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Home My WebLink About05-08-07 REV.l500 EX + (lHlO) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 ~ Z w Q w (.) W Q DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITiAl) SOWERS THELMA DATE OF DEATH (MM-DD-Year) E. DATE OF BIRTH (MM-DD-Year) 10/03/2006 10/17/1924 (IF APPUCABlEj SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL) l!! ~Sll) Ua:~ W~8 %f-l U Q.ID 4( 00 1. Original Return o 4. Limited Estate 00 6. Decedent Died Testate (Altach COllY of WlU) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date 01 death after 12.12.82) o 7. Decedent Maintained a Living Trust (Altach copy 01 TruSl) o 10. Spousal Poverty Credit (dale of death between 12-31.91 and 1.1.95) OFFICiAl USE ONLY FILE NUMBER 2 1 -0 6 1 0 0 4 COUNTvCOOE -vEAA- - - iii'iMBER-- SOCIAL SECURITY NUMBER 2 0 9 - 1 2 - 8 7 0 5 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date 01 death prior to 12.13.82) o 5. Federal Estate Tax Return Required _ B. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ~ l!f ~ II) w a: 8 " ":Rndfl'M~8E;COMetEl8I;m;c()8AE$iQNOamCj;0D1\Cdll(IOENTf_'t.;tUO"11.SNaQI.Dilsi)'RltcreJ+l"d$;;.},. \.... NAME COMPLETE MAILING ADDRESS ROGER B. IRWIN ESQUIRE 60 WEST POMFRET STREET FIRM NAME (If Applicable) IRWIN & McKNIGHT TELEPHONE NUMBER 717 249-2353 CARLISLE PA 17013 z o ~ :) t: Q. C (.) w ~ 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (7) (Schedule G or L) B. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule /) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line B minus Line 11) 13. Charitable and Governmental BequestS/See 9113 Trusts for which an election to tax has not been made (Schedule J) (11) (12) (13) (B) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) z o ~ ~ :) ~ == o Co) S 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X _ (15) 111,680.62 X ~ (16) 0.00 X .12 (17) 0.00 X .15 (1B) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 1B. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT II' OFFI~ USE ONLY C":-:::' ~ -".. I 0) 12,472.89 , C~) 24,813.93 c:) ill 129,786.82 16,730.13 1 ,376.07 18,106.20 111,680.62 111 ,680.62 'UO!ldope JO poolq Aq Ja41a4M 'Iuapa:>ap a41 41!M UOWWo:> U! IUaJed auo Isealle se4 04M lenp!^!pu! ue se 'e:O~6 uO!I:>as Japun 'pau!lap SI 6u!lq!s V '[(E' ~)(e)9~ ~6~ 'S'd U] %e:~ S! s6u!lq!S s,luapa:>ap a4110 asn a41 JOI JO 01 sJalsueJIIO anle^ lau a41 uo pasodll,l! aleJ XBI a41 .[( ~)(e)9~ ~6~ 'S'd U] (e:' ~)9 ~ ~6~ 'S'd U U! palOU se Ida:>xa '%g'v S! S9!Jep!19uaq leaU!1 S,IU9pa:>ap a4110 asn 941 JOI JO 01 SJalsuBJIIO anle^ lau 941 uo pasodw! 91eJ XBI a41 . '[(e:' ~)(e)9 ~ ~6~ 'S'd U] %0 S! 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Alleu9dJlS9J91UI 'E 9E'~66'~ 9E'~66'~ 00'0 L~'E€O'G (c:) (~+ 8 + V) SI!paJ~ lelOl LG'€€O'~ IUnOOs!o .~ slu9wAed JO!Jd 'S l!paJ~ AjJ9^Od lesnods 'V slu9wAed/Sl!paJ~ 'C: (6~ 9Un ~ 9ced) 9na xel ., :SI!paJO pUB sluawABd XBJ. €9'9~0'g ( ~) E~OH I 'Vd I 31SIl\:l'V~ dlZ 31V1S All:> O'VO\:l 3801\:18 S:J10M UP SS3l;lOOV 133l;llS :ssaJ a aldwo s ua aoa PPY I I o ,I P a REV-1502 EX 4- (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SOWERS THELMA E. 21 06 1004 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be 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 Droaertv which is iointlv-owned with rlaht af survivarshiD must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION 472 Wolf's Bridge Road, Carlisle, North Middleton Township, Pennsylvania SOLD - Settlement Sheet Attached VALUE AT DATE OF DEATH 92,500.00 TOTAL (Also enter on line 1, Recaoitulation) $ (If more space is needed, insert additional sheets of the same size) 92.500.00 REV-15G8 EX + (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY THELMA FILE NUMBER E. 21 06 Include the proceedS 01 litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 1004 ITEM NUMBER 1. 2. 3. DESCRIPTION M&T Bank - Club Account #25004920104128 Personal Property - Final Settlement Sheet Attached 1992 Mercury VALUE AT DATE OF DEATH 530.64 10,442.25 1,500.00 TOTAL (Also enteron line 5, Recapitulation) $ (II more space is needed, insert additional sheets 01 the same size) 12472.89 REV-1509 EX.+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL V-OWNED PROPERTY ESTATE OF SOWERS THELMA E. FILE NUMBER 21 06 1004 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Walter R. Sowers, III 3069 Spring Road Carlisle, PA 17013 Son B c JOINTLy-oWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY 0/0 OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. OS/2006 Members 1 st Federal Credit Union 8,816.73 50. 4,408.37 Savings Account #286075-00 **Allowing $3,000.00 exclusion 2. A. OS/2006 Members 1st Federal Credit Union 21,551.02 50. 10,775.51 Checking Account #286075-11 3. A. OS/2006 Members 1st Federal Credit Union 14,180.39 50. 7,090.20 Money Management Account #286075-05 4. A. 0212001 Members 1 st Federal Credit Union 4,000.22 50. 