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HomeMy WebLinkAbout08-16-07 (2) REV-15oo EX + (6-00) ~ Z W C W () W C W I- :t: :!en (J a:::t: W ~(J ::ta::9 (J 0- al 0- <I: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.{)601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Barthel, Hans DATE OF DEATH (MM-DD-Year) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 6 9 7 7 COUNTYCOiiE ---VEAR- - - NuMiiER- - SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) 3 4 8 - 3 0 - 0 523 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 10/27/2006 08/07/1913 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A [X] 1. Original Return o 4. Limited Estate [X] 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER D 2. Supplemental Retum D 4a. Future Interest Compromise (dale of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1.1.95) D 3. Remainder Retum (dale of death prior to 12.13-82) o 5. Federal Estate Tax Retum Required .Q.. 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED.'ALL CORRESPONDENCE AND'CONFJDENTIAL TAX INfORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS DAVID R. GETZ ESQUIRE 508 NORTH SECOND STREET FIRM NAME (If Applicable) WIX, WENGER & WEIDNER P.O. BOX 845 TELEPHONE NUMBER 717 234-4182 HARRISBURG PA 17108-0845 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) z o i= <( ...J ::J '= a. <( () w 0:: I- Z W C Z o 0- en w a:: a:: o (J (1) 137000.00 OFFICIA1.;,USE ONLY C:J .t.::.:> 140,290.64' . .......... (2) ;:0.- (3) (,"") (4) 0.00 v', (5) 48,579.74 ~ N (6) 5,421.59 .r- (..11 (7) (8) 331 ,291.97 22,371.81 (11) (12) (13) 22,371.81 308,920.16 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::J a. ~ o () ~ ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due (14) 308,920.16 0.00 X _(15) 0.00 308,920.16 X ~(16) 13,901.41 0.00 X .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 13,901.41 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o d t' C I t Add ece en s ample e ress: STREET ADDRESS 28 Highland Drive CITY I STATE I ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 13,901.41 12.000.00 631.56 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 12,631.56 TotallnterestlPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (3) (4) (5) 0.00 0.00 5. Ii Line 1 ... Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 1,269.85 A. Enter the interest on the tax chJe. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check (5A) (5B) to: REGISTER OF WILLS, AGENT 1,269.85 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... 0 [2g b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [2g c. retain a reversionary interest; or ...................................................................................................... 0 [2g d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [2g 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 [2g 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 [2g 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 [2g IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS DAT~ SIt SI6'1 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. 99116 (a) (1.1) (i)l. 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 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 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. 99116(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. REV-1502 EX + (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Barthel. Hans 21 06 977 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 Droperty which is jointly-owned with riaht of survivorship must be disclosed on Schedule F. ITEM NUMBER 1, DESCRIPTION House and lot situate at 28 Highland Drive, Camp Hill, Cumberland County, Pennsylvania, being Tax Parcel No. 13-23-0547-451 (valued per settlement sheet attached) VALUE AT DATE OF DEATH 137,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 137,000.00 REV-1503 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Barthel. Hans FILE NUMBER 21 06 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 977 ITEM NUMBER 1. 