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Home My WebLink About02-23-07 ~ 15056051047 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 File Number Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return <:::) 2. Supplemental Return <:::) <:::) 4. Limited Estate C) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required <:::) C) 4a. Future Interest Compromise (date of death after 12-12-82) c::;) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) <:::) 10. Spousal Poverty Credit (date of death <:::) 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received --L 8. Total Number of Safe Deposit Boxes .. Firm Name (If Applicable) RECORDED OFFICE OF REGIS1ER OF WILLS 2007 FED 23 PM 3:31 CLERK OF ORPI-L\NS' COURT CU~mERL\ND CO., PA Correspondent's e-mail address: H (?rY1 PT3' tiJ fkjL.. tom Under penalties of pe~ury, I declare that I have examined this return, 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. DATE / 70 DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --.J t --.J 15056052048 REV-1500 EX Decedent's Name: ELLEN I:::~ 11 iVTZ. Sf-tO R e 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) c=> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c=> Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative (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_ . 15. 16. Amount of Line 14 taxable at lineal rate X.O::l..5 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 ~ 9~ 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~'i~ L--.~ 15056052048 Side 2 Decedent's Social Security Number .1.37 0 '5, CJ,1 () ;3 - 15056052048 --.J r REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME _.. ~LLgJV _.f!3..lic-J.D---..~H.O~h____ STREET ADDRESS ___J..a n/1.l__j.a__Id.._$~__~?$l:)I.._li.Q_~c.__r' .. _ __l....g,rnQ'tJIL.d..--r-P.fi.__L7. Q_L.j~_ CITY lie!" ~~ 3_ __________ _. _ STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 1.5~Lf3 , ________JLh~ 0-0 _ ______ __]~C) Total Credits ( A + 8 + C ) (2) l':f .930 . 3. Interest/Penalty if applicable D. Interest E. Penalty .--------- Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) C07 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5) (SA) (58) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D 129 b. retain the right to designate who shall use the property transferred or its income; ............................................ D 0- c. retain a reversionary interest; or.......................................................................................................................... D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D lCl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 39116(1.2) [72 P.S. 39116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-l508 EX + (1.97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLLEIJ F~ A-NTZ- St{O(<.0> FILE NUMBER ~ 10 G, - oq I 8 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION SEE- ,4 rrf\-o{e-~ 5 (\-.ie-a lALf" VALUE AT DATE OF DEATH TOTAL (Also enter on lineS, Recapitulation) $ .3541579 (If more space is needed, insert additional sheets of the same size) , IiLLEN FRANTZ SHORB 187-05-0703 SCHEDULE E Certificates of Deposit Item Bank Number Amount of CD Balance 10/29/06 1 M & T Bank 31003915824039 25,000 25,946 2 Farmers First, Susquehanna, Fulton 4311183132 10,000 10,136 3 Farmers First, Susquehanna, Fulton 4311183131 5,000 5,017 4 Sovereign, WaVDoint 3295144236 5,000 5,013 5 Orrstown Bank 4000010026 42,000 42,023 6 Community 7200078184 5,000 5,002 7 Community 7200078185 10,000 10,004 8 Northwest 1903038410 5,000 5,016 9 Sovereign,WaYPoint 3295127678 10,000 10,032 10 Sovereign, WavDoint 3295127686 10,000 10,032 11 Sovereign, WaVDoint 3295062784 10,000 10,034 12 Sovereign, WaVDoint 3295062776 10,000 10,034 13 Sovereign, Wavpoint 3295144251 5,000 5,016 14 Sovereign, Wavpoint 3295144301 10,000 10,032 15 Sovereign, Waypoint 3295144277 10,000 10,032 16 Sovereign, Waypoint 3295144285 10,000 10,032 17 Sovereign, Wavpoint 3295144293 10,000 10,032 18 Sovereign, Wavpoint 775510019 10,000 10,034. 19 Fulton 5070213351 10,000 11,079 Checking and Savings Accounts 20 Soverign Bank 3291017439 12,951 21 Members 1 st 273495 1,000 22 Northwest 1901015709 785 23 Orrstown Bank 147000093 1,053 24 Fulton Savings 441705511 1,852 25 Fulton CheckinQ 54828 32,680 26 M & T Bank 89,151 MISCELLANEOUS 27 Undeposited Interest checks 10/29/07 125 28 Highmarkmark refund for Nov 06 - Jan 07 411 29 United Health Care refund 25 Total Cash and Receivables 354,579 inheritance return012707 REV-1511 EX+ (12-99) _ , ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF E LLE /I.} F rZ rtC'v"l"Z. SHO /2.f1) Debts of decedent must be reported on Schedule I. FILE NUMBER :1/0 & - 0'178 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~4J7 1<21\Jwo 1<.,.. H 'i 1- loA r\J cr \'t l't L- }-1omG ). 0A'1 C III.( R C:S,Pru.((ftrJT <04 I B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees (p:.'f,j 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 Ljgo 5. Accountant's Fees - 6. Tax Return Preparer's Fees - 7. TOTAL (Also enter on line 9, Recapitulation) $ t70; ,3'-// (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ELLEN e R Af\112... SN.O R ~ c11 a" - 097 {5 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ~. L,,vKS :J- Q ITa E tl oa Y J1 (9 L.I D fI-'1 ~ Irn a. I? m E clVT QORP 78 L I (Ii 1<' S ~ C'/trlE E If (t() 3. TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,50:1. HEV-1513.EX+ (9-00*, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF E LL~'(V P(.2,r<\tJT2.. SHO (2. fJ-.- NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 3l-lD IT>{ S. He-mfr FILE NUMBER J lOG, - oq,)< RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE 1. Df\ lA& H T e-Vl- IcHJ % ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) , REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS .' '.4 .f...~~.~~. ' . .. L "--" ... :;'" '~;'!J'"...~,_ '. - , --"~II, ~,-:;>'",' - "~\':--~ .. ro'.,. . ,', '.. , .. ..,. I "1 " .. . '4', ,fl, ..... .... . .. .f I \ , i.. '- .