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Home My WebLink About11-18-07 .-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 21 07 0225 Date of Birth 160-16-0839 02/11/2007 04/24/1919 Decedent's Last Name Suffix Decedent's First Name MI Derickson Melva A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI None Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate C.~I 4a. Future Interest Compromise (date of death after 12-12-82) ell' 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;:SI<lOULD BE DIRIiGIED TO: Name ~,~~,~~~,,!~~_~~,?~,,~ber '~_,1 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8, Total Number of Safe Deposit Boxes Michael Cherewka, Esq. Firm Name (If Applicable) Law Offices of . (717) 232-4701' REGISTER OFWIL..LS USE Q~Y First line of address 624 North Front Street ;"<',) r""-.J Second line of address '..,;;:) City or Post Office State ZIP Code DATE FILED Wormleysburg PA 17043 Correspondent's e-mail address:mcestateplanlaw@earthlink.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 representative is based on all information of which preparer has any knowledge. SIG TURE OF PERSON RESPONSIB E FOR FILING RETURN DATE 11/09/2007 PA 17331 DATE 11/09/2007 ADDRESS 624 North Front Street, Wormlevsburg. PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 -I -.J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Melva A Derickson 160-16-0839 RECAPITULATION 1. Real estate (Schedule A). " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 1. 128,190.00 980,703.00 0.00 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. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 31,727.00 0.00 6. Jointly Owned Property (Schedule F) Separate Billing Requested. . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 10,570.00 1,151,190.00 57,765.00 6,308.00 64,073.00 1,087,117.00 548,559.00 538,558.00 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_ 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. 538,558.00 18. 80,784.00 80,784.00 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 15056052059 -.J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Melva A Derickson STREET ADDRESS 713 South Market Street DECEDENT'S SOCIAL SECURITY NUMBER 160-16-0839 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) 80,784.00 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) 80,784.00 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;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 !il 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 !il 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ~ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 39116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. 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 PS. 99116(1.2) [72 PS. 39116(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. 39116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Melva A. Derickson FILE NUMBER 21-07 -0225 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 jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Residence - 713 South Market Street, Mechanicsburg, Pennsylvania. Fair Market Value set at Tax Assessment Value 128,190.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 128,190.00 Detailed Results for Parcel 17-24-0787-224. in the 2004 Tax Assessment Database DistrictNo 17 Parcel_ID 17-24-0787-224. MapSuffix HouseNo 713 Direction S Street MARKET STREET Owner! DERICKSON, MELVA A C/O LIVING TRUST TR PropType R PropDesc LivArea 1476 CurLandVal 48570 CurImp V al 79620 CurTotVal 128190 CurPretval Acreage .21 CIGmStat TaxEx 1 SaleAmt 1 SaleMo 12 SaleDa 26 SaleCe 20 Sale Y r 01 DeedBkPage 00249-03695 YearBIt 1952 OF_File_Date 10/21/2004 HF _Approval_Status A http://taxdb.ccpa.net/details.asp ?id= 17 -24-0787 - 224.&dbselect= 1 11/7 /200~ REV-1503 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Melva A. Derickson FILE NUMBER 21-07 -0225 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 2. DESCRIPTION Ameriprise Financial Services, Inc., Account # 930030963316004 Ameriprise Financial Services, Inc., Account #000193053170021 Janney Montgomery Scott, Inc., Account #7886-9136 VALUE AT DATE OF DEATH ITEM NUMBER 1. 4. U. S. Savings Bonds (See Attached Schedule) 16,337.76 131,650.88 815,579.68 17,134.80 3. TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 980,703.12 Minneapolis, MN 55474 March 22, 2007 SARA RINDFLEISCH NEAGLEY STE 103 4 LEMOYNE DR LEMOYNE, PA 17043-1229 Dear SARA RINDFLEISCH NEAGLEY: Thank you for your recent inquiry regarding MELVA A DERICKSON's accounts. These are the values of the accounts as of 02/11/2007. Account Information Annuities - Post 1985 Account Number Ownership 93003096331 6 004 Individual Ameriprise ONE Financial Account Account Number Ownership 00019305317 0 021 Trust Annuities - Post 1985 Account Number Per Share 93003096331 6 004 Total Value # of shares Asset Value $16337.76 Ameriprise ONE Financial Account Account Number Per Share 00019305317 0 021 Total Value # of shares Asset Value $131650.88 (Embedded image moved to file: pic17870.jpg) The date of death values provided are for estate tax purposes and are not a value to be paid. Accounts may be subject to market fluctuation as governed by each product. Please note that the values indicated for any Life Insurance product(s) reflect the gross death benefit at date of death, not the cash value. Values for any proprietary mutual funds include accrued dividends as applicable. Values provided for brokerage products are manually calculated, and should be used as estimates only. The prices used to provide values are estimates obtained from outside sources believed to be reliable. Ameriprise Financial provides these values as a service to its clients. Actual values used in preparation of tax returns or for planning purposes should be verified by your legal and accounting advisors. We appreciate the opportunity to be of service to you. Please contact us if you have any questions. Ittp://webmail. pas.earthlink.net/wam/printable.j sp?msgid=91453&x= 19602493 3 5 3/23/2007 I' HB142. 