HomeMy WebLinkAbout05-07-07
REV-15oo EX (6.00)
OFFICIAL USE ON L Y
. ..
.
COMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
~L 0134 ___
YEAR NUMBER
REV.1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
--1L
COUNTY CODE
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ III ~
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ 2/6/2006 5/9/1912
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
C
E
SOCIAL SECURITY NUMBER
113-16-5517
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
W
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[X] 1. Original Retum
D 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82)
D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (date of death between t2-31-9t and 1-t-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
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Robert R. Church, Es .
FIRM NAME (If Applicable)
Keefer Wood Allen & Rahal, LLP
TELEPHONE NUMBER
P.O. Box 11963
Harrisburg, PA 17108-1963
717-255-8059
1. Real Estate (Schedule A)
426,603
2,498,819
o
25,000
152,891
o
~~J
~ICIAL USE ~
(1)
2. Stocks and Bonds (Schedule B)
(2)
-~(
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
z
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ii:
c:(
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W
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4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
C")
1,704,306
8. Total Gross Assets (total Lines 1-7)
(8)
4,807,619
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
187,523
5,249
1 O. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
(11)
192,772
4,614,847
o
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(12)
(13)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
4,614,847
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
z rate, or transfers under Sec. 9116 (a)(1.2)
o
~ 16. Amount of Line 14 taxable at lineal rate
I-
::l
~ 17. Amount of Line 14 taxable at sibling rate
o
(J 18. Amount of Line 14 taxable at collateral rate
)(
~ 19. Tax Due
20. [R]
o
4,614,848
o
o
x.O L(15)
x.O 45 (16)
o
207,668
o
x .12 (17)
x .15 (18)
o
207,668
(19)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
~
Yes
D
D
D
D
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] 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.
Under penalties of perjury. I declare that I have examined this retum. including accompanying schedules and statements. and to the best of my knowledge and belief. it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information which preparer has edge.
Decedent's Com lete Address:
SlREET ADDRESS
495 ~. 25th Street
Cumberland Count
CITY
Cam Hill
STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
o
220,000
9,000
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
o
o
TotallnterestlPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE
Make Check
(5B)
to: REGISTER
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1 . Did decedent make a transfer and:
a. retain the use or income of the property transferred;. . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income; .
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promise for life of either payments, benefits or care? . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RElURN
C stal U. Hackett Co-Executor
ADDRESS
110 Bergner St, Harrisburg, PA 17110
SIGNATURE OF PREPARER OTHER THAN REPRESENTATlvyj () ~ P I
Robert R. Church, Esq. ~. ~. ~~
ADDRESS
ZIP
17011-
207,668
229,000
o
21,332
o
o
o
No
~
~
~
[1a
[Jg
[Jg
DATE
.s2.
401 N. Fairfax St, A1exandria,VA 22314
DATE
Itf>r." 2. IP, Z,()07
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 3%
[72 P.S. 99916 (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 0% [72 P.S. 99116 (a) (1.1) (ii)]
The statute does not exempt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax retum 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 steppanent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. 9 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.
3W4646 1.000
REV-1502 EX + (6-98)
f ,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Mary E. Allyn
21 06 0134
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at v.i1ich property would be
exchanged between a willing buyer and a willing seller. neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Real Estate at 495 N. 25th
Street, Camp Hill, Cumberland
County, Pennsylvania, recorded
in Cumberland County Recorder
of Deeds Office, Deed Book 15,
Volume s, Page 551; valued at
the sale proceeds $426,603.13
426,603
3W46951.000
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
426,603
REV-1503 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE 8
STOCKS & BONDS
FILE NUMBER
MaI:y E. Allyn
21 06 0134
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATIE
OF DEATH
1. 4,512 Shares
Air Products & Chemicals Inc, DOD
Value $62.51 per share, NYSE
CUSIP: 009158106
Dividend accrued on 2/6/2006
282,045
1,444
2 1,446.314 Shares
Alliance Bernstein ~d Cap Grwth
CI A, DOD Value @ $6.88 per share,
NASDAQ
CUSIP: 018636100
9,951
3 1 , 200 Shares
Altria Group Inc, DOD Value @
$71.465 per share, NYSE
CUSIP: 02209S103
85,758
4 6,534 Shares
American Express Co, DOD Value @
$52.10 per share, NYSE
CUSIP: 025816109
Dividend accrued on 2/6/2006
340,421
784
5 1,306 Shares
Ameriprise Financial Inc, DOD
Value @ $42.92 per share, NYSE
CUSIP: 03076C106
Dividend accrued on 2/6/2006
56,054
144
6 328 Shares
BP PLC, DOD Value @ $69.96 per
share, NYSE
CUSIP: 055622104
22,947
7 400 Shares
Bristol Myers Squibb Co, DOD Value
@ $22.435 per share, NYSE
CUSIP: 110122108
8,974
8 2,400 Shares
Disney Walt Co, DOD Value @
$25.155 per share, NYSE
CUSIP: 254687106
60,372
Total from continuation schedules
1,629,925
TOTAL (Also enter on line 2, Recapitulation) $
2,498,819
3W46961.000
(If more space is needed, insert additional sheets of the same size)
.
Estate of: Mary E. Allyn
113-16-5517
Schedule B (Page 2)
Item
No. Description
Value at Date
of Death
9 23,012.674 Par
DMC Tax Free Income Tr PA Sh Ben
Int A, DOD Value @ $8.08 per
share, NASDAQ
CUSIP: 233216100
185,942
10 1,938.629 Shares
DWS Technology Fd Cl A, DOD Value
@ $11.78 per share, NASDAQ
CUSIP: 81123F108
22,837
11 15,732.957 Shares
Franklin Custodian Fds Inc Fd Cl
A, DOD Value @ $2.44 per share,
NASDAQ
CUSIP: 353496300
38,388
12 18,297.42 Par
Franklin Tax Free Tr PA TF Inc A,
DOD Value @ $10.39 per share,
NASDAQ
CUSIP: 354723801
190,110
13 126 Shares
Hewlett Packard Co, DOD value @
$30.15 per share, NYSE
CUSIP: 428236103
3,799
14 589 Shares
Illinois Tool Works Inc, DOD Value
@ $84.285 per share, NYSE
CUSIP: 452308109
49,644
15 800 Shares
Johnson & Johnson, DOD Value @
$57.105 per share, NYSE
CUSIP: 478160104
45,684
16 456 Shares
JP Morgan Chase & Co, DOD Value @
$39.455 per share, NYSE
CUSIP: 46625H100
17,991
17 870 Shares
Lehman Bros Hldgs Inc, DOD Value @
$139.41 per share, NYSE
CUSIP: 524908100
121,287
Total (Carry forward to main schedule)
675,682
Estate of: Mary E. Allyn
113-16-5517
Schepule B (Page 3)
Item
No. Description
Value at Date
of Death
18 74 Shares
M & T Bank Corp, DOD Value @
$106.59 per share, NYSE
CUSIP: 52261F104
7,888
19 400 Shares
Mellon Finl Corp, DOD Value @
$34.67 per share, NYSE
CUSIP: 58551A108
Dividend accrued on 2/6/2006
13,868
80
20 1,800 Shares
Merck & Co, DOD Value @ $34.015
per share, NYSE
CUSIP: 589331107
61,227
21 265 Shares
Mid Penn Bancorp Inc, DOD Value @
$26.95 per share, ASE
CUSIP: 59540G107
7,142
22 100 Shares
Pepsico Inc, DOD Value @ $57.173
per share, NYSE
CUSIP: 713448108
5,717
23 14,341.378 Par
Putnam PA Tax Exempt Inc Fd Sh Ben
Int, DOD Value @ $9.10 per share,
NASDAQ
CUSIP: 746852102
130,507
24 1,461.895 Shares
Salomon Bros Invs Value Fd Cl 0,
DOD Value @ $20.85 per share,
NASDAQ
CUSIP: 795478106
30,481
25
26
730 Shares
Tupperware Brands Corp, DOD
@ $21.952 per share, NYSE
CUSIP: 899896104
300 Shares
Susquehanna Bancshares Inc PA, DOD
Value @ $23.795 per share, NASDAQ
CUSIP: 869099101 I
Dividend accrued on 2/6/2006 :
I
I
I
I
valut
I
I
7,139
72
16,005
Total (Carry forward to main schedule)
280,126
- I
Estate of: Mary E. Allyn
113-16-5517
Sche~ule B (Page 4)
Item
No. Description
Value at Date
of Death
27 1,000 Par
US Treasury Bond Series H
Certificate # M17472030H dtd 05/78
Registered to Russell E Allyn or
Mary E Allyn
DOD Value $1,000
Accrued Int to DOD $10.89
Interest accrued to 2/6/2006
1,000
11
28 10,000 Par
US Treasury Bonds Series H
Certificate # X3071461H dtd 05/78
Registered to Russell E Allyn or
Mary E Allyn
DOD Value $10,000
Accrued Int to DOD $108.89
Interest accrued to 2/6/2006
10,000
109
29 10,000 Par
US Treasury Bonds Series H
Certificate #X3071462H dtd 05/78
Registered to Russell E Allyn or
Mary E. Allyn
DOD Value $10,000
Accrued Int to DOD $108.89
Interest accrued to 2/6/2006
10,000
109
30 10,000 Par
US Treasury Bonds Series H
Certificate # X3071460H dtd 05/78
Registered to Russell E Allyn or
Mary E. Allyn
DOD Value $10,000
Accrued Int to DOD $108.89
Interest accrued to 2/6/2006
10,000
109
31 1,000 Par
US Treasury Bonds Series H
Certificate # M17472029H dtd 05/78
Registered to Russell E Allyn or
Mary E Allyn
DOD Value $1,000
Accrued Int to DOD $10.89
Interest accrued to 2/6/2006
1,000
11
Total (Carry forward to main schedule)
32,349
Estate of: Mary E. Allyn
113-16-5517
Sche~ule B (Page 5)
i
,
Item
No. Description
Value at Date
of Death
32 10,000 Par
US Treasury Bonds Series H
Certificate # X3071459H dtd 05/78
Registered to Russell E Allyn or
Mary E Allyn
DOD Value $10,000
Accrued Int to DOD $108.89
Interest accrued to 2/6/2006
10,000
109
33 152 Shares
Verizon Communications, DOD Value
@ $31.65 per share, NYSE
CUSIP: 92343V104
4,811
34 11,632 Shares
Wachovia Corp 2nd New, DOD Value @
$53.89 per share, NYSE
CUSIP: 929903102
626,848
Total (Carry forward to main schedule)
641,768
REV-1507 EX + (6-98)
. .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Marv E. Allvn
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
FILE NUMBER
21 06 0134
All property jolntly-owned wi h right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1 25,000 Par
Loan receivable from Russell E.
