HomeMy WebLinkAbout97-00804
OI"I~r(:I': C()\;1Y
INTERNISTS OF CENTRAL PA., LTD.
"t.I,'dlfVJo~ profltllldo'iil' L'llll/;ur, JOH 1,l!wl.tlt'" :Jt:, i ,. 0, linK JV1, [,..mO)'IIIt, ",\ PO..l alii'!
l'/J'n'/'H .H66 "'AI' ('II'1}'/H"4,!Ji!
Pater M. Brier, ~.D.
Michael L. Gluck. M.D.
JaJOelfJ ,). Tyndal.!. M.D.
Richard ,gchn~i.her, M. D.
Ira J. Packman, M.D.
L. Lynne Britton. N.D.
L,""L"enC<l B. Zimmerman, M.D.
Michael A. DeMichele, M.b.
July 15. 1.997
West shore family practice
550 12th Street
Lemoyne, PA, 17043
RE: REYNOLDS. JEWELL
MR#: 186097
ADMITTED: 06/22/1997
DISCHARGED: 07/11/1997
Dear Doctors:
r'le had the p.l.ea.9ure of discharging Jewt~ll Reynolds from lIoly Spirl t
Hospital on 07/11/97.
She is a '17 year-old patient of yours who presented with a chief
complaint of r!ght;'side~ weakness and aphasia. The patient 11as
been on chron~c Cou.mad~n therapy for a trial fibril.la tion wi th
chronic dizziness. hypothyroidism and history of spinal stenosis.
She was in her usual state of health until three weeks prior to
admission ,,,hen she was having trouble with her low back. She had
a known history of spinal stenosis and was scheduled for mye.l.ogram
and epidural injection and had to stop her Cou.madin. She resumed
it six days prior to admi ssion. On Sunday. 24 hours prior to
admission. the patient stated that she felt weak and could not
ambulate. She had a little bit of difficu1.ty walking but no real
c11ange. T11e family checked on her several times but did not
.r.eceive an answer and went there. [<i'hen they got there she was
nonverbal and unabl e to ge t ou t of a chair. An ambulance was
called and she was seIlt to the ER. In the ER. EKG showed atrial
fibrillation with lateral wall ischemia and the patient was
admitted with a eVA. Review of systems was positive for urinary
incontinence, spinal stenosis and DJD.
PAST MEDICAL HISTORY:
No known drug allergies.
SURGERIES: She had a knee opera t ion several years ago after an
MYA. She also had a cardiac contusion at that time. She has a
history of spinal stenosis and received epidural steroids. She has
a history of hypertension and hypothyroidism.
SOCIAL HISTORY:
until. admission.
and l.ives alone.
She has been smoking heavily and still smoked up
two packs a day for 60 years. She does not drink
FAMILY HISTORY:
Noncon tr ibutory.
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WilHam C. Reynolds
Son
Post Office Box 8318
Lancaster, PA 17604
DOB: 03/03/44
SSN: 206-34-1330
Robert N. Reynolds
Son
1212 Capital Street
Harrisburg, PA 17102
DOB: 03/01145
SSN: 206-34-1295
Judith E. Tilson
Daughter
4706 Weatherhlll Drive
Wilmington, DE 19lOl
DOB: 04/04/49
SSN: 17842-3784
4. The name and address of the institution providing services for the alleged
incapacitated person is Manor Care. Market Street, Camp Hill, Pennsylvania.
5. To the extent known by Petitioner, the assets of the alleged incapacitated person are
valued at approximately one hundred forty-nine thousand six hundred sixty one ($149,661)
dollars, comprising the following:
1995 Chevrolet Automobile 6,000.00
First Area Federal Credit Life Insurance Value 1,170.00
Savings
508 Grandview Avenue Real Estate 95,000.00
East Pennsboro Township
Cumberland County,
Pennsylvania
PSECU Certificates of Deposit 35,581.00
Pirst Area Federal Credit Savings Account 2,610.00
Savings
PNC Bank Checking 9,300 .00
149,661.00
6. Petitioner estimates the alleged incapacitated person's annual governmental income
to be $16,032, including current monthly Social Security benefits of $681.00 and
Pennsylvania State Retirement monthly benefit of $655.
2
7, The alleged Incapacitated person was not a member of the armed services of the
United States and is not receiving benefits from the United States Veterans' Administration.
8, The alleged incapacitated person suffered a major stroke leaving her totally
incapaclta(~d. (See correspondence from Peter M. Brier, M.D., of Internists of Central PA
lAd. attache:d).
9. Because of her mental and physical condition, the alleged incapacitated person Is
totally unable to manage her financial affairs, property and business and to make and
communicate responsible decisions relating thereto, including the ability to communicate her
need for assistance in these areas, (See correspondence from Peter M. Brier, M,O., of
Internists of Central PA Ltd. attached).
10. Because of her impaired mental and physical condition, the alleged Incapacitated
person lacks the capacity to make or communicate responsible decisions concerning her
person and is unable to care properly for herself, including the ability properly to nourish
and hydrate herself, make her own living arrangements, and seek needed medical services,
I I. The following alternative to the appointment of a guardian of the estate has been
considered. Home health care was discussed. This alternative is ineffective since the home
is not conducive to such arrangement and is the opinion of her three adult children, as well
as the alleged incapacitate person's physicians, that it would be in her best interest to be
placed in a nursing facility.
12. The severity of the alleged incapacitated person's mental and! or physical condition
and the lack of viable, le.ss restrictive alternatives necessitate that a plenary guardian of her
estate be appointed to manage and handle all aspects of the alleged incapacitated person's
3
estate, specifically including, but not limited to: all Issues relating to her cash, checks, and
any bank or savings accounts held In her name, her stocks and bonds, her personal property,
her real estate, her life and other insurance of which she is a beneficiary, her entitlement
to any governmental and non-governmental benefit plans, federal, state, and local taxes,
claims made or to be made on behalf of her or against her, the execution of documents,
entry into contracts affecting her and the payment of reasonable compensation or costs to
provide services for her.
13. The following alternative to the appointment of a guardian of the person has been
considered. The alleged Incapacitated person did not have a Power of Attorney executed
prior to her admission to the hospital. In ;Jght of her condition, it was not possible to have
her execute a Power of Allorney in order to avoid Court appointment of a guardian of the
person and her estate.
14. The severity of the alleged Incapacitated person's mental and! or physical condition
find the lack of viable, less restrictive alternatives necessitate that a plenary guardian of her
person be appointed to handle all Issues relating to the person of the alleged incapacitated
person, specifically including, but not limited to: her living arrangements, her medical and
psychiatric care, the administration of medication to her, and the employment and discharge
of physicians, psychiatrists, dentists, nurses, therapists and other professionals for her
physical and mental treatment and care.
15. Petitioner is not aware that the alleged incapacitated penon signed any powers of
attorney or advance health care directives or In any other way designated anyone to serve
as her agent over any of her personal or financial affairs or as her surrogate over her
4
medical care, or that she designated In writing her wishes with regard to health care,
Including the use or refusal of llfe-sustalnlng treatment.
16. The proposed plenary guardian of the person of the alleged Incapacitated person is
Robert N. Reynolds, a son of the alleged Incapacitated person, who resides at 1212 Capital
Street, Harrisburg, Dauphin County, Pennsylvania.
17. The proposed plenary guardian of the person is fifty-two (52) years of age and is
employed as a Dire~tor of Bureau of Program Evaluation for the Commonwealth of
Pennsylvania, Department of Publlc Welfare, having been graduated with a bachelors degree
in English education and a masters degree in education research. The proposed plenary
guardian has been the primary care giver for the alleged incapacitated person for the past
fourteen (14) years.
18. The proposed plenary guardian of the estate of the alleged incapacitated person is
Robert N, Reynolds, a son of the alleged incapacitated person, who resides at 1212 Capital
Street, Harrisburg, Dauphin County, Pennsylvania.
19. The proposed guardian of the estate is fifty-two (52) years of age and is employed
as a Director of Bureau of Program Evaluation for the Commonwealth of Pennsylvania,
Department of Public Welfare, having been graduated with a bachelors degree in English
education and a masters degree in education research. The proposed plenary guardian has
been the primary care giver for the alleged incapacitated person for the past fourteen (14)
years.
20. The proposed plenary guardian has no interes.t adverse to the alleged incapacitated
person.
5
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()FF LeE ('()PY
l"NTERNISTS OF CENTRAL PA., LTD.
Uarr:ltJ....lml/ ,It'lJftl1i/lIOlI,ll t'I"I!;l!l', IOff !":,,,Ulllr fit:" fl,O Uox 10'1, I,OlDoyllll, 1''\ 1'IO",J 0'l(}7
(11'1}'1'14'lJ66' ,..AX ('/1'1)'/'1. 4~!J;1
Peter M, Brier. M.D,
Michael L. Gluck. M,D.
,1alnes A, T,Ylldal..l, M,D.
Richard Schreiber. M.D.
Ira J, Packman, M.D.
L. Lynne Britton. M,D.
I,,'l\~rence B. Z.imm<lrm,'ln. M,D.
Michael A. DeMichele. M.b.
,Ju 1 Y 15. 1997
West Shore Family Practice
550 12th Stroot
Lemoyne. PA, 1'1043
RE: REYNOLDS. JEWELL
MR#: 1. 860'J'l
ADMITTED: 06/22/1.99'1
DISCHARGED: 0'1/11/1997
Dear DoctOlJJ:
...'e had the p.l/9aslJr'e of discharging' Jewell Reynolds from Holy Spirit
Hospital 011 07/11/97.
She is a 7'1 YlJar-old patient of yours \,'ho pre.'lented with a chief
complaJ.nt of rig11t-sided weakness and aphasia. The patient ha,~
been on chronic coumadin therapy foJ." atrial fibrillation w.ith
chronic dizziness, hypothyroidism and history of spinal stenosis.
She was in her usua.l state of llealth until three weeks prior to
admission ,,,hen she was having trouble with her low back. She had
a known 11istory of spinal stenosis and was scheduled for myelogram
and epidural injection and had to stop her Cou.madin. She resWned
it six days prior to admIssion. On Sunday. 24 hours prior to
admission. the patient stated that she fel t weak and cou.ld [JOt
alnbulate. She had a littl.e bit of difficulty walking but no real
change. The family checked on her several times but did not
receive an answer and went there. When they got there she was
nonverbal and unabl.3 to get out of a chair. An ambulance was
called and she was sen t to the ER. In the ER, EKG showed a trial
fibrillation with lateral wal..l. ischemia and the patient was
admitted with a eVA. Review of systems was positive for urinary
incontinence, sp.inal stenosis and DJD,
PAST MEDICAL HISTORY'
No known drug allerg.ies.
SURGERIES, She had a knee operation several years ago after an
MVA. She also had a card.iac contusion at that time. She has a
11istory of spina.l stenosis and received epidural steroids. She has
a history of hypertension and hypothYl"oidism.
SOCIAL HISTORY,
until admission,
and 1.ives alone.
She has been smoking heavily and still smoked up
two packs a day for 60 years. She does not drink
FAMILY HISTORY:
Noncontributory.
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,..,,,,g.,,",.n WO" ,.,._..d,d. ,h. WO" ",,' 'Y Dr. S..Wd 00
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25 qhs. Levoxyl 100 mcg a day, Reg1an 5 109 q8hrs.
.
i'
IN THE MATTER OF
JEWELL I. REYNOLDS, AN
ALLEGED INCAPACITATED
PERSON
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-1997-804
IN REI APPOINTMENT OF GUARDIAN
ORDER OF' COURT
AND NOW, this 31st day of October, 1997, the
Court held a hearing today on the petition of Robert N. Reynolds
to be appointed plenary guardian of the person and the estate of
his mother, Jewell I. Reynolds. Prior to the hearing an
affidavit had been presented to the Court and signed by the
other two children involved in this case indicating that they
agreed with the appointment of their brother as the guardian for
their mother.
Also at the hearing today, as required, we did receive
a deposition from Dr. Peter M. Brier, M.D., and his testimony
would indicate that unfortunately this lady is not able to care
for herself, is not able to conduct any business, and it would
appear that in the future she will not be able to do so;
therefore, I believe that a plenary guardian of her person and
her estate is required.
The condition that led up to the medical problems were
primarily a severe stroke which this lady sustained, and
apparently she is not going to be able to recover from that
stroke. She does own real estate in Cumberland County which is
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'0 ',& (\) '19 ~
~ ~ ~ ~ 0-
%.~~G)4_
,
;J.;
11>
~
'0-.
,"
..
."
,0<
O::..~
~~~
" <P. \(\
~~t:b
. (' ~
\0' ~ ">.
~~O~
\ 0
~~OO
~:;.~
_"l..~
IA., 0
'I!"" .g" ::..
V', ':;" ..0
t:b \. ~
~ 1- VcP
~t..O
~""
?
l'lUNCIPAL ASSETS AS OF DATE OF APl'OINTMENT OF GUARDIAN
1) Certificate of Deposit - PSBCU $ 33,007.87
2) Savings Account - First Area Federal Credit Union 2.628.58
3) Real Estate - 508 Grandview Avenue
W ormleysburg, Pennsylvania (per sales contract) 115.900.00
4) 1995 Chevrolet 6.000.00
5) Household Goods 1.000.00
6) Checking Account - PNC 15,247.98
7) Life Insurance Value - First Area Federal Credit 1.170,00
TOTAL
$174,954.25
2
/ /~ 'Ill?' .
. .
. lPvv(U-,C 1/. Rf-YN621;.5 - C;k/(:k~' WI<,ITTff'J OC/(2 1/1 G
/" I 'L' roOI f1 ',\,/11 '"
'r.,rl/ril'::. ..71/" f'/. r
t /)fi7 e Ii ('() 0 i/ NT 70 f tI f2 fDS'(-;
- -
)Ib 111/ '3 Jt 10/00 ktlit.'Y l/1Oi?rve. CL.t'~!I'i/VGY - f./ous-e
(s-o g tJ:elft/ tt/ /'e V'v')
ly1f ! j gLIf,19 r
Ro8tRT N, A:yNJ.Jf ;<e/r;P~/f$:Ht)8jJ7
I , c:xf""l/th'{I(.r!~
OF -
'J tJ/'vr:! 11i;e iJ ~:r{;ff~1R..
0/1 109 '11 qs:~ (Ii 1I.L//'/k PII/IfIMlY Vkt1tr co-f./1Yf
~
8/Lt..
J~O If;q If '&;12 u ~::-:1 E I. rJ,:7f: I( $;I--(
tP/r. .
)~~ %'1.
f 5-~16~ If (,
)
((;#'10((, l/i(2f.
. fllY/f,(J/)1 of MIVtJ/Cr."-
tJli1-:: t?Fr '10 - 0(7 ~ /
(-if- 'JiJ/? 9''Jo@) ./10 i Pep ~fOlc'N~ flF. it) ;rrtlfd.'i5 )
rlEV\!OOEX:(j$/1 ~~t.'
COMMml~~SYI VAfllA
Qi:PARTMEflT Of Ili:VlflUt
OEPI 28000\
HARRIS jUR PA,,1
Of:CEOENT'fl tlAME IIA'l!, mll,T, AWl "'1[JOt Ie INITIAL) ~~ij ~ bl~flk bled ~~ ~~pllfa!ll "/j<,lfd~
,..
...
Z
W
o
W
o
W
o
~
~l~
~t~
REy(JUi
SOCIAL SECUHlIYtilii,tiiUl
U5
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1
.=-=
I 6 - ;::LC\lO - I
fU HUMBER
,;L I q
-,
00
g () '-I-
IIlJVllfll
-
"
COI.)tIYC
J E. ~\' E
i
,
....-om~'i"-'-----
OATE r)~ IllR1H
//90/1
1q"/
'-I 1/ ?: I V II I / ~>
IIF APPLICAf!lEj SUfWI\IIWl5I'OUS~'S NAMF (LAST. FIR~\l, MJOMID{JlE INITIAL)
S(lCI.AL SECUW1Y NvMRUl
i
~
"
(<,lob'EP.1 N,
FIRMNMlE (1\~rlir.~bI6)
f'j IJ (f;P/1 fil '57f<.'("1'",'
~jM)(I;,SBi'/<6) PIJ, I) IO~)
-
-
1J,10000
1, Roo' Estate (Schedule A)
(11
I I
2 Slocksand Bonds (Schadul. BI (2)
3, Closely Held Corporatioll,Partnership or Sole-ProprIetorship (3)
z
o
5
;:)
l:
~
o
W
It:
4 Mortgages & Noles Receivable (Schedule D)
5, Cash, Bank Deposits & Miscelltineous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule FI
7, Inter.Vivos Translers & MisCtlllaneous Non.probate Property
(Schedule G or l)
8. Tot.1 Grall AII.ts (Iotallln" 1.7)
(4)
(6)
(6)
(71
(&) l I (, 1 I .7 '; {;. () 0
11,O(,{,.[..q
S",,9 0~.5"7
S' fA r r '7 q {) 0
9. Fun~ral E~penses & Adminlstlati\l& Costs (Schedule H)
(g)
(10)
10. Debls 01 Decedenl, Mortgage lIabllitl.., & lIon9(Schedule I)
11. Tot.1 Deductions (Iolallin" 9 & 10)
~
F.