2. DESCRIPTION 666 shares Eaton Vance Ins PA Muni Bond Fund @ $14.96/share DOD Value: $9,963.36; Accrued Div: $38.85 (held with H&R Block Financial Advisors) 40,160.074 shares Franklin Custodian FDS Inc. Income Fund @ $2.61/share DOD Value: $104,817.79; Accrued Div: $0 (held with H&R Block Financial Advisors) 1,666 shares Nuveen PA Advantage Mun @ $15.225/share DOD Value: $25,364.85; Accrued Div: $105.79 (held with H&R Block Financial Advisors) VALUE AT DATE OF DEATH 10,002.21 104,817.79 3. 25,470.64 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 140.290.64 REV-1504 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSEL Y.HELD CORPORATION, PARTNERSHIP OR SOLE.PROPRIETORSHIP ESTATE OF Barthel. Hans FILE NUMBER 21 06 977 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1507 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF Barthel. Hans FILE NUMBER 21 06 977 All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-15G8 EX + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Barthel. Hans FILE NUMBER 21 06 Indude the proceeds of 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. 977 ITEM NUMBER 1. DESCRIPTION Fidelity Select Money Market Account DaD Value: $10,223.86; Accrued Dividends: $38.15 VALUE AT DATE OF DEATH 10,262.01 2. H&R Block Financial Advisors Cash Account 256.38 3. M& T Bank Certificate of Deposit No. XXX-4887 DaD Value: $10,325.16; Accrued Interest: $197.90 10,523.06 4. M& T Bank Certificate of Deposit No. XXX-4895 DaD Value: $10,531.00; Accrued Interest: $40.80 10,571.80 5. M&T Bank Certificate of Deposit No. XXX-5314 DaD Value: 15,687.69; Accrued Interest: $60.77 15,748.46 6. Tax and utility Refunds rec'd per settlement sheet attached hereto 1,218.03 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 48,579.74 REV-1509 EX + (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Barthel. Hans FILE NUMBER 21 06 977 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. Jennifer Dauchess 916 Brittley Way Apex, NC 27502 Granddaughter B Klaus Barthel DECEASED Date of Death: 1/6/2004 Cumberland County Estate No. 21-04-31 Son c JOINTL Y.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %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&B 7/15/91 M&T Bank Checking Account No. XXX7461 10,843.17 50. 5,421.59 DOD Balance: $10,843.17; Accrued Interest: $0 TOTAL (Also enter on line 6, Recapitulation) $ 5,421.59 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Barthel. Hans FILE NUMBER 21 06 977 This schedule must be ccmpleted 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 INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE (IF APPLICABLE) 1. None TOTAL (Also enter on line 7 Recapitulation) $ (If more space is needed. insert additional sheets of the same size) REV-1511 EX+ (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Barthel. Hans SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 06 977 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Neill Funeral Home, Inc. 1,885.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s)/EIN Number of Personal Representative(s) Street Address City State Zip Yea~s) Commission Paid: 2. Attorney Fees Wix, Wenger & Weidner (estimated) 4,300.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 440.00 5. Accountanfs Fees 6. Tax Retum Preparer's Fees H&R Block 261.00 7. The Sentinel (Advertising) 180.59 8. Cumberland Law Journal (Advertising) 75.00 9. Enders Insurance Associates (Bond) 760.00 10. Closing costs per attached settlement sheet 10,888.39 11. Miscellaneous administration expenses incurred (see attached itemization sheet) 3,506.83 11. Wix, Wenger & Weidner (reimbursement of out of pocket expenses) 75.00 TOTAL (AI~o enter on line 9, Recapitulation) $ 22,371.81 (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 Barthel. Hans FILE NUMBER 21 06 977 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. None 0.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 ''''.''''''.'