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Home My WebLink About10-17-07.~ 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY ' PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Q PO BOX 280601 ~ D ~ ~ D / Harrisburg, ~A 1712E-0601 RESIDENT ~ECE~ENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth Decedent s Last Name Si.iffi ~: Day edam s First Name MI (If Applicable) Enter Surviving Spouse's Information Below 5pouse~s Lasl Name Suffix Spouse, First Name P~41 ~V Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CNf~RLE~S ~ Sy/ EL~s ~ ~ / 7/ 7 76~ ozo°I Firm Name (If Applicable) N/ ~- First line of address ~ C ,~ O US ~/~ ~D~D Second line of address I' City or Post Office State ~ ~- e ~ ,~ N ~ ~ s a ~, ~~ ~°,~ ZIP Code REGISTER OF WILLS USE ONLY ,., -> -a - i--? "~; =~ r-_~ __ - _ S.~W _~_ I -__ ~: _:. ._,,,I DATE`EILED -;-, l 7 D SSA ~ 3'~' ~s~.~~ y Correspondent's a-mail address b e a,m e r C J~ CL~ ~ ~ I ~` • net Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal repr~ntative is based on all information of which preparer has any knowledge. SJGND,TURE OE PERB'mN RESOONSIBLE FOf~ILINO RETURN. _ ~ IG / .1_ DATE) ~ SIGNATU 6 - P/J ,~~o ss PL ASE USE ORIGINAL FORM ONLY 15056051047 Side 1 ~'l/, PA I To~~ DATE 15056051047 J J 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~LC r7~/~/~O/~'F ~' T~ ~ ?, 0 7 oj, l(j ~ ~ ~ S RECAPITULATION 1. Real estate (Schedule A) .......................................... ... 1. O a S, fp 2. Stocks and Bonds (Schedule B) .................................... ... 2. '' // ~ ~ j ~ T 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. . t~ 0 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. ~' ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. S g , D (p ~' , 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ~ D ~ ~ 9 9 . D q 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0 ~ (Schedule G) O Separate Billing Requested...... .. 7. , 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ~ ~ l ~ ~ 2 . ~ 0 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ~ ~ ~. Z y 7 D 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. ~ S 9 , q S', ~ ~D 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. ~ D ~ ~n 2 D . ,~ O 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. / D y 9 2 , j O 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which D an election to tax has not been made (Schedule J) ...................... .. 13. . ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. ~ O /' 7 ~ .~ , / ~ 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 O ~ ~ 15. ~ O 16. Amount of Line 14 taxable at lineal rate X .0~ ~ O ~ 9 2 . / D 16. y 7 17. Amount of Line 14 taxable at sibling rate X .12 ~ ~ 17. . ~ ~ 18. Amount of Line 14 taxable O at collateral rate X .15 O 18. D O 19. TAX DUE .........................................................19. 20. FILL IN T1iE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 ~{ 7 2. / 5 O 15056052048 REV-1500 EX Page 3 Decedent's Complete Address: File Number ic.~ ~ ~~ - / ~~ ~C ! _7Y _ ~; _~'L' TT672f~0~'F STREET ADDRESS -- _. _ _- _ cirY L'if~lJ~id h~/Gc STATE PA I ZIP / 70 ? // Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit O B. Prior Payments _ Q C. Discount Q ~~ ~a, is Total Credits (A + B + C) (2) 3. InterestlPenalty if applicable ~ D. Interest -___ - __ E. Penalty ~j Total InterestlPenalty (D + E ) 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. 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. (3) (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT O O Q ~ ~.~. iS' 9• in lf~/. 2~' .~~ ;max ~ ~~.: 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 :.................................................................................... ...... ^ 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 "intrust 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? ................................................................................................................. ....... ^ 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 exemat a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV,1502 EX+ (6-98) SCHEDVLE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FF ~TE,~Q/~OFF~ /~Lc'T Tyr J' ~ / -D(o - 9S / All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t . C ~ m e ~or~ Lit ~beea~ Inn N t.•,rs h e.1 >G sfa,~'es, ~I~rs ti~ y Ce/ihefP,ry. Va,! u.ed ct~• Df-r q ~ nal (~f.LrGl~ asi p r, cep pGr' (,~ ~ S Cu 55 I dN of I~1ar~/~t ~, ZOD 7 [tl r ~.iL ,J. 1 ~i,w1 i ~Ofr t . Sec I.o~ Y oT' o ~ t cJ i vla,l ~.¢~(y~e t CN~t~ al Ge G~ TOTAL (Also enter on line 1, Recapitulation) + $ ZS', D O (If more space is needed, insert additional sheets of the same size) ~ ~e~~ ~e ~~eut~e~~ex ~ ~~ ~ ~~ji~ ~ubEitture Made the " 18th day of January, , in the year of our Lord one thousand nine hundred and S 1 Xty- f1 Ve (196 S), between HERSHEY ESTATES, a Pennsylvania corporation. party of the first part, and BETTY R. KOHR, Derry Township, Dauphin County, Pennsylvania, hereinafter designated as party of the second part, WITNESSETH, That HERSHEY ESTATES for and in consideration of the sum of TWEN'T'Y-FIVE (25.00) Dollars..paid by the party of the second part at the time of the execution hereof, the receipt whereof is hereby acknowledged, by these presents does grant, bargain and sell unto the party of the second part and to ,her heirs, executors, administrators, the full and exclusive right of Interment as hereinafter stated of deceased persons in, and for that purpose the exclusive use and occupation of, a certain burial lot in HERSHEY CEMETERY, situated in Derry Township, in the County of 'Dauphin, Pennsylvania, as located on the plans of the Cemetery, filed and kept in the office of the Corporation, and designated thereon as all Of Lot No. 9S, in Section C, CONTAINING One Hundred Fifty- one and seventy-five hundredths square feet, more or less; TOGETHER with all and singular the rights, privileges, and appurtenances thereto belonging or in any wise appertaining; TO HAVE AND TO HOLD the same unto the party of the second part and to her heirs, executors administrators fer their sole and exclusive use forever, for interment only, as hereinafter stated, and for no other use or purpose whatsoever; subject to the provisions of the Acts of Assembly of the State of Pennsylvania, the Charter and By-Laws of the Corporation, as the same now are or hereafter may be, and the rules and regulations that have been or may from time to time be adopted by the party of the first part in regard to the use of the lot and for the regulation and gov- ernment of the Cemetery. The rights and privileges hereby granted or any part thereof shall not at any time be assigned by the party of the second part, her heirs, executors or administrators, without the permission in writing of the party of the first part, or its successors, first obtained (which shall be evidenced only by a dead executed by the party of the first part in substitution of this deed which shall be surrendered to the party of the first part and cancelled,) but the same are limited to and for the party of the second part, her heirs and the members of their family and friends, without any payment, advantage or profit whatever to ,them, or any of them, so that there may be freely interred in such lot only the bodies of all such persons as may be proper subject to the provisions stated; if the party of the second part, heirs, executors 'or administrators, or any of them, shall at any time, contrary to the intent and meaning thereof, assign the rights:`and privileges hereby granted, or any part or portion thereof, without the permission in writing of the party of the first part, or its successors, or shall and do receive any payment, advantage or profit whatever for the use of the burial lot, or any part thereof, then this grant and all rights and incidents thereto shall cease and become null, void and of no effect whatever. The party of the second part for hex'self her, heirs, executors, administrators and - assigns, accept S this deed subject to all the terms, provisions and conditions thereof, assents thereto, and for herself and them doth hereby covenant to and with the party of the first part, its successors and assigns, to observe, respect, and comply with them. HERSHEY ESTATES acknowledges the receipt of the sum of FIFTY (50.00) Dollars as a contribution by the party of the second part to a maintenance fund and the receipt of the sum of T6VENTY- FIVE ($25.00) Dollars as a contribution by the party of the second part to an improvement fund, which sums shall be applied as hereinafter stated. HERSHEY ESTATES doth hereby covenant to and with the party of the second part and Tier heirs, executors and administrators: (a) that the right of interment in the burial lot described herein iri the quiet and peaceable use and occupation of the party of the second part it will forever Warrant and Defend; (b} that it will at all times hereafter mairitain