02/12/2007 10:16 __._......__H...-,..""..._...W___.___.__,______________~____________..~'...."...._._________________~_____.,...._.... ... _."' . VALU 27171723 HB32 MELVA A DERICKSON ~IV TR DTD 12/26/01 02/12/07 FUNe FRWD 4Cl CASH $802,976.70 Tl-M!V F-CALL USD/EQ Tl-FM/V H-CALL TO'f At T2-LM/V D-INT MARGIN T2-SM/V M-INT OTHER OTH MM/V EQTY % DIV lINT OTH CM/V EQUITY $12,602.9a MMKT $403,876.98 T1 CIA CiA SMA $802,976.70 T1 M/SEC sip $12,602.9aCR FDS AVL $802,976.70 TOT M/V $815,579.68 TOT VL QUANTITY DESCRIPTION SYM eRNC" CUSIP VALUE . T Loe X 42L ALCATEL LUCENT AOS ALU USD 013904305 558.60 1 SEG M 184L ALLSTATE CORP ALL uso 020002101 11238.72 1 SEG H 74L .l\LLTEL CORP AT usn CJ2Q039103 4522.14 1 SEG M-' 18L AVA'lA INC AV USD 053499109 234.18 1 SEG M 640L .l\'./ON PRODUCTS INC IWP usn 054303102 24998.40 1 SEG M 37St BAC CAP TR X CR~ JR 6.25 BAC'S USD 055189203 9348.75 1 SEG M 1530L BLAKRK MUNYLO PA INSD FD MPA USD 09255G107 22659.30 1 SEG M 5179.843L BLCKRCK HGH YLO PT INV B BHYBX USD 09192 9661 42785.50 1 SKF M 227.958L BLCKRCK HGH YLD PT INV A BHYAX USD 091929679 1882.93 1 SKF M 1200L SLACKROCK ENHANCED DIV!D BDJ USD 09251AI04 17952.00 . SEG M .!. 800L BRISTOL MYERS SQUIBB BMY USD 110122108 22816.00 1 SEG M 300L BURLINGTON NTHRN SANTA BNi: USD 12189T104 23739.00 1 S€G M Po.t.i~ Fax Note 767' Dale =:Jf~t ~ -- To Mlk..E f1 From C.HAr<.u lZ ~Ass ..... , CoJOept. Co. ::r f'{l S Phone a !Phone , _....~.H"_...".,....._._ _ ! Fax It - . F~.x It 232. 431t..f 1 il....__ 1 _~ ; Estate of Melva A. Derickson Schedule B 21-07-0225 Series Denomination Serial Number Issue Date Date of Death Value 1 EE 1000 M78902437EE Oct-92 $1,100.40 2 EE 1000 M78902436EE Feb-92 1,144.80 3 EE 1000 M78902435EE J an-92 1,144.80 4 EE 1000 M78902434EE Dec-91 1,144.80 5 EE 1000 M78902433EE Nov-91 1,144.80 6 EE 1000 M78902432EE Sep-98 700.00 7 EE 1000 M78902431EE Jul-91 1,167.60 8 EE 1000 M78902430EE Jun-98 707.60 9 EE 1000 M78902441EE May-93 891.60 10 EE 1000 M78902440EE Nov-92 1,100.40 11 EE 1000 M78902439EE Oct-92 1,100.40 12 EE 1000 M78902438EE Oct-92 1,100.40 13 EE 500 D58264830EE Apr-86 791.60 14 EE 500 D58264831EE Apr-86 791.60 15 EE 500 D58264832EE Sep-86 776.00 16 EE 500 D58264833EE Sep-86 776.00 17 EE 200 R171940701EE Oct -86 310.40 18 EE 200 R171940700EE Oct -86 310.40 19 EE 200 R171940699EE Oct -86 310.40 20 EE 200 R171940698EE Oct -86 310.40 21 EE 200 R171940697EE Oct -86 310.40 TOTAL $17,134.80 REV-1507 EX+ (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF Melva A. Derickson FILE NUMBER 21-07-0225 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 . None VALUE AT DATE OF DEATH 0.00 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1508 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Melva A. Derickson FILE NUMBER 21-07-0225 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Wachovia Bank, Certificate of Deposit, Account #247412041078240 (includes accrued interest 7.07) 2. M & T Bank, Savings Account #015004207038181 (Includes accrued interest $0.02) 3. Citizens Bank, Checking Account #610070-089-5 10,708.87 1,727.78 16,180.01 118.40 4. Refund - State Fann Mutual Auto Insurance 5. Household Furnishings & Miscellaneous Personal Property 2,000.00 500.00 6. 1990 Chevrolet Cavalier 7. Refund, A.T & T Long Distance 19.57 8. Refund - AAA Membership Dues 35.00 9. Refund - AIG Homeowners Insurance 437.38 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 31,727.01 11-07-'07 13:21 FROM-M&T RECORDS MGMT 302-934-2955 T-267 P002/002 F-721 Pm M&fBank 49<) Mitchell Road, MiIIsboro, DE 19%6 Maii Cede DE-MB-12 Phonc (888) 502-4349 Fax (302) 934-2955 November 1. 2007 Law Offices of Michael Cherewka 624 North .Front Street Wormleysburg, Pennsylvania 17043 Re: Estate of' Melva A Derickson Social Security: 160-16-0839 Date of Death: Februarv 11. 2007 Dear Sir or Madam: Per your inquiry received November 07,2007, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Savings Account Account Number 015004207038181 Ownership (Names oj) Melva A Derickson Living Tm.~t DTD f 2-26-0 1 Melva Adericksoll, TRY' * Opelling Date 12/09/99 Closed 04/24/07 Balance all Date of Death $1,72776 Accrued Interest $ 0.02 1'olal $/,72778 Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing tile information above, you believe there are additional accounts not referenced, please provide uS\'l'ith an account number and/or the name of any possible joint accouni holder. For any additional Information on the above accounts, including ownersblp and any changes, closures andior reimbursement of funds, please ealI the Mcchanlcsburg Office # 717-255-2031. Sincerely, ~~ Records Management NOV 07 '07 15:08 FR CITIZENS BANK ~:€ Citizens Bank 717 766 8325 TO 7172324774 P.06/08 Circle Account Statement 1-888-910-4100 Call Citil~' PnoneBank anytime for IWXJnt inrO/l'II$tiOll, current ratfl aM emwen to yo<JI ~tions, o OF 2 Beginning Febru~ry 10, 2007 through Marth 09. 