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Home My WebLink About02-09-07 ~WEAlTH OF PENNSYLVANIA DEP ENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 PENNSYL RECEIVED FROM: INHERITANCE AN OFFICIAL BANK PNC PO BOX 308 CAMP Hill, PA 17001-0308 _u___u lold -------- ESTATE INFORMATION: SSN: 172-01-6744 FILE NUMBER: 2106-0458 DECEDENT NAME: KAUFMAN DOROTHY D DA TE OF PAYMENT: 02/09/2007 POSTMARK DATE: 02/09/2007 COUNTY: CUMBERLAND DA TE OF DEATH: 05/14/2006 TOT Al AM REMARKS: CHECK#473381 INITIALS: SEAL RECEIVED REGISTER OF REV-1162 EX(11-96) VANIA D ESTATE TAX RECEIPT NO. CD 007788 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,303.00 I I I I I I I I OUNT PAID: $3,303.00 WZ BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS WILLS 0PNC WEALTH MANAGEMENT PO Box 308 Camp Hill Pa 17001-0308 (717) 730-2265 February 7, 2007 Register Of Wills Cumberland County Courthouse South Hanover St Carlisle, PA 17013 Re: Dorothy D. Kaufman Estate Date of Death 5/14/2006 File #: 21-06-0458 (') o ::u ~l~ ;-. "-1 l:::::::) c;:;:::> --.I .... r-q CJ:1 Dear Register Of Wills: I U'.) --, ~ : ---=j - On behalf of the Corporate Executor of the above-referenced Estate, I enRIPse a check in the amount of $3,303.00 balance due on account of Pennsylvania Inheritance Tax~ong with two original completed copies of the tax return. I have also enclosed the final inventory along with a check in the amount of $30.00 for filing fees. Please send us the usual customary receipt at your earliest convenience. Thank you for your assistance. ~.. .n:. erely, '. ~, -', ~ \'~~jJ~; Linda J. Lundberg, CTFA?s-- Estate Administrator Vice President Enclosures: LJUjmh Member of The PNC Financial Services Group 4242 Carlisle Pike Camp Hill Pennsylvania 17011 , '.~ l. REV-1500 EX(~) . . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFK:lAL USE ONLY ~ .. ~ FILE NUMBER ~L 0458___ YEAR NUMBER l- . Z W Q W o W Q W ~ :ll:~ ulLU Woo ::E:~ ulUD D- C ~L COl.MY CODE DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) KAUFMAN DOROTHY DATE OF DEAlH (MM-DD-YEAR) DATE OF BIRlH (MM-DD-YEAR) 5/14/2006 11/4/1907 OF APPLICABlE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAl SECURnv NUMBER 172-01-6744 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAl SECURITY NUMBER .... Z W C Z o a.. (/) w II: II: o U NAME COMPLETE MAILING ADDRESS P.O. BOX 308 D [XJ 1. Origilal Retum D 4.linited Estate [XJ 6. Decedent Died Testate (Attach copy of Will) D 9. litigation Proceeds Received D 2. Supplemental Retum D 3. Remailder Retum (date of death prior to 12-13-82) D 4a. Future IntlllllSt Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required [X] 7. Decedent Maintained a living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (data 01 d..th b.tw.an 12-31-91 and l-l-gs) D 11. Election to tax under Sec. 9113(A) (_ch Soh 0) LINDA J. LUNDBERG V.P. FIRM NAME (If Applicable) PNe BANK, N.A. TELEPHON: NlJoIIBER 717-730-2265 CAMP HILL, PA 17001-0308 OFFICIAL USE ONLY C) (-- -'"'=0 i~Q /~:~~ /, r----_l = ~ -..... .." rri 0-, I \.0 1. Real Estate (Schedule A) o o o o 16,084 o ::z:.:, ~ ~. - - a 0;) 343,260 (1) 2. Stocks and Bonds (Schedule B) (2) 29,970 313,290 77 , 935 235,355 o o o 35,303 35,303 3W4645 1.000 3. Closely Held Corporation, Partnership or SoltH'roprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) z o i= :5 :) l- ii: c o W D::: 6. J~ Owned Property (Schedule F) U Separate Bilrlllg Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or l) (6) 327,176 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule Q (10) 11. Total Deductions (total lines 9 & 10) 12. Net Value of Eatata (line 8 minus line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14_ Net Value Subject to Tax (line 12 minus lile 13) SEE INSTRLJCTJa.s ON REVERSE SIDE FOR APPLICABlE RATES 15. Amount of line 14 taxable at the spousal tax z rate, or transfers under Sec. 9116 (aX1.2) o ~ 16. Amount of line 14 taxable at lineal rate ~ ::J 1rE 17. Amount of line 14 taxable at sibling rate o U 18. Amount of line 14 taxable at collateral rate )( ~ 19. Tax Due 20. D o o o 235,355 x.O L (15) x .0 45 (16) x.12 (17) x .15 (18) (19) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o C d ececfennl- ~n1plete Ad ress: . , . SlREET ADDRESS 100 MT. ALLEN DRIVE CUMBERLAND CIlY I STAlE I ZIP MECHANICSBURG PA 17055- Tax Payments and Credits: 1. Tax Due (Page 1 line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 35,303 o 30,400 1,600 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 32,000 o o Total Interest/Penalty (D + E) (3) o 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) o 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) 3,303 A. Enter the interest on the tax due. (5A) o 8. Enter the total of line 5 + 5A. This is the BALANCE DUE. Make Check Pa able to: REGISTER OFWI.LS, AGENT (58) 3,303 