HomeMy WebLinkAbout11-27-07 (3)
REV-1500 EX + (6-ilOl
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0001
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
HORICK
DATE OF DEATH (MM-DD-Year)
PHYLLIS W.
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -07 0 8 8 9
COUNTYCOoE -VEAR- - - NuMBeR- -
SOCIAL SECURITY NUMBER
1 7 - 2 0 - 7 1 9 3
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (date of death prior to 12-13-82)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
'THIS.SEC'\10N.'MUSt.BECOMPt.ETEO,.Att.CORRESPONDENCE'ANDCONFIDEN'\1AttAX lNFORMA'\10N.,SHOULD.'BE"'DIRECTEO'TO:
NAME COMPLETE MAILING ADDRESS
ROGER B. IRWIN ESQUIRE 60 WEST POMFRET STREET
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353 CARLISLE PA 17013
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0.00 X _(15) 0.00
45,379.75 X .045 (16) 2,042.09
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 2,042.09
09/15/2007 03/26/1925
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[Xl 1. Original Retum
o 4. Limited Estate
[Xl 6. Decedent Died Testate (AttachcopyofW.)
o 9. Litigation Proceeds Received
[Xl 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrusij
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
25,439.74
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20. D
, . ',:>'>BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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21 ,578.01
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47.017.75
1,638.00
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(12)
(13)
1 ,638.00
45,379.75
(14)
45,379.75
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Dece ents omple e ress:
STREET ADDRESS 170 PARK STREET
CITY I STATE I ZIP
BENDERSVILLE PA 17306
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
2,042.09
102.10
Total Credits (A + B + C)
(2)
102.10
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check AGENT
0.00
1,939.99
1,939.99
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 lKl
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 lKl
c. retain a reversionary interest; or ...................................................................................................... 0 lKl
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 lKl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 lKl
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 lKl
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knOWledge and belief. it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON R PO E FOR FILING TURN
, ..
ADDRESS 1914 DO
CARLISLE
SIGNATURE OF PRE PARER OTHER THA
ADDRESS
PA 17013
DATE
I Y~I/Il?
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 3%
[72 P.S. 99116 (a) (1.1) (ill.
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 0% [72 P.S. 99116 (a) (1.1) (ii)J.
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 0% [72 P.S. 99116(a)(1.2)],
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S, 99116(a)(1.3)J. A sibling is defined, under Section 9102, as an
individual who hjls at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
HORICK
PHYLLIS
W.
FILE NUMBER
21 07
0889
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
SEWER AUTHORITY SECURITIES - CUSIP #810844 AV2
BEARER BOND #3382
VALUE AT DATE
OF DEATH
5,076.22
2.
NORTHAMPTON BUCKS COUNTY - CUSIP #663722 AQ9
BEARER BOND #2119
5,090.88
3.
NORTHAMPTON BUCKS COUNTY - CUSIP #663722 AQ9
BEARER BOND #2167
5,090.88
4.
NORTHAMPTON BUCKS COUNTY - CUSIP #663722 AQ9
BEARER BOND #2168
5,090.88
5.
NORTHAMPTON BUCKS COUNTY - CUSIP #663722 AQ9
BEARER BOND #2169
5,090.88
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
25.439.74
REV-1508 EX + (6-98)
.
SCHEDULE E
CASH~ BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HORICK
FILE NUMBER
PHYLLIS W. 21 07
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of sUlVivorship must be disclosed on Schedule F.
0889
ITEM
NUMBER
1.
DESCRIPTION
ADAMS COUNTY NATIONAL BANK - CERTIFICATE OF DEPOSIT 166345
VALUE AT DATE
OF DEATH
21.578.01
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
21 578.01
REV-15118<+(12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HORICK
PHYLLIS
Debts of decedent must be reported on Schedule I.
