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Home My WebLink About02-28-07 (2) -.J 15056041169 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO Box 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year tA. \ (:) Co File Number oS d.d- Date of Birth 186-09-9009 05282006 08291916 Decedent's Last Name Suffix Decedent's First Name RIDER CATHERINE MI M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A N/A Spouse's Social Security Number N/A THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW IX] 1. Original Retum D 2. Supplemental Return D 3. I~emainder Return (date of death prior to 12-13-82) D 4. Limned Estate D 4a. Future Interest Compromise (date of D 5. Federal Estate Tax Retum Required death after 12-12-82) 00 6. Decedent Died Testate D 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) D 9. Lnigation Proceeds Received D 10. Spousal Poverty Credn (date of death D 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 JO ANN PAULUS 717-432-3916 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY First line of address 41 FISHER RUN ROAD Second line of address City or Post Office state ZIP Code DATE.FlLED F\) c~ j DILLSBURG PA 17033 !~~ Correspondent's e-mail address: (.-J C.' Under penallies of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA RE O~RSON RE 0 SIBLE R FILING RETURN DATE J ~ 27;27/07 I 701 ? DATE Z/ 2?/1TI , CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041169 15056041169 -.J --.J 15056042160 REV-1500 EX Decedent's Name: CATHERINE M RIDER RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, 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) D Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D 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 taxable at lineal rate x .045 887 , 2 14 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042160 Decedent's Social Security Number 186-09-9009 805,954.00 0.00 38,376.00 63,286.00 907,616.00 17,039.00 3,363.00 20,402.00 887,214.00 887,214.00 39,924.63 39,924.63 D lS056042160 --.J REV-1500 EX Page 3 Decedent's Complete Address: File Number 2006 - 0 0522 DECEDENT'S NAME CATHERINE M. RIDER STREET ADDRESS 773 OAK OVAL MESSIAH VILLAGE CITY I STATE I ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 39,924.63 Total Credits (A + 8 + C) (2) 0.00 3. InterestlPenalty 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 box on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 39,924.63 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) A. Enter the interest on the tax due. 39,924.63 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 IX] b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . . . .. 0 [!] c. retain a reversionary interes~ or ......................................................... 0 [!] 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? . . .. . .. .. . . .. . .. . .. .. .. .. .. . . .. .. . .. . .. .. . .. . . .. .. .. 0 IX] 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? . . . .. 0 IX] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] 0 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. s9116(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. s9116(a)(1.1 )Oi)]. The statute does not exempt 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. s9116(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. S9116(1.2) [72 P.S. s9116(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. s9116(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. REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER CATHERINE M. RIDER 2006-00522 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchange between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. N/A DESCRIPTION VALUEAT DATE OF DEATH TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF CATHERINE M. RIDER FILE NUMBER 2006-00522 All property joinlly~wned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13 . 14. 15. 16. 17. 18. 19. 20. 21. 22. DESCRIPTION 200 SHARES PFIZER INC. (PFE) COMMON STOCK; NEW YORK STOCK EXCHANGE 300 SHARES SARA LEE CORP (SLE) COMMON STOCK; NEW YORK STOCK EXCHANGE 100 SHARES SYSCO CORPORATION (SYY) COMMON STOCK; NEW YORK STOCK EXCHANGE 180 SHARES UNILEVER PLC SPaNS. (UL) COMMON STOCK; NE~v YORK STOCK EXCHANGE 100 SHARES WACHOVIA CORP (WB) COMMON STOCK; NEW YORK STOCK EXCHANGE 100 SHARES BANK OF AMERICA (BAC) COMMON STOCK; NEW YORK STOCK EXCHANGE 100 SHARES BP PLC SPaNS ADR (BP) COMMON STOCK; NEW YORK STOCK EXCHANGE 100 SHARES CITIGROUP INC. (C) COMMON STOCK; NEW YORK STOCK EXCHANGE 100 SHARES CONAGRA FOODS INC. (CAG) COMMON STOCK; NE\v YORK STOCK EXCHANGE 100 SHARES DU PONT E. I. DE NEMOURS (DD) COMMON STOCK" NEW YORK STOCK EXCHANGE 262 SHARES FULTON FINANCIAL CORP (FULT) COMMON STOCK" NASDAQ 100 SHARES GENERAL ELECTRIC COMPANY (GE) COMMON STOCK; NEW YORK STOCK EXCHANGE 100 SHARES HEINZ H. J. CO. (HNZ) COMMON STOCK; NEW YOJ~K STOCK EXCHANGE 100 SHARES JOHNSON & JOHNSON (JNJ) COMMON STOCK; NEW YORK STOCK EXCHANGE 100 SHARES PEOPLE ENERGY CORP (PGL) COMMON STOCK; NElv YORK STOCK EXCHANGE 297 SHARES PNC BANK CORP (PNC) COMMON STOCK; NEW YORK STOCK EXCHANGE 700.421 SHARES AMERICAN BALANCED FUND CLASS B (BALBX) 731.512 SHARES INCOME FUND OF AMERICA CLASS B (IFABX) 5457.666 SHARES VAN KAMPEN HIGH YIELD MUNICIPAL BOND FUND (ACTGX) 1415.094 SHARES VAN KAMPEN HIGH YIELD MUNICIPAL FUND (ACTFX) 2294.052 SHARES JENNISON UTILITY FUND CLASS A (PRUAX) ITEMS LISTED ON SECOND SCHEDULE B PAGE VALUEAT DATE OF DEATH 4,771 5,117 3,092 4,080 5,309 4,909 7,104 4,936 2,264 4,230 4,115 3,425 4,268 6,044 3,687 20,434 12,643 13,796 59,761 15,467 34,961 581,541 TOTAL (Also enter on line 2, Rec:apitulation) $ (II more space is needed, insert additional sheets olthe same size) 805,954.00 REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF CATHERINE M. RIDER FILE NUMBER 2006-00522 All property joinlly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. DESCRIPTION 6129 SHARES ERIE FAMILY LIFE INSURANCE CO. (ERIF) COHMON STOCK; OVER-THE-COUNTER FHLMC 2849 AA RETAIL LOTTERY MORTGAGE BACKED SECURITY CUSIP (313PUT6S4) DOM 9/15/2033; 6% FHLMC 2975 DD RETAIL LOTTERY MORTGAGE BACKED SECURITY CUSIP (31399ANA5) DOM 5/15/2035; 5.50% GNMA 05-36 BD REMIC MULTICLASS CMO MORTGAGE BACKED SECURITY CUSIP (38374LDP3) DOM 5/20/2035; 5.50% NORTH ALLEGHENY PA SCHOOL DISTRICT MUNICIPAL BOND CUSIP (656678JQ3) DOM 5/01/2021; 5.50% GENERAL ELECTRIC CAPITAL CORPORATE BOND DOM 12/15/2023 STATE PUBLIC SCHOOL BUILDING CHESTER UPLAND MUNICIP~J BOND DOM 12/15/2023; 4.75% PENNRIDGE PA SCHOOL DISTRICT GENERAL OBLIGATION MUNICIPAL BOND DOM 2/15/2024; 4.75% DELAWARE COUNTY CATHOLIC HEALTH EAST MUNICIPAL BOND DOM 11/15/2026; 4.875% PENNSYLVANIA POWER & LIGHT (PPL) COMMON STOCK; NEW YORK STOCK EXCHANGE VALUEAT DATE OF DEATH 196,741 7,955 2,772 5,444 25,461 4,825 10,069 10,079 15,016 303,179 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1504 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER CATHERINE M. RIDER 2006-00522 Schedule C.1 or C.2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions forthe supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1. DESCRIPTION 3.92% INTEREST IN CENTRAL MARKET MALL PARTNERSHIP VALUEAT DATE OF DEATH o TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1505 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF FILE NUMBER CATHERINE M. RIDER 1. Name of Corporation N / A Address 2006-00522 City 2. Federal Employer I.D. Number 3. Type of Business State Zip Code State of Incorporation Date of Incorporation Total Number of Shareholders Business Reporting Vear 4. Product/Service Common $ $ Preferred Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DVes D No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DVes D No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? . . . . . . . . . . . . DVes D No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer any stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? DVes DNo If yes, DTransfer DSale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? . . . . . . . DVes D No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DVes D No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? . . . . . . . . . . . . . . . . . . . . . . DVes D No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . . . . . DVes D No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete addressles and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) REV-1506 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF CATHERINE M. RIDER 1. Name of Partnership CENTRAL MARKET MALL ASSOCIATES Address 2316 DAIRY ROAD FILE NUMBER 2006-00522 Date Business Commenced 1/09/1984 Business Reporting Year CALENDAR State ~_ Zip Code 17601 City LANCASTER 2. Federal Employer 1.0. Number 23 - 2 3 3 4 738 3. Type of Business REAL ESTATE PARTNERSHIP Product/Service RESIDENTIAL RENTAL 5. D General IX] Limited partner. If decedent was a limited partner, provide initial investment $ A. CATHERINE M. RIDER 3.92% 3.92% (10,645) B. c. D. 6. Value of the decedent's interest $ o 7. Was the Partnership indebted to the decedent? ......................................... DYes IXJNo If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? . . . . . . . . . . . . DYes IX]No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? D Yes IX] No Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. If yes, DTransfer DSale Percentage transferred/sold Consideration $ Date 10. Was there a written partnership agreement in effect at the time of the decedent's death? . . . . . . . . . IX] Yes D No If yes, provide a copy of the agreement. UNAVAILABLE AT TIME OF FILING 11. Was the decedent's partnership interest sold? .......................................... DYes IXJ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? . . . . . . . . . . . . . . . . . . . . . . D Yel; [X] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D Yes [X] No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . . . . . DYes IX]No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair marlket value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF CATHERINE M. RIDER FlUE NUMBER 2006-00522 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUEAT DATE OF DEATH N/A TOTAL (Also enter on line 4. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF CATHERINE M. RIDER FILE NUMBER 2006-00522 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER l. 2. 3. 4. 5. 6. DESCRIPTION CASH/MONEY MARKET; WACHOVIA SECURITIES; A/C 7079-9563 CASH/MONEY MARKET; EDWARD JONES; A/C 270-05019-1-5 CHECKING ACCOUNT; PNC BANK; A/C 50-7008-4265 MONEY MARKET; PNC BANK; A/C 50-0095-9513 CASH REFUND; MESSIAH VILLAGE MISCELLANEOUS HOUSEHOLD ITEMS VALUEAT DATE OF DEATH 1,737 8,187 6,051 4,406 17,245 750 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 38,376.00 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF CATHERINE M. RIDER FlUE NUMBER 2006-00522 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. N/A B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE VALU I, OF ASSET INTEREST DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FlUE NUMBER CATHERINE M. RIDER 2006-00522 This schedule must be completed and filed ilthe answer to any 01 questions 1 through 4 on the reverse side olthe REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OFTHE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OFTRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. IRA; MERRILL LYNCH; Alc 886-58337 13,085 100 13,085.00 2. ANNUITY; AIG ANNUITY INSURANCE COMPANY CONTRACT NUMBER WY007426 50,201 100 50,201.00 TOTAL (Also enter on line 7, Recapitulation) $ 63,286.00 (II more space is needed, insert additional sheets 01 the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF CATHERINE M. RIDER FlUE NUMBER 2006-00522 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MALPEZZI FUNERAL HOME 11,204 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State - ZIP Year(s) Commission Paid: 2. Attorney Fees 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 680 5. Accountant's Fees 5,000 6. Tax Return Preparer's Fees 7. DEATH NOTIFICATIONS 155 TOTAL (Also enter on line 9, Recapitulation) $ 17,039.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER CATHERINE M. RIDER 2006-00522 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUEAT DATE NUMBER DESCRIPTION OF DEATH 1. 2. FINAL MEDICAL BILLS MESSIAH VILLAGE - NURSING CARE 361 3,002 TOTAL (Also enter on line 10, Recapitulation) $ (II more space is needed, insert additional sheets o/the same size) 3,363.00 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF CATHERINE M. RIDER NUMBER I FILE NUMBER 2006-00522 1. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] JO ANN PAULUS DAUGHTER 278/821.40 41 FISHER RUN ROAD DILLSBURG, PA 17019 JAYNE KELLY DAUGHTER 278/821.40 1030 INGRAM COURT AMBLER, PA 19002 CYNTHIA J. UMBERGER GRANDDAUGHTER 54/928.53 586 LAUDERMILCH ROAD HERSHEY, PA 17033 DANIEL W. PAULUS GRANDSON 54/928.53 149 BIG OAK ROAD DILLSBURG, PA 17019 JAMES D. PAULUS GRANDSON 54/928.53 1216 SOUTH YORK STREET MECHANICSBURG, PA 17055 T. CHRISTOPHER KELLY GRANDSON 27/464.27 103 NORTH COLLEGE AVE. FLOURTOWN, PA 19030 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 2. 3. 4. 5. 6. II B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (Ifmore space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER NUMBER I 10. 11. 7. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] BRENNA J. KELLY 3102 KING LANE PHOENIXVILLE, PA 19460 ERIN J. GALLIS 728 LINCOLN STREET; APT 1 DICKSON CITY, PA 18519 STEPHEN R. KELLY 1030 INGRAM COURT AMBLER, PA 19002 BRADFORD T. KELLY 1030 INGRAM COURT AMBLER, PA 19002 DOUGLAS J. KELLY 1030 INGRAM COURT AMBLER, PA 19002 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 8. 9. GRANDDAUGHTER 27,464.27 GRANDDAUGHTER 27,464.27 GRANDSON 27,464.27 GRANDSON 27,464.27 GRANDSON 27,464.27 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 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) REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on REV-1500 Cover Sheet) ESTATE OF FILE NUMBER CATHERINE M. RIDER 2006-00522 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. DWiII D Intervivos Deed of Trust D Other o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which life estate is payable .............................................. $ 2. Actuarial factor per appropriate table. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Interest table rate- 031/2% 06% 010% OVariable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which annuity is payable ................................................ $ 2. Check appropriate block below and enter corresponding (number) .............................. Frequency of payout - OWeekly (52) OBi-weekly (26) OMonthly (12) OQuarterly (4) o Semi-annually (2) OAnnually (1) OOther ( ) 3. Amount of payout per period ............................................................ $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ....................................... 5. Annuity Factor (see instructions) Interest table rate - 0 3 1/2% 06% 010% 0 Variable Rate % 6. Adjustment Factor (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value of annuity-If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 .. . . . . . . . . . . . . . . . . . . . . . . . . . .. $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 EX+ (3-04) INHERITANCE TAX SCHEDULE L COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT INHERITANCE TAX RETURN OR INVASION OF TRUST PRINCIPAL FILE NUMBER 2006-00522 RESIDENT DECEDENT I. ESTATE OF RIDER CATHERINE M (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12,1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date, Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2. Stocks and Bonds ........................ $ 3. Closely Held Stock/Partnership . . . . . . . . . . . . . . $ 4. Mortgages and Notes. . . . . . . . . . . . . . . . . . . . . . $ 5. Cash/Misc. Personal Property . . . . . . . . . . . . . .. $ 6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . . . . $ 2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . . . . $ 3. Value of Unincludable Assets. . . . . . . . . . . . . . . . $ 4. Total from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ E. Total Value of trust assets (Line C-6 minus Line D-4) ............................... $ F. Remainder factor (see Table I or Table II in Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . . G. Taxable Remainder value (Line E x Line F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpus consumed .......................................................... $ D. Remainder factor (see Table I or Table II in Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . . E. Taxable value of corpus consumed (Line C x Line D) .............................. $ (Also enter on Line 7, Recapitulation) REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER CATHERINE M. RIDER 2006-00522 This Schedule is appropriate only for estates of decedents dying after December 12,1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. o Will 0 Trust 0 Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. 0 Unlimited right of withdrawal 0 Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) .. $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One 06%, 03%, 00% .................. $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One 06%, 04.5% ....................... . $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) . . $ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) . . $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . $ (II more space is needed, insert additional sheets olthe same size) REV-1648 EX (11-99)(1) SCHEDULE N SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION ESTATE OF (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94) FILE NUMBER CATHERINE M. RIDER 2006-00522 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. 1. Taxable Assets total from line 8 (cover sheet) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Insurance Proceeds on Life of Decedent. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Retirement Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 4. Joint Assets with Spouse .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. PA Lottery Winnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. 6b. 6a. Other Nontaxable Assets: List (Attach schedule if necessary). .. 6a. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) 6. 7. Total Gross Assets (Add lines 1 thru 6) .................................................... 7. 8. Total Actual Liabilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 9. Net Value of Estate (Subtract line 8 from line 7) ............................................. 9. If line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part II. Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse . . . . . . . . . . . . 1a. 2a. 3a. b. Decedent . . . . . . . . . . 1b. 2b. 3b. c. Joint ............. . 1c. 2c. 3c. d. Tax Exempt Income . . 1d. 2d. 3d. e. Other Income not listed above ....... . 1e. 2e. 3e. f. Total . . . . . . . . . . . . . . H. 2f. 3f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1 f) + (2f) + (3f) (+3) 4b. Average Joint Exemption Income. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. = If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part III. 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less. . . . . . . . . . . . . . . . . . . . . . . 1. 2. Multiply by credit percentage (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. . . . . . . . 