~g
I-'ll.
Ii
8
12, Net Value of estate (Line 8 minlls Une 11)
13. Charitable and Governmental Rflq\JestslSec 9113 Trusts lor which an election to tax has nol beon
made (Schedule J)
14 N.t Vslu. Subject to Tn (lIno 12 rmnus Unel3)
15, Amount of iine 14 taxable
allho spousaltflK rate , ,
See Instructions on reverse side for applicable percentage
16, Amount of IIno 14 taxable I 'I /,
al6%r3te (I"
17, Amounlo!line 14 taxable
at1fi%rate
x ,0
1/ ,/ 7
'j) 1/
x 06 (16) r? ,7 ~? (. il (,
u .'
x .15 (171
(18) 1 ..., ~ (, rtf,
, /
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <. (
~lieSOfP6tilJl'1,lrlocla;cli'all hilvee~Ami(ledltlls relllrn. inCilldlngOCc~SChO<1l1leSandstatNnanls,andt01habolIOlmYk(lnw!ed\leilndbehe! ilislrIIO_COUf.,,j,lnilCOf!'ll\lfllllllf'<;INiltIOn(,lpreOil16roHlIlr
thoolllo oorsonal!Q1liqscnlaliVCIS ba.wLQD...l!!L!fI.!2fillII.l!.~lill!!.~(WUQ!.n~l!\l1'y.~)l~~JillL__-.. .------------.~-.._-_._--_.. ---.,-.----,~--~--------
sl<J!:lNlI~E~R$9NRE~NlBlEfORFI~NjRETlIRN ADDRESS ,-. : ',,' ., "DATE '4-
'/(hr; 1'~'IfJ/ /) ,1.;J~ I &L_L~f/! /lfJM ~_ <7/,' I ~_'-fjl!ilfl;.~ i/kf.) f&L_D Iv,') - ~)//'j rJ .---
SIGNATURE OF PREPARER OTH HAN REPRESENTATIVE ADDRESS DATE
19
~.~._--_.._-~-~
Decedent'. Complete AddreS8:
STlU:Ef Aonm;8S C"'{' () --'". ,. _--:.._mn-;................~.u
_ .) U r, _f:!.Ffll'/f) UJ' " ,~/ A l/2il!.J.!i'
-4
CITY
((ImP )/1/ L_"
r.x Payment. and Credit.:
1. Tax Due (Page I line 18)
2. Credlls/Payments
A. Spousal Poverty Credit
8. Prior Paymenls
C. Dlscounl -....!JS.1. ',' 'l
liP 1'70 /
(I) .ct'!' rz6, ?6_
Tolal Credits (A + 8 + C I (2)
I! ~f1., '9 II
3, In!eresVPenalty If applicable
D. Interesl
E. Penally
T olallnteresl/Penalty ( 0 + E) (3)
4. If line 21s greater than line I + line 3. enler the difference. This Is Ihe OVERPA VMENT,
ChICk box on Plgl1 Llnl19to requlttt refund (41
5. If line 1 + line 31s greater than line 2. enter the difference This Is the TAX DUE, (5) ...$3' 1/ 'I, ,)~~
A. Enter the Interest on Ihe lax due. (5AI
8. Enter the lotal of line 5 + 5A. This Is Ihe BALANCE DUE, (581 '? vi (I t';, s-f),
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS
BV PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Old decedent make a transfer and: Yes N~
a. retain the use or Income of the property transferred; ............... ..................... .............. ........ 0 !!V
~: ;::::~ ~h~e~~~~I~on:~:~~e~:s~~~.~ll~lIus~th~~r~p~~yt~a.n~f~rr~d pr Its Inco.~~:.:::: B ~
d. receive the promise for life of either payments, benefits or care? ........................................ 0 or
2. If death occurred on or before December 12. 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? If deeth occurrad
after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.... .................... ......................... ... 0 l!1
3. Old decedent own an "In trust for" or payable upon death bank account or security
4. ~\:I~e~e~:n~:~~:~i~di~ld~~I;~il;~~~~;~ccount, annul;~:~;~;h~r non-probate property?:': El ff
!F THE ANSWER TO ANV OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLF.TE SCHEDULE G AND FILE IT AS PART OF THE RETURN
- ~lI~'I.L ~." _____ _ . j II T - bJ _ -V
72 P,S. ~9116 (a) (1.1) (I) provided for the reduction of the tax rate Imposed on the net value of transfers to or for the use of the
surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995.
72 P .S. ~9116 (a) (1.1) (II) provided for the reduction of the rate Imposed on the net value of transfera to or for the use of the surviving
spouse from 3% to 0% for dates of death on or after January 1, 1995. The statute does not exempt stransfer to a sUNlvlng spouse
from tax, and the statutory requirements for disclosure of assets and filing a tax return are stili applicable even If the surviving spouse
Is the only beneficiary.
",.
FOR DATES OF DEATH ON OR AFTER JANUARV 1, 1995" Please answer the following question by placing an "x" In the
appropriate space.
Old the decedent creltel trult or elmlltt Irrlngement which II eolely for the surviving apoula" baneflt for hie or her antlre
lifetime? Ves 0 No ~
If you answered yes to the above question, the tax on the trust or similar arrangement is postponed untlllhe death of the second
spouse, at which time \I will be fully taxable at the rate(s) applicable to the remainder beneficlary(lesl. Enter the value of the trust .on
Schedule J, Part II, In order to remove It from the calculation of the tax due In this estate. You may wish to file Schedule 0 In order to
make the election available under Section 9113. If the election Is made, the trust or similar arrangement Is taxed In the estate of the
first decedent spouse, the portion of the trust or almllar arrangement which benefits the surviving spouse Is taxed at the zero tax rate,
and the remainder Is laxed at the rate(s) applicable to the remainder beneficlary(les). If you choose to make the election, you must
attach Schedule 0 to a timely-filed tax return, along with Schedule(s) K and/or M In order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficlary(les).
A.
jJ.S 'DEPAlHMENT OF HOL/SING .od L/R~AN DEVELOPMENT
, SETTLEMENT STA TEMENl
9MB No 2602.0266
lIllfPRO
I..,arll/lnl
B. TYPE OF LOAN
II I FHA
4.1 I VA
6. FILE NUMBER:
500112
2.' ) FMHA J.:l( I CONV, UNINS
6,' ) CONV.INS.
7. LOAN NL/MBER:
6610307
SECURED LAND
TRANSFERS, INC.
3800 Market Street
Camp Hili, PA 17011
Phone: 761.7744
8. MORT, INS CASE NO.:
C, NOTE: Thi, form Is fllrnlshocllo glvo YOll a slalomool of aCllIalsolllamanl co'ls. Amollots paid 10 and by Iho .olllomonlogonl ara shown, IIams markad
'(p,o.c.)' waro paid olllsidolho closing; Ihoy aro shown hora for inlormallonal purposos and aro nol innlllded In Ihe lolals.
0, NAME AND ADDRESS OF BORROWER: E NAME AND ADDRESS OF SELLER F. NAME AND ADDRESS OF LENDER:
Gregory T. Keenan Robert N. Reynolds, Norwest Mortgage, Inc.
Kimberly G.H. Keenan Executor for the Estate
of Jewell I. Reynolds 5005 Carlisle Pike
Mechanicsburg, PA 17055
Q. PROPERTY LOCATION:
H. SETTLEMENT AGENT:
I. SETTLEMENT DATE:
01/16/9B
50B Grandview Avenue
Wormleysburg BOROUGH
CUMBERLAND County
Secured Land Transfers, Inc.
PLACE OF SETTLEMENT:
1513 Cedar Cliff Dr Camp Hill PA 17011
:'UO~d ,nllJpPV "'IN ',lIU_S
q~?f~~i::jfj
K. SUMMARY OF SELLER'S TRANSACTION:
<00 GROSS AMOUNT DUE TO SELLER
401 Contract salos price 11
~02 Personal property
<03
'n<
.05,
Adjllslmenls lor items paid by saller In advanco
406.CllyfTown la)( 10
401.Counly lax 10
406 ASSeSSffiGnl&
400 School
'10
'"
'"
J. SUMMARY OF BORROWER'S TRANSAOTION:
'DO, GROIS AMOUNT DUE FROM BORROWER
101, Conlrac! ,elos price 11.5900 . 00
'02, Persona' properly
'03, Solllomenl cherges 10 borrower (IIno 1400)
t04,
'0'
Adjll'lrne"l, lor Itoms paid by saller In edvance
106, CltyfTown talC 10
107, County lax to
t08. AUOllmentl
109 School
110.
120 OROIS AMOUNT DUE FROM BORROWER
122101.93 "" GROIS AMOUNT DUE TO SELLER
1165B4.60
"...A.O....Y......D.Y ODIN aEHAlF OF BORROWER '00 REDUOTlONS IN AMOUNT DUE TO SELLER
-'II"~t1i"I'",-'d] -,Ulw [dlll14W1 pu'li '1111' 'pnl'3l1l u.a UOI\:l!^UO'3 U011" 1li1ll'!J'd 'UIlOI l'I!W!' Au' lO '141 uo tal'IS p.ltun '41 Olllll'WIlII'I' "I'I'~IW ~elllMOU~ 01 'Wilt) . It II :DNINtlYM
'1'0 ~Il.e't' lu'~n.,
) 0/9//' --o/T/"';/ r~
'11l'WI'I,1 1'41 411M ''3U'P'OOOI Il' pMlnQIIIP.q ol'punl 841 8,nl'3 11111I 10 plln''3 .....4 I -\Jol\:JtIU"1 1141/0 l(mo:)'3' 'I'ln~~' put l.nl' , II P'J.dlild .....~ I ~~4111 IU'UI'I'IS IlI,welll'S HlnH '-'1
~
'lUIIW01IIS lUIIWlIlllllS ~ 'OnH 8111 10 Adoo I P8"!808J 8^'4I 1141,{j"IIO Jtf4lJnll . On:lliUIlII!4l U,IW Aq luno:l:), Aw UO IplttU
IIUIWltlnqllP PUI'ldjeoeJ nllO IU8wel'I' 811;noo' PUI Inlll 1111 '11IU8q pUt enp81MOU'It Aw 10 lseq 841 01 PUV IU'UUJlllS IU8WIIHG9 ~ 'OnH 14' pe"'l!fI'J AJlnIIJ'O IA'41
In,,.1 ONY 1~IAnB ~O NOI!YOI~I!~IO anH
'UOIlonU"1 1t41 U! U~"'"'M 101Itrlll"U.dl4tOtt
l'uOlllPPt u IlInooo. u~o 'I! 01 ptlUU o. IUIIIUI ~U' IIP":) 01 put UOII"IIIIUI PII"'Ul Ailllap,.:f' Uf lunO:l'3' ftulluq 1""'IUI u, UI Iu.wo.mq.,p 10J P'jOltlOO 'Iunow. ~U' M.od.p olllA' '41""'''''
A1""lh. Aq'j"41<l,n" 11I"""Ill'Sltj'Wul'IS 11l1lW"ill1lS l'Oml'ql uu 0"'U4' II 'l'410,t;Q Pf4IlUIn, UU!I'UJIUIUtlO A:l'1Il0:l. '411011UUnV IIl,w'III'S ~q p.wnn." ,t;IIHqIU ou 1'41"18. .et~"d
I ~~: ~~~ ~~ITI . I.. tSS r _ __ _ _ (~pUI 1'uOllOoS 'Z09 PUI tOI .0UlluOlOluol IIO~YNO !NINIU!II 1't'!Ol'OOtiJ
A. flS'DEPA'HMENT OF HOUSING and URBAN DEVELOPMENT OMB No. 2S02.0266 I
, I
SETTl.EMENT STATEMENT lmEI'fIO
t.uafplilll I
SECURED LAND
TRANSFERS, INC. -
B. TYPE OF l.OAN
3800 Market Street I I J FilA 211FMIIA 3,:l( I CONV.UNlNS
Camp Hili, PA 17011 ~llvA_. 6, I J CONV. INS,
o FILE NUMBER: I 7.1.0AN NUMBEfl:
Phone: 761.7744 500112 6610307
8. Mom INS CA5~ NO,:
-
C, NOTE: lhls lorm h;lurnishfld 10 yivo YOll a Glalornonl 01 actual fiOlllomonl cosls, Amounts paId 10 und by lhe sotlloment agont or8 shown.lloms marked
'(p,o.c)' Wore pAId outside tho closing; they ara shown horo for Informational PU'POlJO!i Rnd ortl nollnc;lllded In tho tOlols,
D. NAME AND ADDRESS OF BORlwWm E, NAME AND ADDRESS OF SEllFll F NAME AND ADDRESS OF l.ENDEH
Gregory T. Keenan Robert N. Reynolds I Norwest Mortgage, Inc.
Kimberly G.H. Keenan Execut.or for the Estate
of Jewell 1. Reynolds 5005 Carlisle Pike
Mechanicsburg, PA 17055
..
G. PROPERTY LOCATION H SETTLEMENT AGENT I. SEI1LEMENT DATE:
508 Grandview Avenue Secured Land Trllnsfe.E!!.t... lnc, -- 01/16/98
Worml~ysburg BOROUGH PLACE OF SETTLEMENT.
CUMBERLAND County 1513 Cedar Cliff Dr Camp Hill PA 17011
---
J, SUMMARY OF SORROWER'S TRANSACTION: K, SUMMARY OP SELLER'S TRANSAOTION,
.00. OROSS AMOUNT DUE FROM BORROWER <00 DROll AMOUNT DUE TO SELLER
101, Contrlcl sales price 1J.5~uu.uu ~Ol Contract saleR PFlco 115900 :..~
102. Personal properly 40? Porsonal properly
103. SeUlement charges 10 borrower (line 1400) 5517.33 ~O3
104. '"
10' '0'
Adjuslmenls Icr lIems paid by .ellor in advence ~~lmflnls for ilems paid b\, saller in advance
106 ClIv/Town lall 10 406.Cllyrrown talC 10
101, County lax 10 "oY.Countv tall 10
1011 A,.olsmont. 10 .08 Anouman's 10
10U. School Ul(lb(9810 UbI3U(9~ bU4. .l;; 409 Dchool 0J.(16/9810 06/30(98 604-.3:.!
110. Sewer: ~67 (q en~o 3( 31 54.33 <to seWer'$67/J end03/31 54.33
111 Refuse::;i.;;<(q ena .1(.;1 ;<~.~~ '" KeIUS6: S3!"(q end J7Jf 25.95
112. m
120. OROBS AMOUNT OUE FROM BORROWER 122101.93 '20 GROSS AMOUNT DUE TO SELLER 116584.60
200 AMOUNTS FAID BY OR IN SEHALF OF BORROWER '"0 REDUCTIONS IN AMOUNT DUE TO SELLER
201, Deposll or earnest money - 2000:0-0 MI,EI<C8SS deposil($ee Instructions)
2". Prinolpal amounl 01 new loen(s) ~;;'1UU.UU S02Selllemenl chorge'lc s.lIo, (line 1400) uS50.00
203. ExisUng loan(s) laken .ubject 10 '03 Exisllng loen(s) laken subiecl~
20t '0< Poycll 01 Flrsl Morlgage Loe"
None
205 b05Payoll of SOCOridMo"gogo Loan
,
206. (S) to (tl) J{epa~rs 160.00 bOO (S) to (B) Repa~rs 16U.OO
207. 601,
20B, SO.
20i, '0.
Adju.lmenl,'or Items unpaid by .eltor Adi;,slmenls imTtOiTis unpold by .olle,
2\0. CltyfToWI'lI.)( 10 fdO,CllylTown 1.)( 10
111, COUOly I,. 01(01(9810 01(lb( ~1:I 18.53 Ii 11. County tall '01/01/9810 01/1~L~~ lB.~J
11,. A.....mont. 10 f.12 A,nQumonll 10
-
213 School 10 51 J School 10
-
214. fi1~
lIS, m
~- ". --
-
117. 517,
111, ,to
-
Ill, ".
