HomeMy WebLinkAbout01-09-08
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
2 1 0 7
File Number
025 9
Date of Birth
17224 7 607
03132 0 0 7
o 105 1 9 3 0
V A L K
H E LEN
MI
A
Decedent's Last Name
Suffix
Decedent's First Name
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
00 1. Original Return
D 4. Limited Estate
00 6. Decedent Died Testate
(Attach Copy of Will)
D 9. Litigation Proceeds Received
o 3. Remainder Return (date of death
prior to 12-13-82)
4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Return Required
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 0 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
o
o
o
o
8. Total Number of Safe Deposit Boxes
2. Supplemental Return
s u S A N J H A R T M A N
Firm Name (If Applicable)
0 U N C A N & H A R T M A N , P C
First line of address
1 I R V I N E R 0 W
Second line of address
71724 9 7 7 8 0
--- --
REGISTER OF WILLS USE ONLY
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City or Post Office
State
ZIP Code
-n
CAR LIS L E
P A
1 7 0 1 3
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Correspondent's e-mail address:susanhartman@planetcable.net
Under /ties of perjury, I declare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief,
it is and complete. Declaration of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge.
SIG RE OF'PERSON ON~B. lE F . 11ING~. ETURNl
!, ". ,'. .J:.. L~..-/
CARLISLE
PA 17015
DATE
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041125
15056041125
---I
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: HELEN A. VALK
RECAPITULATION
172247607
2. Stocks and Bonds (Schedule B)
.................................. 2.
235789.21
3 2 1 4 7 5.5 8
1 . Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
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. 5 5 7 9 4 . 9 7
. . ... . ....
6. Jointly Owned Property (Schedule F) o Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets (total Lines 1-7) 8. 6 1 3 0 5 9. 7 6
. . . . . . . . . . .. . . . .. . . .. .. . . . . . . . ..
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 6 0 4 9 3. 6 9
. . . . . . . . . .. . . . . . .
10. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I) . . . . . . . . . . . . 10. 5 2 5 2 o . 3 2
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 1 3 0 1 4 . 0 1
12. Net Value of Estate (Line 8 minus Line 11) 12. 5 0 0 0 4 5. 7 5
.. . . . . . . . . . . . . . . . . . . .. . . . . .
13. Charitable and Governmental Bequests/See 9113 Trusts for which 5 0 0 o . 0 0
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 4 9 5 0 4 5. 7 5
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.O _ o . 0 0 15. o . 0 0
16. Amount of Line 14 taxable 4 9 5 0 4 5 . 7 5 2 2 2 7 7 . 0 6
at lineal rate X .04L 16.
17. Amount of Line 14 taxable 5 0 0 o . 0 0 6 0 o . 0 0
at sibling rate X. 12 17.
18. Amount of Line 14 taxable 1 0 0 o . 0 0 1 5 o . 0 0
at collateral rate X .15 18.
19. Tax Due . . . . . . . 19. 2 3 0 2 7 .. 0 6
. . . . . . . . . . . . . . . . . .. . . .. . . .. . . .. . . .... . . . . . . .
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
"S
Side 2
L
15056042126
15056042126
---1
RfV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
HELEN A. VALK
STREET ADDRESS
36 BLUE MOUNTAIN VISTA
File Number
21 07 0259
CITY
MECHANICSBURG
STATE
PA
ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
23,027.06
25,000.00
1,151.35
Total Credits (A + B + C) (2)
26,151.35
3. Interest/Penalty if applicable
D. Interest
E. Penalty
T otallnterest/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. (5)
0.00
3,124.29
0.00
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
0.00
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 00
b. retain the right to designate who shall use the property transferred or its income; ............................... D 00
c. retain a reversionary interest; or ........................... ................................................................... _. D 00
d. receive the promise for life of either payments, benefits or care? ....................................................... D IX]
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........................................................... _... _....................... D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ _ D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..................................................................... ......... .................... D IX]
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 J 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P .S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. 99116 (a) (1.1) (ii)). The statute does not exemDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. ~9116(a)(1)J.
