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Home My WebLink About10-04-07 (3) --.J REV-1500 EX(06-o5) PA Department of Rewnue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128.()601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 15056041158 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year 21 []7 File Number []2[]5 Date of Birth 181-32-5279 []2122[][]7 []22719[]9 Decedent's Last Name SuffIX Decedenfs First Name KAUFFMAN DOROTHY MI M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name SuffIX 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 BOXES BELOW []] 1. Original Return o 4. Limited Estate []] 6. Decedent Died Testate (Attach Copy of Will) o 9. Litigation Proceeds Received Future Interest Compromise (date of death after 12-12-82) Decedent Maintained a Living Trust (Attach Copy of Trust) Spousal Poverty Credit (date of death 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 02. 04a. [X] 7. 010. 5. Federal Estate Tax Return Required Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) D- 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) r',.:" SUE MAUERY, VICE PRESIDENT, TRUST OFFICER 717-255-~~(9 --.~J _..~ Firm Name (If Applicable) '! CO) - ) POBOX 2961 :) ',1 ~~-"' M & T INVESTMENT GROUP REGISTER~ USE.o!iLY I First line of address Second line of address (.,) \..0 City or Post Office State ZIP Code DATE FLED HARRISBURG PA 171[]5 Correspondenfs e-mail address: SMA U E R Y iil M T B . COM Under penalties of perjury, I declare that I haw examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparerother than the personal representative is based on all Information of which preparer has any knowledge. SlGNAlUREOF PERSON RESPONSIBLE FOR FILING RETURN m+1 Belin ~ C=x:ecu:-tor O+- ~ES.tl.tteDATE q la~\a'1 o.f. OOR.6"t11~ m\&IAHI'Y\ ~ Y'\ ~'1: .~ m~ ADDRES~. . /") _ \/P -, rf..A:::., o-f'-F. C4.:../V t-JOBox.~q<OI.1 1-Ic..->....r,s64/-cl / l.....a. 1710::' SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE THOMSON TAX & ACCOUNTING ADDRESS 9711 FARRAR COURT RICHMOND, VA. 23236 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041158 6M4647 3.000 15056041158 --.J ~ --.J 15056042159 REV-1500 EX Decedenfs NameK AUF F MAN RECAPITULATION DOROTHY 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Stocks and Bonds (Schedule B). . . . . . . . . . . . . . . . . . . . . . . . 2. 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 Non-Probate Property (Schedule G) D Separate Billing Requested . . . . . 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . 8. 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). . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental 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) . . . . . . . . . . . . . TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers u:]ger See. 9116 (a)(1.2)X.0_ 0.00 16. Amount of Line 141axable at lineal rate X .O~ 70743 . 00 17. Amount of Line 14 taxable at sibling rate X .12 0 . 00 18. Amount of Line 14 taxable at collateral rate X .15 4 50 11 . 0 0 14. 15. 16. 17. 18. 19. TAX DUE . . . . . . . . . . . . . . . . . .. 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042159 6'-'4648 2.000 Decedent's Social Security Number 181-32-5279 15056042159 M 0.00 0.00 0.00 0.00 341466.80 0.00 0.00 341466.80 27719.37 10738.14 38457.51 303009.29 187255.29 115754.00 0.00 3183.44 0.00 6751.65 9935.09 D --.J (3) 0.00 (4) 0.00 (5) 435.09 (5A) 0.00 (58) 435.09 REV-1500 EX Page 3 Decedent's Com lete Address: DECEDENrS NAME KAUFFMAN SlREET ADDRESS 100 MT. ALLEN DRIVE File Number 0205 DOROTHY M CITY MECHANICS8URG STATE PA Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 0.00 9025.00 475.00 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 T alai I nleresllPenalty (0 + E) 4. If Line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Fill In box on Page 2, LIne 20 to request a refund. 5. If line 1 + line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT ZIP 17055- 9935.09 9500.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? ........ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes o .0 o o o o o No 00 ~ IXJ 00 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FLE 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. 99116 (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. 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. F or 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 use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent (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 four and one-half (4.5) percent, except as noted in 72 P.S. S9116(1.2) (72 P.S. s9116(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. s9116(a)(1.3)J. 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. 6M4671 1.000 REV-1502 EX + (1)-98) COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER DOROTHY M. KAtrPP'MAN 2107 0205 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 Vlhich property would be exchanged between a willing buyer and a willing seller, neither being compeled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. None DESCRIPTION VALUE AT DATE OF DEATH 3W4695 1.000 TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 0.00 . REV-I503 EX + (6-98) COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER DOROTHY M. KAtJll'PMAN 21 07 0205 All property jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. Hone DESCRJPllON VALUE AT DATE OF DEATH 3W4696 1.000 TOTAl (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1508 EX + (6-98) COM\4ONWEAl T1-t OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF DOROTHY M. KAUP'FMAN FILE NUMBER 21 07 0205 Include the proceeds of litigation and the date the proceeds were receiIIed by the estate. All property jointly-owned with the right of sUlVlvorshlp must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 HOUSEHOLD FURNISHINGS & PERSONAL EFFECTS APPRAISED VALUE & SALES PRICB USED SALBS PROCBEDS - $104.00 APPRAISBD VALUE- 28.00 132.00 TOTAL VALUE $132.00 (SBB COPY OF APPRAISAL ATTACHED) ------- ------- 2 JEWELRY LADYS 3 DIAMOND 14K RING - 350.00 LADYS LG CUT DIAMOND 14K RING - $300.00 GBNTS 14K WHITE GOLD BAND RING - $50.00 LADYS 14K WHITB GOLD BAND RING - $25.00 APPRAISBD VALUE USBD (SBB COpy OF APPRAISAL ATTACHBD) 725.00 3 UNITED STATE TREASURY 2006 FEDBRAL INDIVIDUAL INCOME TAX RBFUND 30.00 4 PA DEPT. OF RBVENUB 2006 STATB INDIVIDUAL INCOME TAX REFUND 76.00 5 PA PUBLIC SCHOOL EMPLOYEES RBTIREMENT SYSTEM PENSION FOR PBRIOD 2/1/07 TO 2/12/2007 675.94 Total from continuation schedules 339,827.86 3W46AD 1.000 TOTAL (Also enter on line 5 Recanitulationl S (If more space Is needed. Insert additional sheets of the same size) 341,466.80 Estate of: DOROTHY M. KAUFFMAN 181-32-5279 Schedule E (Page 2) Item No. Description Value at Date of Death 6 ON JANUARY 7, 1986, THE DECEDENT CREATED THE DOROTHY M KAUFFMAN REVOCABLE TRUST WITH DAUPHIN DEPOSIT AND TRUST CO. (NOW MANUFACTURERS AND TRADERS TRUST CO.) AS TRUSTEE. THE DBCBDENT RBTAINED THE RIGHT TO REVOKE OR AMEND THIS TRUST AT ANY T:IME BY AN INSTRUMENT IN WRITING DURING HER LIFETIME. UPON THE DEATH OF THE DECBDENT, THIS TRUST TBRMINATE AND ALL ASSBTS SHALL BE DISTRIBUTED TO THE EXECUTOR FOR DISPOSTION AS PART OF HER ESTATE. ON THE DATE OF THE DECEDENT I S DEATH, THE FOLLOWING ASSETS WERE HELD IN THE TRUST(SEE CONTINUATION FOR SCHEDULB E, ITEMS 7 THRU 12): 0.00 7 M & T BANK MONEY MARKET PRINCIPAL CASH 16,630.91 ACCRUED DIVIDEND 26.80 INCOME CASH 7,335.77 ACCRUED DIVIDEND 11.97 $24,005.45 Interest accrued to 2/12/2007 23,966.68 38.77 8 6,461. 908 Shares MTB GROUP FDS STRM CORP BD I I NASDAQ CUSIP: 55376T189 09.79000 63,262.08 9 8,358.564 Shares MTB GROUP FDS sn DUR GV I I NASDAQ CUSIP: 55376T221 09.56000 79,907.87 10 11,926.344 Shares MTB GROUP FDS INTRM BD I I NASDAQ CUSIP: 55376T817 09.76000 116,401.12 11 3,764.762 Shares EVERGRBEN SELECT FIXED INCOME SELECT INTL I NASDAQ CUSIP: 299908830 010.52000 39,605.30 Total (Carry forward to main schedule) 323,181.82 Estate of: DOROTHY M. KAUFFMAN 181-32-5279 Schedule E (Page 3) Item No. Description Value at Date of Death 12 1,723.193 Shares MTB GROUP FOS INCOME I I NASDAQ CUSIP: 55376T858 09.6600 16,646.04 Total (Carry forward to main schedule) 16,646.04 , REV-1511 EX + (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALlH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DOROTHY M. KAUFFMAN ITEM NUMBER A. B. 2. Debts of decedent must be reported on Schedule I. DESCRIPTION 1. FUNERAl EXPENSES: None 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) M &: T TRUST COMPANY, PA Social Security Number(s) I EIN Number of Personal Representative(s) 160 -53 - 802 0 Street Address 213 MARXBT STRBET City HARRJ:SBURG State PA Zip 17101 Year(s) Commission Paid: Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip 4. Probate Fees Relationship of Claimant to Decedent 5. Accountant's Fees 7. 6. Tax Return Preparer's Fees 1 3W46AG 1.000 GBORGB HAAR AUCTIONEBR 25% COMMISSION POR SALE OP TANGIBLE PERSONAL PROPERTY Total from continuation schedules . . . . . . . . . FILE NUMBER 21 07 0205 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) AMOUNT 13,951.34 13,000.00 26.00 742.03 27,719.37 Bstate of: DOROTHY M. KAUFFMAN 181-32-5279 Schedule H Part 7 (Page 2) 2 BRINSBR, WAGNER & Z:IMMBRMAN RBIMBURSBMBNT POR COST 01' PROBATB PBBS 430.00 3 GBORGB HAAR AUCTIONEBR PBB POR APPRAISING PBRSONAL PROPBRTY 25.00 4 BRINSBR, WAGNER & ZIMMERMAN LEGAL ADVERTISING POR ESTATE 212.03 5 C G. BUSBR PEE POR APPRAISAL 01' JEWELRY 75.00 Total (Carry forward to main schedule) 742.03 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DOROTHY M. KAUFFMAN SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 07 0205 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH ALERT PHARMACY SERVICES, INC PRESCRIPTION DRUG EXPENSE 121. 08 2 MESSIAH VILLAGE NURSING HOME EXPENSES 10,186.70 3 HERITAGE MEDICAL GROUP, LLC MEDICAL EXPENSE 30.36 4 THOMSON FAST-TAX TAX PREPARATION FEE FOR 2006 INDIVIDUAL INCOME TAX RETURNS 400.00 3W46AH 2.000 TOTAL (Also enter on line 10, RecaPitulation) $ (If more space is needed, insert additional sheets of the same size) 10,738.14 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DOROTHY M. KAUPFMAN FILE NUMBER 21 07 0205 NUMBER I 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)) NORA KAUFFMAN 118 SUNSBT VIEW DRIVE NEW CUMBBRLAND, PA 17070 RELATIONSHIP TO DECEDENT Do Not List Tl1lstee(s) AMOUNT OR SHARE OF ESTATE CASH BBQUEST: 17,500.00 14K WHITB GOLD RING: 350.00 14K WHITB GOLD BAND: 25.00 COSTUME JEWELRY: 6.67 2 MUSIC BOXES: 4.00 Daughter-in-law 17,886.00 2 ROMAINE NITCHMAN 751 OVAL OAK MBCBANICSBURG, PA 17055 1 MUSIC BOX: 2.00 None 2.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON1INES 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See Attached 3W46All.000 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) $ 187,255.29 Estate of: DOROTHY M. KAUFFMAN 181-32-5279 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 3 ADELLE SHEAFFER 200 FAIRWAY DRIVE DILLSBURG, PA 17019 CASH BEQUEST: 35,000.00 COSTUME JEWELRY: 6.67 1 MOSIC BOX: 2.00 Niece 35,009.00 4 LESLIE E. KAUFFMAN 118 SUNSET VIEW DRIVE NEW CUMBERLAND, PA 17070 CASH BEQUEST: 17,500.00 Son-in-law 17,500.00 5 JEFFREY DOUDEN 119 EWE ROAD MECHANICSBURG, PA 17055 CASH BEQUEST: 17,500.00 LG CUT DIAMOND 14K RING: 300.00 14K WHITE GOLD BAND: 50.00 Grandson-in-Law 17,850.00 6 JULIE DOUDEN 119 EWE ROAD MECHANICSBURG, PA 17055 COSTUME JEWELRY: 6.66 CASH BEQUEST: 17,500.00 Granddaughter-in 17,507.00 7 STBPHANIE W. ACHENBACH 1833 FAIRVIEW AVE EASTON, PA 18042 CASH BEQUEST: 5,000.00 None 5,000.00 8 CHRISTY ROHRBAUGH 131 ROYAL COURT WATERFORD APT YORK, PA 17402 CASH BEQUEST: 5,000.00 None 5,000.00 Estate of: DOROTHY M. KAUFFMAN 181-32-5279 Schedule J Part 2B (Page 1) J:tem No. Description Amount 1 SALEM LUTHERAN CHURCH 1152-R MAJ:N STREET OBERLJ:N, PA 17113 30% OF ESTATE RESJ:DUE 56,176.59 2 CALVARY LUTHERAN CHURCH P. O. BOX 374 MECHANJ:CSBURG, PA 17055 30% OF ESTATE RESJ:DUE 56,176.59 3 MESSJ:AH VJ:LLAGE 100 MT. ALLEN DRJ:E P. O. BOX 2015 MECHANJ:CSBURG, PA 17055-2015 40% OF ESTATE RESJ:DUE 74,902.11 L805 REV 1105 'This is to certify that the information here given is correctly copied from an original certificate of death dQly filed with me as Local Registrar. The original certificate I be forwarded to the State Vital Record nee for permanent filing. WARNING: It is Illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 p 13106507 No. ~lpr Local Regi~ FEB 1 3 2007 Date COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. vrTAL RECORDS CERTIFICATE OF DEATH (See instructions 8IId exampln on _I 1EY11/21108 PRIfT .. - )1(111( ..llIII"'.... 