2,000.11 Life Savings Account #12791-045 5. A. 06/2006 Members 1 st Federal Credit Union 1,013.85 50. 506.93 Certificate of Deposit #286075-46 6. A. 10/2005 Members 1 st Federal Credit Union 49.50 50. 24.75 Savings Account #272688-00 7. A. 10/2005 Members 1 st Federal Credit Union 16.11 50. 8.06 Checking Account #272688-11 TOTAL (Also enter on line 6, Recapitulation) $ 24813.93 (If more space is needed, insert additional sheets of !he same size) REV-1511 EX+ (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER SOWERS THELMA E. 21 06 1004 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home, Inc. 4,254.10 2. Middlesex United Methodist Church 100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number 01 Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Irwin & McKnight 6,250.00 3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship 01 Claimant to Decedent 4. Probate Fees Register of Wills 290.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees Patricia A. Rosendale, CPA 450.00 7. Register of Wills, Filing Fee 30.00 8. Notary Fees 50.00 9. Roy D. Gottshall, Appraisal on Personal Property 65.00 10. Cumberland Law Journal, Estate Notice 75.00 11. The Sentinel - Legal, Estate Notice 137.03 12. Closing Costs on Real Estate 1,237.00 13. Steven W. Barrett Real Estate - Appraisal on Real Estate 300.00 14. Register of Wills - Short Certificates 12.00 15. Roy D. Gottshall, Auctioneer - Public Auction Fee (Real Estate) 1,850.00 16. Roy D. Gottshall, Auctioneer - Public Sale 1,630.00 TOTAL (Also enter on line 9, Recapitulation) $ 16.730.13 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SOWERS THELMA E. FILE NUMBER 21 06 1004 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. PP&L, Electric VALUE AT DATE OF DEATH 1 B6.59 2. Kemper Insurance - Homeowners Insurance 323.25 3. Kemper Insurance - Auto Insurance 62.10 4. Suburban Propane - Fuel/Propane 804.13 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1 376.07 "":'''''''.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER T'-'J::I UI1 E. ?1 OR 1004 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outritt spousal distributions, and transfers under Sec. 9116 (a (1.2)] 1. Walter R. Sowers, III Lineal 3069 Spring Road 1/2 Remainder Carlisle, PA 17013 2. Dennis L. Potteiger Lineal 478 Wolfs Bridge Road 1/2 Remainder Carlisle, PA 17013 3. Jennifer E. Sowers Lineal 1,000.00 3069 Spring Road Carlisle, PA 17013 4. Heath J. Potteiger Lineal 1,000.00 272 Wagon Wheel Drive Ellerslie, GA 31807 , ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) . COMKONWEAlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES IIEPT. za0601 HARRISBURG, PA 171Z8-0601 ~,- 'W6f. INFORMATION NOTICE AND _TAXI?A'tI;R RESPONSE . . '.. FILE NO. 21 ACN 06155045 DATE 11-02-2006 UY-1545 EX AFP CI'~801 WALTER R SOWERS 3069 SPRING RD CARLISLE PA 17013 TYPE OF ACCOUNT ~. , ~T,.,. _..OF THELMA E SOWERS 0 SAVINGS [-: j s:::S~ /NO. 209-12-8705 !XJ CHECK INS DATE OF DEATH 10-03-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. <, COU:=iT REHIT PAYHENT AND FORHS TO: ?'1 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEHBERS 1ST FCU has provided the Departllent with the infor.ation listed below which has baan used in calCUlating the potential tax due. Their records indicate that at the death of the above decedent, YOU were a joint owner/beneficiary of this account. If YOU feel this inforution is incorrect, please obtain written correction fro. the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the COBBonwealth of PennSYlvania. Questions HY be answered by "..tling (7171 7117-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 286075-11 Date 05-25-2006 Established Account Balance Percent Taxable AIIount Subject to Tax Tax Rate Potential Tax Due x 14,180.39 100.00 14,180.39 .045 638.12 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice BUst accoapany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax paYlllH1ts are .ade IIi thin three (3) eonths of the decedent.s date of death, yoU eay deduct a SiC discount of the tax due. Any inheritance tax due lIill becoae delinquent nine (9) IIOI1thS afor the date of death. PART ill A. [ CHECK ] ONE BLOCK B. ONLY c. ~ The above infor_tion and tax due is correct. ~ 1. You Bay choose to r..it pay..nt to the Register of Wills with tllo copies of this notice to obtain a discount Dr avoid interest, Dr you .ay check box "An and return this notice to the Register of Wills and an official asses..ent IIi 11 be issued by the PA Departaent of Revenue. r=J The above asset has been Dr lIill be reported end tax paid lIith the Pennsylvania Inheritance Tax return to be filed by the decedent.s representative. r=J The above infor..tion is incorrect and/or debts and deductions were paid by you. You BUst cOBplete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION OF LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Allount Subject to Tax 4 S. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED TAX ON JOINT/TRUST ACCOUNTS PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Co.putation) I $ Under penalties of perjury, I declare that the facts I cOBPlete to the best of .y knowledge and belief. tJ _ __ /i::C:- W~~,.~...~- have reported above HOME (717) WORK ( ) are true, correct and at/tiw . ~8~ </ , I / I I"~ /,,/_ COMMONWEALTH OF PENNSYLVANIA IlEPARTIENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 Yd., _" -.r,--_ INFORMATION NOTICE ,r'. ",:,~::-,~- r.".. AND ~T~~PAYER RESPONSE FILE NO. 21 ACN 06155044 DATE 11-02-2006 REY-15U ER ifp'ln-.o,' Ct.H.'~.-".' TYPE OF ACCOUNT l-'i'1 ~j~Sif OF THELMA E SOWERS [i1 SAVINGS S.S. NO. 209-12-8705 D CHECKING DATE OF DEATH 10-03-2006 D TRUST !~.r~\;f:rtOUNTY CUMBERLAND D CERTIF. ,~-', p:\ REMIT PAYMENT AND FORHS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 LL:U~J : L:. WALTER R SOWERS 3069 SPRING RD CARLISLE PA 17013 ItEHBERS 1ST FCU has provided the Deparblllnt with the infar.atian listed below which has been used in calculating the patential tax due. Thair recards indicate that at the death of the above decedent, yoU were a jaint owner/beneficiary af thi. account. If YOU feal this infaraatian is incorrect, please obtain written correction fras the financial institution, attach a capy to thl. fera and raturn it ta tha above address. This account is taxable In accordance with tha Inheritanca Tax Laws of the Cassanwealth af P.nnsYlvanla. Questions say be answar-ri by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 286075-05 Date 05-25-2006 Established Account Balance Percent Taxable AIIount Subject to Tax Rate Potential Tax Due x 21.551.02 100.00 21.551.02 .045 969.80 TAXPAYER RESPONSE Ta insure proper credit to your account, two (2) capies af this no tics BUst accaspany your payaant to the Registaraf Nills. HBke check payabla tal "Register of WillS, Agent". x NOTE: If tax payaants are .ade within thrae (3) sonths af the decadant.s date af death, yau aay deduct a 5;( discaunt of the tax dua. Any inheritance tax due 101111 bacaae dellnquant nine (9) sanths after the data of daath. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. FVI The abava inferaatian and tax dUB is corract. ~ 1. Yau say chaasa to raalt payaant to the Register of Nills with two copies of this notice to abtain . a discaunt or avoid interest, or YCU ..y check box "A" and return this notica to the Raglster of Wills and an official assessaent will be issued by the PA Dapartaent of Ravanua. c=J The above asset has been or will ba raparted and tax paid with the Pennsylvania Inheritance Tax raturn to ba filad by tha decedent's reprasantativa. c=J Tha abava infar.atian is incorrect and/or dabts and deductions were paid by you. Yau aust caapleta PART [!] and/or PART [!] below. If you Indicate a different tax rate, please state your relationship to decedent: PART [!] TAX RETURN - COMPUTATION OF TAX ON LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. AIIount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 JOINT/TRUST ACCOUNTS PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury. I declare that the complete to the best of my knowledge and belief. ~~N~~~ I $ facts I have reported above are true. ~V. HOME WORK ( . /7 ) ( ) and T~I rDun"l~ ...ltunr-n COMMONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. za0601 HARRISBURG, PA 171Z8-0601 '* INFORMATION NOTICE . 'J'(- -,,~- ,~---AND. --- .. T-AXPAYE.R. ItESPONSE ,_~ .-...... ,h __. ,,_. FILE NO. 21 ACN 06155043 DATE 11-02-2006 REV-1M! EX IFP lD,-OIl WALTER R SOWERS 3069 SPRING RD CARLISLE PA 17013 TYPE OF ACCOUNT 20D6 i'':.},' i L} E[~1 {,FSfHELMA E SOWERS 0 SAVINGS S. S. NO. 209-12-8705 0 CHECKING C:L:HP~'fE OF DEATH 10-03-2006 0 TRUST ORFf1AcI'2C9.~ CUMBERLAND 00 CERTIF. CUi'/":-' P!~ REttIT PAYttENT AND FORttS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ttEMBERS 1ST FCU has p...avid.d the D.pa...tJI.nt with the infa....atian listad blllaw which has bun us.d in calculating the potenti.l tax du.. Thai... ....co...ds indicat. that at the death of the above d.c.dent, yau w..... . joint own..../b.n.fici....y of this account. If yOU f..l this info.....tian is inco.......ct, pl.as. abtain w...itt.n ca.......ctian f...aa the financi.l institutian, attach a capy to this fa.... and retu...n it to the abav. add....ss. This account is taxable in acca...danc. with the Inh....itanc. Tax Laws of the COlIlIOnw.alth of PennSYlvania. Questions aay b. .nsNll....d by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 286075-46 Date 06-26-2006 Established Account Balanca Parcent TlIXllbla AIIount Subj.ct to Tax R.t. Potential Tax Due x L013.85 100.00 L013.85 .045 45.62 TAXPAYER RESPONSE Ta insu.... p...op.... c....dit to you... account, two (Z) copi.s of this notic. BUst accOllp.ny you... payaent to tha R.gist.... of Wills. MlIk. ch.ck payable to: .RBllIist.... of Wills, Agent". x NOTE: If tax paYllllnts a.... a.da within th..... (3) aonths of the dec.d.nt's data of d.ath, yOU aay deduct a 5;( discount af tha tax du.. Any inha.