W.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
07
0889
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees IRWIN & McKNIGHT 1,500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees ADDITIONAL PROBATE 100.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. REGISTER OF WILLS - FILING FEE 30.00
10. REGISTER OF WILLS - SHORT CERTIFICATES 8.00
TOTAL (Also enter on line 9, Recapitulation) $ 1 638.00
(If more space is needed, insert additional sheets of the same size)
""-""""''*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
PHYU IS W ?1 07 088!=l
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 ~nclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. JEFFREY C. HORICK Lineal 45,379.75
1914 DOUGLAS DRIVE 1/5TH REMAINDER
CARLISLE PA 17013
2. JENNIFER H. BUCHER Lineal
1544 MUMMASBURN ROAD 1/5TH REMAINDER
GETTYSBURG, PA 17325
3. MARJORIE H. BOTCHIE Lineal
524 LAVINA DRIVE 1/5TH REMAINDER
MECHANICSBURG, PA 17055
4. BRIAN L. HORICK Lineal
10105 GLADSTONE STREET 1/5TH REMAINDER
SILVER SPRING, MD 20902
5. JILL H. LANZA Lineal
448 DARTHA DRIVE 1/5TH REMAINDER
DALLASTOWN, PA 17313
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)
4~
d./~:~\:~~~' E$-:' \~,,-~~ ~~<:l~
,..f>"' >\oJ,; '''J~;:(~',,~'' \~,.,.,-% "'t;,.~,
'l'~("~"~~"""" " ~,
1:~"~Jf;-. ~'t "%t:L;j~1
liNITED Sn.TES Of AMEHlCA
I.AI:KAWANNA COliNTY, I'ENNSYI,VANIA
THE SEWER AUTHORITY OF THE
CITY OF SCRANTON, PENNSYLVANI
"'.Ci..~r.'.";,,
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(IS(;OnpORATED l':\m:n TilE LAWS OF TilE (;OMMONWEALTII OF PE:\NS1'J,VM\'IA)
SEWER REVENUE BOND-SEIUES OF 1968
THE SEWEll AUTHORITY OF THE CITY Of SCRANTON, PENNSYlVANIA (Ihe "AlIthoritv"j, (I bod". co<porol. tlnd J'olil\t orgl>rJil,d by the
Moyor C1"d City Council oOf The Cily af Scranton (the "City") Clnd by ~ub'eqlll!nl joinder, Ih, BQfOUCjh oOf Ounmor. (the "Borough"l orld ui~ting under
th. 10"" 001 Ih~ CommOllwflOlih gf Pennsylvania, lor .,alu. r..ceived, hereby promise I to poy. bul only out 01 the r.vemal, renlal~ and montVI,
en p'o~idt!d i" the Ind.ntur, h.r.ir\ofler mentioned, 10 the beo'er, or jf Ih.it bQnd be te'qi~htad 0\ hereinaHer provid.d 10 the regislered o....n.r
hereof. on APRIL I, 2008. unl.1S Ihi5 bond ~holl be redeemabl. and 111.011 h.av. been duly call.d far pr.viQu~ redempl,on and po,.m.nl of the
redemption pric. mod. Or provid.d for, upon ~urr.nd.r lI.reof, Ih. principallum of
FIVE AND TWENTY ONE.HUNDREDTHS pl. CENT 15,20%1
~ .ll.i1IVHO:: 1{'lillOUSAN"U nD:ll>II~If~.~lJ..{{H Im-~
1$5.,0001 <;Ilia 10 pay, b"t only oul of laid ,,,,,,,niles, r,ntgh ono mon.,.,
inlernl Inereon frgm April 1, IUB 0'1 Ih. rat. of
per ~""um payable semi'onnu~lly on April 1 and Oo;tob., I in each v.ar,
5lClrl,ng October 1, 1968, unlil povnunl of laid principal ~um no~ b~.n
mod. 0' pro"id.d for and, unlil Ih. mah"~ly ntreol, upon pru.nlahcl'!