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)
*
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HELEN A. VALK 21 07 0259
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 prooertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
235,789.21
36 BLUE MOUNTAIN VISTA
MECHANICSBURG, PA 17050
[SEE ATTACHED HUD SHEET]
TOTAL (Also enter on line 1 J Recapitulation) $
(:If 1llO~ ~~i~ is needed, insert additional sheets of the same size)
235789.21
REV-1503 EX + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
HELEN A. VALK
FILE NUMBER
21 07 0259
All property joinUy-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
2.
DESCRIPTION
RAYMOND JAMES FINANCIAL SERVICES, INC.
ACCOUNT # 16471183
[DATE OF DEATH ACCOUNTING ATTACHED]
METLlFE 42 SHARES X $60.85
VALUE AT DATE
OF DEATH
318,955.58
2,520.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
321.475.58
~EV-1508 EX + (6-98)
*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HELEN A. VALK
FILE NUMBER
21 07 0259
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.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
DESCRIPTION
PROCEEDS OF ORRSTOWN BANK ACCOUNT # 11100063
VALUE AT DATE
OF DEATH
6,566.97
CASH
235.31
MEDICARE REFUND
130.26
CINGULAR REFUND
20.50
CASH REWARDS CARDMEMBER SERVICES CHECK # 0001932139
50.72
CAPITAL BLUE CROSS REFUND
32.56
PROCEEDS FROM SALE OF PERSONAL PROPERTY
1,190.00
COMCAST REFUND
36.51
MONEYGRAM REFUND
191.81
PROCEEDS OF SALE OF 2000 BUICK PARK AVENUE
[BILL OF SALE ATTACHED]
PROCEEDS OF AUCTION & PRIVATE SALE OF PERSONAL PROPERTY
[BILL OF SALE ATTACHED]
VERIZON REFUND
4,800.00
13,375.51
9.33
METLlFE REFUND
2,949.28
REFUND FROM MATTHEW GAMBER, DC
8.96
REFUND FROM TRAVELERS AUTO POLICY
17.00
PROCEEDS YARD SALE
1,500.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
54775.10
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
HELEN A. VALK
Decedent's Name
Page 1
21 07 0259
File Number
Schedule E - Cash, Bank Deposits, & Misc. Personal Property
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17. PROCEEDS AUCTION 22,959.30
18. PROCEEDS GLASSWARE PURCHASE 150.00
19. PROCEEDS SALE OF PERSONAL PROPERTY 520.00
20. METLlFE DIVIDEND CHECK 31.08
21. SALE OF PERSONAL PROPERTY 520.00
22. SALE OF PERSONAL PROPERTY 300.00
23. ENCOMPASS INDEMNITY COMPANY REFUND 69.87
24. ENCOMPASS INDEMNITY COMPANY REFUND 130.00
SUEHOT AL SCHEDULE E 24,680.25
GRAND TOTAL SCHEllULE E $ 55,794.97
~EV-1511 EX+(12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HELEN A. VALK
FILE NUMBER
21 07 0259
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
HOFFMAN-ROTH FUNERAL HOME & CREMATORY, INC.