-i tanc. talC due will bacaa. d.linqu.nt nine (9) aonths aft.... the data of death. T_ PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. ~ Tha &bav. infa.....tian and tax due is co.......ct. ~ 1. You aay choas. ta .....it payaant to the R.gist.... af Wills with two capies af this natic. to obtain a discount a... avaid inta....st. 0... yOU ..y chack box .A. and ....tu.-n this notic. ta the R.gist.... of Wills end .n afficial .ss.ssmant will b. issu.d by the PA Dap....ta.nt af R.venu.. [] Th. abav. ass.t has b.an a... will b. ...apo...t.d and tax paid with the P.nnsylvania Inh....itanc. Tax ....tu...n to b. fil.d by the dec.dent's ....p......ntativ.. [] Th. abov. info.....tian is inco.......ct andla... debts and deductians NlI.... paid by yau. You Bust coapl.t. PART 0 andla... PART ~ b.low. If you indicata a diffarant tax rata, plaase stata your ralationship to decedent: PART l!I DATE PAID DEBTS AND DEDUCTIONS CLAIMED PART [!J TAX RETURN - COMPUTATION OF LINE 1. D.ta Establishad 1 2, Account Balance 2 3, Parcant Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rat. 7 X 8. Tax Due 8 TAX ON JOINT/TRUST ACCOUNTS PAYEE DESCRIPTION AMOUNT PAID I TOTAL CEnter on Line 5 of Tax Conputation) I $ Under penalties of perjurYI I daclare that the facts I conplate to the best of ny knowledge and belief. !Y.~&~~ have reported above HOME ('71'7) WORK ( ) are true, correct and dC/V - 38 d. c.( I j ,ll 1 I~/ CDMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2110601 HARRISBURG, PA 171211-0601 * INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 OlD lG0'f ACN 06155063 DATE 11-02-2006 REMIT PAYMENT AND REGISTER OF WILLS CUMBERLAND CO COURT CARLISLE, PA 17013 TYPE OF ACCOUNT IX] SAVINGS o CHECKING o TRUST o CERTIF. FORHS TO: WALTER R SOWERS 3069 SPRING RD CARLISLE PA 17013 CU~D!( (Ie On.....l~ .,\~:!';"" ,~......I r'J'T/i.d.,' ," ,'(~" lOT (\t . ,~..-..:.. .j" d-.-l'JVi I J i;..lllf:"i ". .:1, Ti ,r.('; Df, " '..' '.' ',-' '.) . , /4, EST. OF THELMA SOWERS pOl ':lS~. NO. 209-12-8705 d .JblifE OF DEATH 10-03-2006 COUNTY CUMBERLAND 'inrr r, 1'-';' . I LU...~O r~;;".~ ~J f t..t HOUSE HEMBERS 1ST FCU has providlld the Dap.rtll8nt with the infa....tion lisbd below which has been used in celcul.ting the pobnti.l tax due. Thair records indic.te th.t at the de.th of the .bove decedent, YOU were e joint ownBr/benefici.ry of this account. If YOU feel this infa,-..tion is incorrect, please obtain written corr-action fr~ the financial institution, .ttach e copy to this fa... .nd return it to the above .ddress. This eccount is tax.ble in .ccordance with the Inheritance Tax Laws of the COII.onwe.lth of Pennsylvani.. Questions aay be answered by ee!!ing (717) 7117-11327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 12791-04 Date 02-01-2001 Established Account Balence Percent Taxable AIIount Subject to Tax Rate Potential Tax Due x 4,000.22 50.000 2,000.11 .045 90.00 TAXPAYER RESPONSE To insure proper credit to your .ccount, two (2) copies of this notice BUst .cco.p.ny your pay.ent to the Register of Wills. Make check p.y.ble to: "Register of Wills, Agent". x NOTE: If tax payaants are .ede within three (3) aonths of the dacedllnt.s d.te of dnth, YOU ..y deduct. SiC discount of the tax due. Any inheritance tax due will becOlle delinquent nine (9) .onths after the d.te of de.th. Tax PART ill A. t8I The .bove info....tion .nd tax due is corrBct. 1. You .ay choose to re.it payaent to the Register of Wills with two copies of this notice to obtain · discount or .void interest, or yoU aay check box "A" .nd return this notice to the Register of Wills .nd .n official assessaant will be issued by the PA Departaant of Revenue. [CHECK ] ONE BLOCK ONLY B. r=J The .bove .sset has been or will be reported and tax paid with the PennSYlvania Inheritance Tax return to be filed by the dIIcedent.s representative. C. r=J The above inforntion is incorrect and/or debts and deductions were paid by you. You BUst coeplebl PART 0 .nd/or PART [!] below. . If you indicate a different tax r.te~ pl8&se state your relationship to decedent: PART ~ TAX RETURN - COMPUTATION OF TAX LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. AIIIount Subject to Tax 4 5. Debts and Deductions 5 6. AIIIount Taxable 6 7. Tax R.te 7 X 8. Tax Due 8 PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED ON JOINT/TRUST ACCOUNTS PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I complete to the best of my knowledge and belief. have reported above are true, correct HOME ( 71'~ > ,J.l{q - 3.:g ,;,"'- W~:~ r=D~n~lr= ~1~"1>~D and ~fZ~~ 7l:C R SIGNAT R - / I I/o Io~, ---- COIIIlONWEAL TH OF PENNSVLVANIA DEPARTMENT OF REVEillE BUREAU OF INDIVIDUAL TAXES IIEPT. 280601 HARRISBURG, PA 171Z8-0601 .:e INFORMATION NOTICE '.. (,-.. -,-.AND .' 'TA~PAYeR RESPONSE FILE ACN DATE NO. 21 06155042 11-02-2006 .. IEV-1545 EX AFP lU9-ID h , , - .. WALTER R SOWERS 3069 SPRING RD CARLISLE PA 17013 TYPE OF ACCOUNT 2fD51~T'.' 