(Ind I,urrender 01 Ihe ~OUpOIl~ herelo opperlCllnlnq o~th..y sewerollv mature;
Prin~,pol, ,nterelt and premium, if on)". ore payable at the prir,,:lpot offic.
of The Chol. .Manhattan Bonk I Nollonal AI111dalionl /th.- "Trusl..e"),
ar of Clny ~UcC'l<or Irutl.e appaillt"., UII~i!r the Il'ldellhlT.-b-eulnothr m.n-
tioned or at The Philad"lphio Nat,onal Bonk, Pl'lilodelphia, hnn1ylvania
~~l~~)::';~ ~~~i~~o~.~ ~~II~u~r.T:c";' oT~~:U:it:~ \t~~:~o~\ 1~:~r~;. w~~~~-l
at '~e resp.~li.. t,....t!s el payment, .s _lt9al t'l'lo.r lor nle.pay",.~1 0
public ond ~H'''ote debh
Thil bond il one 01 a duly OllthaMtec:f 'bi". of $U:OOe,DOOprin.:ipal
omo,,~t of Se....er Re..,nue Band~ of th,"Authority kllo"'n e$-~'Tb. S,wer__
Authority 01 1", Ctl,. 01 Suanton, ""'ris,I'oll;o, ,S......r lII......iI1Ji, londl-":'
Sertu of 196B" 1111, "5.....r Rev.nu. Idlldl'~I,n1,lmber.d "SIl'l", <:On-
lt~utjYII'IV up..,,'dl and in order al maturity. oll:,of lik. daf., QTTlO"l'It
and tenor, ucepl dl 10 inl.rnt rote, dot" ot:m~u!,ily and pro"ilionl
for redemplion. and 011 iuued und.r al'ld oIt'lqllaIlV, and ratably u.
cured by a trusl indenlure Ith, "lndenture"l do-t.d 01 of !"pril,1, 1"8,
duly e..cuted and delivered by Ihe Authority fo Ih,trulfee. Jhltr-e il
o~se iH\l~d ...ndel the Indentur. an iuue of $2,600,OOQprincipal omoulIl
of lhe S"'....er AS,lelSm!!nt londl-Seri" oflt61 Ith. -"S.....,: Au.u..
me~t BondI") ..h.ch or. ucured ther.und..r btrll'lof "<I...lIy tlnd ratobly
...ilh Ih. Se....er Re..enuI BOndi. R.f.,.nt, h mo.d. to the hld.nhl''e, Qf'>
eucuhd cou"terporl of ....hich h c>>t fit, al -laid prlndpolotlrce of H"
Trust",. lor 0 Itohm!!n! of th,pvrpole1 for whiclt the S.wer Ruellue
8,,~d. 01', illued, Ihe rltV_flUel, ...enlol. and man. 1'1 f'oll1, Qr _in <:on-
neelion ....,!b. tll", Sew.r Sy,lem l)f lh. "'ulnarity Iwhldl hI", by r'ale
doted Aprol 1, lUB. been I.aled 10 the City, and whirh feote and the
renfol, pay?ble therlunder hau b!!en auiq>t.dand pledq.,d 10. th..
Truile.,! wh'ch ha.... b."n pllldQeo, to Itlt! ..t.nt ~'I forth in thelnden.
1\l", lor H'r. poymenl 01 ~l'a. principal ol,,~nd inter..tOIi the S......r
fle..enue Bonds, th" ",ro..i.iani "Ioling to th, ;11!lann of odditionol ......e'
...."nue bondl ....hich sholl b. equCllly altd .ratobly slcu-red ~,.d" the
Ind..nlur. with Ih~ Sewer fl..".nue Bondi hubject 10 thi! prior ,"l~il'l'!$ ot
ce"oin se...er re"'nue bondj of any 'eries to ony Special Sinking Fund
Accounl ,provided Ihu.lorl, In" P'OVilionl r.loting to ol11endmenh ond
modificol,onl 01 th. Ind,,"turl, Ihe dUli'l, obli9aflonl and riqhh of the
:~~ho~i~~n~~d ai' "~~~r~~~:~~ ~~d~~~ '~t~~7~'::\l~he oh~1d~~~ ~~t~h~' s:::;:
fle"'''ue Bond, and 01 Ihe Trullee in relP.d of lueh lecurity and th,
ter"'l ond conddionl IInd.r ....hich th. Se.....' 1I."",II..e' landi, Ofe iuv.d.
