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Home My WebLink About02-08-08 (2) I!! ~ :!!irn u It:~ w&g :r: 1t:-1 U tlD C z o i= ~ ::) Q. :E o o ~ REV-l500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z W C W o W C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) ETTER DATE OF DEATH (MM-DD-Year) ARTHUR DATE OF BIRTH (MM-DD-Year) L. 11/12/2007 05/15/1941 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) [Xl 1. Original Retum o 4. Limited Estate [Xl 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12.12.82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95) OFFICIAL USE ONLY FILE NUMBER 2 -07 0 1 0 66 COuNTYGOoE ---VEA;r-- - - NuMBER- - SOCIAL SECURITY NUMBER 1 6 1 - 3 2 - 3 0 7 9 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Retum (dateofdeathpriorlo12-13-82) o 5. Federal Estate Tax Retum Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach SchO) .... z w c z C A. rn t! It: o U THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND. CONFIDENTIAL T AXJNFORMA TION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS STEPHEN L. BLOOM ESQUIRE 60 WEST POMFRET STREET FIRM NAME (If Applicable) IRWIN & McKNIGHT TELEPHONE NUMBER 717 249-2353 158,318.49 X _(15) 0.00 63,219.27 X .045 (16) 2,844.87 0.00 X .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 2,844.87 CARLISLE z o ~ ::) I- 0: -c: o w ~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested (1) (2) (3) (4) (5) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities. & Liens (Scheduie I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >>BE SURE TOANSWERALlQUESTIONSONREVERSESIDEAND RECHECK MATH c<'< 170,000.00 PA 17013 OF\;:;~ USE ~L~ ] I CfJ (.') ~- ~) -','1 - " .....- I>? 01 C'l 58,439.33 244,204.82 19,050.10 3,616.96 (11) (12) (13) 22,667.06 221 ,537.76 (14) 221,537.76 'uo!jdope JO poolq Aq Ja4ja4M 'IUapa:>ap a41 41!M UOWWo:> U! luaJed auo jSealle se4 04M lenp!^!pU! ue se 'zo ~6 uo!pas Japun 'pau!jap S! 5u!lq!s 'V '[(S' ~)(e)9~ ~69 'S'd U] %Z ~ S! s5u!lq!s s.luapa:>ap a41 jO asn a41 JOj JO 01 sJajsueJI jO anle^ lau a41 uo pasodw! aleJ xel a41 <j '[(~)(e)9~ ~69 'S'd U] (n)9~ ~69 'S'd U U! palou se Ida:>xa '%9Y S! sapep!jauaq leau!l s,luapa:>ap a41 jO asn a41 JOpO 01 sJajsueJI jO anle^ lau a41 uo pasodw! aleJ xela41 '[(Z' ~)(2)9~ ~69 'S'd U] %0 S! 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Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. Signature ~/3 t# Name Address Line 1 Address Line 2 City, State, Zip Dennis B. Etter 39 Pond Road Date Newville, PA 17241 'l7;/IJ r REV-1502 EX + (6-98) ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ETTER ARTHUR L. 21 07 01066 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 orooertv which is iointlv-owned with riaht of survivorshio must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION 726 GRAHAMS WOODS ROAD, NEWVILLE, PENNSYLVANIA APPRAISAL ATTACHED LIFE ESTATE PURSUANT TO PARAGRAPH 2 OF LAST WILL AND TESTAMENT SEE SCHEDULE K VALUE AT DATE OF DEATH 170,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 170,000.00 REV-1508 EX + (6-98) *' '" , SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ETTER FILE NUMBER ARTHUR L. 21 07 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. 01066 ITEM NUMBER 1. DESCRIPTION PERSONAL PROPERTY - APPRAISAL ATTACHED MOTORCYCLE TO MATTHEW B. ETTER $3,395.00, HESS TRUCK TO DENNIS B. ETTER $64.00 VALUE AT DATE OF DEATH 7,149.00 2. REMAINDER ($3.690.00) TO CONNIE M. ETTER 75%, MICHAEL L. ETTER 12.5% AND DENNIS B. ETTER 12.5% CONNIE M. ETTER - $2,767.50 MICHAEL L. ETTER - $461.25 DENNIS B. ETTER $461.25 2001 PONTIAC 5,500.