Allyn Estate, advance of cash for
deceased husband's estate
administration
TOTAL (Also enter on line 4, Recapitulation) $
3W46AC 1.000
(If more spac is needed, insert add~ional sheets of same size)
VALUE AT DATE
OF DEATH
25,000
25,000
- I
REV-1;08 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASI~, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Marv E. All vn
Include the proceeds of lit gation and the date the proceeds were received by the estate.
All property jointly-owned w th the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
1
2005 Form 1040 Refund
2
2005 Form PA-40 Refund
3
2006 Form 1040 Refund due decedent
4
2006 Form PA-40 Refund
due decedent
5
Citizen's Bank Checking Account
#621309-847-3
6
Citizen's Bank Joint checking
account # 610067-789-3
Registered to Mary E. Allyn and
Russell E. Allyn (deceased), JT
WROS
7
Eshenauers Fuel Oil refund
8
Genworth Financial Final Payment
for long-term care insurance
9
Household Goods & Personal
Property sold at auction
Gross auction proceeds $ 11,535'.00
less commission $2,883.75
10
Household Goods and Personal
Property sold at tag sale gross
proceeds $40,571.65 less
commision and expenses $10,642.~0
valued at net sale proceeds
$29,928.75
11
Ryan Beck Money Market Account
#A8T-001660
Interest accrued to 2/6/2006
12
Sale of remaining oriental rugs
valued at sale proceeds
13 Verizon refund for telephone
service
3W46AD 1.000
TOTAL (Also enter on line 5 Recaoitulation) $
(If more spac, is needed, insert additional sheets of the same size)
FILE NUMBER
21 06 0134
VALUE AT DAtE
OF DEATH
1,199
57
1,256
500
15,268
24,925
2,805
1,540
8,651
29,929
66,488
10
250
13
152,891
I
REV-1510 EX + (6-98)
. .
SCHEDULE G
INTE R-VIVOS TRANSFERS &
MISC. t ON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary E. Allvn
FILE NUMBER
21 06 0134
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INClLOE Tt-E ~E OF n-e TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBEF TI-E DATE OF TRMSFER ATTACH A COpy OF THE oeeo FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. Russell E. Allyn Family Trust
under Will 1,691,111 100.0000 0 1,691,111
Interest accrued to 2/6/2006 13,195 100.0000 13,195
I
TO AL (Also enter on line 7, Recapitulation) $
1.704 306
(If more space is neede~, insert add~ional sheets of the same size)
3W48AF 1.000
REV-1511 EX+ (12.99)
SCHEDULE H
FUNERAL EXPENSES &
ADI~INISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
MJ'lr'V E. All vn
Debts of dE edent must be reported on Schedule I.
ITEM
NUMBER
DEpCRIPTION
A.
FUNERAL EXPENSES:
1.
Linda Lowrie
reimbursement for internment fees
at Rolling Green Cemetery
Total from continuation sche1ules
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Name of Personal Representative(s) ~tal U. Hackett
Social Security Number(s) I EIN Number of P~rsonal Representative(s)
,
Street Address 110 Berqner Stre,t
City Harrisbura
State P A
Zip 17110
Year(s) Commission Paid: 2007
2.
Attorney Fees
3. Family Exemption: (If decedent's address is not~he same as claimant's, attach explanation)
Claimant
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Citizen's Bank
Bank Service Fees
charges
& check pr~nting
I
I
Total from continuation schedules
3W46AG 1.000
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needE d, insert additional sheets of the same size)
FILE NUMBER
21 n6 0134
$
AMOUNT
1,195
7,288
90,000
85,000
1,529
43
2,468
187 523
Estate of: Mary E. Allyn
I
Sche ule H Part 1 (Page 2)
113-16-5517
Item
No. Description
2 Musselman Funeral Home
3 West Shore Country Club
Total (Carry forward to main schedul )
Amount
5,981
1,307
7,288
i_
Estate of: Mary E. Allyn
113-16-5517
Sche ule H Part 7 (Page 2)
2 J Kenneth Lowrie
I
Reimbursment of CO-Executor'r 268
expenses
3 Keefer Wood Allen & Rahal LL~
reserve for administrative
expenses 1,000
4 Linda Lowrie miVing
Reimbursement for expenses
personal property I 600
i
5 Lucille Ernst
Cleaning services 600
Total (Carry forward to main schedul )
2,468
r
REV-1512 EX + (12-03)
. .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
D BTS OF DECEDENT,
MORT AGE LIABILITIES, & LIENS
FILE NUMBER
4
Report debts incurred by the decedent prior to death w ich remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
VALUE AT DATE
OF DEATI-j
Brockie Pharmatech
prescription drugs
1,359
2 Connor Rich Associates
medical services
33
3 Don Wagner Landscaping
Fee for Snow Removal
55
4 Homeland Center
nursing home expenses
1,434
5 Lucille Ernst
Cleaning services
675
6 PA American Water
water service
290
7 PA Dept of Revenue
2005 PA-40 personal taxes due
1,000
8 Penn Was te
trash services
53
9 PPL
electric service
182
10 Susquehanna Township EMS
ambulance services
95
11 Verizon
telephone service
73
3W46AH 2.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is nee ed, insert additional sheets of the same size)
5 249
REV-1513 EX+ (9-00)
~ CHEDULE J
~ENEFICIARIES
COMMONlNEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Marv E. Allvn
NUMBER
I
NAME AND ADDRESS OF PERSON(S) REC IVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spou~al distributions, and transfers
under Sec. 9116 (a) (1.2)] !I
Linda M. Lowrie
401 N. Fairfax Street
Alexandria, VA 22314
1
50% Residue: 2,307,424
2 Susan J. Ratcliff
329 S Lee Street
Alexandria, VA 22314
50% Residue: 2,307,424
FILE NUMBER
21 06 0134
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Daughter
Daughter
2,307,424
2,307,424
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS Sf OWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 911 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTlkms
3W46AI 1.000
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
$
o
WILL AND TESTAMENT OF
I, MARY E. ALLYN, f 495 North 25th Street, Camp Hill,
Cumberland County, Penn ylvania, do hereby make this my Last ~ill
!
and Testament, any former wills and Codicils made bYlme.
I
FIRST: I am marri d to Russell E. Allyn, and all refere~ces
I
MARY E. ALLYN
to my husband in this W'll are to him.
(born May 7, 1949).
I have two children:
I
1944); and- Linda Moore Low~ie
Susan Jean Ratcliff
adopted by my
se and any other children born to or
me are described in this will as "m~
children," or as "a chi
of mine." Any person bor::1 to or
adopted by a child of m'ne is described in this will as "my
issue. II Provided,
er, no adopted person shall benefit
hereunder unless the or er or decree of adoption is entered
before such adopted per on attains the age of twenty-one (21)
years.
SECOND: I give my tangible personal property and all
casualty insurance that I am carrying on said tangible person~l
property to my husband, Russell E. Allyn, or, if he does not
survive me, I give said property to such of my children who ane
living at my death to b divided equitably among or between tlem
as they may determine, r, if they are unable to agree, as my !