the lot in good order and condition, and, as often as shall be neces- sary, cause the grass thereon to be cut, and the trees and shrubbery io: be trimmed, provided however, that this covenant shall not be held to include the renewal, rebuilding, paintin or repairin of any structure an the lot; (c) that. it will forthwith set apart the sum of ~Flfty (50.00) '- Dollars, so as to form with other sums contributed in like manner a sepaate trust .fund to be .invested, the income arising therefrom to be applied under the direction of HERSHEY ESTATES to the, perpetual care-, and preservatior. of the grounds and the repair and renewal of the buildings and property of the C,~netery• aqd, (d) that it will forthwith set apart the sum of Wen y- 1Ve 02$.00) Dollars, so as to form with: other sums contributed in like manner a separate fund, which shall be applied to the construction of roads, walks, buildings and the improvements of the property of the Cemetery. The party of the first part does hereby constitute and appoint A. ,R. Whiteman to be its attorney, for it and in its name, and as and for its corporate act and deed to acknowledge this Indenture before any Berson having authority- liy the laws of the Commonwealth of Pennsylvania to take such acknowledgement, to the intent that the same may 12e duly recorded. .T]~',i WITNESS WHEREOF, HERSHEY ESTATES, party of the first part hereto, has caused its corporate seal ,_.; . to be--,hereunto affixed, duly attested, the day and year first herein written. Sig~n~e~d Sealed (and Delivered in the presence of: HER-S~H`EY ESTATES --•- - :• -- --......... -~-:- .......................... •-•-• - •-------~--• ---•-------....-------.,.- -----..... _. ..,. President ~ 7. I/ .....~- _ / -----------•------------•---- Attest: --------------•--------•---~'~..._~------•---'-•----• . _. ._ _. .../~ Secretary. STATE OF PENNSYLVANIA, 1 COUNTY OF DAUPHIN, J ss. I hereby certify, that on this 18th day of January, in the year of our Lord one thousand nine hundred and S 1 Xty-five (1965) before me, the subscriber , a Notary Pub 11 C in and for said State and County, personally appeared A. 12. Whiteman, the attorney named in the foregoing Indenture and, by virtue and in pursuance of the authority therein conferred upon him, acknowledged the above Indenture to be the act and deed of HERSHEY ESTATES. WITNESS my hand and official seal th ay and year aforesaicJij ~L~/ .~ Notary Public IvIy Commission Expires March 28, 1966 O M o! W '1•:. ~~ c., "y 0 0~ N +~ ~ t~U ~ ~4 Q >I cx m N v ate. awa ~ .~, ~~a~ a ~ ~ ~ V 5 ~~ z ~ U .tea ~ s~ o .,~ U 0 Z W a U W ? a a LV ~ z a U o3 a ca W N z z w 0 a ~/ ~ 1.1. ~ W x a = m Q ~F'or ~aiue ~teteibea hereby grant, bargain, sell, assign and transfer unto HERSHEY ESTATES, its successors and assigns, all right, title and interest in and to the within described burial ]ot and the rights, privileges, and appurtenances thereto belonging or in any wise appertaining; and do hereby remise, release, quit claim and- forever discharge the same unto HERSHEY ESTATES, its successors and assigns. WITNESS hand aad seal this day of Signed, Sealed and Delivered in the presence of: STATE OF PENNSYLVANIA, 1 COUNTY OF DAUPHIN, J ss. I hereby certify, that on the day of day of the subscriber personally appeared the above named and acknowledged the above Assignment to be act and deed. WITNESS my hand and official seal the day and year aforesaid. A. D. 19 ~~ - ---...---------------°--. SAL T~ .._-------------------••---. SImAL A. D. 19 before me IvIy Commission I3xpires • BY-~-----------DATE-------- SUBJECT------------------- CHKD. BY______DATE________ o - _. D ~~~ ~ Q y' fI1 D ~ - ~' ~n -~ -~ :r SHEET NO._________OF_______ JOB NO.--------------------• ----------------------------- ,/ o ~-- _ _ - -- - - - -~.,. . ~' s i ~.. ~~ ~ { I 1 ~ ~ ~ ~ ~ '~ i ,4 ~ k ii---- -_ --- ; ~~ ~ ~_ ~ tt i ! 4.5 ~` ~s I x ~asos ex. h-stl SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT iTATE OF FILE NUMBER FF'TT~iYoFF, ,s3E r- TY T. 2 ~- ola - 9S'/ All property jointlyowned wkh right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. ao y SlaK,s o}~ C'o~,no~ sf~ c~ Lucent ~ee.hnolo~ yes ,F,t ~tve. pr«e on cl! o- a! .~ ~. 36 = '~ Sl8/. yy /NX'~ NOTE.' C'ounso/ wua unable ~ ob~u~n h~s}or~ca,1 ~ricivlq d vfa ~dm sfandarcl ~ n~rrnai~'ovl sour~cs . +-k ~-as rol ~ ~d Gn i n ~rrttit aeon a~bfa~xtu~ ,b,)' ~ rektr K'e~l ~eds~ob of ~~ ns a-o' Pr~vo~'~ 1.ea u-. Sae ~' Ge,° ~,n~ ~fia~'ernrJ-~,~' ~r (period Dee.l, zoob .~ ~p.r 3 I , ZoOlo , P 4' o f .~ Sit o w; n~ 54.i d 0.G u.i s i h'on ~d.o~cl.~ ~riG~. f~~ourl~' smutf' is ct1}Ac~ed ~~. TOTAL (Also enter on line 2, Recapitulation) I $ '~~/. ~~ !If mnre enure ie noariell incarf AflrlitlMAl FI1P.P.YR nl' ItIP, FAnle SIZE 0 m m ~. m ~. i~ a ~c V i ~ ~~ v m ~, n m d 4 N d LZ. u o' Q ~ O ~ ~ ~ ~ N °~' ~ s ~ ~ " ~ r ., • ~ -n . o0 d ~ rt v a a N ~ N a ~ w m , .. ..., _ cn ao ~ c O D ~ c g %~' ~ m ~ C ~ ~ ~ +,»> _ m2~rnomTO~ ~~D~ om ~ ~ _ nmOG~~~.1 N . o _ zr°n~y m~ ~~~m ~ _ ~ w m~O~-tni N N ~~vn VJ _ O o `u ~~~~Sm b n ~ -a ~ - c ~ m ~ ON~~~ ° D ~ ~ ee g b~ ~ c : _ - _ `'uoivi ~ ~im2D N oc ~ S n ~ b : ~o : ~ b ~ 1p J -w Q 22'~ iP ~ y l, S . $ ~ g ~ N O ~o r r g d m W : V ~l 1 , ~ O ' '' o g D g g m Z ht v ~ o ~; ~ o z m m ~ ~ cn v~ ~ c m a ~ ~ ~ ~ ~ ':.;~:: ~ o• ~ ~ ~ 3 n ~ ~ fU y 7 fA 7 j~ C O ~~i. R: Q n ~ O ~ n n ~ :»: ~ '. 3 -I ~'`c ~~ ~^ ~ ~~ ~ ~ "' o N i" C ;: ~G O N o ~~ ~C _ ~ ~ ~ te NZ fD ~ ~ rh a p . o ° m o ~ ~ ~ p c f rn G °~ A g ~ ~ ;! C7 Cf °o 00 _ °,° a O c' v ~ = A ~ rr O ~ ~ a ~;, ~ '" ~ tD ~ ~ ~ y ~ c ~. ao v 4 »>»~ {~ rr ~::::>:i:::: `. ;j' y C~ Q' 7 0 $.~ - O O Q = N g 1/1 ~ O m~ ~ O ~ X' ~. N a~ ~ 6 Q ~i a y N O m =:O ov N_.gr c~.~D.a3g:. ~~o ~~.a~"~.m N'K° "~" ~~~'~-a n o off. ~ o ~ vD ~`:`~ 33 ~ w°w me°i~m~-Gf'V'vr m3' ~~wa.3 <O t mm3w~..a a$ mo. vW a~ < ~~ o w~ 7 »_~ a. ~0~ w3 9, ~:.r„ ~ ~. 3g ~ a.~.~~ 3m as :~ ~ ~ ~, ~~..Q' a p ~ "a:. rm,w m m ~Q _:g a~ D ~c ra«.°~ R.~ rm ~:a - y°, ~~ ~ 8,..,~ ~• w ~.v a ~ ro w 3 ~ g v.~ ~ ~-aa ~ ~ ° ~ n~S~ o ~ .+~•.~ m ~ ~ ~' a ~ -~ a w~ o ~ a~ ~,a~c~'~?3e gN v~ $.~ m m'~'~~~D q~q-n z~~. cp~.of° a ap c ~~ m °(~/1 ~c ~. m.N, cm 13'.3 N <~ ~N °D '~° ~° 20 ~a.,a°a. p' gs.'O m 3.~,. cc '~ ~c 3 ~' r ,¢m`~oo~pO-'nom gc i a.. ~_' o~a~~g o,a a go go NN c'Q ~ 3 m r'3 m3 v w a c^ g3 wof Km c. `a. a• a w .~ »„u~~- m,, ~ We w ~O3 ,~ <~ ~.m ~ d~ B~~Y~''rcaig v~ ~3 and °io ~z~.'_~A °.~ ~~ 3aT~m~, oc g ~a ~ °-«.d2 w ~~ So 3 a u a^~an, ww o... °ya ~-^ o.aUNwO ~" .a4r$c,m a3 m ~ N m n "~ a m ~,+m m ~ g 7S a_:~ ~.a a $~ ~ ~ g.g~ $ ro w~ w ~ r> >d;,°< m y o c^i 3 a ~°.'v •a c .< N °a~g'.3"c N_'4Nrv.~3:x° cwa~'~w ~~. sa ~~a.awi~ ~,Z ~ ~~"' ~ tai rc a ~3 °n m m 3'N~OL°•''~~ m~• _ a ~~ To~~3°' io'°' ~~ ~c~°:o cs, ~ ~'~ ~ am °1 a~ o w ~ w o $o'~~•~ a.m ~ c ~4-0rpnosc3 3v ~~. a~~.m~ mm 3 ~ ~ ~'-, 3 roo m~ a• ~~ .~ ~~y~Q~ ~~ Z ~ v'.a Tc~~~•.m ~~ ou aowaw °ro ~ v~ ~• .a<m ~. ~.a ao D ~ m ma~ a{~ ~~ ~' ,aZ ~g tAn~~bew'° ~,`~ 3`^3 ~z~ov %i `m ~ ~ 8 m ~r 'm -o 5•~n m m° m n o w m m m o-c` ro m w ~ woo ~ ~o,a~aa_ ~~ y to Sm O°.:°~7N w o,,c ~v~mS, ~,y c ~ S ~.g " Aa ~~ iX ~ arv ~° c `3 ~ nr~'D~ w ~ ¢ m m $ a ~d ~ 3 mm -n ~ Rr ~ c. c~a°N ma ~ dw vw '~. ~.... ~ ~ ~ ~ Yd ~' ~ 3 2'$ ~? ~ ~' o g w ~ ? m o ~ w a m Ka ° a a~ o; u,.L O ~ ~ ~ r ,,... y p n ~~ ~. a ~^ '3. ~ o ~' a o ~ a c m c "~• ~ r~ o. 3 'v. 5 3 z v. = v ~r6~msi N m°N g Z w 5 y0 r.' °- vicar m o5a N°. a3 < yr ~ °'~ a aro 3 O w 0 ~ a ~ Sim ~~ -•+~, ~ ~ a~ r. ie ~. ~ g a Li O O ~ 5• ~ K D 9, ~, ~ Cm •71 O. 0 3 0.N 7. 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(1.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ~( _~~ _ ~S ~ ESTATE OF ~~ ~?E/e /yDF F ASE ? ~ ~, T Include the proceeds of litigation and the date the proceeds were received by the estate. A{I property jointty-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. y~~~marK ~reea~oiA /3/ue ~itmittn~ ~P~{u.n~ ~ifzw/oi~ 'fh~6_oo (s~~ p~~~y ,~~~~ti~J ~• Gta~~9~ plea/~iCarc, f~,~iE',lQ l~Gd/~ (.are O~~OhS, ~ltr~i~~Ll fil, /0~{ DD ~e1r~bccr~e-nenl' ~r ~joend%'~u.r,es ~v~ tiealtll ~.rC (r/~b~o7) (Ste SJ~DI~p L'O~i a~?G~Ie~~ 3. 1 q9 2 t7oD~E ~5Edd1~A/ V/N ~ / Q 3 X A-`f 6 K~ ~t1 ~' l ~535a ~.aoo ~.vD/TicN (scc ~O~u~ ~~' Ya~ua~io~ a~ached~ ~~, Z 35.D0 t~f, /jlE/aIBEJ4S 1st ~EDF/ef~L CR.~~IT UNlon1 s~N6tE /vD-i~tF ,~CC7.?;: ,9~ ~ QEG ucttie s~~/~vG,S .~f-~T. ~ g39B -oo ~6 Y~l. 9S" ,Q.J A~CGP. /All.' ? vo-~• aN A.1 , zS' C'.) ~slECK~NG A,ecT #~ 939- i/ ~s9~ fn7 D 1 /i<~CQ //YT. ~ D.o.E. DN c.~ . oa (see rafu a lion /efter a fl`a checl~ }~i~,{-naarK H~alfih ~,sur. ~e{und o~ misfaken~y ©uer-b:tl~d ~~ p~o3.o0 prem- um r/},ar~~s ~iz~ia Job) (o. 2 ~S - Z•.~ chine ~Mr /Pe dun al ~a~l. DD TOTAL (Also enter an line 5, Recapitulation) , $ Jam, 9 D (o • ~ 7 (If more space is needed, insert additional sheets of the same size) i iIGHMNZK. Date: 10/24/2006 This Month Gross payment amount 46.00 Net payment amount 46.00 01.1402 ~~~ ~~~TZZ~a~~ ~~~: 0114 G ~ ~ . ;~ ~ ~l ~ H'~ , ~ ~ f v 7Ei15 FreeCZbmBlue - 360._ DATE AMOUNT .Premium Refund 1=0/24-/200.6...