11. P~s1: ~ THELMA E SOWERS [i] SAVINGS 5.5. NO. 209-12-8705 0 CHECKING CLEF::< i=:bATE OF DEATH 10-03-2006 0 TRUST O?F'-!,}.' !~CC.ptmTY CUMBERLAND 0 CERTIF. CUI'. -', -\ rf\ P,i\ REMIT PAYMENT AND FORtIS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 HEtlBERS 1ST FCU has provided the Depart..nt with the infareation listed below which h.s be." used in ~1cu1.tlng the potanti.1 tax due. Their records indicate th.t .t the de.th of the above decedent, YOU were. joint owner/benefici.ry of this eccount. If you f..l this infareation is incorrect, please obtain written correction frae the financial institution~ .tt.ch . copy to this fara and return it to the above Bddress. This .ccount is tax.bls in .ccard.nce with the Inheritance T.x LaNS of the CoeBOnwe.lth of P.....sYlvani.. Ques~ions ay b. answ.....d by "'''JUng (717) 787-83Z7. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 286075-00 Dab 05-25-2006 Established Account BalMce Percent Texebl. Allaunt Subject to Tex Rete Potential TIIX Due x 8,816.73 100.00 8,816.73 .045 396.75 TAXPAYER RESPONSE To insure proper credit to your account, two (Z) copies of this notice BUst .ccoepany your p.y.ent to the Registar of Wills. Make check paY.ble to: "'Reg ister of Wills, Agentft. x NDTE: If tax payeants .re ..de within three (3) BOnths of the decedent's d.t. of dath, yOU ay deduct. 5lC discount of the tax due. Any inheritance t.x due will beco.e delinquent nine (9) .anths .,ter the data of de.th. Tax PART II] [CHECK] ONE BLOCK ONLY A. ~ The above infara.tion and tax due is correct. I. You e.y chao.. to r..it p.Yll8nt to the Register af Wills with two copies of this natice to obtain . discount or avoid interest, or yoU eay check box ftAft and return this notice to the Register af Wills and .n official assessaent will be issued by the PA Departaent of Revenue. B. [] The .bave .sset h.s been or will b. reparted and tax p.id with the Pennsylvania Inheritance Tax return to be filBd by the decedent's representative. C. [] The .bave infaratian is incorrect and/ar debts .nd deductians NBrB p.id by you. You .ust caaplete PART ~ and/or PART[!] below. If you indicate a different tax rate, please state your relationship to decedent: PART [!] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established I 2. Account BalMce 2 3. Percent Taxable 3 )( 4. A80unt Subject to Tax 4 S. Debts end Deductions S 6. A.ount Taxable 6 7, Tax Rate 7 )( 8, Tex Due 8 PART (!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line S of Tax Computation) I $ Under penalties of perjury, I declare that the facts I coaplate to the best of my knowledge and belief. LJ~ R. ' ..L:rcJ-O.....L lZZ:;.. have reported above are true, correct HOME (7/7) d'lt( ~ 3!?c;)t! WORK ( ) and . I / I JM hI,., last Bill axro ~t$lmntn! I, THELMA E. SOWERS, of Middlesex Township, Cumberland County, Pennsylvania, declare this instrument to be my last will and testament, hereby expressly revoking all wills and codicils heretofore made by me. 1. I direct my executor to pay all of my debts, funeral and administrative expenses, as soon as convenient after my decease. 2. I authorize and empower my executor to sell any realty owned by me at my death and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate as follows: (a) $1,000.00 to Jennifer E. Sowers; (b) $1,000.00 to Heath J. Potteiger; and (c) All the rest, residue and remainder to Dennis L. Potteiger and Walter R. Sowers, III, share and share alike, the child or children of any deceased person taking the share their parent would have taken if living. 4. I nominate and appoint Walter R. Sowers, III, to be the executor of this my last will and testament; he is to serve as such without bond. Should he die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint Dennis L. Potteiger, as substitute executor, also to serve as such without bond, with the same powers as are given herein to my executor. 5. I hereby suggest that my personal representative retain the services of Irwin, Irwin & McKnight, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day of October,. 1989. 5"ay~~*-e~ASEAL) _./ THELMA ~ SOW RS Signed, sealed, published and declared by Thelma E. Sowers, the above-named testatrix, as a~d for her last will and testament in the presence of us, who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. ~\f."h,Q, ~'~d ~#~ d!~JJ.#K/ ACKNOWLEDGEMENT AND AFFIDAVIT WE, THELMA E. SOWERS, KATHLEEN M. KENNEY and SHARON L. SCHWALM, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declar~ to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the Will as a witness and that to the best of their knowledge the testatrix was at that time eighteen years of age.or older, of sound mind and under no constraint or undue influence. ~' J5? . ~A '/~:.v <0-- ~<,,"-=-- ~ ~ THELMA E. OWE S ~~,,~ ~ ~& . KATHLE M. KENNEY lMh~~~ ' A . COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Subscribed, sworn to and acknowledged before me by THELMA E. SOWERS, the testatrix, and subscribed and sworn to before me by KATHLEEN M. KENNEY and SHARON L. SCHWALM, witnesses, this ~~ day of October, 1989. . -/} . C-'CL \. . ~O';.:,\;:.;:"l. ~~.