Executor shall determin , after considering the wishes of suc~
children. I have compl te confidence that my husband, my
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children or my Executor ill honor any written instructions that
I may leave with regard t said tangible personal property. Any
such property not so distributed shall be sold, and the proceeds
added to my residuary estate to pass as hereafter described.
THIRD: If my husba ,Russell E. Allyn, shall survive me,'I
bequeath to my Trustee, ereinafter named, IN TRUST NEVERTHELESS,
cash, securities or othe property in the amount specified below,
to be known as the "Bypass Trust."
(1) The bequest shall be $600,000, subject however, to
Paragraphs (2) and
(2) The
increase or decrease, based upon
the availabili -c"' of my f deral unified credit for estate and gift
taxes and the maximum allowable federal estate tax credit for
state death taxes (but 0 to the extent that the use of such
state death tax credit d not increase the death tax payable to
any state), whether due 0 statutory changes, lifetime gifts in
excess of the federal un'fied estate and gift tax exemption-
(3) The beque
credits aforesaid.
equivalent amounts, or a
other transfer which affects the
availability of my feder
shall decrease, even to zero, if
:i.1ecessary to reduce fede
tax payable as a result cf my
death to zero (excluding, however, any federal estate tax due as
a result of an excess re irement accumulation under section 4980A
of the Internal Revenue ode of 1986, as amended, or such similar
section as may then be i effect), considering that my intention
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is to fund the Bypass T
credit for estate and
for state death taxes
balance of my federal
tax unlimited marital
FOURTH: I give, and bequeath the rest, residue and
remainder of my estate, and personal, to my husband. Shoqld
he not survive me, I giv , devise and bequeath such rest, residue
and remainder to my Trus ee, hereinafter named, IN TRUST NEVER~
THELESS, to be held, adm nistered and distributed for all
purposes as part of the ypass Trust.
L~F~H: The Bypass rust shall be held, administered and
distributed as follows:
(1) My Truste shall pay to or apply for the benefit
of anyone or said husband, my children and my issue,
until division into pursuant to Paragraph (5), all of the
net income from the s Trust in convenient installments in
such shares and proporti Trustee in its sole discretion
shall determine primaril for the medical care, education,
support and maintenance reasonable comfort of my said husband,
children and issue, taki 9 into consideration to th2 extent my
Trustee deems advisable, any other income or resources of my said
husband, children ue known to my Trustee, considering that
my husband is the object of my bounty.
using my available federal unified
t taxes and my federal estate tax credit
to eliminate federal estate tax on the
able estate by using the federal estate
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(2) Prior to ivision into shares pursuant to Para-
graph (5), my Trustee ma pay to or apply for the benefit of any
one or more of my said h sband, children and issue such sums from
I
the principal of the BYP ss Trust in such shares and proportiops
as in its sole discretio shall be necessary or advisable from
time to time for the med cal care, education, support and mainte-
nance in reasonable comf rt of my said husband, children and
issue, taking into consi eration to the extent my Trustee deem~
advisable, any other inc me or resources of my said husband,
children and issue known to my Trustee, considering that my
husband is the primary 0 ject of my bounty. Any payment or
a~plication of benefits or a Leneficiary pursuant to this
Paragraph shall be charg d against this Trust as a whole rather
than against the ultimat distributive share of such beneficiary
to whom or for whose ben fit the payment is made.
(3) In additi n to the income and discretionary
payments of pri~~ipal fr m this Trust, there shall be paid to my
said husband during his ifetime from the principal of this Trust
upon his written request during the last month of each fiscal
year of the Trust an amo nt not to exceed during such fiscal year
the amount of Five Thous nd Dollars ($5,000) or five percent (5%)
of the aggregate value 0 the principal of the Bypass Trust on
the last day of such fis al year without reduction for the
principal payment for su h fiscal year, whic~ever is greater.
This right of withdrawal is noncumulative, so that if lllY said
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husband does not withdra , during such fiscal year, the full
amount to which he is en itled under this Paragraph, his right to
fiscal year.
withdraw the amount not ithdrawn shall lapse at the end of that
(4) My husban shall have a special power to appoint
all or any portion of th Bypass Trust during his lifetime by
written document, delive ed to my Trustee, referring expressly to
this Article, or by Will validly executed and attested referring
expressly to this Articl, among such other person or persons
hereinafter named or des ribed absolutely or in trust, as he may
indicate. This special ower of appointment is exercisable only
in favor of a child c.~ m ne as described in this will or to the
issue of any such child. My aforesaid husband shall have no
power to appoint the pri cipal of this fund or income accumulated
thereon to himself, to h s estate, to his creditors, or to the
creditors of his estate. My Trustee may rely upon an attested
of this Paragraph.
will p~obated in any sta e that otherwise meets the requirements
(5) In defaul of the exercise of such power of
appointment by my said
Bypass Trust shall not
death of my said
Bypass Trust, or the
ed, shall be divided
sband, or insofar as any part of the
effectively appointed, then upon the
the entire remaining principal of the
of such trust not effectively appoint-
one (1) share for each t en-living child of mine and one (1)
equal separate shares so as to provide
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share for each deceased ild of mine who shall leave issue then
living. The share provi for a living child of mine shall be
distributed to such chil The share provided for a deceased
child of mine who shall leave issue then living shall be distrib-
uted per stirpes to such issue, but in default of issue, shall be
distributed as follows:
(a) Fifty per ent (50%) to the husband of my
deceased child in t e event that he was living with my
child at the time 0 her death and has not remarried;
(b) Twenty-fi e percent (25%) to my surviving
child;
(c) Twelve an one-half percent (12~%) to
Jefferson Medical C lIege, Philadelphia, Pennsylvania,
without restriction as co use; and
(d) Twelve an one-half percent (12~%) to Zion
Lutheran Church, Ha risburg, Pennsylvania, without
restriction as to u
Should any of the forego'ng bequests fail, the effective bequests
shall correspondingly in
SIXTH: If any shar hereunder becomes distributable to a
beneficiary who has not ttained the age of twenty-one (21)
years, then such share s immediately vest in such benefici-
ary, but notwithstanding provisions herein, my Trustee shall
retain possession of sue share in trust for such beneficiary
until such beneficiary a tains the age of twenty-one (21) years,
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using so much of the net income and principal of such share as my
Trustee deems necessary 0 provide for the proper medical care,
education, support and m intenance in reasonable comfort of such
beneficiary, taking into consideration to the extent my Trustee
deems advisable any othe income or resources of such beneficiary
or his or her parents kn wn to my Trustee. Any income not so
paid or applied shall be accumulated and added to principal.
Such beneficiary's share shall be paid over and distributed 'to
such beneficiary upon
aining the age of twenty-one (21) years,
u.;.;ing all income
ner die, to his or her executors or
or if he or she shall
administrators.
end that my Trustee consider distrib-
h sha:L-e to such beneficiary when ::o:.ch
beneficiary attains the ge of twenty-one (21) years. My Trustee
shall have with respect 0 each share so retained all the powers
and discretions had with respect to the trusts created herein
generally.
SEVENTH: Anything n this Will to the contrarynotwith-
standing, no trust creat d herein shall continue beyond
~wenty-one (21) years af er the deaths of one, the last to die of
my issue living at the t me of my death; and two, all issue,
living at the time of my death, of the individual serving as
President of the united tates at my death and all issue, living
at the time of my death, of said individual's five (5) immediate
predecessors in said off ce; upon the expiration of such period,
all trusts shall termina e and all the assets thereof shall be
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distributed to those ben ficiaries (and in the same proportions)
as are then entitled to eceive the income therefrom.
EIGHTH: If any ficiary and I should die under such
circumstances as nder it doubtful whether the benefici~ry
or I died first, then it shall be conclusively presumed for th~
purposes of this my Will that said beneficiary predeceased me.
NINTH: (1) I name as my Executor and as my Trustee (the
singular gender to inclu plural) my son-in-law, J. Kenne~h
Lowrie, Esquire, Alexand ia, Virginia, and my accountant, Crystal
Hackett, Camp Hill, Penn If either is unable or unwi41-
ing to serve, I name my Heath L. Allen, Esquire, to
replace that individu::;.l. If he is unable or unwilllng to serve,
his law firm an attorney to replace him. If both
my son-in-law and my acc are unable or unwilling to serve,
Heath L. Allen and anoth r attorney designated by his firm shall
serve. If Heath L. AIle is unable or unwilling to serve, his
firm shall designate two (2) attorneys to serve. It is my
intention that two indiv'duals serve at all times. I direct that
my Executor and my without bond in any jurisdiction
in which called upon to
reason, the two individuals identified
successors cease to act in such
r substitute Trustee shall be some bank
powers, which successor or substitute
in a written instrument filed with
(2)
above and their designat
capacity, the successor
or trust company
Trustee shall be
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the Court having jurisdi tion over the probate of my estate and
signed by my husband, or fails to act, signed by or on
behalf of my daughters, the survivor of them, or if they or
she should fail to act, the Court having jurisdiction over the
Trust. The situs may be transferre~ to the situs of
such successor or substi ute Trustee by designation in the
written instrument
(3) For Executor and Trustee, my Executor
and my Trustee shall rec ive reasonable compensation.