120. TOTAL PAID IVIFOR SORROWER 94878.53 .20 TOTAL REDUCTION AMOUNT DUE SELLER 22728.53
300. OASH AT SETTLEMENT FROM OR TO SOR'iiCiWER --
600 CASH AT SETTLEMENT TO OR FROM SELLER
301. Gro.. amounl duelrom borrower (line 120) 1:Z2101.93 601 Gross omount due iQ".ellor (line 420) 11b5114.bO
302 Le.. emount paid bynor borrower (IIno 220) ~41:1'/tl.53 602 less reducllon amount clue soller (line 520) .ana.53
303 OASH (IX] FROM) (I ] TO) BORROWER 27223.40 '" OASfl (!XI TO) (I J FROM) SELLER 93856.07
BUVIf or BOHO"".". Sign.lUIo
Soll"r', Sign. lure
HUD.l R.v, 6/88
U ~i UI.I'AHIMU~llJl tlULJSINll ANLJ UHHAN DLVlLf.J1'MLNI
SETTLEMENT ST ATEMENl
lw" No 2!~I<.U<(i"
Pago 2
---.,." PAID FROM' PAID FHOM
.!::.J!J:TTLEMENT CHARGES 500112 115900,00 6.0 -- BORRoWER'S UELLER'S
700 TOTAL ULE8I.ROKER'S COMMISSION blood on pllco' FUNDS AT FUNDS AT
Division 01 Commlaslofl (IIno 1(0) 81l1ollows Total':-::::IEi, 954.00 SETTLEMENT _.!!Jill. MENT
701 $ 6954.00 10 Jack Gaughen Realtor
702 $ 10 ,
.-- - - 6954.00
703 CommissIon paid nl SUtllllll101l1
10. ._-- ---
noo ITlIIS PAYAlLE IN CONNECTION WITH LoAN
801 l.oon Orlglnollon roo 1. 000 % '---ilor7we s t Mortgage, Ine, 927,00 --
- Norwest
802 Loan Discount 1. 000 % Mortqaqe. Inc. 927.00
803 Appraisal roo 10 Nchael Connor (S275 , POC)
no.. Cledll Reporllo Credco ($-50. POC)
805 Lenders Inspeclio;~-
80(\ Mortgago InsurarwfI AppllGallorl Feola - --
801 Assumption Foo
608 Doc Prep Norwest Mortgage, Inc. 225.0'0
IIOIl Tax Serv Norwest Mortgage, Inc. 96.00
810 Flood - - Ii1C , .
Cert Norwest Mortgage, 16.00
81\ -'_0--
goo ITEIIS REQUIRED BY LENDER TO BE PAID IN ADVANCE -
901 IntereSllrom 01/16/98 1001131/98 111$ 17 , 7 8/d~y 284.48
902 Mortgage Insurance P,emlum for rno to
003, Hazard InSlHanC9 Premium lor 1 yrs 10 Ciqna 200.70
90.. yrs 10
905
000 REBERVU DEPoSITED WITH LENDER FOR 66.92/;'~
001. Hazard Influrance 4 mo II $ 16.73 Imo,
002, Mortgage lnslIranco mo. II $ /mo
003. Cily{Town 10' mo C$ /mo. ............/;.. ',;,
."',;;';. .,..
004. Counly to, 14 mo III $ 34.52 frno 483.28
006. Assessments mo II $ Imo,
006. SrJhool Tax 9 mo III $ 109.17 /mo 982.53 )i{,,;
007 moOS Imo
008. AqqrA01ust moO$ Imo. -450.08 ..< ... .......
100. TITLE CHARGES
-
101. Solllemonl or closing lee 10
102. Ab'"aclO/ title seorch 10 --
103. Till. e,amlnotion 10
104. Title In.uronce bindor 10
105 Documenl preparation 10 Boswell, Snyder, 'I'inter (POC
106 Nolory fee. 10 Cash 5.00
101 Allorney's le8s 10
(Includes above 110m. No.) .....,.......'.. ..;' ;;;i... ..;; .',',;,;;.
108. Tille Insurance to Secured Land Transfers 546.50
(Inoludos above lIems No ) Ends. 100/300/900/M '..,................' "i,'...., ,'.i
f09, Lender's coverage .$ 92,700 ;.......'{)....;.. ,
110. Owner's coveraQo $ 115.900 ,"".,.' """"'"
111. Disb Fee Secured Land Transfers 35.00
t1?.
~.t
200. OOVIRNIIENT RECORDING AND TRANSFER CHAROU
201 RecO/ding tee.. Dead $ 23,50 MOIlgogo $ 29.50 MIS" $ 53,00
202 Cllylcounly 10xJslomps Ooed $ 1159.00Mortgoge$ 1159.00
203 51010 le,lstamps: Deed $ 1159.00Mortg.ge$ 1159.00
20..
205. Home Warr Jack Gaughen Realtor 360.00
300. ADDITIONAL SETTLEMENT CHAROE8
301. SUNey 10
~. Pullnopecllon 10 Bowers 30.00
303 Home Insp (Buyer-POC)
30~. SrTrU,,2.L3 WormIevsburq Borough qq no
-
305. TxlnhEsc Secured I,and Transfers I 13908.00
~oo, TOTAL SETTLEMENT CHARGES (onlor on IJnes 103 and 502, Socllon!. J and K) I 5517.33 22550.00
".fllIIl .glu 1111' no 11.IJili(~ I' ...umlo hy Selllaffienl Aunnl101 the .r,r,lIlacy or i'llnrlll"lon IUHlIslllul hV ottollfl II ,ho"", on thll HI/f).l l'f1WllnlP!'ll !';1~1',"lflrlt I1f1W!l'llIHll Agf'f>I ""'"by 'IJ"""ty
""IVII Ih. rlglll 10 dopa.II Illy ImOunl. l:oHer,ltt1 tor Ifl.tHlI.Offilfllll1 In Intern! bOlting .ecollnl In I r.d'/llly 111,uled In.tHullon .nd 10 Clldll lilY Inlorl.I so limed to It. own .ccount II .ddlllon.1
comptn..Uonlor M.tlrvk:llllllhithtllt.cUon
HUD CERTIFICATION OF BUYERS AND BELLERS
I h..... ell'fully ,.vlewod the HUO.1 Selllemonl SI"lom()ntlnd 10 tho bo.t 01 my knowledgo and bollof, Ills a Irue and accurate slalomenl 01 all rocelplland disbursements
mid. on my account by me In Ihl. (I.mllctio llurlhet corUfy that I ha....o recel....ed a copy (1f Iho HUD.1 Solllomont Statomenl.
~ s~~:! V~. ~f60!d
Buyer'. Add,..., f'1~on.: Sellar'. N'ft Addla" & rho/le
lh. tlUU.1 B.IIIe",.nl filll.m.nl which I h...... pr~plI.d i. . Irufl 'flO .ccur.le.( ':OUIII 01 thlt trllnlll:llo/l I h.v" c.ute" or Will C'l"" 11'lIlund. to be dl,hurtad If! 1000ld,nclI wtlh \hll It,l.mllnl.
_ ~-pJL..t /)../ .fltr I /1(; A \
Stlllem.nl llgenl
1m. loll In
~'..r'.'''''".~
'.
COMMONWEALTfI or PENNSYLVANIA
INHERlf ANCE TAX RE !URN
R IE' ECEO
ESTATE OF -r ~
V t r'vE I L
i
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
j~/J jlLl () / 11(
FII.E NUMBER
Include the prooeeds of lil~.tion and the d.,.,h. proceed' w.re rO<>llved by Ih. e,lal. All pI.party jolntly.owned wtth the rlghtohu,,'v.rlhlp mUlt he dl.ol..ed on Schedull F,
, .
ITEM
NUMBER
1
DESCRIPTION
fIl/5{UI.f;N(JOV.<; JjUU~UIOi D 6'oUO) fJNO
r:URN /:"flit/&~.) rUe f'J j11IP()) 1()()I!.,') e- 1("
(SEE fJ71f10iCD (..Pom 8P'J(/(rU..25 PI()(1IUf'))
jqqS" tfj,'LiRolt.'1 CAVill;!?/( SrlDf)!,,1
0. ,
~~
PNt 8AN k - CHt~(J<lIl/t;.. A (.(o~l/vT
LfPJ-L/~ (flP/./$Lt~k'e (I ~-/-t/Of;.O-?L//n)
(Amf' 1-1/' ( P~I 11/0/1
)
44
.. ,.
F IrzsT ARUI frJDEPfJ! (:PI?{)!T IJr//mj - 5f1i/IM;:;
f-J-OJ 50 u1H 00(((/;) 'S1f<'r?(i; fV(Oi'f>.'T
L-fvv/<':'10vVtJ O~ /r)OI/L/ ~#- LfL.n-W-I.//IS)
J )7i, , l*'1Z1'Y-Oil:}
, I .
PA, 51fT1r EmflO(f,(J5 (peOI1 llr/JON - o)'f/(///'/6f
()r(0!'/!I7
I fP-f!(;rT LIN'JO/V f'1/lO)
11 AR r//:) e r; (\ (-r fA. /"7 /I 0
)
(:# Lf If ~ - /il) - II /I 5)
b~
,
cHr?CI<,' I N L~
-r'
Acc-O LI f'/ I
,
. BliNk
01f11e rrW1/15 fI17/t(Hr!D)
(~I-(o"V PRu- RlI1fO / j'
CAUUJ./I1ilJ/') uF 1!'v1>(<,t'J:;T
10 orm7 or- OfA7H
(r'Pll FHAlf. I
(f;k~ T i riCA! ( V-
rl)
( EJ'1' J F / (filE j
VALUE AT DATE
OF DEATH
/5" 0 /, SO
~ ou 0
) .
r~/I,c,rz .
/ .'
fJ. L; 51., !--~
e"Q7
LfC"1'1
~'1 15', 1("
II SL6, "ILf
15- (,11/15-
TOTAL (Also enle, on line 5, Recapitulation) $ :r:z S' '7 '1
(If mo,e space is needed, inserl additional slleets of tile same size)
-
-
~ .
,/i';rest Checking Account Statement
,.
.I For 24.hour owlomer 1I",loe:
Cell: ,..00.53HZ6Z
InIITOll a...klnl "..ounl numberl 5104020"54U. oontlnued
PNCBANK
'"'........... ,,'.."M7.. tll.lltM7
JEWEll I REYNOLDS INCOMP
PrlmelV tc>lOUnl number: 51-<lOZo.3443
Pege Z of Z
On"o ond lIootronlo .:IInldng D.duod.n. - continued
D4!t. Amount Ollerlplion
I~O~ 2,00 Dlrecl Payment. Dec Due.
Benenu Package 010'8680??oo
D.1y ....nu. D...II
Olt. eillnee
11/06 1~,24'.98
11/18 9,'IU,
IO;~~
(j1/19
11/28
. ----.--..---.,.____...L~~..
Blllnt. )
-~'H~~'gB/
, ,4
Oata
12/05
'est Checking ACCOWlt Statement Gu(1f1)/f;IVrNIP
'(J Dank, Cent~al VA . C lIof?c/<'S _
PrimoIV occounl number: 51-4020.3443
POOl 101 2
,.. Ill. ,.rI.II 11/0111117 to IalOIIIII'
JEWELL I REYNOLDS INCOMP
ROBERT REYNOLDS
508 GRANDVIEW AVE
CAMP HILL PA 17011-1812
Int.r..t Ch.cklng Aooount Summary
A"""unl numb.r: 51-4020-3443
....n.. lumm.ry
B10lnnlnu
bel'M'
14,593,42
Depotlt, .nd Checkl and other
atner IddlUonl dltductlan.
667.20 9,460.74
Av.rag. monthly
blllnet
9,697,37
ATM Blnk clrdA'OS
trlneActiona t"n..~lon'
0 0
PNC Blnk MAC Non.PNC 8.nk MAC
trena.cUon. tr.nllctlont
0 0
I,on...llon Summory
ChIch paid)
wlthdreWllt
5
Inl.,.o, lummory
Annu.I PorClnt.g.
Yllld Earn.d IAPYEI
1,60%
Number of d,y. Avtr.g. colltcttd
In Int""1 period bal.nct for APYE
30 9.678,\10
Aotlvlty Dotall
Dop.o'" ond Oth., Addltiono
0.,. Amount O..r.rlption
11/06 65.1.56 nepos It Reference No. 27503633
12/05 12.64 Inlereoll'.j'ment
Ch..k.
ChICk Oil. Rtl.rence
"umber Amount p.ld mlmbe,
3016 70.00 11/19 16147998
3018. 3,3'18.79 11/19 161176.7
3019 85.20 11/19 16.08!l67
. Gap In chick ..qulnco
Onlln. end EI..l1'onlo Banking Deduotlon.
O.t. Amount O..crlptlon
I V28 22.44 Dlrecl P.ymenl - P.yment
PA we. Capllol n 112409400%
Onlllll and Ellctronlo 80nklng Dlductlon. conllnu.d on no><t pago
PNCBANK
Number ol.ncloour.o: 5
tt For 24.hour ou.tomo, .orvlce or
ourrlnt rllo" Cllll.800-531.2262
I!!lI Wrlll to: Cu.tomer S.rvlce
1'0 80~ 609
P1tt.burgh PA 15230-9138
a Walch for our new E.Malladdr...
VI.lt u. at www.pnobank.com
iii TDDtermlnal: 1-800.53'.1648
For heulnW mllllrli:d dimu only
Jowolll Rovnold. Incomp
Rob.rt R.vnold.
Ending
btllne.
5,799.88
Pl.... "" tha Aotlvlly D'lalla.otlon lor
addlllonallnformotlon,
Ch.ro..
and 'H'
,00
Telltr
t"""etlon.
I
Non-MAC ATM
t"nlletlon_
o
Int.".t elfned
thl.porlod
12,64
A. of 121OG, a tolal 0'.1>>1.04 In Interllt
w.. .amed Ihl. v.ar.
Ther. Worl 2 D.po.lt. and Olher Addition.
tOlaUng .'1'.20,
Cheek
number
3020
3022.
O.te
p.ld
11/18
11/18
R.,.,."~
number
1"56680
185807~
Amount
56.89
5,875,36
Thoro w... 5 ohloks 1I.led totaUng
.".,1.:10_
Ther. wore 2 Onlln. or EI.ctronlo 8anklng
Deduction. totlllng $24.44,
REGULAR SHARES - S 1
PREVIOUS BALANCE
DIVIDEND
DEND RATE, 3.25 ~
AL PERCENTAGE RATE YIELD, 3.30 ~
AL PERCENTAGE YIELD EARNED, 3.55 ~
NEW BALANCE
CHECKING - S 4
PREVIOUS BALANCE
DIVIDEND
DEND RATE, 2.00 ~
AL PERCENYAGE RATE YIELD, 2.02 ~
AL PERCENTAGE YIELD EARNEDI 2,10 ~
NEW BALANCE
ISE~C-;
PENNSYLVANIA
STATE EMPLOYEES
CREDIT UNION
JEWELL REYNOLDS
, .'
.. II'I'UTlIM
: ,: .~';, . ",~TI: ( "'>;
1101
1130
DIV
ANN
ANN
1130
, 1101
I 1130
I DIV
ANN
ANN
1130
1
1101
1130
STATEMENT OF ACCOUNT
MAIN OFFICE:
1 CmiTllfj[ONllLACE
HAIlAISIUAO, PA 11110.2880
234-1484 OA
100.231.1321
'i,;':':/" ;~i'" '_! _j'/~,,', .' i~-'-
.: . , ,. AP'L Y FOIt 'VOUR .W
.;. " P5ECU YlaA NOW
: ,FOR CONYENIENT'
, "; ,"OtlDAY 'It!)PPJNG.
-~:~,,\,:,:;':l, -_-_;-~-_( .' - ..; .'. ,_ .' '.";- ",;--' ("'}_,.:-
'--- '~/.At:_i~4.j""~'~~.(;t- ~-;,,~~1~4Jttl<',~
~.
HAIlAISIUAO, PA 11101.1013
IIUMU-
0448124115
,'IT .
448-12-4115
'~.1lI I To
lit I Q'7illoAA.
~=8f~:fltj~-';fl!
__ _ ....----/ <' i"-. -,
JOINT OWNERS
K.NNI'H L, II.VHOLD.
,'," : ",. ., ';<)',);:'j"'"'' ,., .'.. '. "1
". '___' ,. . '." "cl,i;. .... a.....,NT'.
"i'-:;~ MOfMl,,.,,,,,,"'; i i, i _'(iK~~,~t~,l'(;~;,-y;.::;~r-,9lp:~-"i :"_'",""", _ ".if '.
