The URL can be used to link to this page

Home My WebLink About06-05-07 -.J 15056041114 REV -1500 EX (06-05) OFFICIAL USE ONLY County Code Year File Number PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisbu PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT I 07 00& Date of Birth Suffix 07101927 Decedent's First Name MI 174-20-8268 Decedent's Last Name 01142007 SHERBOURNE (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix DOROTHY G Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW III 1. Original Retum 0 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-1U2) D 4. Umited Estate 0 48. Future Interest Compromise (date of 0 5. Fed8ra1 Estate Tax Retum Required death alter 12-12-82) III 6. DececIent Died Testate D 7. Decedent Maintained a Uving Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of W11~ (Attach Copy of Trust) D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death 0 11. Election to tax under See. 9113(A) between 12-31-91 and 1-1"95) (Attach Sell. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. All CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT G. FREY Firm Name (If Applicable) 717-243-5838 FREY AND TILEY First line of address REGIS'fER)OF WILLS OSEONLY !. ',; Q, -..J (- 5 SOUTH HANOVER STREET Second line of address I c.n City or Post Office State ZIP Code , '-''') ~ , , jJS --I b TE FILED ~: \.0 CARLISLE PA 17013 (A 170(3 SIGNA ~, ~{() 7 Side 1 L 15056041114 15056041114 -.J --.J :LSDSb042:L15 REV-1500 EX Decedenfs Name: DOROTHY G SHERBOURNE RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 4. Mortgages & Notes Receivable (Schedule D) . . . . .. . . . . . . . . . . . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 6. Jointly Owned Property (Schedule F) DSeparate Billing Requested . . . . . . . . 7. Inter-VIVos Transfers & Miscellaneous Non-Probate Property (Schedule G) DSeparate Billing Requested . . . . . . . . 8. Total Gross Assets (total Lines 1-7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . . . . . . . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . .. . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) .. . . . . . . .. . . . . . . . . . . . .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13).. . . . . . . . . . . . . . . . . . . . .. 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O 0 16. Amount of Line 14 taxable at lineal rate X .0 ~ 17. Amount of Line 14 taxable at sibling rate X . 12 18. Amount of Line 14 taxable at collateral rate X . 15 15. 331644.28 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042115 174-20-8268 Decedent's Social Security Number 1. 2. 3. NONE 4. NONE 5. 6. NONE 7. 8. 9. 15056042115 155000.00 78082.39 60638.00 46726.00 340446.39 8553.11 249.00 8802.11 331644.28 0.00 331644.28 0.00 14924.00 0.00 0.00 14924.00 D --.J REV-1500 EX Page 3 174-20-8268 Decedent's Complete Address: File Number 21-07-0063 DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUM8ER DOROTHY G SHERBOURNE 174-20-8268 STREET ADDRESS 23 GREENFIELD DRIVE CITY II STATE I.ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 14924.00 14064.00 703.00 Total Credits ( A + B + C ) (2) 14767.00 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill In oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) (SA) A. Enter the interest on the tax due. 0.00 157.00 157.00 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . .. D C. retain a reversionary interest; or. . .. . .. . . .. . . . . . . . . . . . . . .. .. . .. .. . . .. .. . . .. . . . .. . . .... D d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No [K] [K] [K] [K] [K] [K] D [K] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use ofthe surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent, or a stepparent of the child is zero (0) percent [72 P .S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is twelve (12) percent [72 P.S. ~9116(a}(1.3}]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the deceden~ whether by blood or adoption. 217 REV-1502 EX+ (6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER DOROTHY G SHERBOURNE 21-07-0063 All real property owned lolely or II a tenant In common mutt be reported at fair market value. Fair marl<et value II defined al the prtce at which property would be exchlnged between a willing buyer and a willing seller, neither being compelled to buy or 8811, both having reasonable knowledge of the relevant facts. Rill property which II Jolntly-owned with right of lurvlvorahlp mutt be dlaclond on Schedule F. ITEM NUMBER 1. DESCRIPTION Townhouse at 23 Greenfield Drive, Carlisle. Assessed Value: $125,000. VALUE AT DATE OF DEATH 155,000 TOTAL (Also enter on line 1 RecaDitulation) $ (If more space is needed, insert additional sheets of the same size) 155.000 217 REV-l503 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY G SHERBOURNE 174-20-8268 All property Jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. DESCRIPTION Publicly traded stocks as shown on attached schedule Thrivent Core Bund Fund-A, 312.4 shares @9.87 per share VALUE AT DATE OF DEATH 74,999 3,083 TOTAL (Also enter on line 2 Recaoitulation) S; (If more space is needed, insert additional sheets of the same size) 78.082 217 REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DOROTHY G SHERBOURNE Include the proceeds of litigation and the date the proceeds were received by the estate. All Drooertv lolntlv-owned with rlaht of survlvorshlD must be disclosed on Schedule F. FILE NUMBER 21-07-0063 ITEM NUMBER DESCRIPTION 1 CitiBank N/A bank deposit through brokerage account 639-04118-14 025 2 CitiBan N/A South Dakota bank deposit throug brokerage acct. 639-04118-14025 3 laSalle N/A Certificate of Deposit 4 CitiGroup Smith Barney money market account no. 639-04803-14025 5 Contents of house 6 2004 Buick Century, gross selling price 7 M&T checking account 8 Cornerstone FCU account 9 Federal income tax refund payable 10 Medical insurance refund 11 Patriot News subscription refund 12 Homeowners Insurance refund 13 Real estate tax pro-ration from HUD-1 settlement