(4) Subject t the provisions of subparagraph (2)
above, the situs of all rusts created herein shall be Cumberland
County, Pen~sylvania.
TENTH: (1) to any Executor and to any Trustee
named in this Will Codicil hereto or to any successor or
substitute Executor or T ustee all of the powers enumerated in
this will and all of the powers applicable by law to fiduciaries
in the Commonwealth of P.nnsylvania and in particular through the
Pennsylvania Probate, Es ates and Fiduciaries Code, as effective
and as in effect on the ate hereof, dUi:ng the administration
and until the completion of the distribution of my estate, and
until the termination of all trusts created in this Will or any
Codicil hereto and until the completion of the distribution of
the assets of such trust. I direct that all such powers shall
be construed in the broa est possible manner and shall be exer-
cisable without court au horization.
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(2) In determ ning the federal estate and income tax
liabilities of my estate my Executor shall have discretion to
select the valuation dat and to determine whether any or all of
the allowable administra ion expenses in my estate shall be used
as federal estate tax de uctions or as federal income tax deduc-
tions and shall have the discretion to file a joint income tax
return with my husband.
(3) If at any time any trust created hereunder (or any
share thereof if the tru t shall have been divided into shares)
shall be of such value t at, in the opinion of my Trustee, the
administration expense 0 holding the assets contained therein in
trust is not justified, y Trustee, in its absolute discretion,
may terminate such trust and distribute the trust property to the
person or persons then e titled to receive or have the benefit of
the income therefrom or he legal representative of such person.
If there is more than on income beneficiary, my Trustee shall
make such distribution t such income beneficiaries in the
proportion in which are beneficiaries or if no proportion is
designated in equal to such beneficiaries.
(4) My Execut and Trustee are authorized and empow-
ered to acquire and to r either permanently or for such
period of time as my Exe or Trustee may determine, any
assets, including the ca ital stock of any closely held
corporation, whether suc assets are or are not of the character
approved or authorized b law for investment by fiduciaries and
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in one investment.
whether such assets do 0 do not represent an overconcentration
empowered to disclaim
(5) My Execut r and my Trustee are authorized and
I, my Executor, or my
interest, in whole or in part, of which
stee, may be the beneficiary, devisee,
or legatee, by executing an appropriate instrument (in accordance
with section 2518 of the Internal Revenue Code of 1986, as
amended, or such similar section as may then be in effect).
(6) My Execut r and Trustee are authorized and empow-
ered to s~11 at public 0 private sale, or exchange, and to
encumber or lease, for a of time, any real or personal
property and to give opt ons to buy or lease any such property.
Additionally, my Executo and Trustee are authorized and em-
powered to compromise cl ims, to borrow from anyone (including a
fiduciary hereunder) and to pledge property as security therefor,
to make loans to and to uy property from anyone (including a
fiduciary or beneficiary hereunder); .t:'rovided that any such loans
shall be adequately secu ed and at a fair interest rate.
(7) My Execut r and Trustee are authorized and empow-
ered to allocate propert , charges on property, receipts and
income among and between or income, or partly to each,
without regard to any la defining principal and income.
ELEVENTH: No perso who at any time is acting as a co-
trustee (if any) hereund r shall have any power or Obligation to
participate in or to exe cise any discretionary authority that I
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have given to my Trustee to pay principal or income to such
person, or for his or he benefit or in relief of his or her
legal obligations. Such discretionary authority shall be exer-
cised solely by the disi terested co-trustee.
TWELFTH: No intere
any Codicil hereto, or a
of any beneficiary under this Will,
trust created herein, shall be subject
to anticipation or to vo untary or involuntary alienation.
THIRTEENTH: All es ate, inheritance, succession and other
death taxes imposed or p yable by reason of my death and interest
and penalties thereon wi h respect to all property comprising my
gross estate for death t x purposes, whether or not such property
passes under this Will, hall be paid out of the residue of my
estate, as if such taxes were expenses of administration, without
apportionment or right 0 reimbursement. I authorize my Executor
advisable.
and Trustee to pay all s ch taxes at such time or times as deemed
Last Will and Testament
IN WITNESS WHEREOF, I have set my hand and seal on th:s my
SIGNED, SEALED, PUBLISHE , and
DECLARED by MARY E. ALLY ,
as and for her Last Will and
Testament, on the day an year
last above written, in t e
presence of us, who, at er
request, in her presence, and
in the presence of each ther,
all being present at the same
time, have hereunto subs ribed
our names as witnesses:
his /1 day of ?)~
m. ?-/-1~
MARY ~LLYN
, 1997.
( SEAL)
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-PROVING AFFIDAVIT
COMMONWEALTH OF PENNSYLV IA
55.
COUNTY OF
WE, MARYE. ALLYN,
, and , the
Testatrix and the witnes respectively, whose names are signed
to the attached or foreg ing instrument, being first duly sworn,
do hereby declare to the undersigned authority that the Testatrix
signed and executed the 'nstrument as her Last Will and that she
had signed willingly (or willingly directed another to sign for
her), and that she execu ed it as her free and voluntary act for
the purposes therein exp essed, and that each of the witnesses,
in the presence and hear'ng of the Testatrix, signed the will as
witness and to the best f his or her knowledge the Testatrix was
at that time eighteen (1 years of age or older, of sound mind,
and under no constraint undue influence.
~ ~ t'.~
MARY E. ALLYN, T tatrix
J~tdL L.~
witness
~vv 7fO ~
witness
witness
Subscribed, sworn to, an
ALLYN, the Testatrix, an
acknowledged before me by MARY E.
subscribed and sworn to before me by
, and
, witnesses, this
day
of
, 1997
Notary Public
---"--~-,'---~->.._-~--~.-._-_.- --- --------~-._-~-~---"-.-
COUNTY OF DAUPHIN
COMMONWEALTH OF PENNSYLV IA
55. .
On this, the 21st d
signed officer, personal
- I. D. No. 07138, known to
member of the highest co
witness to the within in
personally present when
witnesses signed the for
IN WITNESS WHEREOF,
seal.
of May, 1997, before me, the under-
y appeared HEATH L. ALLEN, Supreme Court
me (or satisfactory proven) to be a
rt of said state and a subscribing
trument, and certified that he was
ary E. Allyn, the Testatrix, and the
going Self-Proving Affidavit.
I hereunto set my and hand and official
~ to 1/ ''1'
J,.. (j L i -< ~.y,-" ~. f\.UJ{ t) /y~ ( '\..)
Notary P blic 0
, NOTARIAL SEAL
KA~RVN C. ,!OLlINGEFl. Notary PUblic
.ty of H~rr!sburg, Dauphin County
mmlSslon Elpires Feb. 15, 1999
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REY.'85 EX. (1.92)
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AFE DEPOSIT BOX
INVENTORY
COMMONWEALTH OF PENNSYLYANIA
DEPARTMENT OF REYENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128.0601 Please Print or Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL NSTITUTION WHERE SAFE DEPOSIT, BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
a.t dl-D /13-1/P--5~/7
, DECEDENT'S NAME (LAST, FIRST, MIDDLE) DATE OF DEATH
Pt II t) M tA., ;:::ebrv....r
ADDRESS 0 DECEDENT (STREET)
5 N (Th 2~'tl, s+.
NAME AND ADDRESS OF PERSON REQUESTING THE
(NAME)
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JIG ot:r ",er ST. J-tCi.r-(.'s IAr PA
NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO D CEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING
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THE SAFE DEPOSIT BOX
(CITY)
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(STATE) (ZIP CODE)
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(STATE)
(ZIP CODE)
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(RELATIONSHIP)
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(ZIP CODE)
ERE THE SAFE DEPOSIT BOX IS LOCATED
(STATE) (ZIP CODE)
a.
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b. Name ~"d address of personal representCltlve, if namedln the will
(NAME)
(STREET ADDRESS)
(CITY)
(STATE)
(ZIP CODE)
c. Name and address of attorney, if any
(NAME)
(STREET ADDRESS]
(CITY)
(STATE)
(ZIP CODE)
Esta of Mary E. Allyn, Deceased
D Value of Russell E. Allyn
Fam ly Trust U/W Upon Death of
Mar E. All - For P A Inheritance Tax Pu oses
April 25, 2007
1. Russell E. Allyn died on ovember 17,2005 and the Family Trust was established
under his Last Will with he residue of his probate estate.