5. REV-1649 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER CATHERINE M. RIDER 2006-00522 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transferon Schedule 0, th,e personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113(A) trust or similar arrangement. Description Value Part A Total $ Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A) election to tax is being made. Description Value Part B Total $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF CATHERINE M. RIDER I, CATHERINE M. RIDER, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make and publish this my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. ITEM I. I direct that all my just debts and funeral expenses be fully paid and satisfied as soon as conveniently may be after my decease. ITEM II. All the rest, residue and remainder of my estate shall be divided into two (2) equal parts and distributed in the following manner: (a) One equal part will be divided and distributed as follows: / (1) Forty (40%) percent to be divided equally among the then-living children of my daughter, Jo Ann Paulus. (2) The balance to my daughter, Jo Ann Paulus, provided she survives my death. In the event my daughter, Jo Ann Paulus, should fail to survive me, her share will be divided equally among her then-living children and her surviving spouse, provided, however, that the surviving spouse was married to my daughter for a period in excess of five (5) years. (b) One equal part will be divided and distributed as follows: (1) Forty (40%) percent to be divided equally among the then-living children of my daughter, Jayne Kelly-Evans. (2) The balance to my daughter, Jayne Kelly-Evans, provided she survives my death. In the event my daughter, Jayne Kelly-Evans, should fail to survive me, her share will be divided equally among her then-livi.ng children and her surviving spouse, provided, however, that the surviving spouse 2 / was married to my daughter for a period in excess of five (5) years. ITEM III. In addition to the powers conferred by law, I authorize my Executor or Trustee, in absolute discretion: A. To retain in the form received, and to sell either at public or private sale any real or personal property. B. To manage real estate. C. To invest and reinvest only in forms of property defined as legal investments according to the laws of the Commonwealth of Pennsylvania. D. To exercise any optional rights arising from ownership of investments. E. To compromise claims without court approval, and without the consent of any beneficiary. ITEM IV. Any incomE~ or principal payable to any beneficiary who is a minor or to-1)e a beneficiary who, in 3 the sole judgment of my personal representative, is mentally or physically incapacitated, shall be held in trust by Jayne Kelly- Evans, -Trustee, during such minority or incapacity. Trustee is authorized, in her exclusive discretion, to expend from income or principal such sum or sums as may be necessary for the proper care, maintenance and support of such minor or incapacitated beneficiary directly, without the intervention of a guardian or committee; or Trustee may pay the same to any person having care or control of said beneficiary or with whom the beneficiary resides, without any duty on the part of Trustee to supervise or inquire into the application of the funds by any person to whom payment is so made. Any income and principal not so expended by Trustee shall be retained by Trustee and paid to the beneficiary upon termination of the incapacity (including minority), or to the estate of the beneficiary if he or she dies before reaching the age of majority or while still incapacitated, as the case may be. For purposes 4 herein contained, the age of majority shall be twenty-one (21) years. ITEM V. " It is hereby directed that my Executor, hereinafter named, shall pay all inheritance / state, succession and legacy taxes to which my estate or the transfer of any property hereunder may be subject and to charge such tax as part of the administration, payable out of my residuary estate. ITEM VI. I nominate, constitute and appoint my daughter, Jo Ann Paulus, to be and act as my sole Executrix of this my Last will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of my daughter, Jo Ann Paulus, I nominate, constitute and appoint my granddaughter, Cynthia Jo Umberger, as Executrix of this my Last will and Testament. No personal representative or fiduciary appointed herein shall be required to post bond or give any security. 5 IN WITNESS WHEREOF, I have hereunto set my hand and seal this I [(€... day of fJ.>-D.M\AlyJ..;,- , 1997. ~At~' )f1. ~Qv- CATHERINE M. RIDER (SEAL) The preceding instrument, consisting of this, and five other typewritten pages, was on the date thereof signed, published and declared by CATHERINE M. RIDER, 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 as witness hereto. ./~ ~ So I C:, LuOO6i3<JX L..)l/ JJJec Residing at Residing at 501~ LUOO/) ev.x. uv /l?Ec/LI /11-. I 70~-:> ." 