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 12 649.00 REV-1509 EX + (6-98) '* ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ETTER ARTHUR If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. CONNIE M. ETTER B c JOINTL Y.OWNED PROPERTY: SCHEDULE F JOINTLY-OWNED PROPERTY L ADDRESS 726 GRAHAMS WOODS ROAD NEWVILLE, PA 17241 FILE NUMBER 21 07 01066 RELATIONSHIP TO DECEDENT SPOUSE LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DE CD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 07/2003 MEMBERS 1ST FEDERAL CREDIT UNION 661.08 50. 330.54 CHECKING ACCOUNT #207695-11 2. A. 07/2001 MEMBERS 1 ST FEDERAL CREDIT UNION 5,571.89 50. 2,785.95 SAVINGS ACCOUNT #207695-00 TOTAL (Also enter on line 6, Recapitulation) $ 3116.49 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) . .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ETTER ARTHUR SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY L. FILE NUMBER 21 07 01066 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OFTRANSFER ATTACH A COPY OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF APPLlCAELE) VALUE 1. THE HARTFORD FINANCIAL SERVICES GROUP, INC. 58,439.33 100. 58,439.33 ANNUITY CONTRACT #711045273 BENEFICIARIES - CONNIE M. ETTER 75% - $43,829.50 MICHAEL L. ETTER 12.5% - $7,304.92 DENNIS B. ETTER 12.5% - $7,304.91 2. STATE EMPLOYEES' RETIREMENT SYSTEM 238,035.26 100. 238,035.26 0.00 PENSION - NON-TAXABLE BENEFICIARIES - CONNIE M. ETTER 50% - 119,011.(., :> MICHAEL L. ETTER 25%- ~ I ':)("6 ~ J. DENNIS B. ETTER 25% - '5c} I 9::/6 . <61- TOTAL (Also enter on line 7 Recapitulation) $ 58439.33 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ETTER . ITEM NUMBER A. 1. B. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ARTHUR L. 21 07 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: EWING BROTHERS FUNERAL HOME, INC. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: AttomeyFees IRWIN & McKNIGHT Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant CONNIE M. ETTER Street Address 726 GRAHAMS WOODS ROAD City NEWVILLE State PA Relationship of Claimant to Decedent SPOUSE Zip 17241 Probate Fees REGISTER OF WILLS Accountanfs Fees Tax Retum Prepare~s Fees PATRICIA A. ROSENDALE, CPA REGISTER OF WILLS - FILING FEE CUMBERLAND LAW JOURNAL - ESTATE NOTICE THE SENTINEL - ESTATE NOTICE DIVERSIFIED APPRAISAL SERVICES - APPRAISAL ON REAL ESTATE ROY D. GOTTSHALL - APPRAISAL ON PERSONAL PROPERTY TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 01066 AMOUNT 4,534.50 9,750.00 3,500.00 294.00 350.00 30.00 75.00 166.60 300.00 50.00 19050.10 REV-1512,.EX + (6-98) '* SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ETIER ARTHUR L. Include unreimbursed medical expenses. FILE NUMBER 21 07 01066 ITEM NUMBER DESCRIPTION 1. OMAHA BANK - CREDIT CARD VALUE AT DATE OF DEATH 3,616.96 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3616.96 '~""~.I* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER I- I II-I-l ARTHUR I ?1 07 n1nRR 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. CONNIE M. ETTER Spousal 103,105.00 726 GRAHAMS WOOD ROAD LIFE ESTATE NEWVILLE, PA 17241 2 CONNIE M. ETTER Spousal 55.213.49 726 GRAHAMS WOOD ROAD 75% ANNUITY/JOINT ACCTS NEWVILLE, PA 17241 CAR, 75% REMAINDER 3. MICHAEL L. ETTER Lineal 63,219.27 2809 HWY 1110 12.5% ANNUITY/12.5 REM HADDIX, KY 41339-8173 1/3 INTEREST REAL ESTATE 4. DENNIS B. ETTER Lineal 39 POND ROAD 12.5% ANNUITY/HESS TRUC NEWVILLE. PA 17241 1/3 INTEREST REAL ESTATE 5. DANETTE J. LAY Lineal 1002 N. PHEASANT DRIVE 1/3 INTEREST REAL ESTATE CARLISLE, PA 17013 6. MATTHEW B. ETTER Lineal 8 ASCOT LANE MOTORCYCLE 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. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) REV-1514 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on Rev-1500 Cover Sheet . FilE NUMBER ETTER ARTHUR L 21 07 01066 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. 00 Will 0 Intervivos Deed of Trust 0 Other CONNIE M. ETTER 3/9/1948 59 o Life or o Term of Years o Life or DTerm of Years o Life or DTerm of Years 1. Value of fund from which life estate is payable. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 170,000.00 2. Actuarial factor per appropriate table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .60650 Interest table rate - 0 31/2% 0 6% 0 10% 00 Variable Rate 5 % 3. Value of life estate (Line 1 multiplied by Line 2) ......................................... . 103,105.00 o Life or DTerm of Years o Life or o Term of Years o Life or DTerm of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ 2. Check appropriate block below and enter corresponding (number) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( ) 3. Amount of payout per period. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ 4. Aggregate annual payment, Line 2 multiplied by Line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Annuity Factor (see instructions) Interest table rate- 031/2% 06% 010% 0 Variable Rate % 6. Adjustment Factor (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is : Line 4 x Line 5 x Line 6 ............................ $ If using variable rate and period payout is at beginning of period, calculation is : (Line 4 x Line 5 x Line 6) + Line. 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, ARTHUR L. ETTER, of Upper Frankford Township, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. I. I direct that all my legally enforceable debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part - of the administration of my estate. My personal representative shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give, devise and bequeath the right to occupy my residence at 726 Grahams Woods Road, Upper Frankford Township, Cumberland County, Pennsylvania, unto my wife CONNIE M. ETTER, said interest to terminate upon the death of my said wife or upon her remarriage. Upon the termination of said interest, I give, devise and bequeath said residence, in equal shares, unto my sons MICHAEL L. ETTER and DENNIS B. ETTER, and my stepdaughter DANETTE J. LA Y, each of said sons and stepdaughter to hold an undivided one-third (1/3) interest therein as tenants in common, it being my suggestion that said residence then be sold and the proceeds therefrom distributed to said sons and stepdaughter in accordance with their respective interests therein. "" .J. I give, devise and bequeath my 200 I Pontiac automobile or whatever primary automobile I own at the time of my death unto my wife CONNIE M. ETTER. Page I of 5 Pages ,//LF A.L.E. 4. I give. devise and bequeath any checking accounts and savings accounts which I own at the time of my death unto my wife CONNIE M. ETTER. 5. I give, devise and bequeath any financial investments which I own at the time of my death (which investments are currently held through Brookwood Investment Advisors of Carlisle, Pennsylvania) in the following manner: 75% thereof unto my wife CONNIE M. ETTER; 12.5% thereof unto my son MICHAEL L. ETTER; and 12.5% thereof unto my son DENNIS B. ETTER. 6. I give, devise and bequeath my guns and my motorcylce unto my grandson MA TTI-IEW B. ETTER. 7. I give. devise and bequeath my antique Allis Chalmers and Case farm tractors and my H.~s Truck collection unto my son DENNIS B. ETTER. 8. I give, devise and bequeath my motorcycle unto my grandson MATTHEW B. ETTER. 9. I give, devise and bequeath my tools, in joint tenancy with right of survivorship, unto my sons MICHAEL L. ETTER and DENNIS B. ETTER. 