4 7 15056042047 ---I REV-1 SOD EX Page 3 . Decedent's Complete Address: DECEDENT'S NAME ~ A / 7 a:~Y \T.' STREET ADDRESS I OV'&I~ File Number CITY /f1o~cR~ """~.sr r>.eAl'N Sr. ..s-/ C;lpAL.~.r~ ~TATE ~,p ZIP I rC/"/ ~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayment~ A. Spousal Poverty Credit B. Prior Payments C. Discount (1)., 15;29,;;'~ ~ ~. 00 2-/~, F>- TotaICredits(A+B+C) (2) ~ 2./0, G~ 3. InterestJPenalty if applicable D. Interest. E. Penalty _ TotallnterestlPenalty ( 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) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (SA) (58) 3/8, 7-1 5. If Line 1 !,.Line 3 is gre,ater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT "\I!'''''' _.,.~, '-'\.+~;~}~\:~ 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 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or...........................................................................;.............................................. 0 5ll 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? .............................................................................................................. K1 0 3. Dicf"deeedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. Iii 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............................................................................:.......................................... D Jll r-.,.Jt:"if." ~~j"":J~.'-" :~ 1O'" .>; ~'" ..; >" ,":, . ~..,..~-i-{*~~@l$ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. i1~;;1~' 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. ~9116 (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. 99116 (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 or for the use of a natural parent. an 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-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. 99116(a)(1)]. 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. ~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. -....... . I, MARY J. MOWERY, 'of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke all Wills which I have previously made. I I give and bequeath my entire estate unto my son, Harold L. Stough, absolutely if living, and if deceased, I gi~e and bequeath the same to his issue per stirpes, absolutely. II If neither my son nor any of his issue shall me, I give and bequeath my entire estate, to Hillcrest Church of God, - 1250 Wagners Gap Road, Car1is1~, Pe~nsylvania. III I appoint Farmers Trust Company of Carlisle, ./ Pen~sylvania, as Executor of this my Last Will and Testament. that no bond shall be required of any fiduciary named in this will. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 21st day of March, 1983. 7/&~ 9- >/~ ' (SEA J Signed, sealed, published and declared by Mary J. Mowery, testatrix above named, as and for her last will and testament, written on one sheet of paper, in our presence, who, in her presence, at her request, and in the presence of each other have hereunto subscribed our names as attesting witnesses: . \-1~~c~~ 7(.~, REV-l508 EX. (1-97) . COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 3. FILE NUMBER ~"o...s- -0.3/'1 ~TS "" o.v Pe,eS(;)"f) # ~9,OO 7'#~~4L(! I'c3~~"c.... ;:'~pe~ 6~ ~~~,r".', ~~~ IZ~P4'N'J : ~)<;4.~tN - ~~< ~,. .,.., ? ..2. ~ J"'Ctt '" '- 2. ~9/, t?O ~~44#<.- 1~,..t6 .31 $. 41C / ~. t:1t::1 ,,2S:J,/S- -1', / S- .. /~J~NCc.. /~.t"~"''''~1C1< ~4"P~ ";N.rU"'A~ctS C e;~ c."..- r c_ ;;. / , , ,.0 TOTAL (Also enter on line 5, Recapitulation) $ / (If more space is needed, insert additional sheets of the same size) . 42a-'Y ?~/'';/ ~ ~ ~)p~./k3:t+'ut.-~ s/'1 Ca/L~-t~ / rAt /7tC>/3 S-~l~ '-_-J"; ~~ -?~ ~Iq -L ~lt= ~ l1ti ~~la $l~ ~~c .~~ g--k. /~~c ~~~ '/ok -r'- I .' .",.zi -r-t!.-~~ i //. :~/;/ ~JLd /..da-L~'"' .c~."?^(::.;/_~:. ii7hr-d~'. ~l ~~~. '. ... C 'i /' / .' ~~Z4:;G:7::~-' / , . ~"",,~-,"-:;,.> ::/..".,;.4 " ;'~.