2007 Checking SUMMARY hIanc8 Calculation Previous Balance Chl!CkS Withdrawals Oepo$its & Additions Interest Paid ~ent "lance BaI,,," Average 08ily 8s/ance 1$,844.47 16.180,01 361 .3S - ,00 - ,00 + 3.04 t 15,821.70 " Interest Current Int~esr Rate Annual Ptteenr"ge Yield Earned N4JI71ber of Oays Intentst E~tned /nt8re$l Earned Interest Paif;t this Year TUNUCllON DETAILS Chcck," Tllm i$II~1< in Chedt ~r;~ ClleCk' ~t 01" 1183 326 is 02112 f;heCk 1/ 1184 Amount lllltt 34.60 02112 Imerest Oate 03109 Amowm .; ~W'lpcion 3.0.4 '1 nterest Daily Balence Date 02112 &1_ Dale 1&,816.66 03/09 BlIac\Ce 15.821.70 D"Ie hlMlee I NEWS FROM CITIZENS -.Starting May 1, 2007 your sl8temeot will dt~il your ATM and Debit Card traosaction$ made outsi~ of the United S~tts as twO separ8te items; the purcha~ or wittldrawIII amount and the Foreign Currency Fee . mount. Ttle Foreign Currenty Fee amount consi$tS of a 1 % Foreign Currency Fee and any related network fees that may apply. --Are you Shopping fora Traditional or Roth IRA and need help deciding which is right for you? Whether you ""d to ITl3ke a new contribution or are looki09l0 rollover Of transfer IIn existing account. ask uS about our IRA COsI Great nltes are availablejust in time for tax selIson! Invest inyourflJture with a Citizens Bank IRA. Ask a Banker for details. ~~Ii'~.I!":I':< ;.j;~f: @ (':;;.,11 ;"~l'~'lii! ~.r,,'."; LlV TRUST OF MELVA A OtRICKSON MElVA A DERICKSON mE Ci~ Chec:kins with Interest 610070-089-5 .25S .25l1; 28 3.04 9.40 Pr.\I;OlIS &.lar>w 16. t80.01 o Total C~5 361.35 o €) Totallntcrv.' Paid 3.04 Cun-e"\ &aIa_ 15,821.70 JaIIeyllle BIlk lI-lITlUSTEO RESOURCE . . i--' advertisement Ill; Send to Printer 1990 Chevrolet Cavalier VL Coupe 20 BLUE BOOK~ PRIVATE PARTY VALUE Condition Value Excellent $825 Good $700 ./ Fair $500 (Selected) Average Consumer Rating (33 Reviews) Read Reviews tr~~~~ 4.7 out of 5 Review This Vehicle Vehicle Highlights Mileage: Engine: Transmission: Drivetrain: 60,000 4-Cyl. 2.2 Liter Automatic FWD Selected Equipment Standard Air Conditioning Power Steering AMjFM Stereo 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. Vehicle Condition Ratings Excellent ~ $825 "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 - advertisement - Close Window http://www.kbb.com/KBBlUsedCars/PricingReport.aspx?ManufacturerId=9&YearId=1990&Vehic1eClass=...11/7 /2007 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. Good DDD01'~ $700 "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 (Selected) Df..lDI['I'~' $500 "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. * Pennsylvania 11/7/2007 http://www.kbb.com/KBB/UsedCarslPricingReport.aspx?ManufacturerId=9&YearId=1990&Vehic1eClass=...1117 1200', REV- 1509 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Melva A. Derickson FILE NUMBER 21-07-0225 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. None B. C. JOINTLY.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ',OOF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. None 0.00 I ... TOTAL (Also enter on line 6, Recapitulation) $ 0.00 (If more space is needed, insert addnional sheets of the same size) REV-1510 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Melva A. Derickson FILE NUMBER 21-07-0225 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 INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBEF THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. U. S. Savings Bonds (See Attached Schedule) 10,570.00 100 0.00 10,570.00 .... TOTAL (Also enter on line 7 Recapitulation) $ 10,570.00 (If more space is needed, insert additional sheets of the same size) Estate of Melva A. Derickson Schedule G 21-07-0225 Series Denomination Serial Number Issue Date Value 1 EE 1000 M48823642EE Feb-92 $1,144.80 2 EE 1000 M23904775EE Nov-91 1,144.80 3 EE 1000 M48178825EE Dec-91 1,144.80 4 EE 1000 M48493033EE J an-92 1,144.80 5 EE 1000 M69629252EE Oct-98 697.60 6 EE 1000 M58411685EE May-93 891.60 7 EE 1000 M54150162EE Nov-92 1,100.40 8 EE 1000 M53423328EE Oct-92 1,100.40 9 EE 1000 M53423329EE Oct-92 1,100.40 10 EE 1000 M53423330EE Oct-92 1,100.40 TOTAL $10,570.00 REV-1511 EX+ (12-99). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Melva A. Derickson FILE NUMBER 21-07 -0225 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Malpezzi Funeral Home Elizabethtown Monument Company 8,942.53 98.00 2. B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Jean C. Hoffman & Alice M. Brommer Social Security Number(s)/EIN Number of Personal Representative(s) Street Address See Schedule J 36,156.00 City State Zip Year(s) Commission Paid: 2. Attorney Fees 11,644.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 100.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 345.00 7. Legal Notices - The Sentinel 129.50 8. Legal Notices - Cumberland Law Journal 75.00 9. Register of Wills, Cumberland County, PA 25.00 10. Appraisals- Real Estate - Brett Lechthaler 250.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 57,765.03 ..;,XB:~"'~~ifi~~~:~~';M;~' ,:'.:Meclianicsburg, PA 17055' , (717)697-4696 ,m,., March 20, 2007 Jean C. Hoffinan 809 East Walnut Street Hanover, P A 17331 '" .~.,.:>,:.;- ,',," ~ :1.-; \~~~');s'::::: 17"':-;. The Funeral Service for Melva A. Derickson: . 'c'-' ~"..,., : ;:~L::'.;:;,>]_:.,.:~ We sincerely appreciate the cortfid~nce YOH ~~;vepladed in us and will, continue to assist you in every-way we .can. feel free tocontac.t us if.yo......u have anyques!