10. I give, devise and bequeath all the rest, residue and remainder of my estate, whether real. I personal or mixed property. whether tangible or intangible. and wherever situated, in the following manner: 75% thereof unto my wife. CONNIE M. ETTER; 12.5% thcreofunto my son, MICHAEL L. - -- ETTER; and 12.5% thereof unto my son, DENNIS B. ETTER. Page 2 of 5 Pages j -- /.i,t:; A.L.E. 11. I nominate, constitute and appoint my wife CONNIE M. ETTER and my son DENNIS B. ETTER, or the survivor of them, as Executors of my estate. 12. I direct that my personal representatives shall not be required to file a bond to secure the faithful performance of their duties in any jurisdiction. 13. I authorize and empower my personal representatives, in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments or any property of any nature which lawn at my death; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representatives consider desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my personal representatives shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. Page 3 of 5 Pages ~bJ- A.L.E. IN WITNESS WHEREOF I have hereunto set my hand and seal this 6th day of December, 2005. {~~ ~ c!? L!<- (SEAL) Arthur L. Etter SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testator and of each other. ~~ ~ ")r\..\. "\.o\. l "Yv\. f itTIh, Page 4 of 5 Pages COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) L ARTHUR L. ETTER, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. / /; /,L.L -r cS?-/-./L ";. [d~l ~.. t: t:- ~ ~ Arthur L. Etter COMMONWEALTH OF PENNSYLVANIA Sworn or affirmed to and acknowledged before me by ARTHUR L. ETTER, the Testator, this 6'" day of December, 2005. ;j)f;a tm~ !., /; I ( ,tOn} I Notary Public Notarial Seal Sharon E. Bloom, NoIaIy Public North MIddleton Twp., CIX11bef1and County My Commission Expires August 5. 2006 Member, Pennsylllania Association Of Nolaries ) : SS. COUNTY OF CUMBERLAND ) We, ~ hen L .f?:1wn) and [ronnle (V1. tmV the witnesses whose 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 ARTHUR L. ETTER, the Testator, sign and execute the instrument as his Last Will; that the Testator signed willingly and that the Testator executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testator, signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue innuence. ~ ~~_ Address ::l/,QO ( o~;; (:<'1 /1 /2CJc~~j Cc~-I, Sie... , vit'/ 70 r3 / n \ __ 'i. -.:.t \ ., "'1'- l (! Address '-'{'Iv\. ~JChL / L lc C"-\~~\G. ,\.1\\';'":1 1\ J j,\ I '_I t 1 LQ QIL PA IJ )('('\C'L) \(OCLC) \,ZLJI Sworn or affirmed to and subscri bed before n this 6th day of December, 2005, \ I NotaJi8I Seal s,..~ E. Bloom. NotaIy P\.tAic Ntltth MIdtI~ Twp., Cc.mbeIWId Coooly CmvnIuIon ElCplr8c August 5, 2006 "l'I!I'tm~ AaaodICIon 01 ftiarles C:\SLI3\Oflicc - Estate I'lanning\7.J60.5h-will2dllc Page 5 of 5 Pages . / _.~_.- ..--- APPRAISAL OF REAL PROPERTY LOCATED AT: 726 Grahams Woods Road Deed Book 33C Page 682 Newville, PA 17241 FOR: Arthur Etter Estate 726 Grahams Woods Road, Newville, PA 17241 AS OF: November 12, 2007 BY: Susan B. Burkholder State Certified Residential Appraiser This appraisal was completed to establish value for Estate Tax Purposes Summary Format Form GA1 - "TOTAL for Windows" appraisal software by a fa mode, inc. -1-BOO-ALAMODE Diversified Appraisal Services . n orm eSI enla ~ppralsa epo Flle# 010407E TM DUrDOse of this summaIV aooraisal report is to provide the lender/client with an accurate, and adequately supported, opinion of the market value of the subiect orooertv. PropertY Address 726 Grahams Woods Road City- Newville State PA Zip Code 17241 Borrower n. a. Owner of Public