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HomeMy WebLinkAbout10-17-07 -.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number a\ D1 tfi2JlP Date of Birth 201-26-5035 07/12/2007 07/31/1933 Decedent's Last Name Suffix Decedent's First Name MI Roeder Paul S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Roeder Bernadette A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW .. 1. Original Retum 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 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 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes Mark W. Allshouse, Esq. Firm Name (If Applicable) Christian Lawyer Sol. (717) 582-4006 REGISTER OF WILLS USE ONLY First line of address 4833 Spring Road ') Second line of address r) .; City or Post Office State ZIP Code . " DATE FILED Shermans Dale PA 17090 -.,~ ~"- '? Correspondent's e-mail address:mark@christianlawyersolutions@comcast.net - ,,__J .--j t<,,~ Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowle~.!:>and beBef, it is true, correct and complete. Declaration of preparer other than the personal representative IS based on all information of which preparer has an SIGNATUR~Ffl~IL/(~ IO//sE/()7 ADDRESS I' '/. 1 Hellam Drive, Mechanicsburg, PA 17055 SIGNATURE oo:rA00~HER~AN REPRE~ ADD~( 4833~~pr~g Road, Shermans Dale, A 17090 PLEASE USE ORIGINAL FORM ONLY 10/15/07 Side 1 L 15056051058 15056051058 ---l --.J 15056052059 REV-1500 EX Decedent's Name: Paul S Roeder RECAPITULATION 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) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 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) . . . . . . . . . . . . . . . . . . . . . . . . 14. 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.0~ 104,584.15 16. Amount of Line 14 taxable at lineal rate X.O 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 201-26-5035 Decedent's Social Security Number 0.00 0.00 0.00 0.00 23,009.31 0.00 96,753.77 119,763.08 14,719.93 459.00 15,178.93 104,584.15 0.00 104,584.15 0.00 0.00 15056052059 ...J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Paul S Roeder STREET ADDRESS 1 Hellam Drive DECEDENT'S SOCIAL SECURITY NUMBER 201-26-5035 CITY Mechanicsburg , STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) 0.00 Total Interest/Penalty ( 0 + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in avalon Page 2, Line 20 to request a refund. (4) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 0.00 0.00 0.00 0.00 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. 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;.......................................................................................... D [K] b. retain the right to designate who shall use the property transferred or its income; ............................................ D [K] c. retain a reversionary interest; or.......................................................................................................................... D [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... D [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D [K] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [K] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [K] D 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. 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 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 PS. 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 twelve (12) percent [72 PS. 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-15G8 EX+ (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Paul S. Roeder FILE NUMBER Include 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Cash 42.00 2. 