N~;tI1H the cred',1 nOr Ih. IC/ling power of the Clfyor th 80rough
0' 01 Ih. Common....ollh of P"nnl~I..<;IniCl or of OIlV' ""litieal 'Iubdi..llion
th.ertof, i, pl..d'!ed lor Ihe p'lyme~1 01 lilt principal of. or Ihe inter..t
on, Or Ihe prem'um, if 'lnv, poyobl. upon the redernptio!l ot Ill,. beno-,
nor I)<,oll Ih., bond b. de.rn"d Cl'l abliqoli.on of Ihe Cify or the Borough
Or 01 .11.. Commonwe'lllh. or of any pol,lic'll lubdiv";on III.r"ol' nor
~ho~! 'he Cily or Ih.. Borougll or the Common....ealth Or a~y politico( sub-
di.."ion Iher.ol. b. liable lor th" pO'l'm.nl of Wt)<, pr>f\tlpol. ,nl.rul
or oremium
S.....er R...venue Bond, ore lubieel to red.mption, prior to maturity
01 Ihe ophon 01 Ihe Authority, 101 01 0 ....hole, on April 1 1~78 or on
onv dol.. th..reafler, Qr Ib\ ,., pari, by lot, Irem o..oiloble "';aneYI in Ih"
land Redemnl;on ond Imora...m.,,1 FU'ld. in the ;n........ order of th..i,
maluritiel, on April 1, 1"1, or on any inl.rest po."m"nl dole th"r...
af/er, purluonl 10 cerlain requiremenh 01 Ih, lnd.nture lor Ihil Serie!.
Ar.'I such redemption 1)<,011 b. upon paym.nl of IlIe opplicClble redllmp.
lion price lei fodh in Ihe folfowin9 ~chedulll, in .acn cau ....ilh a~crued
inlerell'
Redllmplion Per,od
lealh Ooln Incl"t;'I.t
April 1. 197J_Mor<:l1 JI, 1'I1ll.
"pri! I, 1'178-Mar~h 31, 1"1.
"pril', 1'1B3_.Manh 31, 'UB..
April f 1'1B8_Morch 31,1993...
Ap<ill 1"3_March 11,1'''..
Th.reafter
Rede.tI'\plitlll Pritt
IP.rc.ntogeol
PrincipolAmounl1
In Whole In Part
'"
1004 102
103 101
t01 100
101 too
100 lOll
TRUSTEE'S AUTHENTICATION CERTIfICATE
Th.!. bond i,nn" 01 IhebondJ,of tlleS..ri"l d...i,nal"d
till''"'". d..crlb"d In tile ...ilt"n m.nlionl!d ,nd..nl",..
Pf.lnlrd on In. fn...... n""ol II.' comotel. lul of Ihe
oo~njon 01 Mn~tI, rown,..nd. EIl,ott &. MUMOII. PMladd-
phla, ~a, a ".ned on,lnar 01 ...nielt It On tire wilh th...
d~'~:~~I~~~'a~dll;~';~e~ldto~~'t~. obo~~~ ~;I~i~ l~:ri:;~'naf
THE: CHA.SE M..tHIJ.1T".. B,Ii,HK
" ~ a~::~
Autltorlzd Ollie..