~.;.,. . . \ ~_, ;Jt~ .... / l"t . "'" . '.' )'.. ". ,.." .,.. .. . . . "'\. No. 2006-00978 PA No. 21-06-0978 Es ta te Of: ELLEN FRANTZ SHORB IFirst. Middle. Last) .. '~'t ~,; Late Of: LEMO YNE BOROUGH CUMBERLAND COUNTY Deceased Social Securi ty No: 187-05-0703 WHEREAS, on the April 23rd 1993 was ELLEN FRANTZ SHORB 3rd day of November 2006 an instrument dated admitted to probate as the last will of IFirst. Middle. Last) la te of LEMOYNE BOROUGH, CUMBERLAND County, who died on the 29th day of October 2006 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH Register of wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: JUDITH S HEMPT who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 3rd day of November 2006. * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) LAST WILL AND TESTAMENT OF ELLEN H. SHORB Introductory Clause. I, ELLEN H. SHORB, a resident of and domiciled in the Township of Spring Garden, County of York and Commonwealth of Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all wills and Codicils at any time heretofore made by me. I have one living child: JUDITH A. HEMPT, born November 11, 1943. ITEM Direction to Pay Debts. I direct that all my legally enforceable debts, secured and unsecured, be paid as soon as practicable after my death. ITEM Direction to Pay All Taxes from Residuary Estate. I direct that all estate, inheritance, succession, death or similar taxes (except generation-skipping transfer taxes) assessed with respect to my estate herein disposed of, or any part thereof, or on any bequest or devise contained in this my Last will (which term wherever used herein shall include any Codicil hereto), or on any insurance upon my life or on any property held jointly by me with another or on any transfer made by me during my lifetime or on any other property or interests in property included in my estate for such tax purposes be paid out of my residuary estate and shall not be charged to or against any recipient, beneficiary, transferee or owner of any such property or interests in property included in my estate for such tax purposes. ITEM Outriqht Gift of All Property to Dauqhter. continqent Gift to Named Beneficiary. I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devises) wherever situate and whether acquired before or after the execution o~ this Will, absolutely in fee simple to my daughter, J~ITH A2 ~ HEMPT, if she shall survive me. If my daughter shall~t su~ive~2j me, her then living issue shall take per stirpes the sn~re sne ~~~ would have taken had she survived me, o~ in defaul t o~J~~h ~sua'::: ~~ to my brother, BARTON F. HERR, and my sl.ster, MARGARE'IJ.:1L::q w ::::' C:J SHEAFFER, or the survivor of them. ...oj~~o/" ;-':~;i~ ," O-Tl -u .-n ". <c ::r=. ~7: 0 :~ =0 N 1---: ,.., -:J --I .. 0';, 0 ~'> 0 -fl C) ITEM Naming the Executor. Executor Succession. Executor's Fees and Other Matters. The provisions for naming the Executor, Executor succession, Executor's fees and other matters are set forth below: Naminq an Individual Executor. I hereby nominate, constitute, and appoint as Executor of this my Last Will and Testament JUDITH A. HEMPT and direct that she shall serve without bond. Naminq Individual Successor or Substitute Executor. If my individual Executor should fail to qualify as Executor hereunder, or for any reason should cease to act in such capacity, the successor or substitute Executor shall be MAX J. HEMPT. Final Succession If Individual Successor Executor Cannot Act. If my individual successor Executor should fail to qualify as Executor hereunder, or for any reason should cease to act in such capacity, then the successor or substitute Executor who shall also serve without bond shall be CHRISTINE B. HEMPT. Fee Schedule for Individual Executor. For its services as Executor, the individual Executor shall receive reasonable compensation for the services rendered and reimbursement for reasonable expenses. ITEM Definition of Executor. Whenever the word "Executor" or any modifying or substituted pronoun therefor is used in this my Will, such words and respective pronouns shall include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor or substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers and duties, authority and responsibility conferred upon the Executor originally named herein. ITEM Powers for Executor. By way of illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to Executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, to make distributions or divisions in cash or in kind or partly in each without regard to the income tax basis of such asset, and in general, to exercise all the powers in the management of my Estate which any individual could exercise in the management of similar property owned in his or her own right, upon such terms and conditions as to my Executor may seem best, and to execute and deliver any and all instruments and to do all acts which my Executor may deem proper or necessary to carry out the purposes of this my Will, without being limited in any way by the specific grants of power made, and without the necessity of a court order. ITEM provision for Executor to Act as Trustee for Beneficiary Under Age Twenty-One. If any share or property hereunder becomes distributable to a beneficiary who has not attained the age of Twenty-one (21) years or if any real property shall be devised to a person who has not attained the age of Twenty-one (21) years at the date of my death, then such share or property shall immediately vest in the beneficiary, but notwithstanding the provisions herein, my Executor acting as Trustee shall retain possession of the share or property in trust for the beneficiary until the beneficiary attains the age of Twenty-one (21), using so much of the net income and principal of the share or property as my Executor deems necessary to provide for the proper support, medical care, and education of the beneficiary, taking into consideration to the extent my Executor deems advisable any other income or resources of the beneficiary or his or her parents known to my Executor. Any income not so paid or applied shall be accumulated and added to principal. The beneficiary's share or propert~ shall be paid over, distributed and conveyed to the benefic1ary upon attaining age Twenty-one (21), or if he or she shall sooner die, to his or her executors or administrators. Whenever my Executor determines it appropriate to pay any money for the benefit of a beneficiary for whom a trust is created hereunder, then the amounts shall be paid out by my Executor in such of the following ways as my Executor deems best: (1) directly to the beneficiary; (2) to the legall~ appointed guardian of the beneficiary; (3) to some relat1ve or friend for the care, support and education of the beneficiary; (4) by my Executor using such amounts directly for the beneficiary's care, support and education. My Executor as trustee shall have with respect to each share or property so retained all the powers and discretions conferred upon it as Executor. . . Testimonium Clause. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this .t3~ day of 41"r!{/. l'i r 3 . I ~~.~ ELLEN H. SHORB Attestation Clause. The foregoing Will was this 2]_~ day of /(~(/ I 9 i 3 ,signed, sealed, published and declared by the Tes atrix as and for her Last will and Testament in our presence, and we, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses on the above date. ( SEAL) , -~!l!/tftJ' J of ~ ~/1 v ( /71 710R f(, (n of PROOF OF WILL Commonwealth of Pennsylvania County of York Self-Proving Affidavit We, ELLEN H. SHORB, and 6c/w,Md A J/4~I<'JJI<.I J/t; and :1I.i.C~f\;-tCL r. '~u..be L-, the Testatrlx and the wlthesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last will and that she had signed willingly (or willingly directed another to sign for her), 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 will as witness and to the best of our knowledge the Testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. ~~.~ ELLEN H. SHORB ~4~~~ Witness ?/ ~a~~ ~(/C!~_,iJ Wltness ' v Subscribed, sworn to, and acknowledged before me by ELLEN H. SHORB, the Testatrix and subscribed and sworn to before me by c.:l"",14 A SI;/,vkosl<.: I --:;"'" and ':!",..w,'i. r A~~...I , wi tnesses, this 2-3rr.d day of ,4 1",(,.1 r I f 'j:3 I .~'rY\.LVllt'AA'U'II'~ (Seal) Notary PubllC ~~;~~~vania My Commission Expires: ~o. \9, \'iq ~ r-. NOTARIAL SEAL DONNA, M, MUMMERt, Not.-vy Public Ci~; 01, York, 'fork Cou"ty Comm.sSloo E;;: 'res Feb, 19, 1996 STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA FARNER STRASBAUGH Register for the Probate of wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 3rd day of November, Two Thousand and Six, Letters TESTAMENTARY in common form were granted by the Register of said County, on the es ta te of ELLEN FRANTZ SHORB , late of LEMOYNE BOROUGH (First, .Middle, Last) in said county, deceased, to JUDITH S HEMPT (First, .Middle, Last) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the 3eal of said office at CARLISLE, PENNSYLVANIA, this 3rd day of November Two Thousand and Six. File No. 2006-00978 PA File No. 21-06-0978 Date of Death 10/29/2006 S.S. # 187-05-0703 Jdt~~ ~- NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL , :..J REV-485 EX (05-04) .~. SAFE DEPOSIT ~ BOX INVENTORY PA Department of Revenue Social Security or Death Certificate Number Date of Death 48500041046 PLEASE USE ORIGINAL FORM ONLY County Code Year File Number " -' " ...,.'....,._,. :. ..-',,' .,~.:,. -',', ',' <',"'":, -'n \ '.~ 1 . t) S' \) '1:c-G: Decedent's Last Name' . , .;o:~':\: ~~ <::)\.0 Suffix ~".~ First Name ~ ,lp' b~~(~)~i~ MI 1- b. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: c. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: ~ ~ '\'r\. ..\\: n~ STREET ADDRESS: '\ a.~~~~\~ STREET ADDRESS: CITY: STATE: b. NAME: ~ ~~'-~'" ~~~~ STREET ADDRES~: ~\ ~, '\\00 ~ \.""~ ~~ CITY: ST,uE: '~ If yes, b. Name and address of personal representative, if named in the will NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: c. Name and address of attorney, if any NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: L 48500041046 48500041046 -.J Page REV-485t:X SAFE DEPOSIT BOX INVENTORY ~'INSTRUCTIONS ] (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, Le., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, ete: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (9) Return completed form to: of DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ITEM NO. ITEM DESCRIPTION PERSON RECEIVING COPY OF S DEPOSIT BOX INVENTORY: IGNA RE o Executor(trix) 0 Administrator(trix) e.~~ 0 Estate Representative oint owner of safe deposit box ."OTE: Attach additional 8'/z" x 11" sheet(s) if necessary or use duplicates of this page of 0 The Department is authorized by law, 42 U.S.C. ~05 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxin authorities. The state law prohibits the Commonwealth's personnel from disc/osin confidential tax information except for official purposes. -,-r- r -"C CJ., 1.6 . '. r! M8ffBank Sch f' fi:-' ~ ~f..e, 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 November 30, 2006 Judith Hempt, Executrix Estate of: Ellen H Shorb 763 Limekiln Road New Cumberland, Pennsylvania 17070 Re: Estate of: Ellen H Shorb Account Number: 9840520986 & 031003915824039 Date of Death: October 29. 2006 Dear Sir or Madam: Per a memo from Kim Zglenski at M& T Bank, dated November 17, 2006, please be advised at the time of death, the balance on the above referenced account was: 1. Type of Account Checking Account Account Number 9840520986 Ownership (Names of) Ellen H Shorb .. Opening Date 09/20/05 Closed 11/03/06 $89,150.95 Balance on Date of Death Accrued Interest $ 0.49 Total $89,151.44 2. Type of Account Certificate of Deposit Account Number 031003915824039 Ownership (Names of) Ellen H Shorb .. Opening Date 12/08/05 Closed 11/03/06 $25,860.68 Balance on Date of Death Accrued Interest $ 85.61 Total $25; 946.29- * For further account information, regarding ownership, closures andf or reimbursement of funds, etc., please contact the Lemoyne Office at # 717-731-1730. M &T Bank DOD Unit / Records Management .:II ;l, 3 I ;La --;. c.l '1, ,,,-=> Fulton Bank LISTENING. November 22, 2006 Judith Hempt 763 Limekiln Road New Cumberland, Pennsylvania 17070 Dear Ms. Hempt, RE: Ellen Shorb, deceased October 29,2006 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: Checking # 0000-54828, open 5/20/1998, balance $32,679.84. Judith Shorb Hempt as Power of Attorney. Savings # 4417-05511, open 5/7/1992, balance $1,852.13 and accrued interest $ .88. Judith Shorb Hempt as Power of Attorney. ACC CD# BALANCE INT RATE OPEN -431-1183131 $5,000.00 $17.42 4.89% 6/3/2002 -431-1183132 $10,000.00 $135.86 3.08% 11/21/2003 flOf 't. 0 &- 507-0213351 $10,847.99 $231.03 4.07% 4/23/2004 * Judith Shorb Hempt as Power of Attorney for above 3 CD's. ROLL OVER MATURITY 5/3/2007 2/21/2007 4/23/2011 If you should have any further questions, please do not hesitate to contact me at (717) 291-2437. /-" ....