14,138.81
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) SUZANNE THALER
Social Security Number(s)/EIN Number of Personal Representative(s) 202 -46-5561
StreetAddress 410 TOUCHSTONE DRIVE
City CARLISLE State PA Zip 17015
Year(s) Commission Paid: 2007
22,145.00
AttomeyFees DUNCAN & HARTMAN, PC
22,145.00
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees REGISTER OF WILLS
507.00
Accountanfs Fees
Tax Return Prepare~s Fees HARTMAN & SCHEUCHENZUBER, CPAS
790.00
DEATH CERTIFICATES
SENTINEL - LEGAL AD
CUMBERLAND COUNTY LAW JOURNAL - LEGAL AD
SHORT CERTIFICATE
HELD IN RESERVE (FILING FIRST & FINAL ACCTG.; ADDITIONAL PROBATE)
53.00
135.88
75.00
4.00
500.00
TOTAL (Also enter on line 9, Recapitulation) $
60 493.69
(If more space is needed, insert additional sheets of the same size)
,
.REV01513EX<(9.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HELEN A VALK
SCHEDULE J
BENEFICIARIES
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. RICHARD A. V ALK Lineal
37 TEABERRY DRIVE 10%
CARLISLE, PA 17013
2. RANDALL L. V ALK Lineal
37 TEABERRY DRIVE 90% IN TRUST
CARLISLE, PA 17013
3. VERNA FULTZ Sibling
100 BRIGHTON DRIVE 5,000.00
CARLISLE, PA 17015
4. SUZANNE THALER Collateral
410 TOUCHSTONE DRIVE 1,000.00
CARLISLE, PA 17013
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. CHURCH OF CHRIST 5,000.00
971 WALNUT BOTTOM ROAD
CARLISLE, PA 17015
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 5000.00
FILE NUMBER
21 07 0259
(If more space is needed, insert additional sheets of the same size)
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US. DEf;'ARTMENT OF HOUSING AND URBAN DEVELOPMENT (OMS # 2502-0265)
A. HUD-1 UNIFORM SETTLEMENT STATEMENT
B. Type of Loan
1.[) FHA 2.[) FmHA 3.[) Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4.[) VA 5.[] Conv. Ins.
C. NOTE: This form furnishes a statement of settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
"(p.o.c.)" were paid outside the closing; they are shown for informational purposes and are not included in the totals.
D. Name & Address of Borrower: E. Name, Address & TIN of Seller: F. Name & Address of Lender:
Pearl E. Camerden Estate of Helen A. Valk
, , ,
G. Property Location: TIN of Seller: I H. Settlement Agent:
36 Blue Mountain Vista Place of Settlement Marlin R. McCaleb, Esq.
Mechanicsburg, PA 17050 1 Irvine Row
Carlisle, PA 17013 I. Settlement Date: 112/31/07
J. Summary of Borrower's Transaction
100. Gross Amount Due from Borrower:
K. Summary of Seller's Transaction
400. Gross Amount Due to Seller:
1 01. Contract sales price 249,900.00 401. Contract sales price $249,900.00
102. Personal Property 402. Personal Property
103. Borrower's settlement charges (line 1400) $5,117.50 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. Co/Mun taxes 12/10/2007 to 12/31/2007 $ 37.85 406. ColMun taxes 12/10/2007 to 12/31/2007 $ 37.85
107. School taxes 12/10/2007 to 06/30/2008 $1,119.30 407. School taxes 12/10/2007 to 06/30/2008 $1,119.30
108. Assessments to $ 0.00 408. Assessments to $ 0.00
109. to $ 0.00 409. to $ 0.00
110. Association Fee 12/10/07 to 12/31/07 136.93 410. Association Fee 12/10/07 to 12/31/07 136.93
111. Sewer 12/10/07 tp 12/17/07 6.51 411. Sewer 12/10/07 to 12/17/07 6.51
112. 412.
113. 413.