Se....i!r Ruenu. Bondi malurinq April 1, 200B, ore 01'0 lubj.ct to re-
~~';'ljtit'tfeU;I~~~' ~~ ~~~fin, r~~u~:~e~;g~f t~~~.~~1:;.lub~; i~nl~a?rOo:,
mOn''I'' in the. S-pe<;ial S-inkillq hr.d Actounl in T)<,. aend Fund pro"jd.d
lor in Ihe Ind.nture,. Up<ln po,.ment 01 109.;,. 01 Ih." princ.lpal omounl
Ih.'"of, and accrued ,nlerul
If leu than all auhtond;nlJ_Se...er RI!v.nue Bo~d, of any on. maturitv
(lfa ,te b. celled 'or redempt'an, under Ony of the for'go,ng pra..ilianl,
the,. the particular _Dondl of luch molurity 10 be ~o called sholl be
ehllllln by lot by UI, Trullee
Any Hlc.h red.rnptiem .noli be upon at I'alt 10 day~' prior lIoliti! bv
pllblica.ion,unl.u luc-h notice il ....ai...d in writing by the holder, of the
Do"ds corled f(jr rtd"rnption, o. plo"ided in Ih" Inde~tur., ond Iholl be
in, Ih., mOMer and ,,~derlhe I.rml and conditionl and ....ilh Ih" .H.ct
provid.d int.... lnd.nfur"
th. A"tllo.-if.,. alld the Tru.t.. mo,. treat Ihe b.arer of Ih;1 bond, or,
If thil,bond be rl!gi,teftd 01 to principal o. herein authorized, the p.nan
in _hosena:me th. 10m,' be ,,,git,.nd, (Ii the oblolute Owner hereol, and
- - th41 "lIar.,_ (It a"y intltTlntt&lIpan GJJp.,tai"ing her"to 01 the ab,olut.
o'!"ne.. 1h.rl!~"....hether !if I'of thlt band or luch coupon Iholl b. Ov..r_
dile, 'or the pvrpoltof -""t".;"in9 payment Ihereof ond far all of her
PIIrpUtt~ whaho.v.r,OfId'1I'1all, not b. ',alfeetO!d by ony lIotic.. to 111.
,on?tory. , ' ,- -'-.
In cast on .....11t- _of delQl,jlt, wilh rupec.t to Ih. Se....er Revenue Bondi
:: rr.r:~~d S:~:( t~~",I:::: tl~~dllh~~le~e~~;~1 ~~~; ~~ inuc~~~ ~ ~~ e O\ln::~ I:~ fO'm~I~
b. dedClrtd or "'a., become due ond payabl, upon th, condilion, a~d in
the tfl.o~n., and wifh the .H.et provided i~ the Indent"re; lubj,ct, ho....
,,,e,, fa fh. rlqht I;Inder "rtain cirelll1'l,tantu of the holde'! of Cl maiarity
ill pri1\eipa\ omollnt ot~uch bondl to annul.l"ch d'c1orolion
AI pto'lid.d by IheMul'llclpoUty A,,'ho"tiu ,t..ct 01 May 2, INS, P.l.
]112, 01 oll'l.nded, thll bond, $holl hove all Ih. ,quo!ili!!s of 0 n"qol'abl.
inltrllrn,,1\t und.rthe low mercllant arid ItI. lQ""1 oi tll. Commonw,ollh of
P..nnlyt..ania relotillg 10 ne9"tiobl" illstrul11enh,
AI lurlher pfo-,.ide4 b,. said Act, thil bo~d, ih Irander and the in~ome
h,,,'rorn .li"cludiilt_81lV profih' mClde on the sol" h"reof! shCl!1 at 0!1
t(mu . b, fr.. (fom-i01iaUon ...."hin the Common.....alfh 01 hnn.yl..anio
No reCOil'" Iholl b. bod for th" paym.nl of Ihe principal 01, Ih.