~'.l RO:3;:"I ::~w:;.;. N':lU.~'( r-U3UC ~AR!...ISL:: 5t)ROUGH, :::UM6eRLANO COUNT'f MY CC\4M:.~:3:C~: :X?IM:S OCT 3, ~S~2 M1m~~~, P,,:,.~:,,:~yh'r.~::a ~.!.5.X:;,:-!~::I>~ .,' ~;v ~ar:~s HUD - I UNIFORM SETTLEMENT STATEMENT OMB Approval No. 2502-0265 A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT B. TYPE OF LO/.N 6. File Number: 7. Loan Number: I. FHA 2. FmHA 3. Conv. Unins. 4. VA 5. Conv. Ins. 8. Mortgage Insurance Case Number C. NOTE: This form is fumished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. NOTE: TIN = Taxnaver's Identification Number D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER: Scott Hench Estate of Thelma E. Sowers Walter R. Sowers, Executor 251 Sheaffer Road Carlisle, PA 17013 G. PROPERTY LOCATION: H. SETTLEMENT AGENT NAME, ADDRESS AND TIN 472 Wolf's Bridge Road Jacqueline M. Verney, Esquire Carlisle, PA 17013 44 South Hanover Street Carlisle PA 17013 PLACE OF SETTLEMENT I. SETTLEMENT DATE 44 S. Hanover Street 04/18/2007 Carlisle PA 17013 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 10 I. Contract sales nrice 92 500.00 40 I. Contract sales nrice 92 500.00 102. Pe~onalnronPrtv 402. Pe~onalDrooertv 103. Settlement charlles to borrower (Line 1400) 1 363.50 403. 104. 404. 105. 405. Adiustments for items naid bv seller in advance Adiustments for items naid bv seller in advance 106. City/town taxes 406. City/town taxes 107. County taxes 04/18/2007-12/31/2007 219.68 407. Countv taxes 04/18/2007 -12 / 31 / 2 0 07 219.68 108. Assessments 408. Assessments 109. 409. 110. School Tax 04/18/07-06/30/07 182.40 410. School Tax 04/18/07-06/30/07 182.40 Ill. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 94.265.58 420. GROSS AMOUNT DUE TO SELLER 92 902.08 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 20 I. Denosit or earnest money 9 250.00 501. Excess denosit 9 250.00 202. Princioal amount of new loan(s) 502. Settlement chal'l!es to seller I Line 1400\ 1.237.00 203. Existinllloan( s) taken subiect to 503. Existinllloan( s \ taken subiect to 204. 504. Pavoff of first mort"a"e loan 205. 505. Pavoff of second mortl!:aae loan 206. 506. 207. 507. 208. 508. 209. 509. Adiustments for items unnaid bv seller Adiustments for items unnaid bv seller 210.Citvhowntaxes 510. Citv/town taxes 211. Countv taxes 5 I I. Countv taxes 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 9 250.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 10 487.00 JOO. CASH AT SETTLEMENT FROMITO BORROWER 600. CASH AT SETTLEMENT FROMITO SELLER 301. Gross amount due from borrowed Line 120) I 94 265.58 60 I. Gross amount due to seller (Line 420\ I 92 902.08 302. Less amount oaid by/for borrower ILine 220\ I 9 250.00 602. Less reduction in amount due seller/Line 520\ I 10 487.00 303. CASH FROM BORROWER I 85 015.58 603. CASH TO SELLER I 82 415.08 SELLER'S STATEMENT The information contained in Blocks E, G, H, and I and on line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service (see Seller Certification). If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. You are required to provide the Settlement Agent with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my c.:Jrrect taxpayer identification number. (Seller's Signature) Walter R. Sowers, Executor (Seller's Signature) Estate of Thelma E. Sowers iO EASY SOFT, Inc. 2001 Previous editions are obsolete Page I form HUD-I (3/86) ref Handbook 4305.2 L. SETTLEMENT CHARGES 70&. TOTAL SALES/BROKER's COMMISSION based on nrice S 92 500. 00 @ Di~ision of Commission lIine 7001 as follows: PAID FROM BORROWER'S FUNDS AT SETILEMENT PAID FROM SELLER'S FUNDS AT SETTLEMENT 701. $ 702. $ 703. Commission naid at Settlement 704. 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 80 I. Loan Orillination Fee $ 802. Loan Discount $ 803. Annraisal Fee to 804. Credit reoort to 805. Lender's Insnection Fee 806. 807. 808. 809. 810. 811. 812. 8\3. 900. ITEMS REOlJlRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from 902. Mortllalle Insurance Premium for 903. Hazard insurance Premium for 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 100 I. Hazard insurance 1002. Mortl!al!e insurance 1003.CitvPronertvTaxes 1004. County PronPrtv Taxes 1005. Annual assessments 1006. 1007. 1008. Allllrellate Accounting Adiustment 1100. TITLE CHARGES IlOl.Settlementorclosinllfeeto Jaccrueline M. Vernev Esauire 1102. Abstract or title search to Ace Abstractina 1103. Title Examination to 1104. Title insurance binder to 1105. Document orenaration to 1106. NolaN fees to Valerie Gsell 1107.Attomev'sfeestoRoaer Irwin Esauire (POC) (includes line numbers: deed nreo, sales aar & notarv 1108. Title Insurance to (includes line numbers: 1109. Lender's coveralle $ 1110. Owner's covera"e $ 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordinp fees: Deed $ 38.50 Mortpa"e $ 1202. Citv/cntv tax/stamos: Deed $ 925.00 Mortllal!e $ 1203.Statetaxlstamns: DeedS 925.00 Mortlla"e$ 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to \302. Pest insnection to \303. Pennv G. Davis 1304. 