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Home My WebLink About09-18-07 ---I 15056041125 REV -1500 EX (06-05) PA OepartmentofRevenue. =::Taxes INHERITANCE TAX RETURN Hanisbulg, PA 17128-0601 ~ -~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 7 File Number o 1 9 5 Date of Birth 206 - 3 6 - 8 3 1 2 0 7 2 0 0 6 102 3 1 9 4 6 Decedent's Last Name Suffix Decedent's First Name L I N E GLENDA MI E (If Applicable) Enter Surviving Spouse's Infonnation Below Spouse's Last Name Suffix Spouse's First Name MI L I N E JEFFREY Spouse's Social Security Number 195 - 3 8 - 7 7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 00 1. Original Return D 4. Limited Estate 00 D D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach Copy of Trust) D 10. Spousal Poverty Credit (date of death D 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number D D 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes WILLIAM Firm Name (If Applicable) A. DUN CAN 71724 9 778 0 REGISTER OF WILLS USE ONLY DUNCAN & HARTMAN, P C First line of address c; i".., en.,. 1 I R V I N E ROW ~"-_J (/') , j "J Second line of address co CAR LIS L E PA 17013 r--;(") ~ t;)A:n: FILED :-~ . ~"J _ _oj r...) 1".) Ul -'\ City or Post Office State ZIP Code ., "j Correspondent's e-mail address:billduncan@planetcable.net Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statemenls, and to the best of my knowledge and belief, . is true, correct and complete. . of preparer other than the personal representative is based on all information of which preparer has any knowledge. G U F PERSON R ONSIQkE OR FILING RETURN T Q~~ ) } BOILING SPRINGS PA 17007 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 ....J ~ --.J 15056042126 REV-1500 EX Decedent's Social Security Number 206 -36-83 DecedenfsName: GLENDA E. LINE RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 7807.61 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) D Separate Billing Requested . . . . . .. 6. 7. Inter-VIVos Transfers & Miscellaneous N,Q!];Probate Property (Schedule G) U Separate Billing Requested. . . . . .. 7. 7729.41 9. Funeral Expenses & Administrative Costs (Schedule H) 9. 200625.52 216162.54 8 6 6 6.9 0 8. Total Gross Assets (total Lines 1-7) ........................... 8. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 8666.90 207495.64 12. Net Value of Estate (Line 8 minus Line 11) .........................12. 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) .. .. . . . . . ..... . . . . 14. 207495.64 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O _ 2 0 7 4 9 5 . 6 4 15. O. 0 0 16. Amount of Line 14 taxable o . 0 0 at lineal rate X .0 16. O. 0 0 17. Amount of Line 14 taxable o . 0 0 O. 0 at sibling rate X .12 17. 0 18. Amount of Line 14 taxable o . 0 0 O. 0 at collateral rate X .15 18. 0 19. Tax Due 19. O. 0 0 ............................................... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT D Side 2 L 15056042126 15056042126 --.J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 07 0195 DECEDENT'S NAME GLENDA E. LINE STREET ADDRESS 31 PENWAY DRIVE CITY I STATE I ZIP CARLISLE PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 0.00 0.00 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 0.00 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 No a. retain the use or income of the property transferred; ...................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 00 0 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 of the surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)1. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-halt (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)1. 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-1503 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF GLENDA E. LINE FILE NUMBER 21 07 0195 AI property jointIy-owned with right of survivorship must be dilc:losed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 2,306.03 2. IRA HARTFORD DIV & GROWTH [SEE ATTACHED] IRA HARTFORD STOCK FUND [SEE ATTACHED] 2,739.25 3. IRA HARTFORD CAP APPRECIATION [SEE ATTACHED] AMERICAN FUNDS EUROPACIFIC GRTH [SEE ATTACHED] 511.25 4. 