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Home My WebLink About12-12-07 -I 15056041169 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 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 'A\ (J b\~~ Date of Birth 204038999 01202007 09081917 HARRIS ROBERT MI H Decedent's Last Name Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix HARRIS MARY MI H Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW !Xl 1. Original Return D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) D 4. Limned Estate D 4a. Future Interest Compromise (date of D 5. Federal Estate Tax Return Required death after 12-12-82) IX] 6. Decedent Died Testate D 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) D 9. Lnigation Proceeds Received D 10. Spousal Poverty Credn (date of death D 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number KAYE H. WISHARD 717-506-3800 Q REGISTER OF WILLS USE - ';'~ 1'-., . ., Firm Name (If Applicable) y ." i -) 821 PAMELAS LANE EAST r,.) ,.--~;; First line of address -,...., Second line of address I.) City or Post Office state ZIP Code DATE FILED MECHANICSBURG PA 17050 PA 17050 DATE /2-11:1-67 MAIN STREET SHIREMANSTOWN, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041169 15056041169 -I ~- -I 15056042160 REV-1500 EX Decedent's Name: ROBERT H HARRIS RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. stocks and Bonds (Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) D Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets (total Lines 1 - 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .. . . . . . . . . . . . .. 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. 12. Net Value of Estate (Line 8 minus Line 11). . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . .. 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 line~1 rate x .04 5 162 , 623 . 95 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 162, 623 . 94 15. 16. 17. 18. 19. TAX DUE ........................................................ 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042160 Decedent's Social Security Number 204038999 168,225.97 211,759.31 379,985.28 38,747.39 38,747.39 341,237.89 15,990.00 325,247.89 7,318.08 24,393.59 31,711.67 D 15056042160 -I REV-1500 EX Page 3 Decedent's Complete Address: File Number 210 7 - 0122 DECEDENTS NAME ROBERT H. HARRIS STREET ADDRESS 4421 PACKARD LANE CITY I STATE I ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 31,711.67 13.154.70 657.74 Total Credits (A + 8 + C) (2) 13,812.44 3. Interest/Penalty if applicable D. Interest E. Penalty Totallnterest/Penalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Une 20 to request a refund. (4) 0.00 5. If Line 1 + Line'3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 17,899.23 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) A. Enter the interest on the tax due. 17,899.23 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASe ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; . . . . .. . .. . .. .. . . .. .. . . . . .. . .. .. . . . . .. . . ... D IX] b. retain the right to designate who shall use the property transferred or its income;. . . . . . . . . . . . . . . . . . .. D 89 c. retain a reversionary interest; or ......................................................... D 89 d. receive the promise for life of either payments, benefits or care? ................................ D 89 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . .. . .. .. . . .. . .. . .. . . .. . . . .. . .. . . . . . . .. .. . .. . . .. . ... D IX] 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? . . . .. D !Xl 4. 'Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D \Xl 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 )Qi)). 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 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)]. 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 ROBERT HARRIS FILE NUMBER 2107-0122 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 exchange 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 NUMBER 1. DESCRIPTION VALUEAT DATE OF DEATH 1 4421 PACKARD DRIVE CAMP HILL, PA 17011 168,225.97 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets oflhe same size) 168,225.97 e sc Pr ftrtff PfLe .J:t- SSW of (2ofRltr HM~IS ~ HMGNT OMB NO. 2502-0265 =f.' A. B. TYPE OF LOAN: Ils..DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.oFmHA 3. OCONV. UNINS. 4. OVA 5.~CONV.INS. 6. FILE NUMBER: 17. LOAN NUMBER: SETTLEMENT STATEMENT 07470 12470761 8. MORTGAGE INS CASE NUMBER: C. NOTE: This ftxm Is furnished to Qivf1 you a sta/emant of actual sattlement costs. Amounts paid to and by the settlement agent are shown. /tams marked "fPOCr ,were paid outside the closing; they are shown here for informational purposes and are not Included in the totals. 1.0 3108 (07470107470116) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Trung a. Nguyen and Estate of Robert Harris M&TBank JoAnn Nguyen One Fountain Plaza 447 North Third Street Buffalo, NY 14203 Steelton, Pa. 17113 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1878915 I. SETTLEMENT DATE: 4421 Pa<:kartI Lane Keystone Land Transfer, Ltd. Camp Hili, PA 17011 October 26, 2007 Cumbertand County, Pennsylvania PLACE OF SETTLEMENT '. 3421 Market Street Camp Hill, PA 17011 J. SUMMARY OF BORROWER'S TAANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GRbSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 184,000.00 401. Contract Sales Price 184 000;00 102. Persona\ProDerlv 402. Personal Pronertv 103. Salllement Charaes to Borrower Ine 1400 6 448.36 403. 104. 404. 105. 405. Ac1Justments For ltams PaId Bv SeHer in advance Adiustments For Items Paid By Seller in advance 106. CltYlTown Taxes to 406. CilvlTown Taxes to 107. eountvTaxes 10126107 to 01101108 86.39 407. Counlv Taxes 10/26107 to 01101/08 86.39 l08.SchooITax lll1261ll7 to 07101108 1,156.51 408. School Tax 10/26/07 to 07101108 1156.51 109. SewerlTrash 10126107 to 01101108 93.60 409. SewerlTrash 10/26107 to 01/01/08 93.60 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNTDUE FROM BORROWER 191,784.86 420. GROSS AMOUNT DUE TO SELLER 185.336.50 200. AM()UN1:S F"A1D' BY OR IN BEHALF ()l: BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. DeDOSIt or eamest""""'" 2,000.00 501. Excess Deooslt ISee Instructions) 202. Princloal Amount of New Loan/s\ 174 800.00 502. SetUement Chames to Seller IUne 1400l 15610.53 203. Ex/sUna loan s\ taken sublAct to 503. ExIsl1nc loanls\ taken sub ect to 204. 