2. For PA inheritance tax p rposes, Dr. Allyn's Executor's elected, to subject 100%
of the Family Trust to P inheritance tax upon the death of Mary E. Allyn, who
died on February 6,2006
3. For federal estate tax pu oses, the value of the Russell E. Allyn Family Trust
U/W on February 6, 200 , was as follows:
100% of Family rust Assets per attached Schedule
Less remaining A ministration Expenses of Russell
E. Allyn Estate:
Funeral & Admin Expenses per Schedule H
Debts of Deceden per Schedule I
Decedent's PAin eritance tax liability
Est. DOD Value fFamily Trust upon death
Of Mary E. Allyn
$1,896,652
$ (192,044)
$ (12,697)
$
(800)
$1.691.111
rrepared by SM Garcia 11/3/06
Part
Asset Unit Price DOD Value 11-'10-01/1
Citizen's Estate Checking $ 6,750.48
Ryan Beck MM $ 490,050.12
Merrill Lynch MM $ 19,090.66
Delphi Corp 149 0.304500 $ 45.37
Exxon Mobil Corp 1520 62.130000 $ 94,437.60
Harsco Corp 1124 76.720000 $ 86,233.28
Hershey Co 3840 51.275000 $ 196,896.00
Louisianna Pac Corp 602 28.925500 $ 17,413.15
Raytheon Co New 69 41.750000 $ 2,880.75
Visteon Corp 257 4.760000 $ 1,223.32
Wachovia Corp 2166 53.890000 $ 116,725.74
Plum Creek Timber Co Inc 694 35.840000 $ 24,872.96
Centerpoint Energy Inc 450 12.635000 $ 5,685.75
Merrill Lynch Eurofund CI 373.429 16.670000 $ 6,225.06
Merrill Lynch Global Tech 1402.148 8.070000 $ 11,315.33
Merrill Lynch Healthcare 3798.822 7.490000 $ 28,453.18
Debt Strategies Fd New 547 6.815000 $ 3,727.81
Allied Irish Bks PLC 77 44.410000 $ 3,419.57
Allstate Corp 184 52.420000 $ 9,645.28
AT&T 46 26.930000 $ 1,238.78
Baxter Intllnc 800 35.730000 $ 28,584.00
Cardinal Health Inc 186 70.205000 $ 13,058.13
Caremark Rx Inc 121 49.825000 $ 6,028.83
Citigroup Inc 1500 45.350000 $ 68,025.00
Dover Corp 800 46.105000 $ 36,884.00
Eaton Vance Tax Advt 250 22.995000 $ 5,748.75
Elan PLC 200 15.015000 $ 3,003.00
Glaxosmithkline PLC 400 50.540000 $ 20,216.00
Johnson & Johnson 4800 57.105000 $ 274,104.00
M& T Bank Corp 200 106.590000 $ 21,318.00
Morgan Stanley New 156 61.570000 $ 9,604.92
PPL Corp 400 30.535000 $ 12,214.00
Raytheon Co New 1668 41.750000 $ 69,639.00
St. Paul Travelers Inc 56 44.265000 $ 2,478.84
UGI Corp New 4200 21.365000 $ 89,733.00
Wachovia Corp 2nd New 200 53.890000 $ 10,778.00
Con Ed NY Pines 7.5% 200 25.335000 $ 5,067.00
Wells Fargo Cap Tr 7% 400 25.570000 $ 10,228.00
Verizon NE Quibs 7% 200 25.820000 $ 5,164.00
General Mtrs Nt Sr 200 15.570000 $ 3,114.00
PPLUS Tr GSG-2 A 5.75% 200 23.620000 $ 4,724.00
Preferred Income Strat. 200 20.895000 $ 4,179.00
Franklin Penn TF Inc 1047.69 10.390000 $ 10,885.50
RVS TE Bd CI A 4981.732 3.840000 $ 19,129.85
Merrill Lynch Bd Fd CI B 3145 5.100000 $ 16,039.50
Cumberland Co PA MAC Bd $15,000 101.246000 $ 15,186.90
Dauphin PA Gen AT Hlth $5,000 103.737000 $ 5,186.85
Trust Value 2/6/2006 $ 1,896,652.26
Income Cash Balance $ 11,679.32
Dauphin Co Accrd Int $ 61.88
Cumb Co Accrd Int $ 266.93
Verizon NE Accrd Div $ 87.50
Citigroup Accrd Div $ 735.00
Harsco Accrd Div $ 365.30
Trust Accrued Income $ 13,195.93
A. Sattlement Statement
U.S. Department of HousinQ
and Urban Development ~
,r
OMS No. 2502.Q265
B. Type of Loan
1. 0 FHA 2. 0 FmHA 3. ~ Conv. Unins File Number rLoan Number I Mortgage Insurance Case Number
862358-LAW 0000148700 N/A
4. 0 VA 5. 0 Conv. Ins.
C. NOTE:This form is furnished to give you a statement of ~ctual selUement costs. Amounts paid to and by the settlement agent are shown.
Items C"larked "p.o.c" were paid outside of ctosin ; they are shown here for informational purposes ar.d are not included in the totals.
Elizabefh B. Ferrari
201 North 30th Street, Camp Hill, PA 17011
D. NAME AND ADDRESS OF BORROWER: Jo<eph P. Fe arl
2" North 30t Street, Camp hi' PA 17011
E. NAME AND I.JDRESS OF SELLER:
E, tate of Mar, E. Allyn
Camp Hili, PA 17011
Esta. e of Mary E. Allyn
Camp Hill, PA 17011
F. NAME AND ADDRESS OF LENDER:
AmerlcancHl?n eBank: . .
805'Estelle Diwe, Suite 101i',LafJcaster, PA 1.7601
495 North 25th Street
Camp Hili, PA 1.7011
G.PROPERTY
LOCATION:
H. SETTLEMENT AGENT: LAW OFFICE OF DARI ELL C. DETHLEFS
P'.'CE OF SETTLEMENT: 2132 Market Street, Calnp Hill, PA 17011
~iN: 25>1727631
-.
~ " ETTLEMENT DATE: 031151~006
SUMMARY OF BORROWER'S TRANSAC TION
"':JO. GROSS AMOUNT DUE FROM BORROWER:
RESCISS.' DATE:
K. SUMMARY OF SELLER'S TRANSACTION
400. GROSS AMOUNTDUE TO SELLER:
101. Contract Sales Price
102. Personal Properly
103. Settlements charges to borrower.
S430 000.00 '401. Contract Sales P;;ce
402. Personal properly
403.
$430 000.00
(from line 1400)
104.
105.
ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVA CE:
$12,568.34
404.
405.
ADJUSTMENTS FOR ITEMS PAiD BY SELLER IN ADVANCE:
106. Cityltown taxes
107. County Ta.'ir:~
108. Assessmen'
109. NuniciJ; iiI:
to'
03/15/:1006 to
03/15/2006 lei.
03/J.5/06 to
.~
~:1/. /:1006
06/ 0/2006
06/30/06
03. . ./2006 to 12/3~/2006
03; 5/2006 to 06/30/2006
03/15/06 to 06/30/06
$1,179.~7
$1,232.20
$50.72
$1,179.., '
$1,232. ..0
$50.72
406. City/town Taxes
407. County Taxes
408.' Assessments
409. Municipal:
410.
411.
412,
to
. 110.
111.
112.
120. GROSS AMOUNT DUE FROM BORROWER:
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER:
$445,030.43 420. GROSS AMOUNT DUE TO SELLER:
500. REDUCTIONS IN AMOUNT DUE TO SELLER:
$432,463.09
_~.~~..~..!>;;)osit or earnest money
202, r'rincipal amount of new loan(s)
_~~'3. Existing loan{s) taken subject to
'206.
207
'208.
209.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
-;i
$5,000.00 501. Excess deposit (see instructions)
$339,000.00 502. Settlement charges to seller (line 1400)
503. Existing !r:,:, (s) taken subject to
504. Payoff 0: 5( mortgage loan
505. Payoff of second mortgage loan
508.
507.
508,
509.
ADJUSTMENTS FOR ITEMS UNPAID BY SELLER:
$5,000.00
$5,858.96
205.
210. Cityltown taxes
211. County taxes
212. Assessmen:,:,
to
~O
to
510. City/town taxes
5l1.County taxes
512. Assessments
513.
514.
515.
516.
517.
516.
519.
520. TOTAL REDUCTIONS
IN AMOUNT DUE TO SELLER:
600. CASH AT SETTLEMENT TO/FROM SELLER
to
to
to
213.
214.
215.
216.
217.
216.
219.