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;. . . . . . . . . . . . . . . [X] D b. retain the right to designate who shall use the property transferred or its income; . IX] D c. retain a reversionary interest; or .... . . . . . . . . . . . . . . . . . . . . [X] D d. receive the promise for life of either payments, benefits or care? . . . . . . . . . [X] D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D []!I 4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [j IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDlLE G AND FILE IT AS PART OF THE RETURN. Under penalllas of p8ljury, I declare that I h_ examined this retum, indudlng accompanying schedules 8nd ltataments, ..d to tha best of my knowledga and balief, ft Is true, correct..d completa. Oeclaration of p reparer other than the personal rapruentatiYe II based on a1llnfonnation.of which preparar has any kn edge. SIGNA 6lF PERSON RES IBLE FILING RETURN PNC Bank, N. A. a-l U DAlE SIGNATURE OF PREPARER OlHER 1HAN REPRESENTATIVE ADDRESS For dates of death on or aIIer July 1, 1994 and before January 1, 1995, the lax rate imposed on the net value of1ransfers to or for the use of the survivi1g spouse is 3% [72 P.S.!i 9916 (a) (1.1)(i)). For dates of death on or aIIer January 1, 1995, the tax rate mposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. !i 9116 (a) (1.1) (ii)) The statute does not exempt a transfer to a surviving spouse fran tax, and the statutory requirements for disclosure of assets and filing a tax retum are stm appficable 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 Menty-one years of age or younger at death to or for the use ofa natural parent. an adoptive parent, or a stepparent of the child is 0% [72 P.S.!i 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 4.5%. except as noted in 72 P .S. !i 9116(1 .2) [72 P .S. !i 9116(a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedenfs sibfings is 12% (72 P.S. !i 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, lMlather by blood or adoption. 3W46461.0oo " . ~ REV-l508 EX + (6-98) L ESTATE OF . - DOROTHY D KAUFMAN COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 06 0458 Include the proceeds of litigation and the date the proceeds were received by the estate. AI propertY lolntlv-owned with the r1aht of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 SEE ATTACHMENT 15,633 2 TANGIBLE PERSONAL PROPERTY [ APPRAISAL ENCLOSED ] 451 3W46AO 1.000 TOTAL (Also enter on line 5 Recaoitulationl $ (If more space is needed, insert additional sheets of the same size) 16,084 -\. -~ '. DOROTHY D KAUFMAN L 27-27-004-3995545 ~ THE KIPLINGER LETTER REFUND CASH FOUND IN DECEDENTS ROOM AND WALLET HIGHMARK HEALTH INSURANCE REFUND TV GUIDE REFUND TRAVELERS INSURANCE REFUND PNC BANK NATIONAL ASSOCIATION CHECKING ACCOUNT .5140033114 DATE OF DEATH BALANCE 15,224.40 INTEREST TO 05/14/06 2.50 25.85 69.05 204.45 19.50 53.00 15,226.90 TRAVELERS INSURANCE REFUND HOMEOWNERS INSURANCE TOTAL 34.00 $15,633.00 ============ { '. REV-1510 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COrvYtllONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF - - DOROTHY D KAUFMAN FILE NUMBER 21 06 0458 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 NUMBEF 1. CESCRJPTlON OF PROPERTY N:WlE TIE _E OF TIE TRANSFEREE. THEIR RElATIONSHIP TO OECeoENT AKl TIE D6.TE OF TRANSFER. ATTACHACOPY OF THE OEEO FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE! TAXABLE VALUE A FUNDED REVOCABLE TRUST AGREEMENT BETWEEN DOROTHY D. KAUFMAN, SETTLOR AND CCNB BANK,N.A., NOW PNC BANK, N.A., DATED MAY 30, 1985, LATER AMENDED. THE ASSETS COMPRISING THIS TRUST AGREEMENT ARE REVALUED AS OF MAY 14, 2006, PER ATTACHED EXHIBIT I. 312,076 100.0000 o 312,076 2 THE DECEDENT MADE THE FOLLOWING GIFTS, WITHIN ONE YEAR OF DEATH, FROM THE ABOVE REFERENCED TRUST AGREEMENT: BETTE GRANT: $10,000. DONALD KOPPENHEFFER:$10,000. ALSO GIFTED WAS A WEDDING BAND AND ENGAGEMENT RING TO: BETTE GRANT: $ 1,100. [ SEE APPRAISAL ATTACHED ] 21,100 100.0000 6,000 15,100 TOTAL (Also enter on line 7, Recapitulation) $ 327 176 3W46AF 1.000 (If more space Is needed, Insert additional sheets or the same size) ~_..:. 