statement VALUE AT DATE OF DEATH 4,317 244 9,421 203 5,000 10,000 1,265 21,025 8,230 42 107 200 584 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 60,638 217 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF DOROTHY G SHERBOURNE FILE NUMBER 174-20-8268 DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRAN8F!REE. THEIR FlELATlONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (1'- VALUE 1. CitiGroup IRA, Patricia Ruda, daughter, sole beneficiary 46,726 100.00% 46,726 TOTAL (Also enter on line 7 Recaoitulation) $ 46 726 This schedule must be oompleted and filed If the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET Is yes. (If more space is needed, insert additional sheets of the same size) 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF DOROTHY G SHERBOURNE FILE NUMBER 174-20-8268 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman Roth Funeral Home 727 2. 1 st Lutheran Church, memorial service luncheon 250 3. Georges Flowers 58 4. Interment lunch 205 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City S1ate Zip Year(s) Commission Paid: 2. Attorney Fees 2,500 3. Family Exemption: (If decedenfs address is not the same as claimant's. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 250 7. Expenses for real estate sold. See itemization attached. 3,122 8. Final medical expenses. See itemization attached 1,260 9. Bank charge 18 10. Insurance and registration on automobile sold 163 TOTAL (Also enter on line 9 Recapitulation' $ 8.553 Debts of dececlentmust be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debtllncurred by the decedent prior to death which remained unpaid al of the date of death, Including unrelmbureed medlCllexpenstl. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Bon Ton 144 2. Kohls 70 3. L. L. Bean 6 4. Embarq 13 5. Comcast 16 TOTAL. (Also enter on line 10, Recapitulation) $ (If more lpace II needed, Insert additional lheets of the same Ilze) 249 217 . REV-1737-7 EX + (9-00) REVERSE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF FILE NUMBER DOROTHY G SHERBOURNE 21-07-0063 When flat rate method is elected, list the beneficiaries of the Pennsylvania property. When proportionate method is elected, list all beneficiaries. SCHEDULE J BENEFICIARIES RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONIS\ RECEMNG PROPERTY Do Not list Trullt88ls\ OF ESTATE I. TAXABLE DISTRIBUTIONS pndude outright spousal distributions, and transfers under See. 9116 (8)(1.2)] 1. Patricia J. Ruda Daughter 100% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV-1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE OF REV-1737 COVER SHEET, AS APPROPRIATE. II. NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1737 COVER SHEET S (If more space is needed, insert additional sheets of the same size) c~~~~~~zz~~~~ccc~z~~~~~~~~~~~m~2~~0 zn3 N~=~~rn~ro~~~r~-~no~mmroxx~ro~~~3~n ~Oro ro~n~0~a~~3~! ~~-3~~ ~ oro~~8o~~0 -~ ~no ~ ~ =roo~ n ro~ ro ~~ao<~~-3 ~. ~ _O""t ~ -I ~a.