2,251.08 TOTAL (Also enteron line 2, Recapitulation) $ (If more space is needed. insert additional sheels of the same size) 7807.61 REV-1508 EX + (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLENDA E. LINE FILE NUMBER 21 07 0195 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivolShip must be disclosed on Schedule F. ITEM NUMBER 1. 3. DESCRIPTION MEMBERS FIRST FEDERAL CREDIT UNION ACCT. # 163769-00 [SEE ATTACHED] MEMBERS FIRST FEDERAL CREDIT UNION ACCT. # 163769-11 [SEE ATTACHED] MEMBERS FIRST FEDERAL CREDIT UNION ACCT. # 163769-05 [SEE ATTACHED] VALUE AT DATE OF DEATH 23.15 2. 266.83 7,439.43 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7.729.41 REV-1510 EX + (6-98) . COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLENDA E. LINE SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 07 0195 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV -1500 COVER SHEET is yes. DESCRIPTION OF PROPERlY ITEM INCLUDE THE _ OF THE TIWlSfEREE. THEIR R8.AllONSHP TO IlECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSfER. ATTACH A COf'f OF THE llEED FOR R9L ESTATE. VALUE OF ASSET INTEREST VALUE OF AI'PUCAIll.E) 1. GLENDA E. LINE 457 K SAVINGS PLAN 114,602.78 100. 114,602.78 [SEE ATTACHED] 2. GLENDA E. LINE PENSION PLAN 86,022.74 100. 86,022.74 [SEE ATTACHED] TOTAL (Also enter on line 7 Recapitulation) $ 200 625.52 (If mnm C!:n!'::lI"'Q ie nCCl'lAl'f inC!:crt ~rlrlitinn!)1 C!:hDoClh: ^f tho C!:~mo Cl:i"1a' REV-1511 EX + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLENDA E. LINE SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 07 0195 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME & CREMATORY, INC. 3,146.90 2. OSIRIS HOLDING OF PENNSYLVANIA, INC. - CUMBERLAND VALLEY MEM. GARD. 3,413.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of PeISOIlal Representative (s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AtlDmey Fees DUNCAN & HARTMAN, PC 2,000.00 3. Family Exemption: (If decedenrs address is not \he same as c/aimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS FILING FEE 107.00 5. Accountants Fees 6. Tax Return Preparel's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 8 666.90 (If more space is needed. insert additional sheets olll1e same size) -"""". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLENDA E. LINE SCHEDULE J BENEFICIARIES 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 [mclude =ht spousal distributions, and transfers under Sec. 9116 (a (1.2)] 1. G. JEFFREY LINE Spousal 310 WALNUT STREET 100% BOILING SPRINGS, PA 17007 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 $ FILE NUMBER 21 07 0195 (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, Glenda Elizabeth Line, of the town of Carlisle, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my last will and testament, hereby revoking all other wills and codicils heretofore made by me. FIRST I direct the payment of my debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I ask that my body be cremated and if there be no suitable space available for my interment, owned by me at the time of my death, I authorize my personal representative to purchase such space using therefor funds from my estate, in such amount as he or she shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such space so purchased to be vested in such person as my personal representative shall designate. Further, in this connection, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable, for the purchase, erection and inscription of a suitable marker for my final resting place. SECOND I give and bequeath all the rest of the tangible personal property owned by me at the time of my death, together with all insurance policies thereon, unto my husband, GEORGE JEFFREY LINE, if he survives me by thirty (30) days. In the event he fails to survive me by thirty (30) days, I give and bequeath said tangible personal property and all insurance policies thereon in as nearly equal shares as is practicable unto such of my children (and wherever the term "children" is used in this will it shall be deemed to include children born or adopted after the date of this will) as survive me by thirty (30) days. I authorize my Executor to deliver such articles to which a minor may be entitled under this paragraph to the guardians of the minor or to the person having custody of the minor, or to retain such property until an age at which my Executor considers it appropriate to deliver the property to him or her, provided in no event shall such property be retained by my Executor beyond the time the minor attains his or her majority. The receipt of such of the above enumerated persons as may be selected to receive delivery of such property shall be a full and complete discharge to my Executor. In the event my Executor at any time decides it is desirable to sell any item or items tangible personal property held hereunder for a minor, the proceeds of such sale or sales shall be delivered to the guardians of the property of the minor appointed in paragraph SIXTH hereinafter to be held under the terms and conditions thereof. - 1 - THIRD I give, devise and bequeath all the rest, residue and remainder of my estate unto my husband, GEORGE JEFFREY LINE, if he survives me by thirty (30) days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all the rest, residual and remainder of my estate unto my children and their issue, per stirpes. In default of such surviving children and issue, I then direct that all the rest, residue and remainder of my estate be divided into two (2) equal parts to be distributed as follows: (a) One (1) share to the intestate heirs of my spouse as if he had died unmarried and intestate at the time of my death. In default of such intestate heirs, this share shall be distributed under the terms of sub-paragraph (b), below. (b) One (1) share to my intestate heirs as determined under the Intestate Laws of the Commonwealth of Pennsylvania. In default of such intestate heirs, this share shall be distributed under terms of sub-paragraph (a), above. In default of intestate heirs of both myself and my spouse, I then give, devise and bequeath all the rest, residue and remainder of my estate to be divided and given equally to anyone or more of the surviving persons described as my Sister-in-law, Jennifer Line Raynor, my brother-in-law, David Wing Line and my brother, Stanley Edward Tritt. FOURTH I direct that any and all Inheritance, Estate and Transfer Taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. FIFTH In addition to the powers conferred by law, I authorize my Executor, in his or her absolute discretion: (a) To retain in the form received and to sell either at public or private sale any real or personal property. (b) To manage real estate. (c) To invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principle of diversification. (d) To exercise any option or rights arising from ownership of investments. - 2 - (e) To compromise claims without court approval and without the consent of any beneficiary. (f) To join with my husband, GEORGE JEFFREY LINE, or his personal representative, in the filing of any federal income tax return for any year for which I have not filed such return prior to my death and to consent to the treatment of any gifts made by him as being made one-half by me for gift tax purposes notwithstanding the fact that such action may result in additional liabilities for my estate. Any income or gift taxes due on such returns and any deficiencies, interest, penalties, or refunds thereon, shall be allocated between my estate and my said husband or his estate, or all to any of them, in such manner as my Executor and my said husband or his personal representative may agree. SIXTH I appoint my sister-in-law, MRS. JENNIFER LINE RAYNOR, Guardian of any property, incl,uding but not limited to a1l proceeds of insurance on my life which passes to a child under twenty-one (21) and with respect to which I am authorized to appoint a Guardian and have not otherwise specifically done so. If she is unable or unwilling to serve, then