2004 Honda Odyssey 19,545.00 3. Irish Setter dog (Devereux's Red Blaze of Glory) 800.00 4. Omega wrist watch 500.00 5. Nittany Lion Football 100.00 6. Gold wedding band 150.00 7. Oil painting 50.00 8. Train set 150.00 9. Clothing 400.00 10. Desk and chair 250.00 11. Coins - 14 silver dollars @ $20 each 280.00 12. Coin set - Bicentennial silver proof set 25.00 13. PNC Bank checking account number 5080386996 717.31 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 23,009.31 REV-1510 EX+ (6-98) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Paul S. Roeder FILE NUMBER 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 PROPERTY ITEM INCLUOE 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 (IF APPLICABLE) VALUE 1. Financial Network Investment Corporation Individual Retirement Account 96,753.77 100 Account No. 5FN-607611 96,753.77 TOTAL (Also enter on line 7 Recapitulation) $ 96,753.77 (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 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Paul S. Roeder FILE NUMBER Debts of decedent must be reported on Schedule 1. ITEM NUMBER A. DESCRIPTION AMOUNT 2. 3. FUNERAL EXPENSES: Parthemore Funeral Home & Cremation Services, Inc. total less $189.46 immediate pay discount a. Funeral Services -- $5,390.00 b. Casket & Vault -- $4,083.00 c. Death Notices and Death Certificates-- $556.39 d. Clergy & Flowers-- $385.50 First United Methodist Church - funeral food donation Rolling Green Cemetery Company - interment and recording fees Gingrich Memorials - head stone 10,225.43 1. 4. 1,000.00 1,195.00 1,575.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s}/EIN Number of Personal Representative(s} Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 724.50 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets 01 the same size) 14,719.93 REV-1512 EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Paul S. Roeder FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Visiting Angels Living Assistance Services 459.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 459.00 ~~~ faa&,J, K~ &001 I~B~ 11/~5tf5 ~~.~~ t~ (,/30/0.5) 800 j)11 e --<1 '-1-:-_ -c:f).. N:~l~ ~~~ .~~~ 150 ~~1;r~~ I~~ ~ 400 ~ + ~ J5D ~ N ~ ~ (i)"J.o <1.8'0 ~ ~ ~tt1f,aa; d5 c....JL. i.f~ ~CJ~ AMERICAN KENNEL CLUB NAME DEVEREUX'S RED BLAZE OF GLORY BREED IRISH SETTER COLOR MAHOGANY SIRE CH HEA THERWOOD'S SWEET CRIMSON SN37576805 10-97 OFA31G DAM KA THMAR'S DIAMOND LADY SN7589870411-050FA38G BREEDER JAMES D COOK & KIM ALAN EIFFES OWNER PAUL ROEDER 1 HELLAM DR MECHANICSBURG, PA 17055-6159 NUMBER SR27696603 SEX MALE DATE OF BIRTH JUNE 30, 2005 AMERICAN KENNEL CLUB OM CERTIFICATE ISSUED SEPTEMBER 2, 2005 This certificate invalidates al/ previous certificates issued. If a date appears after the name and number of the sire and dam, it indicates the issue ofthe Stud Book Register in which the sire or dam is published. For Transfer Instructions, see back of Certificate. This Certificate issued with the right to correct or revoke by the American Kennel Club. ii:j~ew......ii:tll~~.~~.~I~(~..~ .--------..-.------- ~~~~ ~ :~.~.:~;~ ;~ t.'~' 23 ~~~~ 'J ,::.;:.;"'''-i .::.....; ~ ;~ ~ ;~ '-l;~ .-::; ~' .- ~"J J y ~ -;;, imml ~; 13 8 ~- ~. ~ ':~. :; ~ ~ ~~ ~. (J ~~~~~~h ~ :JJ .~ ~~i ._' ::;. ~ ~ J~hH '~ .~~ ~; ~ ~~"'2 .~ ~ [ ~ 'J _ ~ ._, Q ~~~~~-~~'~ ~~~:~~~H~ .::~ ~_~~ ~~ _'~, (2 !; ;;.':.":).-?-- .. ::.~. OJ '0~, ,.:,: ::;6 "~~::~~>~ ~ ~ ~ ";;" ~:; -: r ;~. .~~~~ ~ .~, .4 ;_.---. ~.~ ~'~ "~ .T':t ,f;- '.:J :;-:.: -. -- ~Ji~~~ xcno-n d~2~~*? ,l~:i JUlin ~ ,,';:be "'''''"e''::;;.'" ,_ C" ~1~:?m:Z>.?5'Q W (6 F );>',:;>0:J>mP-lJ;5 l~ IUlm ~ ~;~iiiH tD '"-=O()W;rJ:;;~ o ~~U~~i kl i:u""e",,,.'" ~ j:5~;s~~~ b g~~~md~~ ~I' "~~~~~~~ '- ~ ,,,"~);:;J -.