- 46.'0.0 _ ~ - ~ Voitl If not-cashed within 1 .year *FORTY-SIX .AND 00/100 DOLhARS*, FAV THE "ESTATE OF .BE.TTY J FETTERHOFF ~~ A, /~7 b TO THE ORDER OF 436 SPRING HOUSE RD _, ~~~,"~ CAMP .HILL PA 170:1.1 ~i'0 L X46 28ii' x:0 360 76 1 50: 6 20 54 5 2 5B L~~' /i~, f ~ 2 016 • A A R P C K0 5.00762 -001.01644 UNITED HEALTH CARE If you have questions please contact us at: PO BOX 740819 UNITED HEALTH CARE ATLANTA, GA 30374-0819 PO BOX 74081 9 "~~ ATLANTA, GA 30374-0819 TOLL FREE: 1-800-523-5880 TTY#:. 1-800-232-7773 ESPANOL: 1-800-822-0246 PAGE 1 OF 2 ~~ ~~ THE ESTATE OF BETTY J FETTERHOFF* 436 SPRING HOUSE RD CAMP HILL PA 1 701 1-1 452 SUMMARY OF BENEFITS MEMBERSHIP # 023926116 Paid to Provider(s) Paid to You Totals ~o . oo $1 ,1 04.00 JANUARY 1 6 , 2007 If you suspect fraud, call the Fraud Hotline at 1-800-242-0453 Please remember to submit your claims on a timely basis. The certificate of insurance includes a time limit for submitting proof of loss. Health Care United Healthcare Insurance Company (and United Healthcare Insurance ~~ Options' Company of New York for New York residents) are proud providers to Please detach check below and cash promptly UNITED HEALTH CARE - 62-20 PO BOX 740819 S'_ ATLANTA, GA 30374-0819 Citibank Delaware ~ '' O ~ ~ V ~ O V J gii One Penn's Way New Castle,. DE 19720 °<:,_j INSURED MEMBER: BETTY J. FETTERHOFF* DATE : JANUARY '16, 2007 _ I °****ONE THOUSAND ONE HUNDRED FOUR DOLLARS AND 00 CENTS**** ~ t PAY TO THE I ORDER OF THE ESTATE OF BETTY J FETTERHOFF* 436 SPRING HOUSE RD I CAMP HILL PA 1 701 1 -1 452 ( . Kelley Blue Book - Private Party Pricing Report - Dodge, Spirit 1992 Dodge Spirit Sedan 4D Trade-In Value Private Party Value Suggested Retail Value Photo Gallery Blue Book Review ~ Shopping Tools Free CARFAX Record Check Auto Loan from 6.65% APR Compare Insurance Rates Payment Calculator Extended Warranty Quote Print For Sale Sign aUYA USED CAR on Blue Book Classifieds'" Dodge Spirit 30 Miles or less ZIP Code 17011 To View Ads, Click SElL YOUR USED CAR on Blue Book Classifieds'" Reach millions of shoppers on kbb.com, Cars. com, and other popular sites. Find out more, Click FIND THE RIGHT CAR Compare Used vs. New Under $5,000 Both New and Used Sedan To View List, Click View Another Vehicle Select Year... Or Search by Category Or Change lIP Code ht+'f"'\ ./lnnl'rn r 1rh1-.. ............-.... Ivnn 10.....1,... ..........: .....~_ In ___ ..J~~~ _ h Page 1 of3 "-...- - Kelley Blue Book - Private Party Pricing Report - Dodge, Spirit Page 2 of3 BLUE .BOOK:s PRIVATE PARTY VALUE <UHAT'. i'HI:.;: ~ Condition ,ci.(lrlHY'2: YHI,,~ Value Excellent $1,410 Good $1,235 More Photos Fair $900 NEXT STEPS: Search Local Listings Sell Your Sedan Vehicle Highlights Mileage: 70,383 Engine: 4-CyL 2.5 Liter Transmission: Automatic Drivetrain: FWD Selected Equipment Change Equipment Standard Air Conditioning Power Steering AM/FM Stereo Optional Tilt Wheel Cruise Control 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. Check Vehicle Title History Kelley Blue Book - Private Party Pricing Report - Dodge, Spirit Page 3 of3 Vehicle Condition Ratings Excellent $1,410 "Excellent" condition means that the vehicle look5 new, is in excellent mechanical condition and needs no reconditiol1lng, Tllis vehicle has never had any pamt or bOdy work and is free of rust Tile vehicle has a dean title history and will pass a smog and safety II1spection, 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 II1tO this category, Good eeDe $1,235 "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. ~Iost consumer owned vehicles fall into this category. Fair r~7Llr.i $900 "Fair" condition means that the vehicle I18S 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. Thel"e may be some repairable rust damage, Poor '...' ht N/A "Poor" condition means that the vehicle has severe mechanical and/or cosmetic defects and is in poor running condition, The vehicle may ilave problems tllat cannot be readily fixed such as a damaged frame or a rusted-through body, A vehicle with a branderJ title (saivage, flood, etc.) 01' unsubstantiated mileage is considel'ed "poor." A vehicle in poor condition may r~.9uir_e 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. * Pennsylvania 11/2/2006 Accurate Condition Appraisal Change Condition Accurately appraising the condition of a vehicle Is an important aspect In determining its Blue Book value, Taking our 16 question condition quiz will ensure you know the correct condition rating, NEXT STEPS: Search Local Listings Sell Your Sedan ~: .7.006 Kf.~Ifr2Y Blue Book Co., (l1c. AI! rights reB~"./ed, Sep-Dec 2006 Edition. The. specific information reqoired to determine the vaiuc tor this particuiar vehiCle 'rillS supplied by the person gener.3tinq thiS report. Vehicle valuations are opinions and may' vary trom vehide to yehiCle, Actual valuation::; wi!! varl based upon ma,1<et cenditions; specificatiDns, ve/H'cf1!J condition or other p.~rtir::ula,. cirCUI1Jstances pc:.ytinc,-'nt to this partico/ar lienid€ or the tr..:;ns.'1c.tiofi or the parties to the transaction, This report is intelwed tor the individuaf use of" tlie person generating thiS repol't 0rIly ana sflalf ru..'t be sold or transmitted to anDther partv, KeiJev Blue Book assumes IltJ n~5ponsfbj!ity {Pf' errors or OfTl/5SioflS. (V,06110) Primary Owner: 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 Date Joint Ownership Established CHECKING 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 Date Joint Ownership Established CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established VISA CREDIT CARD ACCOUNT: Account Number Date Account Established Balance at Date of Death Name of Joint Cardholder Estate of: BETTY J. FETTERHOFF Date of Death: 10/16/2006 Social Security Number: 207-26-0248 fvl~ MEMBERS 1st FEDERAL CREDIT UNION Betty J Fetterhoff 9398 -00 04/24/1967 $644.95 $.25 $645.20 None 9398 -11 12/14/1978 $592.67 $.00 $592.67 None 9398 -47 04/24/1967 $510.53 $1.03 $511.56 Rodger A Kohr 04/24/1967 4121449999093987 08/12/1992 $1,359.89 None ./1./(' Ii 1/10./01 ~/I ~ { 1s Marsha A Leonard 21192 -00 11/13/1978 $25.00 $.00 $25.00 Betty J Fetterhoff 11/13/1978 21192 -11 03/07/1989 $446.82 $.00 $446.82 Betty J Fetterhoff 03/07/1989 MrfERS 1 ST~DERAL CREDIT UNION 11k&~ /( /{)rt;L Denise A. ~~ ' T- Insurance Services Supervisor January 11, 2007 5000 Louise Drive . P.o. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 . www.members1st.org / Z-PZ;/ oft; <rIIGHMARK. Date: 12/12/2006 This Month Gross payment amount Net payment amount 2,003.00 2,003.00 -.-- - 0121839 ~~ <rIIGHMARK. t: qr.rrZE~.8.sAN~,': 0121839 F-';':!';1 ;,'.',;', Direct Pay Central Premi urn ":Refund , DATE>> /. T 12/12/2006+/' *TWO THOUSAND THREE AND 00/100 DOLLARS* 3-7615 360 2,003.00 PAY TO THE ORDER OF THE ESTATE OF BETTY J FETTERHOFF 436 SPRING HOUSE ROAD CAMP HILL PA 17011 @~ A.l';]~ ~1-i2~~ Ole t"""\ , .., , M .., ,.., ... .. . r'\ , ,.., t"""\ M,., , r-,....... . ,...., t"""\ r- I r'" .., ,...,., . ... st Send Inquires to: 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.members1st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TOO: (717) 697-5312 or (800) 283-2328 ex!. 5312 @ TeleBranch: (717) 795-6049 or (800) 237-7288 MEMBERS 1st FEDERAL CREDIT UNION 5989 1 AV 0.312 5989-5989 1",111",111"""11,.,11..,11,1,,1,1,1,,,1,1.,11,,11.,1,1,,1 ESTATE OF BETTY J FETTERH CIO MARSHA A LEONARD 436 SPRINGHOUSE ROAD CAMP HILL PA 17011 = !!!!!!!!!!! - - - - = - Statement of Accounts May 25, 2007 thru Jun 24, 2007 Account Number: 295567 Account Balances at a Checking: Savings: Certificates: Loans: Money Management: Glance: 443 . 54 4,836.45 0.00 0.00 0.00 Page: 1 of 1 Are you looking for a way to invest your hard earned money? Consider a certificate from Members 1 st. Ask an associate about our monthly specials or visit www.members1st.org for more information. CHECKING ACCOUNTS 11 - CHECKING Date May 25 Jun 24 Transaction Description Balance Forward Ending Balance Additions Subtractions Balance 443 .54 443 ;54 SAVINGS ACCOUNmS 00 - REGULAR SAVINGS Date Transaction Description May 25 Balance Forward May 31 Deposit Dividend.1 .000% (" . . r-; AnnualPercentage 'Yield Earned1.01{}%from 05/01lq007/hrough OS/31/200f Jun 14 DeIJositby Check \ r~ Jun 24 Ending Balance-- ,( ij YTD SUMMARIES \; , , i i' r' r:'.; TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 11 CHECKING ;,' 37.60 0.54 '''_~-';'H\ ?1''''''.: "~l''"'''' ,,~,;" ~::;:. " ;" :,,,,.,,': ~\:..lh ~~.~! ~;:.-n..,;fh,'? :~q, Total Yea r ib JD~te JDi\li.den'oS...l?ai(t.,. ,) NOTE: Total:inoludes1closed'shar,es ~ :.., Additions Subtractions Balance 4,.551..58 4;.5.55 .45 4,'836.45 4;836,45 ..,.-:"'\ ,/~) ,~ .\'" r ~~'\; I 38.14 Don't forget about our new Member Loyalty Rewards Program. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.members1st.org for details. REV 1509 EX . (1-97) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNS\ LVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF rE'TT~tJFF-, ,8€7ry J: FILE NUMBER 2/- O~- YS-I If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A.. tCt:>G~ A. KIJHR aKIt f(,of)6EZ. 11-. K/)HI? J..f J./.oS /JI>y Itl. oAk /e.oA-/J t!.II-NtJ NILt./' /14 17"11 B. mA/f.5N,I A. LsWIH!J) ~3~ SflRI/l/6- H"u$'G ~./) C.lfAf/l HIt.L.,,f7A 17~/I ~ v. St!'JAJ ])JII-tl~1I7b?<.. JOINTLY-OWNED PROPERTY: LEDER DATE EM FOR JOINT MADE ABER TENANT JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. 1. "I;.tI/'''' IIEAlNd/5 1st ~ (!"eE/JJi ttNllJ/V CIiifdlFIIJI-7'j;r d= f)~"str ~ 9.3 'tf- '17 11~//IICltJA/. ~Sl#. S'3'" A-CCte./AJ7: tll. D ~ : A. ,2. "/t3/1' 8. JeE(;U.LIf1( .sAV/It/;;S ,f(!,{!.,T. 4/=. :1.1/92 -co !'lft A/(!I,tJIJ-t. 1.<.). 00 Aef!li. / A) r: -0- _ CNE- ekING A et!-r:.:II: .;1//9 Z - /I fJ/lIMJ/I'.lfl ~ ifll'.t:? A-~. /AJr: - 0 - (set. nZlet.h~A k#4r Il/ladtul ri> sc/r&/. E) ;fsI/fJl lINI>/VIOE1> I1KE-N,+t.F (v3,J INR1eEST IN AU 7J.IAT earA/N ~ S7A7lF S''''~/FrE' ;J.T '13(, SI"ItIN(; HDLtSE' Iei).. M""P HILl) (HIfIHPlJtilV rf,,()~) tJum SGtUIMJi) & i.UJTV. (SeE &py DF lJ~ F1fAIH ta8E7l.r ~ RANO~S, ET it~1 I1rr,fCH1FD HERE7i:J) VA-UIA7i{)j} CA./-t!.ULA'TlIJII.' (! U,WIIjE1f.LANJ> (!.{)UArry 7~X A~SES$AlENr 0iF"~8~ fZP,.12 If~Pt.ltlll9tF MUL'TI/t./c:K /N E'I=FGer A-r 'f).p.D. :::::- /,/~ GbSS mL",=~~~a, I. e. 317/19 , 8. DATE OF DEATH VALUE OF ASSET '10 OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ?-SII. S'~ $2)Z 1 ~ ss, 78 ~ :lS,~() S?;J, ". I ii.Sf) J' iJ"fil,i;l 61>~ ., , ~ 3. III '! to ~ Oi, f/~ "I -SD;! I()~ ~O7. 'If) TOTAL (Also enter on line 6, Recapitulation) $ I 0 ~ , 11" ()? IIf morp. !':O::ll''p' i!': nAArtp.rt inllp.rt ::Irtrtitionill llhp.p.lll of thp. Silme size \ ;)d0&~ ROBERT P. ZIEGLER ReCORDCr. OF DEEDS , ,"~' ". "" ',I ' ~ I T --' , ,..111 Y- PA '02 JUN 5 PM 1 27 tEbt~ iDeeb TAX PARCEL NO. 10-19-1598-170 MADE TIlE ,;]W day of ~ in the year two thousand two (2002) BETWEEN ROBERT BRUCE FLANDERS and RAMONA FLANDERS, his wife, of Camp Hill, Pennsylvania, Grantors, AND BEITY J. FETTERHOFF, single woman, and MARSHA A. LEONARD, her daughter, of Enola, Pennsylvania, as Joint Tenants with the Right of Survivorship, Grantee, -- WITNESSETH, that in consideration of ONE HUNDRED SIXTY-SEVEN THOUSAND FIVE HUNDRED --------------------------------------------($167,500. 00) --------------------------------------------- Dollars, in hand paid, the receipt whereof is hereby acknowledged, the said grantors do hereby grant and convey to the said grantees, their heirs and assigns, ALL THAT CERTAIN lot ofland situate in Hampden Township, Cumberland County, Pennsyl- vania, more particularly bounded and described as follows, to wit: BEGINNING at a point on the eastern side of Springhouse Road, which point is 228.04 feet in a southerly direction from the southeastern corner of Lantern Drive and Springhouse Road, at the dividing line between Lot Nos. 26 and 27, Block "M", of the hereinafter mentioned Plan; thence by said dividing line, North 80 degrees 58 minutes East, 150.57 feet to a point at the dividing line between Lot Nos. 23 and 27, Block "M", of the Plan; thence by said dividing line and the line of Lot No. 22, Block "M", on the Plan, South 10 degrees 25 minutes East, 100.03 feet to a point at the dividing line between Lot Nos. 28, Block "M", Plan 11, Pinebrook, and Lot No. 27, Block "M", of the Plan; thence by said dividing line, South 80 degrees 58 minutes West, 152.98 feet to a point on the eastern side of Springhouse Road; thence by the eastern side of "r,'!..':,. I" '-;) f't"~ 2'l1 '.J ~"u.-... --" ~ BEING all of Lot No. 27, Block "M", Plan 12, Pinebrook, which Plan is recorded in the Cumbeland County Recorder's Office in Plan Book 16, Page 63. HAVING THEREON ERECTED a dwelling house known and numbered as 436 Springhouse Road, Camp Hill, Pennsylvania. BEING THE SAME PREMISES which George R. Fritz, Sr. and Susan L. Fritz, husband and wife, by Deed dated and recorded October 6, 1997 in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book 165, Page 827, granted and conveyed unto Robert Bruce Flanders and Ramona Flanders, husband and wife, Grantors herein. CUllberland COl.ll'\ty Recorder of Oeeds Iftstru~nt Filin~ Receipt*! 366141 Iftstr~ 2002-022965 6/05J2002 13:27:58 Re.arks: CENTRAL PENN FETTERHOFF DEED DEED - WRIT DEED - RTT STATE CUMBERLAND VALLEY HAMPDEN TOWNSHIP DEED - A/H CO IMPROVEMENT FHD REC. IMPRVHT FUND Check" 50285 Check" 50174 Check" 50175 Check" REF 2.00 10tal Received....... 11.50 .50 1675.00 8:3'1.50 8:.~7 .50 11.50 1.00 1.00 $862.50 L50 $1,6'15.00 $8:37.50 $3,375.50 Brr,'; r;'!:1I2 r\f.r. 0"'2 .J .' . h... V .af f, 'J L ;G.U AND the said grantors do hereby Warrant Specially the property hereby conveyed. IN WITNESS WHEREOF, said grantors have hereunto set their hands and seals the day and year first above written. in the Presence of dlr~~~~ ROBERT BRUCE FLANDERS ~I~ RAMONA FLANDERS Signed, Sealed and Delivered COUNTY OF On this, the J /.or day of , 2002, before me, a Notary Public, the undersigned officer, personall appeared ROBERT BRUCE FLANDERS and RAMONA FLANDERS, his wife, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed same for the purposes therein contained. NOTARIAL SEAL Elizabeth Horan Meadows, Notary Public Susquehanna Twp., Dauphin County My Commission Expires Nov. 7,2002 (SEAL) IN WITNESS WHEREOF, I hereunto set my hand and official seal. .... I" .....-jj,':.~~~~)" ..~:tl?_~lI.:.::....:... ," e-~~'rt,~....."..".'<':"~'~V".A.- ,-:;~'.<,~\ ra..... .-o;.~.., ~~'l ~'fr'" ".if' .b". ~ ~,., ;gFt:. -.::IS...fJ!....~.t'.\:l\l.."~~~.' ,::,...~ :J..=te ; l;/ :410 ~~. ~" '::t. cns"" .1.~' .:: 1"-': ;.~';~;:".~_i ~,,~~" :.-: .......:!.". 'f'; _ ~~ lIS 'k""-- ,-..:.,.'.""'" .' . -~t"l <<; ~., Jj .-", .".....:~',. ,if. ,.... J '. ,'-";J!"" ,. ~"~.. r ,I;;f';"" :-.... '".400 ".., 'v"",, ,...,,.:,....It- (""'f ."_ '. . " . . ,~ . <" . \." AI ,l>o ~{-', \i\.~~>.J. ~E\\"-:~..,......J'.'$ '(j,;, .-, ~ 4' ./'J,.... "";:' * If..''', ".' ".. Of'. ."". '." ..... . '!o... .'"', ',\i: '....,. .~" ,p'" r'" If' ~. "~'i,'" '4i~f l~ 0 i." ~\il' " ~1{1I1HljfH~t'~" l:.( -'I' r: t..-f) ',)/I-('i" ll. it:,' 1:;.'(}'Ni /1\'" 203 CERTIFICATE OF RESIDENCE I do hereby certify that the precise residence and complete post office address of the within grantees is: C/:f~ ~'7~/,d.vD- ~ ~~ f'l/ ~I . ~ A 4 ~ /7 a) / . .~~ #.-. :Ut8Fl'l8Y,' Agent fo~ ~ COMMONWEALTH OF PENNSYLVANIA : ss County of RECORDED on this day of A. D. 2002, in the Recorder's office of the said County, in Deed Book Vol. , Page Given under my hand and the seal of the said office, the date above written. Recorder. blinK 252 f'M;[ 204 MAr<E CHECKS PAYABLE TO: Marie Huber 230 S. Sporting Hill Road Mechanicsburg, PA 17050 RETURN SERVICE REQUESTED CUMBERLANDVALLEY SCHOOL DISTRICT 2001108 REAL ESTATE TAX NOTICE TAXPAYER'S COpy · KEEP THIS PORTION FOR YOUR RECORDS MUNICIPAL CODE: Hampden Twp BILL DATE: 07/01/07 PROPERTY: 0436 SPRING HOUSE ROAD BILL NO.: 2890 MAP CODE: 10-19-1598-170 TAXES PAYABLE TO: TAX MilLS: 9.554 Marie Huber ASSESSED VALUE: 182820 THIS TAX IS DUE AND PAYABLE, YOU ARE HEREBY REQUESTED TO MAKE PAYMENT THEREOF. CASH CHECK # AMOUNT $ 2% DISCOUNT FACE PENALTY TO 08/31107 09/01107 TO 10/31/07 11/01/07 TO 12/15/07 $1,711. 73 $1,746.66 $1,921.33 FIRST PAYMENT SECOND PAYMENT FINAL PAYMENT $582.22 $582.22 $582.22 If Paid On or Before If Paid On or Before If Paid On or Before 8/15/07 9/15/07 10/15/07 11586.2890 FULL PAYMENT FETTERHOFF, BETTY J & MARSHA A LEONARD 436 SPRING HOUSE ROAD CAMP HILL, PA 17011 OR INSTALLMENT PLAN NO DISCOUNT SEE REVERSE SIDE FOR TAX NOTICE INSTRUCTIONS MAKE CHECKS PAYABLE TO: Marie Huber 230 S. Sporting Hill Road Mechanicsburg, PA 17050 RETURN SERVICE REQUESTED CUMBERLAND VALLEY SCHOOL DISTRICT 2007108 REAL ESTATE TAX NOTICE RETURN THIS PORTION WITH PAYMENT IN THE ENCLOSED RETURN ENVELOPE Please Indicate: o FULL PAYMENT o 1 ST INSTALLMENT BILL #: 2890 PROPERTY LOCATION 0436 SPRING HOUSE ROAD LOT 27 BLK M Pl 12 PB 16 PG 63 Residential Building OWNER FETTERHOFF, BETTY J & MARSHA A LEONARD 436 SPRING HOUSE ROAD CAMP HILL, PA 17011 CASH CHECK # AMOUNT $ MAil TO: FULL PAYMENT 2% DISCOUNT TO 08/31/07 FACE 09/01/07 TO 10/31/07 PENALTY 11/01/07 TO 12/15/07 Marie Huber 230 S. Sporting Hill Road Mechanicsburg, PA 17050 1111111111111111.1.1.1111.1 $1,711.73 $1,746.66 $1,921.33 OR - If Paid On or Before 8/15/07 $582.22 I 11111 11111111111111 11111 Itllf 1111111111111111111111111111 11586 - 2890 REV-1511 EX+ (12-99) i', _~:,T!t:~ ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FETr€iff!.!Vo;:,c; BETIY .:7. FILE NUMBER 21-L)~ -9$/ ITEM NUMBER A. Debts of decedent must be reported on Schedule I. DESCRIPTION 1. FUNERAL EXPENSES: /11y85 I=tt4lEZ.lli- fI/)/JIE t?P /J1ECV//fA//es~u~ B. ADMINISTRATIVE COSTS: 2. 3. 4. 5. 6. 7. 1', 'I. /0. It. f;} . 1. Personal Representative's Commissions Name of Personal Represenlative(s) hi} ffll.SHIJ. /...E~A/If/(j) f f?6G €I( /({)H~ Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: Attorney Fees CHit /l!..