....'~. '..'lOt,l;" ~ -..:,' ... ...._ ." '';.- ,l '",)-. "~",.:..,iU~i~'- t ,LF,;~t,~_", ,_ ,_, ""li." tit"" '
. _' '.' - ,... .,.- '. , "', " lIJ.'!n,." -.. _ r......,rtillf
02
{.,0"7 :::
698
08
fI 'Iii 466'
~', '4677
4677
PSL LOAN - L1
PREVIOUS BALANCE
NEW BALANCE-PERIODIC RATE .035342~ (~ATE IS
>> ANNUAL PERCENTAGE RATE 12.900~ <<
VAR IAIBL~)
~O
~O
"IlIU""."....""".""""Il"".".".,,,,"""""ufll"....,U ....."" . "...
YOUR TOTAL APPROVED VISA/PSL C~EDIT I~'
YOUR TOTAL CREDIT USED IS,
YOUR TOTAL AVAILABLE CREDIT IS,
"."."..."."....""""""""""."""".."""Ufllll."..U ....... U ....,
II ::. GROWTH SHARE CERTIf.ICAIE
CERTIFICATE 1
~lUUS BALANCE
EARNINGS ON CERTIFICATE
DEND RATE. 5.75 ~
AL PERCENTAGE RATE YIELD, 5.90 ~
AL PERCENTAGE YIELD EARNED. 5.91 ~
NEW BALANCE (MATURES 070798)5.750
uCONTINUEDu
L___ -I
1101
1130
DIV
ANN
ANN
1130
l:rt~
~
n'a
"INOICA,
TOTAL DIVIDEND YEAR- TO-DATE
(. II 'lYIng. mept IlIA.
0MdInd. ,,-, H t1 0 . OVII. w!I III
~d to ~ InlN AI_ .1Me1
lot IN, clllndlr '/III.
"INDICATES EffECTIVE GATE
75DO~0
o
75DO~0
27.30
2730
S7'{/?(.
/1,i{)7
~;;/ 1 ,/ (
5776"
5104~'
5104 ,
TOTAL FINANCE CHARGE YEAR. TO.DATE
I. II ....,
fiil
NOTICE; SM "VIlli 1l4e I. "'_1 1n1_1lon,
tll!I!I,)/'{< FFo/'I;HfJ
......
.
o fl II;' II Y flit -; /05'
.....,
, mSEI~I,!;'J~'
.{' r. ~b/ffiP
STATEMENT OF ACCOUNT
1 C~VM~~f
HARRISBURG, PA 11110.2880
234.8484 OR
100.231-1328
MAlLlNG ADDRESS:
P,O.lllX &76Tr"
HAIlRISBURG, PA 11108.7013
IX'lP~~:t."""~"'1t"......-"" ", .''f~~Y"''-~''''",",'"-''t~
i.Ti,,' ':A'PPLVfOR YOUR
" PSECUVISA NOW'
'FOR CONVENIENT.
,HOLIDAV SHOPPING;;
PENNSYLVANIA
STAlE EMPLOYEES
CREDIT UNION
p.
3
!f
, '" ".,' " '.' \ ,1/:,>''; f,!'
'~.iaJ'wIJ.;..A,::...;w.'~~"~I~,'~ 1";':'_.\..
~..-~,
, NuMm-
0448124115
IOIlIAl lECURITY /I "
448-12-4115
PERIOD
F,om I To
11119711 nn9
.1AIANCE<'i'
.' ,".'!
JOINT OWNER8
JEWELL REVNOLDS
KINNITN L. "IVHOLOI
,~1I'" "'1.W'II
:' ',,'.'
, '
'..'...'." ", ',".". ',' . fiNANCE ~
\. . .'. 1)'IlaCAIP1:~ ,~ ,: ,:.~..';:.i<, ;'., " :" .' ,,~NT) CHARGE I; FINES
~ .:. GROWTH SHARE CERTIF ICATE
CERTIFICATE 2
1101 PREVIOUS BALANCE 11/",/
1130 EARNINGS ON CERTIF ICATE 50.97 5097 .' /..
DIV DEND RATE. 5.25 " "/<J) C'
i /'
.,'
ANN AL PERCENTAGE RATE VIELD. 5.38 " ~-- --
ANN AL PERCENTAGE VIELD EARNED. 5,38 " / I " i . .,
, I 'j I
1130 NEW BALANCE (MATURES 01079815.250 ' /..),' l-
t}. .:. GROWTH SHARE kE,BTIFICATE
CERTIFICATE 3
1101 PREVIOUS BALANCE I r il/i7 I 'I
1130 EARNINGS ON CERTIF ICATE 67.18 6718
.,) )1 .. I
DIV DEND RATE I 5.25 " 'I 1
ANN AL PERCENTAGE RATE VIELD. 5.38 " L.t" 1
ANN AL PERCENTAGE VIELD EARNED. 5.38 " ..............---
1130 NEW BALANCE (MATURES 02189815.2!.i0 /(,'!J!5',tf,;
TOTAL DIVIDEND YEAR. TD.DATE
lor II Q'o'tngl .mplIRA,
rl='~'::In:JJ ~:::.:rll=
orIN. CtlIndIr Y",
"INDICATES EfFECTIVE DATE
1485.32
TOTAL FINANCE CHARGE YEAR. TD.DATE
lor .. loon.,
NOTICE: S.. _II sldI lor ~t ilfonMdon,
1181136
1186233
1186233
1556917
1563635
1563635
0.18
Of...7
A. IJ S' DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OMB No. 2502-0265
SETTLEMENT STATEMENT TlHf.l'Il0
I t"OfJlllfll
SECURED LAND
TRANSFERS, INC, B TYPE OF LOAN
3800 Market Street 3:lC ! CONV, UNINS, i
11 I FHA 211FMHA
Camp Hili, PA 17011 4 I I VA 6,IICONV INS
6. FILE NUMBErt 11, LOAN NUMBER
Phone: 761-7744 500112 6610307
6 MORT IIjS CASE NO.:
-
C, NOTE: This form is furnished to givo you a statement 01 actual Gutllamenl costs. Amounts pAid 10 and by the setllement ngonl ore shown, 110m. morked
'(p,Q.c.)' wore paid outside the closing: they are st'o~n here for Inlorrnulional purposes Rnd are not included In tho tOlals,
D. NAME A"D ADDRESS OF BORROWER E NAME AND ADDRESS OF SEllER. F. NAME AND ADDRESS OF LENDER
Gregory T. Keenan Robert N. Reynolds, Norwest Mortgage, Inc.
Kimberly G.H. Keenan Executor for the Estate
of Jewell I. Reynolds 5005 Carlisle Pike
Mechanicsburg, PA 17055
G. PROPERTY LOCATION: H. SETILEMENT AGENT: I. sETILEMENT DATE
508 Grandview Avenue Secured Land Transfers, Inc. 01/16/98
..
Wormleysburg BOROUGH PLACE OF. SETTLEMENT:
CUMBERLAND County 1513 Cedar Cliff Dr Camp Hill PA 17011
J, SUMMARY OF BORROWER'S TRANSACTION: K, SUMMARY OF SELLER'S TRANSACTION:
100. OR088 AMOUNT DUE FROM BORROWER <00 OROSS AMOUNT DUE TO SELLER
Un Contract 181es prioe ~15!l.~. UU .0\ Contracl sales price 115900.00
102. personet properly "02 Personal properly
103. SeUlem.nl c~,,,ge. 10 bo,rower (line 1400) ~~1'1. JJ .03
to< .0.
10. '05
Adjustments for ilems paid by seller in advance AdJublmflnts for items paid by seller In aelvance
106, CllyfTown lQ)( 10 401lCltyrrown tal< 10
107, County lax 10 "07,Counly tal( 10
iot, AIIOIsmonts to 408 "uossmanlli to
101, School Ul 'lb/~l:lloUb/J.?...LY~ 604,32 409 School 01/16/9810 06/3 0 /98 bU4.J;'!
tlO Sewer:~6'/ Iq endl03/31 ~4.Jj 410 ~ewer:$67/1 endJ03/31 54.33
t11.ReI:USe:~j,/q ena 3/31 25:95 "'_~Iuse:$32 q end J(j1 25.~~
112. 41~
-
too. ORO'I AMOUNT DUE FROM BORROWER 122101.93 '" OROBS AMOUNT DUE TO SELLER 116584.60
_AIolClUNUPAID IY OR IN BEHALF OF BORROWER bOO R~DUCTIONS IN AMOUNT DUE TO SELLER
~ w"'__
1ft 'If'I'P ,O~ III'WIIOtlll1l!11 pUI el/!ll epnl:lllt 1I1:l1l0tl:llAUO:l uodn tltu'Ulq WIOI "IIWI' Aut '0 1141 1I0 1'1119 plllflJn .ljllll III18U,61III' 1t11,1'l1Ll/ ~tlU!MOUII oIIWII,:l I't II ,\'>NINYyM
1110 ",)J Ili-"YIIlIW4tlIl'S
) 1j9//,-qrr~ rz~'
'IUllU8'III'lllllll!M. trHllpl0:l31 \It plllunqllP Iq o\'plinl 8111 81nlO III"" 10 p.lnll:l1^'1lI 'llOIl018tjllllllljlIII IIJr\O'.l:1I Illlh:J:l' pUI Ir"I"1 pnldlllrll^'IlII':llIl/ll. IUIUI8,119 IU1utellI'9 l'OnU lilt
:IUOlld ,nIIPPV AlltN 1,1'I1'S
e;~?TYJ i/;;j'
~
'IU'W'I'\S luewelUlS ~'anH 84110 ,(do:l If pe^l80ej '^'4 I 1'41 NIIJ80 1'411r'lll 0110'IU'''''41 UI'W Aq lunooo, Aw UO efJ'W
11U'W.IJnqIIP pUt Ildleollll' JO IIl,wel'll '1IInoo. pUB snl)' '111 ',IUlq pUt eep'IMOU){ Aw)o I;oq '41 01 pU'lueWGI'IS luawellles I 'anH e41 p'Met^" A11"j"'o '^1tt41
IYI1US aNW SYUnl ~O NOILWOI~ILYIO anH
'1I01l011lJllj'NI Ul le""," .It IOllJOII"~MWO'
flIIIOIlIflPI., l~nO:'lell U~O'1l ell pllu.e II' Ile"IUI AUI "PI.O 01 pili l/OIlOIIl'1I1 plmlUI ~1'1~lj I U, IUM'):l1 ftUt1llq Iltl'llIt II' U1llltWllmq'fp 101 PII:lltIlO:l 'lunOWI AUIIIIOdtp OII~II~IIMlMII
"lid". Aq.llf\f I.;.DV IIH"dIIllIS 1l.fIW!IIj"19 tlllW!IIlUIIS l'Oflt~ 'Ill "OJ UMoll'" ""<410 AI' pl<4'IUJnI uOIl'lUwP" 10 .bllfl:l.l' '111 lnllllltflv IUftlJ"III'S Aq plwnl...t A,",qllll 011 l'lll "lIftl ...~.d
I ~~: ~~~~~ fEE' l. tSS _I _ ___=.::-:.. _~~~~r':u~I~'::~~~9:U'COI ,eulluo 1.lu.lnDYWHO!NII'l~~:~~~~~~.L~~~
A. j,lS: DEPARTMEN' OF HOUSING .od URBAN DEVELOPMENT OMB No. 2502.0265
. SETTl.EMENT STATEMENT
TIflEr'RO
SECURED LAND tltlefplinl
:
TRANSFERS, INC. B. TYPE OF LOAN
3800 Market Street - ..-
1.1 IFHA 2 ( IFMHA 3l() CONV UNINS.
Camp HIli, PA 17011 4 ( 'VA 6. I ) CONV.INS
6. FilE NUMBER' GLOAN NUMBER
Phone: 761-7744 __500112
6610307
B MORT. INS. CASE NO.:
C, NOTE: Thl. form I. hunl.hod to glvo you a .Iotomonl olaolual,olllemo"I 00.1. Amou"t. pold 10 ond by Ihe .olllomoot nganl aro shown. 110m. msrk.d
'(p.o.o.)' woro paid oul.ldo Iho oloslog: they aro .hown horolor Inlormalional purpos.s and aro nollnoll.ldod in tho lolals
D. NAME AND ADDRESS OF BORROWER: E NAME AND ADDRESS OF SEllER F. NAME AND ADDRESS OF LENDER:
Gregory T. Keenan Robert N. Reynolds, Norwest Mortgage, Inc.
Kimberly G.H. Keenan Executor for the Estate
of Jewell I. Reynolds 5005 Carli.sle Pike
Mechanicsburg, PA 17055
-
G. PROPERTY LOCATION: H SETILEMENT AGENT: I. SETIlEMENT DATE:
508 Grandview Avenue Secured Land Transfers, Inc..:.-- 01/16/98
Wo:rmleysburg BOROUGH PLACE OF SETIlEMENT:
CUMBERLAND County 1513 Cedar Cliff Dr Camp Hill PA 17011
J, RUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
IiiO:QROU AMOUNT DUI FROM BORROWER 400 GROSS AMOUNT DUE TO BELLER
10' Conlracl salo. prlco 115900.00 ~Oj Conlract sales price 115900.00
102. P.rsonal proporty 40' Porsonal proporly
18'. S'"lam.nl char go. 10 borrowo, (IIno1400) 5517.33 '83 .--
104 '8,
106. 405
Adjuslmonls lor Itoms paid by .ellor In advanco Adjustmont, 10' Itom. paid by DOllor In odvanco
toe. Cllvnown lall 10 406 ClIyfTown lax 10
-
t07, County la)( 10 407County 181l 10
- -
101. AIIGasments 10 408 AUonmenll 10
tOl. 'chool 01/16/981006/ 604.32 '09 sa;;;;;;} 01/16/98Ia06QO/9S 604.32
110 sewer:~ end/03/31 54.33 410 Sewer:S67/q end/03m 54.33
111. Retuee : f a end 3/31 25.95 '" Refuse: S:32/Q ana :3 /:31 :l5.~
III 41?
120 OROSI AMOUNT DUE FROM BORROWER 122101.93 420 OROSS AMOUNT DUE TO IELLER 116584.60
200. AMOUNT8 PAID BY OR IN BEHALF OF BORROWER 600 REDUCTIONS IN AMOUNT DUE TO IE'.t~r.
201. D.posll or 81lrnElsl money .wOO.OO 6Ol.Exco.. dopo.1I (,oolnstrucllon.) ---
202. Prlnclpal.mounl cl now loon(.) 92700.00 .02Solllemonl chorgo. 10 sellor (IInl 1400) ,c._~ .00
203. Exl,"ng loan(.) lokon .ubjoollo LO'.Exl.llng loon(.) lokon .ub/acllo -
204. ,o,Payoff of Flrsl Morlglgo LOin
None
205. ,o'Payoff 01 Socond Morlgagl Loan
208 (:>) to {I:II I<epalrs 160.00 606 (S) to (B) Repairs. 160,00
207, 607,
201 '08
208. '00
Adju'Imonl. 10' 110m. unpaid by '0110' AdJu.lmenla for 1I0ma unpaid by a.II.,
210. CllylTown I.. 10 I 610,CltyfTown till; I.
It1. County ",1( U1/01/9810 01/16/981 -.-18.53 611~1.ll; 01/01/981001/16/98 18.53
212, A.....m.nl. 10 6U Allenments I.
-
211. lohool 10 613 School I.
214, M4,
211i. 616.
---- -- -:
111. 51.
---
'17, '17
-
'". '18
- -
,,,, 51'
220 TOTAL PAID MY/FOR BORROWER 94878.53 Mo TOT AL REDUCTION AMOUNT OUI IELLU' 22728.53
soo. CABH AT SETTLEMENT FROM DR TO 80RROWER 600 CAIH AT SETTLEMENT TO OR FROM ~ELLIR
~Ol. Groa. omounl dua lrom borrowor (1lno 120) 122101.93 601 Gro.s amounl duo 10 .ollor (IIna 420) .6lr
'02. Lla. lmounl pold byMr ~wor (IIn. 220) 94878.53 502 Lo.. ,oducllon amount duo aollor (~~o 520) 22728.53
3OS. CASH (DO FROM) ([ J TO) BORROWER 27223.40 603 CASH (DO TO) ([ ] FROM) RELLER 93856.07
Buyer 0, Borrow,r', Signature
Sellor', Slgnaluro
-
HUD.l RIV, 1/88
,::l,'i; . Form. - OEcEflrED -
l)opoItmonl 01 ttw T___ -.. SoMe,
1040A, U.S, Individual Income Tax ~eturn II') '1997
.,,-.'1 ,_.... .'