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER B::lrthp.1 Hans ?1 06 977 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 outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Jennifer Dauchess Lineal 154,460.08 916 Brittley Way Apex, NC 27502 2. Christopher Barthel Lineal 154,460.08 4905 Foster Way Carmichael, CA 95608 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 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-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) HtlW~LL-U~W~ U~/~J/OJ -'--:- _.--" . LAST WILL AND TESTAMENT OF HANS BARTHEL I, Hans Barthel, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my Estate or by any recipient of any property, shall be paid by my Executor out of the property passing under this Will, which is not specifically devised or bequeathed, as an expense and cost of administration of my Estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax paid by my Executor even though on proceeds of insurance or other property not passing under this Will. ITEM II: I give and bequeath all my household furniture and furnishings, automobiles, books, pictures, jewelry, china, linen, silverware, wearing apparel and all other like articles of household or personal use and adornment to my wife, Gertrud E. Barthel, if she survives me, or if my wife does not survive me, to my son, Klaus Jurgen Barthel, and his wife, Diane Barthel, or the survivor, of Camp Hill, Pennsylvania, or if neither survives me, to their issue, per stirpes. ITEM III: I give, devise and bequeath all of the rest, residue and remainder of my property, real, personal and mixed, to my wife, Gertrud E. Barthel, if she survives me, or, if she does not survive me, to my son, Klaus Jurgen Barthel, and his wife, Diane Barthel, or the survivor, or if neither survives me, to their issue, per stirpes. Page 1 of 4 pages ~ ITEM IV: In the settlement of my Estate, my Executor shall possess, among others, the following powers to be executed for the best interest of the beneficiaries: (a) To sell either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal estate or interest therein, whether owned by me severally or in conjunction with other persons or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Executor in this Subparagraph (a) or elsewhere in my Will. (b) To pay all costs, taxes, expenses and charges in connection with the administration of my Estate. My Executor shall pay expenses of my last illness and funeral expenses. (c) To distribute my Estate in kind or in money. If any assets are distributed in kind, they shall be distributed at their respective value(s) on the date(s) of their distribution. (d) To retain any investments I may have at my death so long as my Executor may deem it advisable to my Estate so to do. (e) To vary investments, when deemed desirable by my Executor and to invest in such bonds, stocks, Page 2 of 4 pages ----.--.--.---.-.-.-.-. _...._._-~ ..._, notes, money markets, real estate mortgages or other securities or in such other property, real or personal, as he shall deem wise, without being restricted to so-called "legal investments." (f) To mortgage real estate and to make leases of real estate. (g) To borrow money from any party to pay indebtedness of mine or of my Estate, expenses of administration or inheritance, legacy, estate and other taxes. (h) To vote any shares of stock which form a part of the Estate and to otherwise exercise all the powers incident to the ownership of such stock. (i) In the discretion of my Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the Estate. (j) To distribute my personal property directly to the Guardian of the person of any minor beneficiaries hereunder. (k) To elect such settlement options as deemed most appropriate by my Executor with respect to any pension profit sharing or other retirement plan in which I am a participant. (1) To do all other acts in the judgment of my Executor necessary or desirable for the proper and advantageous management, investment and distribution of my Estate. . ITEM V: Any person who shall have died at the same time as Testator or in a common disaster with him, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased him. Page 3 of 4 pages ITEM VI: I nominate, constitute and appoint my wife, Gertrud E. Barthel, to be my Executrix (herein referred to as "Executor"). In the event of the death, resignation, refusal