504. Payoff of first Mortgage 205. 505. PallOff Of second M~e 206. 506. 207. c 507. DeDosit disb. aSOroceeds\ 208. 508. 209. Seller Assistance 1,500.00 509. Seller Assistance 1 500.00 Adjustments For Items Unoald Bv Sel/er Ad(ustments For Items Unoaid BY Se/ler 210. CltYlTown Taxes to 510. CllvlTown Taxes to 211. CounlvTaxes to 511. County Taxes to 212. School Tax to 512. School Tax to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 178,300.00 . 520. TOTAL REDUCTION AMOUNT DUE SELLER 17,110.53 100. CASH AT SET1'lEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross AmountDue From BorrowerlUne 120) 191 784.86 -601. GroSs Amount Due To Seller IUne 420) 185,336.50 302. Less Amount PaId Bv!For Borrower tUne 220f ( 178,300.00) 602. Less Reductions Due Seller (Une 520) ( 17,110.53 303. CASH ( X FROM)( TO) BORROWER 13,484.86 603. CASH ( X TO)( FROM) SELLER :t68'~;97 The undersigned hereby acknov.1edge receipt of a lXlI1lpleted copy of pages 1 &2 of this statement & any attachments referred to herein. -- f:l:'~;:; J Nguyen 50'" ~rr iJ "1,( ulHd Esta 0 obert arris Z,O 7- DI Z 2... e;~. Of (<.oM , 1Afl-R\ S ~rH A A-rtA-CHMeN T flU;; 1* 1-.10 7" () ( Z ~ '... < L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on PrIce $ 184 000.00 tl1l 7.0000 % 12.880.00 PAID FROM PAlO !'ROM DIvisIon of Commission line 700 as Follows: IlORAOWeR'S saJJ:R'S 701. S 6,415.00 to Re/Max Realty AssocIa1es, Ine. FlJNOS AT FUNOS AT 702. $ 6,465.00 to ERA NRT, Inc. serTU!MENT SI!TTI.J:MENT 703. Commission Paid at Settlement 12,880.00 704. Transaction Fee to Re/Max Realty AssocIa1es, Jne. 295.00 800. ITEMS PAYABlE IN CONNECllON WITH LOAN 801. Loan Orlainallon Fee 0.??oo % to 8Q2. Loan D/$count 0.5500 % to M&TBank 961.40 803. ADOnllSal Fee to Klrchmeyer POC:B35lil.OO 804. CredIt Report to CBC $11.00 L 11.00 805. Lendel's lnspecuon Fee to 806. Mortoaoe Ins. ADD. Fee to 807. AssurTlltlon Fee to 808. 809. 810. 611. 612. Tax Service Fee to First American RETS 72.00 613. Flood Cert Fee to First American FDS 8.00 814. Application Fee to M&TBank 100.00 615. ProcessIng Fee to M&TBank 195.00 81'6, DOCIPrllp Fee to M & T !:lank 400:00 617. 818. 819. 620. 900. ITEMS REQUitED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 10126107 to 11101107 (/il $ 31.727397/day ( 6 days %) 412.46 902.MortoaDe InsUl'allcePremiumfor months to 903. Hazard Insurance Premium for 1.0 vears to 904. .. 905. - 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazatd InsUl'allCe 3.000 months $ 42.67- Der month 128.01 1002. MortoaCIA Insurance months $ 97.60 per month 1003. CltvlTown Taxes months $ per month 1004. Countv Taxes 9.000 months $ 39.22 per month 352.98 1005. SChool Tax 4.000 months $ 141.66 per month 588.84 1006. months $ oermonth 1007. months S oer month 11/08. .Atlot1oaale Al!lustment mollths $ per month -549.Bl1 1100. TITLE CHARGES 1101. Settlement or ClDSlno Fee to 1102. Abstract or Tltie Search to 1103. tle Examlnatinn to 1104. Title Insurance Binder to 1105. DocwmentPreoaration to A & A Abstract 75.00 1106. Nolarv Fees to CASH 25.00 15.00 1107. Allomey's Fees to Includes above item numbers: ) 1108. Title Insurance to Kevstone Land Transfer Ltd:- 1 ?78.75 flncludes above item num~: ) 1109. Lender's Coveraae $ 174,800.00 PAL#106211315 1110. Owner's Coverage :(I 184,000.00 . . PA 1111. cnaorsemenls 100,300,8.1 to KeYStone Land Transfer. Ltd.. 150.00 1112. losing Protection Letter to Keystone Land Transfer, Ltd. . 35.00 1113. Tax Certillcatlons to Keystone Land Transter, Ltd. 5.00 1114. Overnight to Keystone Land ransfer, Ltd. 20.00 1 1 15. Retrieve E Mall Documents to Keystone Land Transfer, Ltd. 25.00 1116. Wire Fee to Keystone Land Transfer, Ltd. 15.00 1117. SewerlRefuse (Oct-Dee) to Hampden Township 128.53 1118. 1200..GOW:RNMENT RECORDING.AND TRANSFER CI;IARGES ~.RecordInoFees: Deed $ 38.50; Mortgage $ 68.50; Releases $ 107.00 1Z202. Gltv/€ounlv TaxlStamos: S 1 840.00, Mortoaoe ~ 840.00 1203;SlateTaxlStamos: RevenlieStamos 1 ,840.00: MortIaae 1.MO.00 1204. 1205. Record POA to Cumberland County Recorder of Deeds 17.00 1300. ADDmONAL SETTLEMENT CHARGES 1301. SUrvev to 1302. Pest InsMCtion to 1303. Home and Pestlnsoection to B & T Insoections Inc. POC:B325.00 1304. Transaction Fee to ERA-NRT. Inc. 165.DO 1305. Home Warranty to AmerlQnHomeSh~d 485.00 1400. TOTAL SETTLEMENT CHARGES (Enter on Unes 103 Section J and 502, Section K) 6.448.36 15610.53 ByIill'*'ll_I"lI1loota_~ the oIgna..... oclcnowledge _plot. COl11Ol8ledcopyor_2 "lI1lo~pog'~b /? ~ ~ystone Land TranSfer, Ltd. Settlement Agent Certilled to be a true copy. (07470 I 07470 /115 ) REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT HARRIS FILE NUMBER 2107-0122 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 2 3 4 5 6 DESCRIPTION MEMBERS FIRST Alc #197838 CITIZENS BANK - VARIOUS ACCOUNTS SETTLEMENT FROM ACCIDENT TOOLS, LAWN MOWER, MISC RINGS AND WATCH FURNITURE, FURNISHINGS, AND HOUSEHOLD ARTICLES ERIE FAMILY LIFE INS - ANNUITY #567-255 VALUEAT DATE OF DEATH 60,579.13 79,442.63 7,500.00 3,000.00 10,000.00 51,237.55 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 211,759.31 ~Tflrr Of Rofp2r HMflS ..st MEMBERS '1st, f!El)E.ft.~ l. (;t:{ il)a~r '("MOl< , valnut Bottom .166 Walnut Bottom Road :arlisle PA 17013~ :nquiries Call: 717-249-4666 Icct XXXXXXX838 HARRIS,ROBERT H :ff: 02/08/07 Date: 02/08/07 ~lr: 0171 Time: 1:32pm CERT 45 59,103.31 06/07/07 59,103.31 0.00 #530169 00 1,475.82 59,103.31 60,579.13 #530170 Ii thch:wl from 19 MONTH 'rev Bal: laturi ty date: mount:: 'ew Bal: :eq: 'eposit to REGULAR SAVINGS 'rev Bal: mount: ew Bal: eq: n ~- lJutll/ tY/~ , Authorized by D Source: ~ Drv Lic ] SigCard ] Known ] Other ,OBERT H HARRIS ~c H. r mfACf1fY1 t1'J-r ..~ " :st MEMBERS 1st ~a)J:;j';t.