(1"'" CL K~ B~;~~~ Q.rn"'1:>mcOO; ~ 11'111! v () ~ ~ z (1) :;; o o 6 :;; ::J ~ J> 0- Q. 'B if> (fl ~ in :~. 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"- <-~ I) 'J J ('5 .-f rr:; G '2 -. .~ ';:; r:: ~ )> .~ ?:: \.f, ~, Wi "'. i:::>i O~ j 1,~i; ;:s ~ N !--J' -..l ~ +:::. ~ N ~ The Ill1rJer:;i'Jl1'~cJ flewby milk!'!'> dpplir:ation lor Cofr!iliq,le 01 rill,~ 10 file v0tlic:le "les(;rilx~C1 ilboV0, SUi)joc1lo Ih~ ennJlnhr<:inces <l1l(j.ulher INP.IJ c1,lim~ ;;81 fnrlll herr-) SIGNATur.;E OF APPlICAHT OR AI)THQFlIZED :3IGNEH I ST LiEN DATE, 2ND UENHOLDER STREET CITY FINANCIAL INSTITUTION NUMBER NUMBER Kelley Blue Book - Private Party Pricing Report - Honda, Odyssey co ~"_. IeleyBlueIaek THETltUmo RESOURCE "~_"~__h~_""_ advertisement Page 1 of2 ;;=.; Send to Printer + $1.ooO.....Cash AIlowuce OR$2.OM~ CnftAllowalKe +$1,ooo",u Cash AUown<e OD ChryslefPacIfka 2004 Honda Odyssey EX Minivan 4D BLUE BOOK PRIVATE PARTY VALUE Condition Value ..I Excellent $20,660 (Selected) ~ $1~ Fair $18,025 Average Consumer Rating (8 Reviews) Read Reviews f~f~f~f~{ 4.SoutofS Review This Vehicle Vehicle Highlights Mileage: Engine: Transmission: Drivetrain: 19,833 V6 3.5 Liter VTEC Automatic FWD Selected Equipment Standard Power Sliding Doors Air Conditioning Rear Air Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control AM/FM Stereo Single Compact Disc Dual Front Air Bags Front Side Air Bags ABS (4-Wheel) Power Seat Quad Seating Roof Rack Privacy Glass Alloy Wheels Optional Cassette Leather Blue Book Private Party Value Private Party Value is what a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold "As Is" and carries no warranty (other than the continuing factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. . " MD OTHER GREAT omRS ON OUR AW............. VEHICUS advertisement .elley Blue Book - Private Party Pricing Report - Honda, Odyssey Vehicle Condition Ratings .,I Excellent (Selected) U'w:'Jt10 $ 20,660 "Excellent" condition means that the vehicle looks new, is in excellent mechanical condition and needs no reconditioning. This vehicle has never had any paint or body work and is free of rust. The vehicle has a clean title history and will pass a smog and safety inspection. The engine compartment is clean, with no fluid leaks and is free of any wear or visible defects. The vehicle also has complete and verifiable service records. Less than 5% of all used vehicles fall into this category. Close Window Good $19,545 "Good" condition means that the vehicle is free of any major defects. This vehicle has a clean title history, the paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. There should be little or no rust on this vehicle. The tires match and have substantial tread wear left. A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall into this category. Fair $18,025 "Fair" condition means that the vehicle has some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. This vehicle has a clean title history, the paint, body and/or Interior need work performed by a professional. The tires may need to be replaced. There may be some repairable rust damage. Poor N/A "Poor" condition means that the vehicle has severe mechanical and/or cosmetic defects and is in poor running condition. The vehicle may have problems that cannot be readily fixed such as a damaged frame or a rusted-through body. A vehicle with a branded title (salvage, flood, etc.) or unsubstantiated mileage is considered "poor." A vehicle In poor condition may require an Independent appraisal to determine its value. Kelley Blue Book does not attempt to report a value on a "poor" vehicle because the value of cars in this category varies greatly. W'm,: t.......t * Pennsylvania 7/24/2007 1-4-L~./'-_~__ t 1 1 Page 2 of2 Aug. 9. 