or inability of Gertrud E. Barthel to serve as my Executor, I nominate, constitute and appoint my son, Klaus Jurgen Barthel, to serve as Executor. My Executor is specifically relieved from the duty or obligation of filing any bond or bonds. IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will and Testament, consisting of this and the preceding three (3) pages, this 15th day of January, 1985. jttt',,'1./J 13 (.t., -tt,-v{ Hans Barthel SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testator, Hans Barthel, as and for his Will, in the presence of us, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. f~lt:(t.N U /7 {aculb'l Add 1/ it! tC/;1 (I t'L{ 1 / AiL.. . ress ~~Q,~ Address la 10 ard. >> . ~J PR-- /7/(3 ....,,~1 -) { .)' I Ii Of Jt[. m I {i/~t.'_ l.tt L c. '-Y1 (r, . .J -L>...jll.1 ) l {II! {- t II I~/ (. I / (' (n[,..tl{l~H_.U5 /t.tUCt J /'~} /. .~~ 10. . \../)) ,-:l\tLC.(.v~.~ '1J... ill JL~ Address Page 4 of 4 pages ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF &~ 55. : I, Hans Barthel, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by Hans Barthel, the Testator, this 15th day of January, 1985. ~,,~f, 16 /J.1~rf,.,,,-,l Hans Barthel Testator ,~/ t/Nfk:JJXXJ Notary P lic My Commission Expires: (SEAL) AFFIDAVIT AMY T. \'J:l~ ".i'.~S, r~:,:H': Public ~1~rr~~t~~;:~;~,~~:I;~ ;~.;~'i~;ii~~~ J~i_\.. ;2~, IJS3 COMMONWEALTH OF PENNSYLVANIA 55. : COUNTY OF ~ !20fUVf, (J. Jg'.1fL/l , the witnesses who e names are or foregoing instrument, being duly to law, do depose and say that we were present and saw the Testator, sign and execute the instrument as his Last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness, in the hearing and sight of the Testator, signed the Will as a witness; and that to the best of our knowledge, the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. by ~), :n~ to ~ affirme~ and obscribe 1m ~~;H :~, witnesses, I 5. ,] . I 'I'. '! ",.' . ftelt,.t.! it /; {.I Lt J ~( i Witness '~Q.~ /\. l j -, )" t JltlCl.{/L 0'. /C (t.,L '('1_" witness ( ~1In -r if'4f'IJll:) A'i(k) otary b11c My Commission ~Jil~r\e~:~o. \.::'::'" ?;::"c (SEAL) \;,;"::.::.i;.::.'.: ~...;:..'I::;. <t, llCt A U.s. DEPARTfIErfT OF HOUSING ANJ URIAN DEVB.OPMEHT SETTLEMENT STATEMENT Select Platinum Settlement Services, LLP 3912 Market Street Camp Hill, PA 17011 (717) 737-0884 FINAL C. NOTE: This tIfF" is ItJmished to give )IOu a statement of ac/ulllll8tt18ment costs. Amounts paid band by /ha 1l8/tlement agent 8f8 shown. I//Jms marked TP. O. c.}" \\e/8 paid outside the closing; /heya/8 shown h_ for informalionlll putpOSN and are not Included In the totIIIs. D. NAME OF BORROWER: Elaine Henninger Po"" Alloravod OMll ND.2502-G2&5 B. TYPE OF LOAN 1.0 FHA 2. ~ FMHA 3. UCONV.UNINS. 4. 0 VA 5. 0 CONY. INS. 6. ESCROW FILE NUMBER: 7. LOAN NUMBER: 00071534-001 CER 6. MORTGAGE INSURANCE CASE NUMBER: ADDRESS OF BORROWER: E. NAME OF SELLER: ADDRESS OF SELLER: Estate of Hans Barthel F. NAME OF LENDER: ADDRESS OF LENDER: G. PROPERTY LOCATION: 28 Highland Drive Camp Hill, PA 17011 Cumberland County 13-23-0547-451 Parcel #13-23-0547-451 Select Platinum Settlement Services, LLP 3912 Market Street, Camp Hill, PA 17011 7/3112007 PRORATION DATE: 7/3112007 DISBURSEMENT DATE: H. SETTLEMENT AGENT: PLACE OF SETTLEMENT: I. SETTLEMENT DATE: J. SUMMARY OF BORROWER'S TRANSACTION IK SUMMARY OF SELLER'S TRANSACTION .. - . . . , 101. Contract Sales Price 137,000.00 401. Contract Sales Price 137,000.00 102. Personal Property 402. Personal Property 103. Settlement charges to Borrower (line 1400) 2,659.25 403. 104. 404. 105. 405. ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE' 106. CitvfTown Taxes 406. CltvfTown Taxes 107. Countv Taxes 07/31/07 to 12/31107 201.56 407. County Taxes 07/31107 to 12/31107 201.56 108. Assessments 408. Assessments 109. School Tax 07131107 to 08130108 957.98 409. School Tax 07/31107 to 06I30I08 957.98 110. Sewer 07/31107 to 09130107 21.39 410. 5_ 07/31107 to 09130107 21.39 111. Refuse 07131107 to 09130/07 37.10 411. Refuse 07/31107 to 09/30107 37.10 112. 412. 113. 413. 114. 414. 115. 415. 