€S E. 5# / GZ.DS 71J: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant P/A-I(SfJ~ A-. LEt)A!/f1e./J Street Address /f;jfs:. -SPitiNG /II/Its:€' /f?I). City (JfiJ1! fJ /1/ a State jJlf Zip /7/')/1 Relationship of Claimant to Decedent ::DA- tlGIiTc-7( Probate Fees ttM.d or'<if\J "ISSue sf sho,..r ae.rf;/;'e4J-u Accountant's Fees J71tle~ r3r;"vkb',I\ 1 LJ '-11 I-l + ,.. I~ Pt./(. c1..sc.~ I o'fD J Tax Return Preparer's Fees P A- I.fo , 12~ I DI./ I PHI{./, etz . , AMOUNT , ", '17' " ()tJ ()J!J.l V E".D ~ 3 / ;~O,.f)O -; 3) S/JO. /)/) ,. m.OO /335: 00 Add/f,'ollA-/ d,,;rt c.e,../i h'at,-b; Jtla'/I/I)J1a1 jJ/YJ/Jak.. lee. F,'//1! Fee -k. ;??;.5~ f).f. tv/lis -kr J;,her. ~ RehtrJ1 F///Itf He. #'r r;/-sf au.Q r'l/Jal .4(!.a.otalA~ Ad rei" I/s /'if 01 Cu.m bU'" / tl41.Ii L,,-uJ .:Ji u rJt a-I AdJlerf/.5iitr )rJ eLr//sle ~t,I1hAe./ AlCtMf;'JafJM"' (c1'~ (Jp/J h A /.( A h#J1 .shed- ) TOTAL (Also enter on line 9, Recapitulation) S I ~ ~ J Lj, 7tJ (If more space is needed, insert additional sheets of the same size) 1', ';l. CO , 1.5,00 5' /5.60 t / 3f), PO ~ 7.s: 00 11 II $..25'" seHt=lJ H. ~1V1iJ1!alfllp/f sNa:T _____________ _L3..-- .clzJ,.t'its___~1--iJ2K-d(}~-~-E,sill~-~ff--I!!Mt--- ___________________52 .~- __ _____________l11------tl&.'m-hulS.tlJ/tJJfj---tk--CAIlr:k~-tf:2Jekl~--_.7L _~~_I!_k iPf!.()/l!~-;r-,---------------- ___________ __r'-rqf/h-fdl-~1!'~f--d41-f----~dur~/-4L-~~cl~/!'IJ----m------ ---------- ---?~~-~---- . ___0--'.' ._. __________...__ ~--.- ".-.-- _._--_.....-_._-_..__..---------_.---------~.-._-_..,.-----_.~._--_._--_..----_._._---_._.._------_._--------_..- .___'._' ______."~_..._~~__...._.__.____.~__.____~.__._______..._______..._~,.___.__._._..____.__.__,______~__.___..__.__.~___.___________.___.____~______..h___.___ , __~_.____.__.________._,--.------_.------~ _.._.--_._----._-~._--~_.__..._--_._------.-._._.__._~-_..--_._,-~-_._--_._.__._-_.~.-.-------------_.~------.---- ---~---,-------_..--_.-- --------,-_.._--_._------~._-.----------------~----_.-_..,----_.------_._._._----------~_. __~__~___~-.----- __._.____.__..__d________.__.__~______._~__~_.____._._------~----.<~.~-..--------_.-_.--.---------------.-----.---~ -_.._.---------_..._-_._~~---_.~-_._---------_._~-------~_._-------- -------- ---------------------~ ._..~---------<------------~~----------~~_.--------- ---.----.---- ----.---- -_._---~_._~.--,--------------_._~~------<--~~_._._-----------.----- ---.--------- --------_.-._-----~~._--_._-< -----~~-~~---------_._----_.--~----------------- ------~------~--_.~---~-~----~_._-----_.~_.__.._.--_..--_._---------------_._~----~--~----------------- _ ~_ ______ _____ __~________n___~~' -- --.-. ----- --- ----- ---- --- - - - <--- ~-- --------.- -- ----- -~--------_.-.__._--- .---,._--_..-._--_._-----_._._---------_.__._-~-----_._--------------~~-------._--_.__._-------_.----_._-------~_.._._._-~._-- .-------..--,-----.-.--- - _.--------.--~----_. -----.-.-.------------..---- .~-:--_._~-~._._------~-_.._----_.~---~-_._-----------._--_.~. -....-- ._.__.__.-------~--~_._--._._---_..~_..~----~--_.~-~_.-.-_.._--_.--_.._-,-,,----~._-_._._---_.._-----_..--------._.~---_._- ..----~-------~-.-.__. -----_._._~.- -------... m__._ ..___.____..._.._____~__ --..~~-.------.~-.--.-.--- -.-- - . - -. . --<.._._-._----_..--~.~-.-.----'"_. -----_.__._-_._--------_.....-.-..~._-~_.__.--.. I \ \ I 8C!./,/Et;>. H. ArmeN//1/ENT If?c.' C!€>-/i:x€(!L,{Tuc5 ,sr t)J= rE77'~~,c~ 4E7'T)' v: ~/-L)6-9S-1 / (j,-EX.EC!U~R5' (J}/JIAt/SS/MlS.' /J1A,eS}//f A. ~If)/ft2..I) q~ S,!l&N& N~~,en. .C!I/-At/!JlI/t~~/!/{ ..IZ~(( YpM ~IIJI/S5IP# PA-' b : 5s~ ..1 If) .s~~ 3S9/f J0;G&(".. }(P>J/A1 . ,'-',. ..- ,'. '-- "--" ...,.... ',-- ;QI,~P/Ji~ /j./(/)tll! un _/i1: () ~ ;Q;~/f?t)~/( JFtjJ. IC,1lJ1fJ )lILL /JA /7tP/ / ......-i-................ ....-". ....u... ... ..~.. ......--....... .. ~.-...-...:.y~. ...~IU1I..f~(!!.!f!.L~L'~ SS#.I9S -:-3.E - ZlJ'I . . Four G~m;:ra(iolls... ~MYERS ~~Un6Ta-! cYe(jffld, @no. ERAL GOODS AND SERVICES SELECTED . ST A TEMENT OF FUN . d If e are required by law or by a cemetery or crematory to use any items, we wIll Charges are only for those items that you selected or that are require. w , explain in writing below. . . f lith viewin y u may have to pay for embalming. You do not have to pay for embalmmg If you selected a funeral that may reqUire embalmmg, su. ch as a . unera w. g, diate ~~ If we charged for embalming, we will expl it! wh below.. you did not approve if yo' s lec~an ement\ ~ as a dlr t cre~at1o 0 1 1m I~ Date OfJeath ) 0 I\:; 2..acJb For the serv~' _Of .' .' or - I " ( ~ ~...L · . '-I lie S- (L';d\:/..i\ L (J1t f.. /0 " A--y ,,:tC, Charge to: - ~-^-- A Add 7City State Name ress BOYD L. MYERS, JR., Supervisor 37 E. MAIN STREET MECHANICS BURG, PA 17055 (717) 766-3421 A. CHARGE FOR SERVICES SELECTED: 1. PROFESSIONAL SERVICES Services of Funeral DireclOr/Staff Embalming Other preparation of body Other clothing iti:v".C S'Z-vL $- $- . . '~h~~' '~-J4rc--L Cremation urn , (Description) OTHER ~l,~ \~,f')~. i rz$. :9~ ~ L-l _..c.;;~ \l.u. I S~$ ~ . $_ 'Ai)"('-~ ..B~ .hL ~- L SUB-TOT.U OF PROFESSIONAL SERVICES ,. Al $~ 2. FACILITIES AND SERVICES LIse of facilities and services for viewing (Visitation/Wake). LIse of facilities and services for funeral ceremony lIse of facilities and services for Memorial Service Use of equipment and services for graves ide service, Other use of facilities .~.L s~(..l ~ $_ ~L $_ TOT AL MERCHANDISE SELECTED. , C. SPECIAL CHARGES: Forwarding of remains lO $- (Funeral Home) Receiving of remains from $- i~L SUB-TOTAL OF FACILITIES/EQUIPMENT.. ........ 3 AlITOMOTIVE EQUIPMENT Vehicle lO transfer remains to Funeral HQ.~ L Local., ,..... ,.....,........ i ,J-:N Hearse (Caskel Coach) Local. Limousine local, Family car local. i_ ~~oC:ler, car or floral diSPOSition. . \' . i~ le ad car/ c leJ!l..y {~ar .J';J; J....... local... .\J1Uu ~f.+y1u<;'fi-,.. i~ Car for pallbearers Local. . . . , . , . . . , . . . . Out of lOwn transportation. A2;U (Funeral Home) Immediate Burial. . S '. $-J ES::aCrematlOnfSLL'Se.LU:$' i--.11JS ~ \..j'1q~ SUB-TOTAL OF SPECIAL CHARGES ,......... C $_ D. CASH ADVANCED Opening Grave .... J. IlAJ.if. . . Cemetery Equipmem . lot and Deed. , , , . . , . . . . Newspaper Notices-local Newspaper Notices-Out-of.town. . . Telephone & Telegrams Airfare . . . , , . . . . . . . Clergy/Mass Offering. Pallbearers . , . . . . . . , . . . . . . . . , Certified Copies of the Qearh Certificate, . is. 9.. . 6-c~ . Police Escort Flowers Vault Service Charge. i .) ,("0, -ti- i_ $ F~'-~ S 2C6-';;~ i-=- $ - . , . , -i!:i'(,C i~ s~~ i_ $ qa ,_ ;.1)>- i_ S Z <?lC::,~~ $- $_ i_ i_ i_ i_ i_ D i ,() 7..\;.. I $_ 1?~ i_ S SUB-TOTAL OF AUTOMOTIVE EQUIPMENT. TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT --y-' . L A3~ SUB-TOTAL OF ADVANCES.,. A s~ We charge you for our services in obtaining: (specify casb adl'allces tbat are marked-up) \N c' f\ If?. 'J v Acknowledgemem cards Register book(s) . . . . . . . . , . . , . Memory folders . . , . . . . . . . Pra yer cards . Temporary grave marker. Burial clolhing . . .. ........ ~ $_ S i SUMMARY OF CHARGES A, Professional Services. Facilities and Equipmem, and Autommive E . .~~~ qUlpmem , . . . B. Merchandise, , . . . . , . , $ ~~ C. Special Charges . . . . . . . . i.~.~..s:.Cu~ D. Cash Advances. . . . . . . . . . . S I ~ ....~._~ TOTAL OF ALL SECTIONS, " . . . . . . . . . V . . , .\...;. PAID AT TIME OF OR PRIOR TO A/J~ t~'tA- ARRANGEMENTS. . . . . . , . . . , . BALANCE DUE. . . . . . " . . . N FOR EMBALMIJ'G r. ^ ~ .... ~ X'-le...S \ If any law, cemet ..' or crematory requiremems have required the purchase of any of lhe items listed above the law or requirement is explained below. ~ 2 7"- 2. ;;7""- f'--t '1 Iii. ...$_ B. CHARGE FOR MERCHANDISE SELECTED: _ Caskel, , . . . . , . . , . ' . . . .. ",' i? ~( (Description) S> L..~4tt Other Receptacle . , . . . . . . r .. ' '"",' i ~ (Descriplion) (1 ~~l";Y'J C_crv-~\~ Outer burial container . . . . . . . . . . i_ (Descriplion) R ~'-c ~ '-~ ~:~ I agree [hal I have examined lhe items of goods and services sdected above and found them to be correCl and according to the arrangements I have requested. I acknowledge receipl of a copy of [his Statement of Funeral Goods and Service;..Sdc;cted. I repr~s. lh;it I have sufficient funds available for paymem of the cash price for the goods and services sele([ed. I also agree to ij!jlke payment of i IV.; &t-!, within .:" dars. I agree to be joimly and severally liable Wilh anl'one else who signs below. A late charge of ) "Zo per month amouming 10 I 1; per year will be applied to the unpaid balance beginning '~( days from lhe da of this agreement. [ will also pay to the Funeral Director all reasonable cas IS paid by [he funeral Director to collect amounts I owe under this agreement. Those COSt lay include orneys' fees, coun com and Other cosrs. Any additional services or merchandise ordered or requested aft.er the dar of [his agreement will be conside art t 5 agreement and the cost thereof will be reflected on the final bill or Stalement. /.. ~ (Seal) " / I '1 ]A:J'd WHITE - funeral DircclOr (Seal) t3~SJ.5 oJ=" CJ}'-Cu..LA- TioN t!)