7. STATE FI.E NUMIIER 4.llIII ilOoIII (MaoIh.'" ,.., February 12, 2007 "'_ar 97 VII. ... ClluNy '" DooIt Cumberland Upper Allen Twp. 11.-"""" "'__ _'" "'00"'_ Schoo~lf.r;'acher Ecft1'C!m~ lI.-!I!i!l'Il_J!lI!.IIl,clr/_......codoI 100 Mt. A~len Dr1ve Mechanicsburg, PA 17055 l~jci&"rrMr.""'t'hope Feb. 27, 1909 Steelton, Id.Foc:IIr_,....__...._...~ ?}~ U~a 12. _ OocodInI_fn.. u.s.__, 0_ l3No ~ __I7a._ 1111. ClluNy PA Cumberland ""'" Cly/- l'tft"RJtt~"m'1~ker 2lIb. -.ra -._ (aool....,_ _..... 118 Sunset View Drive, New Cumberland, PA 17070 21c."""'~"""'-"~ar_"",,, 21"~lCIr/__.-. Camp Hill, PA 17011 PA 17070 25. Dolo _ Dood jUooIl."'"", Ol/SO M. r.LJ.,. i~ ;;1007 CAUSE OF DEATH Is- _ _........., _U.""'t -"'~-_",,"",,"""""""-"""""_"'_DOIlOT___"'.__ ........,_ar___-............ UIl...,__..._.... =:n-==~ L fM../<<..~7 ~. b. 0..110(... ___111-""""",- --- 21. -Coa_~__/CooloorIar._0I00r_~ar_7 0- 110 ..,.........- 0n00I.. DoolII ""'1:-- bul........ II........... _.... II "'" I 21.DId_IIIo~.._ 0.... 0"""'" J8110 0- al_ Ii! NaI___ pool,.. o "......,,_ o NaI_....__c...,. ,,- o NaI_bul_43...,....,.. -- 0-'__......,.. 321c..... ".....".-. F-. -. F-,. Ollc:ollulldfnl,....~ ~...-.,0I1\l .. ........an...L _ _CMJII =-..:I:t.~ <3 3 c. fMlO/<<.'_all: II. 0....1110 0.... Olio 1lI- 0- 0- 0.................. 0- OClUllNolIII-.... :rar. _"...., 32g.~"IrjIlry(8nol.dIJ/__ 3lIL _. AoIopor - :IIIb. _,.".,-.go __IOConoIIIoIIon 01 Couoo " DoolII? 31._"DoolII 3ll.1~""'~ OllrMr/ep.-. 0"- o- at... ~ 3:IL~1d**cn,"" :Db. __"'1llool~ ~ . CorIIIInI,."......,."...odIfnI-"---.....-....__-........-_231 .......~ }-" ~~i..., /-'1.1 "'......"'..-..... - -.. ............ -. --- - - --- ---- -- - - - - - --- --- - - - __ _ _ _ _ 0 . r.-...cortIlIOI,."......,...,.........-._...~IO_"....... 33r:.la._ ( 33d. DoIoSlgnolflllollll. ~ . ::.==---"..-_.................--w.._.______u__uu___u 0 11/) ~ t ~ Sf IF ~,/2' '17 00"'_01_ ..."..~....,.......--"...--................IO............,-.-- 0 34.-..._,,__~COUOO"DoolIIlIIOlZL1la&I______ _ r. WIIQIIllI,II.D. :.......~ ~ I J.t I,J..II II ~-I3. .",..., 2140f"ISIlerRoad II. STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND SHORT CERTIFICATE I, GLENDA FARNER STRASBAUGH Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 6th day of March, Two Thousand and Seven, Letters TESTAMENTARY in common form were granted by the Register of said County, on the estate of DOROTHY M KAUFFMAN , late of UPPER ALLEN TOWNSHIP (Filst. M~. wt) in said county, deceased, to MANUFACTURERS TRADERS TRUST CO and that same nas not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 6th day of March Two Thousand and Seven. File No. PA File No. Date of Death S.S. # 2007-00205 21- 07- 0205 2/12/2007 181-32-5279 rli1l!/JI cg(L,~ J-t1us.b~i{f . eglster Of 1:S . ~& (l~ Deputy NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL - ,-- " - REGISTER OF WillS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF lETTERS ~ , \ II}.' ' c." I . .\ '-,:/ t ':'" \ \ltj\ . . ' No. 2007-00205 PA No. 21-07-0205 Estate Of: DOROTHY M KAUFFMAN (Fit#. Middle. ustJ j <" ; ',' J \ \ , \ .' , " \. " ,J , - .. . l).'