inler.!t on, 0' fh. premiilm; if any, poyable upon Ih.. redemption aI, Ihil
bond, o~ fc>r C1ny claim baled heri!on or 0" III. tnd.nt"r.. or On Qny ind"!I_
ture IlIppl"menlol tnerela, aljlainlt dny m.mb.r, officer, or employee, PIIII,
pr"eM (lr fufur., af III" "'uthority, or 0' anv lucceslor corporalion, at ,uch,
.ilher dlrettl." or Ihrough the Authority or any lucll corporalian, ....h.,h"
by virlll' of ony con~tilutionol provi~i<;Il\. ~Iahlli! or 1'11\' ci 10...., er bv the
~ If~~ ~ hm~~ ~ ~~ r~~YOHi'cl:: I':~ ~::~ I~: en:t(,'.. i~rq arl;l: ~~ ~ 'J ' 0~1 ~ f ~ ~~ dli\~ ~~ Ii ~~
and os Cantiderotion for Ih, ,"uculion of I~e lndenl~rl and Ihe iHU' 01
Ihi, bo"d and ,"ollpen\.
Thil bond ;1 Ironlf.rable by d.l;"er", unleS! reqislered 01 10 principal
ill th. naml of Ih. o....n.r Oil Ihe boo~1 01 Ih. "ulhority to b. lLept lor
thalpu,po.e otthe office ollh.. Trultee, .uch reqislroJion tob. noted
"ueon bv 1)<,.. 1rusle. on b"holr of Ihe "uthority AII.r ,uch. reqillrotion,
no transfer hereoflha!! b. valid u(lleu mode by.th. rl!gilterl!d owner in
person or bv hi. duly oulhorind ottorney and "milo,ly nOled u!:'on loid
book. and her..a~_ Thil bond. ho..,..", mo,/ b. di~d,(\r'qe.d l.<)f'II aghha_
t;o~ by be,n9, in Ii.. monner, Ironllerred to beor"r o~d Ihi!r.upon franl_
f,robilily by d..)i""ry Ihnll b.. rellored, after ....h.ich I!>is bond may again
from lime to I,mII', b, reqillered or mod. 'ronllerable b,. deli'l.ry 01
b.lore. Such r",qi~\'Q\io!l, 1''':....eH., ,~ol\ n1;l\ off"" the negotiability. ot the
cOuponl for inlu'I' herelo opperlo,ninq, wh,ch .11011 ol"'aYI conl,nue 10
be povoble to bearer ood to b. IrQnderoble by deli"ery mer"ty, o~d
poymenl to Ih.. beore' Ih.."of Iholl fully dilcharge the Authority and the
,"rust.. in nsp.d 0' the inlerut I'nerein menlianed, ....helner or not tlli!
bond be regill.r.d.
Neither thi, bond nor ony (oupon far inlerul h.",o ollach..d ihall b",
"ntill",d to any benef,' under th" Indentur, or be ...arid or betomi! obliq'll_
lory lor "ny purpolt unlil Ihis bond ~hatl ho-... b"en C1ulh.nlicaled bv the
cerlificol. endor..d tler.on duly lign.d by the Trultee or its IUCtU10r
i~ the Ir"ll under Ihe Indenlur.,
/n Wilnul Wheu,of, THE 5-EWER. ~UlHO"\TY OF "THe ell., OF SCRAN_
TON, Pt:NNSYLYANIA, ho. eguled thil bo~d to be liqn.d in ill ngm.
o~d on its bellalf by its Chairman or Vic..Choirman and ill corparot.
II'!:!I or 0 fotl;mile thereof 10 bl! hereunto offind, d"ly aUe,ll!d by ill
S-i!cr"tOfY or "nhtant SecretorI'. ond caupo~s for interut, bearinq the
focsim,l. lignolure of its Tr.asur.., 10 b. aUachi!d 011 as of thl! 1st day
of April, 1'68
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Adams County National Bank
Print Date: Sep. 15,2007
Account Title
Now Account
A~count S~mmary
Account Number Account Type Account Balance Available Balance
605174 Checking 47,161.52 47,161.52
Investment Summary
Investment Investment Investment Investment Last Investment Maturity Last
Interest Renewal
Title Number Type Balance Amount Rate Date Date
12- 166345 Certificate of 21,578.01 809.33 3.740% May. 19, May. 19,
MONTH CD Deposit 2008 2007
Cl,lc,l
!6;)..
.rc71
9'/9
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