~ " """"l ,-....;' ( /' / /~4~(! , ~#J~J:2,/ . '-(:! v ~~~ ~ ti-li-"'- <<..:'-",f':."'C,,/ I ~ (;;;:/e~.:::_<cr--:~~~: "/- -4 ./ _~. /:/ /" ~~ r:t:k't~ Yt-~~.R~_k~_:/4>:' ii ~;;;7~"Z.L~~=~~=.._ ,'?U~'c~ I /~. '--L ' i ~ ('::~~~/ ./'~~- , ..'l".:J /'.i .,~_~~~ ,<?/.<" .// ~~:4tf--; :.-?;;.-... . .' ..[ c.. CO ~..." ..____.____._______ ~~;..~~~_.~ ' r 3' P;(7 -~~;-d:~~::?J.A!/4~;:..47-.~(f(:!?-:;t:.~}-.E?;:; -; _. -- .-/ .- /". /~ "', /'J .--"1 /, .~ - UJ'O'az;;Fa/ ~;?~ .-2..t! ,._.~c.~~~..._~---qr ,. : c. c~.:.;/,..:::~?~,..;:/~~/~~:fZ:.-.--...._.____ 2..€ ..,/' . ~~:~:~0':'----.---h ....__.__.... // .r fr' . ~-"--'-- 7~,.1~ . ~:1~ ala ~ ! l .._____.____u._...._............ .......-. . I 't/a.cL.k.4<",?/("'d~""~L7m___ . ..?__._" . (0 I~ -~-------~---._-_....~-~ ----_.~~ .----llili---- 'm_ ~'-'":--.--____+ . IS app.raisat~-~.---~---=_._.- i .~--~-~_....~-=.!~~~~===~s=--i~. I . ---.-.......-------...-------.--.-..........---.-...-------4-... 1_ . REV-1Sl0 EX + (1-97) '* SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH a: PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT OECEDENT ESTATE OF ^' , -,oweCr , ~~,;I/( r ..::r. FILE NUMBER ~OS-.... O:J"~ This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER 1. DESCRIPTION OF PROPERTY INClUDE THE NAME OF THE TRANSFEREE, THEIR RElATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. ;; c/ 7/2 C=/VS B,eJ///<=- % ~ C:Z02ff5-3U-3 (:::To",,,.J!'" I'P C' c...t- ~~....r"J"'; E/ 2~- _.~S' 4rI'G .s t::'N) c!'/ ,/ 2. C. 'v; /3 ,.,f-" // (c C2) -:# ~z~o- o//oL/2s- ( J'c/ N"'" /7 ~ c...1. esr.:3 /2.r~/;.;s ya..so"'''.J m rr. T e"., "'~ /C.. 7"4 .# ~ 2 C) 7 5 '7(65;": .3~ ~ _ ~ ./ /~1j;;:;:;> -L 7P' c.::.rco-) 4, /l7 P( r- 9;.;,/(<::.. CD # .3?/t/'c:f 3:>9 /cJ8 tXJ :3 73 (e-.J'~_ :3/2~0~' :L'7F G S'o~ ) 0-; /l) rI T P;:::;J,.". (<: CO .tt' 3/0CJ3C)/"7'ft7S0'?3 (CST, :3-/~/c;::s-- ~rp G s~--.,) So y c.-- /::;:. CE / <';;.y /J. /;.( // /<- ; -- I ~. - 02) #/9 35'Z~/C) 82- 7, co 7/ /(, r S..? Oc9 7'80 t3, / . Q:)=I'7 35:Z ~~2-3~ (/9/1 c-.rr; :L 7";: C s-'C>",/ ;, 7~/~ ," '---. - / -- :/ '--'-' W/oiC#cV/-4 9 co 11;2-9 -;~/ ::<O'/I/29/f'2 I J . .."....., , .~, /0. CiJ 11 cJ. ~ ?*o/ / ;:;..0 t C-I -7'-.6 ~~ Cf ( 70/'/\! r r9-.~ c..7..r, es-.,-, 3/~/bF c--..// b S~"'j 3, DATE OF DEATH VALUE OF ASSET '? ....-, /' I '} ,,< ~G,. I ~ VQ557:t1 9; /?5:9f /009C,.B6 2~ >';9 8, ~3 .., / c:-q r&:,' ""'" I c"./ 1,-..-/./ ..:!7/ 90 ~, ?;5' ~ / S::J, '" /O/~~:s,3{. /0 ~O,C7V I %OF DECO'S INTEREST EXCLUSION (IF APPliCABLE 1 TAXABLE VALUE ?8~,/7 Jr, 550/,.(,1 ~ /rS;CJ~ /009t,f?( 38 ~8B. 33 / ~/ t $9" 6"""'S- bI9(7~,:3.0 ~; /50, 7-./ /4~55;3G q c<::x:..;;, ~ (-/ TOTAL (Also enteron line 7, Recapitulation) $ / oB; 9 ~ ~ J-- (If more space is needed, insert additional sheets of the same size) J-O S- ::J 30CQ /00 .7/ /0:) /cc- / c .::: /,,;/0 -.!;; -C/ !;" ....,,/ . ".: ~.,~:'J :,:~od/"".";Q j' ~._ tIl ,7 ....~ ...C~t~~ell;) ib9;@rl',\ 'Jlt3> .......... ..... .... ." ~.' ".. ~ . !. j '-'- 1-800-773-7373 CaUCitizens'Phone8ank anytime for account information, . current rates and answers to your questions. Citizens Circle Gold Account Statement . OF 2 Beginning March 12, 2005 through April 13, 2005 , .'.,,_.'~' ~:(h'ecking c,. .' SU.M~~ R.'t " . B~lariciC~I~~la~on Balance Average Daily Balance . ',', ,"" ':..'."'. '''..':':.<. _, .':>: c'", 'pk~6as'B~ianc:~ Checks.. ". O\vithdra.~als .... 'D~posits:&Additions Interes't. Paid Current Balance 286.17 .00 - .00 - 51.67 + .07 + 337.91 - Interest Current Interest Rate Annual Percentage Yield Earned Number of Days Interest Earned Interest Earned Interest Paid this Year 301.82 .25% .26% 33 .07 .19 MARY J MOWERY THOMAS LEE STOUGH Circle Gold Checking Hi Interest 620255-326-3 Previous Balance TR A N SA C U 0 N DET AILS Deposits & Additions Date Amount Description 04/04 51.67 Transfer From Savings Acct 6240410425 Interest Date 04/13 A!"Ount Description .07 Interest Daily Balance Dille Balance 04/04 337.84 I NEWS FROM CITIZENS --Citizens is