1; . REV-1511 EX+(1I2-99) \ J .. COMMONWEALTH OF PENNSYLVANIA INl-ERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DOROTHY D KAUFMAN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 06 0458 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAl.. EXPENSES: 1. MYERS HARNER FUNERAL HOME INC 7,788 2 ROLLING GREEN CEMETERY 1,195 ~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 4,000 Name of Personal Representative(s) PNC BANK . N.A. Social Security Number(s) I EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 4,000 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 SEE ATTACHMENT 897 TOTAL (Also enter on line 9, Recapitulation) $ 17.880 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) '- 1 .. DOROTm' D KAUFHAN 5/31/06 6/06/06 6/07/06 6/07/06 6/16/06 7/10/06 7/17/06 27-27-004-3995545 AmmfISTRATIVE UPEHSES REGISTER. O~ WILLS SHORT CERTIFICATES 16.00- JOBN E SLJXB ESQUI:RJ: REIMBURSEMENT FOR PROBATE COSTS 113.00- CLADDE C WOLD & ASSOCIATES APPRAISAL n:s: U JEWELRY 75.00- CLADDE C WOLD & ASSOCIATES APPRAISAL n:s: U PERSONAL PROPERTY 75.00- JOBN E SLJXB REIMBURSEMENT FOR COPY O~ N pALMER XAlJE'MAH pENNA INHERITANCE TAX RJ:TDRH AND CLOSING L:B:'l."'rER 6.00- TBJ: SENTINEL LEGAL ADVERTISING 216.89- WILDEMAN & OHOCK CPA TAX PREPARATION FEE U 2005 INDIVIDUAL INCOME TAX 395.00- TOTAL ADKINISTRATIVE EXPENSES 896.89- ~. " REV-1512EX+ (12-03) COMMONWEAlTH OF PENNSYLVANIA INI-ERITANCE TAX RElURN RESIDENT DECEDENT ESTATE OF . . DOROTHY D KAUFMAN SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 06 0458 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses. ITEM NUMBER DESCRIPTION 1. SEE ATTACHMENT VALUE AT DATE OF DEATH 12,090 3W46AH 2.000 TOTAL (Also enter on line 10, Recaoitulation) $ (If more space is needed. insert additional sheets of the same size) 12,090 l' " . DOROTB!' D ICAUFMAH 27-27-004-3995545 DEBTS OP DECEDENT 5/15/06 PRe RAN1C NATIONAL ASSOCIATION ~ ACCOUNT 15140033114 CBECIC ISSUED PRIOR TO DEATH HONORED SUBSEQUENT 'l'BERETO 700.00- 6/06/06 MOBILE X RAy IMAGING !HC SERVICES 83.43- 6/06/06 ALERT PHARMACY SERVICES mc PHARHACY SERVICES 9.00- 6/06/06 MESSIAH VILLAGE SERVICES 7.835.70- 6/06/06 pAm. D DALBEY DPM MEDIcAL SERVICES 40.57- 6/13/06 VERIZON SERVICES 6.09- 6/15/06 MESSIAH VILLAGE SERVICES 3.388.90- 6/21/06 AT&T pINAL pA!MENT 26.72- TOTAL DEBTS OP DECEDENT 12.090.41- REV-1513 EX~(9-00}' \ SCHEDULE J BENEFICIARIES . COMMONWEALTH OF PENNSnVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF . DOROTHY D KAUFMAN FILE NUMBER 21 06 0458 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] SEE ATTACHMENT 235,355 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 SEE" ATTACHMENT TOTAL OF PART II . ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 77 935 .. . 3W46AI1.000 (If more space IS needed, Insert additional sheets of the same srze) " " DOROTHY 0 KAUFMAN ESTATE BENEFICIARIES DATE OF DEATH 6114106 27.27-004-3995545 FA REV-1513 EX+ NAME/ADDRESS SCHEDULE "J" BENEFICIARIES . SHARE OF ESTATE Amount . . RELATIONSHIP Elaine D. Koppenheffer, Dec8ased Item II(A)- Specific bequest Given to niece prior to her passing-longer than one year befonI her death . Number I -1 . Donald Koppenheffer 3511 Walnut St. Apt #3 Camp HiD PA 17011 Item II(B}- Specific bequest I Grandmolhel's clock J $100. 00 Item I of codicil. tangible persoj'nal property . . $351.00 I - 2 . Bette Grant do Jeffrey M. Grant, POA 2459 SW 172nd Sl Burien WA 98166 Niece by marriage Item II(C) - Specific bequest ] 2 diamond rings. - Given to nie ::e per authorization dated 416106. I $1,100.00 Item meA) - 25% of 25% (6.251 ) I $19,483.69 i I I - Zion Lutheran Church B-1. 15 S. Fourth Sl Harrisburg PA 17101-2202 I I - Shriners' CrIppled ChDdren Hospital B- 2. Attn: Katherine D. Stoddard Legal Depl PO Box 31356 Tam a FL 31356 I I - Bethesda Mission B- 3. Ross G. Weidman, Director of Development 1500 N. 2nd Sl Harrisbu PA 17102 Item III(A) -151Jft of 25% (3.75~) I I $11,690.21 i Item meA) -15% of 25% (3.75%) , $11,690.211 I I - American Red Cross B-4. PA Capital Region Chapter Attn: Jim Heckman 1804 N. Fourth Sl Harrisbu PA 17110 Item meA) -1R of 25% (3.75%) I $11,690..211 I I - Salvation Army. Harrisburg Area B- 5. Attn: Major John Griner PO Box 2205' Harrisb 17105 Item m(A) -15% of 25% (3.75%) 11 690.21 I I - Messiah Village B-6. Attn: Development Office 100 Ml Allen Dr. Mechanicsbura PA 17055 Item III(A) -15% of 25% (3.75%) $11,690.21 I - 3 . Elain" D. Koppenheffer, deceased and herhusband,DonaldKoppenheffer 3511 Walnut Sl, Apt #3 . CamD HiD PA 17011 I - 4 Bette Grant clo Jeffrey M. Grant. POA 2459 SW 172nd Sl Burien WA 98166 Item 111(8) - 30% $93,521. 70 Niece by marriage Item II of codicil-1/2 of 45% (22.5%) $70,141. 28 I - 5.,Jeffrey M. Grant j2459 SW 172nd Sl I Burien WA 98166 Great nephew Item II of codicil- 1/2 of 45% (~~.5%) $70,141.2f $313,290.00 TOTAL I \' '1"II\f ,~;~ 'i' ; ,J\'r;\f:f , p~I' :1,'1" ',"'1" ,I ~IO ",:;!."".;,I,I-, ,~\,; .' ,:\If'''''..j' . ,,,......:(. :!\l""0.,\",,'(;!;':I'~ ,.' ,,~' .,.." " d)!:.. ,."" J ,,,,, " ,,'i!' SA1D~' ,,\roYY' ~~,..", ,,,,,,,,,,,,;,...,r; .,' ., . ,"'..,; ,'.' " ",...,'" ....". 