>\ I 'J{ iPffVMQ.N , Walnut Bottom 1166 Walnut Bottom Road Carlisle PA 1701TY Inquiries Call: ~ 717-249-4666 Acct XXXXXXX838 HARRIS,ROBERT H Eff: 02/08/07 Date: 02/08/07 Tlr: 0171 Time: 1:34pm Withdrwl from Prev Bal: Amount: New Bal: Seq: REGULAR SAVINGS 00 60,579.13 60,579.13 0.00 #530358 Check Disbursed -60,579.13 ESTATE OF ROBERT H HARRIS Ref number: 00 249117 ~ )l1J~ Authorized by ID Source: I&J Drv Lic D SigCard D Known D Other ROBERT H HARRIS ~ACHOVIA BANK> NA Carlisle Financial Center Carlisle DEPOSIT TO ACCT# 2xxxxxxxx1277 AMOUNT $60,579.13 02/08/07 85516 0017 ~ 00DOl75 Time: 01 :48 PI1 Calendar Date: 07.08/07 Deposi t EffectivE Date: G2/DEii07 f(LE -It -l/07 ~DIZL ',st MEMBERS 1st fl$E.\(~\l.(;~~J'~J.Q.!<" : Walnut Bottom 1166 Walnut Bottom Road Carlisle PA 17013tf\ Inquiries Call: tJ; Acct XXXXXXX838 Eff: 02/08/07 Tlr: 0171 717-249-4666 HARRIS,ROBERT H Date: 02/08/07 Time: 1:32pm Deposit to Prev Bal: Amount: New Bal: Seq: Comment for APY Earned REGULAR SAVINGS 00 1,475.54 0.28 1,475.82 #530069 REGULAR SAVINGS 00 0.99% 02/01/07 to 02/07/07 0.28 Share Dividend Authorized by ID Source: D Drv Lic D SigCard D Known D Other ROBERT H HARRIS ~~CHOVIA BANK I NA r_~I~~I~ ~l'n-nc~_1 Cen+e~ ,,",Oll.l.OlC I 0 .lOl \, 1 ('a~ll'~}e ... ,L I .::> DEPOSIT TO ACCT# 2xxx^xxxx 1277 Af1O!vtt--}T $202.39 1}}./11/G7 85516 i:t GDDD356 ..-co;"\.Lr UIJ~O TlittE'; 02:49 Pit Cnl"ew1lar Da'tE: Gj'/i9/t17 D'EPosl't EFfective uatE: 03/19/07 ts-mrr- of ~of!dl HI1f~{S ~Cyt f ATTmtm8V0, MLE k:f ltD 7 rDt Z Z ~. . , .....' , "I ?- SAVE ~;ms. RiJCORD .~ . "'-V--'~':'::'-'.. ,1 . '\. '-., "I~ -".,. ;~' 'Ii," ,$~ 1.;" ,', ~ . ~~~~~,t1NLBSS,~(Jf)l>\r,IS~' .:......... "'1.' :.f) ~. . ~\ ~ '. .," l,', ;" i' ,~. '. ';', '; . ,.~;'"' : ' g C~tizens Bank r;s~ of ~~7y;lrHPMS Date -1. / 8 / 01 Bank/BranchClQ 0 / t~ I . This amount has been charged to your account. Please adjust your records. Name frtu 1L ~... 1?O$>(WG/lAIS Address I: 5 g go... . .051: - \"nc\"r\.II'tu ~C~ { A17A(~Yvlfj\J\ f1 LE # Z /0 7 ~o I Z Z Amount Debited. I $ ;;l (y D d. . 1& For: rJo~ d du..Q -to fief} th Debit Acct. o Q. 0 1/ C(778 \ / ' r lJ(;Li~ Ii Ill} diu ~ r ~~ Citizens Bank Customer Receipt Please be sure to enter this transaction in your records. Transaction Description Date Account Number Amount ~ l&JJ. r~ I 1- 11 375. fer I t 1(P/PO~r '11- r ~~qS~~q ~ . 7-q, 4VJ. ~ 3 -=------ 00602(11E900947 5024 02/08/07 17:32 NX 02/09 SA/IR vJTH{S~Ji F 0060 ,S247287432 1"C302 $311275.19) Funds from your deposit may not be available for immediate withdrawal. All transactions are subject to 22089-BUNKER 8/06 1 M1PK verification as outlined in the rules and regulations of the Bank. Member FDIC a Citizens Bank Customer Receipt Please be sure to enter this transaction in your records. Transaction Description Date Account Number Amount 006029iE900947 5025 02/08/07 17;32 NX 07;,/(...... SA/IF t~TH(SW) F 0060 6140741807 TC302 $161609.77 Funds from your deposit may not be available for immediate withdrawal. All transactions are subject to 22089-BUNKER 8/06 1 M1PK verification as outlined in the rules and regulations of the Bank. Member FDIC ~~ Citizens Bank Customer Receipt Please be sure to enter this transaction in your records. OO19uoqleq Qoql1-t Transaction Description ?OJ.lQ OZ(c4(;)7 Date Account Number rrb, O'"k(oq ~~) e; -rArE Dr fo Pfif-T 'Hm\s . Erie Family Life ~ Insuranc8@ s c~ E ATrfrOilVlelVr PILE #: 2!D7~o/ Z'L ...t, .~, Member Erie Insurance Group. Home Office. 100 Erie Insurance Place. Erie, Pennsylvania 16530 814.870.2000. Toll free 1.800.458.0811 . Fax 814.870.2437 . www.erieinsurance.com February 21, 2007 Gayle George 401 South&32nd Street Camp Hill, PA 17011-5105 Re: Death Claim on Robert Harris Annuity # 567-255 Dear Ms. George Enclosed please find our check in the amount of $50,663.79. This amount represents the net death benefit. The following is a breakdown of how that amount was calculated: $51,237.55 - Gross Death Benefit $573.76 - Less Federal Income Tax Withholding $50,663.79 - Net Death Benefit Please advise the beneficiary, federal law requires us to report this transaction to .the Internal Revenue Service on Form 1099-R. A copy of this form will be mailed to the beneficiary by January 31, 2008. The beneficiary should also be instructed to notify us if they have an addres~ change before that time. Also, the final annuity statement that is mailed to the estate of the deceased will not reflect the withholding amounts shown above. Therefore, the beneficiary should keep this letter for their records. Thank you for your help in handling this claim. condolences to the annuitant's family. If you have any questions, please call me at 1-800-458-0811, extension 2243, or Melody Bokshan at extension 2922. Please extend our Sincerely, S~~ Sally Austin Life Claims Specialist Life Policy Administration SLA: SLA Enclosures: Check(s) *AN05672550* Disclaimet:rrhe info~mation contained in this letter is.intended to give you a general understanding of the manner in which certain Internal Revenue Code provisIons apply to parocular transactions involving Erie Family Life products. This information should not be construed as tax or legal advice bu~ instead, as informational only. The tax treatment of any parocular transaction may vary depending upon your individual circumstances and you are encouraged to consult with your tax advisor or attorney if you have any questions concerning the tax treatment of this or any other transaction involving an Erie Family Life product. The ERIE Is Above Allin Service". We commit, care and serve. It's our true blue promise. f ((()(!;E12-f H~ IS Check Date: 2] .Feb.2007 Invoice Number 0 Vendor Number: Invoice Date Voucher ID ANN567255 SLA 2] .Feb.2007 ANNUITY PROCEEDS Vendor Number 0000]57335 Check Number 40]34937 Date 21.Feb.2007 ... a; ~,.) q"; ,= ....;:: ~) ....- (,.) .'~ ?\:;';'O;a..l ~:::.,.;-., ~- ~) OJ a:r ,: "'1 q_ G:J......., ...:j ~: >- :> "-l~J <::).~- ::l- ~l ~.) 3......,.......... ...:~ n .,~ 07052]71 Vendor Name Estate of Robert Harris 1:: 0", ~~~: :::; ~<c:"'') 2~ ~<~:::I 1:;:;J ~<....::. ,;;) l'<c; '::~ t~W'') ~l: ;<.~+ ~< "',I *~ ..... (..) (..) <$: o ....- ,- a:l f,,) ....- ...-\.....