HomeMy WebLinkAbout04-16-07 (2)
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15056041147
REV.1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
.
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN 2 1 0 6
RESIDENT DECEDENT
File Number
0781
171421130
07292006
Date of Birth
01241916
Decedent's Last Name
STAUFFER
Suffix
Decedent's First Name
SARA
MI
B
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
D 1. Original Return
D 4. limited Estate
9. litigation Proceeds Received
0 2. Supplemental Return D 3. Remainder Return (date of death
prior to 12-13-82)
0 4a. Future Interest Compromise D 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust 0 8. Total Number of Sate Deposit Boxes
(Attach Copy of Trust)
D 10 Spousal Povert Credn (date of death D 11. Election to tax under Sec. 9113(A)
. between 12-31- 1 and 1-1-95) (Attach Sch. 0)
00
D
6. Decedent Died Testate
(Attach Copy of Will)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD B~ ,?IRECTED TO:
Name Daytime Telep",",e Number :-,::-;
EDMUND G. MYERS 7177614::$<!-0 ::.:;
~-.': =cJ ~
-::] ~
Firm Name (If Applicabte)
JOHNSON DUFFIE
_'...i
REGISTER OF Wij.;a;.-5lUSE OllIL Y
-, c:; c-,
First line of address
301 MARKET STREET
--i
N
Second line of address
a
City or Post OffIce
LEMOYNE
DATE FILED
State
PA
ZIP Code
17043
Correspondent's e-mail address:
Under penalties of ~rjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knoWledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN . '-l~~ ^1
<::T'\ .J IIh _ f;J~g...... . David M Stauffer If 0 U
ADDRES~ ' -
EDMUND G MYERS
DATE
4: 13 - 01
301 MARKET ST., Lemoyne, PA 17043-0109
Side 1
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15056041147
15056041147
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ESTATE OF
Stauffer, Sara B
PA Inheritance Tax Return
Signature of Additional Fiduciaries
FILE NUMBER
21-06-0781
Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information
of which preparer has any knowledge.
Signature #2
Name
Address1
Address2
City, State, Zip
Date
.: !
Evan E Stauffer Jr
2800 larkin Road
Boothwyn, PA 19061
l/l (~7
t
II
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15056042148
REV-1500 EX
Dacedent'sName: Sara B Stauffer
RECAPITULATION
Decedent's Social Security Number
171421130
1. Real Estate (Schedule A).......................................................................................... 1.
2. Stocks and Bonds (Schedule B)............................................................................... 2.
16,894.99
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages & Notes Receivable (Schedule 0).......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 5.
70,753.90
6. Jointly Owned Property (Schedule F) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D Separate Billing Requested............. 7.
217,561.69
8. Total Gross Assets (total Lines 1-7)....................................................................... 8.
305,210.58
6,618.77
764.30
7,383.07
297,827.51
9. Funeral Expenses & Administrative Costs (Schedule H)......................................... 9.
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)................................ 10.
11. Total Deductions (total Lines 9 & 10)...................................................................... 11.
12. Net Value of Estate (Line 8 minus Line 11)............................................................. 12.
13. Charitable and Governmental Bequesls/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPUCABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
297,827.51
0.00
15. o . 00
16. 13,402.24
0.00
17.
0.00
18.
19. 13,402.24
297,827.51
0.00
19. Tax Due.......................................... ...........................................................................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
D
Side 2
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lS[]56042148
15[]56[]42148
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-06-0781
DECEDENT'S NAME
Sara B Stauffer
STREET ADDRESS
325 Wesley Drive
Bethany Village
CITY I STATE [ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
10,500.00
552.63
Total Credits (A + B + C)
(2)
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
13,402.24
11,052.63
2,349.61 i
2,349.61
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.................................................................................. ~
~: ::::~ :~e~::i~~:~:~~a~es~~..~.~.~~~.~~~.~~~.:.~.~~.~.~.~~~~~.~~~~~..~~.i~.~~~~~~:::::::::::::::::::::::::::::::::::: D
d. receive the promise for life of either payments, benefits or care?.............................................................. D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?... ........... .................... ......... ................... .......... .............................................. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ [!]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?........... ................................ ................... ................................................ ........ D [!]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
No
~
~
[!]
D
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P.S. ~9116 1.2) [72 P.S. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
...
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Rev-1 &03 EX + (6-111
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stauffer, Sara B
FILE NUMBER
21-06-0781
All property Jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 74005P104 219 shares of Praxair Inc - Com. EstateVal valuation is 54.315 11,894.99
attached to this Return
2 U.S. Treasury Note/ Maturity Date 12/31/2006 5,000.00
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TOTAL (Also enter on Line 2, Recapitulation) 16.894.99
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
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Rev-ll08 EX + (8-88)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stauffer, Sara B
FILE NUMBER
21-06-0781
Include the proceeds of litigation and the date tha proceeds were received by the estate.