pleased to announce that the convenience of check images included in your account statement is here. In february, we mailed you a brochure with your account statement describing all of the benefits of check images, as well as answers to questions you may have about check images. You can now enjoy the benefits of check images, including simplified account balancing, convenient storage and easier income tax preparation. The IRS, Federal Reserve, local and state governments, courts of law and merchants all accept check images as valid proof of payment. If you need an image of the back of any check, we are happy to provide it. Copies of checks are available seven years from the date they are posted to your account. Just call the number listed at the top of this account statement anytime, or stop by your local branch. The following accounts did not automatically receive check images: Commercial, Municipal, Escrow, JOLTA, Citizens Asset Management Account, and Insured Money Market. Check images are not available for Braille and large print statements at this time. If you have any questions, or if for any reason you would prefer not to receive check images, please call Citizens Bank's request line for returning paper checks at 1-888-617-2600 anytime or stop by your local branch. In most cases, your request will be filled within 60 days or less. Thank you for banking with us. Dille Balance 337.91 Date 04/13 n.:::;-:t; ~','" ;=D:C :; ': '.i ~ 0: t-::':' ;...:; -~ ,- ; S.s'-3 ;2;.,'3;.-5c sid= f:.; !rr:,:,c',~~:'H-: Balance 286.17 , (+) Total Deposits & Additions 51.67 (+) e Total Interest Paid .07 Current Balance 337.91 ~ CD Statement ~~ Citizens Bank 1-888-910-4100 . OF 1 Call Citizens' Phone Sank anytime for account information, current rates and answers to your questions. Beginning January 01, 2005 through September 11, 2005 USOI0 BR289 MARY J MOWERY ~168 REMINGTON AVE BALTIMORE MD 21211 CD Balance Calculation Previous Balance Withdrawals Deposits & Additions Interest Paid Current Balance 20,554.64 V 21,001. 37 - .00 + 446.73 + .00 - MARY J MOWERY THOMAS LEE STOUGH 24-29 month CD 6240-410425 SUMMARV Interest Interest Rote AnnuolPe~entoge ~e(d Interest Paid this Year 2.96% 2.96% 446 .73 Pnvtous Balance TRANSACTION DETAILS 20,554.64 Date Amount Description 01/04 51. 67 Interest 011.04 51.67 Transfer To Checking 6202553263 021.04 51. 68 Interest 02/04 51. 68 Transfer To Checking 6202553263 03/04 46.67 Interest 03/04 46.67 Transfer To Checking 6202553263 04/04 !:ll.bl Interest 04/04 51.67 Transfer To Checking 6202553263 051.04 50.01 Interest 05/04 50.01 Transfer To Checking 6202553263 06/03 51.67 Interest 06/03 51.67 Transfer To Checking 6202553263 07/01 50.01 Interest 07/01 50.01 Transfer To Checking 6202553263 08/04 51.67 Interest 08/04 . 51.67 Transfer To Checking 6202553263 08/29 41.68 Interest 08/29 20,596.32 Withdrawal 0 () ('cOJJJl -S: Total Transactions Q ..( or 0le or 20,554.64 0 Current Balance .00 Member FDIC @ Equal Hous i n9 lender See reverse side for important information . ~ ' i.. \. ::.'\ '2 .{'),i' 5. " j,} ''', ~.!" l )....\ l L. _" t'.....; o I.- \ . ,._,1(-( , , ;J < I !. '''. I .... , .; . I ..1 1 "" . ( Page 1 of 1 ~ Conunand ::::::=> RMAB CUSTOMER-TO-ACCOUNT RELATIONSHIP BROWSE 193-36-3745 MARY J MOWERY 03/25/05 09:28:51 ReI Cd p/s/o Appl Account Number Stm PR D/1/R Prod Ctl1 Ct12 Ctl3 Ctl4 Brnch PRI JNT P 1M 6202553263,' ':,\M..ch.I\l.~ AIB D 055 0001 0060 0000 0000 289 PRI JNT P ST 00006240410425 ~~ AID D 324 0001 0060 0000 0000 289 Trlr Status Balance Date Cycle 286.17 08/02/2003 B09 20554.64 08/02/2003 033 AVAIL NORMAL OPENING AVAIL NORMAL OPENING Tbt'^- StoO 6H - 40\..D1" Accv'!:!.' ~.. ~ j' \]\. - '-" \. ~l(}S- ~\\Q .s\~ 0 ( " ,) ",j~ r;C ~) )}\,\'.. ~ IV}) ~. ~ \.;..,J '-..J\ \ ~ C.' ~ ("~' . ~y \'1-- (5 /1'\ \ ," /'\ v -........................ PFI-Fwd PF5-CustAcctBr PFB-CustAddr PF11-CustSvc PF14-AcctNonLeg PF2-Bkwd PF6-CustRel PF9-SesSetUp PF13-AcctLegTtl PF21-Top RMPCABS1 RM3180 I: PURGED ACCOUNT INFORMATION EXISTS 1ST UTG http://branchplatform/touchpoint/3 2 701 emu13 270. htm 3/25/2005 . . ADDRESS CHANGE - At least one choice must be made In each of the following Sections (1 and 2). Verify that no special mailing conditions exist for the customer. 1. To change the Customer Residence AND the associated Statement maiUng Addresses. BOTH CR and ST must be selected: Custom.. Residence (CR) ANDlOR Statement Address SpedaI MaIling Conditions: 00 Not Mail (OM) Tem Statement Address or End 2. Change ALL Addresses. Ust one account for reference: Complete requested change for Title 1 and TItle 2. 00 not change account (5) with ST addressees). OR Change the address for SPECIFIC accounts. list all accounts lD be changed. TYPE T'tPE ~E/111J,li ~E - "no: s~ ~ legal dac:unenlatloo for -. _10 be changlId. LIst TYPE - TYPE /' . ~ 15~'- 0 -~i,') I CLl~ 13/cY0B9J~"tr& ~ . COMBINE DUPLICATE RECORDS - Provide es and tie numbers (CULO): Commercial Customers and/or conunen:laI accounts cannot be combined. TIE I TlE c=J DUPLICATE STATEMENTS: Establish Duplicate Statement Account Holder TItle Change address on duplicate statement Account Nmnber of Statement to be Duplicated I · Commercial accounts must ..-quest or IndlcaW change of acldreu(n) on business lettertlud. signed by .uthorlzed slgrier. - Old InformIItIon New InfonnMlon Refer to DDMU 11 AND ACAL Addess t# of Mall To Street CIty, State. ZlD No..: Ant additional address (up lD 8) can be listed on a separate sheet. please attach to this form. Delete DupUC8tt Statement: Address '_of _ (refer to OOMU 11 and ACAL saeen) Addreaed To I I =~~$'~ I ~~~/~ /) ~"'~..1J~A ID~'o ~"".C"rJ ~>-~H../~ Date ~~~tlCC 'II ~ 0/ 7~ , Account . 0ItginII- Accaunt SeMcII . Copy- ~ GF.072 12104J2D01 . . MODIFICATION OF TOTTEN TRUST I (we) request that/the/my r-;) (account type and number) ~h/?d /c',K office of the Manufacturers and (Name of Branch) ~'Y r I'IIe!JlQerY Traders Trost Co., presently titled ,)0 -Qn/H~ (},~/aJJ S~i Jb,J to be changed to A/:L~ :T A'b"~r J: (Tit e on CIS) J" -"Q/1" ~ Ot>";7/~.rJ' S/7:>'tI J,~ ~ol?1aJ Lc~ S~r::f..4 ( z r Ji9 (new title)\~ iJiJ.-f- '1~ 9 7~9 COA - 31oo3~ ICJ~373 cOA-- 3 }C>o3<1/i./"7~7J 3-;<l-j -oS- (Date) maintained at the +(jA.WJL bt~~ J ~oA wner 1) ~ \.. (Owner 2) Sureof :if/ County of l::' - #q,;t- Cy On this the ;;2 7' day of -A.rc/ , 20t:!'>, before me personally appeared person(s) described in and who executed the foregoing and ged to me that he/she/they executed the same. (Notary Stamp and Seal) MATIHEW'WIiN$TEIN N-.....v PUBY:~C)i~AAND My (.ommj__~:~20~'2~ . !t' GF.363 (7103) I"~ .&.YMX.L Ll"O' an. CKINCl...CCOUNT HlAlBER SAVINGS ACCOUNT NUMBER .o.cCOllNT TITLE (OTHER THAN IHOMCUALI JOINT ACCOUNT) . LAST NAME (OWNER 31 FRST NAt.E SOCIAL SECURITY NO. SELl' EtoM'lO'l'E07 eYES ONO EMPLOYERIMATURE OF SELF.atPLOYMENT HOME STReET ADDRESS (P,O.IOX IS NOTACCEP1'A8LE) LAST NAME (OMd!R4I FRST NNoE SOCIAL SECURITY NO. SELl' SoFLOYED? eYES C NO BolPlOYERINATURE OF SELF-EMPLOYMENT HOME STREET AODfIE5S (p.O. lOX IS NOT ACCEPTA8LE) o ~CK lOX F .IClWT ACCOUNr OWNERS ARE HUSBAND AND WIFE lBtP. ADDRESS ""...,...""_n....... __a -_" _VVVU'" I vr ~I""~~ .,...\C"'...~. CITY CERTlACATE OF DEPOSIT.o.ccoUNT NUMBER CAT!: OPENED BATHDATE . -,;(-170/ COUNTRI" BtR'THDATE HOME PI-4ONE WORK PHOtE ST"'TE COUNTRy BRTHOA.'TE HOME PHONE WORK PHONE STATE COUNTRY BtRTHDATE HOME PHONE WORK PHONE STATE ~Y ZIP 36 ZIP CITY ZIP CITY START CAll! EXP. DATE ACCOlM' MAlUNG ADDRESS (W OFFERENT FRON PRIMARY HOME ADDRESS) OR Ml T EMPLOYEE NO. AND .JlWlCH OR DEPT. LOCATION MAILING STReET ADDRESS CITY STATE COUNTRY ZIP LAST NAME FClRTIIUST POOACCT.) FltSTNAME SOCIAL SECURITY NO. 8lRTHOot.~ (/< (!) q ee I - t.; -0 '/D /. -.3 -~' ~SS .8OXISNOTACCEPTA8l.E) crrY. J!A COUNTRY ZIP .:$ G .;I?~ ,#'7/;" ~ ..t?Q: ~~.n./7? ~ /.:<./ / c-........ lhIer pnIlIes or pIIjIrJ, I (CUIIIIlrY' 1) CIr'lIfy: (1) that !he IUIIber shlMn III this fonn Is my ccmc:t TIIlP1lWW IdenlIIIcatIan Number (or I am waIIklg far a IIImber 111 be ..... 111 fill), n (2) lilt 1111 nal UtjIct tD bICIcup wIIltlcd1g bIcuI (I) 11m eumpt fram tIlIcIq) wlllltlDldlng, or (b) I have not been natIfted by the InIImIlIIMnut SeM:e (IRS) 1IlBl11lll1UIIIect tD bIckup ....1Id1ll Is. ,.... of . fIIIIn 10 report IIIntnst f1I cMIencls, f1I (e) the lIS has no1IfIed me thallllll no iangill' IUIIIeCt 111 baclcup wIIhhc*Ing, and (3) that 11m I u.s. pnan (including a u.s. resiStnt aIIIn). c-........... IIIIIruc:IIaaI: '(au IlIIIt cross out I8n (2) IbcJo.Ie If you have been nolIfted by b lIS 1h8t you are cumnIIy subject 111 bacIcup wIthhddIng because of undemlportlng Interest << cMIends on JU III reIIm. (Also _ Plrtll- C8rtIIlcdan under SpecIftc InSIr1Ic:IIana llIlb IIPIfBI8 W-9 form.) ~IIS does not ..... JaIr-P, tD IIIf provision or 1t1Is documInt a1h. than ~ cer1IlIC8IIons nIQUIrId 111 avoid backup wIlhholdilg. ~ _~ M.D ht.u,- _ ~U LL PtJ{j Ml. ~Al1\-fj 'A~ mJiA{) (CUsIa1Ier 1)' ~ I) Slgnature"(Customer 2) III SIgnaII.n (QIsIomer 3) I) Signature (~ 4) III By ...... ...... I (we) (1) ~ ht MT Bank open In my (our) Il8IlIIS 1he depolIIt account(s) /8llU8SIId below willi lhe ""a requested, II1d (2) ackuowledge receipt of, n ...10 II pnMsIons of, lie GInnI DBposIt Aa:curt ...... AwIIIIIIIIIt>>' DIscIoIura far Consumer DeposIt Accourds. 1he SpecIt\c FtaturIS IIlCI Terms COI'I1Ilning ~,f.. ....6.n about 1he IICCOIJIt, 1M applicable ... sc:hedWe. nI, If !he ICCClUI1t II I Junbo Cer1IIIc:8I8 at DepasII, 1I1e Agreement for TeIIphane hJlructIons. ., ......... ........ I (we) lICknlIwIedge and agree that If 1he account Is opened In 1he naII8I ~ two f1I mOl'llndlvlduals, 1he account wi be a JoInt ~ WlIIIlIght of SUrvIwonI1Ip unless It Is allduclary or CUSIDdIII account. SOURCE OF FUNDS If this account will be opened with . CASH deposit of more than $10,000, pIeue check a1lh followtng that apply: o Business Rewnue o Inherttance o Account close out o Sale r:J personaIlt8m o Other (describe) o Not wiIHng to provide ANllCIPATED N;;2:;CNT A WI,.. Tran... AdIvtty: WIIIltIs account be used to I\'1CQ th 1 (one) OUTGOING wire transfer per week? 0 Yes 0 . If YES, pie.. 8IISW8r the o WUI the account be uaecI beneficiary? 0 Vi No o WUI the account countries? es 0 WUlltle D Yes D If YES, plealle an r the IJIIowi questions: o WIll the t receive . rs from multiple originators? DYes o Will the account recei wire transfers from originators in foreign countries? D Yes 0 No Cuh Activity: W1l1lt1e account be used to make more lh greater in cash per week? 0 Yes 0 0 If YES. please check all the following that apply: o Reta" Store Revenues o Parking LotI Garage Revenues o ProfessIonal Service Provider (Physician. Attorney, etc.) Revenues o Restaurant Revenues o Car/Truck IBoat/Farm I Equipment Dealer Revenues o Currency Exchange I Money Transmitter/Check o Other (describe): Will the account be used to make more or greater In cash per week? 0 Yes No If YES. please check 81 the following that apply: o Operating Cash to support business (check all of the following that appfy): o RetaB Store o Restaurant o Parking Lot/Garage o Car/Truck/Boat/Fann/Equipment 0eaIer o Professional Service PrcvIder (Physician, Atlcmey, etc.) o Currency Exchange/MoneyTransmitter/Check Cashing Facility o Other (describe): o Cashing Checks for customers of its business o To Fund an ATM o Other (describe): Facility Revenues Original- Acoount ServIces 0 Copy - Branch . Copy - Customer BR.524MD (11/02) "?;~'--/- .j~<.. ,(>f-.. :/ lr /'/,' . i"i { A . · 11 MBrI'Bank ... "".,. ........ .... .., ...............".... ............... . .. .:-:s~~~trE~io.ti:-:: . 429759 CLASSIC CHECKING MAR.24-APR.22,2005 1 OF 1 00 3 04319M M 021 MRS MARY J MOWERY ATF THOMAS LEE STOUGH 1 W PENN ST APT 514 CARLISLE PA 17013-2356 HIGH STREET-CARLISLE 17,582.48 .....