- ",., {j'):::: 'P <:;);) 0:;:' O"i~ ~::' 4J ':; "..:. (:)~.. (." 1'1'~" \t'~J 0:::::' ,~ ',1'.:\ l~: ":1 l~' -:, I,:':, Gross Amount 50,663.79 Total Amount $50,663.79 ~~ ~; o~: f.~. I,::J I~..J 1:"...1 ,'. :..... t....,f ':"..s ,~ I;:;:;' ":1 t"'":1 ':'l'~J 0:::::' fu il.J "",,~ -t-, ,tj !9 1...-1 1.......1 ~u is ""1 ,,- ~u :j.... ;::;. 11) .",,,",, 'r:;l -f""'" ~:::- l) ~IJ ~tJ ~J.... id ';I... l~..) \,U .<t..' ...:-1 i.f\ ~) ;1- i!::\ ~., r(L~ I:F liD 7 - 0 7-2 Check No. 40\34937 Discount Available Paid Amount Total Discounts $0.00 Discounts Taken $0.00 01 01 dJ ,:::: ""i 01 :::1 A::. .., ~s G:l :..... ."'; "')I: ... h Cl $" l._ ~) G:;l "J ~!ll: ,) -.,. J- -~c:; ,:::: G:::I ..l:: ....- 0.00 50,663.79 Total Paid Amount $50,663.79 'W' , . or .~8~T l-lAiJ2l.S SCH f An1+CHfVlef\J( ,<< BUSIness Checkln.g " " 01. 20000181112n 752 130 0 138, ,163,058 WACHOVlA 00056076 _............~.... SNGLP 1111111. J.III...... 11111 f.I..1 ,I ROBERt ~ HARRIS ESTATE CAROLE H HILLER EXEC KAYE H WISHARD EXEC c/o 3G S HANOVER ST CARLISLE, PA 17013 ' CB fr tE It kit) 7:~ 6'1 Z' ~'" , _ ' oiioIiIiiiiiIIi, ~ Busin~ss Checking 3/01/20'07 thru 3/3O/200T " Account number: Account owner(s): 2000018111277 ROBERT H HARRIS ESTATE CAROLE H MILLER EXEC .. . ... KAYE H WISHARD EXEC Account SUmmarY' Opening balance 3/0'1 D~posit,S and 'other credifs' 'Checks" Clo~in~ ba,la:ncc 3/30 $1'I:!5,661.13 7.702.39 + 9.485.30 - $183.878.22 Deposit!fand d'tlu!t Credits Dare', ' '" , AmouNt, Dilscrlpt/on 3/19.',,',' ",:. ".. COUNTER DEPOSIT 3/27, COUNTER DEPOSIT ota Checks ," Dsta Da~ Number Amount D(Jst~a Number Amount Dost 0999 1.501.93 3102 " 1002 ' 170.00 ' 3113 1000' 42.S1 3102 1003 789.95 3/29 1001 438.35 ' "3706 1004 ., "542.46 3/2Y Daily"Batance Summary Dates ' 'Amollnt Dates Datil ' N/Jm~e':~~,,,:.':~',:, , '..~'~~~~~t. ~ -eosssa.. TotaJ . .. ".$9.485.30" , ..', ,,:. AmoIJnt DBt"'~ 3f02 ' 3f06, , .. 178.116.59 ' 177,678.24 1 n.508.24 177.710.63 3/13 3/19 , 1..- Itmounr 3/2:7 .., 1 ~~;21 O.~? 3/29 .., ~' '1a.S,878..2?, " :: WACHOVIA BANK, N.A. . CARLISLE page 1 of 2 REV-1511 EX+ (10-06) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT HARRIS FILE NUMBER 2107-0122 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. 2 DESCRIPTION AMOUNT FUNERAL EXPENSES: MUSSELMAN'S FUNERAL HOME ATTORNEY - LAUKS 8,501.93 300.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. Name of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: Attorney Fees 16,227.35 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees 6. 5. Accountant's Fees 7. 8 9 10 11 Tax Return Preparer's Fees 650.00 PENSION PLAN PAYBACK MARIE HUBER, REAL ESTATE TAXES MSH MEDICAL CENTER CHURCH OF GOD HOME, NURSING HOME UTILITIES TOTAL FROM CONTINUATION SCHEDULE 1,764.70 1,699.93 340.64 2,609.78 843.29 5,809.77 38,747.39 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) ESTATE OF ROBERT H. HARRIS SCHEDULE H PART 7 (PAGE 2) 12 REPAIRS 13 BALANCE DUE ON CREDIT CARD-FLYING J, ECT. 14 MARIE HUBER, COUNTY REAL ESTATE TAXES 15 MARIE HUBER, PERSONAL TAX NOTICE 16 ATTORNEY, ABOM & KUTALAKIS, LAW SUIT 17 HOME INSURANCE 18 MISC TOTAL (CARRY FORWARD TO MAIN SCHEDULE) 204-03-8999 $2,050.03 95.63 470.62 9.80 2,040.13 428.00 715.56 $5,809.77 e;,~O(;- Ro6112T HARRIS )Q\ H fmttoj/(ltN1 FILE: 11 2107-0('<-7- ..PaGC ........--.. 25 Y~rI of Pensoion Protection BETHLEHEM STEEL PENSION PLAN PBGC Case Number: Date Of plan Termination: ~~ 12/18/2002 Benefit Estimation Shown below are the benefits you were receiving prior to the date of plan termination as well as an ESTIMATE of your benefits payable from the Pension Benefit Guaranty Corporation (PBGC) after the date of plan termination. The data used by the PBGC in calculating your monthly benefit was obtained from Bethlehem Steel. We will send you a final dete~~ination of your benefit after we have collected all data and reviewed all plan provisions. Participant's Information participant Name: ROBERT H. ~~RIS Social Security Number: 204-03-8999 Gender: Male Date of Birth: 09/08/1917 Type of Retirement: 30 Year Form of Annuity: Life Annuity Spouse Date of Birth: 09/13/1917, ~ I I L Eligible for Surviving spouse Benefit, Yes I&/J{!)d.k ~~:~_~:~:=~:_~~:~:~_:~~~~_:~_~::=_~=_:~:~_::~~~~::~~n________~-----~ ~37 J()/I ;=:=;;;;;~;;;;:;;;;=;;:;;;:~l:_~=::~_~:::_~f_:=~_::~~~::~;;:~:::~:_ vf~crt( * PBGC Monthly Benefit $1,764.70 PBGC guarantees your benefits up to the limits allowed by federal pension law. There are three limits in the law that may cause your estimated PBGC monthly benefits to be less than the benefits you were receiving from the plan. Your benefit was not affected by any limitations. rf) .'.' \ 'I f/l . L:{I/ , ~ 1V '~ \ f\ \ ' r .1'\ t \1 ~\ \ \.' \ \ /)\ '\)V u ;! .,' l~ \ " \ \J \. \ \, " \& ~~ ". y.... "~te~ ",)- to the promotion 't ~S11l1T~of ~of!;~ H ;;;;;;;;;;;;;;; ~ === - - - --- - --- - Switch to Paperless Statements and eltle will plant a tree on your behalf. By receiving your statement online, you'll be able to: . Reduce paper clutter . Access account information anytime . View and print current and past statements Eliminating just one million paper statements saves 1,500 trees per year. --- ~ --- --- --- - --- ~ ~ Enrol:ing : l Paperiess Statements is fast ane: easy. To register or for more information, visit www.plantatree.citicards.com ~ Cltl Citiqp Dividend Platinum Select~ Card Account Number 5424 1810 3031 0192 Customer Service: 1-800-950-5114 80X'6500 SIOUX FALLS, SD 57117 sale Date Post Date Cash Advance Limit $700 Available Cash Limit $700 Purch/Adv Mlnlmum'Due $20,.OQ,:, , " 1/23 Available Credit Line $1204 Amount Over Credit Line $0.00 + Actlvltv Since Last statement PaYllents, Credits r. Adjustllents AUTOPAY 777770069734025RAUTOPAY AUTO-PMT .'.."