120. Gross Amount Due from Borrower $256,318.09 420. Gross Amount Due to Seller $251,200.59
200. Amounts Paid by or in Behalf of Borrower: 500. Reductions in Amount Due to Seller:
201. Deposits or earnest money 1,000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) $15,411.38
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage
205. 505. Payoff of second mortgage
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. Co/Mun taxes to $ 0.00 510. Co/Mun taxes to $ 0.00
211. School taxes to $ 0.00 511. School taxes to $ 0.00
212. Assessments to $ 0.00 512. Assessments to $ 0.00
213. to $ 0.00 513. to $ 0.00
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid By/for Borrower $1,000.00 520. Total Reduction Amount Due Seller $15,411.38
300. Cash at Settlement From/to Borrower 600. Cash at Settlement To/from Seller
301. Gross amount due from borrower (line 120) $256,318.09 601. Gross amount due to seller (line 420) $251,200.59
302. Less amounts paid by/for borrower (line 220) $1,000.00 602. Less reductions in amount due seller (line 520) $15,411.38
303. Cash 101 from 101 to Borrower $255,318.09 603. Cash 101 to 101 from Seller $235,789.21
Substitute Form 1099 Seller Statement
The information in Blocks E, G, H, I & line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being
furnished to the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this item is required to be
reported and the IRS determines that it has not been reported. If this real estate is your principal residence, file Form 2119, Sale or
Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form
4797, Form 6252 and/or Schedule D (Form 1040). You are required to provide the Settlement Agent (named above) with your correct
taxpayer identification number. If YOLl do not provide the Settlement Agent with your taxpayer identification number, you may be subject to
civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct
taxpayer identification number.
(Seller)
(Seller)
L. Settlement Charges
700. Total Sales/Broker's Commission: (based on price) $249,900.00 @ 5% Paid from Paid from
Division of Commission (line 700) as follows: Borrower's Seller's
701. Central Penn Real Estate: 6,272.50 Funds at Funds at
702. ERA-NRT, Inc.: 6,222.50 Settlement Settlement
703. Commission paid at Settlement $ 0.00
704. Commissiom paid at Settlement 12,495.00
800. Items Payable in Connection with loan
801. Loan Oriqination Fee
802. Loan Discount
803. Appraisal Fee
804. Credit Report
805. Lender's Inspection Fee
806. MortQage Insurance Application Fee
807.
808.
809.
810.
811.
812.
813.
814.
900. Items Required by lender to Be Paid in Advance
901. I nterest from I I to I @$ I Iperday
902. Mortgage Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000. Reserves Deposited with lender
1001. Hazard insurance months (j ~ $ oer month $ 0.00
1002. Mortgaqe insurance months (j ) $ per month $ 0.00
1003. City property taxes months ~ ) $ per month $ 0.00
1004. County property taxes months ~ ~ $ per month $ 0.00
1005. Annual assessments months ~ ~$ per month $ 0.00
1006. months G D.$ per month $ 0.00
1007.
1008.
1009. Aggregate Accounting Adjustment
1100. Title Charges
1101. Settlement/c1osina fee
1102. Abstract/title search
1103. Title examination Community Settlement LLC 220.00
1104. Title insurance binder
1105. Document preparation
1106. Notary fees
1107. Attorney's fees Marlin R. McCaleb, Esq.; Susan J. Hartman, Esq. 845.00 P.O.C.
-(includes above item numbers 1101 & 1102; 1101 & 1105
1108. Title insurance Community Settlement LLC 765.00
(includes above item numbers
1109. Lender's coverage
1110. Owner's coverage
1111.
1112.
1113.
1200. Government Recording and Transfer Charges
1201. Recording fees: Deed 38.50 Mortqage Release $ 38.50 $ 0.00
1202. City/county tax/stamps: Deed 2,499.00 Mortgage $2,499.00
1203. State tax/stamps: Deed Mortgage $ 0.00 2,499.00
1204.
1205.
1206.
1300. Additional Settlement Charges
1301. Survey
1302. Pest Inspection
1303. PMI-(Resale Certificate) 150.00
1304. BCCHCA (Initiation Fee) 750.00
1305. BCCHCA (December Association Fee) 193.00
1306. Silver Sprinq Township Authority (Sewer: 09/28/07 to 12/17/oi) 74.38
1307.
1308.
1400. Total Settlement Charges (This Number Transfers to Lines 103 & 502 Above) $5,117.50 $15,411.38
, "
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment For details see: Title 18 U.S.