~,.,. .....:]:.mREST~ ~IN:G.. .B~~I~G: . "'BALAN:Ctf" 0.00 0.00 "p,OSTlNG' ... ................... ......------..................... ... .. : DEPOSITS~.~R,E.~T ... "MCi(S:&:::O'I'HER: :::-:,:::,":::::-:::-::..:DAIliY:.::.,.:" ':' .. .. ......................----.......-.-.. .. ...-...."......".-....................--. .....-....."......."..................... . SUBTRACTiONs.: < ...........:~CE::<:. :DATE": , : , .. . '-::T~SACTlciN:DEscRipTiON .. ... ... ..... ::&i":01'RER:::AnD:ITIONS: 03-24-05 BEGINNING BALANCE $17 , 582 48 03-25-05 CHECK NUMBER 1594 35 32 17 547 16 03 -28- 05 DEPOSIT 172 88 03-28-05 PP ELEC BILL 61 59 03 -28- 05 CHECK NUMBER 1593 17 51 17 64 0 94 ~ 03 - 30- 05 CHECK NUMBER 1595 8 465 00 9 175 94 I" 04-01-05 US TREASURY 303 SOC SEC 357 00 9, 532 94 04-04 - 05 CLOSEOUT 9, 532 94 0 00 ENDING BALANCE $0 00 ACCOUNT ACTIVITY I: . . .. ................, - -. ,..,. - . . - . , , . . . ':CHEor<s:"~AIb>sUAAAA~:: . ... ._-.... .......... . . ................ . .........,........... . . .. ..,-....... .-. ..-.......... .. .... >>1 1593 03-28-05 17.51 1594 03-25-05 35.32 1595 03-30-05 8,465.00 M&T CHOICEQUITY, THE FLEXIBILITY TO CHOOSE FIXED RATE LOANS OR A LINE OF CREDIT ANYTIME. APPLY AT ANY M&:T BANK BRANCH OR CALL THE M&T TELEPHONE BANKING CENTER AT 1-800-724-3222. EQUAL HOUSING LENDER. l'?- <+ /' T4/~ecertl . . . .'~i L. I . _~: -. .J "~"" ..... .... '/,;:t ' \ - <") 'k..r;-. . ....... . <(I.~.. . . "::',~ \)0 \. ve 0 1- D'- C 1~ u.s.o F '. . ~ .... .....,.:' j L~# e:?tOo..'l91J..il('7s-C/f.l..... A3~, ~;~d3?~: l.. . C h.*' "sltlt) ~q '9<caoJ 1:5 _ $IAtJCIl;~fC-6J Yi:~ . .l'\" . , \ C~ts(!oN-h(JJ-Qo' fJJ1b- ~ JPU:J ch'-l/41rx ch# 3lcfJ-~,g16t-j,Y6 '-' /JZ{b,b~~ /9 '. 0-* 38,558-33+ 10'096-86+ , ., .\ 002 {~ 8 , 6 5 5 - 1 9 * .1-' \ c; . . 0-* ~ 38,558-33+ 10'096~86+. 002 ~---.......~ I . .......... 48,655-19* , . " ", 0-* ,r .':.0- '. ", . . ./ :" " " "-.,. . . . ./ --:.. \ '. - // '\. .//. . ., - \,.~ ......4.:" . .. \ . , . ' " ' , . l - . . . , . " ~.o t ~ . ..".- . i . ' ..1 i . J. -I , .; . . 1 '='oM~~ .. High Street-Carlisle April 8, 2005 4375 THOMAS LEE STOUGH JO-ANNE DOUGLASS STOUGH 3168 REMINGTON AVE BALTIMORE MD 21211 Re: New Certificate of Deposit Account Dear Thomas Lee Stough, Thank you for opening your new Certificate of Deposit account with M&T Bank. The following is a summary of your new account information: Account Number: Amount of Opening Deposit: Date Opened: Term: Maturity Date: In terest Rate: Annual Percentage Yield: Daily Percentage Rate: 31003908161646 $ 48,655.19 ~ 04/04/05 V- 12 Months 04/04/06 3.440 0/0 3.50 0/0 0.00942 0/0 If you have any questions regarding your new M&T Bank account, please call the M&T Telephone Banking Center at 716-626-1900 or 1-800-724-2440. Thank you for banking with M&T Bank. Sincerely, Michele Cole-Hecto~ Michele Cole- Hector Customer Service Manager CONREN ACRCSl .. ... ,'i I \)a \ 0f o:r Milestone Banking .Grow. Achieve. Thrive. Ask for details, caIIl-8n-SOV-BANK U-877-768-226S), or visit SlMll8ilJbank.aJIII. '. Sovereign Bank CUSTOMER RECBPr TD Wth Date 04/04/05 15=52 Tlr 001 T A/N 193524~ Seq 0212 167 AMt $2,682.36 _ '") ...-'"l..r;l ?--~I"'" BROOO8 (Rev. 9104) ./ c..J: ". MerrtJer FDIC ii:if.6< MIlestone Banking Grow. Achieve. Thrive. Ask for details, call-877 -SeJ/-BANK (1-877-768-2265), or visit SOYIlRli&nbank.am. ;. Sovereign Bank amoMER RECBPr TD Wth Date 04/04/05 15=50 Tlr 001 T AIM 1675208480 Seq 0208 167 AMt $5,961.36 BROOO8 (Rev. 9104) - ~-7, 06 ------.# ~'JPZ"/ MerrtJer FDIC '" ~ Milestone Banking Grow. Achieve. Thrive. Ask for debils, call 1-877 -SW-BANK (1-877 ~]68-2265> I or visit SlNIlI1IiIJbank.am. . Sovereign Bank -;:;i;'S ctm'OMER RECBPf TD Wth Date 04/04/05 15=51 Tlr 001 T A/N 1935244234 Seq 0210 167 - AMt $4,202.31 S'. ']" 10 .,..-.---......-:> Werrtler FDIC BRCXXl8 (Rev. 9/04) flFdt U '1/'1 /O~- .-:J: CA (("00 .,v,~ () fJ . ~ MARY J MOWERY 912 VIEW ST HAGERSTOWN MD 21742-3963 SAVINGS/CERTIFICATES VOUCHER - PAYMENT ADVH:;E _h_._____,.