~.on$inregard to this statenient.' ...../< .. .... ,"" '.'.-,.. .,........,....:...:.'",..,... THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff. . . . . . . FUNERAL HOME SERVICE CHARGES SELECTED MERCHANDISE: $3865.00 $3865.00 Steel Protective Casket. . Sentinel Burial Vault. . . . . Register Book, Folders, Acks.. . . . . THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED. . ..'. . .;. . .'. . . $8130.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES $3125.00 $1095.00 $45.00 Opening Grave. . . . . Cemetery Equipment. . . Certified Death Certificates. Newspaper Notices - Patriot. Clergy/Mass Offering. . . Flowers. . . . . . . TOTAL CASH ADVANCES AND SPECIAL CHARGES . CONTRACT PRICE . . . . . . . . . . . . mSTORY 02/11/2007 Clergy Discount - Trad all services . 03/20/2007 Payment-Cumb Cty, . TOTALAMOUNTDUE. . . . $600.00 $140.00 $72.00 $144.53 $100.00 $106.00 $1162.53 $9292.53 $-250.00 $-100.00 (28942.9 c: t11v $ ~ /31 I jf 30 GLENDA FARNER STRASBAUGB Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17~13 Recetpt DSlte: Recelpt Tlme: Receipt- No. : 3/09/2007 13:16:52 1047610 DERICKSON MELVA A Estate File No. : Paid By Remarks: 2007-:-00225 JACK R HOFFMAN JA ------------------------ Receipt Distribution ------------------------ Fee/Tax Description PETITION LTRS TEST WILL AUTOMATION FEE SHORT CERTIFICATE JCP FEE Check# 2064 Tbtal Rec~iv~d~ . . . Payment Amount 30.00 15.00 5.00 40.00 10.00 Payee Name CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D $ 10 0 . 0 O. $100.00 / ( Whitcomtf:<.Tax and FinanciaF'Services 43 West Main Street Mechanic~Ryr9, PA 17055-626?p",. Phone: (717) 766-9477 . . Email: al@whitcombtax.com April 06, 2007 MELVA A DERICKSON %JEAN HOFFMAN 809 EAST WALNUT ST Hanover, PA 17331 Phone: (717) 630-9318 Your 2006 tax return was prepared by ALFRED WHITCOMB. Summary of Charges Charge Federal and Supplemental Forms Form 1040 -U.S. Individual Income Tax Return Schedule B -Interest and Ordinary Dividends Schedule D -Capital Gains and Losses Form 6251 -Alternative Minimum Tax Form 8879 <-E-File Signature Authorization Form 9325-General< Information for Electronic Filing Statement -Schedule B - Name of Interest Payer Form 1099-R -Distributions from Pensions Wksht CG -Schedule D Worksheet - Capital Gains Comparison -Tax Year Comparison Sheet Wksht 8SB -Social Security Benefits Worksheet Wksht 1250 -Unrecaptured Section 1250 Gain Worksheet Wksht EIC -Investment Income Limitation ES Summary -Estimated Tax Summary Page Form 1040ES -Estimated Tax Vouchers Page 1 Form 1040ES -Estimated Tax Vouchers Page 2 Form 1040ES -Estimated Tax Vouchers Page 3 Form 1040ES -Estimated Tax Vouchers Page 4 Interest Listing-Listing of all Interest Pennsylvania PA 40 PA AB PA AB PA D PA 8879 Forms -PA Individual Tax Return -Int, Div & Est or Trust Income -Int, Div & Est or Trust Income -Gain/Loss from the Sale of Prop -PA Pin Signature Form 24 Total Forms $ 345.00 ,,~ [tile NO. Ul~fl ~~~~~ItI:I'[ t'age #111 ~t~ . :-~,:~-' '. . FROM: Brett Lechlhaler 16 San Juan Drive Mechanicsburg, PA 17055' INVOICE: "'}~INVOIC.eNUriiaEB. 07-713SMARKET,J '; ~;~~'U,~;;ni;( May 2, 1 Telephone Number. 717-697-1828 Fax Number. 717-697-0220 ~, TO: ~4~REFERENC '. , Internal Order #: lender Ca8e #: Client Ale #: Main Rle # on form: , Other FOe # on.form: Melva A Derickson UVing Trust C/O Mrs. Jean Hoffman 809 E.Warnut 5t f:ianover, PA 17331. ;~,.e~~~"o~\!!!!!!er. 7:17-630-9~1 &. Afternale Number. . Fax Number. E~Malt . .. . Federal Tax ID: Employ~r 10: 07.7f3~JI41';;~ ;f . :"\:-", ';f. ~ f.:.',.- -:Y: lender: Melva A Derickson Living Trust Purchaser/Borrower: NA ' Property Address: 713 S Market 5t City: Mechanicsburg County: Cum ber\\lnd ' legal Description: Deed BoCik 249 Page 3695 State: P A Zip: 17055-6413 ....... '"1 ,.~ '~ . c(JtL. s- If" 7 (!.bk#'" ...:?h zj SUBTOTAL TOTAL DUE $ 250.00 " Form NIV~- "TOTAL for Windows' appraisal software by a la mode, inc. -1-800-ALAMOOE. Appraisal Solutions {717]697-1828 REV-1512 EX+ (12-03) .. COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABIUTIES, & UENS FILE NUMBER 21-07-0225 ESTATE OF Melva A. Derickson 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 10. 11. 12. 13. 14. 15. 16. 17. 18. 20. 21. 1. 17.83 Quantum Imaging 2. 51.76 Kilmore Eye Care 3. 1.68 Quantum Imaging 4. 46.48 PPL 5. 258.46 Erb Heating 6. 34.43 AT&T 7. 37.87 PPL 8. 214.27 Erb Heating PPL (had not billed for several months) 153.05 9. Erb Heating 44.72 PPL 54.67 AT&T 42.32 AT&T 33.93 AT&T 39.73 AT&T 40.08 117.50 Borough of Mechanicsburg - Sewer & Refuse United Water 0.92 72.26 United Water 19. Taxes - Real Estate 589.80 Taxes - Personal 9.80 1,665.80 Taxes - School 22. 2006 Federal Income Tax 756.00 23. 2006 Pennsylvania Personal Income Tax 345.00 24. 40.20 AT&T 25. FROM CONTINUATION SHEET 1,639.87 6,308.43 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) CONTINUATION OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Melva A. Derickson 21-07 -0225 26. United Water 8.50 27. Snow Removal - Tom Beitler 50.00 28. Snow Removal - Tom Beitler 50.00 29. Meals on Wheels 30.00 30. Life Line Medical Alert 19.00 31. AT&T 33.06 32. AIG Insurance 789.00 33. Repairs - Michael Ryan Tree Removal 475.00 34. Your House Doctor - Chimney Repair 120.00 35. PPL 65.31 Subtotal $ 1,639.87 ~ ., z 0 ? (/I ." < "" ". ". ~ 0 .... tT 0 0 0 0 0 ~ m c .... H III .... .... <> :J!' III 0 i .... ~ z Z -..l ". XI "tl ". ., ::r n r- m r r- !\> ,< ()1 ,.,. c ..,., m -..l S Ol ,.,. III m ". H' U1 ... <:l !II XI VI Z . 