....,.1:",." Total Credit Line $2300 Statement/ CID.IRq Date 02/02/2007 Rltfereoee Number Past Due $0.00 + :'~<;;"~~#rf~~"?;;~~" ,"Amount 1/02 1/04 1/14 1123 2/02 1/04 1/04 lZ14 1123 Standard Purch CREDIT PROTECTOR fEE MNTHLY 8009505'114 CVS PHARMACY #1650 Q03 HERSHEY PA fLYING J CARLISLE PA fJ,.Y'~ J. CARLISLE PA .MeS'SEt.MlN fUNERAL HOME LEMOYNE i~A 6NPP335L H8DF4JQl 8F6MJQl Y'6$RX8JF 3.46 3.46 :tour next Autopay automated payment of $1,095.63 will be deducted from your d~~jgnated bank account on 02/22/2007. :rs.;~':t~ry" ",.;0.'" ;P)\Yil'~lollars Total . e.dby Category s',ned this period s Aliailable 57.47 10.96 3.46 14.42 71.89 BonusC~l~f1ir'Bac:klllCl'Y take one to two bi 11 i ng cvcl es to appear Please refer to the specific terms and conditlons pertalning for further,details. oz .j>.Z NZ oz U'1 I OZ wz wz 0-< o. ..... Z Cl:lZ .j>.Z .j>.z o. oz oz ....-< z cffi~ New Balance $1095.63 Minimum Amount Due $20.00 -423.98 ;94,,;2'3' ,2.0(.37 33::03 33.00 1,000.00 Di V Do l1arJl;v:ailab Ie' balance isat least $50, ca 11 us at 90. t?wvm;'Fiticards.com, so that we may send you a check. "!\" ....... "f.....".""" I~.,..; Musselman . Funeral Home & Cremation Sernces, Inc. Established 1895 '" Brian C. Musselman, ED. SUpervisor WiHlam G. Pegan, ED. P.O. Box 137 324 Hummel Avenue Lemoyne, PA1704S.0137 (717) 763-7440 Fax: 717-730~9798 www.musselmanfuneral.com 2007 January 24 PROF. SERVICES,FACILITIES,AUTOS "Sterling" Metal Casket Wilbert 'Continental" Vault Cash Advance Items: Casket spray Copies of death certificate N~wspaper death notices Minister's gratuity Altar flowers Organist bench fee Grave opening ~ closing Tent & grave servicing TOTAL (Paid on account, by Carole Miller SUB-TOTAL : L.w . x:: .= ., :::z::: i;Y"J r::o . L.L1 ~ r-- .....1:::> 13:'= l.l'":l :~<r:~~;ti ~ L&.J _j r-- co :f:!5~~(.:':'~ .Ll-X:: .-0....... . =r.,.. r..... "r'-f : ~ ::r; !Z! i::::: ~ ..:a::: q- :>- .r.... 1.1.., .. --I C-..j c:a r- ......... .~~:n:::'--~ .. c..":I L.I.J ....... .. (..."3 _-I . :;:::. . x:: FOR APPOINTMENT PHONE 717-763-7440 ..",. 1:"'..1 .. r-- ....... ..-t ":e t;.~ ag 'a; f'CI """""'" I:r-. Q. ':_J t:s:>> IS) . M ~....... ::a:. QJ ~ 1:"'-:' ......1;s:J ...1 cr:t 'tl = x:: ..... co :#: ...... '<:f" "'" '-'.J o .. 11:!"" .. . r-t (lJ iJ'-" OJ W QJ .+oJ- j."".i........ (.) -c (.) >. f"t;f r::: 0 of 'tl~- = QJ(.J ,;;:: V'l ;:.., '-.. C.f J;:' -0.... A s:... ':u rJ.I..c::: s::t. r"1$ ::- .:;. !::&........ .,.-j' ""+-.....-a 1ft ~rt:il:..":'''::r::: .;.(11:::;0.. t-- '-=- c:t:: L.LJ 1..&..1 '':/1 C'.C -:t:. a:: r- I3:l = ~ .1 ~3 III :~I""'I =I'l;i (/.1 _...., i~'."'" I::::':' (S) -.0 u..J ISJ r"-- :::> === .=1.1"")= CSI ."".. Q.. ISl~ ~ !~ 1;s:J ". 0;:. ,...-1 ::z:: frLE f:t 2/67~bIZL ,. Feb.20,2007 $3,745.00 1,825.00 1,350.00 $159.00 90.00 456.43 75.00 26.50 150.00 500.00 125.00 ; .~~ j'i2 q:; '" E . ....... . (/.J r,----; , ~ $6,920.00 $1,581.93 $87,~n'1rr9,3' $1,000.00 $7,501.93 f~b~\01 ~a J LflJ es tR11( 6 F fD 6eR-r H ftRt1 c; S G{ ~ Ar11tC~ fYl ~('JI ..~ " ~. FiU:#Z/6 7~O(ZZ. 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 NOTle TAXPAYER'S COPY · KEEP THIS PORTION FOR YOUR RECORDS MUNICIPAL CODE: Hampden Twp BILL DATE: 07/01/07 PROPERTY: 04421 PACKARD LANE BILL NO.: 4095 MAP CODE: 10-20-1846-126 TAXES PAYABLE TO: TAX MILLS: 9.554 Marie Huber ASSESSED VALUE: 181560 y\ ~)Y ;e .~ THIS TAX IS DUE AND PAYABLE, YOU ARE HEREBY~' <.Y \" pO REQUESTED TO MAKE PAYMENT THEREOF. \1 'r ~\ CASH HARRIS, ROBERT & LOUELLA R 4421 PACKARD LANE CAMP HILL, PA 17011 OR CHECK # AMOUNT $ FACE PENALTY 09101107 TO 10131107 11/01107 TO 12/15/07 $1,734.62 $1,908.08 FIRST PAYMENT SECOND PAYMENT FINAL PAYMENT $578.21 $578.21 $578.21 If Paid On or Before If Paid On or Before If Paid On or Before 8/15/07 9/15107 10115107 11586.4095 FULL PAYMENT INSTALLMENT PLAN NO DISCOUNT SEE REVERSE SIDE FOR TAX NOTICE INSTRUCTIONS HOD ')( sfitf ) C/ rz. t:;b r tYf-f,ClS - 1rdJd)(J, 9f .... --::::::::--=:.:..:=-~ + {p, ~ 7' ~ ;1.GoQ ~~<~ I /~ ?;.'>" (t1.f:X?"I' C(90 (00) I 1 "Please do not pay at this time ~eing billed to your co nsurance" ____L .AOJUSTMENTS PAYMENTS 4046.00 $ 4046.00 ji;..~.';:"';'. TO REORDER CONTACT: CONSOLIDATED GRAPHIC COMMUNICATIONS. KEVIN MANN. (570) 368.8866 2/01/2007 2/22/2007 .t .~" I UNITS! REFERENCE # --- --------r------------- I ..1 1. 00 I AMOUNT DATE TRANSACTION DESCRIPTION AME LABELS AYMENT, THANK YOU! 996 5.95 -1812.96 ~ PAYMENTS ADJUSTMENTS i'-I "" TO REORDER CONTACT: CONSOLIDATED GRAPHIC COMMUNICATIONS. KEVIN MANN' (570)368-6866 e;mrr or fo6etl~ fiARRlS SQ{ ).\ Am$~Mt:y'$ T f(LE #:- 2/6 7 r-6/Z Z ,.... 8 N ...... o ..... ...... o ..... N l'.J ............ <J \ \'- o -- ~ :\\: .\.D -.J -- D- \- ~ ~ ~ (I) 'r: r... CJ ::I: :i ci. ~ o o ..0 ~ U III .s::. U III ~ CJ ~ (I) w =r= :Q <../) ~ ~ \- ~ ~ ~ <G ~ k.n ~ 8 "'. \.;;.l.. ........' /2 ~ ~ ~ ~ ... ~E~ s' f; 'f" - '0, ;; ..~ E E '>, \ ~' ...J it "f i ~~ ; ::> .J.-:?; \ 'A - IC .::? "-..I '" 'V < ~ ''I, ;Sv ", -"l ;-....r ~ \::: ':::: -..J~ ~.., =- ~ 'l., ~~ ,'L.V ",;:;, '..0 ..,. '.:... ,--," c~ I':: ~'~ "~ 1:C tC ::t ;-- 1-';. 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'7t'r-Z49 9341 T-406 P.OOZ F-964 eUQ~ncg~ checking ~ Ol 20000~a1~~?' '52 130 o 138 SAFEKEI?T Rcpl~emene Seae~ment 07S ROBERT II IlIUUUS ~Sl'ATE CllR(lI.S II M:tLLER EXEC:: IQYE II WISHlUUl EXEC: C/O 36 S ~QVl;:R ST CARLISLE PA 17013 c:s ~~ine=D Checking l\cCQ\lon1; n\Jl1\bcr: l\ceQ~n1; o","crl~)' 2/0a/200? th~ 2/28/2007 2000018111277 ROBERT Il HARRIS ~'l'll.'l'E C/>.RCtJ;: H M:tLLU EXEC: JQ,Yi: H W:tSffARO =C l\.c:counc. SlIull1lA.t'y Opening b:o.l"""e 2/08 Depo~ic~ :nd ocher "reditc 50.00 190. Gas .55 ~ 5,024.42 - Check:> C1QS1~9 Dalaneo 2/26 ~U$. U~.~3 D~po~ic.~ &nd Oc.ber credlts Dac.e ~OUAt Dsscrlptlon 60,5?9.~3 COUNTER DEPOSIT ?9,4.42.63 COUNTER DEPOSI'r SO. 663 . 79 COlJ~ DEgOSIT ~1~O.685.SS 000008424587708 2/0& 2/09 2/2H T01;i11 0000004226aS052 0000084271iS7i43 Checks N&1ml:ler Amount Date NUmb~r Amount Date Number ~UQC. D:J.r.& 0991 0992 09~ 1,095.6'3 63.64 13.90 2/15 2/16 2/20 0994 0995 0996 1.7&4.70 J.46.00 1.812.,6 2/21 0997 2/22 0998 2/23 TccfU. 120. 7~ 6.B7 55.024.'12 2/22 0~27'919SJ 0851017030 02555937( 2/26 0650722520 02555'3520 SS2?4704~ 0654933190 0~52D2400D Duly B::U.="= Sul1\lll:UY ~t.Co <\mol,lnl; 0......." Amount O::l'CCB .:l.mount 02/08 60,579.13 02/20 138,848.59 02/26 134, ,rn .34 02/09 1'10.021.7& 02/21 ~3?, 0~3. 89 02/20 1B5,661.13 0:!/1S 138,926.13 02/22 lH,817.17 02/16 138,862.49 02/:13 :I.3~. 004.21 WAC:IlOVIA 8.UlK. N .A.. c;IR.,IStJ;: P"'9C 1 of :! ~~' 02~5~m f<9r~m~ria ~l!tf{.s Sm H ~liMl~(\JT IV ILe -/:=:F 2/07'-0/2? 