120. GROSS AMOUNT DUE FROM BORROWER: 140,8n.28 420. GROSS AMOUNT DUE TO SELLER: 138,218.03 .. -- - 201. Deposit or eemest money 5,000.00 501. Excess deooslt (see Instructions) 202. Principal amount of new laan(s) 502. Settlement charges to Seller (line 1400) 10,888.39 203. Existing laan(s) leken subject to 503. Existina loan(s) leken subject to 204. 504. Payoff of first mortgage loan 205. 505. Payoff of second mortgage loan 206. 506. 207. 507. 2OB. 508. 209. 509. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER' 210. CityfTown Taxes 510. CitvfTawn Taxes 211. County Taxes 511. County Taxes 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAlO BYIFOR BORROWER: 5,000.00 520. TOTAL REDUCTIONS IN AMOUNT DUE SELLER: 10,888.39 . -.--" 301. Gross amount due from Borrower ( line 120) 140,877.28 601. Gross amount due to Seller Cline 4201 138,218.03 302. Less amount paid bylfor Borrower ( line 220) 5,000.00 602. Less reduction in amount due Seller (One 5201 10,888.39 303. CASH ( IKI FROM) ( 0 TO) BORROWER: 135,877.28 603. CASH (0 FROM) (iii TO) SELLER: 127,329.64 . , . , BASED ON PRICE$ 131,000.00 C %= $1,535.00 PAID FROM PAID FROM DMSION OF COMMISSION (lINE 700) AS FOllOWS: BORROWER'S FUNDS SELLER'S AT SETTLEMENT FUNDS AT 101.$ 3 192.50 Ie Re/Max Realtv Associatas SETTLEM ENT 102. $ 3.142.50 Ie ERA-NRT. Inc. 103. Commission paid at settlement 1,535.00 104. Transaction Fees to ERAlRemax 165.00 295.00 .Ie L '. 801. Loan Orfalnatlon Fee 802. Loan Discount Fee 803. ADDraisal Fee 804. Credit Reaort 805. Lenders Insoectlon Fee 806. Mortaaae Insurance Aoollcation Fee 801. AasumDlion Fee 808. 809. 810. 811. , "j " ~..' ., 901. Interast From Ie o $ Iday % (days) 902. Mortgage Insurance Premium for Month(s) to 903. Hazard Insurance Premium for Years(s) to 904. 905. , , ' , 1001. Hazard Insurance months C $ per rnon1Il 1002. Mortgage Insurance months C $ per month 1003. City Property Taxes months C $ per rnonlh 1004. County Property Taxes months C $ 40.01 per monIh 1005. Annual Assessments months C $ per rnon1Il 1006. months CD $ per month 1001. months ell $ per rnonlh 1008. monlhs ell $ per month '. "~ . , liZ' 1101. Settlement or closing fee 1102- Abetrad or title search 1103. TItle examination 1104. Tille insurance binder 1105. Document preparation to WIx, Wenger & Weidner 125.00 1106. Notarv fees to SettiementJNotary/Clerfcal 15.00 15.00 1101. Attomey's Fees (Includes above ilema numbenl: ) 1108. Tille Insurance to Select Platinum Settlement Services, LLP 1,043.15 Qndudes above It8ms numbers: ) 1109. Lenders coveraae $ 1110. Owner's coveraoe $ 131,000.00 1111. Ovemight Fee to Select Platinum Settlement Services, LLP 15.00 1112. 1113. Q "- /0' '. ." i. . -, ,.~ 1201. Recordlno Fees: Deed $ 40.50 Mortgage $ Release $ 40.50 1202. C1MCountv taxlstamos Deed $ 1,310.00 Mclrtlla08 $ 1,310.00 1203. State taxlstamas Deed $ 1,310.00 Mortaa"" $ 1,310.00 1204. 1205. ; '''i .~: > ,;; 1301. Survey 1302. Pest In8pect1on 1303. Tax Cert to SPSSlRemax 10.00 13.00 1304. 2001 School Taxes to Bonnie K. Miller 1,022.89 1305. SlIW8r 1/1 to /930 to Lower Alien Township 32.00 1306. Refuse 1/1 to 9130 to Lower Allen Township 55.50 1301. Home Warranty to American Home Shield 425.00 1400. TOTAL SETTLEMENT CHARGES (Enleran Ine l03,SeclIan J - ond-lne 502, Sectlon K) 2,659.25 10,888.39 I he... ""..fIlIIy rev_d the HUD-l Settlement Statement IIld III the bell or my knowIIIdge ond belief, It '" I true Ind lCCurobl statement or II receipts Ind dlsbulSements mede an my -~'7/; '-_~'_._..w.~'".,_~ ~ ' E1"'''''''_ ~f EO _..... ~ Bomlwers Sellers The HUD-l Settlllmen! Stale"""t which I hive prsQ Is ." Jj""" aa:ount althi. t'1InlOdlan. I he... caused or wiD cause,e f1Jnds to be dlsbulaed In .=.