1305. \306. 1400. TOTAL SETTLEMENT CHARGES (enteron lines 103 SectionJ and 502 Section K\ 11 363.50 1.237.00 CERTIFICATION: I have carefully reviewed the HUD-I Settlement Statement anJ to the best of my knowled~e and belief, it is an:::zaccurate statement I I receipts and disbursements made on my account or by me in this transaction. I further certiJy that I received a copy of the HUD-I Senle tatement. (A/~-,,;1.. 5t?U~ ~--~ ~ Estate of Thelma E. Sowers Borrower 7/ SCott Hen-th - .1. ~ /~ 300.00 100.00 I I 92500.00 Release $ 38.50 925.00 925.00 tax collector 2007 count v taxes 312.00 Seller Seller Walter The HUD-I Settlement Statement wh this saction. Sowers Borrower ve prepared is a true and accurate account of the funds disbursed or to be disbursed by the undersigned as part of the settlement of ILc tI ~ 04/18/2007 ,,--<, ent Jacqueline M. Ver y, Esquire Date WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. ~ EASY SOFT, Inc. 2001 Previous editions are obsolete Penalties upon conviction can include a fine and Page 2 form HUD-I (3/86) ref Handbook 4305.2 .- /:. OWNER ~-sh;~~ FINAL SETTLEMENT d -r-hdmCl. E, So",vQ("!:. Date 5 - "3 I - 01 Address Date of Sale Sale Location Auctioneer Clerk Cashier Other PROCEEDS OF SALE: Cash ___u_u___ _____uu__uu_u__ _uu___u_u___ $3,)g~-5o I, ~5q./S Checks _________ ___u______u______u______________ Other _____________ uu_u__ _u_u_ _u______u -u-___u__u_____u____u_uuuu_u__uuuu__ ------------------------------------------------------------...--..-----...---..-----------......--. Miscellaneous (see attached list) TOTAL PROCEEDS OF SALE ___u________________. $ I 0\ "\-~:,). ~f) LESS SELLER'S SALE EXPENSE: Auctioneer's Fee ____u___u_ ________u__________ _____u____u__ _____ __u_ _______u_ $ 5~~.QO Other Seller's Expenses Advanced by Auctioneer: Adv "30.00 K' u'.t ~ .l r "'0.00 Cl-t...\L C\~".k -:J:/\. ~\ ck. (:)U- 5\ ~ ~ot1-oo ~oq. Co Miscellaneous (see attached list) ________u________u_____u____u_____________ DEDUCT TOTAL SELLER'S SALE EXPENSE _____________u________________ $ ~ I "30- 0 0 TOTAL NET PROCEEDS TO SELLER ___________u___Uu______Uu_ $ ~, %, d . ~ ~ I. (or we), the seller of goods, merchandise, and/or property sold at public auction on above date and location, acknowledge and accept this settlement of proceeds of sale. I (or we) agree to accept all responsibility for providing merchantable title to all goods, merchandise, and/or property sold, and for delivery of title to the purchaser. J-~I-07 (Seller's Signature) (Seller's Signature) Form No. FS Reorder from: MISSOURI AUCTION SCHOOL Phone 1-800-835-1955 .No. 1594775 .' ... z ... :II z '" Iii ~ ~ A. gI J! a. PA TI11.E NUMBER (AS SHOWN ON ATlJICHED nTl.E) 45226213001 SO MAKE OF VEHIClE f1l(!.Il.CU/l. CONOmoN . VEHICLE IlENTFJOlIlON NUMBER 3f'1APfH OJ. 1 NR6 0079 3 X1DioP.. .... . B. (OR RJlL BUSINESS ) c Sow /l.~, lhelma, ~ =t co-sEU.ER . C. LAST NMIE (OR All lllJSltESS l'W;1EF" Ija~alon.i.~ co-fllR:HASER I u i ~a1all.m Hou~e Lane i 22 ~O . CITY .Camp H.i.t..f., ',!,,"SUUE" PlI. " . ZIP CODE 17011 . D. LAST tw.E lOR RllIllJSlolESS NAME) FIRST NAhE MIDDlE INITlAl 0IlTE N:OlIflEl)I PURCHASED ... z ., II: I ., i ~ 0 ~ ~ 0 z '" E. "0 U F. ro-PIJRCHASER SffiEET . . SOOE ZIP CODE CITY REFER 10 tnmY CODES LJS11lIG ON RE'IERSE SlOE 6. Transfer Fee OF PINK COPy . . MAKE OF YEt<<:lE 10. 7. Increase Fee . . MODEL YEAR 8. Rep/&cemet~ Fee . . D~ DIldOR 9. 0R0&Al PLAtE J ~ 'Qnij'" o PUUEroBE~BY BlR:AU (f'ROOf OF lilt. SURANcE ..sr BE ATe 'OCHEO.) O ElCCI-lANGE A.ATE TO BE ISSUED BY BlR:AU r:hY ~ l'I.RE 0' ISSUED BY F1.I.l. AGENT o TRANSFER OF PREvIOUSt.Y ISSUED A.ATE o 1iWlsFER & RENEWAL OF PlATE .0 TR.INSFER & REPlACEMENT OF PlATE o TRANSFER OF PlATE & REPlACEMENT OF STICKER PAlO (Add llhru 6) 149 . Send ~. Ch&6k in This.A1nOliliit 11.GRANO TOlJl.L (Add 9 & 10) REASON FOR RE~NT DU)5T D DEFACED O~~~~~=b' block is c:heckt!d I/lN ... h II o srot.EN ~- ~". '91 "(, GMS4129 832402 G. \n;11IU.t:. ~ ~('iV'NR MIGHT' N'O. " ~~~alty ISSuING 1CERi'FY llW"ONMONTH .. .1 DAY ~ ~ = :.