1-406 P.004 F-964 <--- ll=ine"" chccl~lDS 01 ~000018111277 752 130 o 1JB S~FElCE!'T Replacemenc SCGecmCn~ 075 ll.oaO:liT H HARRIS ESTATE CAROLE K MILLER EXEC ~Yli: K WISHARD EXEC c/O 35 S IUlNOVlm ST ~Ie~ Ph 17013 CB lIu"iQ~" ChecKing Ac:C;:Qune numl:ler: Ac:c;:cnme owner(s) : 3/01/2007 ~hru 3/30/2007 2000016J.l1277 ltOll~T It IlAARIS ESTATE CAROI.1i: H MILLl!R E.1CEC lOIYE II WISIIMD EXEC Ac:CQunc summary Opening 'olllance 3/01 S165,661.13 7,70:L39 ~ DCPQ"i~.. ana otner credita Checks' 9,4.85.30 - $183.878.22 CloslDg bA1~c= 3/30 D=PQ~it" ~d o~cr creditB Dat.e ~mouct Descript.ion 3/15 3/27 202.39 COUNTER DEPOSIT 7.S00.00 COONTER DEPOSIT 57,702.35 0000004288108" 000001021592B02 Total Cheelca b1U1l1ber Amount Dat.e Number 0"5 1000 1001 7.501.93 3/02 42.Gl 3/02 430.3!i 3/06 1002 .003 1004 IImounc. Dat.E: NUIlIber .Amount. O:>cc 170.00 3/13 TOIoaJ. \l~,485.30 08504354~0 0952701.280 789.95 3/29 0850438890 0357470530 511:2.4G 3/29 5928920052 5G20S69'/~" i\mount Dac.sa AnIOU:> t. 177.508.2~ 03/27 185.210.63 177,710.G3 03/29 183.878.22 Oaily BalanCE: Sum~ry Cac.Cla AmOl.lnl; Dates 03/02 03/05 178.1lO.59 177,678.24 03/13 03/1~ WP.OIOVIh Ill\NJe. N ...., C1>.RLISLE p"se 1 cf ~ ~~ Oof59~O~a~~~,N.A~CH H Armc~vnf~41 Bueil:lelu. Chec:Ici"9 01 20000~8~~1217 752 130 ROBERT H Hl'.RRIS ES!l'A.1'~ Cl'.ll.OLE H HILLER EXEC: . !CAn: I!: WISWllU:l lO:XE:C C/O 3& S HAN~ ST CAAl.:tSIJ!: I'A 170:1.3 SU~~ncss Checking Account number, JI.c:=t ownerl") : 200001Bl11277 ROBER.'!" H IO\JUUS ElSTA'I'~ CAAOLE H MILLER EXEC !<An: J.I WISIWlD EXEC Ac:c;:oum; SUmmary Qpcning balance 3/31 CI1eck.e Cloaing b~l~nc:c: 4/30 Checks Number Amounc D~t~ Number 1005 10'0. .lil07 13,154.70 "l/19 1l.80 4/25 4'70.62 4/25 .1.008 1009 ~010 Do.ily)~alanc:" SUmm:u:y O...ce& ;>.moun c 06.1:10" 0"l/19 0"l/25 1'70,723.52 170,2i3.10 04/26 04/27 WAClfOVIP, BANI" N' .1<.., c:AIlLtStoE o 138 SAPEKEP'I' CB S193, 878 .22 1.,196,58 . $H7,681.64 /\mounc Dace Numb~~ 107.77 4/27 TOl:al 413.56 4/2(; 2,040.13 1/27 }\lllounc Dal:.... lG9,82.9.5"l 157, G81. 64 f( L-l? J4:: '2-; 0 7 ~ 0 /7 Z- T-40S P.OCS/017 F-9S4 ~epl~cemenc Sc~~cmcn~ 3/31/2007 chru 4/30/2007 Amount: P::al:C $16,1$6.58 }\lllount P"9" 1 of 2. 075 0452534330 2024187261 862~588B1~ 5626039754 862~S88818 02505990"l0 (?711rH3/ OF (<O!6eJZT w Mp, \ Oct-03-Z007 OZ:59pm From-Wachovi:~;~~~t. 3tH H ~~ a~ine=c CheQ~ing 01 2000018111277 757. 130 V~:'Le ~ 7/o7~O/7- L T-406 p.ooe/017 F-964 SJ>.PE.KI! P'l' Repl~cemcn~ S~~tomonc 075 o 138 ROBERT H IWlJtIS ESTATii: C1IROU: H M1= 1i:Xt:c KAYE fI WJ:StlAlW EXEC C/O 36 S ~ ST CARLISLE Pi\. 17013 CB 5UBlneas Checkin9 ACCOUDt number: Account o~ne~IB): 5/01/200, ~hru 5/31/200, 2000018111.277 ItOllZRT H 1Qll.~:tS EST1ITe CAXOLE H MILLER ~C KA~E II WISx;um =C Account:. SUllIllIarY Opening b~13nce 5/01 Cb..ck.e $lb?, b81. 64 300.00 . Closins balance 5/31 ~l6'7 .3 B1. 61 Chocks NUmllsr lOll kmaunl:. C~I:.Q NUmber hmcunc O~te Number 300.00 s/~e Total S300.00 Daily B..J..'!Lnc" su..m.o.ry Cat.c:D I\mount Oat..." AmounT; C;;!tOG cS/u 167,3Bl.6~ WAc::IlOVIA ~, N."'.. Cl\Rl.ISU: l\.mount Date 0:?53 e' 9"'~ 0 Amount ~ge 1 of ;! BJ~ DF '(o6~ KAf((\S SCH Oct-03-Z00T 03:00pm From-Wachovia Bank,N.A. H A1mC~EN\ .pIU~~ '2-/07-017-,7- . T17 Z49 9341 r-406 P.OIO/OIT F-964 ~ue~ess Chccktng 01 2000018111277 7S2 130 o 1;;S SAn:KE1n ReplRcamont St~temeuc 075 ROWUlT H Irol?IS i:S'rATE " c:A.ROLE H MIIJ:.1i:R EXEC lCA.Y2 Ii WISHAAO ltXEC 1. 04 C1.1\.Y RD CARLISLlil Ph 170U c:B BuslnQ~5 checking JlcCO\lllt number; Ac:=?l't owner tel, 6/01/2007 tbru G/29/2007 2000018.U::77 ROlIERT H HAAlUS ESTA:t'12 euou: H MILLER ~c /CAre H WISIliIlW E'XEC l\C:CO\ll1r. Sum_%)' Opening b..l,"llce 6/01 Cheeks CJ.ceing bil).;lllce 6/29 checka Number Amoum: C...te Number 1012 272.96 6/14 :10:1S ).013 UO.22 6/21 1.01.6 :1014 :10.28 G/18 1017 S167, 3e:J.. 64 ~a.4,46" . $166, 357 . :IS OG/21 OG/20 MOW11:. OOltc:: Number A1roo\JJ1c '0:11:: 250.00 6/29 Tot;.l $'S4.46 56262S'SG7 1153n"4S0 281.00 6/21i Ol:Z2,07S6'1 55543s7&50 50.00 6/26 ,5957562350 5G20975802 AmCUTl'l: Ol:1~t:e Amoun'l: 1Gb,976.18 06/29 l'G,J~7.1S lGG,6-47.:U PilUy El~a.nce SUmmary 06/14 06/U ;uqcunt 167, 10S.sa 167,0,S.40 Diil.tes Pil'l:CD WAQlOVl~ BlINK, N.h., ClUU.J:SLIl page 1 of 2 ~\A'Tt~ of ~OBEfL1 HPrRRt S Oct-03-2007 03:00pm From-Wachovia Bank,N.A. :Bue:Lnu.. Cbecl<:ing 01 ~000018111277 752 130 ROBERT II IlARRIS esTATE: CAROLe II MILLeR ~EC KAYE H WISlWtll =c 104 eI.i\lr RD C~LISLE Ph 17013 SUQ~n083 ChecY~n9 Al;:coum; nU1l\l)er: Accoun~ owner(s) : SCH H ~l~fitfr f"1 Le ~ 2J fJ '7.- () I Z f"] T-406 P.012/b17 'F-9g.f '-- o lJe S1\PeKEPT RcpJ.=emcnc SCilcement: CIl 6/30/2007 tnru 7/31/2007 20000181U277 Rom:RT II IlAARIS ESTATE CAROLE Il MILLER exec ICI\YE H WISHAJU) EXile Accou..c.t Su....Cl%)' QpenlD9 balacc.. 6/30 CllocJ(S cloA~ng balance 7/31 Cl>ecko NUmber Juno_c Due Nu.'llber 1018 180.00 7/11 Dil 11 y Dalanc:e Summ:>.ry Dace.. no::l.~=D Moun I:. 07/11 166,217.18 lIAqiOVIA lllINK. N .A. . CilRLISLE $166.397.18 760.00 . SlG5. 637 .16 1\mOUIlt Dace Nwnber 10151 580.00 7/19 Tocol 1\mcUD.t:. C:z;c.ea 07/19 165.637.18 Mount Date $760.00 hooUtl t page 1 of 2 075 942'035974 0%23671737 tJ;tfl~ Df ((D~T Hf1f<R.1S SCH H A1l1tCt4IY1b^JT Oct-03-Z00T 03:00pm~ From-Wachovia Bank,N.A. . IT~f24;- 9341 flU:;; -# 2-/D7-0122- T-406 P.014/01T F-964 Su=ineBS CheC~9 01 2000016111277 752 130 o 138 SAPEJ(UT Replacemen~ s~a~emen~ 075 ROBERT k lii\JlRIS ~TATli: CJ\ROLl! II MILLeR EXEC IQ,YE Ii wXSl'O'\RI) EltEC 104 CIJl.Y aD c;AAI.ISU Pi\. 1 ?013 CB BueincuB Check~og Acc""". nUmber; Aecovnt cwaer(B) , S/01/2007 ehrQ 6/31/2007 20000Ull1277 ROSERT H HARRIS BSTJ\.TE OIROIJ! H MILLER E:;''EC ~YE H wrSHARD EXXC J\.c:caun~ SU1IlIG%y opening bal"oce B/Ol $16S,oJ7.J.B Depo31tS ana other credlt~ c:lleclte ClOB1:>g b<>latlce 6/31 30040 . U2,63S.~4 - .$33,036.64 Dspo~i~B and O~hQr Credits C:aee Amount OeDcrlptl0n 36.40 DEI'OSI'I' 00CCCC62616:l35C S/13 Total .$36.010 Chee>ko Number 1020 1022. 