--. .j f.... i : "'. ~~""':"') j" J " , ~ :~. j ~.~ n;: i ',._ ~,~; I # \ It ~.~. >', I.! L.J i..,. i '.~ j j ,q 1 .. ., "-'V." Very truly yours, ~~~~ Credit Inquiry Processor . '....~..H _.;.' ,-., ," .,'--.l -:' ~ ~ , ; ,'.C,:: :.. :.....1 !C'" J. ~. " '.:'., ." _ A ~l i.'~ ~~~: <: ~': I, r':- ~;c::_ POBox 4887 Lancaster, PA 17604 fultonbank.com 1.800-FULTON-4 Ji'-/ Hq-18 ~O I / Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: Ellen Shorb 187-05-0703 October 29,2006 Account #: 3291017439 Type: Checking In the name of: Ellen H Shorb Date of Death Balance: $12,932.86 Int.(YTD) from 1/1/2006 to 10/3/2006 Accrued interest to date of death: $18.24 Other Info: Account closed on 11/14/06 for $13,288.86. Open date: 2/16/1994 . : $177.17 tL J.D Account #: 0775510019 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $34.27 Other Info: Account closed on 11/14/06 for $10,015.98. Open date: 8/12/2004 t1: I 'B $311.90 Account #: 3295062776 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $34.27 Other Info: Account closed on 11/14/06 for $10,015.98. Open date: 5/27/1994 fJl~ $311.90 Account #: 3295062784 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $34.27 Other Info: Account closed on 11/14/06 for $10,015.98. Open date: 5/27/1994 ti. II $311.90 Account #: 3295127678. Type: CD In the name of: Ellen H Shorb Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $30.32 Other Info: Account closed on 11/14/06 for $10,014.14. Open date: 1/30/2004 :ii~ $276.00 Page 1 of 3 Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: Ellen Shorb 187 -05-0703 October 29,2006 Account #: 3295127686 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $30.32 Other Info: Account closed on 11/14/06 for $10,014.14. Open date: 1/30/2004 ~IO $276.00 Account #: 3295144236 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $5,000.00 Int.(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $13.15 Other Info: Account closed on 11/14/06 for $5,006.13. Open date: 7/16/2004 ~~ $119.67 Account #: 3295144251 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $5,000.00 Int.(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $16.15 Other Info: Account closed on 11/14/06 for $5,007.53. Open date: 7/16/2004 ttJ3 $146.97 Account #: 3295144277 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $32.30 Other Info: Account was closed on 11/14/06 for $10,015.06. Open date: 7/16/2004 !:t15 $293.95 Account #: 3295144285 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $32.30 Other Info: Account closed on 11/14/06 for $10,015.06. Open date: 7/16/2004 #. It" $293.95 Page 2 of 3 Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: Ellen Shorb 187 -05-0703 October 29, 2006 Account #: 3295144293 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $10,000.00 Int,(YTD) from 1/1/2006 to 10/29/2006 Accrued interest to date of death: $32.30 Other Info: Account closed on 11/14/06 for $10,015.06. Open date: 7/16/2004 t:t 17 $293.95 Account #: 3295144301 Type: CD In the name of: Ellen H Shorb Date of Death Balance: $10,000.00 Int.(YTD) from 1/1/2006 to 1/29/2006 Accrued interest to date of death: $32.30 Other Info: Account closed on 11/14/06 for $10,015.06. Open date: 7/16/2004 ~'4 $293.95 Page 3 of 3 .~ 1It. . . .~iS~ .'1>> IIaJlk ::if.lM8It "',f+Tlt MAl MB3 02-10 Court Ordered Processing P,O. Box 841005 Boston, MA 02284 January 23,2007 Attn: Judith Hempt 763 Limekiln Road New Cumberland, P A 17070 RE: Estate of Ellen Shorb Date of Death: 10/29/06 Dear Ms. Hempt: Per your request, enclosed please find the account information as of the date of death for the above-named decedent. For your" information, accrued interest is not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. V1 truly yours, NWc ()~ Nicole Job COP Specialist III Decedent Department (617) 533-1364 ~ S' ~ ).3 ORRSTOWNBANK A Tradition of Excellence November 17,2006 To: Judith Hempt 763 Limekiln Rd New Cumberland Pa 17070 77 East King Street P.O. Box 250 Shippensburg, PA 17257 From: Traci Shaffer Orrstown Bank Customer Service Center PO BOX 250 Shippensburg, Pa 17257 Re: Estate of Ellen Shorb Date of Death 10/29/06 IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK. CHECKING ACCOUNT Account # Title of Account 147000093 Ellen H Shorb Date opened 4/28/06 Principle 1052.96 Accrued Interest 0.00 SA VINGS ACCOUNT Account # Title of Account Date opened Principle Accrued Interest CERTIFICATE OF DEPOSIT Account # Title of Account 4000010026 Ellen H Shorb Date Opened Principle 4/28/06 42011.50 Accrued Interest 11.50 -1 L./.;J 0 /;). 3.(JrJ \\ \\ \\.orr\lo\\ ILl 0111 - Communit~Banks J:;t (p ,j. ] Decedent's Name Ellen H. Shorb Social Security Number 187-05-0703 Date of Death October 29, 2006 Account Number 7200078184 7200078185 Account Type Time Deposit Time Deposit Date Opened 09/26/02 09/26/02 Principal Balance $5,000.00 $10,000.00 Accrued Interest at Date of Death $2.29 $4.57 Balance at Date of Death $5,002.29 $10,004.57 Maturity Date 09/26/07 09/26/07 Account Ownership Individual Individual Names of Joint Owners, if any Date Joint Ownership/Beneficiary was Established Interest Rate 4.1690% 4.1690% . . Additional Information M. (1n~ ~ '-_':>."~~~ \.