2007 3: 05PM PNC BANK 412-705-2747 No. 0770 P. 1 o PNCBAN< The Thinking Behind The Monty August 9, 2007 Mark W Allshouse, Esq 4833 Spring Rd Shermans Dale, PA 17090 RE: Paul S Roeder (Deceased) SSN: 201-26-5035 DOD: 07-12-2007 Deal' Mr. Allshouse: In response to your request for Date of Death balances for the customer noted above, OlD" records show the following: Cheddng Account Account # 5080386996 Established 01-19-1995 PAULSROEDER DOD balance: $717.31 non interest bearing P1~ note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not pr0CC88 any financial t:ransaetioDS or provide statements. If you need assistance with any of these items, please call1-g8g-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, ~ co~ . 1-800-762-1775 P7-PFSC-04-F SOO First Ave Pittsburgh. PA 15219 Member FDIC Page I ofl Senior Checking Plan 1-\.ccount Statement l'NC B:lIlk For the period 01/12/2007 to 04/11/2007 Primary account number: 50-8038-6996 Page 1 of 1 Number of enclosures: 0 z PAUL 5 ROEDER I HELLAM DR MECHANICS BURG PA 17055-6159 g For 24-hollr bClnking, and transaction or &:::!. interest rate information, sign on to 1)' PNC 8ank Online 8i\l1king ilt. pnc.coln. For customer service call1-888-P~~C81\NK between the hours of 6 AM and Midnight ::T Para servicio en esparlol, 18b6-HOU\PNC Mo..ing? Please contact us at 1-888-PNCBAf'lK o Write to: Customer Service PO 80x 609 Pittsburgh PA15230-9738 tJ Visit us 3t pnc_corn L3 Ii TOO terminal: HlOO-531-1648 FOI- hC;'lring iTllp;lircd clit'nt" 1)1)ly - R(~lIle.-s. Are yom' valuahles coven~d'! rf a lire or other unexpected event occurs, your landlord's insurance isn't likely to cover replacement of your personal property. Renters insurance can help YOll protect yourself For more in!()t1nation and a Ih:e no ohligation quote visit PJl\;.colll/immrance. Product not availahle in FL, NC and NJ. _ The PNC Visa(R) Gill Card is the perlect gin J(Jr everyone on your I is!. So, let them do the shopping. Stop ill allY hranch today or visit pnc.com/gilkards. You get the gift of convenient, one-stop shopping and they get what they want. .~ -- - Senior Checking Plan Regular Checking Account SUlnmary Account number: 50-8038-6996 ~ ~ . Paul S Hoeder Balance Summary Beginning balance Deposits and other additions Checks and other deductions Ending balance 717.31 .00 .00 717_;\ I Average monthly bdlanr;e Charges and fees 717_~ I J)O Your Money. Your Business, YOUR FUTURE, PMC rnves~ments can help you plot the course of a solid financial journey! \Vllether your destinal ion is education, retirement or somewhere along the way, we have the products and services to help YOII create :t sPllnd tiuancial plan. I:or more informatioll call 1-800.PNC-6111: Stop by your IOl.:al PNC Brallch; or Visit (J/lC.COIII Not FDIC Ins~lred ,<, May IJosl~ Vahl(' * No Rank Guanlllh'e, Important Investor IlIformation: Securities and brokerage services are provided by PNC II/vestments LLC, member NASI) and SIPC An/1uities and other insurancc products are offered by PNC Insurance Services, LLC a licensed insurance agency. Pay the rrotec~cd way with your PNC Rank Visa Check Card. Use your card to set up automatic payments. your int<Hlllatioll is prolec1cd by Visa's multiple layers of cardholder protection, including 24.hour fraud monitoring. Find out more at pnc.com/payhycard. o >=-~ ::;~ ~= ~~ 0, ~ cO cD ~ ~ ~ o ~ " ~ 2:: f';: Q c, c... 9.. r: ;) ~ ;f- c; ~rn ... ... C o s::: 26' ;:;~ --l S !!!. ~ CO' e;") =r ~ e .." " ;::- e:: 2i ::T 5" ~ 8 Cl. ~ ~ ::T rn .c c <' '" co ~ ." 