1023 102'1 Junc>UTlt D:o",o NIl,,,,,er Amoun~ Da~e Nwnbcr /'.mOun", Pats 126.53 S/02 1\/25 3.8.B7.5.00 6/17 1030 lG2.0Q 6/27 09S7912860 86276'6157 li2538704( 147.00 s/3.7 1026 16,8'75.00 8/21 To~:>J. $~32,Gn.g4 .5953'57530 13$2125540 76.41 B/16 3.C2SY 3'7,750.00 S/20 0921722152 592B530133 1B.675.00 B/:::1 102~ 37.750.00 6/22 1152'52800 84253S5990 .rndlcG~e" a ~reak in check number Dcquence OiLl.ly 1l001.ance: SU1lllllary o...t;QS 1\mOunc oac.e>; Amount Oat-eo AmcW"l ~ 08(02 08/13 08/16 16$,508.';$ 165,5'17.05 U5,'1?C,64 OB/:I.'I OS/::!O oa/n 146,44B.64 10B,611S.64 70,'48.6'1 09/22 OS/"27 33.:I.~B.64 33,036.0'1 WACHOVI1\ &.wK, N.II... CAALISt.E l?a~e .1 of 2 .~ft; of ~o6fJ21 H~~<; Oct-03-2007 03:01pm - From-Wachovia Bank,N.A. SCH U ~Hr{\nBNL E/LJ~.# Z/07rbIZ2 . n '7h~zI49\9341UVl T-406 P.0167017 F-964 . 8Usin=a~ CheckiQg 01 2000018~~~~77 75~ 130 o 138 SAi"SKEPT Ropl~eemenc SCbtement 075 ROBIl'R!l' H MRRIS J:STA'l'E CAAOLE H 1'III..LEll li:XEC 1QI.;tE II W1SW\At1 ~C 104 CLAY 1m Cl'\lU.I61.l: 1'1L :l. '7013 a"",tneu l:hoc!U.r.g CIil 9/01/2007 thru '/28/2007 ACCOunt nl1lllb=, AteauQ~. owner\Q) ; ~00001nn27'7 ROaERT H HARRIS ESTATE CAROLs H MIUER l:.:mc ~y~ H WIS~ EXEC Aceo...." INrnmary opeaiag baliilJ1ee 9/01 CA...,k:J closing ~.l~nee 9/28 $~3.03G.G4 20,574.'iJ3 - $12.<lG~.71 Chec:lc;/ Number ^tllOunt Date Number hmoun. Dace Number J\.mounc j)"t.c ~Dn ~,6''iJ.9J 9/07 1027" 18,875.00 9/0G Toc~l pO,SH.93 0'25516755 Ol~8'55J22 wInc!ic""c6 a ~re;ol< 1n check number llequCllC6 0~1y 5al&Dcc Summary 0"t06 Mount Dacca Amount D8l:ee 1.mOUllC 0'/0. ~4,l.l,G1 O'iJ/07 12,461.71 WJll:HOVIA SJWlC, N ,A.. c;uu.ISLE p;,\ge 1 oJ: :1 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF ROBERT HARRIS FILE NUMBER 2107-0122 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 JENNIFER K. PARKS GRANDCHILD 12.5% 81Q5 CHERRY LAUREL LANE IRVING, TX 75063 2 MELISSA K. CARRION GRANDCHILD 12.5% 4135 WERTZVILLE ROAD ENOLA, PA 17025 3 ERIC MILLER GRANDCHILD 12.5% 229 GLASS MILL ROAD CHICKAMAUGA, GA 30707 4 ELAINE YORKS GRANDCHILD 12.5% 3800 RIPPLETON ROAD CAZENOVIA, NY 13035 5 KAYE WISHARD DAUGHTER 25.0% 36 S HANOVER STREET CARLISLE, PA 17013 6 CAROLE MILLER DAUGHTER 25.0% 104 CLAY ROAD CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18,AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE FURNITURE, FURNISHINGS AND HOUSEHOLD ARTICLES II 1 10,000.00 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS JUNIATA COLLEGE 1700 MOORE STREET, HUNTINGTON, PA FIRST CHURCH OF THE BRETHREN 219 HUMMEL STREET, HARRISBURG, PA 17110 2,995.00 2 2,995.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 15,990.00 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVAN'IA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 October 18, 2007 Telephone (717) 787-3930 FAX (717) 772-0412 James E. Holland Certified Public Accountant 7 West Main Street Shiremanstown, Pa 17011 Re: Estate of ROBERT HARRIS File Number 2107-0122 Dear Sir or Madam: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before April 20, 2008. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension( s) will be granted that would exceed the maximum time permitted. Sinc /); J. C!i._,-f._A--<-_C'~ \ Claudia Maffei p,ervisor Document Processing Unit Inheritance Tax Division .- I., -..J ~ ~J ~ 'J :::c LAW OFFICES SNELBAKER & BRENNEMAN LAST WILL AND TESTAMENT OF ROBERT H. HARRIS I, ROBERT H. HARRIS, of Hampden Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be ~ ld as soon as practical after my death by my Co-Executrices hereinafter named. 2. As soon as conveniently may be done after my death, and prior to any distribution pursuant to the Third Paragraph of my Will, I give one per centum (1%) of my net estate to each the First Church of the Brethren, 219 Hummel street, Harrisburg, Pennsylvania and to Juniata College, 1700 Moore Street, Huntington, Pennsylvania. The term "net estate" as used above shall mean the value of my estate determined after deducting all charges, deductions, debts and expenses, including expenses of administration, including, but not limited to inheritance taxes. Although the above bequests are made by me in this my Last will and Testament, they are to be considered by the two beneficiaries as contributions from and in the memory of me and my wife, LUELLA R.HARRIS. 3. All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath as follows: A. I give and bequeath twenty-five per centum (25%) of my Estate unto my daughter, CAROLE MILLER, if she survives me; \? I~ (....l ~ ~ LAW OFFICES SNELBAKER & BRENNEMAN B. I give and bequeath twenty-five percentum (25%) of my Estate unto my daughter, KAYE WISHARD, if she survives me; and C. I give and bequeath fifty percentum (50%) of my estate in equal shares unto my grandchildren living at the time of my death, share and share alike. D. If either of my daughters above named shall predecease me leaving lawful issue to survive me, then I order and direct that the share which such deceased daughter would have received had she survived me shall be distributed unto her said lawful issue per stirpes, said issue to take the ancestor's share by representation and not per capita. 4. If neither of my said daughters and none of my grandchildren are living at the time of my death, then in such event, I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed and wheresoever the same may be situate as follows: A. I give and bequeath forty percentum (40%) of my Estate unto my sister, JEAN SWARTZ; B. I give and bequeath forty percentum (40%) of my Estate in equal shares unto the brothers and sisters of my wife, LUELLA R. HARRIS, who are living at the time of my death, share and share alike. c. I give and bequeath twenty percentum (20%) of my Estate unto Juniata College. 5. I hereby nominate, constitute and appoint my daughters, CAROLE MILLER and KAYE WISHARD as Co-Executrices of this my Last Will and Testament with the direction that they are not required to serve with bond in this or in any other jurisdiction. If for any reason either of my said daughters should fail to qualify or -2- LAW OFFICES SNEL6AKER & BRENNEMAN cease so to serve as Co-Executrix, I nominate, constitute and appoint as a substitute Co-Executrix to serve in her place, the oldest surviving child of the daughter who fails to qualify or ceases so to serve. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last will and Testament written on three (3) pages this 11th day of January, 1994. R.-iri>-Uvt j-I . f/ ~~ (SEAL) Robert H. Harris . signed, sealed, published and declared by ROBERT H. HARRIS, the Testator above named, as and for his Last will and Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. y:: .~I .~ , 'V) Z - "'#. I tcr. 1'1 ,'y'Z:4t' f/.' U .- ~", (SEAL) b-- f J7fJ-, (SEAL) -3- LAW OFFICES SNEL8AKER & BRENNEMAN COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) We, ROBERT H. HARRIS, KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last ill and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the resence and hearing of the Testator, signed the Will as witness to the best of his or her knowledge the Testator was at hat time eighteen years of age or older, of sound mind and under no constraint or undue influence. Kd>-fA fl. 11 A~ . / /'1Testator !At(/-1 (1f~t~-1a---- witness ~~;/ V witnej; . Subscribed, sworn to and acknowledged before me by ROBERT H. IS, Testator, and subscribed and sworn to before me by KEITH BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this 11th day of January, 1994. c9~~:U 9. ~ Notary Public NolariaI Seal PalriciaJ. ~Pltlic ~~~31,~ of '1 '::t. ~ 1 ~ LAW 0 FFICES SNELBAKER Be BRENNEMAN CODICIL I, Robert H. Harris, of Hampden Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, declare this to be the one (1) Codicil to my Last will And Testament dated the 11th day of January, A.D., One Thousand Nine Hundred Ninety-four (1994). I hereby add the following to my Last Will And Testament: This addition to my Last will And Testament is made in contemplation of my marriage to Mary Elizabeth Hoover, and shall be effective only in the event I shall predecease her and be married to her at the time of my death. Because of the mutual love and respect we have shared and the commitment we have made to share our lives with each other in an effort to provide an abundant life for ourselves and our families, I give and devise to my wife, Mary Elizabeth Hoover, during her lifetime, my house at 4421 Packard Lane, Camp Hill, Cumberland County, Pennsylvania, together with all of my furniture, furnishings and household articles located therein that she chooses to utilize during the term of her life estate, as well as all insurance thereon. As long as my wife, Mary Elizabeth Hoover, shall use the premises, she shall be responsible for paying all costs associated with such use, including, but not limited to, maintenance, repairs, insurance, mortgages, if any, taxes and special assessments. My wife shall not be required to post bond as the life tenant. Upon the earlier of her death, renouncement of this life estate or the later election of my wife not to use my home as her residence, my Co-Executrixes or Executrix, whichever the case may - ~ ~ ~ .~ j ~ LAW OFF'ICES SNELBAKER & BRENNEMAN be, shall distribute my house in accordance with Paragraph 3 of my Last Will And Testament, or if applicable the aforementioned property shall be distributed in accordance with Paragraph 4 of my Last Will And Testamp.nt. The furniture, furnishings and household articles chosen for use by Mary Elizabeth Hoover shall be distributed in accordance with Paragraph 3 of my Last will and Testament or Paragraph 4 thereof, if applicable, upon the earlier of her death, renouncement of this life estate or the later election of my wife not to use same. Nothing herein shall preclude my wife from removing any items of furniture, furnishings or household items, which are the subject of this life estate, from my home, for her use in any other home, facility or location in which she will reside. Any duly appointed personal representatives or representative is authorized to sell, at public or private sale, any real or personal property of my estate, with the exception of the home, furniture, furnishings and household articles which are the subject of the life estate noted above. Upon the termination of the life estate as set forth above, or its renouncement, my house, furniture, furnishings and household articles may be sold or same distributed in kind as my personal representatives or representative in the exercise of their or her discretion may decide. Any reference in my Last will And Testament to "my daughter", "my daughters", "my grandchildren" and "issue" shall mean and refer to my child.ren, grandchildren and./or issue of and from my marriage to my first wife, now deceased, Luella R. Harris. Paragraph 2 of my Last will And Testament is hereby amended to reflect that the bequests designated in said Paragraph, although made by me, are to be considered by the two -2- L.AW OFFICES SNELBAKER & BRENNEMAN beneficiaries specified therein as contributions from and in the memory of me and my first wife, now deceased, Luella R. Harris. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this the one (1) Codicil to my Last Will And Testament written on Three (3) pages this l(jih day of December, 1994. K ~JI)J ~ Robert H. Harris (SEAL) Signed, sealed, published and declared by ROBERT H. HARRIS, the Testator above named, as and for his Codicil to his Last will And Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. 14 !~~tufr' jp>w.---1 J'l)" (SEAL) (SEAL) -3- LAW OFFICES SNELBAKER & BRENNEMAN COMMONWEALTH OF PENNSYLVANIA) ss. COUNTY OF CUMBERLAND) We, ROBERT H. HARRIS, KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his one Codicil to his Last Will And Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Codicil as witness and that to the best of his or her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Ro-~f/, fJ- ~ I / /'1 Testator {ltl r/1J!tttlttIA witness )~~- ~ 1f;J, l.tne / subscribed, sworn to and acknowledged before me by ROBERT H. HARRIS, Testator, and subscribed and sworn to before me by KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this /~~ day of z9gC$~~' 1994. ~~'<tJQ.~ N ary Public NolilriaI Seal Pal1icia J. Tho.-n::-<:>n. Nota;y Public Mech81~rg !:;v"O, Cumbsrbro Counly My CommisSion Exp'ores Dee. 31 . 1994 . Associallan of