0 flj .... 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"'''''''', .;r Page J 93360~69007 ",,1ien in SO.OO ELI':CTRIC UflLITIES Cbarges Total Charges: KWH- P.:r Day "",^~,,,~,,,~"""""""~ $ 46.48 J8 ~>'~>""""~V= b/~ 7 I r Electric Use I'his y,Jur overthe last 1 months. Types of Meter Readings: Actual _ Estimated o 15 12 9 (, 3 () Fi\iIAMJ J AS()ND J F 2006 Months 2007 Meter Reading InformMioIl Average - Fch k\~tl(I';~~llr)~y '-'early Use: Mar Feb 2006 Mar. lieh 2007 2006 ,~:'iF I" 2007 24F 14 Total I'sc 493(1 4850 A vcragc MOllthh 41'1 404 Other important information on back ... Your AT&T Statelnent "................ ... ."-";\ h 23 - April 22, 2007..7 -,.._"->>"''''''".~''^-,,.,....."'-~-'' #SWNCJFM #(l"Hl2151728S01811 73697.272.617241 AT 0.308 111.1111111..11...11111111111,11111' .1.1,,111,11,1,1,1,. .11111 MELVA DERICKSON 800 E WALNUT ST HANOVER PA 17331-2055 1,,1111111,"111111111111111,1. 111,,1,1,11111,,111,11. 1,,11,11,1,1,11111 Summary of charges Previous balance Payments... .. . . . AT&T local Services ...... AT&T long Distance Services.,..."...,,,,. Total amount due Date due ......,.66,99 ,.-66,99 .33,98 .45 mp 7 .1' 4.... ....p 6 May 17, 2007 Your sfl.'Vings and benefits Never Mail Another Check to Pay Your AT&T Bill. F O! the ultimate convenience, enroll in A T& T Automatic Payment (ABP) and have your future payments automatically deducted from your enclosed check. To enroll, check the box and sign on the line on the back of the remittance and return with your payment Or sign up for online billing review and pay your bill each month by logging onto'your AT&T Online Billing account at w.vw att. comJremitdoc .. at&t Customer 10: 717 766-4366 1511285 1 of 7 Customer Service: 1800288-2747 Text Phone (TTY): 1800833-3232 Internet Address: www.att.com Extra! Extra! New AT&T PrePaid Phone Cards help you stay connected the world over. low rates and now cards are available for each branch of the Military. Benefit news Sign up for AT&T OnHne Billing and you won't get another paper bim To sign up just visit w.vw.att.com/online Why more customers are choosing online billingl Simply visit w.vw. customerservice. att c om to manage or set up your online account Contiuues on ha"t,. PPL Electric .... Itles Electric Service VA or write to: Custol1u:r Service 827 Hausman Rd. Alh.:ntnwn, PA 18104.9392 \VW,V .pplelcctric .C(1tl'l ~uml11aryPage<<~. {/""'lalancc as of Mar 21~ 2007'~'>., '".~. .-- .~.---_.,.~..... ...~.__.. "... .., Page I 93360-69007 $0.00 L ELECTRIC UTH.ITIFS Charges Total Charges 18 K\VH AVf;'Hlge Per $ 37.87 . f [ I D Electric Use Tbis gmph shows your electric use over tbe last I.' montbs. Types of Meter Readings: Actual _ Estimated Customer D 15 12 9 (. 3 (l rvfAM J J AS () N D J I'M 20f}6Monfhs 2007 Meter Reading Information A \'erage - Mar Tempera..fure K\VH P~'f Day Yearly Use: ApI' 2005 . r-,.Iar ApI' 2006. Mar 2007 351' II 2006 .wI' 15 Total I :sc 4921 4740 Average Monthly 41tl 395 Other important information on hack ... ~ ~lI'I<I:- O-<l 0"011> -:) ~ e: c HEA! iN" OR KEROSE:NE: DIESEl <\)Ee ClASOU..€' -FlAMMA8lE lIQU!D Meter Reading - 8efore and After Delivery !~ S'J~ ~~ .~ ~ '== ~ . ;~ Q== ~= =-... e: ~.. ~~ ~~ ~ . UNLESS A BUOGfT CiJSiDMER THiS 1$ A Wll PlfA,:,{ PA( fROM THiS IN'vOCf TtRMS 3D 1>\ st?"lCf CHAliGf ADDfD MifR:m [JAYS IBIS fXP!\E&SfS AN ANN;;A; fl,Uf Of 16'1, PAYMENT RfCEI\fW CHECK CASH PPL Electric Utilities Electric Se W\'ltw.ppldectric.com Summary Page Balanee as of Aftg20, 2007 Page 1 93360..;69007 Total Charges UrUJTU;SCbarges $0.00 $ 54.61 $ 54.61 Account Balance $ 54.67 r~ .~ Electric Use This ~ph.shows yoor electric Qver the last months. T~s of M.r Radings: Actual _ Estimated Cu~r 0 KWH.. !}er Day 18 15 12 9 6 J () ASOND J I'MAM J J A 2006 ~1onths 2001 Meter Reading Infurmamo Yearly Use: 2005. Aug 2006 - Aug 2006 78F 1" .' 2001 77F 16 Total Average Use Mouthlv 4954 415 4548 379 Other important information on back ... Statement tlBWNCJfM -0902151728 S018# 2867.12.482.873921 AT 0334 'I ulllwlllJl, "II,m' '111"11,,, 11,11,1,1111.,,1,1,1,1,,11 MELVA DERICKSON 009 E WALNUT $T HANOVER PA 17331-2055 '"IIIII',...III,I,I'"IUlI,IIII',.I,I,UIIIl,UIIII,IIlU,U1111,1 .lll Sumnuuy of charges Previous balance. Payment received May 4. * Thank you AT&T Local Services AT&T Long Distance Services.. Total amount due Date due ..3443 -34.43 uu33.98 ...p 4. ..up fL Your savings and benefits Never Mail Another Check to Pay Your AT&T Bill. For the ultimate enroll in AT&T Automatic Bil! Payment (ABP) and have your future payments automatically deducted from your enclosed checK. To check the box and on the fine return with your payment Or and pay your bl!! each month onto your AT&T Online Billing account at wwwatt.comfremitdoc ~ at&t Customer 10: 717 766-4366 1517285 1 of 8 Customer Service: 1 800288*2747 Text Phone (TTY}: 1 800 833-3232 Internet Address: www.att.com .r Extra! Extra! For collect calks dial down the center 1 BOO C-A*l-l-A- T - T. You.rA tatement "".v~ ~~V>""""m,.._____ (Febmary 23 - M~\rch 22, 2001\ .. ''''----~. ,j "^' -~"""^''''~''''-'-'''-'''-'^''~'-'''~',^",,'''''=~'''.m''~_N__'''W'' ~,..c,..,..- ...._N ' #SWNCJFM illJ9rJ2151728501tU 7818.7.293.632071 AT 0.300 I m 111...II.II,"IIIH.III.IIIII,II.I.II.I.IIII,III.ll.I,,11 MELVA DERICKSON 800 E WALNUT ST HANOVER PA 17331-2005 1'1111111....1l1.!.I1 nlllll,l.lllnl,I,IIII",111.1I.1,.II.Il.I.I.I.1I1 Summary of charges Previous balance......... . Payments . .... ..... 