I appoint MRS. PHYLISS LEHMAN LINE to serve in her place. If she is unable or unwilling to serve, then I appoint my daughter MISS SHELBY LINE to serve in her place. In addition to the powers given by law, I authorize the Guardian: (a) to use such amounts of both income and principal as she, in her sole discretion, deems proper for the support, education and welfare of such child under twenty-one (21) without leave of any court. (b) to invest in any property without restriction to legal investments. The Guardian shall not be required to give bond or furnish sureties in any jurisdiction. SEVENTH In the event my said husband predeceases me, I appoint my sister-in-law, MRS. JENNIFER LINE RAYNOR, Guardian of the person of any of my children who may be minors at the time of my death. If she is unable or unwilling to serve, then I appoint MRS. PHYLISS LEHMAN LINE to serve in her place. If she is unable or unwilling to serve, then I appoint my daughter, MISS SHELBY LINE, to serve in her place. - 3 - EIGHTH Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to the said children, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, pledge, or obligations of any beneficiary, and shall not be subject to any execution or attachment. NINTH I nominate, constitute and appoint my husband, GEORGE JEFFREY LINE, as Executrix of this my last will and testament. In the event of the renunciation, death, resignation, or inability to act for any reason whatsoever of my said husband, I nominate, constitute and appoint my daughters Shelby Line and Darby Line, to act equally as Executors of this my last will and testament as long as each has attained the age of twenty-one (21). If both daughters have not attained the age of twenty-one (21), I nominate, constitute and appoint Mr. Stanley Tritt, my brother, as Executrix of this my last will and testament. In the event of the renunciation, death, resignation, or inability to act for any reason whatsoever of one of my daughters, the remaining daughter shall act as Executrix of this my last will and testament as long as she has attained the age of twenty-one (21). If she has not attained the age of twenty-one (21), I nominate, constitute and appoint Mr. Stanley Tritt, my brother, as Executrix of this my last will and testament. In the event of the renunciation, death, resignation, or inability to act for any reason whatsoever of both of my daughters, I nominate, constitute and appoint Mr. Stanley Tritt, my brother, as Executrix of this my last will and testament. I hereby relieve my Executor from the necessity of posting security in connection with his or her duties as such in any jurisdiction in which he or she may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal this Th"\~d day of G(,-:h.?J h(t( , A.D., 1994. i ., - 4 - Signed, sealed, published and declared by the above-named Testator, GLENDA ELIZABETH LINE, as and for her last wil1 and testament, in the presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. c?~I/P~ 7 Address 51{ ;;",..$;'" /t c'..e1 r I,. '> Ie- r4tr 0 r3 /? j)) /-? . -I (~~~ /' j ~l f!J~ L ii Address /// 4 fJ!. k A- ~ J /,.{2 G~\ ~<;.LL iA- I lOf.3 - 5 - COMMONWEALTII OF PENNSYLVANIA ) ) ) SS: COUNTY OF CUMBERLAND We, GLENDA ELIZABETH LINE'~\>f\.9l\c\~et 0;'-'< and Jt~1K1 {\tIc .N~ the testatrix and the witnesses t r pecti vely , whose n mes are signed to the attached or foregoing instrument t being first duly affirmed, do hereby declare to the undersigned authority, a Notary Public, 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 therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of his or her knowledge the testatrix was at that time eighteen years of age or older, of sound m d and under no constraint or un~ue influence. Testatrix ~ /~ p~' "...., '.. ~:~c. j'.. .' '"t't:A tf--JJ.('i (;";R ~...