-.. wth 1hI. ~c I ~ SettiementAgent 7/3//07 Date Sate Platinum Settlement Servfces, LLP WARNING: It Is I crme III knowngiy m.... fllse statemenll to the United States an this or ony Ilmll' I'orm. Pe_ upon canvfctlon ClIn Include I fine end inprlaonmenl For _as see, Tille 18 U.S. Code SeclIan loollnd Section 1010. H&R BLOCK- financial advisors Wix, Wenger & Weidner 508 North Second Street P.O. Box 845 Harrisburg, PA 17108 December 19,2006 Re: Estate of Hans Barthel Acct # 1356-9750 Social Security # 348-30-0523 Dear Denise Williamson, Enclosed you will find the date of death estate evaluation that you requested for Hans Barthel. The account was held in single name and this was the only account associated with the above mentioned social security number. You will also find all paperwork necessary to convert the title of the account into estate form. The "Request to Journal Funds" page and "Affidavit of Domicile" both require a signature from the administrator in front of a notary. Please send the signed papers back with the court ordered short form naming the administrator and an original death certificate. I have included my business card with all contact information should you have any questions pertaining to this matter. Sincerely, Investment services and securities products offered through H&R Block Financial Advisors, Inc., member NYSEISIPC. H&R Block, Inc. and H&R Block Services, Inc. are not registered broker-dealers, Tax services offered through subsidiaries of H&R Block Services, Inc. H & R Block Financial Advisors Inc. Estate Valuation Case E121306-125159 Date of Death: 10/24/2006 Valuation Date: 10/24/2006 Processing Date: 12/14/2006 Estate of: Hans Barthel Account: 1356-9750 Report Type: Date of Death Number of Securities: 4 File ID: Barthel Shares or Par Security Description High/Ask Low/Bid Mean and/or Div and Int Adjustments Accruals Security Value 1) 666 EATON VANCE INS PA MUN BD FD (EIP) COM American Stock Exchange 10/24/2006 14.96000 14.96000 H/L 14.960000 9,963.36 Div: 0.05833 Ex: 10/20/2006 Rec: 10/24/2006 Pay: 10/31/2006 38.85 2) 40160.074 FRANKL,IN CUSTODIAN FDS INC (353496300; FKINX) INCOME FD CL A Mutual Fund (as quoted by NASDAQ) 10/24/2006 2.61000 Mkt 2.610000 104,817.79 3) 1666 NUVEEN PA DIVID ADVANTAGE MUN (NVY) COM American Stock Exchange 10/24/2006 15.25000 15.20000 H/L 15.225000 25,364.85 Div: 0.0635 Ex: 10/11/2006 Rec: 10/15/2006 Pay: 11/01/2006 105.79 .4 ) 256.38 Cash (CASH) 256.38 Total Value: Total Accrual: Total: $140,547.02 $140,402.38 $144.64 Page 1 This report was produced with EstateVa1, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4) ,. !!ltlf!lflJ'- February 14,2007 Wix, Wenger & Weidner Attn: Denise Williamson 508 North Second Street P.O. Box 845 Hanisburg PA 17108-0845 Dear Denise Williamson: Weare responding to your request for information about Hans Barthel's account with Fidelity. The table below lists the account holdings and values as of 10/27/2006. Fidelity account Z44-347051: HANS BARTHEL -INDIVIDUAL Securitv Description CUSIP Quantity Unit Value Market Value FIDELITY SELECT 316390814 10,223.86 $1.00 $10,223.86 MONEY MARKET Total Value $10,223.86 The table below shows the accrued unpaid dividends from 10/1/2006 through 10/27/2006 Security Description Dividends FIDELITY SELECT $38.15 MONEY MARKET We hope this information is helpful. For questions concerning account holdings or instructions on how to transfer the ownership of the accounts, please call our Inheritor Services Group at 800-544-0003 between 8:00 A.M. and 6:30 P.M. Eastern time Monday through Friday or visit our website at www.fidelitv.com. Sincerely, Fidelity Investments Our file: W001403-12FEB07 Brokerage Services provided by Fidelity Brokerage Services lLC Member NYSE, SIPC Clearing, custody, and settlement service, by National Financial Services LLC Member NYSE, SIPC 444192 P.O, Box 770001, Cincinnati, OH 45277-0034 . m M&fBank 499 Mitchell Street, Millsboro, DE 19966 January 22, 2007 Wix,.Wenger & Weidner Attorneys At Law 508 North Second Street Post Office Box 845 Harrisburg, PA 17108-0845 RE: Estate of Bans Barthel Date of Death: October 27, 2006 .Social Security No.: 348-30-0523 Dear Ms. Williamson: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Jype........................... Certificate of Deposit Account Number. .... ... ...... ... ..... .31 003913384887 Ownership (Names oJ)...............Hans Barthel Opening Date.......................... .03/24/05 (account closed 12/22/06) Balance on Date ofDeath.........$1O,325.16 Accrued Interest $ 197.90 Total.................................... ...