~' , .,' .. " ." .,., ' ~.. " /. .... ~ rI,.:'-': '"', Late Of: UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Securi ty No: 181-32-5279 WHEREAS, on the 6th day of March 2007 an instrument dated May 5th 1998 was admitted to probate as the last will of DOROTHY M KAUFFMAN (Fitst. Middle. ust} la te of UPPER ALLEN TOWNSHIP, CUMBERLAND County, who died on. the 12th day of February 2007 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: MANUFACTURERS TRADERS TRUST CO who has duly qualified as EXECUTOR(RIX} and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 6th day of March 2007. J1Ln.h ,4(fj1ll!U" /J;1ti ,/;all?f egtster 0 ills ~-hJLt o~ i~~i~'1jEf~~lf?;~~_1~~ft~i~ft~;t'W~ WILL OF DOROTHY M. KAUFFMAN I, DOROTHY M. KAUFFMAN, currently of Upper Allen Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. m. I intend to keep with this my Will a separate memorandum. concerning disposition of certain items of tangible personal property. I bequeath the items on said list to the persons designated. ' N. During my lifetime, I have received an inheritance from my sister, Onata Brown, and it is my desire that the bulk of this inheritance stay with my side of the family. Accordingly, I make the following specific bequests: A. Thirty-five Thousand Dollars ($35,000) unto my sister-in-law, Florence G. Shope. If she predeceases me, this bequest shall lapse and pass as part of my residuary estate below. . B. Thirty-five Thousand Dollars ($35,000) unto my niece, Adelle Sheatrer. If she predeceases me, this bequest shall lapse and pass as part of my residuary estate below. V. Because of the wishes of my beloved husband, Earl Kauffman, I wish to distribute unto his family a sum that approximates the amount we received from the sale of our house. Accordingly, I make the following specific bequests: ~ -1- 0<").--;' ,..p.:/ /77. ~','/-A ~ r~~... 11m _ : _: ~~,__ ':~ ,,~~ ~~=-;?':~~.~', ~ ::::~_~"r'-,;-:~ ~:: ~> ~~ - ~~}~ :__;-"~- ::.-_?:',~~ Ir_ .., A. Thirty-five Thousand Dollars ($35,000) (total) unto Leslie E. and Nora Kauffinan, or the survivor of them. B. Thirty-five Thousand Dollars ($35,000) (total) unto Jeff and Julie Douden, or the survivor of them. VI. I bequeath the sum of Five Thousand Dollars ($5,000) unto Stephanie Waraksa. If she predeceases me, this bequest shall lapse and pass as part of my residuary estate below. VIT. I bequeath the sum of Five Thousand Dollars ($5,000) unto Christy Rohrbaugh. If she predeceases me, this bequest shall lapse and pass as part of my residuary estate below. VDI. All the rest, residue and remainder of my estate, of whatever nature and wherever situate, including property over which I hold a power of appointment, I devise and bequeath as follows: A. Thirty percent (30%) unto Salem Lutheran Church, Oberlin, Pennsylvania, in memory of myself and my late husband, Earl, and my late parents, Benjamin H. and Minnie M. Shope, to be used as it sees best B. Thirty percent (30%) unto the Calvary Lutheran Church, Mechanicsbllfg, Pennsylvania, in memory of myself and my late husband, Earl, to be used as it sees best C. Forty percent (400tlo) unto Messiah Village, Mechanicsburg, Pennsylvania, in memory of my late husband, Earl, myself: and my late sister, Onata Brown; one-half (112) of this bequest shall be used in its Endowment Fund and the remaining portion shall to be used as the Village sees best IX. I appoint Dauphin Deposit Bank and Trost (or its successors), Harrisburg, Pennsylvania, Executor of this my Will. IN \VITNESS WHEREOF, I, DOROTHY M. KAUFFMAN, herewith set my hand to this my Last Will, typewritten on three (3) sheets of paper including the attestation clause and signatures of witnesses, this S~ day of n.-f v , 1998. ~~:Jn~~~) DOROTH . KAUF MAN ~~ . ~ -2- ~_~.- - r.. _ ~ "'~~""::i ~~~',,-.- ~;-~.~ ~ ~:,~-;7-':ji;"; ~:"::V:~;;:"";jt..J-~~~~'~' ~-=~:.~:;..:::~.-t~.~~ ~~, '::-:~Q'*);-1-~ ;,_~";;:~~~:~~..:~~'~:; - Signed by DOROTHY M. KAUFFMAN, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this s'fl1. day of .H 4-'" , 1998. ~J2J?~ ~.,~ " xiA<> m~ residing at ~,,;Lt r f: residing at ;{.i/??me/J?~l7tV~ ~ ,. -3- ~~~?:~:.~:~~:.? ~ ".-~~~;'::~-;~=--:i::-;--.{:' .:-.~ :.'~ '. COMMONWEALTH OF PENNSYLVANIA COUNTYOF l.E:&ANoN WE, DOROTHY M. KAUFFMAN, GERALD J. BRINSER and S'UE I11PrvE:R~ , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the lDldersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her .free and voluntary act for the pmposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~'hr!. J~ DOROTHY M. KJfiJFFMAN . ~~..;' -l (JJ,.;...