-" Witness Witness Subscribed, affirmed to and acknowledged before ELIZABETH LINE, the testatrix and subscribed the witnesses: 12(,(\uM t2(~ {1d '-lJ. h... me, a Notary Public, by GLENDA and affirmed to before me by and ~9J(Vtcttd day of Go to~'~ (1-((,. ~0 this , A. D. 1994 Edward Jones Art Amundsen 21 W High St Carlisle, PA 17013 717-258-4688 03/02/07 Date of Death Values on Glenda Line's account # 377-02655-1-4 (12-7-06) Qty Security Price/share on 12-7-06 Value 110.867 IRA-Hartford Div & Growth $20.80 $2306.0336 125.069 IRA-Hartford Stock Fund 21. 83 2730.2562 13.454 IRA-Hartford Cap Appreciation 38.00 511. 252 45.791 American Funds Europacific Grth 49.16 2251.0855 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 Name of Joint Owner CHECKING ACCOUNT: Account Number/Suffix Date Account Established rincipal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix Date Account Established rincipal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Estate of: GLENDA LINE Date of Death: December 7, 2006 Social Security Number: 206-36-8318 fvl~ MEMBERS 1st FEDERALCREDlT UNION 163769-00 11/27/1996 $25.13 $.00 $25.13 None 163769-11 11/27/1996 $266.83 $.00 $266.83 None 163769-05 09/02/1999 $7,439.43 $2.42 $7,441.85 None ~F~~lli:: Danielle A. Kline Insurance Services Specialist August22,2007 5000 Louise Drive. Po. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 . www.members1st.org ~ep-ll-~UU( lU:~U fin "a~lOnWloe lnsurance C~qC~qCOC~ 6/6 o DC -4()(J3- 11/02 Nationwide~ Retirement Solutions q Nationwide" Financial company September 11, 2007 G JEFFREY LiNE 31 PENNWAYDR CARLISLE PA 17015 Re: Employer: Withdrawal Conl1m1atiou Cumberland County 638003 Dear G Jeffrey Line: Thank you for your recent inquiry regarding your Deferred Compensation Account. AccQrding to our records, a withdrawal1fom your account was processed on April 16, 2007, and a check in the amount of$114,602.7& was mailed to: ING NEW BUSINESS #902620999023 909 LOCUST ST FBO G JEFFREY LINE DES MOINES JA 50309 We appreciate your participation in the plan and the opportunity to selve you. If YOll have any questions Qr need further assistance, please contact our Customer Service Center at 1-877-677- 3678, between the hours of 8:00 A.M. and 9:00 P.M. Eastern Time, Monday through Friday. Sincerely, Nationwide Retirement Solutions Securilles offered I)y Notionwide In'Il"tment Services Corporation, Memoot NASD In Mlcl\lgon only: "loliOnwide In'le,tmen~ Svcs. Corporollon 5900 Porkwood Ploc",. CnhJIl1blJs. OH 43016 ~h, NOTICE OF AMOUNT PAYABLE UPON DEATH OF PENSIONER County Cumberland Name of Deceased Pensioner Glenda Line Date of Pensioner Death 12/7/2006 Date of Retirement 6/29/2006 Designated Beneficiary (ies) G. Jeffrey Line spouse (relationship) (relationship) (relationship) Option Selected at Retirement: Option One Accumulated Deductions withdrawn at retirement by pensioner $ Amount Pavable To Desienated Beneficiarv Pro rata portion of basic pension for days of $ The balance of the pensioner's accumulated deductions: Accumulated Deductions at retirement Total Pension paid to pensioner through Balance to be paid to designated beneficiary $ $ $ The balance of the pensioner's present value: Present Value of pensioner's pension at retirement Total Pension paid to pensioner through November, 2006 Balance to be paid to designated beneficiary $ $ $ 89,505.82 3,483.08 86,022.74 Pro rata portion of basic pension for Pro rata portion of survivor pension for days at $ days at $ and $ di 'J! \ Continuing monthly payments to be paid to surviving designated beneficiary beginning $ f\\() \01 By ~~~,~. ~~ Hay Group Date Hoffman-Roth Funeral Home & Crematory, Inc. 219 North Hanover Street Carlisle, PA 17013 (717)243-4511 September 11, 2007 Jeffrey Line 31 Pennway Drive Carlisle, PA 17015 The Funeral Service for Glenda E. Line 14913-232 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. (A) OUR SERVICE: CREMATIONPACKAGE#3 . Facility,Staff, and Equipment Graveside Service. . . . . FUNERAL HOME SERVICE CHARGES $1790.00 $190.00 $1980.00 SELECTED MERCHANDISE: Marbelon Universal Urn Receptacle Mahogany Urn (Curved Sides) . Acknowledgement Cards. Visitor Register . . . . . Memorial Folders. . , . . THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED . . . , , . . . . , . . . $340.00 $390.00 $20.00 $25.00 $25.00 $2780.00 Cash Advances Newspaper Obituary Notice -Sentinel, Clergy Offering . . . , , . . Certified Copies of Death Certificate , Coroner Authorization Cremation Fee, TOTAL CASH ADVANCES AND SPECIAL CHARGES . $81.90 $200.00 $60.00 $25.00 $366.90 Total Total Cost. $3146.90 History 0111012007 G. Jeffrey Line. $-3146.90 TOTAL AMOUNT DUE $0.00 This statement is net and payable in full within 30 days of receipt. - -. - -........................................................ ---........ .......................... -........................ Please return this portion with your Remittance $ Amount Enclosed Service 10 # 14913-232 Glenda E. Line -- ...... Lris Holding of Penosylvania LLC ("LLC") Osiris Holdiog of Penosylvaoia Subsidiary LLC ("Compaoy") Cumberland Valley Memorial Gardens ("Cemetery") 1921 Ritner Highway. Carlisle, PA 17013 717-243-3541 Osiris Holding of Pennsylvania, Inc. Retail Installment Contract and Security Agreement CJ Tri-County Memorial Gardens LLC ("LLC") 0 Westminster Cemetery LLC ('UC") Tri-Coonty Memorial Gardens Subsidiary LLC ("Company") Westminster Cemetery Subsidiary LLC ("Company") Tri-County Memorial Gardens ("Cemetery") Westminster Cemetery ("Cemetery") 740 Wyndamere Road, Lewisberry, PA 17339 1159 Newville Road, Carlisle, PA 17013 717-938-3435 717.249.2029 :tI2!c!i;M~- Contract # ~ LLC and Co pany som time re erred to collec ivel,.i.n this Agreement as "Seller") are owners and operators of the Cemetery. THIS AGREEMENT is made by and between Seller and e: . hereinafter called the "Purchaser". W ITN ESSE H HAT Purchaser agre.. to bu and LLC and Company agrees to sell to Purchaser, or his designated beneficiary itraccortlance with the tenns hereof, the following items to be provided or used at the above checked location. 1. DESCRIPTION OF BURIAL RIGHTS. The Burial Rights covered by the Agreement are shown by the map of such gartlenlbuilding on file in the office of the CEMETERY, and are more particularly described below. _ Burial Rights in: _ Grave Space(.) .. _ +Mau.oleum: 0 Chapel 0 Garden 0 Tandem 0 Side-by-Side o Single 0 Developed 0 Preconstruction _ Lawn Crypt: 0 Double Depth 0 Slde-by-Slde Niche: 0 Chapel 0 Garden 0 Single 0 Companion 0 Developed 0 Preconstruction o Single 0 Developed 0 Preconstruction +Maximum casket dimensions are: /"",h 8$ n, width 29", hc;ghl16" 1 st Choice ht Choice 2nd Choice Garden Section Lot Spacers) Building Section No.(s) Level Building Section No.(s) Level 3. ITEMIZATION OF CHARGES (A) Burial Rights (u dcsoribcd in Pa... I above) _ $ (B) Perpetual Care $ (C) Less Certificate Discount $ (D) Second Right of Interment / $ (E) Vault(s) $ (F) Urnes) (G) Mausoleum Lettering/Crypt Plate (H) MemoriaVMonument (I) Granite Base(s) (1) Installation Charge (K) Caskets (L) Initial Fee for Interment (M)F,JDa1 Interment/Entombmentl~n~nunent Fee (N) Permanent Records &. Processing Fee (0) Other (P) Sales Tax $ 4. TOTAL CASH PURCHASE PRICI!; (A THRU P) c-1J..C. Company. 2. MERCHANDISE: -- - Cemetery's Name: A, VAULT(S) #1. -- ~ B. URNeS): (' $ l~ s ,.-. -r C. MEMORIAL INFORMATI~ ~' MemoriaIDeSigl~G1 . 't\\'l~ ~~ ~'.l.'b \l-t Bronze Size X Granite Size ~ 6 Location (Section, etc.) L 9: I t..{ 6:1) ~ L\ X vas~ - <6' !.S. 0 0 -oJ '7.:j . .if's:1lil $ $ $ ..... $ ~ L\.\ 2>,0 cJ ~~~%\~~ D. MONUMENT INFORMATION: ~. Ifl g.,O '0 6 ~ \ Type: Color: ITEMIZATION OF THE AMOUNl- FINANCED (I) Total. Cash Price ............:..... /. .. . .. . .. . . . .. $ (2) A. Down Payment a Cash a C~eck Ill' Credit Card ..... $ B. Trade In: . . . . . . . . . . . $ Old Agreement No. E. CASKET(S): C. Total Down Payment (2A + 2I'l) . . . . . . . . . . $ (3) Unpaid Balance of Cash Price (I ,- 2e) ... . . $ I. Model: Gaug:: (4) Finance Charge ................................... $ 2. Model: .' .. ;. ..>~au~e: .. . ... . .... .......... ...... ... .. (5) TotaIUnpaidBalance(H4) .......................