-~\4 \\\~ Authorized Signature I~C\\S~ Date P.O. Box 350 . Millersburg, PA 17061 . Phone 1-866-255-2580 ,~ Communit~Banks December 1, 2006 Judith Hempt 763 Limeliln Road New Cumberland, P A 17070 RE: Estate of Ellen H. Shorb, deceased Enclosed you will find the information requested on the above referenced individual's accounts. Unless otherwise noted, the information furnished is as of date of death. Please feel free to contact me at 717-354-3590 if! can be of further assistance. Sincerely, Deborah K Lorah Deposit Services Manager P.O. Box 350 . Millersburg, PA 17061 . Phone 1-866-255-2580 n !i- ~ 0( "" N NORTHWEST SAVINGS BANK # <is. 4 J.~ 2220 SOUTH QUEEN STREET - YORK. PENNSYLVANIA 17402 - [717J 747-8880 - FAX: [717] 747-8882 RE: Ellen Shorb DATE OF DEATH: October 29,2006 SOCIAL SECURITY NUMBER: 187-05-0703 I hereby verify that the following is a complete list of all accounts held by the decedent as of the date of death. Account Number 1901015709 1903038410 ~ Type of Account Savings Certificate of Deposit Date Opened . 03-21-2003 02-11-2005 I Date Closed (if applicable) 11-14-2006 11-14-2006 Maturity Date N/A N/A Account Ownership Individual Individual Name of Joint Owner N/A N/A Date Ownership Established 03-21-2003 02-11-2005 Account Balance on DOD '}? 1 78444 5000.00 ~t;;~. . ./ Accrued Interest to DOD . . .79 16.19 Interest Rate 1.24% 3.94% DATE / / - / 5 -0 ~ NORTHWESTSAVTNGSBANK BY /, lo/r (..lLJd&, A CENTURY OF SERVICE D000273495 SHORB,ELLEN A Transaction Summary Post Date 10 10/31/2006 S 00 ')10/31/2006 S 00 Eft Date Transaction Balance... IntlP... Fees New Balance Description/Pmt 10/31/2006 %% APY Earned ~~/01/06 to 10/31/06 ~ 10/31/2006 Dividend... ~..J 0.00 0.00 ~I 1.000% ~ ~1~ ~\)~ '\\611 9'j~ dC(eG _ ~eca~1.~~~.. ~J\ '\1 7J.~fCU&~~~' 7'2.~'\~ Page 1 J:t tl. 1 11/14/2006 sce b <lItvl!.. <; +~ert\ad Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.members1sl.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TOO: (717) 697-5312 or (800) 283-2328 ex1. 5312 TeleBranch: (717) 795-6049 or (800) 237-7288 MEMBERS 1st FEDERAL CREDIT UNION >t =:::; .... - ....- - ()1 N_ o- - >t 12646 1 AV 0.278 12646-12646 1'11111111111'11111111111'11111.1111.11.11..1.1.11.1.1.111.111 ELLEN A SHORB 20 N 12TH STREET LEMOYNE PA 17043 Statement of Accounts Oct 24, 2005 thru Dec 31 J 2005 Account Number: Account Balances at a Checking: Savings: Certificates: Loans: Money Management: Page: 273495 - Glance: 0.00 1,001.89 0.00 0.00 0.00 1 of 1 2005 1 099-INT and/or IRA Fair Market Value information is provided with this statement. No separate tax mailing will be made for the tax information provided. This information is being furnished to the Internal Revenue Service. Please retain this statement for your tax records. SAVINGS ACCOUNTS 00 - REGULAR SAVINGS Date Transaction Description Oct 24 Balance Forward Oct 24 Deposit by Check Oct 31 Deposit Dividend 1.000% Annual Percentage Yield Eamed 1. 010J6 from 10/24/2005 through 10/31/2005 Nov 30 Deposit Dividend 1.000% Annual Percentage Yield Eamed 1. {)()(J}6 from 11/01/2005 through 11/30/2005 Dec 31 Deposit Dividend 1.()()()01o Annual Percentage Yield Eamed 1. {)()(J}6 from 12/01/2005 through 12/31/2005 Dee 31 Ending Balance Additions Subtractions Balance 0.00 1,000.00 1,000.22 1,001.04 1,001.89 YTO SUMMARIES 1,001.89 TOTAL DiViDENDS PAiD 00 REGULAR SAVINGS 1.89 M1STOl 1,000.00 0.22 0.82 0.85 ~ ~ \,ommunl Ltl:Xll 1l\.B " DRAWEE:~ Illlll". vMAMLt::>TUN, VVV :;; ~c..h E ACCOUNT NUMBER # !}.] .; ~ 7200078185 DATE 10/26/06 Thirty four & 26/100 dollars AMOUNT * * * * $ 3 4 . 2 6 Ellen H Shorb C/O Essex House 20 North 12th St Lemoyne PA 17043 DRAWER:COMMU~BANKS ~~ ~m"llonlZ'CD SIGNATYRE III j B 5 5 j 2 III I: 0 5 . ~ 0 0 j 5 j I: 0 . bOO .0 j .0 . . ? III - - - ~ . -- ": , ,: . THIS DOCUMENT HAS AN ARTIFICIAL WATERMARK PAINTED ON THE BACK THE FRONT OF THE DOCUMENT HAS A MICRO.PRINT SIGNATURE LINE. ABSENCE OF THESE FEATURES WILL INDICATE A COPY ., ('I; l:j ~ Communit'lBanks ISSUED BY: MONEYGRAM PAYMENT SYSTEMS, INC, 6591-395 3 8 5 5 31 P.O. BOX 9476, MINNEAPOLIS, MN 55480 DRAWEE: BB&T, CHARLESTON, WV :;; ~ ACCOUNT NUMBER 7200078184 DATE 10/26/06 Seventeen & 13/100 dollars AMOUNT * * * * $1 7 . 13 Ellen H Shorb C/O Essex House 20 North 12th St Lemoyne PA 17043 DRAWER: CO~.. S ~ . , - . . II' --- '"""R G...ruR"- III j B 5 5 j . III I: 0 5 . ~ 0 0 j 5 j I: 0 . bOO .0 j .0 . . ? III . ..' CommunityB8nks ISSUED BY: MONEYGRAM PAYMENT SYSTEMS, INC. P.O. BOX 9476. MINNEAPOLIS, MN 55460 DRAWEE: BB&T, CHARLESTON, WV 372397 ! ~ ACCOUNT NUMBER ~ ~ 7200078185 DATE 8/26/06 Thirty five & 41/100 dollars AMOUNT ****$35.41 Ellen H Shorb C/O Essex House 20 North 12thSt Lemoyne- .~ PA 1'7043'--" DRAWER: COMMUNITY BANKS >>l.~X~~. .- A'CrrHOl'REDoSlGNAtURE ,.-- ~... III 3 ? 2 j q ? III I: 0 5 J. gOO 3 5 31: 0 J. bOO J. 0 j J. 0 J. J. ? III ~ ::Ii l;ommUnl1\!tlanKS DRAWEE: .....u. DU^--~/O, MINNt:At-'ULTS;Mf'I :>::WOV BB&T,CHARLESTON,WV .,;- f c:....J';:; U -* 'J 7 l. ACCOUNT NUMBER 6 . DATE 7200078184 8/26/06 'Seventeen & 71/100 dollars AMOUNT * * * * $ 1 7 . 7 1 DRAWER: COMMUNITY BANKS Ellen H Shorb C/O Essex House 20 North 12th St Lemoyne PA 17043 ~,"'-' -*'~: ;,t~'\ ....r.... ..';........'/ It/ ..... f. '~I / .~:?(r~ f;~~~~>: ./?(:~~h,.M' -' AUTHORIZED SIGNATURE" -' III ~ 7 2 ~ 9 I; III I: 0 5 I. 9 0 0 j 5 ~ I: 0 I. I; 0 0 I. 0 ~ I. 0 I. I. 7111 Please detach check before redeeming. THIS CHECK IS VOID WITHOUT A BLUE AND GREEN BACKGROUND, MICROPRINT LINES IN THE BORDER, A WATERMARK AND VISIBLE FLOURESCENT FIBERS. '. . .... . ~ .-,: ':":~ :::~.~.::-~ - .:~.... '.; :'~>~, PAY'" ..:..:~t~ .. 