97-553/94828-1 6 O~~OO~~OOO~~OO~OO~M ~NN~O~~OOOMNo~~~mM~ O~N~mOO~m~o~~ro~m~omM ~~m~OOOM~M~N~~roM~~O ~~~OOMm~mNN~~NO~~~~~ ~~~~~~~~~N~~~~0~o0M~ ~ NmO~ > ~M~ " n; 1;; w~~~~WWW~~~~~~~~~~W~ ~~M~~~O~OON~m~rn~~ M ~m~~~mmN~M~~~~mN m ~m6N~ooomNN~~No~m m ~N~MN~~~~NV~M~~M~ N .. 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Iti' a '<:t Q) C) l1J 0- U) o o N >- ct :i o o c:i o C!- It) CO) .,.. o o N o .... ~ ::s o U U ftI Q) a c c;; - .. i .& ii l:l. ~ C ::I E ii o I- ( Total Banking Statement PNC Bank ~ PNCBANl< For.... period O4It8l2008 to 05lt8l2008 Primary account number: 50-7008-4265 Page 1 of 4 Number of enclosures: 0 B H CATHERINE M RIDER 773 OAK OVAL MECHANICSBURG PA 17055-8408 Q For 24-hour banking, and transaction or interest rate information, sign-on to 1!' Account lin~ bV Web on pncbank.com. For customer service call1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espa~ol, 1-866-HOlA-PNC Moving? Please contact us at 1-888-PNC-BANK t!!:I Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 .Q Visit us at pncbank.com _ &I TOO terminal: 1-800-531-1648 F'or bearing impaired clients only Relationship Overview Bank Deposit Accounts Description Interest Checking Money Market .,. ''\I Deposits , Account Number Oeposit 6alance 6,050.85 - 4,406.47 ... 10,457.32 50- 7008-4265 !H).0095-flrl13 - IMPORTANT ACCOUNT INFORMATION Amendment to the Consumer Schedule of Service Charges and Fees The infonnation stated below amends certain information in our Consumer Schedule of Service Charges and Fees. All other information in the schedule continues to apply to your account. Please review the following information and retain it with your records. Effective July 3, 2006 Other Account Charges and Services Overdraft Protection Transfer Overdraft Protection Transfer from a PNC Bank checking, savings or money market account or credit card. Choice Plan, WorkPlace Choice Plan and Senior Choice Plan * $10 per transfer Checks and Additional Deposit Tickets $8 disc,ount 011 all check orders. No free check styles. ~ information on exciting offers and promotions for our free Online Bill Payment service, stop any PNC Bank office, visit pncbank.com, or call l-800-PNC-BANK for further details. FORM953R.1005 Your individual account statements begin on the following page ~ '...I ...I ex: ex: w :e ...I 4 t- O ... - -- ~ r- (t) (t) <Xl ~ <Xl <Xl t.: Q) .0 E =' z .- c:: =' o u u <( ~~-_.---.'--... ill o o ('4 ...-i ('f) ti =' -oil ::l <( , ~ ~ i o ~:t {:!. <'4 C\I .... lU ~ ill o o C'l ...-i o .... <fl ::l -oil ::l <( \ ~\~~ ~ ~Ilril.{) ~ o ..;~ .... \ \ \ ~\ ~\ 0\ \ ! \ i ! \ \ i \ \~ .<( 0: <( (/) c: ~ ,Q :s:: 0.. Z 'i: <( o co II) --1 ~ :2 0:: w Q 0:: ~ LU Z 0:: UJ ::J: ~ t.> o co L&. (f) 2: o i= <.) <( (f) 2: <C 0::: l- I- 2: :) o <.) <.) <( I- 2: LU ~ LU a:: j:: LU 0::: a:: :) ~ ..q C lU 6 en !II ~ Z {l o 'S ~ a !II ~ Z lU < ~ 0:: 0 I- 0.. UJ Q) Q) :E 0.. ct: o ~ c: (,) c: !O 0 Z 0 ()~ ~ _:01--- I- 0 Q)lU~ !II ~ EO'" ~ c: 815 ... UJ~c:;'UJ I- I-- _(I) Z Z =::::.. !II Q Z UJ o Q) ~ m Q 0 ~'\ ~ 0' :51~ Q) ~ . o Iln \~ \ \ \ \ \ I I i i II --1 <co ,3 I(}J1 10 \ :I: ill !!= to '3 '<t l>- ~ c: 1 a:: to o ,<( lXl ''-:; I SJ lXl ,9-il.l- 0 bWI- II) z...... Q) W a::: o co I- ~ I.{) ~ to co m to o cO to lXl m to o cO ;;1 '0 ~ ~~ ~ a::: (/)0 UJ 0 en OOlzen UJ'<tz i!=0<(oill8~<( _~>--10--10l~ 3tOl.I;lO~00l, ~ >-N~>-('f)>- .- ~N~~~~~~ O('f}:S::OlXlO('f}:s:: G:tOUJG:oG:tOUJ w.:2ZWl-w:2Z Z >-z-u.-z >- UJ :s:: <( UJ a::: UJ-:S:: <( COO ,,",\COl-coo""'\ E c !O ::, 0' !II Q) Z 0.. o ~ ~ '3 ~ ~ ~ ro 0::< :g g ~ ~ ... L 0 0:: ~ ""'\ UJ X ~ X ~ (,) to Q) ..; rod>- e 0 .:s:. u dl ..c o ~ d>- o ~ .... c W ro c :; o ""'\ .:s:. o CI> ..c () m N --.... co o g ~ '<i ~ ~ ~ ~ ~ m N d>- o 2' "0 Q) .... o ';;)- ... :0 Q) o .... CIl .c. e. <l t; I- ti:i Z lU ... o :0 :3 (/) + AIG Annuity Insurance Company AIG ANNUITY INSURANCE COMPANY P.O. Box 871 Amarillo, TX 79105-0871 A Member of American International Group, Inc. QUARTERLY GROWTH REPORT OF YOUR POLICY FOR THE QUARTER ENDING 06/30/2006 1-800-424-4990 iiiiiiiiiiiiiiO === iiiiiiiiiiiiiiO - - - iiiiiiiiiiiiiiO >20041 4531822 001 008129 CATHERINE M RIDER 773 OAK OVAL MECHANICSBURG, PA 17055-8408 · Contract Number · Policy Date · Annuitant . Policy Type · Agent · Composite Annual Yield WY007426 05/31/2002 Catherine M Rider Non-Qualified Home Office - Financial iiiiiiiiiiiiiiO ~ === ;;;;;;;;;;;;;; ~ 5.00% Important Messages---------------- ~- ----- -- -- --------- For access to your account 24 bours a day, please visit our website at www.aigannuityaccess.com.