. ,
'}:':;fII,l
II 14, UN the IRa "'1, OthllrwiH
Presidential Election Campaign Fund (See p1g~ 14,)
Do you want $3 to go to this fund'l . . . . . . . . . .
If a oln return does our s se want $3 to 0 to lhls fund?
1 Single
2 ' 0 Married filing lolnt return (~ven If only one had Income)
3 0 Married filing separate return, Enter spouse's social securl1y number'
abov~ and full name here, ..
4 0 Head of household (wI1h qualifying person). (See page 15,) If lhe quallfytng person Is a child but nol your
dependent, enter this child's name here, ..
II 0 uallfyln wldow(er) w"h depende~lld (year spouse died.. 19 ), (See page 16,)
88 You...". II your porent (Of aomeont llse) cen claim VOU lIS I dependlnt on hll Of Iw tax return, do ,not
check box Ga.
. No
For PrIvacy Act and
PlperwOrtl . , .
Reduction Act .
Motlce, _ fllllle 42-
t4oll: Checking "Y8lI" will
not chanr/8 your tIK or
reduce r refund,
.. .'
llli!!!L namo
wi""'"
'12l Depondont'. IOClII
Nr:UrIty IIlIlIW
I3l Dependent'.
lllatlonlhlp
to)'OU
\041 No.oI
lOO!lthI
lI'Ied 1nYl1Uf
home In 1997
Ho, of ba..
checked on ill
..nib .
No, 01_
..,lIdren on
"""0: D
,--
,..
, did not IIvo
with ,.. clut
10 dlY_
or MparllUon D
(N' pa,1 17)
Dtpandtnle
onlonot D
Intlrlld ebove I"
b UII
C Dependentl. II mOl' than 01. dependenll, _ pog. 16,
d Total number 01 exemptions claimed, .
. , . . . . , .
Add num"'"
.nt.red In CD .
. . .. boa.. lbow
, I
7 Wages, salaries, tips, etc, Attach Form(s) W.2, '
811 Tuable Interest Income, Attach Schedule 1 If required,
b Tax.exempt Interest. DO 'NOT Inclu~e on ~ne 8a, .
II Dividends, Altach Schedule 1 il re9,!!!red, '
_ 10a Total IRA DTIIIJJ 10b Taxable amount
== distributions.' 10a (see page 19).
. 11a Total pensions ~ 11b Taxable.mount
;; and annu"les, 11a ~ (see page 19).
'ElI 12 Unemployment compensation. ," . 'l
== 138 Social security 13b Taxabla amount .
I!!!l benellts. 138 see age 21).
m
.. 14 Add lines 7 through 13b (far right column), This Is your total Income.
I!!I
II 111 IRA deduction (see page 21 ),
.. 18 Subtrectllne 151rom line 14, This is your adjusted groea Income. .
;; II under $29,290 (under $9,770 II a child did not live with you), aee lhe
Ele Instructions on page 27, .
. Attach Copy B of W.2 and 1099.R here.
CIntI
. " ~83H
8b 1JJJIill.
8 [[]]J]]]
10b DTIIIJJ l
11b~
12 [[]]J]]]
.'3b [[]]J]]]
~14~
15 DIIlJJ
~18~
1897 Form 1040A
Dollere
Cot. No, 12B02S
.
~.
. ,
32 Amount 01 line 30 you want Ippll.d to your 1998 "tlmlt.d tax.. 32
ii :i3 "line 28 Is more than line 2ge, subtract line 2ge "from line 28, This Is the Imount you 33 DJJIII]
_ OWl. For details on how to pay, see page 34,
II 34 Estimated tSJ( penalty (see page 34), 34 [[[]]]
_ Sign Undtr penaltill of ptrju'YJ I deel." thall have Ilf.amlf'ltid thi. rtturn It'Id aceo""panylng aehldul.. and .tlllrMnll, and to the
_ btlt 01 my knowltdgtano bllllf, thty III true, correct, and ACCl.lrtl'l)' hit all amount. Inn lourcea of lnCon'lll rlOti....~ dyrlng
h.... tho '" Yilt. OeClII.'1on 01 P , (Olho, than lilt luplyo~ I. baNd on all "Iormalion 01 ..Nch "'0 prOpl1I1 hu IIIl_go.
.. ~ If u, '10 t ~ OIt, You, occupatIOn ,
;; ". . ,t)t.tMri J 9 cX{!(;II1'C(l. Of U1'Aie
Klep I copy of ..
= Ihl, IItum for pou..'. _upollOn
_ your ",cordi,
.. Paid PropllOf'. ..
= preparer'll algno...o ,.
_= use only Film'. n.me (0' \'OUII .
- K ..K,omployod) ond
II Idd....
'1997 Form' 0040A page 2
/
1L-E!11er the a!S\!nt lrom line '6.
.181 Clleck { l!!I You were 65 or older 0 Blind } Enllr number 0,1 . A _ ril,
If: 0 Spouse wu 65 or older 0 Blind box.. oheokld . ~
b " you 1111 manied filing aeparately and your apoulelt.miles deduotlol\s, .
aee page 23 and check hel1l . . . . . . . . . . , . , , . . . ~ 18LQ
19 Entar the ltandard deduotlon lor your filing atatus, But see page 24 II you checked
any box on line 18a or 18b OR someone can olalm you liS a dependent,
.8Ingl'-",150 - Manied filing jointly or Qualifying wldow(err-6,900
e Head 01 houaehold-6,050 . Married filing separately-3,450
Subtract line 19 from line 17. " line 19 Is mora than Itne 17. enter O.
MuKlply 52,850 by the total number of exemptions claimed on line 6d, 21
&Jbtract line 21 from line 20. If IIrl8 21 Is more than line 20, enter O. This Is your laublelnoome,
"you want tht IRS to flgul't your tax, ... PlIge 24. ~ 22
23 Find the tSJ( on the amount on line 22 see a e 24 . 23
248 CledK for child and dependent care expenses, Attach Schedule 2. 248
b CradK for the elderly or the disabled. Attach Schedule 3. 24b
. c Adoption cradK. Attaoh Form 8839. 240
d Add lines 24a. 24b, and 24c. These are your totll ClfIdItl.
25 Subtract line 24d lrom line 23, II line 24d Is mOI1l than line 23, enter O.
2e Advance earned Inoome eredK payments from Form(s) W.2,
. 27 Househol~ employment taxes, Attaoh Schedule H.
28 Add lines 25, 26, and 27, This Is your total tax.
29. ~ederallnoome tax withheld from Forms W.2 and 1099.
b 1997 estimated tax a ents and lmoUnt I lied from 1996 retum,
o Eamed Incoma credit. Attach Schedule EIC If ou have a ual' n child,
d Nontaxable eamed Income: emount ~ and
. Add lines 29a, 29b, and 29c, These al1l your total paymenta. ~ 2lle
30 " line 2ge Is more than line 28, subtract line 28 from line 2ge, This Is the amount you overpaId. 30
31. Amount 011lne'30 you wlInt refunded to you. If you want K directly deposKed, see 31a
page 33 and fill In 3tb, 31e, and 31d.
b Routing rrrTTTTTT1
number LLL..L..L.J.... c Type: 0 Checking 0 Slivlnga ,
d Account
R.lmber
2ll
21
22
i24d
25
2~
27
~28
o
',' .
,
Chocl< "
M"""'P!O
EIN
ZIP
ced.
,.",'.,."
(i) -..--
, .
'U.SGO\1II'n"","tPr."ngOllIOl; 1197-..1....
, .
.
17~
-;. "
19
20
~
,.
, .
. .
.";
. .
,,'
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to i;;2 ~ ~ IJ ~ ., 1ft llif';:; I. ~ 5
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t ltfih ~ l!iUhl hili : 1111 ~ U II l II i I i III Ii
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= ..' MOH~'~~~ . 80. EO m I III II I II I
. ......... ....~... ~.. _..... .-. -'., .~.
, -, .._.~ ...". .'", ~',.,ot___
MIFFLlNTOWN MARBLE AND GRANITE WORKS
.ff(arblt anti fJranitt ,fMemorials
MIFFlJNTOWN, PA.
....11I F.... 8lrHI
UWIU
. .'1 . ( '/ \. <' - (
, ,
....w_ .....
.....
Date .... t{ ::. L~.. .... . ..19~t.1
Y f fhl-"(-"l-" J~/1-1
ou may urn.8 ............ ...... .....~.,........ I..,.. t.... ~ ... t,~'" .'.............. ~.... ~..,
Erect In .............. .1.... f:. i. :':';'..:.1 !;\..:....................... Cemetery 011 cement foundatloll
City or Town........,...... .~v. ~,(,(j"1.t.I.\.,.........",....."....................,,...... .......,
AI! orden subJecl to delays from breekdoWlll, Ilrlkll6 or other utnorllmll")' hlDdrlDeeI,
Detalla l
h\ Cl H t;. . it
'1 t: ~.:. t: LL I' i'( t ,/\1( k0)
::: u. I~ '. I') I( .1'
!'j I. 1'.; 'J 11,t; ")
C'
I.
~'-
Upon completion and delivery, according to above Information, .................................. arre_
to pay to Mlftlnlown Marble and Granite Works the aum of .....,... '. . . . {. .1. :.. I .c:;.,./..... . ... . .......
. \ \ \ -LL /"
.:4"l<;':\~\. j: '; .'~.:;.;....",\;~' :....,............. ....,.... .l';( Dollara, 8ubJect to the followlni' terma.
. . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . ". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
........................,.,..................... ................................................
\Ve accept above order
and all'lI lo carTY It oul in
full compUan<e IWth the lerma.
:<'rei/1N. tlf,AillJh
.....~, "'-
j,l.,l~ ("'i',H~')I.
1\,.. r"l "",. ~I~
1\ b expressly agreed thai UUe and ownership lo remaJn the property ~ the MlIf1intowD Mamie ud
Grarule \Vorlts until the terms ~ the contract have been fuUy compIled with. JIIs fw1her ",reed thai
. aU work In the future on lhe above goods shall be for a further,;"slderallon, aareed or' at that ~
Deposit Received....................,.,..... SI8'lled ~.(;jfh ,:rk.4-d...d:;.f;?..:...
(
Signed by: MIJo'.'LINTO\\'N~ AND GRANlTE \VORKS
Por _~~ t...L~~,'
.. If ( ~
---~_. --I _._..w...
- ......_, ...,. ~-_.._--
A. US. DEPARTMENT OF HOl/SING and URBAN DEVELOPMENT OMB No 2502.0266
, . SETTl.EMENT STATEMENT
THt.EfltIO
SECURED LAND 1 luelllrlnl
TRANSFERS, INC. B. TYPE OF l.OAN
3800 Market Street IIIHIA 21IFMI;A 3.X I CONV UNINS
Camp Hili, PA 17011 ~ 1 IVA 5.1 I CONV.INS --
6 I'ILE NUMBER I' LOAN NUMUER
Phone: '161.7744 1-_500].12 6610307
6 MORT IN~ eM'E NO .
- - -- --- - -
C NOTE This form Is furnished 10 givu YOll" slnlnfllonl 01 (lelual &91l1ftnHHlI GORin. ArnOllnl1l pllld 10 urICI hy 1110 BolllnlTlunl auonl flfO tlhown, Iiams nlArked
'(p.fl c.)' wure palrl outsido lho closIng; thnv are shown here lor Inforrnaliorll1l purposos 8rld UfO nnll"cllldfld In till lolals
o NAME' AND ADDRESf' OF BORIlOWER E NAME AND ADDRESS OF flHI.Hi .- I. NAME AND AD{)fI[ ror. OF l.ENtJHI --,,---
Gregory T. Keenan Robert N. Reynolds, Norweflt Mortgage, Inc,
Kimberly G.Il. Keenan Executor for the Estate
of Jewell I, Reynolds 5005 Carlisle Pike
Mechanicoburg, FA 17055
.. -
G. PROPERTY 1.0CATION H SETTLEMENT AGENT. I. SETTLEMENT DATE:
508 Grandview Avenue Secured Land Transfers, Inc. 01/16/98
Worml eysbu rg BOROUGIl PLACE OF SETTI.EMENT
CUMBERLAND County 1513 Cedar Cliff Dr Camp HHl PA 17011
J, SUMMARY OF BORROWER'S TRANSAOTION: K. SUMMARY OF SELLER'S TRANSAOTlON:
'00 GROiS AMOUNT DUE FROM SORROWER '00 OROSS AMOUNT DUE TO BELLER
101 Conlraclll818s pricD l1:>J!..UU. UU 401 Contract salas price 11"~UU..~
102. Personol properly 407 Parsonal properiy
,.3 Selllemonl charge. 10 borrower (line 1400) 5517.33 '03
10~ '0'
10S 'os
Adjuslmenl. for lIems paid by selle, In alivance Adl",'menls for lIem. peld by seller In advanca
t 06 CllyfT own tal( 10 406 CllyfTown til( 10
101. Counly lal( 10 "Ol,County tall 10
t08 Auoumentl 10 408 Aasossmenl& 10
lOll lohool 01/16/981006/3 0 19 8 6()~.32 '09 echocl 01/1~9Blo06/30/98 604.32
110 :;ewer:$67/O enOloJ.LJl 54.33 "0 Sewer:$67/o eno03/31 !:l4.JJ
111 Retuse: ~ enCf3731 25.95 '" Retuse:~i3:l/O ena 3/31 :l5.95
'" '"
120 GROSS AMOUNT DUE FROM BORROWER 122101.93 .,. aROSS AMOUNT DUE TO SELLER 116584,60
200 AMOUNTS PAID BY OR IN BEHALF OF BORROWER '00 REDUCTIONS IN AMOUNT DUE TO SELLER
201, Deposit or earnest money .UU M1.Excess deposit (see instructions)
202. Prlnclpolomounl 01 naw loen(s) 92700.00 '01.Selllomenl charge' to .ellor (lino 1400) 22550.00
203 E,'sling loon(.) takan subject to '03 E.i.ling 10an('llaken stlbjacllo
2g4, ,0,Payolf of Firsl Morlgoga Loan
None
205 505 Payoll of Second Morlgage Loan
to . 160.00 (S) to (Bf Repalrs 160.00
20B I:;) {I:l) l<epalrS '0'
201, . 607,
20B '0.
200 50'
- Ad,u.tmenl. for lIam' unpaid by Belle,
Adjustments for Items unpaid by seller
"0. Cl1vlTown ~I( 10 f.,10CltyfTown tall 10
211. County IIIC 01/01/ !ltllo ul/1b/ ~tl 18.53 bl1.COunly lax 01TIJl /981001/16/98 1B.:>J
212. A.....menl. to !i12 A..enmenll \0
213. School 10 fi13 School 10
atot fiI~
2U.. ...
il1. s"
211, 5\7
~1a. ...
211. b"
220 TOTAL PAID BYlfOR BORROWER 94878.53 510 TOTAL REDUCTION AMOUNT DUE SELLER 22728.53
300 CASH AT SETTLEMENT FROM OR TO BORROWER BOO CASH AT SETTLEMENT TO OR FROM SELLER
so, Gross amount due from borrowor (line 120) TI2101.93 601 Gross amounl duelo ,eller (line 420) 1165tl4.bU
30. Lo.. emount paid by~or borrower (line 220) !:l4tl'ltl.:>J 6021.0S5 reducllon smollnl due sell~r (hna 520) :l:lntl.53
'os. CABH (DO FROM) (( I TO) BORROWER 27223,40 003 CABH (DO TOI H I ~ROM) BELLER 93856.07
Buyer or Borrowe,', Slgnllule
Seller" Stgnalulo
HUD.' Ro,. 6/B6
U:' lJLI'AIIIMI.NI UI 1I11lJ:OINli ANLJ LlIIHAN LJl,VI.LUI'MLNI
SETn fMLNl S1 AI fMfNl
OMIJ No 2!J112'0265
P8QO 2
L,8ETTLEMENTCHARQES 500112 ---- -. -'-liA'lllFliOfr---pj]bFAOM
. -- I' ( ,,-- BORROWER'B BELLER'B
700 TOTAL ~SIBROKER'S COMMIBSION b~~.d on Pll... 11 ~ JOO ,00 6,0 FUNDS AT PUNDUT
701 S 6954,00 10____ .rack Gallghf?11_.B~~ltor . j' i
~ 10 ._.______.__._______ _. _.__.~.. ,
703 ComfTIltifllon paid nl Settlornllfl! G 9 5 4 . 00
-~-----,- ._---- ---------....-----.-
704 ____________. _____.._________n____ __ __
800 ITlMS PAVABLE IN CONNECTIDN WITH LOAN
~(;tTOR" 611~11\ilIIOII fon 1-:-6oo'~~:--' NOl'wost MOl'tgag("..LJ.!lC. -9"~~=~g: -=~~_._.._.