All property JOlntly...wnod with the right of survivorship must be dleolosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Asbury Communities (Bethany Village) - Refund for Nursing Home Care 974.70
2 Magazine Subscription Refund 21.07
3 Medicare Supplemental Insurance Refund 170.75
4 PNC Bank Certificate of Deposit Account No. 31200268702 10,010.19
5 PNC Bank Certificate of Deposit Account No. 31300252431 30,053.47
6 PNC Bank Certificate of Deposit Account No. 31400252653 10.023.98
7 PNC Bank Certificate of Deposit Account No. 31600283828 7.659.75
8 PNC Bank Checking Account 5070075799 11.585.07
9 PNC Bank Money Market Account No. 5080034288 254.92
TOTAL (Also enter on Line 5, Recapitulation)
70,753.90
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
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Rev.lfilD EX+ (8.IS)
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SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF peNNSYLVANIA
INHeRITANce TAX ReTURN
ReSIDeNT DeceDeNT
Stauffer, Sara B
FILE NUMBER
21-06-0781
ESTATE OF
This schedule must be completed and filed W the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM T DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Commonwealth Financial Network Investment 216.821.29 216.821.29
Account No. HDS-086860 - Transfer on Death
Account
Beneficiaries on Account: Evan Stauffer, David
Stauffer
2 City of Philadelphia Pension Payment - Pension 201.00 201.00
terminated upon Death.
3 EE $500 Savings Bond - Transfer on Death to 539.40 539.40
David Stauffer
TOTAL (Also enter on Line 7, Recapitulation) 217.561.69
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (12-81'
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stauffer, Sara B
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-0781
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 682.54
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
- .
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Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Johnson Duffie 5,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant ,-
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 185.00
5. Accountant's Fees
6. Tax Return Preparer's Fees 400.00
7. Other Administrative Costs 351.23
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 6,618.77
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
,
Rev-l &02 EX + (&-'8)
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SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stauffer, Sara B
FILE NUMBER
21-06-0781
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Bethany Village - Memorial Services
210.00
2
Memorial Service Honoria - Pastor and Organist
150.00
3
Parthemore Funeral Home
322.54
Subtotal
682.54
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1602 EX+ (6-88)
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SCHEDULE H.87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stauffer, Sara B
FILE NUMBER
21-06-0781
ITEM
NUMBER
1
DESCRIPTION
Cumberland County Register of Wills Office - Filing Fees for Inheritance Tax and
Inventory
AMOUNT
30.00
2
Cumberland County Register of Wills Office - Additional Probate Fees
75.00
3
Cumberland County Register of Wills Office - Additional Short Certificates
8.00
4
Cumberland Law Journal - Notice of Estate Administration
75.00
5
Patriot News Co. - Notice of Estate Administration
163.23
Subtotal
351.23
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
R.y.1612 EX+ (1.81)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMON~THOFPENNSYlVAN~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stauffer, Sara B
FILE NUMBER
21-06-0781
Includ. unl1llmbul1l.d medlc.1 ...p.n....
ITEM
NUMBER DESCRIPTION
1 AARP Premium Payment
VALUE AT DATE
OF DEATH
170.75
2 Alert Pharmacy
89.32
3 Checks Clearing after Date of Death
250.00
4 City of Philadelphia - Pension Refund
6.73
5 East Pennsboro Ambulance
220.00
6 Flagship Rehabilitation
16.50
7 West Shore School District - Yearly Assessment
11.00
TOTAL (Also enter on Line 10, Recapitulation)
764.30
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1613 EX+ (8-00)
.
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Stauffer, Sara B
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
aistributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not Llat Trustee'a'
FILE NUMBER
21-06-0781
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
I.
David M Stauffer
4118 Overlook Drive
Jarrettsville, MD 21084
Son
1/2 of Estate
Evan E Stauffer, Jr
2800 Larkin Road
Boothwyn, PA 19061
Son
1/2 of Estate
Total
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
ESTATE OF SARA B. STAUFFER
SCHEDULE OF EXHIBITS
EXHIBIT A Last Will and Testament signed by Sara B.
Stauffer dated February 25, 1981
EXHIBIT B Estate Val Valuation for Praxair Stockfor Date of
Death
EXHIBIT C PNC Bank Valuation of Decedent's Assets
EXHIBIT D Commonwealth Financial Network Valuation of
Decedent's Assets
:2938/5
EXHIBIT A
..' .' '. .~ ...:........ .,~.,~
"-_ c-~.~
~:.....