'i" "" ."" !., '..1"'.1' ",' ,..,;..1 l ,~,~ \' 1"""- q'r"l'l~ CODICIL ~ OF DOROTIIY D. KAuFMAN 1, DORO-raY D. KAUfMAN, the witbin named '\:estatriX. do herebY, make and publish this eodicU of roY Last Will and '\: estanlent dllted fe\>r11llfY 28, 1997. L 1 herebY revoke 1he provisions of paragraph U relating to 1he disPOsition of roy tangible personal propertY, and provide tbat aU of roy tangible personal proPerty shall be given to roY deceased niece's husband. DONALD ROpp~noVl of CatnP Bill, pennsylvania. n. 1 amend paragraph ro..c to provide as folloWS: 45% of soid residue sball be divided evenlY betWeen roy niece, BETl'B GRAN'!:, and her son. JEfFREY GRAN'!:. Shoull ei1her of 1heJll fail to survive roe, 1heir respective shates sball be divided evenlY among I organiZ"tions listed in paragraph ro- A. IlL 1 hereby ratify and confirtn 1he reJ118ining provisions of roy Last Wi '\:estatnent dllted febfUllIY 28, 1997. IV. 1 appoint pNC Bank. N.A. and John E. s1ike, Esquire, as co-execu~ estate. IN Wfl'NESS WHEREOf, 1, Doro1hY D. ~ haVe hereunto set . seal to this Codicil to roy LaSt Will and '\:estanlent this i!!!:- daY ofNovernbf SAIDIS Uff. FLOWER .~ LINDSAY ~ 09 Mar\l.et Street Camp KiU. PA SAIDIS UFF, FLOWER l LINDSAY iORSEl'S-AT-LAW 09 ~Luket Street Camp Hill. PA ~ · J J Signed, sealed, published and declared by the above-named Dorothy D. Kaufinan, as and for a Codicil to her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of said Testatrix and of each other. {l4<<# )/~P< / ' ~ ADDRESS: ,V1IJJimV~ ADDRESS: (J--7 ~ p/-t COMMONWEALTH OF PENNSYLVANIA . . : SS. COUNTY OF CUMBERLAND D~)Iythy D. ufinan, R ~ 2~' . ; and ~ \IV'( the Testatrix and witnesses, respectively, whose names are signed to the f4 egoing attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Codicil and that she signed willingly and that she executed it as her free and voluntarY act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Codicil as witness and that to the best of their knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. fl~.#:t~ Dorothy D. Kaufin )\ Subscribed, sworn to and acknowledged before me by Dorothy D. Kaufinan, the Testatrix, and subscribed to and sworn or affirmed to before me by ~ ES'!:Ji and ~i !JI. 7&~"l ,witnesses, this by of November, 2005. ClMIllNWEAllH OF PEN<SVLVANIA ",c"'. ;,. . .4. ~~- ~ NatarIaI Seal -. /" . (j "'N P bI' SaraJ. Ensinger. Notary PtbIic : ~'.~ -.. ,'..l-.. '. ~ .' ..... '. . U IC ~~ ~ ::;:;i:/i:F.;'i;~'~:':~~~":~: . Member. Pemlylvanla Auociatlon of Notaries ,.,.J "':C. .', :;"':~' t.:: 'i::: :::;>[~ 0::~~:::'/-::( "f';;~~~~:~~--:;,.. ~'..w~';.~~.il:~"'~~;l.:~~r.::~~.:.~:'~"'h'~~~"'--- -,.. -~ I " i ,~ . .J (; I r,.,1 r: v ,-\l~ ,,' . ,~l-- " f)-.\1tI -J (f) r;r r~' Ii/) \ '-\ v) \ . IDIS, GUIDO, SHUFF & MASLAND 109 MaItct Street Camp Hill. PA - LAST WILL JUfD TBSTAMEHT OF DOROTHY D. KAUFMAR I, DOROTHY D. KAUFMAR of Upper Allen Township, Cumberland County, Pennsylvania, declare this to be my Last will and Testa- ment, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses, if any remain unpaid, out of my estate as soon as may be practical after my death. II - I make the following bequests of my tangible personal property: A. I bequeath my diamond watch and my diamond solitaire ring with basket-setting to my niece, Elaine D. Koppenheffer. B. I bequeath my Grandmother's clock to my niece's husband, Donald Koppenheffer. . ,C. I bequeath my three-diamond ring and my four- diamond wedding band to my niece, Bette Grant. D. I direct that my executors hereinafter named divide my remaining tangible personal property, not including cash and securities, between my nieces, Elaine D. Koppenheffer and Bette Grant, as they shall determine or that said property be sold -and the proceeds thereof added to the residue of my estate. III - I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate in the following manner: .J~/f Page 1 [)~\> : rr~1~\ '<;~\. .!. J . \j "I"~ 'IV " t A. 25% of said residue shall be divided among the following organizations in the percentages indicated: Zion Lutheran Church, Harrisburg, Pennsylvania - 25% Shriners' Crippled Children's Hospitals - 15% Bethesda Mission, Harrisburg, Pennsylvania - 15% PA Capital Region Chapter of the American Red Cross - 15% Harrisburg Area Salvation Army - 15% Messiah Village, Upper Allen Township, Cumberland County, Pennsylvania - 15% B. 30% of said residue shall be paid to my niece, Elaine D. Koppenheffer, and her husband, Donald Koppenheffer. Should they both be deceased, said amount shall be divided evenly among the organizations indicated in Paragraph III-A. C. 45% of said residue shall be paid to my niece, Bette Grant. Should she fail to survive me, one-half of her share shall be paid to her son, Jeffrey Grant, and the other one-half shall be divided evenly among the organizations listed in Paragraph II"I-A. IV - I appoint John E. Slike, Esquire and Elaine D. Koppenheffer, Executors of this, my Last Will and Testament. UD~,GUEDO, Should either of my executors fail to qualify or cease to act as SHUFF " ~ such, then I appoint PNC Bank, N.A. as substitute executor. !109 Mubt StRlet ~~PA None of my executors shall be required to post bond in this or any jurisdiction. - J; ~-;{ Page 2 ill>1S, GUIDO, SHUFF It MASLAND :109 Mada:t StR:ct Camp Hill, PA · I f IR WITBESS WHBREOF, I have hereunto set my hand and seal on this, the ~~1S- day of 7f'~ ,1997. I . )rtJ-7 t'-~)) .1i <c jp.... .