- .."":-> WITNEss ' ~IA-L /na..u../>/ WITNEsS Subscribed, SWorn or affirmed and acknowledged before me by DOROTHY M. KAUFFMAN, the testatrix, GERALD J. BRINSER and Sue- fnAUcP-Jj witnesses, this Sl'h day of <<l~, 1998. (SEAL) uh ~~ ~PubIiC W L Notarfaf Seal p~~~ My Commission Expires Sept 10. 1 -4- ~~~ l;r~ ~~0~~~";;~~~:;:' 1IIt1~~t-~InIJi9CiiJi~l;l ~L,~ _______~: ~ rJt~ TO MY EXECUTOR~ These are the inl;tructions I refer to in Paragraph III of my Will dated May 5 . 1998. Please see that these items are given to the persons indicated. 1. My ring with three (3) diamonds and wedding band I give to Nora Kauffman. 2. My costume jewelry I give to Nora Kauffman, Adelle Sheaffer and Julie Douden. 3. My music boxes I give to Adelle Sheaffer, Nora Kauffman and Romaine Nitchman. 4. My clothing I give to Messiah Village. 5. My scrap or picture books and birthday books I give to MalY Sofleiss. 6. My holiday books I give to Nora Kauffman. 7. My travel scrap books and the remainder of my furniture, I give to Julie Douden and Adelle Sheaffer. This distribution does not need to be equal. 8. My floor lamp I give to Leslie Kauffman. 9. My large diamond ring with side diamonds and matching wedding band I give to Jeffrey Douden. 10. Any items not chosen are to be sold by my Executor and pass as part of my residuary estate. 11. My remaining diamond I give to my niece, Adelle Sheaffer. ~ ;V;;~-- Do'.-othy M. K ffman L/ Witness: ~~,L ~:.-... . , Dated: Jttt.t1-p /~ 1''17 P REVOCABLE LIVING TRUST by and between DOROTHY M. KAUFFMAN Settlor and DAUPHIN DEPOSIT BANK AND TRUST COMPANY TRUSTEE D Dauphin Deposit Bank . and liusf Company ,. l _ .........,.. I, Dorothy M. Kauffman (Settlor) of Camp Hill, Pennsylvania I hereby transfer to Dauphin Deposit Bank and Trust Company (hereinafter called the Trustee), a Pennsylvania bank and trust company. the property described in the attached Schedule, to be held in Trust as follows: FIRST: Dispositive Provisions For My Benefit - During my lifetime: A. All of the net income shall be paid to me at least quarterly or shall be paid or accumu- lated and added to principal, as I may direct in writing; B. As much of the principal as I may from time to time request in writing shall be paid to me, or as I may otherwise direct; C. If, in the Trustee's opinion, I am at any time unable to act or apply the payments to my own best interest and advantage, the Trustee may apply directly for my benefit as much of the income and/or principal as the Trustee may, from time to time, deem appropriate for my welfare. comfort, support or emergency needs and may add to principal as much of the income as the Trustee deems advisable. D. Trustee shall keep true and correct books of account, which books of account shall at all reasonable time be open to the inspection of Settlor or his duly appointed representa- tive. Trustee shall also quarterly render Settlor a detailed statement showing all receipts and disbursements on account of the trust estate and the manner and form in which the trust estate is invested at the time of the rendition of such statement. SECOND: Dispositive Provisions After My Death - Upon my death while t.he trust continues, the Trustee shall pay the then-remaining principal and income to my Executor or Administra- tor for disposition as part of my estate. THIRD: Right to Revoke and Amend: I reserve the right to revoke or amend this trust, in whole or in part, at any time and from time to time by an instrument in writing, delivered to the Trustee and intended to take effect during my lifetime; except that the duties, powers and liabilities of the Trustee shall not be changed without its written consent. The Trustee reserves the right, at any time upon thirty (30) days advance written notice to me, to resign the trust and deliver the trust estate to me, after deducting therefrom its fees and any expenses then due and payable. FOURTH: Additions to Trust Subject to the approval of the Trustee, either I or any other entity may add property, real and personal, to the principal of this trust. FIFTH: Trustee's Powers: In addition to the powers granted by law, my