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(0 0. ~. 3' c: 3 0. ~ 6' S- o' ::l V1 ;0 s:: o ~ C V1 C ~ -< er (0 <e 5' 5' S' (0 '< '" ~ 'C3 c: ..... .., Co o O'l Co N :>> 3 o c: ;;a ~ ::r- g- '" :;;: :l -<: '" ~ 6" o '" ~ "" <::> o <::> :>> 3 o C ;;a ;:0 '" .c ~. '" 0. 6" 0- '" ~ ::r- 0- c;; ~ :l ~ N o 8 - w 00 <::> en Co N GO CD ::l ~ ("> 0;' -<' ;:0 '" ~ o' ~~ ~> cD w <.n w -0 o C <.n m -0 '" ;::I. n' -0' '" ;;a co '" ;:;J ~ M' ;;;' -<' o o ~ ~ - ~ <0 ..,. c.n " '" n C 2r o' ::l -.; '" ("> o ~ o ~ N c.n N ~ g> -<: (0 ~ <'0 ::l 0. .." ~> ;:0 CD .c c: ""l CD Q, S -. ::s 3 c: 3 c -. VI ... .., -. :s: "" ~ <: "" c: '" ..,; s:: .5 C" c: - -. o ::s (I) c: 3 3 Q) .., '< .... <.D c.n <.0 w N o ..,. "'" ~ " ;;; ;;- "'- ~ " a ----- .. ~ LAST WILL and TESTAMENT I, PAUL S. ROEDER, JR., of the Township of Upper Allen, Cumberland County, Pennsylvania, hereby declare this to be my Last Will and Testament, and revoke all Wills which I have previously made. FIRST: J direct my hereinafter named executrix to pay all my just debts and funeral expenses as soon after my decease as may reasonably be done. SECOND: I give, devise and bequeath all of my property, real, personal and mixed, of whatsoever nature or kind and wheresoever the same may be situate at the time of my decease unto my beloved wife, BERNADETTE A. ROEDER, if she survives me by thirty days; otherwise I give such property to my son, DOUGLAS R. ROEDER, if he is alive at the time of the death of the survivor of BERNADETTE A. ROEDER and myself. ill-E'q'lill shares r.s.~. THIRD: In the event that my wife does not survive me by thirty days and we have no children surviving us, I give, devise and bequeath all of my property, real and personal and mixed, of whatsoever nature or kind and wheresoever the same may be situate at the time of my decease unto my surviving nieces and nephew, SARAH JANE VIKNER, SUSAN RUTH SCHWARZ and ROBERT W. BOWDEN. FOURTH: If any of my heirs named in this document do not want my dogs surviving me, I devise and bequeath them to the Humane Society of Harrisburg Area, Inc. I specifically bequeath and devise $1,000.00 to the Society and request the Society to find my dogs a good home. If the Society is unable to find a suitable home, I request it to humanely dispose of the dogs. ?au~ ff ~~.f/V; r./. (SEAl) FIFTH: I nominate, constitute and appoint my beloved wife, BERNADETTE A. ROEDER, executrix of this, my Last Will and Testament. In the event my wife is for any reason unable to serve as executrix, I nominate, constitute and appoint my son, DOUGLAS R. ROEDER, executor in her place and stead. In the event my son is for any reason unable to serve as my executor, I nominate, constitute, and appoint my nephew, ROBERT W. BOWDEN, in his place and stead. No executor or trustee named herein shall be required to enter bond or furnish sureties in any jurisdiction. IN WITNESS WHEREOF, I, PAUL S. ROEDER, JR., have set my hand and seal to this and one preceding sheet of paper as and for my Last Will and Testament this ~~ day of April, 1997. RJP ~.~ ~fr- (SEAL) The foregoing typewritten instrument was signed and sealed by PAUL S. ROEDER, JR. in our presence on the day it bears date, and he stated, published and '-,~:~::_7.~,:y,~ tha' .~ " ;""\ - he '_(.... i.i..., ~ ~,~.;: ': Reconh~ (}~-:r~cc for D';::cnl~F~'(::-n( tlw-/2.-' ,7~) %~~/).,<.I;;M?~c " r1 -~_._---~ REV 1112006 . ?flINT IN vlANENT CK INK COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE NUMBER 1. Name of Deceden1 (Firsl. middle. last, suffix) Paul S. Roeder 5. Age (lasl 8irthday) 73 6. Dale or Birth (Month. day, year) July 31, 1933 y", y. 8b, COunty 01 Death . ad. FaclTrty Name (If not insmution. give slreet and number) Cumberland Upper Allen Twp. most of work' life. Do not state retired Kind of Business I Industry Law . 