$ . n,e LLC and the Company shall ~ach reinain sccond~nlYliablel;,\h . otherror tb. sales ofit~rits and :s.;mces ,providtaby one ahoilier flursuant tcilJ{is Ag~ment; however, Purchaser shall not be required to exhaust any remed,es agamsr rhe LLC or the: Company before proceedmg agam t the other. : Size: x P P P Die: Base: x "" ~ S. PAYMENT. The Purchaser shall pay ANNUAL PERCENTA~E RATE FINANCE CHARGE AMOUNT FINANCED TOTAL OF PAYMENTS TOTAL SALE PRICE the SELLER for such rights in accordance The cost 01 your credit as a yearly rate. The dollar amountlhe credit wiU cost you. The amount 01 credit provided 10 you Th& amoun" you will have paid alter you The total cost 01 purchase on cretlt, incIud- with the following disclosure statement: C (}) ." () ^ DR your own bahall, have made all paY!l1enls as scheduled. ingdown~nlot$ ,... ~ 0 ,... $ .- 0..... % $ $ $ . Ifl ~ r. 0 YOUR PAYMENT ~~enls ~~ments ~~nt Due ~ale Thereafter, paym~e Due SCHEDULE WILL BE: $ ~ o Monthly on the ~ $ SECURITY: You are giving a 5ecurity interes( in the goods or properly ~ing qurchascd or in part of the funds paid under this Agreement held in a Merchandise Trust Fund. PREPAYMENT: If yoo poy off early, yoU will not have to pay a penalty and Y9u may be entitled 10 a refund of part of the Finance Chorge. NOTICE: See the remainder of this Agreement (including General Provis~ons ?n the reverse side hereof) for additional information about nonpayment, default, deHnquency' charge, security intere.'itsl any required payment in full belan: the scheduled date. and prepay.ment refunds. and penalties. t THIS AGREEMENT ARISES OUT OF A CONSUME~ i.. DIT SALE AND IS SUBJECT TO THE ADDITIONAL GENERAL PROVISIONS CONTAINED ON THE REVERSE SIDE OF THIS AGREEMENT, WHICH ARE A PART OF nqs REEMItNT. This Agreement shall be binding upon the heirs, executors,! ad inistralOts, successors and assigns of the parties hereto. THIS AGREEMENT AND tHE FAMILY PROTECTIO CERTIFICATE,IF APPLICABLE, CONTAIN ALL THE COVENANTS AND PROMISES BETWEEN THE PARTIES, AND NO AGENT, SALESPERSON, OR OTHERREPRESEN J\TIVE OF EITHER PARTY HAS AUTHORITY TO MODIFY, ADD TO OR CHANGE ANY OF THE TERMS AND CONDITIONS CONTAINED IN THIS AGREEMEN! ~D{OR THE FAMILY PROTECTION CERTIFICATE. . I ; I NOTICE TO ASSIGNEES OF SELLER Any holder of this consumer .credit contract is subjkct to all chums and defenses which the d~btor (Purchaser) could assert agairist the Seller of goods or services obtained pursuant hereto or with the proceeds hereof. Recovery hereunder by the deb~, r (Purchaser) shall notexcee. dthe amount paid by the debtor (P.....h. aset)hl'l'.~!Indel1 ct t . . I i; NOTICE TO 'flIE PURCHASER tmsCOOU'8C[ISSUDJ.e oasecunly nterest . .i. . '. In favor of Fleet National e~m!(. as collateral agent (I) Do not sign tlus Agreement before you read It or tf It contams any blank spaces. (2) You are entitled to a completely filled in copy of this Agreement at the time you sign it. (3) Under the law, you have the light topay off in advance tl17 full amount due and under certain conditions to obtain a partial refund of the finance charge; to redeem the property if repossessed for a default; to require, under certain conditions, a resale of the property if re~ossessed! . . . . . . . . , . PURCHASER'S RIGHT TO CANCEL If this Agreement was solicited at your residence ~nd you do not want the goods or services, you, the Purchaser, may canceHhis Agreement at any time prior to midnight of the third business day after the date of this Agreement. (For an explanation of this right, see the attached Notice of Cancellation (orm. ) Recovery Fund: A Real Estate Recovery Fund exists to reimburse persons who have suffered monetary ioss and have obtained an uncollectible judgement due to fraud, misrepresentation, or deceit in a real estate transaction by a Pennsylvania licensee. For complete deiails call (717) 783.3658 or 1-800-822-2\13. SE RS In 0 DI s executed this Agreement this \.2) ay of Seller by: Counselor: Social Sinty No. 2. Purchaser Social S urity No, Date of Birth f' - Address: Ib.\ R-.l\\N\J..l~ ~ C~'Q..\\~\c ~~. t~o ~ '-\:~ ~ Cl ~~5"' ' !:' Z\ Home Phone Number:::;);. -~\\ ~ ~ 2.lo ~ Date of BIrth 1. Employer: 2. Employer: Phone Phone Stale License No. PINK COpy. Purchaser's Copy GOW COPY. Purchaser's Copy