0.00 UNPAID B.ALANCE DUE UPON RECEIPT H",,,...,,.....,,$33.06 AT&T local Services .1' 43386 AT& r long Distance Services. . . I' Current charges due ApI' 16, 2007 ..m."m.......mm Total amount due $66.99 Your savings and benefits Never Mail Another to pay Your AT&TBHL For the ultimate convenience, enrol! in AT&T Automatic Bill Payment (ABP; and have deducted from your and sign on the line return with your payment Or and pay your bill each month Billing account at .1 . at&t Customer lO: 711766-4366 1511285 1 of 7 Customer Service: 1800288-2747 Text Phone (ITY): 1800 633-3232 Internet Address: www.att.com Extra! Extra! For conect calls just dial down the center 1 800 C-A-L-l-A- T. T B~/flJ Benefit news up www.att.comJonline Why more customers are choosing online billingf Simply visit w.vw. customerservice.att. c om to manage or set up your account Continues on back F'1 -- y ou!~AT&T'c-Statement ~laf2j . J Hue 22, 2007 ') C~_",_,_",,,.,,,_,,,,,,,,,,,,,,,,,,,,,,,,,#.#^ #BWNCJFM tiJ"llJ21S1128S01U 6585.5, l00A4586 1 AT 0.334 ',It 111111'1111. UIlIIIIIl"II'IIII,.I.III'I" 111,1'1'111',111 MELVA DERICKSON 009 E WALNUT 5T HANOVER PA t7331-2Q55 111I III 1 1llIll"lllll'lnl n.I.'I'I.IIIIIIIlIII"','IIIIIIIII"'I"""1 Summary of cbarges Previous balance "'''H'H''HH''@'''''''''''H.",,,...42.32 Payment received Jun 7 - Thank you ."" -42.32 AT&T local Services .p 433.98 AT&T long Distance Services .,,,,,,.p 6.. ".".5.75 ." ""''''''''':'',,, Total amount due ($39,]3 > '''x...". .." Date due July 17, 2001 Your sa'\rings and benefits Never Mail Another Check to Pay Your AT&T Bill. For the ultimate corlVlilnience, enroll in AT&T Al,ltomatic 13111 Payment {ABP} and have your payments automatically deducted from your enclosed checlt To enroll, check the box and sign on the Hne on the of the coupon, and return with your payment Or up for online billing to review and pay your bill each month by logging onto your AT&T Online Billjngaccount at www,attcomfremitdoc . . {,ll!1 j' "b rJ J [ ! at&t Customer 10: 7177664366 1517285 Page 1 of 8 Customer Service: 1 600 288~27 47 Text Phone (TrY): 1 800 833~232 Internet Address: www.att.com Extr.ll Extra! Get your telephone and DSl network equipment at one place, www.attcom/buy. Benefit news Sign up for AT&T Online BiUingand you won't get another bim To sign up just V>NIIN, att com/online Why more customers are choosing online billingl Simply visit www.customerservice.aU. c om to manage or set up your online account Continues on back ~ Your AT&T Statement June 23 - July 22,2007 #SWNCJfM #0'1021517265018# 4005.8.328,70920 1 AT 0,334- '",U I 1111 "U",U'lUlIl,I,III"III,I.,I,IIU lI,III,..I,.11 MELVA DERICKSON 80S E WALNUT 131 HANOVER PA 17331-2005 tutlt ut....' n .1,11" Jill J .1.111,.1.1, II II"IIH 111.1.,11,11 ,1,1,1,111 Summary of charges Previous. balance... H ,"'H' "'" ..."..., '" .H....." ..39,13 Payment received Jul 6 - ThanK you. , H " .. . H. .. . H H .. .... -39.73 AT&T Local Services ................................p 4.33.95 AT&T Long Distance Services.,...,..,...",.."",p 6.... ....6.13 Total amount due Date due $40.08 August 16, 2001 Your savings and benefits Never Mall Another Check to Pay Your AT&T Bill. For the ultimate enrol! in AT&T Automatic BUI Payment (ABP) and have YOllr future.payments automatically deducted from your EHiClosed check. To enroll, (ihecl< the box and sign on the line on the back of the remittance coupon, and return with your payment Or sign up for billing to review and pay your bill each month by logging onto your AT&T Online Billing account at www.attcom/remltdoe I . at&t Customer to: 111166-4366 1511285 Page 1 of 7 Customer Service: 1800288-2747 Text Phone (TTY): 1 800833-3232 Internet Address: www.att.com Extra! Extra! Get your telephone and DSL network equipment at one place, www.aft.com/buy , Benefit Sign up for AT&T Online Billing and you won't get another paper bill! To sign up just visit www,attcomJonllne Why more customers are choosing online billing! Simply visit www.customerservlce.afte om to manage or set up your online account. 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Heckard Sr ASSESSED VALUE: 128190 CASH PAID THIS TAX IS DUE AND PAYABLE, YOU ARE HEREBY REQUESTED TO MAKE PAYMENTTHEREOF. AUG 20 2m7 DERICKSON, MELVA A LIVING TRUST TR 713 SOUTH MARKET STREET MECHANICSBURG, PA 17055 BtRr)v',~ , _A h j l1bCKf\ J A X CO~ah t;;fj r (if? NECri ;\N t r's' ;~flt::=--~ F:i'\. FULL PAYMENT CHECK # AMOUNT $ 2% DISCOUNT FACE PENALTY TO 08/31/07 09/01/07 TO 10/31/07 11/01/07 TO 12/31/07 $1,665.80 $1,699.80 $1,869.78 FIRST PAYMENT SECOND PAYMENT FINAL PAYMENT $566.60 $566.60 $566.60 If Paid On or Before If Paid On or Before If Paid On or Before 8/31/07 9/30/07 10/31/07 OR INSTALLMENT PLAN NO DISCOUNT SEE REVERSE SIDE FOR TAX NOTICE INSTRUCTIONS . - H _ u,. ............ ~'_'.."~~.!,..~._.~~.~._..~~~.~. "..!.:"_!.!.! _"!"_~,' ',U '''~''_''.'''''''''''''.'. u n.......... .~. ...... ........ ...