~ ( SEAL) v Doro .. D. ' .a~man Signed, sealed, published and declared by DOROTHY D. KAUFMAR, Testatrix therein named, on this and two (2) other sheets of paper as and for her Last Will and Testament, in our prese~ce, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~ ;0 ~' Name . ~lc(,tJ~ Name J ~~ Li-1!rA ~~!4- Page 3 UDIS, GUIDO, SHUFF & MASLAND :109 Malbt Street Camp Hill. PA '. t COMMONWEALTH OF PENNSYLVANIA) SSe COUNTY OF CUMBERLAND) WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instru- ment, being first duly sworn, do hereby declare to the under- signed authority that the testatrix signed and executed the instrument as her Last Will and Testament'and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will. as witnesses and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. ,l~~),tilbI>>U4l) . T; tatrJ. t1 Subscribed, sworn to and acknowledged before me by the testatrix, ando~~bscribed and~worn to before me by both wit- nesses, this ~cii1\ day of 't,. , 1997. NOTARIAL SEAL JO SMITH, Notary Public Camp Hili, Cumberland County My Commission Expires May 6, 2000 "p'_ -_'fP'-'" ":-:.:.'" {r,"/.f ~ ~Mi iJ, "./ " /<,,}~;:~;;'~~:'"i:~~',- .:.~ ~. -',:~. :.......,.; _.c C,:.'. >.":.~./...,,..,.~ ",', :,.-.....~ .... .. . ....' L .~.-;...;.:-.,.: . 'J~~;~~?:1~~2' '_L~ } " t 0'PNC Deborah K Deremer/PNCAdvisorslSCP/ PNC 05130/2006 12:25 PM To Unda J LundberglPNCAdvisorslSCPIPNC@PNC, Carol S KoscienskilCorpHRlSCPIPNC@PNC. Judith M HaftllPNCAdvisorslSCPIPNC@PNC ee bee Subject Fw: Date of death balance - Forwarded by Deborah K Deremer/PNCAdvisors/SCP/PNC on 05/3012006 12:24 PM - ... ErieaL-- .... ~legellConsumerlPGHlPN .. . 11.. 11 05/3012006 11 :18 AM Subject Date of death balance . To Deborah K Deremer/PNCAdvisorslSCPIPNC@PNC ee Estate of Dorothy D Kaufinan (Deceased) SS# 172-01-6744 DOD 05-14-2006 ACCOUNT NUMBER * DATE OF DEATH BALANCE + ACCRUED INTEREST DDA #5140033114 $15,224.40 + $2.50 If you selected the balances to be sent to the "Branch" they will only be sent to The requestor by Lotus Notes. Have a great Day!!! :-) '" lIr, ""~;~ .J... -i<<'- -e d. ~ to '* ___. " t d.l....~{....OfY.r-~qqSS~ CLAUDE C. WOLFE & ASSOCIATES " ~E6EI~ED AUCTIONEERS &; APPRAISERS PNC ADVISORS FAMILY OWNED SINCE 1910 2009 LINCOLN STREET · CAMP HILL, PA 17011 JUN U 7 (U06 717-737-0734 May 17, 2006 Appraisal for the Estate of Dorothy D. Kaufman Room 55, Messiah Village, Mechanicsburg, PA 17055 CONTENTS OF ROOM Secretary desk on Queen Anne legs Aqua colored wing back chair Zenith console TV Kindel dresser - poor condition Iridescent table lamp 100.00 25.00 25.00 65.00 20.00 Misc. costume jewelry Pedestal candle stand Western Germany Grandmother's clock End table - poor condition Brass table lamp . 10.00 20.00 100.00 4'" 3.00 5.00 Victorian side chair with needlepoint seat . Occasional chair with ottoman 2-Drawer file cabinet Clear glass table lamp Scales Misc. contents of room 20.00 10.00 7.00 5.00 1.00 35.00 APPRAISAL TOTAL S 451.00 This Fair Market Value appraisal is true and correct to the best of my ability as an auctioneer and appraiser with 35 years experience. Member: Certified Appraisers Guild of America lJ,IL ~~ &.~__ W. K. Dusty Chapman, CAGA /' SAIIHS n.: FI.OWER 1.1 N USA Y n;~..i \,.-\ 1;;-,~\f \1.lIl..d ~lIt'l'l '''I' lid' 1'.\ " t '. '~I-~l-C1J \ --5\ \~ ,q \ ' .' , \ SECOND AMENDMENT TO TRUST AGREEMENT THIS AGREEMENT made this l' c.( d--day of November, 2005, by and between DOROTHY D. KAUFMAN, of Upper Allen Township, Cumberland County. Pennsylvania, hereinafter called "SettlorU, and PNC BANK, NATIONAL ASSOCIATION, with a regional office in Hampden Township, Cumberland County, Pennsylvania, hereinafter called "Trustee", WITNESSETH; WHEREAS, Settlor established a Funded Revocable Trust Agreement dated May.30, 1985, with CCNB Bank, N.A., which is now merged into PNC Bank, National Association; and WHEREAS, Settlor re~ained the power to amend the Trust 1n whole or in part; and I WHEREAS, Set t lor 1S desirous .;9Y amending certain provisions of the Trust Agreement '. NOW, THEREFORE, J.n consideration of the mutual covenants ,i , contained herein, 1: 1S agreed by and between the parties that the aforesaid Trust Agreement dated May 30, 1985, 'is further amended as tollows: 1- Pdl-agraph I 1- C of i: he Amendment dated February 28, 1997, is amended to read de: tollows: / / · ., i / ,\ II)lS :. FLOWER INns,\\, ,II" \I" \II .11 ~'" Su "l't I Ifill '" ... C. 45% of said residue shall bel divided evenly between my niece, Bette Grant, and her son, Jeffrey Grant. Should either of them fail to survive me, their respective shares sha1l be divided evenly among the organizations listed in Paragraph II-A. IN WITNESS WHEREOF, the parties heretQ, intending to be legally bound hereby, have set their hands and seals on the day and year first above written. WITNESS: -4 l' . c; ~. I . , ~ .J..J. \. '. " / ," . .. ~ . - '. it ...