Code Section 1001 and Section 1010.
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LAST WILL
&
TESTAMENT OF
HELEN .l4. V ALK
HELEN A. V ALK, of Silver Spring 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 any and all other wills and
codicils heretofore made by me.
FIRST. I direct that all my just debts and funeral expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be interred within my family's burial plot in accord
with my expressed wishes.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shaH consider necessary and desirable for the purchase,
erection and inscription of a suitable marker for my grave.
FOURTH. In the event I have not previously given an annuity to the Church of Christ,
then I give and bequeath the sum of Five Thousand ($5,000.00) Dollars unto the Church of
Christ, presently located on the Walnut Bottom Road, Carlisle, Cumberland County,
Pennsylvania.
FIFTH. I give and bequeath the sum of Five Thousand ($5,000.00) Dollars unto my
sister, Verna A. Fultz, absolutely, if she survives me.
SIXTH. I give and bequeath the sum of One Thousand ($1,000.00) Dollars unto
Suzanne },,1. Thaler.
SEVENTH. I give, devise and bequeath all of my estate of whatever nature and
\vherever situate as follows;
10 % unto my son Richard A. Valk and 90 % to my trustee hereinafter named to hold In
Trust for the benefit of Randall L. Valk in accordance with the provisions and conditions as
hereinafter setforth:
A. The Trustee shall invest and reinvest this Trust Estate and shall distribute the
net income (hereinafter called "Income") and principal as follows:
(1) During the lifetime of my son, Randall L. Valk, if he survives me, the
Trustee shall pay the income monthly to him for his benefit, and may expend in addition such
sums from principal as it considers advisable up to ten (10 %) percent per annum, in view of
other readily available f1..mds of ,:vhich it has l<"JlO"wledge, to provide for his welfare and
comfortable support. The trustee shall also pay to my son such portions of the principal as he
requests in writing, not to exceed in anyone calendar year or a noncumulative basis, two (2~;Q)
percent of the aggregate value of the principal as at: December 14, his birthday, PROVIDED
that my son shall only be entitled to this amount if he is gainfhlly employed during the year
prior to making the request. In the event my son is unable to work because of a medical
disability, then this employment requirement will be waived. Upon my son reaching the age of
sixty (60) years, there will no longer be an employment requirement attached to this provision
and he will be entitled to the above distribution of principal upon request in writing.
(2) In the event of the death of my son Randall L. Valk, prior to
complete distribution of the Trust, then upon his death, the Trust or remainder thereof shall be
distributed to Cameron P. Valk and Lauren Mackenzie Valk in accord with the provisions of
Paragraph 14 ofthjs my Last Will and Testament.
(B) No beneficial interest under the Trust, whether in income or principal, shall
be subject to anticipation, assignment, pledge, sale or transfer in any manor, nor shall any
beneficiary have the power to anticipate, encumber or charge such interest, nor shall such
interest, while in the possession of my Tnlstee, be liable for or subject to the debts, contracts,
obligations, liabilities or torts of any beneficiary.
(C) Any income, accrued or undistributed at the termination of any estate or
interest, shall be paid by my Trustee as income to the persons entitled to the next successive
interest in the same proportions in which they take such interest.
EIGHTH. All fiduciaries acting under this Will, whether or not named herein, shall
have the following powers in addition to those vested in them by the common law, by statute
or by the other provisions hereof: all of which shall be exercised in a fiduciary capacity,
primarily in the interests of the beneficiaries, applicable to all property, including property held
for minors, whether principal or income, exercisable without court approval and effective until
actual distribution of all property.
(A) To retain and to hold any securities or other property, real, personal or
mixed, received from my estate without regard to any principal of diversification or risk.
(B) To invest and reinvest in all forms of property, including stocks, bonds,
fiInds and other securities, whether operated by my Trustees, and affiliate or others, without
restriction to investments authorized for Pennsylvania fiduciaries, as they shall deem proper
without regard to any principal of diversification or risk.