~,. '," ~ ..... TAXPAYER COPY Bill No: 1181 3/01/200r 2007 .Statement of Personal Taxes Bill Date: PAYABLE TO: BARRY L HECKAI=lD SR TAX COLLECTOR 605 SOMERSET DRIVE MECHANICSBURG, PA .17055 p. A iO CONTROL NO: 016- 001493 4 Assessed Value o DESC: APR -3 lm7 COUNTY OF CUMBERLAND DIscount Face Penalty Rate 5.00000 2% 10 CNTY pic 4.90 5.00 5.50 BOROUGH OF MECHANICSBURG Rate 5.00000 2% 10 MUN pic 4.90 5.00 5.50 TAX AMOUNT DUE-> $9.80 $10.00 $11.00 Xf Paid On or After ~~~~~?007 5/01/2007 7/01/2007 Xf Paid On pr Before 4 30 2007 613012007 % % 8ARRY.HECKARD TAX GOLLECT9R ....... MECHANICSBURG~ fA. CASH ONLY AFlER 12/15107 UNPAID TAXES SUBMITTED TO DEUNQUENT COLL 12/31107 TAX DERICKSON, MELVA PAYER 713 S MARKET ST MECHANICSBURG PA 17055-6413 OFFICE MAR-APR TUES&THURS 10AM-4PM HOURS: WED 5-7PM MAY-DEC TUES 10AM-4PM OFFICE CLSD MAR 8,9,21,22 &23 PHONE (717)766-6205 Return Bill with Payment. For a Receipt, Enclose Self Addressed Stamoed Envelope. F TAXES ARE IN ESCROW, FORWARD THIS BILL TO mRTGAGE CO. $1.00 FEE FOR EACH ADDITIONAL RECEIPT TAXPAYER COPY Bill No: Bill Date: Total I 128,190 . .. Face l 292.91 I 23.07 I 688 3/01/2007 'AYABLE TO: BARRY L HECKARD SR.TAX COLLECTOR 605 SOMERSET DRIVE .~, M~c:;HANIC,SBURG, PA 17055 ASSESS.NO -17000936 MAP NO::,.17-24;07'87-224 713 S MARKET STREET ACRES .210 DEED 0024~ 03695 LAND LESS THAN 1 ACRE Residential Building D i\ RESIDENTIAL It...... hECH Control No: 017 - 000936 Assessed Land Values 48,570 COUNTY OF CUMBERLAND ,.J,'I,ates ,....'. <,'~".,,'>'O~2:28500 ::COUmY'R!ll:',,{ .~';,.i10: 98 Rates" .00018000 Penalty . 10 % 322.20 .10'% 25.38 lEse: 10 % 314.45 $662.03 TAX AYER DERICKSON, MELVA A LIVING TRUST TR 713 SOUTH MARKET STREET MECHANICSBURG PA 17055 "* SEE REVERSE SIDE OF BILL FOR A BREAKDOWN OF YOUR COUNTY TAX DOLLARS "* IFFICE MAR-APR, TUES&THURS 10AM-4PM lOURS: WED 5-7PM; MAY-DEC TUES 10AM-4PM OFFICE CLOSED MAR 8,9,21,22 & 23 PHONE (717) 766-6205 BILL TO (BeitCer's Lawn & Chimney Service 56 Regency North Carlisle, P A 17015 J call IIofIinan 809 East Walnut Street Hallover,PA 17331 Snow removal DESCRIPTION QUANTITY SERVICE FOR Melva Derickson 713 South Market Street Meehaniesburg, P A 17055 ~, DATE 3/1 7/2007 1 RATE SEI<VICED 50,00 3/17/2007 ,/11-- . J/ We appreciate your business. Any questions, please call 791.-0149. Cut along line to return with payment. ~-J:I;;- :l ~ Cf7 /01 Total Invoice INVOICE if 100 TERM~S Due on receipt AMOUNT 50,00 $50,00 YJlllrAI&I~ Statement /"-~'~'" t~U1uary 23 - Feb~~,~_::~_~~!:~':,) "^"'w,~=",.""_"..,~",',,.~,~.,,"~">' #BWNCJI"M 1t09Q2151726501&# 46758335608761 AT 0,308 111111111111111111111111111111111111111111111111111,,111111III MELVA DERICKSON 713 S MARKET ST MECHANICSBURG PA H05S-6413 11111111111111111111111111111111111,11111111111111111111111,11,11111,111 Summary of charges Previous balance ,>>..".".."......"... Payment received Fel:> 7 ~ Thanl< you" ,. . A T& T Local Services AT&T Long Distance Services..".,,>>>> ^' , Total amount due Date due .",.34.60 "" -34.60 P 4.",,>>,.,,30,62 ."p 6..,,>>>>.....2,44 ~ Your savings and benefits Never Mall Another Check to Vour AT&T Bill For the ultimate convenience, enroH in AT&T Automatic elll Payment (ABP) and have your future payments automatically deducted from your enclased checl< To enroll, check the box and sign on the line on the back 'Of the remittance coupon, and return with your online and pay your bill onto your AT&T Billing account at www.att.com/remitdoc ~ ~ at&t q~\ ,\\ ~ ti' Custamer 10: 117166-4366 1511285 Page 1 of 7 Custamer Service: 1800288-2741 Text Phone (TrY): 1800833-3232 Internet Address: www.att.com Extra! Extra! For collect calls just dial down the center 1 800 C-A-l-l-A-T-T. /1 10 m { ~ Benefit nc\\'s up for AT&T Online and you won't get paper bill! To sign up just visit www,attcomlontine Why more customers are chaosing 'Online billing! Simply visit www.Cllstomerserviceat!.c om to manage or set up your online account Contmues on back 1""'1 '~",,'''' ~\:r-..;~"" \-< "/<;,,:,i;:";.:r, .,","",' -;~.'f'~"'!,/' .1, )-', :t::,:<; .,~",:,~},',':i:.(.~,' {:'~:,>.;.~.;'" - "; ':~~i~;;:::j~::!,;'>;- ,';,~ :.' ".-, :'~:'~i J?:,(','; ')':>~'::'/"--;:"" ) :"1"'" " _"~ -,t; ')f'~~;~':~ ,-,>,;,s';." ',,~, i<,'-' ',":: {,. :',';'_,f,I:'::<''V:,::~:;,,:: ."1,:, '.,(. ",~ ;:" ;'::';';.1"":;:"; i....,b::~~'l::~-'>" ,/;'; ::--" <\;:;~'~I'\\ MI:CHAEL E. IYAN I I Dillsburg, PA 17019 (717) 432-5297 TAX ID: 23-2911377 Tree Removal Insurance Policy: G401876 Bill To: All Invoices are COD ~on /-/o.-fhnvn f09 E /<JalnO-f :S.frc:c.:f ;/c;"76VC.f', /?;, /733/ l-ocal-;6/1 .' . /713 S, /7?6rf:.c-l sf. Illechoo iLS bi:L1 , .,4. /7t')S:S~ Item Descri tion Total /~-\lIlnvoices COD t Subtotal Misc. Balance Due Make checks payable to M~chael Ryan Michael E. Ryan RV;:ln'!': TrAA R"'mn\l<:>l \.-.dlcir . qI ::( &> .s- tI 0/020? ,,~,'>F,:'t,'i;'t "..\ "..-.-, \....,:1." John M. Freidhoff 441 Berkshire Lane Mechanicsburg, P A 17050 717-766-7068 Fully Insured and Bondable Estimates based on $55.00Ihr plus materials Please review terms and conditions on reverse side :T PI7vv /i-o PF fi'1/l ~ 7 / S 5. /lA/f-/-1c c;::-r .// /Vl t:c/fA- /v' (c: _5"' ,g r.J /L G 17,,1- 6 - ~ 6 ~o 7 I "? 0 S--.5- lSi'LC t:-V . T6 .70 7 F/J-fT. W..#(.ftu/ s/ /1/}~d'1JC^-. fl /- /"7 :3:2 ) f<-oor ,/f/vd ff/~ T 6-~ /~L,~ S //~~ G t<-c-// 4/fz- -.5" 7{) fL kC (J /f #\ /!- (, e- /!-; 7/3 -S', /v1/7Ye- k f:;--r sr ~ ~cc//~/C/7 CJ'4~C --;;; T;fc- /f/1/1-7 d? t' :1 L if- L.h g o'.rc 47'/2000 ->< '-- 77/;1/-/ K- y- 0 tr' -- ~ I I~ ~GV :t' (p) IJ- 1 PPL Eledric: Utilities Rd. AlJenw'Wtl. P A 18104-9392 www.pplelectric.cxlm Summalj' Page Balance as of Septl, 2001 @ 93360-69007 $0.00 UTILITIES Charges $65.31 $65.31 Total Charges Electric Use This maph.shuws your electnc use over the last 13 months. Tvpt'$ or Meter Readings: A,,1ua1 . I:stimated Custumer 0 KWH- 1'1.1' Day ,(; 30 24 18 12 (} () SONDJFMAMJJAS 2006 Momhs 2007 Meter Reading Information !