$10,523.06 2. Account Jype. .. .. ... .. .. .. .. . .. .. .. . .. . Certificate of Deposit Account Number. . ... ... ... ......... .. .31003913384895 Ownership (Names oJ)...............Hans Barthel Opening Date.......................... .03/24/05 (account closed 12/22/06) Balance on Date of Death....... ..$10,531.00 Accrued Interest $ 40.80 Total. . .. . .. . .. . . . . .. . . . . . . . .. . . . . . . . .. . .. .. $1 0,571. 80 . Page 2 January 22, 2007 3. Account Type.. ............. ........ ....Certificate of Deposit Account Number.......... .......... ...31003913385314 Ownership (Names ofl...............Hans Barthel Opening Date.......................... .03/24/05 (account closed 12/22/06) Balance on Date ofDeath.........$15,687.69 Accrued Interest $ 60.77 Total................................... ....$15,748.46 4. Account Type..... ...... .... ......... ...Checking Account Account Number. .. .. .. ... .. .. .. . .. .. .. 1107461 Ownership (Names ofl..............;Hans Barthel, Klaus Barthel, Jennifer Dauchess Opening Date.......................... .07/15/91 Balance on Date ofDeath.........$10,843.17 Accrued Interest $ 0.00 Total................................... ....$10,843.17 The above named decedent did not have a safe deposit box. For any additional information on the above accounts, including ownership, statements and closures please contact our Highland Park branch at 717-737-3322. Sincerely, ~..---. /' -'-, ~)W l,Wilt '--, Charlene Warrington, Records Management 1-888-502-4349 Date Check # Payee Expense Amount 15-Jan 501 Lower Allen Township Sewer $87.50 28-Jan 503 Jen Dauchess Travel Expenses $642.21 28-Jan 504 Messiah Village Life Alert $70.67 18-Mar 505 Bonnie K Miller Property Tax $471.71 9-Apr 507 US Treasury 2006 Taxes $872.00 9-Apr 508 PA Dept of Revenue 2006 Taxes $311.00 9-Apr 509 PA American Water Water $28.42 9-Apr 510 PP&L Electric $26.61 9-Apr 511 Lower Allen Township Sewer $87.50 23-Apr 513 PP&L Electric $26.61 23-Apr 514 PA American Water Water $56.84 23-Apr 515 PA American Water Water $28.42 23-Apr 516 UGI Gas $212.48 23-Apr 517 PP&L Electric $17.88 5-May 518 UGI Gas $117.51 23-May 521 PP&L Electric $14.25 23-May 522 PA American Water Water $26.62 5-Jun 523 UGI Gas $54.29 5-Jun 524 Korth's Building Maintenance Lawn $160.00 24-Jun 525 PP&L Electric $13.26 24-Jun 526 PA American Water Water $32.02 14-Jul 527 PA American Water Water $29.03 14-Jul 528 Korth's Building Maintenance Lawn $120.00 $3,506.83 WIX, WENGER & WEIDNER RICHARD H. WIX THOMAS L. WENGER DEAN A. WEIDNER STEVEN C. WILDS THERESA L. SHADE WIX' DAVID R. GETZ STEPHEN J. DZURANIN JEFFREY C. CLARK PETER G. HOWLAND KATHRYN L. WIX A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 508 NORTH SECOND STREET POST OFFICE BOX 845 HARRISBURG, PENNSYLVANIA 17108-0845 ROBERT C. SPITZER, Of Counsel * Also Member Massachusetts Bar (717) 234-4182 FAX (717) 234-4224 www.wwwpalaw.com Suburban Office: 4705 DUKE STREET HARRISBURG, PA 17109-3041 (717) 652-8455 August 15,2007 C) '-::'0 :_~g .' I~Q f-.....) ~ --' Ms. Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 :P' c:: (,; nI -, .-. ,,/-... 0" -r , \ ::"~ N .. Re: Estate of Hans Barthel Estate File No. 21-06-977 Our File No. 825-14210 r (Jl Dear Ms. Strasbaugh: We enclose the following document for filing on behalf of the above-captioned estate: 1. The original and two copies of the Inheritance Tax Return; 2. The original and one copy of the Inventory; 3. Estate Check No. 535 in the amount of $1,269.85, made payable to the "Register of Wills, Agent," representing the tax due; and 4. Our check in the amount of $30.00, made payable to the "Register of Wills," representing the filing fees for the tax return and the Inventory. Please process these documents at your earliest convenience and return time-stamped copies of the tax return and Inventory to our office. A self-addressed, stamped envelope is enclosed for your convenience. Thank you for your assistance in this matter. If you have any questions regarding the above, please call me. By: /dbw Enclosures cc: Ms. Jennifer Dauchess David R. Getz, Esquire