Record Arthur Etter Estate County Cumberland Legal DeSCription Deed Book 33C Paoe 682 Assessor's Parcel # 43-04-0385-017 Tax Year 2007-2008 R.E. Taxes $ 1,924.06 Neighborhood Name n.a. Map Reference 4-385 Census Tract 130 Occupant ~ Owner 0 Tenant o Vacant Special Assessments $ n.a. o PUD HOA$ o per year o per month It Property Rights Appraised ~ Fee Simple o Leasehold o Other Idescribe) Assignment Type o Purchase Transaction o Refinance Transaction ~ Other Idescribe) To establish value for estate tax purposes Lender/Client Arthur Etter Estate Address 726 Grahams Woods Road. Newville, PA 17241 Is the subject property currently offered for sale or has it been offered for sale in the twelve months prior to the effective date of this appraisal? DYes ~ No Report data sourcerSl used, offering price(s), and daters). The subiect was no listed in the Central Penn MLS in the cast Year. I 0 did 0 did not analyze the contract for sale for the subject purchase transaction. Explain the results of the analysis of the contract for sale or why the analysis was not performed. n.a. : Contract Price $ n. a. Date of Contract n. a. Is the property seller the owner of public record? DYes 0 No Data Sourcels) n.a. Is there any financial assistance (loan charges, sale concessions, gift or downpayment assistance, etc.) to be paid by any party on behalf of the borrower? [] Yes o No · If Yes, report the total dollar amount and describe the items to be paid. n.a. Note: Race and the racial composition of the neighborhood are not appraisal factors. Neighborhood Character/sties One-Unit Housing Trends One-Unit Housing Present Land Use % Location 0 Urban o Suburban ~ Rural PropertY Values 0 Increasino ~ Stable o Declinino PRICE AGE One-Unit 70 % . Built-Up 0 Over 75% [:-;(] 25-75% o Under 25% Demand/Supply ~ Shortaoe o In Balance 0 Over Supply $ (000) (yrsl 2-4 Unit % : Growth o Rapid [8J Stable o Slow Marketing Time 0 Under 3 mths ~ 3-6 mths DOver 6 mths 100 Low 2 Multi-Family % . Neighborhood Boundaries The subiect neiahborhood is bordered bv Perry County. Bloserville, Newville 400 High 250 Commercial % ~ Road and Doublina Gap Road. 175 Pred. 50 Other 30 % Neiohborhood Descriotion Rural area with stable ownershio oatterns within reasonable commutino distance to schools. places of worshio. shoPoino and transoortation. Market Conditions lincludina SUDDort for the above conclusions I Marketino condition are oood. The averaoe marketino time is three to six months. Dimensions Irreaular Area .50 acre Shape Irreaular View Averaae SDecific Zonina Classification None zonina Zonina Description Existino use is oermitted in this zone. Zonina Comoliance ~ Leaal 0 Leaal Nonconformina lGrandfathered Use) 0 No Zonino 0 IlIeoal (describe) Is the hiahest and best use of subiect oropertY as imoroved or as oroposed per plans and speCifications) the oresent use? DYes ~ No If No, describe Utilities Public Other (describe) Public Other (describe) Off-site Improvements - Type Public Private Electricity [8J 0 Water 0 [8J Well Street Macadam [8J 0 Gas 0 ~ n.a. SanitaN Sewer r l ~ On site Alley None 0 r 1 FEMA Soecial Flood Hazard Area DYes ~No FEMA Flood Zone X FEMA Mac # 421588 0010 B FEMA Mac Date 4-5-88 Are the utilities and off-site imorovements tvoical for the market area? [8J Yes o No If No, describe Are there any adverse site conditions or external factors (easements, encroachments, environmental conditions, land uses, etc.)