0.1:1.,..... ELLEN H SHORB JUDITH ANN HEMPT ESSEX HOUSE APT 333 20 N 12TH ST LEMOYNE PA 17043-1448 00519 -.:,.':-. ';. ... ~:j" ",:':' ~ ..::.f1!!:fs · ~;;"" II. ? J. j j J. ....11. I: 0 j J. j 0 J." 2 21: o J. '10 000 21;11. rli1M&rBank Manufacturers and Traders Trust Company D SAVINGS ~ CHECKING DATE ~ h I DEPOSIT TICKET 1/ 07 0" DOLLARS CENTS CASH CHECKS TOTAL TOTAL FROM OTHER SIDE I {)..!5 a8 TOTAL DEPOSIT DDEHl24 (3101) b CHECKS AND OTHER ITEMS ARE RECEIVED FOR DEPOSIT TO THIS ACCOUNT SUBJECT TO THE RULES AND REGULA nONS OF THIS BANK I: 5 ~.... I. II' 9 I; 0 5 1 : <HIGHMARK. ,.. BLUE SHIELD ~ .sc.h C :# J- '0 P.O. Box 382102 Pittsburgh PA 15250-8102 Invoice 03-4-2491 .....1r....1IC<<irNjIl'-"oI6rt'8Itt<:C....aNl8Iuc-~"'-"......lfl P.O. Box 890171 Camp Hill PA 17089-0171 Date Group 10/05/06 06605279 Company Code Billing ID 01 900063874 111111111111111111111111111111111111111111111111,111111.1111,1 ELLEN H SHORB 855 MOFFETT LA YORK PA 17403 Member CoveraQe Period Account Status ID Number BeginninQ EndinQ Previous Balance 410.55 103393762001B 11 /01/06 01/31/07 Payments Received CR (410.55) Adjustments 0.00 Coverage: MedigapBlue - Plan C Prior Balance Due 0.00 Individual Coverage Period Premium 410.55 Total Balance Due 410.55 - Look for important information in this space on future bills. We will provide updates on your benefits, health tips and other information. If you have any questions about your coverage, please contact our Member Services department. The address and telephone number appear on the reverse side of this statement. :trISQ1 loll~ ID& To ensure proper credit, please indicate your Member ID Number on your check or money order. See reverse side for important information. "'..............1- TT~........ __..1 n~~....._ n_......__.._ n_._~_._ "'1~....1- 'T___~. n__.____~ ~ ""- Sc.h t P" d), q '. , :INVOICE PURCHASE VOUCHER ORDER NUMBER GROSS AMOUNT ': OISCOUNT NET AMOUNT NUMBER DATE NUMBER' , GPS80080~OO64/86 1'2-2:-2006 86601:)65 2::i.O~ .SO 2::.C2 YOUR .ACC:::UIH I,o:A5 ;;R~";:CUSL y l:..RWNA-:-EC. FIlS R~F ...ND REP~FSErrS FLNJS R:CE:VED ,~F -ER "O"R T :RHI N."'''" ICN J;\-F. IF y()U H.A.~,/ : QUESTiGNS. P~EASE CNL 1 - 888 867-557~ (TTYI-877-J30--llS2;. 'o'11_VI'. "VI'~U_I' Jv...J..J.:,.}v..... VENDOR ; TOTAL 525..03 $.OC 525.D3 O~O:)O64?85 :;:. ..::: . :::~". : v'i'.., ""'.~'~:.. 1,1.".1.' ''lII. ", i":'fl. "'io' ;'!::;:::~;,.;,;11F:~: :";.;~I ...11' .....::. I~ .: 'tI:I:.!a,: . t(~ "II l"III~( It l-':i.I'a.1 J.I.'I~~II~.I]..~~I;!.... .~:i.) :,'''1% fI r:"I~1 ,Ill ;.t!....jll;~:..t'.. lJl:: ,!,I \ 11:)!"I.'..!.f.~:~:~~,~~ ..t:..::t~i1rr7'?"~_=''''riT~'~ ~:i~.nIIE. t:\: i'!'FIl1eahhcare' UNITEDHfAUHCARE SE.RVICES, INC (877) 620-6192 PO BOX 1459 ~WOv8-W34a MINNEAPOLIS ~~v 55440-1459 l--t"~t 1 ~o lNlnc~o( St DATE ,.,,,tlfur<! CT 06120 12-22-2006 CrlECK NO. 30039306 :;1.44 119 272 - Pay TWENTY FIVE AND 03/100 DOLLARS ., ..~'S 03 PAY ONLY ~":~.' p~ - - To The Order of ESTATE OF ELLEN H SHORB . ESSEX HOUSE APT 333 ~ ~ 12 N 20TH ST , ~ LEMOYNE PA 17043-0000 - - ".UTIIORIZEO SIG!otATIlRE ~ ..r~~~~ .~ iill JII; ;t;:t.u':: ;..t :.". !:. ~~~.,::1 ! ~J! ..;.'~li.I~.J~:. :~!:'; Ijl~,~~li_'~"~;tJIt1~.<I~:~:~;J.:11~~i": \f . ~'I~. ,_ : ;~rl.'~::J:::::r~ ., iliaD 300 3 ~ 30 bill ':0.. gOO L. L. 51: 5 . ~001l1 ./ . . UNiTEcheatthcareo UNITEDHEALTHCARE SERVICES, INC (877) 620-6192 PO BOX 1459 MN008-W340 MINNEAPOLIS MN 55440-1459 Page 1 90-GO CHECK DATE 12-22-2006 CHECK NUMBER 30039306 ..... , ..........,.......... :::;:;:::;:;:;::.::;:::;.::;:::;:;:;.::::::;::::::.;:;:;:: f{\!?rUf!f}r~f~):~::;:::::::::::::::::;::::;';';':"""..... ;rlllR.'~~\'.::li;.;;;.;;...;;.;;;;.G;;..;.;.;;;.;;;.;;R.;;....;.;...;.p..;...;;.;.;....SS.;..;.;.;.;.;.;.;.;.~~~IL;;; Hm:tlQM~'ft? ,;;;;;';"',.;,};;} GPS0000000064786 12-21-2006 86601365 25.03 YOUR ACCOUNT WAS PREVIOUSLY TERMINATED. THIS REFUND REPRESENTS FUNDS RECEIVED AFTER YOUR TERMINATION DATE. IF YOU HAVE QUESTIONS, PLEASE CALL 1-888-867-5575 (TTYl-877-730-4192). .00 25.03 ............-..... .................. .................. .................. .................. .................. .................. .................. :::::Y~P.QR OR00064786 .mT W;!!111'!1&lllllj mmml .................... .................... ................... ................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... ........m .................... .................... .................... .................... .................... .................... ....,............... ......,............. .................... .................... .................... ....... ........... $25.03 I $.00 I 125.03 I .................. ................. . . . . . . , . . . . . . . . . . . .................. .......,........... ............................ ............................ ............................ ............................ .......-.................... .....-...................... ............................ .......................... . ............................ ............................ ............................ '::1'OTA( ....................,..... ............................ 001802 1000237 0001 30039306 UN.0612t7Q-OOOOI7t7 12/21106 19.37 OR000647860001 72621-0001 19604 Sch H A 1 Mrs. Judith S. Hempt 763 Limekild Road New Cumberland, PA 17070 .. KENWORTHY FUNERAL HOME INC Funeral Expenses of Shorb, Ellen Frantz Contract #: 0020070025 Date of Death: October 29,2006 Date of Statement: November 2, 2006 $100.00 $6,675.00 $185.00 $6,860.00 $85.00 $6,945.00 $206.80 $7,151.80 $175.65 $7,327.45 $90.00 $7,417.45 $675.00 $8,092.45 $150.00 $8,242.45 $175.00 $8,417.45 $1,842.45 $8,417.45 $8,417.45 y~ V~ J(~ \~\O(y \\ Funeral Home Charges Basic Services of Director & Staff Embalming Other Preparation of the Body Use of Facilities & Staff for Viewing Use of Facilities & Staff for Funeral Service Transfer of Remains Hearse Service/Utility Vehicle Lead Car Casket as selected - Adams Coppertone Vault as selected - Oxford Acknowledgement Cards Register Books Memory Folders 4 Extra DVD's $1,775.00 $625.00 $310.00 $150.00 $400.00 $240.00 $220.00 $105.00 $115.00 $1,450.00 $995.00 $15.00 $50.00 $85.00 $40.00 Total Funeral Home Charges $6,575.00 Cash Advances Clergy Honorarium Flowers Paid Death Notices - Evening Sun Paid Death Notices - harrisburg Patriot Paid Death Notices - York Papers Certified Copies Opening & Closing Grave Tent and Equipment Marking Stone Total Cash Advances Total Original Charges: Amount Currently Due: $8,417.45 WA~E \: KE:-.o"\VORTHY SUPERVISOR 269 FREDERICK STREET fiANOVER. PA 1733 I 7 I 7-637-6259 ERIC V. KENWORTHY SUPERVISOR 66 E. fiANOVER STREET GETTYSBURG, PA 17325 7 I 7-337-93 I I $1,775.00 $2,400.00 $2,710.00 $2,860.00 $3,260.00 $3,500.00 $3,720.00 $3,825.00 $3,940.00 $5,390.00 $6,385.00 $6,400.00 $6,450.00 $6,535.00 $6,575.00 $6,575.00 (! heel' ci: ) 0 \ II ) I~)O fI Sch H y+ cl BAY CITY SEAFOOD CO., INC. FINAL BILL Organization: Hempt Contact: Type of Function: Date: Address: Time: Phone: Guaranteed: IIITEM II IINUMBER II II COST II TOTAL IISUMMARY II Appetizer $0.00 Food $678.00 $0.00 $0.00 Bev $0.00 Sub Total $0.00 Entrees $0.00 Misc Buffet # 2 40 $16.95 $678.00 $0.00 Labor $0.00 . $0.00 Sub Total $678.00 Sub Total $678.00 Desserts $0.00 Tax $40.68 $0.00 $0.00 Liquor $0.00 Sub Total $0.00 Wine $0.00 Beer $0.00 Beverages $0.00 $0.00 $0.00 Gratuity $122.04 Soda $0.00 Sub Total $0.00 Liquor $0.00 TOTAL $840.72 $0.00 $0.00 Sub Total $0.00 Wine $0.00 Less Deposit: $0.00 $0.00 Sub Total $0.00 BALANCE $840.72 Beer $0.00 $0.00 Sub Total $0.00 Page 1 ----- Sch J.1 (6.Q.. ( Michael L. Bangs, Attorney-at-Law Bangs Law Office 429 South 18th Street Camp Hill, PA 17011 E-mail address:mikebangs@verizon.net Invoice submitted to: Judith S. Hempt 763 Limekiln Road New Cumberland PA 17070 January 11, 2007 In Reference To: Estate of Ellen Shorb Invoice #24404 Additional Charges: Amount 12/14/2006 Check to The Sentinel Total additional charges Previous balance 115.25 $115.25 $537.50 Balance due $652.75 ( Sc h 1-1 t3 L/ RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17G13 Receipt Date: Receipt Time: Receipt No.: 11/03/2006 14:03:34 1046229 SHORB ELLEN H Estate File No. : Paid By Remarks: 2006-00978 JUDITH HEMPT JA ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL AUTOMATION FEE SHORT CERTIFICATE JCP FEE Check# 5599 Total Received......... 360.00 15.00 5.00 40.00 10.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D $430.00 $430.00 5 <-h .:r -1- DATE DESCRIPTION OF SERVICES OR SUPPLIES UNIT RATE AMOUNT I voice for week ending 10/30/06 *** CNA .J...v/22 NA WALTON T N 0.50 19.50 9.75 10/23 NA CAMPBELL T E 8.00 18.00 144.00 10/23 NA CAMPBELL T N 0.50 27.00 13.50 10/23 NA TYLER E N 7.50 18.00 135.00 10/23 NA WALTON T D 8.00 17.55 140.40 10/24 NA CAMPBELL T E 8.00 18.00 144.00 10/24 NA TYLER E N 8.00 18.00 144.00 10/24 NA WALTON T D 8.00 17.55 140.40 10/25 NA CAMPBELL T E 8.00 18.00 144.00 10/25 NA HUTCHINSON D N 8.00 18.00 144.00 10/25 NA HUTCHINSON D D 0.25 17.55 4.39 10/25 NA WALTON T D 8.00 17.55 140.40 10/26 NA CAMPBELL T E 8.00 18.00 144.00 10/26 NA HUTCHINSON D N 8.00 18.00 144.00 10/26 NA WALTON T D 7.75 17.55 136.01 10/27 NA CAMPBELL T E3 f\~ 8.00 19.50 156.00 10/27 NA WALTON T D 8.00 17.55 140.40 ** Subtotal for CNA ~\).- ~,,\~~ 112.50 2,024.25 ** Total for Invoice 218619 112.50 2,024.25 ~ \\ .~ ederal rd. #: 23-2830131 TOTAL INVOICE 7~~1 INYOICE NO. WEEK DIDI:-iC <:L.l :::;'~T CC?'( THIS BILL PAYABLE UPON RECEIPT . . ." ~' 7.3 0 - 7~OJ E.Ss~x. S.ch .l- Ii 1. J,:J..!50 Me. CT\'Ic.._hr.'~t St.. $c oR '1730j. So-{~ I Security Deposit Worksheet Facility: Essex House Resident: Ellen Shorb Move-In Date: Move-Out Date: 11/25/2006 Facility #: 5119 Resident #: 375469 Unit #: 333 Total Amount of Security Deposit Cleaning Charges (ifapp/icablei : Cleaning $ Carpet $ Paint $ ()ther $ Total Cleaning Charges Final Month Rent Charges Prior Balance Payments Received For Final Month Non Refundable Fee Refund (if applicable} Security Deposit Interest (ifapplicablel Rent Allowance (if applicable) Balance due to resident - O'Balance due to facility i ../ i ~;f ,{ .rvv. i. 1 \tV " Ignature D ~.~ Jrl Title Billable/Payable to: Judy Hempt Address: 763 Limekiln Rd New Cumberland Pa 17070 $ 787.50 $ $ $ $ $ $ $ $ $ 0.00 1,358.33 0.00 0.00 0.00 (493.00) 77.83 C \( tt I 0 ~ II ), '-\\ 0 (., I,t- il~r-j, \ OY . Date * The estimated balance assumes no past due billings * ~ . j . Unit Billing Move-Out Notice Facility: Essex House Resident: Ellen Shorb Unit #: 333 Facility #: 5119 Resident #: 375469 Date of Notice 10/27/2006 Move-Out Date 11/25/2006 Base Rent $ 1,630.00 $ $ $ . $- Total Occupied Rent $ 1,630.00 Prorated Rent $ 1,358.33 *This is an estimate of balance due for final rent payment -. - ~~:. SLH I IL .-- -. .:> DAtE DESCRIPTION OF SERVICES OR SUPPLIES UNIT RATE AMOUNT ) I voice for week ending 10/23/06 CNA . ./13 MUHAIMIN A N 8.00 19.50 156.00 10/14 MUHAIMIN A N 8.00 19.50 156.00 10/15 MANSFIELD S N 8.00 19.50 156.00 10/16 FEIMSTER T E 7.50 18.00 135.00 10/16 HUTCHINSON D N 8.00 18.00 144.00 10/16 MIDDLETON T D 8.00 17.55 140.40 10/17 FOTI M E 8.00 18.00 144.00 10/17 HUTCHINSON D N 8.00 18.00 144.00 10/17 WALTON T D 8.00 17.55 140.40 10/18 DANIEL C E 8.00 18.00 144.00 10/18 HUTCHINSON D N 8.00 18.00 144.00 10/18 WALTON T D 8.00 17.55 140.40 10/19 HUTCHINSON D N 7.75 18.00 139.50 10/19 JACKSON J D 8.00 17.55 140.40 10/19 JACKSON J E 8.00 18.00 144.00 10/19 JACKSON J N 0.25 18.00 4.50 10/20 BELLAMY-HUNTER T D 7.75 17.55 136.01 10/20 FEIMSTER T E3 8.00 19.50 156.00 10/20 FEIMSTER T N 0.50 19.50 9.75 10/20 HUTCHINSON D D 0.25 17.55 4.39 10/20 WALTON T N 7.50 19.50 146.25 10/21 FOTI M D 8.00 19.50 156.00 10/21 HOUSTON A E 8.00 19.50 156.00 10/21 WALTON T N 8.00 19.50 156.00 D\-:?\ \Ol.J J at- IO/.;lc,/d I ta.\~ /- ** Continued on Next Page *** TOTAL INVOICE # 7~ 1put! INVOICE :'010. WEEK E'iUI'iG Links Care THIS BILL PAYABLE UPON RECEIPT Lfnks '(are Remit To: Links2Care P.O. Box 800.5 Lancaster, PA 17604-8005 INVOICE NUMBER 217955 2123 4#SHOELL 4711 Queen Ave., Suite 101 Harrisburg, PA 17109 717-545-6591 FAX: 717-651-5364 Judith Hempt c/o Ellen Shorb 763 Limekiln Road New Cumberland, PA 17070- WEEK Oct 22, 2006 ENDING AMOUNT ENCLOSED = TERMS: NET UPON RECEIPT PLEASE DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE DATE DESCRIPTION OF SERVICES OR SUPPLIES UNIT RATE AMOUNT 10/22 CAMPBELL T E 8.00 10/22 19.50 156.00 CAMPBELL T D 10/22 CAMPBELL T 0.25 19.50 4.88 10/22 N 0.50 19.50 9.75 MCBRIDE E N 7.00 19.50 136.50 Subtotal for CNA 83.25 3,400.13 * * Total for Invoice 217955 83.25 3,400.13 Fe eral Id. #: 23-2830131 TOTAL I E 3,400.13 # L lJ"Iks ,:Care 7~ 1put! INVOICE :-Ill, "'EEK E~D1:'.;(; .:L:::~l-:-- C":~.:)': THIS BILL PAYABLE UPON RECEIPT ff:1 M&l 'Hank c:;c h .-1_ tt.E ~ ACCOUNT PAGE i- 000009840520986 2 OF 2 , : ~J:<< L !NO( S:J. ~04t?Io- .s.. ~ I Lot(] tN''', <..""...'0. 7Z r1.1-,. -a..!..!'-":~ _. ..&-. ILLIN H &HORII ~ tIOUS.