__,__________________._._.__.._..~'___._..~....-...---~..----.-.--.- CHECr<. Dil.iE NUMBER c.~ 1S75208480 -- ~J\,,'K)UNT A r;lC;U!-'!"; AMOUNT ._--~----~------_._-_.__.._...-._'_.__...__._-_._--. .-.-..------------------ 59.0SG 59.061 '*.....'*...59.0S.. .____,..__....__.___,___._.~__.._,....__.__._.E~~::~_0~~~~,,!S_!.;~~~Q.i.!!.~.~~.. __"_.,__,__.,~___'__'__. _EGEND , - PRINCIPAL PAYMENT - INTEREST PAYMENT G - tiR\.Y::S it-j T!:::;'::i~. ~'_; t ;:'"yova:rJ-; 'I/O; - r f-L,E F~AL T';:".< ~'jn i" "'lhELD '_-.0::" ._~.-.~~;-,:;.~:~~:=;:-~;,:;::;;;;~~~;:::~~?...=.::~ii:,;..-:tii:~~ ,,,,,. "'-~-' '....-- ';:::~-"'''''' THIS DOCUMENT HAS I\N ART!FI'::.;,_ WATERMi0;1' i'RITr-~[) 6N'HE B~~,~" 1liS:f'(;I''''- OF fiiE :::;S:::;~1E,';-f-::;j\:3 ;;-tv:JGRU.PRI~F SIG~')AT~:FlE LINE. ABSENCE OF i:-iESE rEA", ~RES WIl.L iNDICATE A COPY. 8sovereign Bank .. " : ;. \ .. Visit www.sovereignbank.co!7i and :;neck out Sovereign's on-line calculat,)fs to make Your financial planning easy. . -.. C. 'H. ECK .. NUMBEA 5566952 22.1676/960 REFERENCE NUMBER DATE 08803263 03-31-2005 PAY AMOUNT .'*.*..*.'*"59.0S"* ;~E MARY J MOWERY ORDER 912 VIEW ST OF HAGERSTOWN MD 21742-3963 *."*..*..*59.06.. 00167 Drawer: Sovereign Bank ."....-. ---.--,-_.~".,_.-._._.__._.~---_._-_.._.._- -- ._--~~._._-_.~._- _.- .....-.,.' -.....-.,. ..- - --.-.. ~Z"~:-..r."~:"':":'~~~':'::""-- - .._...~~.. ',"~_~.__._.~".z.:~." .-. ~.....:...:!!-~:.~.'~~,....J.:.' . M.__"'_ __.____..~.___~_. ._.______~..________ - -'-----'--"- ---. .. .._. -" --,.-...- --- WP ISSUED BY: TRAVELERS EXPRESS (;('MF'~.r" P.O. BOX 9476, MtNNCAFUUc,'. "JiN DRAWEE: US BANK, ST PAUL. ivlN - - ,,"' .t.. :00..::.'. ]3(;66 M 5377::J-L3 II. 5 5 b b q 5 2111 I: 0 q b 0 . b ? b 51: 0 . bOO .0 b 2 5 1. b 2111 . ~ MARY J MOWERY 912 VIEW ST HAGER5TOWN MD 21742-3963 VOUCHER - PAYMENT ADVICE 556772~ CHECK DAT(~3-31~~ AMOUNT SA VING5/CERTI FICA TE5 NUMBER C. f/ ij 1935241982 193524~ - AMOUNT AMOUNT 22.81 G 52.10G 22.811 52.101 TOTAL CHECK i\MOUNT **********74.91 ** _EGEND ) - PRINCIPAL PAYMENT . INTEREST PAYMENT G - GW)SS INTEREST P.A.YMENT \'Ii - :=a)EP,~L TAX WiTHHELD THIS DOCUMENT HAS AN -'\RTIF1CIAL WATERMA~~ PI'lINTED ON THE BANK. THE FRGNT OF THE DOCUMENT HAS A MICRO-PRINT SIGNATURE LINE. ABSENCE OF ,THESE FEATURE~ WILL INDICATE A COpy '''''~ .overeign Bank r::~f/ i \,;\~'.\ '" ' Visit www.sovereignbank.com and check out Sovereign's on-line calculators to make your financial planning easy. - CH'CK _ NUMB'A 5567725 22-1676/960 REFERENCE NUMBER 08804036 DATE 03-31-2005 PAY TO THE ORDER OF AMOUNT *****"'****74.91 ** MARYJMOWERY 912 VIEW 5T HAGERSTOWN MD 21742-3963 *"'********74.91 ** 00193 ",. ISSUED BY: TRAVELERS EXPRESS COMP,l,NY, lNC P.O. BOX 9476, MINNEAPOLiS, MN 554&0 DRAWEE: US BANK, ST. PAUL, MN _". _"M _ _.. '. ~...,..... . ............ ~'- ~. , 33866 i M 53773-L3 II- 5 5 b ? ? 2 5 II- I: 0 '1 b 0 . b 7 b 5 I: 0 ~ bOO ~ 0 b 2 5 " b 2"- . WAC '{i aU f f\ 1f11o~ UN Ut:c Of-/t('('OJ;Jf 'DART I A922564 BPZ90116 Org : 075 Serv: CDA Acct: 247412041179142 Date: 04012005 ---- Short Name: MOWERY MARY J TDA History Transaction Inquiry BATTI075 01/17/06 11:31 State: PABank: 24 MORE: + Posting Date 04/01/05 Effective Date 04/02/05 T/C Amount Description PY IC 49.30 + 49.30 - INTEREST PAYMENT ~ INTEREST PAID BY CHECK ~ CHECK # 00238794322 CURRENT BAL: 10,455.36 06/30/05 06/30/05 PY IC 142.19 + 142.19 - INTEREST PAYMENT INTEREST PAID BY CHECK ~ CHECK # 00238840305 CURRENT BAL: 10,455.36 Command: F1=Help F3=Exit F7=Bkwd F8=Fwd F9=APTDAI /0, l'lS"7*'. f.. ~ r -"~..._....---."....,......-.>;--.-..;.;,~.._...,..