? DYes [8J No If Yes, describe General Description Foundation ExterIor Description materiaJs/condition Interior materials/condition Units ~ One 0 One with Accessorv Unit [8J Concrete Slab o Crawl Soace Foundation Walls Cone block/Ava Roors Wood/Good # of Stories 1 o Full Basement ~ Partial Basement Exterior Walls Vinvl sidino/Avo Walls Drvwall/Good Type ~ Det. 0 Att. 0 S-Det./End Unit Basement Area 1 188 SQ.ft. Roof Surface Shinales/Ava TrimJRnish Wood/Good [8J Existino 0 Proposed 0 Under Const. Basement Finish 0 % Gutters & Downspouts alum/Ava Bath Floor Vinvl/Good Design ISMe) Ranch o Outside Entrv/Exit o Sump Pump Window Tvoe Dbl-huno/Good Bath Wainscot Drvwall/Good Year Built 1960 Evidence of o Infestation Storm Sash/Insulated Insulated/Good Car Storaae r T None Effective Aoe rYrSl 10 years o Dampness o Settlement Screens Yes/Good ~ Drivewav # of Cars 2 Attic r 1 None Heatino [Xl FWA Ir 1 HWBB Ir l Radiant Amenities r l Woodstove(s) # Driveway Surface Macadam o Drop Stair o Stairs o Other I Fuel Elec [2J Fireplacels) # 1 o Fence [8J Garage # of Cars 2 o Floor [2J Scuttle Coolina [8J Central Air Conditionina ~ Patio/Deck Cone ~ Porch Covered II 1 Caroort # of Cars o Finished o Heated o Individual lr 1 Other o Pool o Other ~ Att. o Det. o Built-in . Appliances [Xl Refrigerator ~ Range/Oven [8J Dishwasher o Disposal o Microwave o Washer/Dryer o Other (describe) - Finished area above orade contains: 5 Rooms 2 Bedrooms 1 Bath(S) 1,638 Sauare Feet of Gross Living Area Above Grade ; Additional features (soecial enerav efficient items, etc. I. 2-car detached aaraoe. storaoe shed. - Describe the condition of the prooerty-Oncluding needed repairs, deterioration, renovations, remodeling, etc.). All improvements are considered to be in averaae to loood condition. Are there any PhYSical deficiencies or adverse conditions that affect the Iivabilitv, soundness, or structural intearitv of the prooerty? r l Yes [Xl No If Yes, describe Does the propertyoenerallY conform to the neighborhood (functional utilitY, sMe, condition, use, construction, etc.)? I'X1 Yes n No If No, describe U if R 'd f I A IR rt :reddie Mac Form 70 March 2005 Page 1 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-800-ALAMODE . m arm eSI enla lppralsa epart Aiel 010407E There are 0 comoarable orooerties currently offered for sale in the subiect neighborhood ranging in orice from $ 0 to $ 0 There are 3 comoarable sales in the subiect neighborhood within the Past twelve months ranging in sale Plice from $ 179,900 to $ 184 900 FEATURE I SUBJECT COMPARABLE SALE # 1 COMPARABLE SALE # 2 COMPARABLE SALE # 3 Address 726 Grahams Woods Road 205 Alters Road 196 Lawrence Lane 342 Bloserville Road Newville, PA 17241 Carlisle Carlisle Carlisle Proximity to Subiect 4.89 miles 5.10 miles 2.51 miles Sale Price $ n.a. $ 183,000 $ 179 900 $ 184 900 Sale Price/Gross Uv. Area $ sQ.ft. $ 116.86 sQ.ft. $ 119.30 sa.ft. $ 137.57 sQ.ft. Data Source (s) Courthouse Courthouse Courthouse Verification SOUrce(5) MSL MLS MLS VALUE ADJUSTMENTS DESCRIPTION DESCRIPTION +(-) $ Adjustment DESCRIPTION + H $ Adjustment DESCRIPTION +(-) $ Adjustment Sales or Financing None known None known Closing cost -4,000 Concessions Conventional Conventional FHA Date of Salemme 5-9-07 9-24-07 6-29-07 Location Averaae Similar Similar Similar Leasehold/Fee Simple Fee SimOle Fee SimOle Fee SimOle Fee Simole Site .50 acre .78 acre -1,400 1 .4 acre -4 500 1 . 