~ "TTb/cAlEY.5 FEb-S. I i - -1' - ------------___ _. __ __n__ _"_H~__Z1e -..-€~~tik!!m.k~-_;tlIYd_WltlJSl:U_ _ _~__ _'-4 /11~~II!..~ l j ._. ?;'me h!1t.[:q&/I~1!I'.. ... !d___~_t(.[t{~ll'P4_hfl~_l!)f~~i4R _ f2.t'P"tLte;f.2d;/~/'.I2'-,[i1J , LlZ_.___ . A-fl~!:a_c( //1[C&[bj4 40'7.[ --fautlQff~A~d/j-!t!l::r" .:en/! Ct:JU1Ite.!'.~~/tr fl_/t'k_i/!Jtlr: p-.t'cy.-k"~"._. Uq.t 1(~'l._/J!_I4!_ ~b/.lf,'n~~..Ii..44V:e. ..4/,.$~t:/. Ilf/SR-,- 6/JJ(#/L...f ibr/l!!ttt'~I1f--d'(,~hiz;-~~'/( _qe..~~~/l?':r'_ :/J1,.I$~lr .J"4cJ(..~~ (!.,tY!l'1/s_ .__~_rS/t!1;/~_~ .' /1(~~~, -- --j/kl/;/;_/;!1tt! ~i?t~L _L~__~~~~~/ .._~..._//;~pk~~fj/_ ...lY4 ~ - . -------~-b~~L~PL~4~~j!~d-~~/-(!!:~q"/&C.L-~/I'l.- --- . --------J-de,t&l'lJ1L~/'/lfk~e&r--dRt;e~!tZf.~urhfl,.-~~""tL4e.--.- ._____..___ -.-..olo_4!ft,_fp--~-g,/'~R&~~_o/?~L~7j_._~!::_~i!!~L~/!~ed ~___.o._.. '0_0'_'_ --.r~U"lT_lLntl!~J~ -. /.4.b~LIi2t~~t!.~,_ ..&t;$; __... ~~p.. _~"'_ -0___-___. __.__,$: .... -.l----. --:;['1_ofl~_J~ljl_/L__~"'-_l!~ ~~t~e-.'_____L. AO v~___t:l~_~ ______________..___ ..- - .--- ---- .-.-J~'b~12Ll-jiXi~~pi.7--bAYL~L,L!t-~/_-d~~---q-~~-----n..---- _==~=~:~:-~~,,;'~~~~ -:;Z:~~~_h~e=~~=-.__...-__.. -..-.-..--..-.--..-.-.- -L..-.~eIL~q'Ltkp~~_~-p2~_~~M__~..... ..~~/--~J...?~_-!!{~!_?"4~....~J!rt:. .?~.... -...............-- ..-+-~~u_E .......__._.n....~_ -~LtfhJ~rI~L~t,J'~/l- ~j.a-~ :u.z.!tr2fi)~l-.~=~'~.1f. ~ . ...o_un__J u.______ .. m__m.n74IlALu~~f/.~_..~ ~ ....~:L~~q/J.s.. t4__~~'c 1JtI1fI1E.~~I1~~rt...t!'l....!~ht;eDka//~ . - ..-ru./' ~ ._eiteltllls_iM.C.e.5/Llt_t:ltf._,-~~!.~r!l-rML!iq~/;o/l. _n_ou. .'._m .l~-.;5Y'Pd---~..e2e~~L .uZh.aJ5: -&qd:"'1ttadct'/b..::'!I~1 I &l.QI'n,.~ L'eq'~d;'~ .zt:J;Jl1t?- "" ... I I .......+ ... i I REV-1512 EX" (12-03) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS /3 E 7 ry J. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF F -r IE T I EIe HOFF... FILE NUMBER .;ll- Oft, - 95 I ITEM NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH 5. .,. ~. 3. 1. DESCRIPTION fr}FI>>B8'lS J$t F-l::lJt:1!.AL CR.J;1J/T 4JJ/'D/IJ V/.slf- r!.-ReDJi CIHeD /J..et7: #' 0//21 ~i.j.f'l 9909 J?8'7 ~Ac./MjeE 1:>u..€ A-T D.{).j) (see J/t(/tlllhb/1 Ie Iter aJfa-c.hed ~ sdted F -f!Dr ver; he.- Q -hCIr "I 4e611 Jt j/Ff( IZb# EliI FINIrN(!lA-t.- SETLv/(]ES FllE.H:t SC,/ If 000 ~ ~Z7 I!t:-: ~SC!bYS At!e7: Alt>. /- 1'/1'1-- Lf3/2. 7 sYS 7/Jfitl /)E73T IU IfIYAG~/J1aJ'T, /NC.. A-eer. Alt>. u;(){)8 89PI 4'17$ Ljtl'1.5 ;eE: oJ.. e. FJ€/YAJE}' C.teGtH1 SG12V/(! au FINA-AffJ/AL .5iF~YlCES ALE: -# 811-1 OfJO ('){) 331) S Ili:/ &N-~AI /l-ee-r: AlP, dI//C.- tJ/f11J -;7q;( -1)098'--1 /,(JESr Sf/pI<F Ems I ~.( Jt/#a:.=L(JJ.lHI~;ff1/f) 1/VI.4I.!'I'7"/lT 7. HOlY sfJlR.lr HIJ~fJ/r~L... 8'. 6A-LIrA/(!;F 'Due ON M./)~Tr;Ar;G AN)) If}o7'G of .fuN€".s; :2002 7P "811 A-At~P.l LA Jj:;(( ~~> /G/lIEtJ 70 SUA) musT: (SEE ~~/l-AlA-?7/)AI h': t!.1.A/.IH;::o.,te F/At-L :beDuc...1i$/U ~F 7j;nti /!-MIP"AlT ~/= uA-AJ $~t!E A:: fJb7l '])/seu.ss/o VJ / T# f7A ilL ])18Slr of /7Jlkeet/ ;15" 200 7) , ~ I J '359, J19 ~ I 31. S:l- , 17S". 00 7' '-I-oS. GJS ? /2. " t>O ~8/.o'f ~Pl 0.00 f 83, eeQ1.o7 TOTAL (Alsc enter on line 10. Recapitulation) $ 'i f)" 7'1 s. 60 (Ii more space is needed. insert additional sheets oi the same size) 01../1 ~~~~'~:~i~~i~~~eries, Inco July 17, 2007 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE CARLISLE, PA 17013-3387 Our File #: Dear Sir/Madam: Enclosed please find a release to be filed in the estate as referenced. If there are any questions concerning the enclosed document, please feel free to contact our office. Thank you for your cooperation in this matter. Sincerely, ~~Lh( Financial Department 410-444-8022 Ext. 294 Encl. Sys:re1cvr NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION This communication is from a debt collector and is an attempt to collect a debt. Any information obtained will be used for that purpose. P.O. Box 3542, Baltimore, Maryland 21214 I~ -?i!L.~' INRE: ESTATE OF: BETTY J. FETTERHOFF ESTATE NO. 21060951 DECEASED. SATISFACTION AND RELEASE OF CLAIM The undersigned, Kathy M Peyton, Agent for ERI FINANCIAL SERVICES, has accepted a settlement in the amount of $126.00, satisfying the claim filed in this proceeding on behalf of the Creditor. This satisfaction and Release of Claim is executed to acknowledge discharge of the claim and to release the estate and personal representative from all further liability in respect to the date of death liability on account number 2116041017620098. Executed this July 17, 2007. ERI FINANCIAL SERVICES Claimant BY,J~~~ Kathy M Peyton, Agent Estate Recoveries, Inc. P.O. Box 24566 Baltimore, MD 21214 TYPE OF BILL DATE OF BILL DATE OF PREVo BILL HOLY SPIRIT HOSPITAL 503 N 21ST ST CAMP HILL, PA 7i7 763-2138 17011 BIRTH-DATE 03/02/32 ~c HOSP NO. F:PAUDD 390004 2863191 ADMISSION DATE DISCHARGE DATE P L PATIENT NAME FETTERHOFF ,BETTY PATIENT NUMBER 10/13/06 C.O.B. INSURANCE COMPANY NAME GROUP NUMBER POLICY NUMBER GUARANTOR BETTY FETTERHOFF NAME 770 POPLAR CHURCH ROAS AND CAMP HILL. PA 17011 ADDRESS HARTY JAMES I PLEASE RETURN THIS PORTION WITH YOUR PAYMENT. 7~ ~ I A~g.~tt:TN~F I $ DATE POSTED DESCRIPTION OF HOSPITAL SERVICES SERVICE CODE TOTAL CHARGES EST COVERAGE INS. CO. NO.1 EST. COVERAGE INS. CO. NO.2 EST COVERAGE INS. CO. NO.3 EST. COVERAGE INS. CO. NO.4 PATIENT AMOUNT DETA L OF CURRENT CHARGES, PA MENTS AN ADJUSTM NTS 10/13 CLOST DIFF TOXI012545108 20.00 20.00 SUMM RY OF CURRENT CHARGES LABORATORY 300 20.00 20.00 SUB-10TAL OF CURRo CHARGES 20.00 20.00 FEDERAL IDENT. NO. 23-1512747 TOT A L S 28631919 REFER ALL QUESTIONS TO THE BUSINESS OFFICE (717) 763-2138. 20.00 PLEASE SEND PAYMENT TO: HOLY SPIRIT HOSPITAL 503 NORTH 21 ST STREET CAMP Hill, PA. 17011-2288 20. PATIENT NUMBER HOLY SPIRIT HOSPITAL CAMP HILL, FA PAY THIS AMOUNT 20.00 ADDITIONAL PATIENT BILLING MAY BE NECESSARY FOR ANY CHARGES NOT POSTED WHEN THIS BILL WAS PREPARED OR IF INSURANCE CARRIERS DO NOT PAY ANY PART OF THE AMOUNTS SHOWN UNDER ESTIMATED INSURANCE COVERAGE WESTSHOREEMS-BLS 205 GRANDVIEW AVE SUITE 211 CAMP HILL, PA 17011 Phone #: (800) 367-0512 Federal Tax 10: 23-2463002 PATIENT NAME: BETTY FETTERHOFF PATIENT NUMBER: CALL NUMBER: DATE OF CALL: TIME OF CALL: CALLER: FROM: TO: INSURANCE: MEDICARE B 175057074D HIGHMARK -FREEDOM BI FER105095129001 147699W BETTY FETTERHOFF 436 SPRINGHOUSE RD CAMP HILL, PA 17011 REASON(S) FOR TRANSPORT INVOICE .!.!~,. 1:.~ >, ~ .I WEST SHORE ,':\',:~i'.~ \'1L-:.IIJ' J\; ~';lJ~_\'!' 20292 WCS 147699W B 10/11/2006 12:08 PM COMMUNITY GENERAL OSTI COMM GEN OSTEOPATHIC HOSPITA WEST SHORE HEALTH AND REHAB RENAL FAILURE -ACUTE DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT Wheelchair One Way - Member A0130 1.0 42.19 42.19 Transport Van Mileage A0999 12.0 3.24 38.88 Total Charaes 81.07 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT Total Credits 0.00 PLEASE PAY THIS AMOUNT - INVOICE DUE UPON RECEIPT --. $81 "07 RETURNED CHECK FEE - 32.00 $ DETACH ALONG PERFORMATlON AND RETURN STUB WITH PAYMENT AMOUNT DUE 81.07 :JATIENT NAME: FETTERHOFF, BETTY J CALL NUMBER 147699W AMOUNT $ :JATIENT NUMBER: 20292 BILLING DATE: 11/24/2006 ENCLOSED This account is now PAST DUE!! Payment must be received WITHIN 10 DAYS. Collection process will begin. WEST SHORE EMS - BLS 205 GRANDVIEW AVE VISA :.' VISA AND MASTER CARD ACCEPTED CAMP HILL, PA 17011 From: "Marsha leonard" <Maleonar@hacc.edu> Subject: Loan Activity Date: October 4,200712:41 :17 PM EDT To: beamercs@epix.net Drint document Loan Activity 0132467523 436 SPRINGHOUSE RD CAMP Hill, PA 17011-0000 BETTY J FETTERHOFF Balances: Principal balance: $0.00 Escrow balance: $0.00 Unpaid late charges: $0.00 Disclosure: The transactions displayed within the payment history reflect funds that you have paid and do not necessarily represent funds that are due. - ------ 08/03/2007 Escrow Refund $0.00 $0.00 $1,931.11- $1,931.11- $0.00 $0.00 07126/2007 Loanpaid';in-Full $0,00 07/26/2007 Payment Applied $0.00 $0.00 $0.00 $27.00 $1,931.11 $82,620.91 0711 0/2007 Payment Applied $'732;98 $1;931.1'1 $82,620;91 06/07/2007 Principal Reduction $7.02 $0.00 $0.00 $7.02 $1,704.71 $82,739.65 06/0712007 P<lyment Applied $118.15 '$366A3 $226;40 $'732,96 $1,7.04.71 $82,'746.67 05/1712007 Insurance Paid $0.00 $0.00 $561.00- $561.00- $1,478.31 $82,664.82 05/1412007 PrinCipal Reduction $'7.02 $0,00 $0,00 $7:02 $2,039.31 $82,864.82 05/1412007 Payment Applied $117.57 $389.01 $226.40 $732.98 $2,039.31 $82,871.84 04/0912007 Principal Reduction $7;02 $0;00 $0;00 $7.02 $1;812.91 $82,989A1 04/09/2007 Payment Applied $116.99 $389.59 $226.40 $732.98 $1,812.91 $82,996.43 04/0512007 City Tax Paid $0.00 $0.00 $4'73:69'- $47'3;69- $1,586.51 $63,113A2 03/14/2007 Principal Reduction $7.02 $0.00 $0.00 $7.02 $2,060.40 $83.113.42 03/14/2007 Payment Applied $116A1 $390;17 $226;40 $732.98 $2,060.40 $83,120.44 02/1212007 Payment Applied $115.86 $390.72 $226.40 $732.98 $1,834.00 $83,236.85 01/1212007 Payment Applied $115.32 $391.26 $226.40 $732;98 $1 ,607.60 $83,352.71 12/1312006 Payment Applied $114.79 $391.79 $226.40 $732.98 $1,381.20 $83,468.03 11/0912006 Payment Applied $114.25 $392;33 $249;15 $'755.'73 $1,154;80 $83,582.82 10/1312006 Payment Applied $0.00 $0.00 $272.94 $272.94 $905.65 $83,697.07 10/13/2006 Payment Applied $113.72 $392.86 $222:55 $'729:13 $632.'71 $63,697.07 ~ 09/13/2006 Payment Applied $113.19 $393.39 $222.55 $729.13 $410.16 $83,810.79 08/2412006 School Tax Paid $0.00 $0;00 $1,711.73- $1,711;73- $187.61 $83,923.98 08/09/2006 Payment Applied $112.66 $393.92 $222.55 $729.13 $1,899.34 $83,923.98 07/14/2006 Payment Applied $112.13 $394;45 $222.55 $729.13 $1,676.79 $84,036.64 06/12/2006 Payment Applied $111.61 $394.97 $222.55 $729.13 $1.454.24 $84.148.77 05/16/2006 Insurance Paid $0;00 $0;00 $547:00- $547.00- $1,231.69 $84,260.38 05/11/2006 Payment Applied $111.09 $395.49 $222.55 $729.13 $1,778.69 $84,260.38 04/14/2006 City Tax Paid $0.00 $0.00 $458A2 - $458.12- $1,556.14 $84,371.47 04/11/2006 Payment Applied $110.57 $396.01 $222.55 $729.13 $2,014.26 $84,371.47 03/13/2006 Payment Applied $110.05 $396.53 $222.55 $729.13 $1,791.71 $84,482.04 02/14/2006 Payment Applied $109.54 $397.04 $222.55 $729.13 $1,569.16 $84,592.09 01/17/2006 Payment Applied $109.03 $397;55 $222.55 $729.13 $1,346.61 $84,701.63 12/1412005 Payment Applied $108.52 $398.06 $222.55 $729.13 $1.124.06 $84.810.66 11/1612005 Principal Reduction $10.00 $0.00 $0.00 $10.00 $901.51 $84,919.18 11/16/2005 Payment Applied $107.97 $398.61 $233.82 $740.40 $901.51 $84.929.18 10/18/2005 Payment Applied $0;00 $0.00 $135.27 $135.27 $667.69 $85,037.15 10/13/2005 Payment Applied $107.46 $399.12 $243.13 $749.71 $532.42 $85,037.15 09/16/2005 PaymenU\pplied $106;96 $399.62 $243.13 $749.7'1 $289,29 $85,144.61 06/19/2005 School Tax Paid $0.00 $0.00 $1,711.73- $1,711.73- $46.16 $85,251.57 08/1612005 Principal Reduction $15.;29 $0;00 $0;00 $15.29 :$1,757;89 $85,251.57 06/16/2005 Payment Applied $106.39 $400.19 $243.13 $749.71 $1,757.89 $85,266.86 07111/2005 PaymentApplied $105.90 $400;68 $243013 $749;71 $1,514.76 $85,373;25 06/09/2005 Payment Applied $105.40 $401.18 $243.13 $749.71 $1.271.63 $85,479.15 05/16/2005 Insurance Paid $0.00 $0.00 $535.00- $535.00- $1 ;028,50 $85,584.55 05/12/2005 Payment Applied $104.91 $401.67 $243.13 $749.71 $1.563.50 $85,584.55 04/15/2005 City Tax Paid $0.00 $0.00 $423 ;91- $423;91- $1,320.37 $85,689.46 04/11/2005 Payment Applied $104.42 $402.16 $243.13 $749.71 $1,744.28 $85,689.46 03/11/2005 Principal Reduction $5;29 $0.00 $0;00 $5.29 $1,501.15 $85,793.88 From: "Marsha leonard" <Maleonar@hacc.edu> Subject Escrow Information Date: October 4,200712:43:31 PM EDT To: beamercs@epix.net 1 Attachment, 1.1 KB (;,;sii(l~O'w;:~ 0132467523 436 SPRING HOUSE RD CAMP Hill, PA 17011-0000 BETTY J FETTERHOFF Escrow Information last escrow analysis date Current escrow account balance Old monthly escrow payment New monthly escrow payment Taxes Your CITY TAX is paid Your taxes are next due on We estimate your CITY TAX to be Your SCHOOL DIST TAX is paid Your taxes are next due on We estimate your SCHOOL DIST TAX to be Homeowner'sjHazard Insurance(s) Your Hazard Insurance Company is Your policy number is Your policy expiration date is Your annual premium is 09/18/2006 $0.00 $249.15 $226.40 annually 04/2008 $473.89 annually 08/2007 $1,711.73 ERIE INS EXCH Q533110308H 05/31/2008 $561.00 Settlement Statement Optional Form for Transactions without Sellers U.s. Department of Housing and Urban Development OMB Approval No. 2502-0491 Name & Address of Borrower: MARSHA A. LEONARD 436 SPRING HOUSE ROAD CAMP HILL PA 17011 Name & Address of lender MEMBERS 1ST FEDERAL CREDIT UNION 5000 LOUISE DRIVE MECHANICSBURG -----..-.-.-.---. ----------_."._~------- PA 17055 Property Location: (if different from above) TAX PARCEL#10-19-1598-170 436 SPRING HOUSE ROAD CAMP HILL Place of Settlement: Settlement Agent: MEMBERS 1 ST SETTLEMENT SERVICES ~-_._----.~----.__._-----_..---_....__. ------..--...,..-,.--..-..-----. Loan Number: . - ..---------- PA _~170.1L____ -~QQQ.LOLJ1~!::_QRIY!::..MEgJ:!ANlc;~BLJRG,F'A 17Q5!i_ Settlement Date: . 7/20/2007 Dlsburse 07/25/07 M. Disbursement to Others -----SUNTRUSTMTG.-CO.-- 'n_ ---1 nU--82~966.23 :::: ~~~:::~::::~:~ - --- --I u5}9209 CAPITAL ONE --- --.-- - t --~-- 1503. 1,461.38 1887798 L._~ettlell1~':1t<:harges _________________.. ~____ 800. Items F'ay~b_le In ~onn~ctio':1~i!'1..~~~.'1._ .__________ ____ 801'---Lo_~n.o~i~irl<:1!ionfe.e_ _______ %-~~-----___m_ 802. Loan discount % to __. - ____'u..___,_,__. _______...__.__...________. 803. Appraisal fel:! to______ 804. Credit report to --.....----...-- -- --------_.,_.._._-_.,-,--~--- 805. Inspection fee to________.___________________ 806. Mortgage insur~n~l:laepnc!lti_on fee.lc>___.__________ '________ ~07. MortJlCl~~~_'"~l:!~.fe~t()_________._____ ~<2.~.j\F'PLICATJQtiE!;J~ .. n'__ ~__i~~50.00 P.O.C) 809. UNDERWRITING FEE MEMBERS 1 ST --~._._~-~_._-- -~--~----_._~._---_.,_...~---_.._,--,-- 810. DOCUMENT PREP FEE MEMBERS 1ST -------,.,.,-.--------~------_.-, -______~__.____.M~.___.__.__._~.__.~_. 811. " ---"- -..._----" --- - ------_.,..._--_..._._------_._--_."-----,-~--------. 90~._lt.e-""'~ Reqll!~~c!~~Len_~.e'"_t()_b~~c!~I'I~_dvance ______ 901:_--'nt~~~stfr()~9]l?_5LQ?mtc:>07Z31/0L_~_$19J 389 per day _____ 902. Mortgage insurance premium for months to WASHINGTON MUTUAL 1504. 3,252.41 -~-- -~---~-_.,--_.._.__._~-_._- JUNIPER 150.60 1505. --_.- -_._~-~-_.._- --______..,.___.____n_ ~__ __ __ ________._._.____._ 275.00 2007/2008 SCHOOL TAXES 1506. MARIE HUBER ---...-----.-.------------...-- ----.--..---.------...- MEMBERS 1ST VISA 2,422.31 -----rn.97 1507. ACCT#412144-999-1347332 773.17 1,711.73 ------.-------....---....--..--...-.------__..______....____wo.____ _____ 1508. 903.-Hazai:Cfinsurancepremlumlm'---year(s) to ---~-----..._--_.-~--_. -- __....______.~__~~ n_______.____ .____. __._. __.___ 1509. -------.-----___.___________.m___.___...._.~__...__.~.___..._...._~._________.__.. ____.._________ 904. ..---.-_____m_~___________ 1510. 1000._R~serves_Depo~~t~c!_'I\I~~ L~'!.dE!,"--__ _ . __ __ ____ _______ .---_~___m_____..___. ._______ 1 001.J:laza!.d__insLJranc_e _____~ _1l1()I'1~hs.<glL___4_tJ.. 75 p~':..r~.lo!l_t.':1 _233. 7~ 1511. 1 OO~'u~c:>.~~l!e ~nsLJ!~_~c.EJ__..___ITl()l'1t~s_~~_____~per month _______ ______~___.__. . __._____ 1 003.c:;itrErc:>e~rty..!a~e~_.______ __lTlonth~~L______Y~-,"-lTlonth . 10Q~<:;()LJnty_ P!OPl:!r1Y !<:1x~s. _l3___.mo.n'-~Jt~__...1.~~49 per month 1 O~~,- ~nl'1l.JaICls~~s.sm..!'ln.!s... _ ______1l10~~~_~_1.__ .__~_ll1onth 1006. Sc;!:IQQI"IIYS_____~__~()nttJ~.~__L~:Q1_pl:lr mon!h __...l.g,~2 _~513.____~_____.__.___m__________ __n_ 1007. un u__._ ___.. ____nun un _r:I'1()':1t~s ~J______~r:I'1onth 1 OQ~._AGQBEGAI!=~DJU~L~I;NT_____________ .. 11 00. Iit!e~~arges _~____ ---_______u.__.._~__. __~_ 1515. 11Q!.~~t~em~_~t c:>.r~osil'1~_fl:!~!<).__.. ~_ _ ____ ____ 1102. Abstract or title search to .._---_.-----."--_.__...-_.._---..__._.._--~_..._.__._--._------~_."'~._----------- 1103. Tille examination to .- -----.--..--.--.-----.--- --.-..----- ...----.-.. ...--.~---_._-------_._-~--- 1104. Tille Insurance binder to --.---------.. ----~-_...__.__._.._-----_.._..._--_..._....._---- - ----...---...-.-- 236.94 1512. -298.21 1514. -~- 1520. TOTAL DISBURSED (enter on line 1603) 97,879.32 !!05. DO~u_rT1l:lntpreparCl.tio~t()Jv1LlBRI;'=Ji_\tVALTERS, III ESQ. 1.!96..!'!ot<:1-'Y!e~ to. ANNETTE C._ MYERS__.__~_ 1107. Attorney's fees to (includes above item numbers ) - -----._._--------._~- - ------_._-_.._------~-~.--._-_..._-------------~--~.- 1108. Tille insurance to Murrel R. Walters, III Esq.l Penn Attny's 853.00 ___~~CI~~~s_~~o'Je~:rn_ num.b~~_1.9J2,300.~JLt__.___.l _____ ~u109.n~e~~r'~_cove~a~e___.___..._____~__ 104,000.00 111 g. <:>vvn_e~~~_ovl:ll"age .------________L________~_. 1111. 1112. 1113. ----.-.-.----.-.-....- -----... ~_.- --~----- - - --~--- 1200. GO\'Elr.l'1.mel1t..Recor~!':1~al1_~.I!:Clnsfer Char.!lEl~______ _._______ 1~01:~ecor~ingfees:_MQBI9t.~E_~_DEE:J2_..____~ 103.00 N. !?02. City/courJ.lL~)(~stClm~s: ___.___________ 1203._~tCltl:!_!ax/st,<lmE.s:___..__________________________ 1204. -__.....______ _.____m_. . _____.______...______~.___._._______..____...~_____.____.__.____~__ ___~.. 1205. -. . ---- ---.----..--.---..... ..--------. .._.._--_.------_._--~-------_.- 13~~:~d~i~()':1al~~t!I~01Ell'lt~~I:I,"_ge~___. .. 1301. S_ul\lE!}'!().___ __.______u______.________. 1302. Pest inspection to ____... ________.._____...n__......._.__..___ 1303. ,l\~c:.hite~tura!/e~gine~~nQ_sE~rvice.s!o___.______ 13g~: !:3lJild!~"perrni! t(),~_ _ _ __ _____ ___ _ ___ ____ _______ 1305. OVERNIGHT FEE 15.00 1604. Equals Disbursements to Borrower ___mo. ..________ ___.,~______....__._________.~__...._____.._.._______._ 1306. (after expiration of any applicable - - __...