\{e1er#79008683 Sep 10 A,,1ual Ang 20 Actual - ;"- Kwi~Xi- 20506 19863 643 2007 73F 31 Avenge - Sep TL"tUpL'fl!ture KWIl Per Day Yearly Ule: (k1 2005 - &:1' 2006 Cll.::t 2006- Sep 2007 2006 68f 12 Total Aver c [Ill' Mon 4964 414 4814 401 Other important information on back .. REV-1513 EX+ (9-00) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Melva A. Derickson FILE NUMBER 21-07-0225 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Jean C. Hoffman Niece $269,279.00 809 East Walnut Street, Hanover, PA 17031 2. Alice Brommer Niece $269,279.00 502 American Legion Blvd., Pine Grove, PA 17963 .. 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 None 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. St. Mark's Evangelical Lutheran Church $10,000.00 117 West Keller Street, Mechanicsburg, PA 17055 2. Greater Harrisburg Foundation $538,559.00 200 North 3rd Street, Harrisburg, PA 17108 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ $548,559.00 (If more space is needed, insert additional sheets of the same size) .. - .. Last Will of COP~ MELVAA.DERICKSON I, MELVA A. DERICKSON, of Mechanicsburg, Cumberland County, Pennsylvania, make this Will and revoke all of my prior wills and codicils. Article One My Family I am not now married. I have no children, living or deceased. Article Two Distribution of My Property Section 1. Pour-Over to My Living Trust All of my property of whatever nature and kind, wherever situated, shall be distributed to my revocable living trust. The name of my trust is: MELVA A. DERICKSON, sole Trustee, or her successors in trust, under the MELVA A. DERICKSON LIVING TRUST, dated December 26, 2001, and any amendments thereto. In a /)r f(J-. I')'~. .~ Page 1 Section 2. Alternate Disposition If my revocable living trust is not in effect at my death for any reason whatsoever, then all of my property shall be disposed of under the terms of my revocable living trust as if it were in full force and effect on the date of my death. Article Three. Powers of My Personal Representative My personal representative shall have the power to perform all acts reasonably necessary to administer my estate, as well as any powers set forth in the statutes in the Commonwealth of Pennsylvania relating to the powers of fiduciaries. Article Four Payment of Expenses and Taxes and Tax Elections Section 1. Cooperating with the Trustee of My Living Trust I direct my personal representative to consult with the Trustee of my revocable living trust to determine whether any expense or tax shall be paid from my trust or from my probate estate. 1J],oJJ Sfc/ JqL Page 2 Section 2. Tax Elections My personal representative, in its sole and absolute discretion, may exercise any available elections with regard to any state or federal tax laws. My personal representative shall not be liable to any person for decisions made in good faith under this Section. Section 3. Apportionment All expenses and claims and all estate, inheritance, and death taxes, excluding any generation-skipping transfer tax, resulting from my death and which are incurred as a result of property passing under the terms of my revocable living trust or through my probate estate shall be paid without apportionment and without reimbursement from any person. However, expenses and claims, and all estate, inheritance, and death taxes assessed with regard to property passing outside of my revocable living trust or outside of my probate estate, but included in my gross estate for federal estate tax purposes, shall be chargeable against the persons receiving such property. Article Five Appointment of My Personal Representative I appoint the following to be my personal representatives: JEAN HOFFMAN and ALICE BROMMER, or the survivor of them. I direct that my personal representatives not be required to furnish bond, surety, or other security. 1rra,jJ src{ 2y-e / I Page 3 I have initialed all of the pages of this Will, and have signed it on December 27, 2001. ~!(,~ M LVAA. DERICKSON c Py SIGNED, SEALED, PUBLISHED and DECLARED by the above-named Testatrix, MELVAA. DERICKSON, as and for her Last Will and Testament in the presence of us who, at her request, in her presence and in the presence of each other, all being present at the same time, have hereunto set our hands as witnesses. ~~ WITNESS ,-' ~~ ~~A/ COMMONWEALTH OF PENNSYLVANIA) ) ss. COUNTY OF CUMBERLAND ) I, MELVA A. DERICKSON, Testatrix, whose name is signed to the attached or foregoing instrument, having been dilly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ?11~(f,~ ME VAA. DERICKSON Sworn to and subscribed before me by MELVA A. DERICKSON, Testatrix, the 21 tJ.. day of . 1eqJ1(t6/l/ , 2001. ~/ ~k-- Notary Public 7htqJl . / Sf(~/ LoL I Notarial Seal Michael Cherewka, Notary Public I Wormleysburg Boro, Cumberland County , My Commission Expires Feb. 5, 2005 Page 4 Mr-r",her, PernSV'1/3JlIi3 Association of Notaries . " COMMONWEALTH OF PENNSYLVANIA) ) ss. COUNTY OF CUMBERLAND ) We, ~ r 11. and L;z'd~.-c" G L~o~~I,-- , the witnesses whose names are si d to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time eight~en or more years of age, of sound mind and under no constraint or undue influence. ~~~ /\ fJ - h....t~ u , C \. ~~L/ _.. Sworn and SUbSC. fl.'bed before me?y Sr~~ .(..'-..,. c-B-, N~1::..C~d Le","", \ l ..? G L-'Lc___G-.h , Witnesses, thIS 2?f1t day of , , 2001. ~Md~ Notary Public Notarial Seal Michael Cherewka. Notary Public Wormleysburg Boro, Cumberland County My Commission Expires Feb. 5, 2005 Member. PennS\lI';c,'l'" Association 01 Notaries I ~ SICJ Page 5