Trustee shall have the following discretionary powers, applicable to principal and income, which shall be exercis- able without leave of court and shall continue until distribution is actually made: A. To accept and retain any or all property, including stock or other securities of the Trustee or of a holding company controlling the Trustee; B. To invesi in all forms of property (including, but not by way of limitation, real estate, all types of stocks; bonds, options, and participations in common trust funds and money market fundS); without being confined to investments prescribed by statute and without being required to diversify; C. To buy investments at a premium or discount; D. To hold property unregistered or in the name of a nominee; E. To give proxies. both ministerial and discretionary: F. To compromise claims; G. To join in any merger, consolidation, reorganization, voting trust plan, or other con. certed action of security holders, and to delegate discretionary duties with respect thereto; H. To borrow from Dauphin Deposit Bank and Trust Company or from others, and to pledge real or personal property as security therefor; to loan cash or securities upon such terms and conditions as trustees deem appropriate; I. To sell at public or private sale for cash or credit or partly for each, to exchange, to im- prove, or to lease for any period of time, any real or personal property; and to give options .f._r ...._1_,... .o",..h~nl'\o~ nr IQ::IC::~~. J. To allocate any ..,roperty received or charge incurred to principal or income or partly to each, without being obliged to apply the usual rules of trust accounting; K To distribute in cash or in kind or partly in each; L To retain any part or all of my business interests held in this Trust as long as the Trustee considers it advisable to do so; and to conduct, alone or with others, any such business in which I am engaged, with all the powers of an owner or with respect thereto, including the power to delegate discretionary duties to others and to pay adequate com- pensation to any such person; to invest other property in such business, and to incor- porate it or change its form. SIXTH: Compensation: The trustee shall be compensated in accordance with its standard schedule of charges in effect from time to time during the period of its services, and this com- pensation shall be paid from principal or income or partly from each in the sole discretion of the Trustee. SEVENTH: Non-Assignment: No part of the income or principal of the property held under this Trust shall be subject to attachment, levy or seizure by any creditor, spouse, assignee or trustee or receiver in bankruptcy prior to actual receipt thereof. The Trustee shall pay over the net income and the principal to the persons herein designated, as their interests may appear, without regard to any attempted anticipation (except as specifically provided in this agree- ment), pledging or assignment under the Trust, and without regard to any claim thereto or attempted levy, attachment, seizure or other process against me. EIGHTH: Law Goveming Trust: This trust is created and accepted in the Commonwealth of Pennsylvania and shall in all respects be governed by its laws and shall have its situs at . Cumberland n ~_nty, Pennsylvania. Executed oil' 0 7 , 19 db. NOTE: Before executing this document you may want to consult with your Attorney to as- sure that your wishes are being set forth accurately and in proper legal form. ~~'~EAW Settlor ., ~ The foregoing trust is hereby accepted. Executed on January 7 ,19 86 . COMMONWEALTH OF PENNSYLVANIA } COUNTY OF DAUPHIN On this, the 7th day of January , 198 6 ,before me, a notary public in and for the said Commonwealth and County, personally appeared Dorothy' M. Kauffman ,known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Revocable Living Trust and acknowledged that he/she executed the same for the purposes therein contained. WITNESS my hand and notarial seal. Dauphin D~it Bank and Trust Company By ~~ Jl/. ~~.(.. .e.