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CG7
LAS'!' WIll, AlID 'lImA!' [HI'
OF
Sf-.RA B. ::lTt,tJFJ7I-.'Il
I, ~;J\RA t. m'AlJl;>}'[Ji of EaltillPre County. I.arylr:no. beinr; of seluna
and dlspo!llne mind, 1leJ!D1"y und undf,ratancllil[; ond capable of execut:1ng a valid
deed or contract, do l1erel.Jy maJ.-e, publish flJ1d declarethla inatrunent to be
Iii}' last \...lll Dnd Tf:Btanent, he~by rovokln[; and cancel:llnr: all forner wills
and codicils by Ire at ~. t1lre nncle.
PITlST: I direct nw Persooal r.epreaentati ve to payor cause to be
paie.! and satisfied all of my legal del)tn and the expenses of illY .lallt illness,
f\ll1enl.l and interIl~mt m sueh DlOO\.lI'lts as he n~y deem to be prqJer, as soon arte
illY death all I~ be pracUcable. "'lY said Personal Pepresentative is authorized,
en powered and d1rectec1 to :incur such bills and expe:nfles for my funeral and
mtenrent as m his discretion are prq>er, l'ritlxlut rer.:ard to any l1mitatioo
!ntJQ8l..'1l by law or rule of' Court :in force at IllY leg,al domicile at the t1n2 of
illY denth. Further, I d:1.:rect tlmt nu PerlJ01al Hepresentati.ve payout of IIW
l"eoidUi.II;/ estate, \/ithout appcrtiorlllent. nIl Nltnte, inher1.~"Uice md like
taxes 1nposed by tile l!'Overnr.ent of the United ~ltate[1 01' atl~' state or territory
thereof :in respect of 'all propf:rty requ.1red to be included in nw I]'I'OSl3 estate
for estate or 11~:e tax PllI'poses by an,v ouch govemnents llbetlier tte prqJerty
pa.sses wider this Vlill or otherwise, without any ccntribution by any recipient
of any such property.
SEOOND: I gl.ve, devise SlitI bequeath all the refit, residue and rdincle
of lilY estate, property and errectfl, real, pereonn1 find ndj:ed, wtntl!oever and
\./b.::revel" situate Wlto my chUuren, F.VAI'1 E. s'mtWI'I:'R. JH. ond DAVIn N. :3'l'AtH:ofi'EJ\.
in equal parts, 5hare and share n11ke, abso1ute~', and :in fee smple pl'Ovided
that they 81Jal1 aur'V1ve (fa by nlnet;y (90) da.vs, jn the event that either child
sh2.ll not aur'V:1.ve I;e by ninety (90) dayl1 hut nliall It!ave n child or children
who do survive me by ninety (90) days then said cb1111 or children shnll tnke
the deceased parent's share, othem1se, if there be no aurir.!. vint!. child or
chiJ.dren. lilY surviving cldlrl sllllll take the whole.
'IlIIllD: In the event lIlY children shall not aur-v1ve Ire by ninety (90)
cU1ys, and lilY children leave no child or children who survive lie by ninety (90)
dl"vs. and I would otherwise die without a direct decendent, I then maJre the
'.f
f'ollowinr; clim'itable leqlleatll, hy eiv1n{!, devis1l'll:, and bequeathine all the
l'~st, r-eshlue and rellk'l1l1(lel' of IT'd property and effects, real, persrnal and
nd.xed, htJ.:-t.t:;o3vur and 1'lhcIi-;soew!I' situate, unto the DETIIAIJ'I VTLLl\CE Rm.'Im'en'
em'B'n, ~1e('.l:lBIl1cahurg, Penns~'lvaI11a snd the UEANJN VAUEf rorlI'ilE, Annville,
P,mnnylvlInla, their successor or successors, in equal parts, share and share
alike. abflolutely, and in fee s:1nple.
FOllfi'm: I hereby nor:dnate, const1tutc and appoint rcw 80m'!, ,EVJ'II1 E.
:;".'f,lU?FtR, JIL and DPVID H. C'i'AUJi'Ti'ETI, to act as Per300al Reprecentattveo of tilts
lilY l.A~,.r WIIL AND 'l'Ef.Tf.r.'IEI-I'I, IInd exprellsl.v request that they be exerrpt frcm the
neceSG.l.ty of f").v1ng bond. I hereby E:'1ve I'l\V Persorw.l Representatives full power
Hnd d1rwret1.on 1n the manacel:-ent and control of Il'i!f estate, re!.'.l, personal, and
WiXE.l, wilt! the t'1eht and pO-vier to sell all, or any portion thereof, \'II11ch they
01' he Hay cl!:!€11I a.:lvisable or i\ec.;,sB81'Y for the pa~"lIent of nw ler:aJ, debts or the
~,ivlmt:.lf,e01m ::JC:lttlen;nt of' ro,y er:tate, 'iTttlDut the necessit;:r of rraldJI{~ 3)1p11-
outien to, 01' of obta.inin[ the approval of any Court; and no purchaser from
IllY Daid Personal Rel'reflent.ot:tver. al.all be under any obl1gatirn to Dee to the
<l!lpltcatlcn of l'urcl1a!Je lTKil1ey.