(C) To sell at public or private sale, to exchange, or to lease for any period of
time any real or personal property, and to give options for sales, exchanges or leases for such
prices and upon such terms and conditions as they shall deem proper..
(D) To hold property in the name of any of the Trusts created hereunder, or in
the name of my Trustees without designation of any fiduciary capacity, or in the name of a
nowinee or unregistered.
(E) To allocate receipts and expenses to principal or income, or partly to each,
as they from time to time, in their sole discretion, shall think proper.
(F) To vote in person or by proxy all securities, and to become party to any
stockholders' agreement deemed advisable by them in connection with such securities.
(G) To borrow money from any person or institution, including my Trustee or an
affiliate, upon their bond or promissory note, and to secure the repayment thereof by
mortgaging, creating a security interest in, pledging or otherwise encumbering any or all real or
personal property as they, in their sole discretion, shall choose without regard to the
dispositive provisions of this Will.
(H) To make any divisions or distributions required hereunder, wholly or in part,
in kind or in cash, and to make non-prorate distributions of assets in kind.
(1) To exercise any election or privilege given by the Federal tax and other tax
laws, including without limiting the foregoing, the election of the alternate valuation for
Federal Estate tax purposes, the election to claim items of deduction for estate tax or for
income tax purposes, and to make or not to make equitable adjustments or apportionments for
the exercise or nonexercise of any such election or privilege.
(J) Should the principal of any of the Trusts created hereunder be or become too
small so as to make establishment or continuance thereof inadvisable, my trustee, in its sole
discretion, may make immediate distribution of the then remaining balance of the principal and
accumulated income of any beneficiary's share to the legally appointed trustee of such
beneficiary or may appoint and pay such share to a custodian for such beneficiary under the
Uniform Gifts to Minors Act of any state, without further obligation or responsibility for such
distribution so paid. Upon such termination, the rights of all persons who might otherwise
have a successive interest therein shall cease.
(K) To compromise any claim or controversy.
NINTH. In the event a beneficiary under this Will or Trust who is otherwise entitled to
distribution of a bequest or to income or principal from a trust for health maintenance and
support, or both, becomes disabled, as determined in the sole discretion of the executor or
trustees, then and thereafter, while such beneficiary is disabled the executrix or trustee shall
retain such funds in trust and apply the income and principal of such fund, within their
complete and unfettered discretion generally to enhance the like of such beneficiary, but only
to the extent not provided for by insurance or by Federal, State Local or any other assistance
programs of any nature whatsoever, including Supplemental Security Income benefits under
the Federal Income Maintenance Program as then existing. Accordingly, while such
beneficiary is disabled, the income and principal of such fund may be used as judged necessary
and appropriate as a supplement to but not to supplant, such Federal, State, Local and other
assistance and to the extent the income of such bequest or trust is not used, the trustee may
accumulate the income and add it to the principal of such fund. Furthermore, while such
beneficiary is disabled, any right such beneficiary has to withdraw principal of such trust or
receive a distribution of a bequest shall be suspended until such beneficiary is no longer
disabled, again as determined in the sole discretion of the executor or trustees. All such
determinations and decisions by the executor and tnlstees shall be final, and the executor and
trustees shall be indemnified and held harmless from any and all claims resulting from such
determinations and decisions.
TENTH. I appoint Orrstown bank, of Carlisle, Cumberland County, Pennsylvania,
Trustee of the Trust created under Item VII hereof ~Ay Trustee shall be entitled to
compensation for the performance of its services hereunder in accordance with its standard
schedule of fees in effect from time to time during the period over which its services are
rendered. I direct that the situs of said Trusts for administrative and accounting purposes shall
be Cumberland County, Pennsylvania, and all questions concerning the validity, construction
and administration of said Trust shall be determined under the laws of the Commonwealth of
Pennsylvania.