802 L<~"" Ol.counl 1 . 00 0 ._~___.___lli'E~~~-'i9E.~~~.sJ~J__!.~~~=- '__ 92 7..:..Q.2._____.._
801 App",I..I!'oolo Ml.Cllael. Connor (,.27';. POC)
ii04C~O?1I Ho!>,;lIlo . ._ Credc-t) ($ 5'0. FOC)-'- .
805 Lende,s 11181'01:11011 Fon
606 MorlyaYlJ Insu"u;~ Appliclllioll hUllu
~^6Sllrnpljon FAO
"'~
806 Doc Prep
809 Tax Serv
810 FIOOer Cert
811
900 ITIIMS REQUIREQ BV LENDER TO BE PAlO IN ADVANCE
901
902
--
--
Norwest
Norwest
Norwest
-.------..-.....-.-, -----."
--. '---,-~-
Mot:tg~',~l''', "~
MCJrt..9~~lnc ._____-2..6,00
M~~..sJ~~~__ ___~_O_
Inie,e.lfrolll 0~/98
MOrlgaye Insuranca Premium lor
Halard Insurance PremIum lor
In01/31/98 0$
rno to
"..,-
1 y" 10 Clgna
yrs to
17 :78/dilY
284,40
9
1Il0.0$
1Il0 C$
mo. C$
mo C $
mo C$
1Il0 0$
mo.O$
mo. C$
16.73
Imo
Imo
Imo.
/mo,
Imo
Imo
/mo
Imo.
200.70
--
66.92 .'
--
483.28 : ;::!~i
982.53
-450,08
"
!403,
904.
906.
IOQO RESIRVES DEPOSITED WITH LENDER FOR
1001
1002
1003
1004
IOOf)
006
007.
008 A~grAdjust
toO. TITLE CHARQU
iOI. Selllemenl or closing leo 10
1102 Abslracl O'"l1e .e.rch io
t03 Title IlCBm:nallon 10
104, TiU, Insurance binrJer 10
105 Document preparation 10
lOll. Nolary lee. 10
107, Allmney's lees \0
(include. .bove ilom. No :)
1108, Title Insurance to
(Include. .bove lIems No)
109. Lander'. coverage $
1110, Owner', coverage $
J2.!.J?isb Fee
112.
113.
200. aOVERNMENT RECORDING AND TRANSFER CHARGES
201. Recording!ees: DeedS 23.50 Mortg.geS 29.50 MI.c.$
202. Clty/counlylax/.iamp. D80d$ 1159. OOMorlgogeS
203 St.l. t.x/slamps: Deed $ 1159 . 00 MOIl gage S
204.
206. Home Warr
300. ADDITIONAL SETTLEMENT CHARGItS
301. Survey III ~
302. Pe8lln.pocllon 10 Bowers 30.. 00
303. Home In~ (Buyer-POC)
~ srr'1I2~. Wo~.l<Y,bu'. Bo,ou,h ~~~_____.. 99,09.-.
306. 'l'X!llhEsc. ....E..~ureC1 Land Transters I --l~908. 00
400. TOTAL SETTLEMENT CNARQES 'onlor on ~~os 103 and ~02. Sections J and KI L__S'3 ]'.l~LE 550 . 00
f'.rUn .g,.. Ihlt flO Il.bml~ I. I'll/mild bV SVW'''llC!r11 AUflIllloI Ihe 1I1;1;II'ICY nllntrlfmlllonlufIll!h8rt l,y olh'HIIS Ihnwo otlHlfllll![).1 fif,llh'nHII,1 '<;1/11"(110'11 ROlll"n'flol ~"flf11 ""'II11y "'PI'Mtt'
'l"fVllIlhl,lgnt 1(1 depoll! IOy ImOUtltl toUlclld lo! dllhu,,,nrnftnlll1l!l lnlfllflll bOlrlhU .ccounl In I fedttf.lI., IlIlufun Inltiluliofl Ind 10 (:f(frjil Illy 111(11I6111 1(' "'1I9d 10 ill own ,(wovnl.' ,ddlllGnll
(lOfnpln..lion tOI K' "NIc., In Ihl, h.nllcUon
HUD CERTIFICATION OF BlIVERS AND SELLERS
I have c.lelully revlewod tho HUD. 1 SelUffmonl Staloment And 10 Ihe boa' 01 my knowltldge and b(lllof, Ills 8 true and aCCLlrsle alatornonl or all locolpl18tld dllbu"emenlt
mad. on my .:nl by m"7 I furlher celllly 1t,.11 have leceivod a copy of Iho HUD.l Solllome"l Si'lomonl _
~ sf!.~~:~? 01 , ,/6 -Il)~(j!d
Hazard Insurance
Mortgage Insurance
Clly/lown lax-
Counly ISI(
Assessmenls
School Tax
4
14
34.52
109.17
Bo~wellrSnyder,T1nter(POC
Cash
5.00
Secured Land
Ends. 100/300/900/AA
92,700 .
115,900
Transfers
.,~
546.501
.:.......-
--.. .,.'. .
35.
Secure'd Land Transfers
53.00
1159.00
1159.00
Jack Gaughen Realtor
360.00
Buy" 01 801l0W,r't SlgnlhUfJ C
Buye", Add".. & Phone
SIU8", Nnw Addlen & Phlllll
lh, IIUO.1 S,III.mlllt SllteOllnl which I hlVI fH8VI'.d It 1111/8 Ilf,<1I';Clllllt~. ,c(;(\UIII nllhillllflllr,Unn. i hll"" C'llIflcl 01 will c,ulfllhft Il/lIf;' tf' bu ell,hl/llfld In Illt,ord,nc. Wllh thll,I,llm,nl
/-;:o<'!j ffiA-- 1/16/V ~
StltllRl.nl AUllht .tf//i'L
WARNING Ill, I Cllml to know!1i
I
I Ol'flClAL__V
--.J Pi COil · "" -i7003l.00U
PENNSYLVANIA INCOMETAX RETURN ~~~ ~.~ ~~:D c ....,.
'11M llociol SoMly Number 1IJouM', &.loIaJ IlIcuI1Iy _, Tn- Flit" ~. ~ 0rIr Onol Ie..
>4 u e I Q. JJ I'I J;. r, 'I, . I I f ...,.-,-r-, II C -....-- 'c"
w.r(;.~~:' .. ,01.. 7_~~ ' I J '--~.u.r~,J...U'\\Iu!~~ -==-.u-,~ r'J!
!i~ E Y NO CDs":'llIiJJJI[[Jj ri1~i.iwJ!l L l:.I
~1.~O"',AjIlNo'SuII"FIool'.RRr:!",.Qt I LDJj' ',FIII1N1mt 0
I I I , , ' . ' I I 'I 1 JIITlIIIJ
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jl~1- ,~} K!l p1.T:eyi lAJ~~'~JlgJJJJ ciI.LJjj:m]
:~~~P~"~h~iL: {) -\ ,! ell rJfii fr'107l,J =::~NI~~~: [r/~
ro .. _""o.~ ...._._~..AIIY~......_._""""t"''''....... (III-, 0011811 CliI*
_'OIIA...IOOIlLIT..,..,......._DONOT_"""T.._"'.,....~....... ... - r I','" . .
II OrwPATwbII~tionllomW.2fo"n..ndOlhllWlg..lIf1m1n11................. 11~,..I'>_ JJ I ~.J.J
tb UnrllmburHd Employee IklsilIIs EIipIrM from PA Sc:hIdulI UE, ........................ lb, ,J, I /'11 t
1c Nit PA Taxable Compenaallon, Sublrscl Une 1b from la, ,.......,......,..... 1c f ~t'l~tl"''(' I q-~
,.-;&,;'1"... ':__._"~:' ,'~:' :~,.
2 PA Taxable Interast. .Complete PA Schedule A M lMIr" ,000. ,.,.,.".....,.... 2 bl .L I/.' 1; fJ~' l~
3 PA Taxable Dividendi. Complete PA Schedule B" IMr ",000. ................. 3 )' I '1-) . '.', 1 ,
111 ..:.....,..~~...:;.J.J)~ .
~~ 4 Tn' PA Tlxabl. InCOmtl. Add Unto,<. a, Il ,.............................. 46 L",' ~Jl< ".'IIoL.. : ~,~...1.1~','D...: "'!'J~l
5 Tolll' PA Tax Wablllty, Multiply Wne . by 2.1% (0.028).. .. .. . .. .. , .. . .. .. .. .. I .... 01
CI .. "At W 8 i. J I....l-I...I~F i -11-'
'" 8 .Otal r, ax Withheld from .2 forma and other atatamenfa. . . . . . . . . . . . . . . , , . . . r
r 7 TOtal PA Estimated Paymanll and Credlta, Sea InatJuCtiDnI, .....".......,.... 7 f-.;.-T.;:i~\...:;;'r:r.:I';7t:1
.. Dtptndonll from PA SdtIduIt SP, Pall 8, Lid .................... 8/l] III r-Jl-,-rt'l'\ j'
It) TotIIEhgibllltylnoomehomPASohIckAISPPlr1C,Lnt11. .......'...............:........... ~:~ ~..: ":. '0.. .;::~'4.-'-__r.
8c: Tax Forglvene" Cred" from PA Schtdula SP, p.n D,Unt 18, ......................... 8c: ,I I t ,~ It b I
8 TolIIl Paym.nt. and Crtdlla. AddU-I, 7,tnd.. "...........,.......,.. ,.. 81":-~:':-'1 ;,;.f.:.i.~~r't\~.i
10 ~~~~~~.I: ~b~el;~: ~~:~~~~~~E8u:":.~:.~=-=~~~HOWTOPAY, 101 ), , I I, i rl , if
.
11 DVERPAYMENT, " Una 8 1111IOI1 thin Una 5, enllr lha dlff.fIIIQI haft, .......,...."....... 11 r,b_~JJi4::J.Jat
12 Rafund, Arnc>urlI of Una II yooJ "'n1 II uhtck 1NIl1tdlol'Oll. .........,.......,.... ..... '.... 12 ~j~..J.-;.:; Lf~_~:~ J..
13 CradIL. Amoun1 of Una II yooJ "''''" , mdIt lo l'Oll' 18911 E_lId TII At:alIIt ................. 13:. f,\J:.:...IJ<\')aJ
14 Donation 'AmMt of Uno l1l'Oll WlnlloOlwlolhlWlld R.lOIIroI Con..rvlllDn Fund. ...... ..... 14 "'_~';)") ,,~~ tJ.=~.:!;.
15 Donatlon,AmouniolUna l1l'Oll"'nlloOlwlohu.s. Olymplc Comm,"",PA DlvlIlolI. ....... 16 J. t,JJl t;,o:~ J
18 Donation. Amoun1 of Uno l1l'Oll wanllo Olw lo h O'll.n DoIID! Aw.relllll TNIl Fund. ........ 18 F ))J... ~~.J.~ji t ,,"-I. ,
17 Donation. AmounI 01 Una 11 l'Olllllll'lIDIIwIOIheKo'IINltlnan1 lIamorlallno. ...... ....... ..... 17 !.J...!_!.).:rr, JJ
18 Donation. Amounl of Uno ,t l'Oll",nllOolYlIO 8r...' , C.rvlcal Clncer R....roII............. 18.' r-r'r1f'-lJJ
_ Thl tot.1 of Une '2 t!llQuah 111 "IUII.auII Line 11. 1_ ,- ..:..'...~..r.."'I. ..:.r.~
O",CIAL utI ONLY
r~c...1
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'Ige 3
'1?OO3J,OOloS
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'170031.DOloS
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P1. 40EZ I 1./8 IUE.2. 1197
PlHNSYLVAH\A INCOME TAX RETURN- ... 2
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LocallnlormlllDn. f..... _.. IOU Me!.. "'1I1l...I' L I, P,1I711
Municipality wnf( fr.lli!'I?LlIJA- B..QgO ___ County:
.IU_ __.._'....""'__..'''''.._......_.__..._........"..'''''_....._.._
ff~J!l!i.--7);*'~a c.xeC-i/. II.M I q~'-~"'~"'"
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~ II '~I YOU IANO 'OUtll.'Ou.~_
.., Of ny Hlmo, _, IIIn "llpIYO~'" boNd on .'_1IOn "'_ ':"tro, hi. any ...........
rp;,"4iit;t'R.Ey'/i"Q'UJf -[xE~II.TOR LW I (I'
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Himel"II _how" on ~I PA laJl rwlurn:
:l.EweL-L. "X. RfYNOL/J5
PA SCHEDULE A - TAXABLE INTEREST
H ""', ~A 11_ In".." _ ...., . t ,000, compIt" 1NI1CIlIdu1l. Bot...
"""'1lon. In IOU' ~A Ill< _III fOf """lnl""'" "'_01 ...rnpt _
-IonI'_ulI.._d
Nlml 01 lhl PlY"
Employ.,'1 NI",.
Your _SoclII.~ NlIITIbe,
ffiilij.1"@ .7IiJZrn
PA SCHEDULE B - TAXABLE DIVIDENDS
."""~A"'___....,."ooo,~,,..._ Bot
III ""'_In""" PAIIl< _fOfwflll_ """'be -"'lu""
.... AlllclI__I-.._
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, 1 f C. . I: 'f T.""AT"lble 01........ ""- " L I.),,} '_J., .
ALLOWABLE EMPLOYEE BUSINESS EXPENSES 199'
r l....NYlllflootW.. .a.MYJAMl't.iITI
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:r Total PA ,...bl. Int.,..llncome I I
CI
C1-
r- PA SCHEDULE UE.2 10""1
.... . NIme ollalrj>lyer .14lmlng theH l"""nHI
Ernpk)ytr', Addrll.
OtICl'~ the dUll., of the ~b in which you Incurr.d the" 'KPlnM.:
... In'lructlon. ~or .,ch type 0' '.p."" In ~ou, book II" llpe"... mu.' M rtqulftd II . condltlon of rour .mploym.n' .nd 1ft not "Imbu'....,
PART A: UNION DUll. llllth. name of .Ich Uf'llon .nd amount PfIkt '0 lien Union, Ent., ~t.lI,
NI"" & Amount Nlrnt . Amoun' A r-r-r-n--r-,-,
Nlm. . Amou"' N."... & AIlIOVnI L..J..L;t-..U.,.J.a.L 1-,
PART B: WOAK CLOTH" AND UNlfDAMS. Pou"IP"on Ind tmoun" paid. Clolhlng mUll nol ......- rm-r-r-n
Of Iv.ryay..... B ~!...t-U
C rnJ.IIJJ
o o:::rrn:o
E D:TIIJ:O
tb 0.1..1J-1, J1
PART 0:
SM~LL TOOLS AND 'UPPLIU. Due,lpUon Ind Imoun" paid. T""" Ind '~II' _1lllI be
prOvldod by "'" .mployo,.
PART D:
PAOfESSIONAL LICENSE nU.IlALPAACTICEIN'UA~NCI, ANO flelLlnlOND PAEIlIU....
o.IC"I'IIOn 1M '~unt plld,
PART E:
TA~VIL AND IllLIADI. En," Imounl Itom .""hld Form I'''. II elllmlng olh., l"PInHI
trIm L1n. 4 of form 2101, HlCrh,
T..,. U"ftlmbu'tld employ" lu.l".., I.p.n....
Add PI~' ~ th,ough I, Inll' 110.. Ind on L1n. lb.I your TI. Alty",.
Iplrl'. .ch. ul.. mUlt il. you IVI mc". nON
OGcup.Uon and/or VOUI .poUIt .1.0 I"curt .mplo~.. bUIln... ..pen...,
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"I7DO~i!DDloi!
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I
/'
....t. A.ferenc. Typo Out.lpllon QUlnllly Amount
,,/ 11/17/97 CASH ~AYMENT - THANK YOU - CK3019 -85.26
10/25/97 Rc:59677 DESIPRAMINE HCL 50MG TABLET 28 5.30
(f(PINORPRAMIN)
NOel 007BI-1973-13 DAYS SUPPLY I 28
10/30/97 R2E.0340 METOPROLOL TARTRATE **** 50MG 4" 5.29
,.