( AP'1_ :.r::u roNtif'ntBT U.-..aw'll...... .JOt.a y~ I(')J,,(! II': (.. , . 1039 I ~ ~:::':~'~~ .C...... ~ ~.e t/ T....!'!I' .s......~ "(".'" H.-NAI1L'O I!u.EN H SHORB 1SStJf~.N'T,J,I:J 10.. 1,"" ST ~",*.~n~ ~.,zt 1040 ! 12MarBank ! --_.-.- I $:.ic.~'i ~ ----=--OOlLARi m IF= ..,.~/~ D . ,..", . . ,j . $..1",,,- ..n... " ~'?'fiv ':0 ~ 110 1'1,,5': . (J. #~/~_~ qa~05l~.OOOO~O~~~~' ; rm~:.~ _DC1LLUS!l J!!..=" ..-.. ~ ;IJtjtS'~. .:03HOl'lSS': .---) / J ~c.;.J'....--c- /7~;-, fJ,J1f___ qaI,OSm'laf.".~CI,O ...OOOOiI,OOI)'" .~.,~~_..- - --. -----'-'".... Check 11039 Paid :10/24/2006 2039.56 Check 11040 aid : 10/31/2~' " I 3400.13 m M&rBaDk . 1:""n";~;;;(~;'~;:~~f_', ": ACCOUNT NO. ACCOUNT TYPE STATEMENT PERIOD PAGE 9840520986 H&T CLASSIC CHECKING W/INTEREST OCT.21-NOV.20,2006 1 OF 2 00 o 06123M NH 117 159 ELLEN H SHORB 20 NORTH 12TH ST ESSEX HOUSE APT 333 LEMOVNE PA 17043 INTEREST PAID YEAR TO DATE 53.61 WEST SHORE PLAZA BEGINNING DEPOSITS & OTHER CURRENT ENDING BALANCE OTHER ADDITIONS CHECKS PAID SUBTRACTIONS INTEREST PD BALANCE NO. I AItOUNT NO. I AItOUNT NO. I AMOUNT 91,188.78 01 0.00 21 5,439.69 2 I 85,752.26 3.17 0.00 ACCOUNT SUMMARY POSTING DEPOSITS, INTEREST CHECKS & OTHER DAILY . DATE TRANSACTION DESCRIPTION & OTHER ADDITIONS SUBTRACTIONS BALANCE 10-21-06 BEGINNING BALANCE $91,188.78 · 0-24-06 CHECK NUItBER 1039 2,039.56 89,149.22 .0-27-06 INTEREST PAYItENT 1. 73 C 3,400.13~ Q 89,150.95 10-31-06 CHECK NUItBER 1040 85,750.82 11-01-06 HEALTH PROGRAIt ItEHBERSHIP 1.60 85,749.16 11-03-06 INTEREST PAYItENT 1.44 11-03-06 CLOSEOUT 85,750.60 0.00 ENDING BALANCE $0.00 ACCOUNT ACTIVITV CHECKS PAID SUMMARY 1039 10-24-06 2,039.56 1040 10-31-06 3,400.B ANNUAL PERCENTAGE YIELD EARNED 0.10 .% It&T BANK HAS JOINED THE PLUS NETWORK, THE WORLD'S LARGEST ATM NETWORK - WITH ItORE THAN ONE ItILLION ATIt LOCATIONS FOUND IN OVER 160 COUNTRIES. WHEN YOU TRAVEL AND NEED TO TRANSACT SOItE BUSINESS AT A NON-H&T ATM WITH YOUR H&T CARD, SIHPLY LOOK FOR THE PLUS, STAR CRl, AND VISA CRl NETWORK LOGOS. AS A RESULT OF OUR NEW AFFILIATION WITH PLUS, H&T BANK IS NO LONGER PARTICIPATING IN THE CIRRUS AND NYCE NETWORKS. FOR QUESTIONS, PLEASE CALL THE H&T TELEPHONE BANKING CENTER AT 1-800-724-2440. THANK YOU FOR BANKING WITH It&T. lOO8A (1103) :(f~< } ~ t~~1 : H',l,~ ' '1 J:' ~;~1 ~"", t'l !ld\I",11 r . . .~~" ~'!I I ~l'll~~J .dl ~ >- '\ I' .J~;, ~'j: I II ~ I ~ ~ 'f n:~t..._ ~~ ~,~ ".'~ I ., I!I ~ ~I . ,~~ mlM&TB8nk-- .. c:f'~~lut;;.t.~.*,.......,....:.~..;::;.;...~.~~..:~....~.~.::, ! btu. '1/.1 JDr.~ , --r- ",,','. 02 'I PAY.J ""1 +J..:. oJ H.o'.r I. $ 7CJ,go:j ii S.:::;;;7~.", {I Q:: ';',,_Iil = 1!..f!1~~.._" ',-,;..~...,_':".\:"...,.""".,"~<';~".' ..' '.' ,.,"',' "Ii...:.'~ ':~., !1~7n,~i.:J,..L~... ... .. ~~ .i"..~.- ':OH~0!'1S5':' '18..'iO'S'{. a..oo';u " Chlack !to Paid : 11/06/2006 70000.00 (f,.r"'':4 (If Ea."".~ ~.t'~ ~: 94 _IIIJlo(" R~~~7: l;lA~'~;'I ~,_..- ~~ S~ t7 '1.(. ''It':.ur THI'I,..... Mf. ~Il." H",,,,,n"t:'n S"l.i"'''''' ,-,CIV . m:- DCIU..AU Ii) s.::- rm~~ ......, .~u,-"" S..,.,'-C._ ~~.J&""Ft .'''~.. ':OinOl'lSS': '16..iOIo'i6'16"00'1" ..OOOOBI,UI,V -.---.-. ---:- ~~-""~'."'_._"".l'-:.~'-:o9"-""'---"':;_~- Chlack !to Paid : 11/15/2006 8417.45 I' - UTAlE Of ELU!H. F lHORa oIUPITlt ItHN HalPT, ~ lGUlII1Klt.N1lD . .-wW'-"LANtJ. _.. '71"1t)..Z311' ~":l!5I 103 DolIn 1,1../101. I ~~~Qus~ 12>,...,&, - ---g, _'--1 $~.i~.::"J ! ~'&.i... ""...aJ~l1'L.:-n t="f'"T'..._T...."ITc.r.. 7" -DCIL1...AU 8.-::- l rmML.~ .., ..... .'. .....~ . N_;;;':;' ~ :x"',. g-'-!fr ~..,J f'4'''- ':OH30l'l55': '181,30'58 8"0'03 "00000'11,1570' Chlack 1t103 paid : 11/27/2006 943.57 000009843065898 3 OF 3 u...",~. ~,. G ....~ t= ,$......(~ ...-. .. "/9/!'" 10 I $ .3.0..l'/-I' :::~l;~"'-~ .:l Can~ - - - ~I;' - TLo...H'1o ..,~.,\."""'n "T"\.\.I.:-t.n'l'. 1~l":.IA." . h'a _l_m~ rmM!!!.~ '\l> ()~;&:.JP~-rCX,""-" '18"30'58'18"00'15 ,'OOOO!O...lS" ~_ ".JII!'.'~ .:aB 30 .'i5 5': paid :11/07/2006 2024.25 .STATI Of ElLEN , lItO... ..JUDrrH ANN HEMPT. EXEC J81oi.IW'.""''''D. MIW(UMIt!..LANO,"" 1;'0'700~" ~1tl1 Dfroft /./, </~J ! I ~~~,-r;- ~'J' V ct flmh :(~ ! rt~~Fcr~I-"* . =~--- . _r:~'oPn~-1T ~.,,~C 9'i<J 'I.5e1 .,3lra (~)....ttD<..,.)~ e.",/!!. ':0~13al'l5S': '18IdaI>58'1il"'oiO' .'oooaOll....O~l.t ._~ -;l<'Z . , $'2'1<', -. _ --9OI..LAl.5 6i !E.= ss~~ Chlack !tl01 paid :11/22/2006 840.72 9S 101 r:;;} M&l'BalIlf~'&~~liJI!"",$;:C' :",::"'?:"~~':~,.,,, __IfI;,."""_"T%"l_~. .-% """"""'~~W~~ ~ ,J~~~'T'"'~'."" ACCOUNT NO. ACCOUNT TYPE . 9843065898 H&T SELECT WITH INTEREST STATEMENT PERIOD NOV.03-DEC.01,2006 00 0 06123H NM 117 1378 ESTATE OF ELLEN F SHORB JUDITH ANN HEMPT, EXEC 763 LIMEKILN RD NEW CUMBERLAND PA 17070-2317 INTEREST PAID YEAR TO DATE 10.86 WEST SHORE PLAZA ACTIVITY DEPOSlTS.INTEREsT & OTHERADDITIOHS CHECKS & OTHER SUBfRACTIONs 11-03-06 BEGINNING BALANCE 11-06-06 DEPOSIT .1-06-06 CHECK 11-07-06 CHECK 11-10-06 DEPOSIT 11-15-06 CHECK 11-16-06 DEPOSIT 11-16-06 DEPOSIT 11-16-06 DEPOSIT 11-20-06 VERIZON ARC CHECK PYMT 000000000000102 11-22-06 CHECK NUMBER 0101 11-27-06 CHECK NUMBER 0103 11-28-06 DEPOSIT 12-01-06 INTEREST PAYMENT 111,708.72 15,023.90/' 8,417.4 148,318.31 44,105.8lt 125.28 20.1 10.86 ENDING BALANCE , '~"'''''''''l1'rr,'' ' p~ 11~ ENDING BALANCE 237,064.6'1 $0.00 41,708.72 39,684.47 54,708.46 46,291. 01 238,840.44 238,817.35 237,976.63 237,033.06 237,053.85 237,064.6'1 · .CHECKSPAIDSUHtlARY $237,064.69 11-06-06 10111 11-22-06 11-15-06 8,417.45 70,000.00 840.72 11-07-06 10311 11-27-06 2,024.25 943.57 ANNUAL PERCENTAGE YIELD EARNED = 0.09 X ", "\ Jf f, 't.' ~ 'Vi, ~ ~}t.~".... ." , A 1 . ~.., ,.' """U; '.. '0" I ~)d')1, ;, ~ <~\ ~r~$:;;i~frl~~A~:'~~: IJ I J~f"'J ~ f ~;:;~J:~:~l ';" ~ dl:~~Z~:"~:.~~. ;~~.;: . - c .. .~.: ,.~' " ~"I;'" . ,..;,'ii';;{ ;.; RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisler PA 17G13 Receipt Date: Receipt Time: Receipt No. : 2/23/2007 13:21:39 1047435 SHORB ELLEN FRANTZ Estate File No. : Paid By Remarks: 2006-00978 JUDITH HEMPT WZ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name INH TAX RETURN Check# 113 Total Received......... 15.00 ---------------- $15.00 $15.00 CUMBERLAND COUNTY GENERAL FUN