- ~:.. Dorothy D. iciaufman ./ ( SEAL) ,,~ - ATTEST: PNC BANK, NATIONAL ASSOCIATION Pat~'(-(l~ /1-,'" .d....-~\ c. .l <::. i(...... " "( I . BY' J.. '-",I I I.' . . .. .. . ~ . <.. L ,,,.: "'1 "'1 ,-"~., ..- - - 'j . . ' '. ) ."} '.. \-1 s..;, ( ,. \.....1... \_ 1 :-;./ - 2 .. '~' I ) t . . "<';;'.'" -..,..",\.... .- . ,,"! ,'.""'f1<~.~~.~..~.~,lt~,.,J1.~,~<\', . ,'" :;"".' $<~.,..;.....;;._..~~~~.::~:~,:":;.;~.~>~L.:..""',.,. iAIDIS, GUIDO, SHUFF " ltfASLAND 2109 Martet Street Camp Hill. PA -~ 'f. ;-', ,'.... :.> fY AMEIfDMENT TO TRUST AGREEMENT THIS AGREEMENT made this o~~ day of ld~ , 1997, by and between DOROTHY D. KAUFMAN, of Upper Allen Township, Cumberland County, pennsylvania, hereinafter called "Settlor," and PNe BARK, National Association, with a regional office in Hampden Township, Cumberland County, pennsylvania, hereinafter called "Trustee," WITNESSETH; WHEREAS, Settlor established a Funded Revocable Trust Agreement dated May 30, 1985 with CCNB Bank, N.A. which is now merged into PNC Bank, National Association; and WHEREAS, Settlor retained the power to amend the Trust in whole or in part; and WHEREAS, Settlor is desirous of amending certain provisions of the Trust Agreement. HOW, THEREFORE, in consideration of the mutual covenants contained herein, it is agreed by and between the parties that the aforesaid Trust Agreement dated May 30, 1985 is amended as follows: I - Paragraph I is amended to provide a new subpara- graph D as follows: , ; J. " t SAlDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill, PA :_~t,~,. / ..) ...... "" l . I . D. To continue making annual cash gifts of $10,000 each to my niece Elaine Koppenheffer, or if she is deceased, to her husband Donald Koppenheffer, and my niece Bette Grant as I have been doing in the past several years; provided that my trustee believes there are sufficient funds to continue making these gifts and to provide for my needs. II - Paragraph II is amended to read as follows: Upon the death of the Settlor, the balance in my trust shall be distributed as follows: A. 25% of said residue shall be divided among the following organizations in the percentages indicated: Zion Lutheran Church, Harrisburg, Pennsylvania - 25% Shriners' Crippled Children's Hospitals - 15% Bethesda Mission, Harrisburg, Pennsylvania - 15% PA Capital Region Chapter of the American Red Cross-15% Harrisburg Area Salvation Army - 15% Messiah Village, Upper Allen Township, Cumberland County, Pennsylvania - 15% B. 30% of said residue shall be paid to my niece, Elaine D. Koppenheffer, and her hus- band, Donald Koppenheffer. Should they both be deceased, said amount shall be divided evenly among the organizations indicated in Paragraph II-A above. C. 45% of said residue shall be paid to my ~- niece, Bette Grant. Should she fail to sur- '<:i"" vive me, one-half of her share shall be paid "/ to her son, Jeffrey Grant, and the other one-half shall be divided evenly among the organizations listed in Paragraph II-A above. - 2 - " I.," " ~ ;AlDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill, PA ~ . IN WITRESS WHEREOF, the parties hereto, intending to be legally bound hereby, have set their hands and seals on the day and year first above written. WITNESS: ~ ATTEST: PNC BARK, NATIORAL ASSOCIATION ~/ /J /' · . {~4#~~~/~~~ - 3 - FUNDED REVOCABLE TRUST AGREEMENT THIS AGREEMENT made this rfl. .5 6 - day of lu 'd ' 1985, Cumberland County, by and between DOROTHY D. KAUFMAN of Camp Hill, Pennsylvania, hereinafter called "settlor" and CCNB BANK, N.A., Camp Hill, Cumberland County, Pennsylvania, hereinafter called "trustee," WITNESSETH: WHEREAS, settlor desires to create a revocable trust of certain assets for the purposes hereinafter contained; NOW, THEREFORE, in consideration of the mutual covenants containec herein, settlor does hereby assign, convey, transfer, set over and deliver to trustee certain assets to have and to hold the same and any other assets which the trustee may hereafter at any time hold or acquire hereunder, all of which assets being .hereinafter referred to collectively as the trust estate, IN TRUST, nevertheless, for the following uses and purposes and subject to the terms and conditions hereinafter set forth; I Trustee shall hold, maintain, invest and reinvest the trust estate for the benefit of settlor. It shall collect the income there- from and first pay any expenses of the trust, including trustee's ARNOLD & SLlKE, AlTOR.NEVS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 1701 I i I I '! j I , I ..