____n__n___._.___.__.. _._____._..___________...________._______.~._._~ 1307. ~-... - ----._------_._-_._-----~._._---- 1400. Total Settlement Charges (enter on line 1602) 75.00 20.00 NET SETTLEMENT 1600. loan Amount $ 104,000.00 1601. Plus Cash/Check from Borrower $ 1602. Minus Total Settlement Charges (line 1400) $ 2,111.27 - 1603. Minus Total Disbursements to Others (line 1520) $ 97,879.32 $ 4,009.41 rescission period required by law) 2,111.27 Borrower(s) Signature(s): . \. A ./l..A . Il ~ ^ 1. ^ f\ D .J ^ .____~_~ n___.______________________________ 0~1__nt_l~t.l-LQ!L~- _____~~-- form HUD-1A (2/94) ref. RESPA EXPLANATION AND DETAILS REGARDING CLAIM FOR FULL DEDUCTIBILITY AS PER DISCUSSION WITH PAUL DIBERT OF MARCH 23, 2007: (1) By deed dated May 31, 2002 and recorded June 5,2002, in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania in Deed Book 252, page 201, Robert Bruce Flanders and Ramona Flanders, his wife, granted and conveyed a residential dwelling house at 436 Spring House Road, Camp Hill, Hampden Township, Cumberland County, Pennsylvania, to Betty J. Fetterhoff, single woman, (decedent herein) and Marsha A. Leonard, her daughter (survivor herein), as joint tenants with right of survivorship. (See copy of deed attached to Schedule F.) (2) Subsequently, by a NOTE dated April 24, 2003, Betty 1. Fetterhoff obligated herself to pay back a refinance loan in the amount of eighty-eight thousand and Noll OOths ($88,000.00) dollars. Rights to repayment were assigned to Sun Trust Mortgage, Inc. Because of credit concerns, Marsha A. Leonard did not sign the NOTE. (3) By a Mortgage dated the same date, a lien was placed against the premises to secure the said loan. This mortgage, in accord with the ownership interests in the premises, was signed by both Betty 1. Fetterhoff and her daughter and co-owner, Marsha A. Leonard. This mortgage was also assigned to Sun Trust Mortgage, Inc. (4) Betty 1. Fetterhoff, in her Last Will, Item 3a. refers to the said mortgage and directs that her daughter, Marsha A. Leonard, pay the then remaining balance due, either by assuming the balance of the monthly payments or by means of refinancing the loan or other similar means. (See copy of Last Will attached to schedule J). (5) In accordance with the instructions above referred to, Marsha A. Leonard, refinanced the said loan by obtaining a new mortgage loan through Members 1 st Federal Credit Union, of Mechanicsburg. (See copy ofHUD Settlement sheet attached which shows pay-off of Sun Trust Mortgage, Inc. in line 1501 and the new loan in line 1600). REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF r e-rre7f!N~FfJ 8ET7'y J: FILE NUMBER ,;:(./ -0 b- 9.s I 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ReGG7e II-. KoHl< I.PIO 5 ,eo Y II (,. PI,e If p. eA-1It1 II//L/ /1/- /7PI/ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER I (1)>I4Pst-SAVI5l! /1V1f. . SDI() ~a6r ([) tnEml3. JS)r ;:.~. u. (/.../l-Pse:D (l) D.qBLe: HD~O~ 'PJAMlWD e.'N~ (LA Pst'D) (3J.ilD4 ~h. Df LlU!.ENT 7EtWA/. (J<< sdlul. 8) ~. h1I1-I/SHA-,4.. LRlYlh€j) '13[, :5PIlIN& HPII~!f./>~ (!Ah/P ~/t.t J I7A 17'1/ 1) Au GH7i:--,e AcL. /#&- ~T ,?A/{) ~/L)tlt:. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF BETIY JANE FETTERHOFF I, BETTY JANE FETTERHOFF, currently of 436 Spring House Road, Camp Hill (Hampden Township), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and fimeral expenses as Soon as conveniently may be after my decease. 2. I give and bequeath my double horseshoe diamond ring and my Super Saver Investment Account at the Members First Federal Credit Union to my son, ROGER ALAN KOHR. In the event that he fails to survive me, then to my daughter MARSHA A. LEONARD. A.)I give and bequeath all of my shares of Lucent Technologies that I own at the time of my death to my said son. In the event he fails to survive me, then to my said daughter. 3. As of this date, I am the owner of an undivided one-half (1/2) interest in a certain residential dwelling house and tract of land, as is more particularly described in that certain deed from Robert Bruce Flanders and Ramona Flanders, his wife, dated May 31, 2002 and recorded in Deed Book 252, page 201 in the Recorder's ofice in and for Cumberland County. The other undivided one-half (1/2) interest is owned by my daughter, MARSHA A. LEONARD, we hold as joint tenants with the right of survivorship and not as tenants in common. In the event that at the time of my death, if for any reason whatsoever, I own or hold any interest in or to the premises which does not pass to my said daughter through survivorship, or, in the event that she fails to survive me, then my said interests in the said premises are hereby given, and devised to my grandson, DAULTON J. LEONARD. In the event that he is under the age of twenty-five (25) at such time, his interest shall be placed in trust with my son, ROGER ALAN KOHR and to my niece, SHERI A. MOYER, to act as Co - Trustees. In the event neither of them is willing or unable to serve, then I appoint the ORRSTOWN BANK as Trustee in their place and stead. My Co - Trustees, or my successor trustee, as the case may be, in their sole and absolute discretion may sell said premises and invest the net proceeds therefrom in good and safe investments and may, again in their sole and absolute discretion, use so much of the income and principal, if need be, for the health, maintenance, support, and education of my said grandson. Upon my said grandson's attaining the age of twenty-five (25) years the principal and any interest accumulated thereon shall be paid over to him. In the event he fails to survive me or fails to live to attain the age of twenty-five (25) years, the principal and any interest accumulated thereon shall go to his issue in equal shares. In the event he is not survived by issue, then I direct that the principal and any interest accumulated thereon shall be divided and distributed as provided for in the residuary distribution set forth herein below. Any death taxes, fees, commissions and the like which would ordinarily be assessed against the value of this devise, whether passing under this will, or by virtue of a joint tenancy with right of survivorship, shall be paid from the residue of my estate. 3.a. My said daughter and I are currently the mortg~gors on a mortgage~ ~=~~ ....t fffJ dated on or about June 1,2003, in the amounfof .eJ ~/~ thousanrl.($??;;! 3~ . (gJ.. !J(~ . ,~ ~1 ,~v -* fit ~ ~ ~ ~ &t ~ ~ d.Jflbh./" :Z~o'l-fJbV~. ~~) ~ -......_.....~._"';.O.~....,'___________..._.._...... dollars. In the event of my death, I direct that the then remaining balance on said mortgage and/or any replacement or additional mortgages on the said premises be paid by my said daughter, either by assuming the balance of the monthly payments or by refinancing the balance or by other means which she may adopt in view of the circumstances as they may exist at the time. The purpose of this direction is to assure a place for my daughter and grandson to live. In the event that my said daughter has predeceased me, there shall be no obligation in the part of my said grandson to make such payments. However, as above stated in paragraph 3 my said Co-Trustees or sucessor trustee, as the case may be, shall have full power and authority to sell the said premises and payoff any mortgages thereon from the proceeds of the sale. 4. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to my daughter, MARSHA A. LEONARD, In the event she is survived by her said son, then in trust for his benefit as is more fully set forth above. Should my daughter predecease me and not be survived by her said son, then her share shall go to her said brother. 5. Should both my daughter and son predecease me and not be survived by issue, then all the rest, residue and remainder of my estate shall be divided into two (2) equal shares and be distributed to Ai38E;)' ~ A f).-:;- my grandnieces, LINDSEY JEAN MOYER and ABBY RUTIfCMOYER, both currently of Appleby Road, Harrisburg, Pennsylvania. In the event either of them predeceases me, then to the one who surVIVes me. 6. I nominate, constitute and appoint my daughter, MARSHA A. LEONARD, and my son, ROGER ALAN KOHR, to be the Co-Executors of this, my Last Will and Testament. In the event that both of them predecease me, or for any other reason, both of them are unable to act as Co- Executors, I appoint the ORRSTOWN BANK to be Executor in their place and stead.. I further direct that they shall not be required to file bond or other security in the Office of the Register 0 f Wills for the purpose of administering my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of ~ A.D.200tg;E ~--- 6.0;7'- ~''''''~&'1$' (SEAL) U BET ANE FETTERHOl Signed, sealed, published and declared by the above-named BETTY JANE FETTERHOFF, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subsc 'bed our n me as witnesses. ft,;zjjzl- /!cll:u~l!u~ ~ -:DD--X 4 s--- 1\9pd,4S- fJ A PO . z ~ ~~~,