(HALF-TAB) (RP 1 LOPRESSOR)
NDCI 00781-1,371-01 DAYS SU~PLYI 28
10/30/97 R2E.0340ECOPAY PREMARIN 0,625MG TABLET 28 7,00
Noel 00046-0867-99 DAYS SUPPLYI 28
10/30/97 R2f,0340 COPAY LEVOXYL (LEVOXINE) 0,1MG TAB as 5.90
NDCI 00689-1110-01 DAYS SUPPLY 1 28
11/03/97 R2606731COPAY COUMADIN 4MG TABLET 28 7.00
NDCI 00056-0168-75 DAYS SUPPLY I 28
SUBTOTAL RX 30.49
SUBTOTAL CHARGES 30.49
B.I.nee ForwRrd Ne", ChArgtls Finanoe Chalges Paymonts L AMOUNT OUE
.85.26 30.49 0,00 85.26 30,49
Current O\ter 30 Ovo, 80 1CNer 80 DaY'
30,49 0.00 0,00 0.00
DR, PETER BRIER
FOR THE ACCOUNT OFI REYNOLDS, JEWELL 19 11116
'I"tahnk
OFFICE HOURS I MONDAY - FRIDAY 8130 AM - 5100 PM EST
PI1.rmocy li<rvke. PHONE I 800-864-7958
.01 .
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t~,\ .'~>'/"( .. (:~'-.. .\ttf~~/..,\.~..'$' :).::.-~..~'~:.;, ~ f"-'~ "':'~:~','~"".tlbw 1: ,
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l. .~.... ~ ... t.; lei"';; ~_'.;;~ d ';-~"d'''~'~'~l-~';:i'''''';';'. &l
com StllVlct HE~10tf1[D CHARGES ORf,OIlS
-,..-.-- ._-_.<._....._-~-- ~,---_.-
11/01/':!/ PI'<I.::VlOUn EIHLilNCE 5, irl~., :~6
1111'1I'n Plll'NLtfl -. '1 HI'INK YOU
10/1:~/':il ':!0:~':)I~J fll'lH - WHl:.I::.LCHAll~ tHY 1 ) 105,00
I1/0U':)1' t1j01. 7~1, OXYGE,N CHY 1 ) 4/:" 0l!)
11/03/':il ':ifJ,!':!") Cln! I C AID crn 1 ) iI,61
11/04/':i7 100M! UlIEX EXMI GLOVE (E1X/H?l:J) CHY 1 ) 13, E.~j
11/04/':ii At (1~.J .,')(:,~ (iflULI.:: bF-(JHGE 41;4 CHY 1 ) 0,63
11/0'1/':1/ 't6ilC!0 H IlJf(uClIl.I.ID I>F<EbSlNG 4X4 crrY 1 ) 41, E.1
111lil::;/':il 10':iilb 51 H~~I)fHW PliO 00 (~'K(j 12) CllY 1 ) 13,06
ll/lil5/rn ~1,0j,~:;0 OXYGEN CI\NNULA CnY 1 ) 2,36
. Hr(l'IEI'IT 'DUE lJPO~1 f~ECErPT
11A~IOI~CAI:~1': IU,i;iLI H 1,i::.i'~V): CEn BBa
<7i:7) -'73'Hl551 rAMOUNTOUE J$
MANOR CARE HEALTH SERVICES 583
1$
".....
BOSWBLL, SNYDER, TINTNER & PICCOLA
COUN8EL.OR8 AT L~W
31 ~ NORllI fRONT 811\881'
P,O, BOX 741
HARRISBURG, PA 17108-0741
j7111 *3e.8:117
rAl( 11171 .:'8-8316
,
WII.LIAM D. I{oSWELL
DONN L. SNYDER
LEONARD TINTNER
JEFFREY (,. PICCOLA
JEffREY R. SOSWELL
8RI010 O. AI.fORO
MARK R. PARTHEMER
CHARLES J. HARTWnL
DYLAN PAINttR DAYTON
RICKARD fI WiCKERSHAM
Of COVNSEL
I,'
Mr, Robert 'M. R.ynoldl
lata C'PIIII .Irnt
H.rrtaburl, PA '7102
.,,23
DlICEM8IlR OS, 1991
3179.0001 '
,.OUIIIONAL IUVICU REIIDEREll ,~CllOtf NOY1!~ERJO, '991
A. Dncrlbld ,.Iow
REI J_ll ..ynoldl'lnc""""",lancy
PROfESSIONAL IE.VICES
07101/97 Hf" Rnnrch "'1 P_r of Attorney by IIIrk
07117197 "fA .....rth rll OUIIrdl_hlp
07/18197 "fA Inltl.1 _II.... with Roberl R.ynoldl r'l
IlI.oIrdllnlhlp
Oua8197 DLS Hnll.... II IIIchenlcoburl ."'ob.
08/01197 "fA .....rch; L.II.r 10 Dr. Irl.r; T.lephone
Dr. Irllr
08/26/97 DL' Obl.ln Mldlcll rocordo for "r.. ..ynoldo_
frOM Dr. p.l.r Irl.r
rt910J197 DLI ....orch rll Inc-,",Iency procedur..
rt9103l97 "f" P.llllon; Molle.; Conoonl; order;
Me..orch; Inl... offlco confor....
rt9/04/97 MrH Rc...rch; MOIII.... wllh .. P'l~ldo
rt91rt9197 "fA T.leph_ confor..... wllh J. R.ynoldo
rt9/17197 A'" T.lephone conf.r..... with Dr. Irl.r;
R...orch
rt9/24/97 "fA Telephone confor.... wllh J. TIl.." r'l
Coneonl. Cor....pandInc:.
rt9/28/97 DLI R.vl... P'llllon end ...1.11.... doc.....1I
rt9129/97 "f" T.lephone confor.... wllh Dr. Srlor;
I nl... of fI c. conflr..... .11 j. T ",on
cane.r,,"; Hnll.... .llh Dr. Irl.r;
Propor. documenl' for fIll.... wllh Courl
rt9/Z9/97 DLf Tr.vel 10 C.rll.,.. 'I'. P.llllon for
Apppolnl....1 for Gulrdllnlhlp & Enlry of
Appe.r..... wllh Courl Acillnl.lr.lor
10/01/97 DLP Obl.ln c.rllfled copln of Ordor of
Courl frOll judg. Ihn'.y & hll.lor of
conttlUd
"" '"..'-""-" ~T"""'. ,
,.. - ...""'._-----_.~ --.., ..,,"',.,
Will.
10/0S/97 OLf abUI" cll.tl_ f,o. C.....rllnd COlIIty
...I.t., of Will.
10/09/91 MfM Prlpln Notlc. to J_1l 'eynoldtl
AffldaYlt of Iorvl.. for Ole; AffldaYlt
for Or. Irl.r; Notl.. of 'entl.1 of
Co"n..l/ NotIfy children of ....rlftlll
1cIIIGJ1. dopoIltlon of 0'. Irlor
10/14/97 OLl ,.ylllI dc",,-,UI IIIHrch
10l\S197 MfM Motlftll .t Moolo' C.r'l tonf.rone. wIth
AWotnhtntor of _ COro; ToI""'_
conf.rone. wIth I. loynoldo;
Corrllpondonc' to Adtlnl.trotor of 1IIno,
COr. (I. lorln)
10/20197 OLl oopooltl.. of Or. ,.ter Irlor
10/20197 MFM Oopo.ltlon of Or. Irl"1 flnoll.. Motlc.
of C.....I for FllIftlIl CorrtllflO'lClonc. to
Or. Irl"1 AIMo>d AffldaYlt for Or. Irl.r
. 10/24/97 DlF 'rovol to COrlt.I'1 FH. Affldaylt of
Dr. Irlor & AffldaYIt of Iorylc. with
1..I.ur of WHII
10/2&197 OLI 10y1... fIl.; ...."ftlI with Mr. I.ynoldo
10/2&/97 MFM ....tfftll with M'. loynoldo to propen for
hoorlftll
10/30197 DL. I.vlew of fll. and doctaoont. fo, flltftll
10/lO/97 MFM Prope" Ordo, end It.t..."t of light.;
,.1""'011I conferone. with .. 'oynoldo
10/31197 DLI Prepo'. fo, Ind .ttend M..rlftlll ....ttftll
with M'". I.ynoldt
10/31197 MFM Prepor. for end .ttend M..rlftll; Vfllt J.
'.ynoldtl Corrllpondonc. to .tbllftllll
.....'ch r" Inventory Ind Accounttftll
1\/06197 DLI abUln corfltlled coplll of Order of
Court fro. C.....'lend County 1..I.t.rof
lit III
'O'Al FE,e 4;UMO
o "UIlNEM"
10104197 POI U8I .oeovered 9;00
UPe D.llvory
101\6/97 POI Ug. loeovered 4.38
10/24197 '..v.l Client I..overed 12.00
Corl hI.
10/31197 Photocoptll .oeovered 10.00
10131197 Photocopt.. 'oeovered 1.40
1\ 104/97 POIt"o loeovered 2.29
1\/06/97 POI Ug. .oeovored 1.24
11/01/97 Po. tag. loeovered 0.55
continued
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tEns! lIIill nub (]"eslnmeu!
KNOW ALL MEN BY THESE PRESENTS, That I. JEWELL I. REYNOL S,
of Fermanagh Township, Juniata County, Pennsylvania, being of lawful age and
of sound mind, memory and understanding, do make, publish and declare this
instrument to be my Last Will and Testament, hereby revoking and making void
any and all former Wills by me at any time heretofore made.
ITEM I; I direct that all my just debts which may be legally owing and
collectible, my funeral expenses and expenses in connection with the adminis-
tration of my estate be paid as soon as practicable after my death. I also
hereby direct that all legacy, succeuion, inheritance, transfer and estate
taxes which may be levied or assessed upon 01' with respect to any property
which is included as part of my gross estate for the purposes of any such tax
shall be paid by my Executor out of my estate in the same manner as an expense
of administration and shall not be prorated or apportioned among nor charged
against any property paning or which may have passed to any of them, and that
my Exer.utor shall not be entitled to reimbursement for any portion of any such
taxes from any such person or persons.
ITEM II: I devise and bequeath the residue of my estate of every
nature and wherever situate to my husband, KENNETH L. REYNOLDS.
ITEM III: Should my husband, KENNETH L. REYNOLDS, predecease
me, then the residue of my estate wherever situate is to be divided equally
among my three (3) children: ROBERT N. REYNOLDS, of R. D. I, Dillsburg,
York County, Pennsylvania 17019: WILLIAM C. REYNOLDS, of 191s Vinewood
Avenue, No.2, Pueblo, Colorado s1005; and JUDITH E. REYNOLDS, of P. O.
Box 392, Camp Hill, Pennsylvania 17011; however, if any of my said three (3)
children predeceases me, then his/her share is to be divided equally among or
between his/her surviving children, and if he/she has no children which survive
him/her, then his/her share is to be divided equally between my surviving
children.
ITEM IV: I do hereby nominate, constitute and appoint my husband,
KENNETH L. REYNOLDS, Executor of this my Last Will and Testament. Shoul
my husband, KENNETH L. REYNOLDS, predecease me, fail to qualify, or ceas
to act as Executor, I appoint my son, the .Aid ROBERT N. REYNOLDS, Executo
of this my Last Will. I direct that my Executor shall not be required to file a
bond in any jurisdiction. I hereby fully authorize and empower my Executor,
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without order or authority of any Court, to /lell, either at public or private sale,
,exchange, lease, mortgage, pledge and hypothecate any and all of my real, per-
sonal and mixed estate, for such prices and upon such estates, terms, periods
of time and conditions as my said Executor shall deem wise and expedient; and
to re-execute such powers in his discretion from time to time, and to do any
and all things that to him are deemed proper ur.til final settlement and distri-
bution are made hereunder: and to make, execute and deliver good and sufficient
deeds, leases, mortgages, assignments, notes, pledges and other assurances
in the law that may be necessary to carry out such transactions, without any
liability on the part of such purchaser, mortgagee, etc., to see to the applic-
ation of the proceeds thereof, and free and clear of any charge or trust hereunde
ITEM...Y.: In consideration of KENNETH L. REYNOLDS executing his
Last Will and Testament on the same date as this instrument, I hereby expressly
covenant with said KENNETH L. REYNOLDS not to revoke, cancel, annul,
modify, amend or change this my Last Will and Telltament without his consent,
it being expreuly understood and agreed that I shall respecti vely continue the
said provisions of this Last Will and Testam(lnt in effect during the respective
lives of myself and KENNETH L. REYNOLDS and at the time of our respective
deaths, and that said provisions shall be Irrevocable.
IN WITNESS WHEREOF, I have hereunto Bet my hand and seal this
~ day of \ iVA.'e... , 1977.
'.
, ;
~jJ4.{'~9'~~J:"i.L17 (SEAL)
ewe . eyno II
'.
Signed, sealed, published and declared by the above named Testatrix
as and for her Last Will and Testament in the presence of us, who at her request
and in her presence and in the presence of each other, have hereunto subscribed
our names as witnenes, all being present at the same time.
.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF IND1V1DUAL TAMES
INHERITANCE TAM DIVISION
DEPT, 280601
HARRISBURG, PA 1I1lS-060t
NOT1CE OF INHERITANCE TAM
APPRA1SEMENT, ALLOWANCE OR DISAl.LOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAM
DATE
ESTATE OF
DA TE OF DEA TH
FILE NUMBER
COUNTY
ACN
05-11-98
REYNOLDS
11-20-97
21 97-0804
CUMBERLAND
101
[~~"~"==:~o.~~~=~~:!~~~:< j
MAKE CHECK PAYABLE AND REHIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-v:is4"j-ix-"AFP"-{o9":97i""NoiricE-"oF"1"NHER-ifAN"CE"T"AX"AjipRA-isEM-ENT~""ALliiwANiCE-o-R---'""---"-"--""-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
JEWELL I FILE NO. 21 97-0804 ACN 101
ROBERT N REYNOLDS
1212 CAPITAL ST
HARRISBURG
PA 17102
ESTATE OF
REYNOLDS
TAM RETURN WAS I (X, ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R.al eat.t. (Schedul. Al
2. stocks and Bondi (Schedull II
3. tlo..ly Held stock/Partnerlhip Inta,....t (Sohedull C)
4. Horta.gls/Not.. Rlclivabl. (Schedule DJ
5. C..h/Bank Depolits/Hilc. Parlonll Property (Schedull EI
6. Jointly Owned Property (Schedule F)
1. T,..ansfa,... (Schedull G'
a. Tnt.l Au.t.
APPROVED DEDUCTIONS AND EXEMPTIONS I
9. Fun.,...l E)(Pln.../Adllt. COlh/Mhe. E)(~.nl.' ISchedul1 tl)
10, Dabts/"ortgaoa Liabi1itt../Lilnl (Schadul. X)
11. Tot.1 D.ductions
12. N.t Value of T.~ Raturn
13. Chartt.bl./GoYlrn~.nt.1 Baqua.t'l Non~.lacted 9113 Tru.t.
14. Nat V.lu. of E.tat. Subjact to T.x
NOTE I
If an asssssment Wss issued prsviou81y, lins8
reflect figures that include the totsl of aib
ASSESSHENT OF TAXI
IS. A.ount of Lin. 14 .t $Pbu..l r.t. ClS)
16, A.ount of line 14 taxabl. at Lin.II/ClIss A rata (16)
.17. Allour.t of Lin. 14 t.xabl. It Coll.teraI/C1... B r.te (17)
18. PrinciPII TlX Due
TAX CREDITS I
PAYMENT
DATE
02-13-98
, CHANGED
III
(2)
131
(4)
(5'
161-
(7)
115.900.00
.00
.00
.00
52.878.00
.00
,00
(S)
191
ClO)
17,066.69
5.263.57
III ,
112'
(UI
(14)
(Sch.dul. J)
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.Iv.l..' U .,~ 1ft.,,.
JEWEL L
I
DATE
05-11-98
NOTEI To insure proper
cradit to your lecount,
.ubllit the uppar portion
of thh for.. with your
tax ply...nt.
168,778.00
".33n 'J(.
146,447.74
,00
146,447.74
14, 15 and/or 16, 17 snd 11 will
returns assesssd to date.
.OOM'OO,
146,447.74 M .06,
.00 K .15,.
1111
_._------_._.~ -----_._---~.__._~-_.._.-
RECEIPT
NUMSER
AA269762
D1SCOUNT (t)
INTEREST/PEN PAID (-)
----"-~-~34--.-'-..---8, 347~52--
AMOUNT PAID
,00
8,786.86
.00
8,786.86
----. ~" '" ""i''.~f---='' "....
~~~~~~~r:F~i~~~U:~ -,~---, ' : H
Ir TOTAL DUE IS LESS THAN '1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE 1S REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS..