15. Decedent's Mamng Address (Street. city 1l0000, slate, zip code) 1 Hellam Drive Mechanicsburg PA 17055 1 Hellam Drive 12. Was Decedent ever In (he U.S. Armed Forces? DYes filo Decedent's ActualAesidenca 17a. Stale 13, Decedenl's Educalion (Spec;fy oo~ highest 9'ede oompIele<l) Elementary I Secondary (0-12) College (1-4 Or 5+) 12 5+ Pennsylvania 17b. County Cumberland 18, Falher's Name (First middle, last. suffix) Paul S. Roeder 20a. Jnformanl's Name [Type I Print) 3. Social Securtty Number 201 - 26 - 5035 4. Dale of Death (Month. day. year) July 12, 2007 14. Marital Status: Married, Never Marrie<l, Widowed, Olvo<eed (Specify! Married Bernadette A. Mahek Upper Allen Twp Did Decedent 00 ir. a Township? 17c. 0Cl Yes, Decedent lived in 17d. D No. Oec<denl LMld wffhin ActuafLimitsof City/Bora f9. Mother's Name (First, middle, maldensumame) Miriam H. Small 200. Informant's Mailing Address (Street city! toWn, slate. zip code) 1 Hellam Drive Mechanicsbur 21b. Oate of Disposition (Month, day, year) 21c. Place ot Disposition (Name of cemetery, crgmatory or olher place) PA 17055 21d. localion ICily /lawn, sl"e. z~ code( 1 7011 Lower Allen Twp., PA Rolling Green Memorial Park 22c. Name and Address of Faci~1y FH&CS Inc., PO Box 431, New Cumberland, PA 17070-0431 23b. Ucensa Number 23c. Date Signed (Month, day, year) PM. 24.1ime of ~ 0:\0 CAUSE OF DEATH (See instructions and examples) Item 27. Part J: Enter tl'le ~ - diseases, injuries, or complications - that direclly calJSe<l the deatl'\. 00 NOT emer terminal eventS sucl1 as cardiac arrest. respiratory arres1, or ventricular fibrilla Non withOut showing tI'Ie etiolOgy. Ust only one cause on eacn line. 26. Was Case Referred 10 Medical Examiner I Coroner fOT a Reason Other than Cremation or Donation? Dyes 1!(INO ~d1;~~~S~~t~~dise~ a. f1P..:tCL~-1' f1 ~ (:~J ~-i O-'~ Due 10 (or a5 a consequence of): <-J 'j YS Approximate interval: Parl II: Enter other sionifrearn condltions cootributir.CI to neath, 2a. Did Tobacco Use Contribute to Death? Onsello Death bul not resulting in the under1ying cause given in Par11 0 Yes 0 Probably .t;3->>o 0 Unknow' Sequentially list concfi1ions, if any, ~~t~~O ~o~~v:~~~~ a. (cfisaase or injury that initialed lhe events reSU~irIg In death) LAST. b. Due 10 (or as a consequence of)' Due to (o~ as a COl'\~uel'lCe of): d. 3Oa. Was an AlIlopsy Performed? 3Qb, Were AlIlOf)Sy Findings Available Prior 10 Complel!on 01 Cause 01 Death? DYes ~o 31. Manner 01 Dealh ~-atural 0 HomIcide o Accident 0 Pending Investigation o Suicide 0 Could Not be Determined M 32d. Time of Injury DYes~ 33a. Certilier (check only one) ~7~:;$r:r::~~~:,n~:~== ~~~~I~::;u:~7;~h=:: ~~_~~th ~a~~~ ~~ ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 ~~:u=~a: =~~:an~=~~ :~i~":.;n~::c~~:rtZei~~ca:~~~~~ man~r as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _.. _ _ 0 ~~~::~;:~n;;,":~;~r:t:~ and I or i~stigatior., In my opir.\on, death OCCurred at lhe time, date, and p.Iace, and due to the cause(s) and manner 8S stated_ 0 I J.,I I ~ 1,1 I 35. Aegislrar'sSignal ~ f"""~ C4:/V\{<L.... , 29. It Female' o Nol pregnanl within pest year o Pregnanl at ~rne of death o Not pregr.anl. bl1l pregnant wrthin 42 days of death o Not pregnanl, but pregnant 43 days to 1 year before death o Unknown if pregnant within the past year 32c. Place of lniufy. Home. Farm. SrQel. FatlwY. Olflce Buil~ng, e~. ISpecjfy) 32g. Location olll'llury (Street, city I tOWll, slate)