~~:) :'l . l,)-- 'J--":.~ .~z..,. .... /-:;r' , J j. .. t t f' . reasonable expenses incurred in performance of its duties and reason- able compensation to the trustee for its services. Trustee shall pay to settlor, at least quarterly, the net income of the trust estate and shall further pay to settlor all of the principal or such portion of the principal as settlor may from time to time request in writing. In the event settlor becomes ill, incompetent or requests, trustee, at its discretion, shall use so much of the income and principal of the trust estate as it believes necessary and proper for the support and maintenance of settlor, and may disburse such amounts in anyone of the following ways: A. To that person or corporation who is taking care of or has custody of the settlor; B. Directly to the settlor; c. To any creditor of settlor for his benefit. II Upon the death of the settlor, trustee shall continue to hold the ."\ balance of the assets in the trust for the benefit of my husband, M. Palmar Kaufman, subject to the same terms as to the payment of income and principal as set forth in Paragraph I. Should my said hus- tor of my estate to be distributed in accordance with the terms of my Last Will and Testament. - 2 - ARNOLD 8< SLlKE, AlTORNEYS.AT-LAW, 2109 MARKET STREET. CAMP HILL. PA 17011 ,. . -'.1 t ~ ~ ... . III No interest in income or principal shall be assignable by, or available to anyone having a claim against, a beneficiary before actual payment to the beneficiary. IV Trustee shall have the power but not the duty to make such expenditures out of this trust as, in its discretion, it may consider desirable in order to facilitate the settlement of the estate of settlor. In exercising such power, trustee may pay in whole or in part any of the following items: the expenses of last illness and burial, including cost of gravemarker; debts; income taxes; death taxes on any and all property included in the gross estate for tax purposes; and all other items in connection with the settlement of the estate. Any such items may be paid directly by trustee or the fundz for their payment may be transferred by trustee to the executor or the administrator of the said estate, and neither such executor or adrni~is- trator nor any beneficiary of such estate shall be required to reim.r.,lrse trustee for any funds so paid or transferred. - 3 - ARNOLD lie SLIKE, AlTORNEYS-AT-LAW. 2109 MARKET STREET. CAMP HILL. PA 1701 J . -II ~ j " f) << v Settlor hereby reserves, exercisable whenever and as often as settlor may wish while settlor is living, the power to withdraw all or part of the principal, to add to the trust upon approval and acceptance by the trustee, and to revoke or alter this trust in whole or in part by writings other than a Will delivered to the trustee, but not to increase the responsibilities of the trustee without its written consent. VI Any corporation resulting from any merger, conversion or consoli- dation to which CCNB Bank, N.A. may be a party or any corporation otherwise succeeding generally to all or the greater part of the assets and business of CCNB Bank, N.A. shall be the successor to it as trustee hereunder without the execution or filing of any paper or any further action on the part of any party hereto or beneficiary thereunder VII This instrument shall be construed and administered in accordance with the laws of the Commonwealth of Pennsylvania. The validity of the trust hereby created shall be determined in accordance with the laws of the Commonwealth of Pennsylvania. - 4 - ARNOLD Be SLIKE. ATIORNEYS-AT-LAW, 2109 MARKET STREET. CAMP HILL. PA 1701 I ~:' , ..., # t , f J .. VIII The trustee shall have the following powers and duties in additior to those already vested in it by law and by other provisions of this trust: A. To retain any or all of the assets of this trust, real or personal, including its own stock, without regard to any principle of diversification or risk. B. To invest in all forms of property, including stock, common trust funds and mortgage investment funds whether operated by it or others, without restriction to investments authorized for Penn- sylvania fiduciaries, as it deems proper, without regard to any princi~ of diversification or risk. c. 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 it deems proper. D. To allocate receipts and expenses to principal or income or partly to each as it from time to time thinks proper in its sole discretion. E. To lend to, or purchase from, my executor even though trustee may also be such executor. F. To hold property in my name or in its name, or in the name of a nominee or unregistered. IX Trustee shall receive compensation for the performance of " its functions hereunder in accordance with its standard schedule of fees in effect from time to time during the period over which its services are performed. - 5 - ARNOLD Be SLlKE, ATTORNEYS-AT-LAW. 2109 MARKET STREET. CAMP HILL. PA 17011 , A j # l .. 