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
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MUl:RVATlONI E.tat.. of ellelldlnts dying on or bltlor. O.oubet 12, 1982.. If any future Int.r..t 1n the ..tate Is tran.fltt.d
tn POI....lon or .njo~..nt to Clast B (Clollat,rel) bln.flalarl.. of thl aOelldlnt .,t.r thl IMpiretlon 0' InY ..tnt. for
Ii'. or fnr Vlar., thl Co..unw..lth hlr.by 'Mpr...lv t...ry.. thl right to appral.. And a..... tran,'.r Inh.rltancl TIM"
at thl lawful tift.. 8 (ooUahral) rat. on any such 'utur. Int.r..t.
PURPOSE OF
NOTICE I
PAVHEHTI
REFUND (tR I:
OBJECTIONS I
ADHIN
ISTMATJVE
CORRECTIONS,
DISCOUNT I
PENAL TV,
INTEREST I
To fulfill thl requlre.lntl of s.ction 2140 of thl Inh.rH.ncl and fltah Tal( Act, Aelt i!l of 1995. (12 P.S.
S.cUon 91401.
Dttach thl top portion of thll ~otlce and lutlllllt wit" your f1l1v..nt to the Rllght.r of Wills printed on the re..,erlll tide.
u"akM ch.ck or 1I0ney order pllll/ftbl. tal REGISTER Of HIt.LS~ AGENT
A refund of II hI( oredit, whloh WIU not rllqlluted on the hl( Return, IIUIIY b. request.d by co.pletlrtg /'In "Appllcatlnn
for Refund of P.nnlylvlllnl. Inh.ritance IInd Estah Tal(" (REV..UUI. Application. are IlvaHahl. at th.Offlc.
of thll f:lllght.r of Will., anI/ of the 23 R.vlnue Olltrlct Offlc... or by cftlllng the 'Pllclal 24-hour
anlw.rlng ..rvlct! nu.b." for for IllS ord.rlng: In Penn!I/IIJ"nla l-aOO-362-Z0S0, ouhld. P.nnlylvarda snd
within 10".1 tlllrrhburg sr.a (717) 7&7~1l094, TDOI (717) 71Z-Zl5Z 01."rlng I.palr.d Only).
Any party In Intllr..t not satltfl.d with the 8Jlprah....nt, allowanc. or dltal1owanc. of deductlonl, or a.......nt
of taK (Including dhelount or Int.rut) al Ihown ('n thh Hotlc. IIU.t object within IIKty (60) day. of recelpt of
thh Notlc. bYI
uwrUhn prot..t to thll PA O.part.ent of RevenuR. loard of AppRl'lll, n.pt. Z810i"I, Harrhburg, PA 11128~1021, OR
H.leotlon to ha.... the lllathr d.t.rlllmld ftt ftudit 0' thl aocount 0' the p.tlOflltl r.pr.s.ntatl...., OR
~-app..1 to the Orphan.' Court.
factual errort dhelov.r.d on this u......nt should be ftddr....d In lofrltlng tal PA D.paf-t..llnt of R.v.nue,
Bur.au of Individual T&I(.', ATTNl Po.t AI'.'I..nt R.vl.w Unit, Oept, 280601, Harrl.burg, PA 17128-0601
Phone (711) 187-6505. S.I pagl 5 of the bookl.t "Jnstructlons 'or Inherlhnce Tal( R.turn for a Ruldent
Ulo.d.nt" (MEV-1501) 'or afl .I(phn.tlon of Ilcl.JnhtraUv.ty corrlctlllbl. .rror..
If any tal( due II paid within th,". (3) clllllndar ..onth. IlIftlr the dec.d'nt'. dlath. a fll,l. p.runt (5%) dhoount of
the tal( paid I. allowed.
Th. 15~ tal( aMn..ty nnn-p_rtlclpatlon p.nalty I, cOMPut.d on the totft} ~, the tal( end Int.r..t ft......d, and not
paid b.'or. Jenullry 18, 1996, the Utlt day after the Ind of the tal( a..nuty p.riod. Thh non-part1clpltlon
penalty I. ftpp.aldbl. In thl .a.. ~anner Ind In the the sa.. tl.e p.rlod &1 you would app.,1 tn. tll( nnd lntlr..t
that ha. b..n a......d .. Indlcatld on thll notlc..
Int.rl.t I. chftrg.d beginning with Utlt dal/ 0' dellnqu.ncy, or nine (9) IIOnthl and one (ll day froll the date tlf
d..th, to the date of pay.ellt, TIII(I. which bee... dellnqu.nt b.'orl January I, 1982 b..r Inter..t .t the rlt. of
.IK (61:) parc.nt p.r annUlI cfllculatld at II dally rate of .00016,.. All tll(" which bIen.. dellnqulnt on IIl'ld .ftllr
January I, 1982 will b.ar Int.rut at ft rllt. which will vflry 'ro. cfthnd&r y.ar to (Calendar y..r with that I'lt.
announced by thl P~ n.pftrt..nt of Revlnu.. Th. appllolbl. Int.rl.t rat.. for 1~8i" through 1998 ar.l
'!!!! Intlrut Ratl Dally lnt.rut Factor ~ Int.r..t Rate R.!..llL!n \II r., t Factor
19&2 20% .000548 1981 9Y. .000247
19U 16% .000458 198'+ 19C11 111-: .000301
1914 11% .000301 1991 91-: .000247
1985 BY. .0003S6 1993-19911 lY. .00019l
1986 1OY. .0002711 1995-1998 9Y. ,000241
..Int.rnt I. calculated .. folloWl1
INTEREST . BALANCE OF TAX UNPA10 X NUNIER OF DAYS OEL1NQUENT X DAILY INTEREST FACTOR
--Any Notlc. I,'uld Ift.r the tal( blco.e. delinquent will rl'llct an Intlrllt caloulltlon to fl,t.en (15) dlY.
beyond the date of the .........n\. If pII/..lnt It .ed. .ft.r thl Interl,t cOIlPutatlon datI .hown on thl
Hotlo.. additional Int.r.lt .u.t bl c/'llculftt.d.
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I'ETITION 1I01( ItROIIATE lInd (~RANT OI" LETTERS
'F' J t "/ l' I',) I/~ /1)' 'f)'/
1,:\'1<1'(, 01 vi:' V, J'1- -, 1'1 r'H /1..-'
also knull''' tl\.
NtI,
1'0;
21-97-Q04
, " f /h'('f'lIsc'd,
Sod<ll ,\('('11/'11,1' No. Ifll S:' I;) ... 11/ I,~u
I{('ghler tlf Will, for Ihe
('(HIIIII tlf ((J(Jlit'l.'Liy'jL., in Ihe
('OllllllOllwcallli of Pl'l1llsylvaniu
'I'he pel II inn Ill' I he 1IIld\'l'sigll('d lTSjll'l'lrHlly I'l'Pll"'l'lIl... I hal;
YOtl! pl'litiolll'l(q, wllo i.../ul'l' IS "ViliS 01 age or oldL'l' dlllht'l'.\l'l'tlI.O(\ .u_~.~. numed
in I Ill' IuS! lI'ill tlf Ih,' ""tlve de,','dl'IH. d,",'d .l'(""c't: 19'1"/ 'i.,_. ;.71.,,;..),:".~;;,>.-,;;:,..,I)/.i',f'~.',"'_"
nml I'"dil'iil'~ di\l,'d /1//-il/ltJl.' F"'''''j';;';J,(: tiJ/) /<,p,(:.'I'."c!.J/I..t. I''''''"' __[L / ~
t2d':t.:r!:)/'O Ji/iy;r, /j''C'.:.' u_.....__..___.___.
/
F,J6't't.'l M ,(:(:IV1/i'/C!') .t..x r)L.'t//"o.!2
hldlc 11'1l'\,l!1l df<ljl1\';ldth~'\, ( ~, /\11\111\1,1111111 dl'oIlll \lll'\I.'l'lIliH, l'll.' I
1>. C)i.'e'Hklll \Ii" ,hllllkikd III dClll1i II, L~t>/f)l'Jr!k'l./f'/'./,C.. ,,,"...._.. (. 'n,uIlIY, pUI\I1SYlvl.ll1ln, with
her./, III" 1IIIIIIIv llllllIH'lplllll',"kIC" III 5;)1. a12I)I'/vL-j,b"':V, fi.f/t)r>k!,:{::'____~__..__
, cA'm/' II//ll ". F!<;,. , I!.Z.<2.ii~~.,_........._
(11\1 ',II"~'1. Illllllhl'l did 1I11llh:ipalrtq
~, ~
,/1/'/ f1/" ?/J...j ';:<1/,) 0"/
I lel'ClldCIII , IliclI // ,1'Cill\"lllge, died<t L;',/(~/n!;i(jC._u_"7'"", ..,. 19_/~_.
1I1/17,111!(''<' (/1',; 'c' I r:"lv1fl/ )111 L, 1 ('I,'" ",' __..._-;-__u
I'.\l't'pl (1'0 IldIO\\'i, d~'l't'dl'IH did rHlll1laIT~', Wi!" Ihll (I1vor.:cd alld dl<J lIol have a duld born or udopwd
tine!" l'\l'l'lIIll1ll (lllhl' will olTnl'd for IHllhaH,'; W(\S [WIthe victim or a Killing and \\'as never adjudiclItcd
i IlL'{) 111Ilt'll'lll: ..._________._____...._,_..___.~
I>l'l.'\.'lldtlll HI death \lwlIl'd pr{lp('l'l~' wilh l'slil1liltcd \'allll'\ ii, follows:
(If dOlllil'ill'd in I'a.) All pl'r\ol1<.d prnpl'l'ly
(If !lot domil'ikd il\ PH,) I'L'r\Ollal pl'llpt'rt)' ill Pennsylvania
(II 1\01 dillllk'ikd ill I'.!.) l't,'f'>OlHlI propnty in Cnllllly
Valli!..' 1.11' IL'all''>t;tll'lll l'l'IlIl,>Yhalliaj! . /
,>iltl<lll'd a~ Illlhnh: " !(t'I;U {J 0
$ L/.!,' 0 ()c
$ ~~~D1jjl;tj.m-mr:
$ "'--..---..----
$._..."...............__...'-,~.
WIILKUORI. I'l'liliollel(" le'pel'lfllll~' 1'''<1",,'11') IiiI' prohal" of Ihe lusl will nnd codicil(sl
pre"'III"d 11I'1<'lIill1 and Ih,' glalllof kll"" ri,'~;'rfj(f'i!l..,rrtl.eY.. _...._m.....____.._..,_.__.._
Ihl'tUI1.
ll~'~lilflll'lllar); Udlllil\!\lhlll(Jl\ l',I.'iI,; mhninL,lrlujOfl d,h,n,c,t,ll.)
12-
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OATH OF PERSONAL REI'RESENTATIVE
COMMONWEAl,T1I OF I'ENNSYLVANIA
COl: NT\' OF C'JIM13ERT,Ai'll
I
, W"':,'
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Till' pl'lltjPlll'I('>) aIHl\'l'-tH-llllCd ,>\H';Il'(\) PI' allirm(;.,,) thaI the qalellH'llh illlh(' foregoing petition arc
11'11" illhll'lll'l'l'IIO,I,lll' IW~1 ullbe kllowll'dge a III I hl'.lil..'I.'."r 1.'.'..'lili01.'crl') iln.d.lltal a',':f.onal rcprescn.
lali"'I'1 "I' Illl' IIh"'l' lb",dl'III1l"ili""l'r(q \lill \I~)'1l4,1,\,I,'.I1i,J',:ill~"~!.h~, e,':;I/~~~llg 10 Inw.
S"tI'" I" "' IIllilllled illld ,"It"'lil>,:d I 7/j(((j-(/.../l,' I'.('.:~/_~~_IJ~~~___. ~
be 1"0 l"l' 11H' lhh ,9th dil;. nr (/ ... ..__.....__..__._ ~
()la/><j, 8!,C~;J:II.~~ I~ 97 . 1 .."~== ~
() IJ) I>. C:\ ->. , Iil",il'l'/' ;;;-
...," ,p,,c.\'r,,l~ " ._u_.__._........._..,~_ ~
1E~t!ill\till nttb Wes!nmeu!
KNOW ALL MEN BY THESE PRESENTS. That I, JEWELL I. REYNOL S,
of FOl'managh Township, Juniata CDunty, Pcnnsyl vania, !lCing Df iawful ago and
of sound mind, m(J11101~y and understandinA, do mako, publish and doelare this
instrumont to be my Last Will and Tostamont, heroby l'ovokinA and maldnA void
any and all fOI'mor WiI]s hy mo at any limo heretoforo made,
ITEM I; I dil'nd thai all illY just dobls which may be leAally owlnA and
colloctiblo, my funel'a] exponsns and nxpensos in "onnodion with tho adminis_
tration of my o"tato be paid as soon as pract:i.cable afte,' my dcath, I also
hereby direct: that all leAney, [iucccBsion, inhorltancc, b'alwfer and ostate
taxes which may bo lovied Ot' assossed upon ot' wlt:h I'osped to any property
which is included as part of my gl'oss ostate fOl' the purposos of any sueh t:ax
shall be paid by my Executor olll of my ostalo in the samo mallllDr as an expense
of administrat:ion and shall nnt bo prol'atcd 0" apportl(lOod among nor charged
against any property passing or which may have pasBod to any of them, and that
my Executor shall not be entitled to I'eimbur[iement for any portion of any such
taxes from any such person or porsonB,
ITEM II; I doviso and!mqlloath the rosiduo of my estate of every
nature and wherever situate to my husband, KENNETH L. REYNOLDS,
ITEM III: Should my husband, !<ENNETH L. REYNOLDS, predecease
me, then the residue of my ostate whet'ever situate is to be divided equally
among my three (3) children; ROBERT N. REYNOLDS, of R, D. I, Dillsburg,
York County, Pennsy,lvania ]70]9; WILLIAM C. REYNOLDS, of 19]8 Vinewood
Avenue, No, 2, Puob!o, Colorado 81005; and JUDITH E. REYNOLDS, of p, 0,
Box 392, Camp Hill, Pennsylvania 17011: however, if any of my said three (3)
children predeceases me, then his/her share is to be divide>d equally among 01'
between his/her surviving children, and if he/she has no childron which survive
him/her, then his/her share is to be divided equally betweon my surviving
children,
ITEM IV: I do hereby nominate, constitute and appoint my husband,
KENNETH L. REYNOLDS. Executor of this my Last Will and Testament, Shoul
my husband. KENNETH L. REYNOLDS, p,'edecease me, fail to qualify, 01' ceas
to act as Executol', I appoint my son, the gaid ROBERT N. REYNOLDS, Executo
of this my Last Will. I direct: that my ExecutOl' shall not be required to file a
bond in any jurisdiction, I heroby fully authorize and empower my Executor,
"
without order or authority of any Court, to 8ell, ~Ither at public or private sale,
exchange. lease, mortgage, pledge and hypothecate any and all of my real, per-
sonaland mixed o8tate, for such prlcos and upon such estatos, terms. periods
of tlmo and conditions as my said Execllhll' shaJl doom wise and expedient: and
to re-exec\lte such powors In his discretion fl'om time to Ume, and to do any
and all things that to him are deemod propel' until final set,tlement and distri-
bution are made hereunder; and to mako, exeC\lto and deliver good and sufficient
deeds, leases, mortga!!es, asslgnmonts, notos, ph1(lges and nthf,r assurances
in tho law that may be nocossary to cal'ry out such transacl:lnns, without any
liabillty on the part of s\lch purchasol', mortgagoe, etc., to soo to tho applic-
ation of the proceeds thoreof, and free and clear of any charlIe 01' trust herounde
ITEM V: In consideration of KENNETH L. REYNOLDS executinll his
Last Will and Testament on the same date as this instrument, I hereby expressly
covenant with said KENNETH L. REYNOLDS not to revoke, cancel, annul,
modify, amend 01' change this my Last Will and Tostament without his consent,
it being expressly understood and agreod that I shall respectively continue the
said provisions of this Last Will and Testament in offect during the respective
lives of myself and KENNE1'H L. REYNOLDS and at the time of our respective
deaths, and that said provisions shall be irrevocable.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
tli: day of ,)/./,'/.,'" , 1977,
'I")~" It
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I fJ'{ ul { 'Lc'yu[c'1J,. /;
ewe 11. eynold ./
/,1? (SEAL)
.
Signed. sealed, published and declared by the above named Testatrix
as and for her Last Will and Testament in the presence of us, who at her reque,st
and in her presence and in the presence of each other. have hereunto subscribed
our names as witnesses, all being presont at the same time,
.
_./
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