~~ 0 04' ~ ~~iii':c~~ ~"C ""t ~ ~ ro ~iii'~ro ""t ro-. nr 'j....,. ~ 7'\_ ~ ~ n n n~;::;a. '? ~a. n ~~roQ.~ ~ ::J ro ~ ~o~- oro ~ n""t~a.-n ~ ""t n~ ~n ~::J a: 0 ~ n ...... - ...... ...... N ~WN NmW...... ...... w~o NOO NW~Wm 00 ~ ~W......~~N ~NN ~~~m........................~NWWN~......NOOO~OO ~~NNN~~~Wm~ WN~~OON~~~~~WNNP~~~~~~WOO~W~~~~~N~~~~~ ~~~~......~mW~~W~N......OOOOOOOO~~~~~~OON............~......~~N~~~ ...... - ...... ~WN NmW...... ............W~ NOO Nwwwmwoo N~W ~ NN ~"""N~~~~m............wom......ww......~............~~~~~~~~o......~......w ~b N~~~W~w~~~~m~o?Nw~~~~~~~mN~~~N~~W~W~ ~N~~oo~~mw~~~""""""~"""~W~Noo~~"""~~mN~oo~~wN~ ~w N ...... ~......N ~~wm . . N ~. ~ ~. ...... ~~m~~~~~~ ~~W~~N~~~ ...... - ...... ...... ......w~o NOO N WOO ~N~ ~~ N ......~......m......ww......~ ......W~W~~~~..................W......WN ....... . . . o. . ~....... ~o~OO. . W. . . ~~. . N~ w~~~~m~~~~~~~oo~~w~~~ooo~~~~ ......~~~~~~~~N~~......~~~~~~~~~N~~m. ~WN N~W""" ~"""N ~~~~ \om~~oo~o~~ ~~W~N~~N~ ...... - ...... ...... ~ ............W~OWNOO~...... W~W WOO~~N~W"""~~ ......~......~NOWW~NNooo~mOOOO~N......N~~~WN~ ~N~~\oOOOON~~~o~m~Nw~m~N~w~~~~ ~"""~~~~"""~~~WOON~W~~~~OO~~~~OO~- ~ ~ ~W N...... ...... - ...... N~N W...... ............W~bWNOO ......NWWWmW ~~N~W"""~~N~ N~~m~m""""""w......mOOWN~"""......~~m~~OON""""""O~~WNmb ~~~~~woowoooW\oWW~~\o~~\oN~\o~~N~~OO~~~W~ ~N"""~~~~~Nwoom~"""~W~OOWNN~wm~~oo~~~......~~ ...... ...... - ~WN N~W...... ............ ~OW ~...... W W ~~N~ ~"""N~~~~~""""""~W~"""ONOO~NN~~~~WOO~~N~W"""~wm . . . ~. . . . . . . ....... . . WN. . N. O. ~OO~W..................~~. . . ~ WW~. ~~OO~OO~O. ~~~. . ~N. ~. ~. . . . . . . . . N......~< W~WOO~~"""~OO""""""Nm~"""~OON~Oo"""~~o~m~W~OON~Nro ~~~~~~~~~~~~~~~~~~~~~~~OO~OON~wmNoo~~~ N ~W ~WN ~~ ~....... ~N' . . . ~~~OO~ o~OO. . WOO ~~N~mNN ~~~OOW~~ ~ ...... W WNOO~"""NW W WOO ~N~ N< ........................~......OWN~N......~ ~~~~~..................W ~ro ~oow~~~~m~~~N\oOO~\o~\oN~\oN~~~t~~~ . ~~ONOO. WNOWW~OO. ~OO~OO~~~OO. . . ~~ ~NN~~~~N~~~~NN"""~WNNOONNN~~O~Nro ~~~~~~~~~~~~~~~~~~~~~~~~~~OO~ W~NN~NN~""""""~~""" ~"""N~~NWNNW""" ~O~~OOW"""~O~~~OOWN~OO~N~OOO~ N N ~ W N~N"""~ ~~N~O~ '**' o ...." ~ ~ ~ ""t ......NWro ~OO~ ............ ............ ............ .................. ........................ ~~~............N 0 ......~~~OO ~NW ~OO......~............WW~~~............~......~ N~~~W~ ON..................~...... OOWW~NW~WWWOWW~~~......~~~< ~~~......W~OO~OOWNNN~~OO~OOO~WO~~OO~~~~~OOOO~~~ N~o~~~omom\oo\ow~~~~~~~~\o~~N~\o~~~~~~OOc oo~m~~~o~~WW......OON~~......~~~N~~~OO~W~~~OO~~~OOro o o o c} ,..,. QI )>)>)>nc~~nn~~~nnnn~ - 3 -0 c m ~ QI -. m m c~' 0 0 ~ ~ ~QI~@m~~~~~)><Ql283m~ N ~ ,..,. QI a. m 0 (I) ::I'A n -< o 3 r :r < ,..,. .... n QI - ::I m QI m ~ 8 -. ~ - c b 0 (I) ::I (l)O"~ 3!!!'