220. TOTAL PAID BY/FOR ..
BORROWER:
300. CASH AT SETTLEMENT FROMITO BORROWER:
$344,000.00
$10,858.96
~.~_.(3ross amount due from borrower (line 120)
C J. Less amount paid by/for borrower:(line 220)
.i. CASH ( ~ FROM) (D TO ) BORROWER:
$445,030.43 601. Gross aelount due to seller (line 420)
$344,000.; 00 902. Less rod,r.:ions .Inaml. due seller (lino 520)
~
$101,030.43 603. CASH (D FROM) (~TO; SELLER:
$433,462.09
$10,858.96
$421,603.13
HUD-1 (3-86) - RESPA, HB 4305.2
PAGE 1
I
HUD-l (Rev. 3/86) OMS No. 2502-0265
L, SETTLEMENT CHARGES
700. TOTAL SALES/BROKER'S COMMISSION PAID FROM PAID FRO~
BASED ON PRICE $430,000.00 @ %- BORROWER'S SELLER'~
-- FUNDS FUNDS
__n
DIVISIOt\ ( COMMISSION (LINE 700) ".J cOLLOW : AT AT
701. to SETTLEMENT SETTLEMENT
702. to
703. to
"/04 10
l05. Commllision paid al settlement
706.
600. ITEMS PAYABLE IN C NNECTION WITH L AN:
801. Loan origination fee % to American Home Sa """
802. Loan discount % to American Home Ba '*
803. Appraisal fee to: Robert Banzhoi:f $350.00
804. Credit report to: Credco $21. 00
,3J5. Lender's Inspedlon fee American Home Bank .- I
;3. Mortgage insurance application fee to American Home Bank I
307. Assumption fee American Home Bank
80a. Admizti..stration Fee to AmerJ.can Home Bank $390.00
609. Swirview - WebPosting $5-POC
810. F~ood Cert Fee to 1st American $14.50-POe
811. ArJS to CLUES $35-POC
812 .Fraud QUard - Sysdome $ll-POC
813 Tax Service Fee to First American $96.00
81'
816 :rie~d Spread Pram $5,932.sp-POC to Integ . ty Bank by AHB
818 Htg Broker Application Fe.' to Integrity B "'* $345.00
817 -.
818 - -
~19
820
900. ITEMS REQUIRED BY LENDER TO BE ,'AID IN ADV NCt:::
901. Inl8r8s1 from 03/15/201).6 to 04/01 2006 @ $63. 85/day $1,085.45
902. Mortgage inst.;rance premium for mas. to
903. Hazard insu,ance premium for yrs. to
904. Flood insurance premium for yrs. to
905.
1000. RESERVES DEPOSr ED WITH LENDER:
1001. Hazard Insurance 3.00months@ $72. 67 per month $218.01
1C02. ~Jortgage insurance months C per m:mlh
, -':;ily property 18)(85 months@ p9rr".mth
--_... ~~ 00 months@ $122.83 nonth $245.66
: County property taxes
_u I~r month
. .J5. Annual assessments months @
006. Flood insurance months @ ler month
1007 School Taxes 10.00 months@ $354.11 per month $3,541.10
100B. months @ per month
1009. Aggregate Accounting .Escrow Adjustment ($854.63)
1100. TITLE l,;HARGES:
1101. Selllemenl or dosing fee 10 LAW OFFICE OF DARRELL C. DETHLEFS
1102. Abslract Of tille search to
1103. Tille examination to
1104. Tille Insurance binder 10
1105. Document preparation 10
1106. Notary fees to
1107. Attorney's fee; 1
(includes abovE :ems Numbers: )
1108. Title insurance to Security Xitle/':'aw O~Lic o~ Darrell c;. Det.h1.ers ---
(includes abova itams Numbers: Ba.sic - 3 E~d. )
1109. Lender's coverage $339,000.00 ( $339,000.00 )
'11'0. Owner's coverage $430,000.00 ( $430,000.00 )
1111. C~osing Service Letter Fee to Security T t1e $35.00
1112 I I
~113.
1200. GOVERNMENT RECORDING AND TRANSFER CH RGES:
1201. Rocording fees: Deed $38.50 : Mortgag $80.50 ; Releases I $119.00
_~~:..,~iIY/COunIY lax/stamps: Deed $4,300.0 : Mortgage I $4,300.00
2~:" StaLe tax/slamps: Deer! $4,300.00 ; Mortgag : Othel I $4,300.00
~ ? C' 4 . - .-
"2;)5. I
} 300. ADDITIONAL SETTLEMENT CHARGE:;:
1301. Survey to
1302, Pest Inspection to
1303. OVe.rn.igh t Fee to Law O~fica o~ Darrell DethJ.ers (UPS) $18.00
1304. Janet Millerl Tax Collector (2006 Co/Bo 0 Tax) $1,473.96
1305. Borough or Camp Hi1~ (Jan. 1, 2006 tllru ~e 30, 2006) $85.00
1306.
1301.
1400. TOTAL SETTcEMENT CHARGES $12,568.34 $5,858.96
- --- ----
Borrower:
Seller or
Dale: __ _ Agent:
Borrower:
Seller or
Agent:
Date:
The HUD-1 Settlement Statement whIch I have prepared is a true an accurate account of this transaction. I have caused or wil
with this statement.
Date:
use the funds to be disbursed in accordance
Settlement Agent:
\\ ~RN1NG: It is a crime to kno'Nir.~J'Y make false statements to the ,liled States on this or any other sirll:-:r form. Penalties upon convictio,..-. :;an include a fine and lmprison-
.nt. For details see: Title 18 U.:;. Code Section 1001 and Section <f 110.
Dale:
ti~fld.
~
S./ Sc(.,
Date:
Date:
Date:
5-'S- OG
------- I
11<.
~~ Citizens Bank
525 William Penn Place
Suite 153-2618
Pittsburgh, PA 15219
November 1, 2006
SHARON M GARCIA
210 WALNUT ST
PO BOX 11963
HARRISBURG PA 17108-1963
Estate of MARY E ALLYN
Date of Death: Feb 06, 2006
SSN: 113-16-5517
Dear Sir/Madam:
In accordance with your request, the atta hed information sheet has been provided in the above decedent's
name as of his/her date of death.
For IT.., or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 888-999-6884
Sincerely,
Pfeil, Mamie
Operations Services
J:.:' Citizens
Account Number
Account Title
Date 0 ened
Account T e
Princi al Balance as of DOD
Interest from Last Postin to DOD
Account Balance as of DOD
YTD Interest to DOD
a:nk
6213098473
MARYEALLYN
11/29/2005
Checkin
$15264.10
$.00
$15264.10
$11.86
02/08/2007
17:03
i#
.~:E (,itizens Bank'
Account Number
Account Title
Date Opened
Account Type
Principal Balance as of DOD
Interest from Last Po sting to DOD
Account Balance as ofDOD
YTD Interest to DOD
6100677893
DR RUSSELL E ALL YN MARY E ALLYN
6/6/1966
Checking
$24924.82
$.00
$24924.82
$8.78
NO.851 [;l002
I .
, j
,
I I
I
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. ,
~~ Citizens Bank
525 William Penn Place
Suite 153-2618
Pittsburgh, PA 15219
November 1,2006
SHARON M GARCIA
210 WALNUT ST
PO BOX 11963
HARRISBURG PA 17108-1963
Estate of MARY E ALLYN
Date of Death: Feb 06, 2006
SSN: 113-16-5517
Dear Sir/Madam:
In accordance with your request, the atta hed information sheet has been provided in the above decedent's
name as of his/her date of death.
For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 888-999-6884
Sincerely,
Pfeil, Mamie
Operations Services
.. .
02/08/2007
17:03
)I~ c.t". B .,.,
,,~ ;i lZ:enS .~an(
Account Number
Account Title
Date Opened
Account Type
Principal Balance as of DOD
lnterest from Last Postinlrto DOD
Account Balance as of DOD
YTD Interest to DOD
6100677893
DR RUSSELL E ALLYN MARY E ALLYN
6/6/1966
Checking
$24924.82
$.00
$24924.82
$8.78
NO. 861 1;1002
. i
,
11
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)II( Citizens B a:nk
,.~
Account Number 6213098473
Account Title MARYEALLYN
Date Opened 11/29/2005
Account Type Checking
Principal Balance as of DaD $15264.10
Interest from Last Posting to DaD $.00
Account Balance as of DaD $15264.10
YTD Interest to DaD $11.86
-~- ------- -- -- -
Mary E. Allyn Estate
R a Beck Cash Balances at DaD
Ryan Beck Acct. # A8T-001 00
Cash Balance at DaD
Accrued Int to DaD
$ 66,487.69
$ 10.15
$ 66,497.84
Prepared by SM Garcia
1 0/30/06
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~Gehworth Financial
PO Box 40007, Lynchburg, VA 24506-9939
...~ t Y..
~,~...
",
March 2, 2006
Russell Allyn
1901 N. 5th St.
Harrisburg P A 17102
CLAIMANT:
POLICY NO.:
CLAIM NO.:
Mary Allyn
HFN6378901
V69856
Dear Mr. Allyn: 1>\~60
Please accent our condolences n your recent loss. ~
The [mal benefit check is hein sent under separate cover. This payment is f~ the period
January 15, 2006 through Febr ary 05, 2006 in the amount of $1,540.00. 7~ ,
We have asked Policyholder S rvices to cancel this policy and refund any premium due.