~. AM~ A342950 BPZAQ217 Acct Maint - Nam,:'/Addr /Taxid Customer :.e"-<') Cust Tax Id: ~rg: 075 Serv: CDA Acct: 247412041~142 ) St: PA Status: S Change Name: S Chg ROS :'.,,,. S Cur Name: ROS: MARY J MOWERY t ( THOMAS L STOUGH \ CZ66200 AV^ ! V\) {'K. OPEN S Change Address: S Chg Adr Tp: Cur Adr: Adr Tp: N 912 VIEW ST HAGERSTOWN MD 21742 s Chg Tax Id: Chg W/H Cd/Dt: S Affl PRIMARY 193363745 MARY J MOWERY PRIMARY 219540710 THOMAS LEE STOUGH Cur: 8193363745 Prnt DAA: NCAA: Y Cur: 01 05022000 Prey W/H CD: VIEW REMINGTON HAGERSTO MD BALTIMOR MD NO DATA CHANGED Command: AMS3 PF1=Hlp 2=Release 3=Exit 4=Pass 5=Refrech 7=Bkwd 8=Fwd 10=Lft 11=Rt 12=Altaddr ~,., {]1> " }V ''"'' \, ,. LJ \. 't\.' ...) r"tA..' 1:- J1~ ., l U<: ~ AMS2 A342950 ~ustomer: Org: 075 Serv: S Change Name: BPZAQ217 Acct Maint - Name/Addr/Taxid CZ662001 Cust Tax Id: CDA Acct: 247412066145448"\ St: PA Status: OPEN S Chg ROS :'-",-.~.,~.t; S Cur Name: ROS: MARY J MOWREY THOMAS LEE 8TOUGH 03/24/05 10:27 J S Change Address: S Chg Adr Tp: Cur Adr: Adr Tp: N 912 VIEW ST HAGERSTOWN MD 21742 S Chg Tax Id: Cur: 8193363745 Prnt DAA: N CM: Y Chg W/H Cd/Dt: Cur: 01 02071998 Prey W/H CD: S Affl PRIMARY 193363745 MARY J MOWERY VIEW HAGERSTO MD PRIMARY 219540710 THOMAS LEE STOUGH REMINGTON BALTIMOR MD NO DATA CHANGED Command: AMS3 PF1=Hlp 2=Release 3=Exit 4=Pass 5=Refresh 7=Bkwd 8=Fwd 10=Lft 11=Rt 12=Altaddr .. L4J!tCt/lYU I A L1 J71lJ~ Value of' ()('cOJ)J{ -" .", TDAHTI A922564 BPZ90116 TDA History Transaction Inquiry BATTI075 01/17/06 11:32 Org : 075 Serv: CDA Acct: 247412066145448 Date: 04012005 Short Name: MOWERY,MARY J State: PA Bank: 24 MORE: + Posting Date 04/07/05 Effective T/C Date 04/07/05 PY IC Amount Description 41.53 + INTEREST PAYMENT 41.53 - INTEREST PAID BY CHECK CHECK # 00238796567 CURRENT BAL: 10,000.00 06/30/05 06/30/05 PY IC 112.93 + INTEREST PAYMENT 112.93 - INTEREST PAID BY CHECK CHECK # 00238840510 CURRENT BAL: 10,000.00 Command: F1=Help F3=Exit F7=Bkwd F8=Fwd F9=APTDAI . ~EV-1511 EX+ (12-99) _ ~~ '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF /l1 dWC'A2:.r / . A?,f-R r (f: FILE NUMBER ~O.s-- 03/~ Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1. b/ /1/ C pZ Ie k' //? c' //} C' /Z/ p1' c:.. S"/ cd /2- p;:;' ~/-c;;'" s: /' ',;...;' // e 4 I 5.::;1, .::/:J I B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 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. Attomey Fees /:./~:., Q:.'<f "., lV' . "" ,::-- /J ""-""0 /, vU., ~ Or? 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees d7 _ j ,;:; '/ /ru- ,f'/f/;.Lr- ;- r.-~, Accountant's Fees ' ~- G:.3 CZJ ,. 5. 6. Tax Retum Preparer's Fees 7. Q.,rh?~r~~ ./ ?/.'7?/ ;;~/i;;"';/ ~~~ ;:,:)o!i:- Brs 7: .; ~co / ~;2.., ,S-I ,:/..5: ./- r..? , c:.o ,,20,Q:) S-Oo ,0cJ 8. 7~'(:: C VL~/-//;r"~; 9, [7 ,<0(:, ,.- c i/-~:::A' /. < r--;'J: ,:~'''I'...: ,j', ;.;" C ~ c.. ./ /.; -cfe_ /:J. / I, ,f?"" ...... _~ ,., . v~ ...,~..; ..k" ....~'. -/ .C r 1'':',. ~ "" ". )--,.-- ,.- / "- '- ~, r '. '_ . ,'~. ""I' . -:-- .- J ..s- c:: 7T L/ /v' C c5 oS _~4_' e- TOTAL (Also enter on line 9, Recapitulation) $ <:9 9 70', ..!i) (If more space is needed, insert additional sheets of the same size) . REV- 1512 EX+ (12-03) .~ *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILlTlES, & UENS JrI COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /VI owe~r~ /V14R( v, FILE NUMBER :2./0.r-o.:3J4 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. (/:/t"C c:;../:~ J' ..t, -J /"/6 ,.-...../,( /~ ,......"" f- ."::?Pr p<.. m/ ,;)~~5' I ...t:;- G , 00 S~r 33 r') C"- J) j;/ L '-~ " " ) \ ,.,"<>'." C' ~ " .: '- '. ," ,., '. I T-'!-.d, /;!p/. k ...../:'.( ,2 );...' ;.<?'/ ;/ /' r I" I 5.!::J-; ~.s- TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) ;2,(,8,/8 . RiV-1513 EX+ (9-oo) ~~. *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT seNIDULI J BENEFICIARIES ESTATE OF MOUle~y J . FILE NUMBER A?4RY ~ ,,2/t::JS - O.J / ~ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER I 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] r~AI;ps ~, Sr-ouc:4 .JI '8 R4A)/N~~ ~r~. 13,;p.~ ;7~o~ ~j;) ,<t'~// c~~ /ILL- 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 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. insert additional sheets of the same size)