~~ 3\O-Ql,..,.n ~ (I) 0 0 ,..,. ,..,. -. _ ~ ::1m. n ::I a. 3 n III rcorm)>-<c m -'-'3 =QI <; :roO" ""':r3 3~G)gmo. QI::Io~no~ ::I O".c 0 :::!. co QI ~ to ~ _ 't:l _ o m (I) -< ~W~ WNW NNW ~~~~OO~N~~ ~OO~~OO~N OO~N OOOOW~~N~~NWN~ ~N~~~~~N~N~~O~WW~~WO~O~~ W~~~WWN~~~~~~~~~~~~~~~~~ ~W~~ NWNNNW ~~~ OO~ ~~N~ O~~~W~NOOOOOON OON~ OONN~OOO ~NO~~~~W~~~~~NW~~~W~W~~O ~~~~~W~OO~N~WOO~N~~~~~~~~~ ~W W NW ~ ~ ~ ~N~ ~W~~~NNNN~N ~N~~OOON~NOOO ~~~O~~~~~O~~~~~~W~~~~~~N ~~OO~~~W~~~~W~~~~W~~OO~O~OO OO~~~~~OO~~~~~~N~~W~~~OOOO~~~ ~W~~WNWNNNW ~~~ OO~N N~ ~OO~~OO~NOOOO~WN OOW~ W~~~~~O W~WN~~~~~OO~~~~~~W~~~~~O ~~~~N~~N~OO~~~~~WN~~~~~OO~ ~W ~WNWN NW ~~~~OO ~N~ O~~W~~~OO OONN~OOW~~N~N~~OO~ ~~~~~~~ON~~W~W~N~W~~~~~~ N~~~~~~NOOW~~~~OOOO~~~~~~~~ ~ WN NN ~~~ OO~ ~W~~OO~WNOOOOW ~OOW~~N~ . OO~~' . NOO' . NN' . . . ~. . ~. . . N~. . N~. . ~~~~. OO~ W~~~O~~N~O~~N~OOO~~~ OO~WN~~~W~~~~N~~~~~~~ N ~N OO~N~~ . W' . ~ ~. OW. O~WWOO ~~~~~ ~ ~ NW N W ~ ~~OO N ~ ~W~~W~N 00 N ~OO~~~N OO~ NO ~OO~~OO~NN~N~N~~WN~W~~W~~O NO~~O~OO~O~~WNOON~~N~~~~~~ NOO~~OO~N~N~NOON~~~NNON~N~~ OO~~~~~~~OO~~~~~~~~~~N~~N~~ N N N 'M. ~ ~ W ~ ~ N 00 W W)q'~ ~ ~~O~~~OOOOOO~~O~~~ ~ '" o 0 N ~ O~~N ~OWO~O~ ~ ~ ~ ~~ ~ ~~ ~ ~N ~ OO~ OO~W ~~~ ~ ~N ~ ~ OO~~W ~ ~NN~WN~WN ~~N NOOOOONOO~~~O~~~~NNOOOb~~~ ~~~NN~O ~N~~~~W~~~ ~~~ ~~N~~~~tW~N~~ONN~~~~~~ ~~~~W~~OO~W~WW~~~OOOOWOO~~ WSJ.com Stock Charting for MINX 03/06/2007 11:22 AM hrlvent Fds:Cre Bond;A (AAINX) (FUND) Date Price High Low U.S. Dollar Volume 1/12/07 9.87 nla nla nla No Splits 2 ~h (Daily) @BigCharts.com 07 Feb 9.95 9.90 9.85 Get another quote any day after 1/2/1970 1.m.2 2mo 3mo 2mQ m ~ ~ 1/2/1970 Symbol: L____J Date: L!/12/0!_~ UIII Copyright C 1999-2007 BioCharts.comlnc. All rights reserved. Please see our Terms of Use. Historical and current end-of-day data provided by FT Interactive Data. Copyright C 2007 Dew Jones & Company, Inc. All Rights Reserved http://www.blgcharts.com/custom/wsjle/wsjbb-historical.asp?symb-aalnx&c1ose_date-1562F 12562 F07&x=0&y"0 Page 1 of 1 WSJ.com ~tock Charting for AAINX 03/06/200711:23 AM hrlvent Fds:Cre Bond;A (AAINX) (FUND) Date Price High Low 1/16/07 9.88 nla nla No Splits Get another quote any day after 1/2/1970 U.S. Dollar Volume nla 1/2/1970 Symbol: I I Date: L.l/16/07 1 [11'1_ ...",,~~~-,,~~,~- ,~____^,~~,....J Copyright C 1999-2007 BiaCharts.com Inc. All rights reserved. Please see our Terms of Use. Historical and current end-of-day data provided by FT Interactive Data. @BigCharts.com 07 Feb 1 mo 2mo ~ 2!:!:lQ llr ~ fur Copyright C 2007 Dow Jones & Company, Inc. All Rights Reserved http://www.blgcharts.com/custom/wsJle/wsJbb-hlstorlcal.asp?symb_aainx&c1ose_date-1"2F16"2 F07 &x-O&y-O ~.9S 9.90 9.~ Page 1 of 1 Final Medical Expenses Humana Moffitt Heart Lancaster HMA Physicians Hartzell Eye Carlisle Regional Medical Center Kunkel Surgical Group Hematology & Oncology Moffitt Heart Cummings Assoc. PC Jackson Enterology Kunkel Surgical Group Cardiovascular Surgical 23 16 12 131 8 18 55 53 131 148 73 590 2 Total medical expenses 1.260 Expenses from HUD-1 settlement statement Final UGI bill Final Met Ed. Bill UGI Appraisal fee to S. W. Barrett Real Estate HB McClure - repair Met Ed UGI Met Ed UGI 1,985 207 20 94 325 282 42 81 5 81 Total expenses for real estate 3.122 A. SeUlement Statement U.S. Department of Housing and Urban Development ~ ,r OMS Approval No. 2502-0265 B. T 01 Loan 1. 