If you have questions regardin this, please contact our Policyholder Services at 1-800-
456-7766.
Please let us know if we can be of further service to you during this difficult time.
.'(i..'
,..,\:"';.: .: ..'
iF~[i\~~~::~cncUT
....
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GenworthFinancial :7;"t
.' "~LIJ'BI'8 '.
LONG TERJI CARE DIVISION
P.O.Box 8021
SAN RAFAEL CA 94912-B021
.~l:~3lro,;,J~tP.',:,~~j~~:,.:ro:~j;'r.'.,;ml~~~~7'-''',. -. l~~~lIlII
. '. CHI;CKNO. . . 51-44
2020562196 119
I
CNE Tt-OJSNV FIVE I-l.JlII:RED FCRTY AKJOO /100
VOID AFTER 120 DAYS
PAY TO THE ORDER OF ESTATE OF MARY ALLYN
1901 N. 5''::H ST.
HARRISBUE.G.PA 17102
V69B56
1I"2020Sf:.2.gbll' ,:O..gOOloloSI:
5 ~Ologll"
Affiliate Company: Genworth Life Insurance Company
~"~~4/e9/2ee6 12: 16
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, i
. 2151 Mat'ket Stt'eel
Camp Hilt, PA 17011
.; (717) 731-8662
, (717) 731-9830 Fax
. ;.'
,
, .
7177377431
71 77377431
CRYSTAL U HACKETT
PAGE 132
RDIER
TIQ1JES
& fine art
www.cordierantiques.com
APPRAISAL SERVICES
INTERNET SALES
ESTA TE LIQUIDATIONS
March 7,2006
TO:
Lowrie, Executor
Fairfax Street
'8., VA 22314
onner
Antiques & Fine Art
RE:
Person Property
Estate fM~ E. AUyn
495 N rth 25 Street
Camp ill. P A 17011
Enclosed pie
as well as a s
being sent to
wjth photo
find tbe Estate Tag Sale final report for the Estate of Mary E. Allyn
ement check Tbe report. original carbon copy receipts and check are
stal Hackett's office per Ken Lowrie's direction. A duplicate H~port
es of receipts and cbeck are being sent to Ken Lowrie's residence.
We <.in: also losing an inventory list of the Oriental rugs and Boehm porcelains
that are going 0 be sold at auction on March 17 and 18.
Thank you for choosing Cordi~ Antiques & Fine Art. Jfyou have any questions or
comments, pi se don't hesitate to contact us.
Reg~
AJj
Sponsor
WITF.TV
_, . El4/ ~6
"
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"
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- --- --
7177377431
r/2ElEl6 12:16 71 77377431 CRYSTAL U HACKETT
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PAGE El8
ESTATE AG SALE FINAL REPORT
Estate of Mary E. Allyn
495 North 25th Street
Camp Hill, PA 17011
SALES:
"'Gross Sak;s (receipts end ed)
Cash
Checks
Post sale
TOTAL
Commission (25%)
Due Consignor
$ 2,263.30
$37,803.35
5 500.00
$40,571.65
<510,142.90>
$30,428.75
AdvertisingiConsignor
(St~e Promotion/Attendance pag~)
<$ 500.00>
Net Due COllsignor
Paid Check #20 t 2
"'Includes family and friend sales
$29,928.75
r^,>> ~ ~-~
Davld . o'tdter ------- D?,i~
Cor1ier Antiques & Fine Art
~tlzens Bank
Pennsylvania
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291
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EST OF MARY E ALLYN
CR.vSTAL U HACKETT CO .EXE
J KENNETH LOWRIE CO-EXEC
110 BERGNER ST
HARRISBURG, PA 17110
""'."1:
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Musselman
: 1Fllmeral Home
& Cremation
Services, Inc.
Established 1895 '
r'i1n C. Musselman, ED.
::;/JjJ~rvlsor
William G. Pegan, ED.
P.O. Box 137
324 Hummel Avenue
Lemoyne, PA 17043-0137
(717) 763-7440
I;, 717-730-9798
www.musselmanfuneral.com
7 b ~ 501: b2~3 El 7531..211-,
i~
To Funeral Expenses of
ARY E. ALLYN
Feb.27,2006
Crystal U. H ckett
11 0 Bergner t.
Harrisburg, A. 17110
2006
February. 10
PROF. SERVICES RENDERED,AUTOS
"Country Pine" Casket
$3,070.00
2,500.00
$5,570.00
Cash Advance Items:
Flowers
Copies of dea h certificate
Newspaper dea h notices
Minister'S gr tuity
$12.72
120.00
178~40
100.00
$411.12
$5,981.12
TOTAL
POSTED
/
4\tt( aft VO
FOR PPOINTMENT PHONE 717-763-7440
,.
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ESTATE OF
EST OF MARY E ALLYN
CRYSTALU HACKETT CO -EXE
J KENNETH LOWRIE CO-EXEC
110' BERGNER ST
HARRISBURG. PAl7110
FOR
POSTED ,
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West Shore Country Club
100 Brentwater Road
Camp Hill, PA 17011
phone: 717-761-4530
fax: 717-761-4530
r--.-.-...-.-...... --..-.---..---
i Booking Contact
Ratcliff, R2553
,---------- ,----_...
I Guests I PO #
!25(Pln) 130381
- --1
Allyn Reception
Crystal Hackett
110 Bergner Street
Harrisburg, PAl 711 0
Ba quet Invoice
Event dat Friday, February 10, 2006
1
52
2
52
2:00pm.. Ba - Premium Brands - BOC @ 402.75
Imported Ch ese and Fresh Fruit Display @ 3.95
Assort d Finger Sandwiches @ 55.00
Ass rted Mini Desserts @ 6.50
Subtotal
Serv Chg
Taxes
Total
402.75
205.40
110.00
338.00
1,056.15
211.23
39.20
1,306.58
Paid
Balance
0.00
1,306.58
Please remit the "Total B lance Due" within 10 days of receiving this invoice.
Send Check with full amount to West S ore Country Club 100 Brentwater Road Camp Hill, P A 170] 1.
For any questions con erning this invoice, please reference the PO #.
Thank yo for this opportunity to serve you.
'1'-2005
09:49
ROLL r NG ::;.EEt"< CEMET=:R')'
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THIS ^Gllm'':~IE.'''T PRO\'10~.:s FOR ENDO ME~ CARH . .
.:lo:METERY INTEIlMDoo"T RIGHTS, MtRC!l4NDIS1! AND SERVICES I'l'RCIfASFlSECFR!TV AGUEME1',T
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O~tir Hilmi Conui.aCl." - l\oll..riu _______________.__.__ __.
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I REMARKS: _____.. ____.
I
f---...------.-...----.
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--......------..--.j
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TERMS - C....SK SALE
1n, 'f,.tol Cosh rrl.. Is d~~ -lid p.,..bl. .. of Ih. dale of Ill" Alr","onl. ., de'. 'le?"q ehtrg. (.f -==- p.......I..ilI b.
.".,,,,d monlhly on ~ny boiln.. nol peld wlthh, 30 doyuft". dOI.oftl':' AlrUm" .t. lfIeo, ,....IUI' parnlfnllS rfcelved, 5<11..
sf\;;;ll deducc thtaca-~Jr(. d,lItlqueJlCY cftarae from 'i'te lIlDoant rl!uhtd, Rn4 ("Htilt tI,e 1'~m4irtdl.'.r .ll ~h{' p&~'m.el~~ receh',d to.) tho
l'np.i<I lllll.n.o.
SECURITY INTtl:REST: Sell.r (or It. .lIi"ns, will ~,. a ...urlly iaUr..1 in , " Joo......t MI~.". onJ ,.,.........<11,< b'illl
pu"{'h:t..' as du.rlt",~ O"~'". SeRer will ,,,.111 tllle to ,attllr'ulIJenl RI:~IS r-;j ~~erellind;l~ "",II lbe 10t81 (..,. F.-IH,
tGlI,ethrr wit\. .J,y deU"41~tne.y cbarcc. tl1:-, .'''', l,ai'e bttn p&id \,. "'Jr=h.!IItr 1.-:0 ~ t4"t.
Pu<<hour aartoslhatall right. eon,eytd under Ihi.AureOle"1 .r< .ubJetl to, ~m1Pltcha.r Ig1'o6;0 01 aJlliluo eOfllplv \lilh.
Uue prtlOftt (and "may bi :'lIr..tt.. .'opted lIMUld.d or aturid) Rultit-, R"yJari nt- lItnd Bylaws .,rSIifUert ..Ilkb er1f .\'ailJM~
for e"Il',lullon In SeReT', ome..