@ Account Information Beginning Value Withdrawals Interest Accumulated Value Current Quarter 04/01/2006 - 06/30/2006 50,000.00 (408.53) 609.44 50,200.91 Year - To - Date 01/01/2006 - 06/30/2006 50,000.00 (1,011.26) 1,212.17 50,200.91 Deposits And Withdrawals Processed During This Quarter Date Amount Date Amount 04/30/2006 (200.91) 0~/3112006 (207.62) Additional Messages NOT A DEPOSIT - NOT INSURED BY THE FDIC OR ANY FEDERAL GOVERNMENT AGENCY - NOT GUARANTEED BY ANY BANK - MAY LOSE VALUE -- --- 8 Market Plata Way. Mocha/ticsburg, PA 17055 Phon., 697-4696 Ma!pezzi FUNERAL HOME STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain the reason in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalm. ing you did not approve if~OU selected arrangements such as direct cremation or immediate burial. If we charged for embalming, we will explain why below. For the Service of A 4 \,Q r, ," M k, ,'0 r Date of Death 1\').., "7 SI' ?,~ Charge to: /.('"., P.hl.., L-j) /-::,,/.u' E., 1),,,\ D.f(.L... n 170/ ' . Name Address City t' SlOte - Other clothing Michael J. Malpezzi, Owner Jeremy J. Shartzer, Funeral Director A. CHARGE FOR SERVICES SElECTED: t. PROFESSIONAL SERVICES Services of Funenl Director/Staff Emba.1rning . Other preparotion of body $~ $- .....$- $~ . . $--'-=L Cremotion urn . (Description) OTHER $- $- $- $ --4>.LL SUB.TOTAL OF PROFESSIONAL SERVICES.. 2. FACILITIES AND SERVICES Use of facilities md services for viewing (VisilOtionIWake). $~ Use of facilities and services for funen! ceremony . . . $_ Use of facilities and services for Memorial Service $_ Use of equipment and services for graveside service............. $~ Other use of facilities A I $-.i.::LL . .. .. B $J~ 5(,:: TOTAL MERCHANDISE SELECTED. C. SPECIAL CHARGES: Forwarding of remains to (Funeral Home) Receiving of remains from $- (Funen! Home) Immediate Burial . Direct Cremation. . . $- ...$- $- $~ ..................$- SUB.TOTAL OF FACILITIESIEQUlPMENT . 3. AUTOMOTIVE EQUIPMENT Vehicle to tnnsfer remains to Funeral Home. Local................. L.w...\_ Hearse (Casket Coach) Local. . .. .. .. . .. . . .. Limousine Local . Family car Local. ............ $_ Flower car or floral disposition Local. Lead car/clergy car Local. Car for pallbearers Local . .. .. .. .. .. .. .. .. . Out of town transportation . ..A2$~ SUB.TOTAL OF SPECIAL CHARGES.. ............ C $..- () -, D. CASH ADVANCED Opening Grave $ ~ Cemetery Equipment. . . . . . $ ~ LotmdDeed..... $_ Newspaper Notices-Local $..2c.!.:::.... Newspaper NOlices-Out.of.town.. $_ Telephone & Telegrams ........... $_ Airfare.............. ...... $_ Clergy/Mass Offering. . . . . . . $ ~ Pallbearers...................... $_ Certified Copies of the Death Certificate..I.!:.<J .i>'L. &. "-.c.t<. Police Escort .. .. .. .. .. .. .. Flowers .... . . . . , . . . . . . . . Vault Service Charge. . . ~,/~! : ,'~~ d ~ ~l ' Li" k::.:..,-,> ,a\ .. .. . $..l...4..L- ....$- $- $- $- $- SUB.TOTAL OF AUTOMOTIVE EQUIPMENT... TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT .. .. .. .. .. . $ .:i1::.:- $- $~ $- $~ $ ....l..U..;L $ />'D $- $- $- $...l....l.LL- .......$~ SUB.TOTAL OF ADVANCES,.. DLL~ A3 $....!...U.L We charge you for our services in obtaining: (specify casb advances tbat are marked.up) .......... . A $ 3 J'fc B. CHARGE FOR MERCHANDISE SELECTED: Casket . $ 3!L.:::.:: (Description) "'. . I ,. , (' I.. " I C), ;V'l', (xl,,\.- Other Receptacle (Description) $- SUMMARY OF CHARGES A. Professional Services, Facilities and Equipment, and Automotive Equipment . .. .. .. .. .. . B. Merchmdise.. .. .. .. .. .. . C, Special Charges D. Cash Advances. . TOTAL OF ALL SECTIONS. PAID AT TIME OF OR PRIOR TO ARRANGEMENTS. . . . . . BALANCE DUE. . . . $ 'S]'j{) . . $ I, ?tc S $~ $ --1..':L:J.. $11, ZL-LI Outer burial container . (Description) 7 "'- .~ ~l. c\ ACk~O~l~~ge:~~: ;J; Register book(s) Memory folders . Pnyer cards Temporary grave marker. Burial dOlhing . . . ... $.ld!.h.. y,l ,.'" '\ ..$~ $ ...iLL- $~ ....$- $- .....$- ...$...:~ ............ Ji./...ZL!..L If my law, cemetery, or crematory requir ents have required the purchase of'my of the items listed above the law or requirement is explained below. t" ,j"., 1-:.~,. I rL L.;, J ~ ,,' \ L,/ CP'''1"J-~,7'-- I agree that I have examined the items of goods md services selected above md found them to be correct and according to the arrangements I have requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available for payment of the cash price for the goods and services selected. I also agree to make payment of $ / < . (" L/ within 7< , days. I agree to be jOintly and sevenlly liable with anyone else who signs below. A late charge of I '/. per month amounting to I ;J 'X. per year will be applied to the unpaid balmce beginning ~_ days from the date of this agreement r will also pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement. Those costs may include attorneys' fees, court costs md other costs. Any additional services or merchandise ordered or requested after the date of this agreement will ;;.:,,~-....... -, "'" "'~, --.. k """'" 00 "" "'" "'<<.""""" C; ~ ~ \. / (P r), . ~,; ~) (Seal) . ,...::: ~ -- W6E _ Funera~~torFunCii1 