~ Ass f:t Vice PrQj~a~nt & Trust Officer ~~7a~7/.tf/d2: // Nota. ublic Mv Commi~<::inn ~vnir~<::' SCHEDULE OF PROPERTY Referred to in the annexed Deed of Trust dated from Dorothy M. Kauffman Company, Trustee January 7 ,198 6 , to Dauphin Deposit Bank and Trust $11,900.00 Cash $ 8,803.13 Dauphin Deposit Money Market Account $11,500.00 CCNB Bank, N.A. 7.45% Certificate of Deposit Due 2/1/86 $12,000.00 CCNB Rank, N.A. 7.6% Certificate of Deposit Due 7/15/86 $12,000.00 Commonwealth National Bank 9% Certificate of Deposit Due 3/5/86 $11,627.81 Dauphin Deposit Bank & Trust Company 8% Certificate of Deposit Due 7/151 $15,133.99 Dauphin Deposit Bank & Trust Company 9% Certificate of Deposit Due 5/2/~ $10,000.00 First Federal Savings 8.1% Certificate of Deposit Due 6/19/87 $10,000.00 Harris Savings Association 8.4% Certificate of Deposit Due 12/20/86 $21,298.37 Hill Financial 11.7% Certificate of Deposit Due 3/25/87 $14,054.94 Hill Financial 9.4% Certificate of Deposit Due 1/15/88 $10,000.00 Hill Financial 8.75% Certificate of Deposit Due 7/18/87 $22,000.00 Hill Financial 9.1% Certificate of Deposit Due 3/1/86 2,463.054 Shares IDS High Yield Tax.....Exempt Fund, Inc. "T}f Crit. Docs. - Blue Backer o Legal - Orange o Fee - Green o Corres. - Red o Accounting - Pink o Annual Report - purple o Misc. - Yellow . o Real Estate - BroWn o ReviewslApproval- Gray o Special Pmts. - Blue .0 Tax - ManRla CG BUSER & SON 875 Market Street, Second Floor Lemoyne, PA 17043 (717) 972-1230 Diamond Mounting A Specialty Prompt Attention To Mail Orders April 3, 2007 Appraisal For: Estate of Dorothy M Kauffinan D.D.D.2-12-07 Lady's 14K white gold illusion style ring containing three brilliant cut diamonds. The center diamond weighs approximately 37 pts and is chipped of I color. The two side diamonds weigh approximately 18 and 19 pts and are ofVS clarity and K-I color. The ring weighs approximately 2.25 dwt. Total fair market value, approximately $ 350. Lady's 14K yellow and white gold ring COfItaining one large brilliant cut diamond and four single cut diamonds. The brilliant cut diamond weighs appro:Kitrurtely 1 ct and is chipped ofH-I color. The single cut diamonds weigh approximately 2 pts each and are of VVS clarity except one that is chipped, all are ofI-H color. The ring weighs approximately 1.80 dwt. Total fair market value, approximately $ 300. Gents 14K white gold 3.5 mm wide band ring that weighs approximately 2.65 dwt. Total fair market value, approximately $ 50. Lady's 14K white gold 2.25 mm wide band ring that weighs approJCimately 1.20 dwt. Total fair market value, approximately $25. dA~,~g: Charles G Buser m I.S.A, G.G. Fair marlret value: The price in the marlret place .in which the item would ~ bands between willing buyer and willing seller, neither being under any compulsion to buy 01" sell and each having reasonable knowledge of the relevant facts, i.e., the price in the market place in which the item is most cnrnrnomy sold to the pubhc. Also taken into considecation was a reasonable and realistic time ftame for willing buyer and willing seller to reach an arms length tIansaction within the appropriate market ManufacturinS! 1ewelers & Diamond Setters , I-IUIJ. j I. LVV I 'j: jLI-IIV! IV! , IIW;)! NV. OVjO r. L George Haar Auctioneer 933 W. Siddonsburg Rd Ditlsburg. PA 17019 711-432-3815 Dorothy M Kauffman Estate 100 Mt Allen Drive Mechanicsburg, PA 17055 Listed bekNI is the appraised value of items for the above named estate. ITEM Maple Dresser Costume Jewelry (4 sm. Boxes) Panasonic COloi TV table model 3 comer TV stand Piano music box Bear music box Round music box Baby Carriage music box Round mirror wlpicture music box Clown music box Music box Mise box lots 4 drawer file cabinet Are Proof storage box (no key) ~JI!()1 If... R ~ e. IfemS .e 't' ~ tPS41d - cI I ,,~ () e. rele 4 1< ~s ./I/O 5,0(1 (J]I S [0 (Y> S :J- (, ~ o~ AMOUNT 40.00 20.00 r/ 25.00 10.00 2.00 v 2.00 ,/ 2.00 ,/ 2.00 ./ 2.00 2.00 2.00 1.50 8.50 4.00 123.00 - ~g- ------ "95'" /)' 7 ~"Y~ ~ George H%neer 933 W. Siddonsburg Rd OiUsbUrg. PA 17019 717-432-3615 .; DtS1(lbu..-t-e ~ {f1f 1