0 FHA 2. 0 FmHA 3.0 Conv. Unlns. S.FlleNu_ 4. 0 VA 5. 0 Conv.lns. B. Mortgege InlW'llnc8 ease Nurmer C. Note: This fonn Is fumlshed 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 closing; they are shown here for InfannaDonal purposes and not Included In the totals D. N8rrwandAddreuol_ E. Ne.. ond Add.... 01 SeUer F. No.. end _ 01 Lender Alice J. Etter Dorothy G. Sherbourne Estate Ruby C. Zeager G. Prqlerty Lac:ellan H. Setllomenl Agent 23 Greenfield Drive Allen E. Hench Esouire PIece of_ 1._Oete Carlisle PA 17013 220 Market Street 4/2/07 Newport, Pa 17074 IlIabunemenl Dele lot: B1DC1<: J. Summery 0I1lorroww'. T......ctIon 100. . Groll. Amount Due From ~ K. Summary 01 Sell..... T.......ctIon 400. Grou Amount Due To Sell... 101. Conlrect..... orIce 155000.00 401. Conlrect alea orIce 155000.00 102. PenlOI1al """""'" 402. Parsonal """,...." 103. Sattlament """""'" to botroMr nine 14001 2748.50 403. 104. 404. 105. 405. Adlu.tmenta for It8ma nald hv HI.... In .clVllnca Adlustmanla fOr ltama nald hv ..II... In acIVIInca 106. CIlvIInwn_ to 406. CINIklwn_ III 107. Countv_ 4/2/07 to 12/31/07 246.91 407. COUntv..... 4/2/07 III 12/31/07 246.91 105. Aaaeaamenbl to 408. AIaeaamenta \0 109. School tax 4/2/07 III 6/30/07 336.79 409. School tax 4/2/07 \0 6130/07 336.79 110. \0 0410. to 111. 10 0411. to 112. III 0412. 10 113. \0 0413. \0 1104. to 04104. to 115. \0 0415. to 120. GI'08. Amount Due From ElomIwer 158,332.20 0420. Groa. Amount Due To Sallar 155,583.70 200. Amounta PaIcI Bv Or In Behalf Of ~ 500. Reductlona In Amount Due To Sail... 201. O_oraarnestll1DllllV 500.00 501. Excesa de_II 1188 lnatrudIon.\ 202. PrindDel amount of new 1oan1.1 502. SatlIement cha...... \0 88II1II' nine 1400\ 1 985.11 203. EJd.ti"" ...."'.1 b1ken .u_1Il 503. Exlstlno Ioenlel taken .ubltlCt III 204. 5004. Pe'"'" of fil'Bl """"'0- loan 205. 505. Pe""" of II8CO/\d mtVln_loen 206. 506. 207. 507. 205. 506. 209. 509. Adlu._nts for ltama unnalel hv ..II., Adlustmanla for ltama unnald bv .eller 210. Cltvllawn_ to 510. CINIklwn taxes to 211. Cou"'" taxes to 511. COU""'taxe. to 212. AssMsmen1s to 512. AssMsmenls to 213. to 513. to 214. to 5104. to 215. to 515. \0 216. 10 516. to 217. to 517. \0 218. to 516. to 219. to 519. to 220. Total P.1eI BylFor Barrower 500.00 520. Total Reduction Amount Due Sa'tar 1,985.11 300 C..h At Settlement FromITo ~ 800. Caah At Setllemant ToIFrom Sellar 301. Groas Amount due from botroMr nine 1201 158 332.20 601. Groat; amount due to aIIar nine 420\ 155583.70 302. L... amount ""'" ........ barTOwar OIne 2201 500.00 602. Lese nKlucllone In eml due sellar nine 5201 1 985.11 303. C..h l&J From o To ac.n-r 157,832.20 803. Ceeh l&l To o From Saltar 153,598.59 SUBSTITUTE FORM 1099 SELLER STATEMENT The Infomultion oon1slned In Blocks E, G. H, and land on line 401 (or, line 403 end 404) I. Impoltant tax Information and Is baing fumlshed \0 th8 Intamal Revenue Service. W)'OIl ere requlnKl to file a retum, a negllgenOl penalty or oIhar ancllon will be Imposed on l'llU If this 118m Is requlnKl to be repotI8d end th8 IRS datarmlnes that II hu not bean repotI8d. W thi. reel _ Is yOUr principal resldenoe, fila Form 2119, Sale 01 Exchenge of Principal Residence, for any gain, with lIllur Income tax return: for other lrensacllon., compIeIe th8 applicable pa/lII of Form 04797. Form 6232 and/or SchecluIe 0, Form 1040). You are requlnKllo pmYIda th8 SattIemanl Agent (named abolie) with your COIYlIcI taxpeyer IdsntHlosfJon number. If yOU do not pmYIda th8 Setllemenl Agent with yOUr COIYlIcI taxpeyer ldentlflostlon number. l'llU may be .ubject \0 cIvlI or cr1mlnel penalllee Imposed by 1_. Under penarJee of peljury, I OIr11fy th8t th8 number shown an this .l8l8menl Is my COIT8cl taxpeyer Icl8ntIfIcstIan number. (Sell8ts~~ ~(J R ({ciA-- FU=r. ?\ ~9~ x-~e~ I{ ~31D ,DO .J ~ 6\D.uD N.A.PD 1tf1tI'f"1 :J:JfMO GNUHllllIlIfJfIfB\OO 'Ill GleO "" . 'O~O~ lJlll108S pue ~oo~ uog:l8S 8POO 's'n S~ 8IlU :88lI1\18l8P JO;jlUswuos~dw! pue suy e epnf.lUl Ue:J UOfI"l^lJOO uodn '&Ilfeoed 'WJOj Je//WI" J8ljlO Aue JO SI'll uo SIlIIlIS PlllIUn S'll 01 Sl_III' "Jej S~SW ~leulMOU~ 01 SWlJO e Sill: ~"'M J!nbS3 'ljOU9 lU&e...1U&WSIll&S JltMllJJog H 'S96 ~ OS'9vL (; ()I UOPS 'zos PUB r UOJl'l8S 'tO~ nUll uo JflUS) eeDJB~O Iu.....mes 18\0.1 'oor~ '8Ot1 'Loel OO'S UO!leO!l!l.l90 XBln9qdwe~ Apnr '9Ot1 OlnO~ II!q J9leM i J9M9S leu!.:l 'soe~ 'voe~ ~6'BZE s9xefCI!ljSUMov~unoo LOO(; 'toe~ 01 uo!J'liOiUf '''''d c:oe ~ 01 AeNns 'Ioe~ _B~ \llewsmes IBUOIIIPP'f' 'DOt~ OO'09S ~ $ $ oo'OSS ~ OS'Be $ SllSB9f&~ : 'elH 'Z~H ~Od h911!.L i hEIJ:l 'I~H $ -1l,IlIUM() 'OHI $ stle.IlWlO ',J8pUlIl '60H ( :SJeqwnu 'W8\18^OCl& oepnJOUJl 01 IlOUllJnOUISPIJ. '90~ I ( :SJeqwnu 'WIlIl8^OClB ""P"JOUI) oo'OOE 9J!nOS3 ljOU9H '3 U9nV' 01 'B8j s,.\llWOll... 'LOH OO'O~ 01 SSIIjAlGlDN '90I~ 01 UOfleJeOajQ luewn:lOQ 'SO~ ~ 01 J&pUJllllOUllJnsuJ spu. '10'0 H 01 UOIIWIW'" BJIl.1 'eo H OO'OOL = 09 ~$lO lunOOSIP SS91 09B$ 01 _"IlIlJOlOlIIllKlV'ZOH oo'09~ 01 B8j IIUI8DP JO IU8W8Jl18S '10 ~ ~ HlUlIqO SJIU 'ooH SO"^'~ '0001 IUIlWl8 P'<f PunDO:>'<f 8lB V '9001 'LOOI '9001 SlUews.88SB renuuv 'SOOI S8Xlll UROO '1o'OO~ 10 'eoo~ 'ZOOI IlIUOW IlIUOW J IlIUOW J 'llUOW J I.AUOW J IlIUOW J 'llUOW '906 OJ SJ_ '10'06 0181_ , 'OJ wnlWSJd 80UIlJnsUI plBZBH 'eoo 01 S'IlUOW JOj wnlwaJd 80UIlJRlUI 8CleOIlOV/ 'ZOO "BPI $!llI 01 W<lJj J8Q18\UI ' ~ 06 106 SUII - s::Ife:J UJ AIlp 1881 epnPX3 sOU"^PV UI P1Sd "8 0.1 .epu., As ""lnbeij.W8\I '006 '&IS '~~s '~IB 'OIB , 'DOS 'BOB 88;j UOfldulnsoy 'LOB ll\ 88;j uDp80IIClllV IlOUIlJRlul 8lleO\JllI'l 'BOB &8;j UOJIOiQiUI ....pusl 'SOB 0\ lJOCl8!i MP8IO '1>09 0\ &8;jlel,IlJdCl\t '&OS % IUROOSIO ullD1 C:OB % &8;j UOfl8Ufll!JO U801 'IOS Ul101 IIIIN1 _uoO ullijijiMd .1U8\1 'OOS 'vOL IU8W8IJl8S Ie Pled UOfOSIWUJO:> 'SOL 0\ $ '~OL IU&W&IJl8S I-AlSS OJ $ 'IOL I'<fspuR;j 1....pUn;j 8,J8tfBS s~ltMllJJog :SNIOfIOj se (OOL eulil UDISlIlWWOO jO, uO/sl^IO WDl;j pj'd WDI;j PI'd 00'0 -% lllloo'ooO 9S~ $ SO"" uo ....sq uo,ulwWOO B,J8llO'8/881111S 18\0.1 'OOL ..IiI. uewe . ~Ol ms.,