rec~:Low _ Cus!Omer Revised 4/94 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 RIDER CATHERINE M Estate File No. : Paid By Remarks: 2006-00522 JO ANN PAULUS JA Rece~pt Date: Recelpt Time: Receipt No.: 6/13/2006 10:53:01 1044672 ------------------------ Receipt Distribution ------------------------ Fee/Tax Description PETITION LTRS TEST WILL AUTOMATION FEE SHORT CERTIFICATE JCP FEE Check# 901 Total Received......... PaYment Amount 610.00 15.00 5.00 40.00 10.00 ---------------- $680.00 $680.00 Payee Name CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D RETAIN THIS PORTION FOR YOUR RECORDS REMITTANCE ADDRESS I Bill TO THB SBNTINBL - LBGAL JO ANNE PAULS P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER I CLASS SALESPERSON BilLING DATE LINES 312444 10 PUBLIC NOTICES andej 08/23/06 22 * 2 AD DESCRIPTION START DATE STOP DATE ESTATE NOTICE NOTICE IS HEREBY GIV 08/09/06 08/23/06 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 79.86 TOTAL AD CHARGE 79.86 3 PROOF OF PUBLICATION 01PRF 6.35 PREVIOUSLY PAID -86.21 DAYS RUN PURCHASE ORDER PAY THIS AMOUNT .00 .00* Catherine Rider * AFTER 09/22/06 MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Tammy Shoemaker 243-2611, ext 203. Fax your legals to 243-3754, attention Tammy Shoemaker You can also EMAIL yourlegaltoClassifiedads:classified@cumberlink.com Please send a cover letter including your name and address as an attachment DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT THE SENTINEL - LEGAL 1-' . d POBOX 130 CARLISLE PA 17013 Catllerlne Rl er . . AD NUMBER ClASSO START DATE STOP DJl.TE 312444 PUBLIC NOTICES 08/09/06 08/23/06 AD DESCRIPTION BilLING DATE TELEPHONE NUMBER ESTATE NOTICE NOTICE IS HEREBY GIV 08/23/06 717--432-3916 GROSS AMOUNT OF .00 DUE AFTER 09/22/06 TOTAL AMOUNT DUE .00 ENTER AMOUNT ENCLOSED JO ANNE PAULS 41 FISHER RUN ROAD DILLSBURG, PA 1...11111.111""1.11111'1..1.11 17019 20200000003124440000000000000000000000000000009 Bargain Sheet & Dillsburg Banner 31 S. Baltimore Street Dillsburg PA 17019 432-3456 Invoice DATE INVOICE NO. 08/17/06 5678 BILL TO Jo Ann Paulus 41 Fisher Run Road Dillsburg PA 17019 'TERMS DUE DATE 08/17/06 ITEM DESCRIPTION QTY RATE AMOUNT 6 Legal, Rider estate, 2.5 col inches, ran 2.5 8.75 21.88 8/17 6 Legal, Rider estate, 2.5 col inches, ran 2.5 8.75 21.88 8/24 6 Legal, Rider estate, 2.5 col inches, ran 2.5 8.75 21.88 8/31 66 Notary 3.00 3.00 pJ ~Iq lo~ . ,01 I Total $68.64 PAUL D. DALBEY, DPM 5 KACEY COURT, SUITE 202 MECHANICSBURG, PA 17055 CATHERINE M. RIDER 222 MESSIAH CIRCLE ROOM 300 MECHANICSBURG, PA 17055-8619 Account Number: 1182 Closing Date: OS/25/2006 Charge: Credit: $35.00 Date: 25-Apr-2006 Code: S0390 Description: ROUTINE FOOT CARE DUE FROM PATIENT $35.00 [ q I 010 rJ' lP #J Due From Patient Charges Marked * Have Appe~red on a Previous Bill $35.00 Your prompt payment is appreci Current ~~~ nn Over 30 Days Over 60 Days Over 90 Days ~n nn ~n nn ~n nn Total Balance ~.~~ nn [I~,[~';; TAX AMOUNT DUE , 30.60 ~J NON-LEGEND FOR MONTH Total Payment & Credltll .00 PreYloq. Balance Finance Char e 295.66 LEGEND FOR MONTH TOTAL CHARGES Char... thl. month 6. 6.00e 30.00e 3.06 G.OOe 153.98 7.36 2.53 30.00e G.OOe 6.00e 6.00e .00 + .00 326.26 + 326.26 .00 326.26 FOR ALL PHARMACY RELATED INQUIRES PLEASE CALL Alert Pharmacy Services, Inc at 1-800-266-9954 Statement Terminology on reverse DATE DESCRIPTION RATE DAYSI CHARGES CREDITS BALANCE UNITS Balance Forward 1,154.33 OS/22/06 PAYMENT RECEIVED - THANK YOU!!! 1,154.33 0.00 *** Nursin~ Care *** 05/05/06 BARBEWBEAUTYSHOP 12.00 1.00 12.00 12.00 SHAMPOO/SET 05115/06 BARBEWBEAUTYSHOP 48.00 1.00 48.00 60.00 PERM OS/24/06 BARBEWBEAUTYSHOP 12.00 1.00 12.00 72.00 SHAMPOO/SET OS/27/06 RM/ BRD - NURSING - SEMI-PVT 236.00 9.00 2,124.00 2,196.00 OS/27/06 OXYGEN 17.50 9.00 157.50 2,353.50 OS/27/06 AIR MATTRESS 3.00 9.00 27.00 2,380.50 OS/27/06 PREV AIL BRIEF XLI15 18.90 2.00 37.80 2,418.30 OS/27/06 PREV AIL PROTECTIVE UNDERWEAR 21.63 1.00 21.63 2,439.93 XLI14 *** Residential Livin~ *** 05/01106 MNTHLY CHG TIOGA 05/01-05/28 551.87 1.00 551.87 2,991.80 05/01106 EXTRA STORAGE - APT 05/01-05/28 10.00 1.00 10.00 3,001.80 I 0/1) {}\. if 1- 0 \ , ~}O RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 29803 3,001.80 , 0.00 0.00 0.00 0.00 $3,001.80 RESIDENT NAME Mrs. CATHERINE M. RIDER \ 1 % finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! Form PB-Q1 If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! C> C> ~ C> C> ~ ~ ~ ~ 0 C-) u >'s~ . . ~ ~ rJl~ ~ j~&~ ;0 ....OrJl~ !-..:> ~u....~ r;:r.) ~QrJl< - ~ 1.0 o~5r.. ---::::l i&- - - Cl ,,~~~ rn ....,,~~ ~ ~....~~ ',) - - ~~ ~ - == tr ~~O~ (-~) - 1.0 ....pU (.,;.~ =~ - ru ctU....U - ~ - - - - ::r Cl Cl Cl - - Cl - 1.0 - - rn ~ == == - - ::r iiL- == Cl Cl r- w a: c.:l Cl; ~ c.:l I'- Ul CC C> ooffilR' ,I- a.~Ulcl'-~ .~8I'-NO ~ ~-al~ :::l :J: W W u.. W ::c In c:::i7 _lI'l , - ,~ _c tx::)UJ ~g M C> I'- \