=o~~~~v:~r Mo\nON ~ WJTlf AU. APPI.JCN3lE PROIIlSIONS OF TfE veHICLE CODE .. ANb'~REGlUl1ONS. I!WE CERTFY l1W I/WE HI'IoIE EXAMNED AND SIGNED THIS FORM AFTER ITS COMPLETlON. . THAT INFOR IS ct.J\NED, 1lE fUlCHoill5ER FUmiER CERJFlES 11iI\T HE/SHE IS Alffi10RlZED TO CLAIM THIS ExeMPTioN. IIWE PRII/LEGE(S) OR \IEt<<:lE ~GISTIW1ON(S) FOR f'M.mE TO ~ F1I'WICW. RESPONSIlIUTY ON THE CURRE REGISTl'WlON. I/WE ACKNOWlEDGE nw I/WE MM BE SUBJECT TO A fINE NOT ElCEEDtNG $5,000 AND IMPR FH.Se SllVEMENT 1HIlr IW<E ON TItS FORM. alA 'ed ~ aI AUIIiDrimd Signer ~ 5 ~ .. u TELEPHONE NUMBER 17 763 7761 1ST ASSIGN- IiIENT SigI-.re 01 Second_ or _ 5q\er TELEPHONE NUMBER I ) 2ND ASSlGN- MENT SignaIure cI Co-P\Jft:haser /Title 01 AUharized Signer H. .... z ~~~ ~"'15 i ~ NOTE: If a co-purchaser othei'lhan y'our spOuse is Iisled 8ndyou want the title to be listed as .Joint Tenants With Right of Survivorship. (On death of one owner, title goes to surviving owner.) CHECK HERE O. Otherwise, the title will be issued as "Tenants in Common. (On death of one owner, interest of deceased owner goes to his/her heirs or estate). NOTE: F THE VEHIClE IS TO BE USED AS A DAILY RENTAL OfllEASEO VEHICLE. CHECIl;THIS BLOCK 0 ,IF BLOCK IS CHECKED, COMPlETE AND ATTACH FORM MV-IL. MESSENGER NUMBER: l.RWIN & McKNIGHT 12791 -00 ~~ ~ 12/14/1971 f'W\ $69.67 ^,)( \..; (}' $.00 l}l~JJ~ $69.67 U~~)p $.24 ~ \ ',.., Walter R. Sowers, II 04/23/96 " fvl~ MEMBERS 1st FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Interest Earned from 1/1/06 to Date of Death Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Interest Earned from 1/1/06 to Date of Death Name of Joint Owner Date Joint Ownership Established . 'i'''', J un "Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Interest Earned from 1/1/06 to Date of Death Name of Joint Owner Date Joint Ownership Established LIFE SAVINGS ACCOUNT: Account NumberlSuffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Interest Earned from 1/1/06 to Date of Death Name of Joint Owner Date Joint Ownership Established 12791 -04 02/01/2001 * $4,000.00 $.22 $4,000.22 $30.16 Walter R. Sowers, III 02/01/2001 ~I~IUW(~ DEe 1 4 2006 286075 -00 OS/25/2006** $11,816.08 $.65 $11,816.73 $43.15 Walter R. Sowers, III OS/26/2006 286075 -11 OS/25/2006** $21,550.73 $.29 $21,551.02 $18.63 Walter R. Sowers, III OS/26/2006 ,~., it $14,178.85 $1.54 $14,180.39 $96.09 Walter R. Sowers, III OS/26/2006 CERTIFICATE OF DEPOSIT: Account Number/Suffix 286075 -46 Date Account Established 06/26/2006 Principal Balance at Date of Death $1,013.67 Accrued Interest to Date of Death $.28 Total Principal and Accrued Interest $1,013.85 Interest Earned from 1/1/06 to Date of Death $13.85 Name of Joint Owner Walter R. Sowers, III Date Joint Ownership Established 06/26/2006 $ f/(!f()lfrb w~re 1lltUf11/5 Md ~ 1eeOLnf hl/dtrs a{lt!tJbnf /)tL/Y}(xY5 were ..sfvkn. AJfw OfllYnn6 Ind m Ix ~ 5000 Louise Drive · Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 · www.members1st.org .. "Account opened by transfer of funds from 12791-00 ....Account opened by transfer of funds from 272688, originally established 1/19/06 REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established Date Account Closed Principal Balance at Date of Death Interest Earned from 1/1/06 to Date of Closing Total Principal and Interest to Date of Closing Interest Earned from 1/1/06 to Date of Closing Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Date Account Closed Principal Balance at Date of Closing Accrued Interest to Date of Closing Total Principal and Interest to Date of Closing Interest Earned from 1/1/06 to Date of Closing Name of Joint Owner Date Joint Ownership Established ~ ........ ....." ....",....,: Account . umer/Suffix Date Account Established Date Account Closed Principal Balance at Date of Closing Accrued Interest to Date of Closing Total Principal and Interest to Date of Closing Interest Earned from 1/1/06 to Date of Closing Name of Joint Owner Date Joint Ownership Established Estate of: THELMA E. SOWERS Date of Death: October 3, 2006 Social Security Number: 209-12-8705 272688 -00 10/07/2005 06/26/2006 $49.50 $.00 $49.50 $74.81 Walter R. Sowers, III 10/07/2005 272688 -11 10/07/2005 06/26/2006 $16.11 $.00 $16.11 $23.50 Walter R. Sowers, III 10/07/2005 CI . l- ~)~.~ , /OC 05/31/2006 {\ ((\ \~(;\ .~ 01 C; $14,068.20 il0LUv flo $16.10 \J';\; liD" $14,084.30 .~()S\ 0 $92.98 r \ \ Walter R. Sowers, III 01/19/2006 tJB~RS 1/.' .. ~ERAL CREDIT UNION ~( d/~Z:~, enise A. Wolfe Insurance Services upervisor December 7,2006 .. Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 L 7,2006 Walter R. Sowers, III 3069 Spring Rd. Carlisle, PA 17013 The Funeral Service for Thelma E. Sowers We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES St:rvices of Funeral Director/Staff. . . . . . . . . . . . . . . . . FUNERAL HOME SERVICE CHARGES . . . . . . . . . . THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED . . . . . . . . . . . . . $3995.00 $3995.00 $3995.00 Cash Advances Clergy/Mass Offering. . . . . . . Certified Copies of tire Death Certificate. Sentinel Obit. . . . . . . . . TOTAL CASH ADVANCES AND SPECIAL CHARGES. $75.00 $72.00 $112.10 $259.10 Total Total Cost. . . . .. . . . . . .. . . . .. .. .. .. . .. .. .. .. . . .. $4254.10 S UB- TOTAL INITIAL PAYMENT / DISCOUNT / CREDITS TOTAL AMOUNT DUE $4254.10 0.00 $4254.10 The unpaid balance over 45 days is subjected to a 1.00 % service charge per month - 12.0000 % per annum. Member of National Funeral Directors Association d PJ ~c.oo. aU J)~'C. :;lLQ 0 I 00 \\ A PD .,