ELEVENTH. I have specifically omitted my son, Ted P. Valk from the provisions of
my Last Will and Testament and have limited the share of my son, Richard A. Valk;> because
both sons are financially stable and will inherit from their father. I love all my sons, any
disparity in inheritance merely reflects a difference in need.
TWELFTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed
upon my estate passing under my \vill or otherwise, shall be paid out of the principal of my
residuary estate.
THIRTEENTH. I hereby nominate, constitute and appoint my sister, Verna A. Fultz,
as Executrix of this my Last Will and Testament. In the event of renunciation, death,
resignation or inability to act for any reason whatsoever of Verna A. Fultz;> I nominate;>
constitute and appoint my niece, Suzanne M. Thaler, as Executrix of this my Last Will and
Testament. I hereby relieve my Executrix from the necessity of posting security in connection
with her duties, as such;> in any jurisdiction in vlhich she may be called upon to act insofar as I
am able by law to do so. In addition to the powers conferred by law, I authorize my Executrix;>
in her absolute discretion, to retain in the form received, and to sell either at public or private
sale any real or personal property oV/ned by me at the time of my death.
FOURTEENTH. If any grandchildren of mine shall be beneficiaries of this, my Last Will
and Testament, and shall be under the age ofthirty-tp..ree (33) at the time of my death, then any
portion of my estate in which they share shall be held in trust for them with Ted P. Valk as
Trustee. The trusteeship shall end \vhen the child attains the age of thirty-three (33) years. As
Tnlstee, Ted P. Valk shall provide for the care:> maintenance and education of said children and
shall from time to time use either principal or income from the inheritance to provide for these
needs.
FIFTEENTH. I have made, or may from time to time make, a written memorandum
expressing my desire to give certain items of personal property to specific persons. I urge my
Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be
stored in conjunction \vith this Will.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
~nrl Tpcot~n1pnt '"'''ncotcot1ng Of'fi'lTP h1pp"l.1l7r:+tpn naO"P~ tbi's 7 d~'lT OF I" ^ ;> f~003
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HELEN A. V ALK "
Signed, sealed, published and declared by the above named Testatrix Helen A. Valk as and
for her Last 'Vill and Testament, iIl the presence of us, \vho, at her request, in her sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
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COll1MONWEALTH OF PENNSYL V ANlA
VC1
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COUiVTY OF CUAfBERLA1VD
I, Helen A. Valk, Testatrix whose name is signed to the attached or foregoing instrument,
having been duly qualified according to lavv, do hereby ack110"wledge 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.
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Sworn or affirmed to and
aCk110\vledged before me, by
Helen A. Valk this '7 rhday
of Nc L"t' JUh{'Q003
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N~tary Public .,/ ..~~~~.': ,/// -' -
NOTARIAL SEAL
Cynthia L Darr, Notary Public
South Middleton Twp., County of Cumberland
My Commissi~~3xpi~:~~~, 14, 2004
COMMONWEALTH OF PENNSYLVANIA
ss.
COU1VTY OF CU1\JBERLAiVD
We, 6"-'..e:..c( "'''\ ,T. HGt"(- -L.vv, C~ y-, and I<;t.:t. t:.\r,~ l., jVh..~ Vvl W\ e ct the
\vitnesses \vhose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw Helen A. Valk sign and
execute the instrument as her Last Will; that she signed willingly and that she executed 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 v/ill as witnesses; and that to the best of our knowledge, the
Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no
constraint or undue influence.
Sworn or affirmed to and
subscribed before me by
:(;' \.J~ ':"", ,,'S He. f,'L ;",":'n and
hC.\t~I, " L, /V',<.( .,; 'Ut ii , 'witnesses,
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this J'haay of her', 2003,
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NOTARIAL SEAL
j Clfnthia L Oarr: Notary' Public,
I ':;nuth Middleton Twp, -, ';(;r}f\r!8nd ~
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