'J , x The situs of this trust for administrative and accounting purposes shall be in the County of Cumberland and Commonwealth of Pennsylvania, and all questions pertaining to the construction or validity of the provisions of this instrument shall be governed by the laws of that Commonwealth. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above appearing. WITNESS: ~~ JP -/~ );d4~!~w~/ DOr~hY D. K,ufman (SEAL: CCNB BANK, N.A. ATT~S//JJW By: ~~ '/:.-"".... "0' .. ~~ t J ri i :'.;':~ ASSISTANT SECRETAR"f - 6 - ARNOLD & SLIKE, AlTORNICYS-AT-LAW. 2109 MARKET STREET. CAMP HILL. PA 1701 J . .I , '" . j .. .f. .. C(.;<< ~-N B MAIN OFFICE 331 BRIDGE STREET NEW CUMBERLAND. PENNSYLVANIA 17070 CCNBBANK.N.A. BANK (717) 774-7000 DIRECT (717) 763-5743 TRUST OFFICE, POST OFFICE BOX 308, CAt~ HILL, PA 17011 November 19, 1985 Received from Dorothy D. Kaufman on this date $60,000 for the initial fund made to the Dorothy D. Kaufman Funded Revocable Trust Agree- ment, dated May 30, 1985. ~ Ro ert M. 'Lane Vice President and Senior Trust Officer lao "J~,.., CLAUDE C. WOLFE & ASSOCIATES AUcnoNEERS & APPRAISERS F..fMILY OWNED SINCE 1910 2009 UNCOLN STREET · CAMP HILL, PA 17011 717-737-0734 p,NG BAt!)< \\ECSVEO t\t:..'< '51006 \ tJl& T CPA April 6, 2006 Appraisal for Dorothy D. Kaufman _ _ Located at 4242 Carlisle Pike, Camp HiD, PA 17011 14K white gold wedding band with 4 sman diamonds 14K white gold engagement ring with .9Oct and 2 smaII diamonds '. 175.00 925.00 . . APPRAISAL TOTAL S 1,100.00 This Fair Market Value appraisal is tlUe and correct to the best of my ability as an auctioneer and appraiser with 35 years experience. Member: Certified Appraisers Guild of America , \).\{.))~cQ.~- . w. K. "Dusty" Chapman, CAGA . . . . ~ G PNCBANK ESTATE OF DOROTHY D KAUFMAN DECEASED (DIED 05/14/06) LATE OF THE TOWNSHIP OF UPPER ALLEN CUMBERLAND COUNTY PA INVENTORY ;g, .0 ':5:J ) "'0 1-,- ("") -~~_: F~.~~ ~u /' 1'.J c::.:? = -..J -fl P'1 CD I \.0 WILL NO 21-06-0458 ~.l ~_J --I .. COMMONWEALTH OF PENNSYLVANIA o \.0 SS COUNTY OF CUMBERLAND LINDA J LUNDBERG VICE PRESIDENT OF PNC BANK, NATIONAL ASSOCIATION ONE OF THE EXECUTORS OF THE ESTATE OF DOROTHY D KAUFMAN DECEASED HAVING BEEN DULY AFFIRMED ACCORDING TO LAW DID DEPOSE AND SAY THAT THE ITEMS APPEARING IN THE FOLLOWING INVENTORY ARE PERSONAL ASSETS WHEREVER SITUATE AND REAL ESTATE IF ANY IN THE COMMONWEALTH OF PENNSYLVANIA OF SAID DECEDENT THAT THE VALUATION PLACED OPPOSITE EACH ITEM OF SAID INVENTORY REPRESENTS ITS FAIR VALUE AS OF THE DATE OF THE DECEDENT'S DEATH AND THAT THE DECEDENT OWNED NO REAL ESTATE OUTSIDE THE COMMONWEALTH OF PENNSYLVANIA EXCEPT THAT WHICH APPEARS IN A MEMORANDUM AT THE END OF THIS INVENTORY AFFIRMED AND SUBSCRIBED BEFORE ME : THIS 7;#- DAY OF U-- 20127 c."" j.,." , ,: ~j A ,I '-~ -.f' htJ,..f G '-"'h ' j ",,-) '" . 'O"~'~::'.:'OF PE.' N,c""l v) " , ,...... '''-''--''-''_. ''-' 1 -' Vr1.~ .i.i" I '", Notarial Se I Der.js~ e~lllenb~r , Notary Public 1" Han;pdem:lwp" ( berland County My Commission Expires Dec, 1, 2008 ~~ cY-- < , ( " ... ,- ---- "---.. fI..1e:T:bcr !:;'crTl.-;;\ti\ftnj'.~~ .t\:~,;$c)ciai:on of Not3ries - 1 - TRSN01 (10/02) . .. ~ PNCBANK COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND JOHN E SLIKE ONE OF THE EXECUTORS OF THE ESTATE OF DOROTHY D KAUFMAN DECEASED HAVING BEEN DULY AFFIRMED ACCORDING TO LAW DID DEPOSE AND SAY THAT THE ITEMS APPEARING IN THE FOLLOWING INVENTORY ARE PERSONAL ASSETS WHEREVER SITUATE AND REAL ESTATE IF ANY IN THE COMMONWEALTH OF PENNSYLVANIA OF SAID DECEDENT THAT THE VALUATION PLACED OPPOSITE EACH ITEM OF SAID INVENTORY REPRESENTS ITS FAIR VALUE AS OF THE DATE OF THE DECEDENT'S DEATH AND THAT THE DECEDENT OWNED NO REAL ESTATE OUTSIDE THE COMMONWEALTH OF PENNSYLVANIA EXCEPT THAT WHICH APPEARS IN A MEMORANDUM AT THE END OF THIS INVENTORY AFFIRMED AND SUBSCRIBED BEFORE ME THIS L... OF!J,'7- 20~ ~~ ~ F;jk COMMONWEALTH OF PENNSYLVANIA Notarial Seal Sara J. Ensinger, Notal)' Public Carlisle Bora, Cumberland County My Commission Expires Oct. 17, 2009 Member, PennsyllJanL (\<'i.iciation of Notaries - 2 - TRSNOI UO/02) ,. I . DOROTHY D KAUFMAN PNC ADVISORS MISCELLANEOUS PERSONAL PROPERTY CASH THE KIPLINGER LETTER REFUND CASH FOUND IN DECEDENTS ROOM AND WALLET HIGHMARK HEALTH INSURANCE REFUND TV GUIDE REFUND TRAVELERS INSURANCE REFUND PNC BANK NATIONAL ASSOCIATION CHECKING ACCOUNT #5140033114 DATE OF DEATH BALANCE 15,224.40 INTEREST TO 05/14/06 2.50 AXA EQUITABLE LIFE INSURANCE POLICY #04025305 PROCEEDS TRAVELERS INSURANCE REFUND HOMEOWNERS INSURANCE TOTAL INVENTORY - 3 - o PNCBANK 27-27-004-3995545 451.00 25.85 69.05 204.45 19.50 53.00 15,226.90 3,755.80 34.00 19,839.55 ------------ ------------ TRSN02(10/02J