m rl~EBTJ}lONY HllERI.OF, I have hereunto set Ir.J' hand and sMl to tilts
11({ ].J\.'JT ~IIIL IIND TIT.'1'l~U€NT, 1n Hestl'rlnster, rilaryland, thiS':-J.-S~y of
l"? lL'Ot;T-.--' 1981.
,/~:I J<<Hl.;...l; ~1!.?tt,IIt'::!.j_._(~rgAL)
JAr B. n'l'AUFFNl It-'.
'lhe foregoing 1nstrument. c.onsiSt1nl!; of this and two other typewritten
pvees \\'118 s:l.f!Tled, Bealed, publ1uhed and declared tJY SARA B. STAUFFER, the
here1n i1B.Jred Testator as for her Last Will and TestaJoont, in our presence
-2-
and jIl the presence of each other. we bave heretmto BubscrllJed our narres as
attesting witnesseB.
. ,
I/~/ //t;/v. {1' j/ / It A 'hi
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i\ddreOG II _-!...:-!!..:. . .;... .'. .,.fI.vl
dl.t:);/)!r.I.?I)~((-I )xr( .)}J<;}
/ < I 7),:, III -T" l' (' ';;:1 ~ l:l
~'),t-J- /' .(..{ C, I'. I t (,- 1(..
I i\ddress P;'-,-Lj I/Lt ~~ 7J;;-l
/tie )/)7-'(';' 1/u, Ill.! ) II ) )
.
-3-
EXHIBIT B
- - - - -~~-~.'" - --_...~ -- --- -
Estate Valuation
Date of Death: 07/29/2006
Valuation Date: 07/29/2006
Processing Date: 02/02/2007
Estate of: Stauffer, Estate of Sara
Account: 9741-1
Report Type: Date of Death
Number of Securities: 1
rile ID: Stauffer
Shares
or Par
Security
Description
High/Ask
Low/Bid
Mean and/or Div and Int Security
Adjustments Accruals Value
1)
219 PRAXAIR INC (74005P104)
COM
New York Stock Exchange
07/28/2006
07/31/2006
54.78000
55.12000
53.60000 H/L
53.76000 H/L
54.315000
11,894.99
Total Value
Total Accrual
Total $11,894.99
$11,894.99
$0.00
Page 1
This report was produced with EstateVa1, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4)
EXHIBIT C
OCT-12-2006 22:12
PNCBANK
I .
~ PNCBAN<
October 13, 2006
Dana L. Wieseman
301 Market Street
P.O. Box 109
Lemoyne, PA 17043-0109
RE: Estate of Sara B. Stauffer, (Deceased)
SSN: 171-42-1130
DOD: 07/29/2006
Dear. Ms. Wieseman
412 768 3458
In response to your request for Date of Death balances for the: customer notcd above, our
records show the following:
Certificate of Deposit
I Account # 31400252653
SARA B STAUFFER
DOD balance: 510,000.00 + $23.98 accrued interest
? Account # 31300252431
SARA B STAUFFER
DOD balance; 530,000.00 + $53.47 accrued interest
j Account # 31200268702
SARA B STAUFFER
DOD balance: 510,000.00 + $10.19 accrued intereSt
~ Acoount # 31600283828
--
SARA B STAUFFER
DOD balance: 57,640.88 + $18.87 accrued interest
Checking Account
Account # 5070075799
C I Dse.dL
SARA B STAUFFER
DOD balance; $11,583.01 + $2.06 accrued interest
'-
Savings Account
Account # 5080034288
SARA B STAUFFER
DOD balance: $254.92 + SO.oo accrued interest
Established 12/08/2004
Establishcd 12/08/2004
Established 07/22/2005
Established 08/10/2004
Establishcd OS/27/1993
Established 05/31/1995
P.01/02
1
OCT-12-201216 22:12
PNCBANK
412 768 3458
j , . l
Please note that this office only provides date of death balances for deposit accounts
(IRAs. CDs, Checking and Savings accounts). We do Dot process illY ftnlllcial
trallsdons or provide statements. If you need assistance with any of these items,
please call1~888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
SincerelY,
~
1-800-762-1775
P7-PFSC-04-F
500 First Avenue
Pittsburgh PA 15219
Member FDIC
P.12l2/12l2
2
TOTAL P.12l2
EXHIBIT D
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