~OTKR: BY SIGNINC THIS }1.(;REEMii:NT, PURCIIA.'-E~ IS AGllF~INC'm T ANY ClAIM PlilKllASER M.\Y fUn
t. (.'\lti,,"r TIlE SELI.51! stULL BE RESOL n:n BY .\UrrAATIOl\" MiD PI,R,: \~t;Jl IS (;IV Il'/O liP IfJSlHER RlGflf 'f0 !I
cn~;!" flR Still\' TRJ^t AS WELL AS HISIIIEI RIGHT OF API"F_\L. SCI f" i\:Snv...NI... .UNfRAL Sfl!VICE$, IN<::.
"." R~lIloG GREtN aMfUIlY
I ~ ID. . '-AM lIlII. ,. Il'IlII
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HOMELA
1901
HARt<.13
Te1ephon
D NURSING HOME
FIFTH STREET
URG, PA 17102
: (717) 221-7900
POSTED \
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Statement Date: 02/01/2006
CRYSTAL HACKETT
110 BERGNER STREET
HARRISBURG, PA 17110
Re: MARY E ALL.YN
Account Nr: 14
Date
Description
D ys
Qu nt
Rate
Charges
Payments
Balance
BAU,~lr:E FORWARD 11,832.90 11,832.90
01/16/06 PAYMENT 11,832.90 .00
01/29/06 OXYGEN 1. 00 138.00 138.00 138.00
01/31/06 CABLE TV 1. 00 20.00 20.00 158.00
01/31/06 MEDICAL SUPPLIES J .00 10.72 10.72 168. 72
01/31/06 PERSONAL SUPPLIES 1. 00 13.86 13.86 182.58
01/31/06 FOOD SUPPLEMENTS 1. 00 62.48 62.48 245.06
01/31/06 INCONTINENT PRODUCT 1. 00 95.00 95.00 340.06
02/01/06 SEMI-2RIVATE ROOM 5 199.00 995.00 1,335.06
-a' CUizens Bank
Pennsylvania
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.. ESTATE OF
vN
EST OF MARY E ALLYN
CRYSTAL U HACKETT CO -EXE
J KENNETH LOWRIE CO-EXEC
110 BERGNER ST
HARRISBURG, PA 17110
~ FOR
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111000 SOb III I: 0 3 b ? b ~ 50 I: b 2 ~ 3 q ? 5 3 l. 2 III
BROCKIE PHARMATECH
209 NORTH BEAVER STREET
YORK, PA 17403
A FINANCE CHARGE OF 1.50 ~ PER MONTH
(AN ANNUAL PERCENTAGE RATE OF 18.llil~ 1.) t..JILL BE
CHARGED ON ALL AMOUNTS 30 DAYS OR MORE PAST
DUE
PHONE: 717-854-902B
;TATEMENT OF ACCOUNT
TO AVOID FINANCE CHARGES,PLEASE PAY BEFORE
TH[- 25TH OF THE MONTH TH~)NI-<--Y()U!
nATEMENT DATE: llI2"i/01./2006
l
j
PLEASE DETACH HERE
PHARMATECH
(iLL N, lT1nFN E
CRY~ H~L HriCKETT
110 BERGNER STREET
HAR IBBI.JHS P~)
nL.L YIYI
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PAGE
1
.171..10
AMOUNT PAir
DATE
I Rx NUMBER I QTY. I
NO RETURN TOP PORTION WITH YOUR PAYMENT
209 NORTH BEAVER STREET YORK~
DESCRIPTION
I ~~T 1~1~~gl AMOUNT I
** ACTIV[TY FOR ALl vN,i MARY E I
Z12/01/06' 20340361 -:iiL/i MClPPHN SUL - 20MG/! 01
!I2//211/061 68256831 12: FUROSElvJIDE 201't!G Ti 01
I l ~ !
Zl;::UI2H /06; 6825685j 180, DUONEB 2.:".) 0.5MG/l 01
Z12/1L~;:I/'7.l6i 68099111 30 FERROUS SU'..: 325MI 01
212/03/061 68253421 30: PREDNISONE 1.0MG TI 01
212/03/06j 68098651 30ASPIR-LOW 1MG ECl01
212/03/06: 68098661 30: ZYPREXA 2. MG TABl 01
212/03/061 68098671 60' POTASSIUM L 20 ~ 01
~2/03/06' 68098691 30i FUROSEMIDE 20MB TI 01
~2/03/06; 68050781 60' NAMENDA 10 G TABLi 01
>! ~
2I2/0J/IZ16i 68119791 30 ARICEPT llZl HiBi 01
Zl2/1Z13/06' 68l?1i5081I 30 SINGULAIR 10M13 TAl IZlI
~2/03/06i 6805089/ 30; FAMOTIDINE 20MB TI 01
212/03/06: 4048593' 30 LORAZEPAM .5MG Ti 01
Z12/03/06: 6826396) .1.5 HYOSCYAMIN 0. 1251 01
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I SALES TAX I ITEM TOTAL'
1:.l:l:"j[.III....:,.l..'~ltll + rtl:r'l:{t1~"'.:II"""'['I~Il:l +
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PLEASE DETACH HERE AND
PHARMATECH 20
ALL YN,
CRYSTA
110 BE
HARRIS
(
C
CHARGE OF 1.50 % PER MONTH
PERCENTAGE RATE OF 18.00 %) WILL BE
ALL AMOUNTS 30 DAYS OR MORE PAST
BROCKIE PHARMATECH
209 NORTH BEAVER STREET
YORK, PA 17403
PHONE: 717-B54~902B
~TEMENT OF ACCOUNT
FINANCE CHARGES,PLEASE PAY BEFORE
OF THE MONTH THANK--YOU!
:MENT DATE: 1lI3/01/'=2006
nU...YM
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PAGE 2
1 7110 AMOUNT PAID
TE I Rx NUMBER I QTY. I DESCRIPTION I ~riT Irl~~gl AMOUNT I I SALES TAX liTEM TOTAL
ETURN TOP PORTION WITH YOUR PAYMENT
NORTH BEAVER STREET YORK, PA 17403
~CTIV~TY FOR A~LYN,! MARY E
~3/06i 6826462\ 60\ FUROSEMIDE 1
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LEGEND
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CHARLES W. RUBENDALL II:
ROBERT L. WELDON
EUGENE E. PEPINSKY, .JR.
.JOHN H. ENOS m
GARY E. FRENCH
DONNA S. WELDON
BRADFORD DORRANCE
.JEFFREY S. STOKES
ROBERT R. CHURCH
STEPHEN L. GROSE
R. SCOTT SHEARER
ELYSE E. ROGERS
CRAIG A. LONGYEAR
.JOHN A. FEICHTEL
DONALD M. LEWISm
STEPHANIE KLEINFELTER
ERIC R. AUGUSTINE
TODD F. TRUNTZ
CAROL L VERISH
KEEFER
000 ALLEN & RAHAL, LLP
ATTORNEYS AT LAW
210 WALNUT STREET
P. O. BOX 11963
RISBURG, PA 17108-1963
ESTABLISHED IN 1878
OF COUNSEL:
HEATH L. ALLEN
N. DAVID RAHAL
SAMUEL C. HARRY
PHONE 17171 255-8000
WEST SHORE OFFICE:
415 FALLOWFIELD ROAD
CAMP HILL PA 17011
17171 812-5800
EIN No. 23-0718135
www.keeferwood.com
WRITER'S CONTACT INFORMATION:
(717) 255-8032
Fax: (717) 255-8003
E-Mail: sgarcia@keeferwood.com
SE T BY CERTIFIED MAIL
RE RECEIPT RE VESTED
May 3, 2007
Glenda Farner Strasbaugh
Cumberland County Register of
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Mary E. All
DOD: 2/6/2006
File No.21-06-0134
Dear Mrs. Strasbaugh;
("".....
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r~"-_)
G~
c.=.:J
........
....,.,..
-0
.'
-<
,
,
--.l
, deceased
o
~-
I enclose for filing an ori . nal and one copy of the Pennsylvania Inheritance Tax
Return for this estate. I also enclo e for the Pennsylvania Dept. of Revenue a copy of the
decedent's From 706 and attac ents. A check in the amount of$15.00 for the filing fee
is also enclosed along with a cop of the signature page of the Pennsylvania Inheritance
Tax Return. Please date-stamp an return the signature page in the self-addressed
envelope. The Inventory has bee sent to the Co-Executors and will be filed separately.
Please do not hesitate to c 11 me if you have any questions.
Very truly yours;
KEEFER WOOD ALLEN & RAHAL, LLP
By: ~ tvJ~'
Sharon M. Garcia
Legal Assistant for Trusts & Estates
",
Allyn Estate - Page Two
Enclosures
CC: J. Kenneth Lowrie, Esq., Co- Executor (w/out enclosures)
Crystal U. Hackett, Co-Exec tor (w/out enclosures)