18 acre -3,400 View Averaae Similar Similar Similar Design (StY'e) Ranch Ranch Ranch Ranch QualitvofConstruction Vinvl BrickNinvl -5 000 Vinvl sidina BrickNinvl -5 000 Actual Age 47 vears 19 vears -5 000 11 vears -5 000 33 vears Condition Ava to aood Similar Similar Similar Above Grade Total I Bdnns.1 Baths TotallBdnns.1 Baths Total I Bdrms. Baths Total BdrmsJ Baths Room Count 5 I 2 I 1 6 1 2 I 2 -4,000 6 , 3 2 -4 000 7 I 3 11.5 -5,000 Gross Uving Area 1 638 sQ.ft. 1,566 sq.ft. 1,508 sQ.ft. +3 900 1,344 sa.ft. +8 800 Basement & Finished 1,188Sq.Ft. Full bsmt -3,000 Full bsmt -3,000 Full bsmt -3,000 Rooms Below Grade 0 None 50% finished -5,000 50% finished -5,000 Functional Utility Averaae Similar Similar Similar . Heating/Coolina Fha Oil, CA Elec bsbd +3 000 Ht oumo. CA EBB, wall units +2,000 ~ Energy Efficient Items None None None None : Garaae/Carport 1-car att aaraae 2-car aaraae -5 000 2-car int aaraae +1 000 2-car aaraae -5,000 . Porch/Patio/Deck Porch patio Porch, deck Porch, coal sty Porch sun orch -2,000 . Shed fireplace Shed fireolace None +2 000 None +2,000 . 26' X 30 dt oar None +8,000 None +8,000 None +8 000 . . · Net Adjustment (Total) 0+ ~. $ 12,400 0+ k8J. $ 6,600 0+ ~- $ 11600 Adjusted Sale Price Net Adj. 6.8% Net Adj. 3.7 % Net Adj. 6.3 % of Comparables Gross Adj. 18.8 % $ 170600 Gross Adj. 20.2 % $ 173 300 Gross Adj. 28.8 % $ 173 300 . I [)<J did [J did not research the sale or transfer history of the subject property and comparable sales. If not, explain My research o did ~ did not reveal any prior sales or transfers of the subject property for the three years prior to the effective date of this appraisal. Data Source (s) Assessment records My research o did ~ did not reveal any prior sales or transfers of the comparable sales for the year prior to the date of sale of the comparable sale. Data Source(s) Assessment rec09rds Report the results of the research and analysis of the prior sale or transfer history of the subiect property and com arable sales (report additional prior sales on page 3). ITEM SUBJECT COMPARABLE SALE #1 COMPARABLE SALE #2 COMPARABLE SALE #3 Date of Prior Sale/Transfer 12-23-87 9-16-99 8-4-05 10-21-01 Price of Prior Sale/Transfer $900 $117,000 $0 $110300 Data Source(s) Courthouse Courthouse Courthouse Courthouse Effective Date of Data Source(s) 1-08 11-07 11-07 11-07 Analysis of prior sale or transfer history of the subject property and comparable sales No sale has taken olace in the past three years for the subiect orooerty or the comoarables in the past vear. Summary of Sales Comparison Approach A $2,000 oer room adiustment was made for the total number of rooms, $2,000 oer bath and $1 000 per half bath. I Indicated Value by Sales Comparison Approach $ 170 000 Indicated Value by: Sales Comparison Approach $ 170 000 Cost Approach (if developed) $ n.a. Income Approach (if developed) $ n.a. I The Sales Comoarison aooroach beina considered the most accurate in arriYina at mv final ooinion of value. The Income aooroach was not ; considered since this is an owner occupied sinale familv dwellina. The Cost aporoach was considered to be unreliable since this is not new construction and may be misleadina to the reader. This appraisal is made k8J "as is", o subject to completion per plans and specifications on the basis of a hypothetiCal condition that the improvements have been . completed, 0 subject to the following repairs or alterations on the basis of a hypothetical condition that the repairs or alterations have been completed, or 0 subject to the · followina reauired inspection based on the extraordinary assumption that the condition or deficiency does not require alteration or repair: Aopraised in current condition. Based on a complete visual insP..8Ctlon of the interior and exterior areas of the su~ect pro~ defined scope of work, statement of assumptions and limiting conditions, and appraiser's certification, my (our) opinion of the market value, as efined, of e real property that Is the subject of this report is $ 170000 . as of November 12, 2007 which Is the date of inspection and the effective date of this aDDra/sal. U Of R od f I A IR 'reddie Mac Form 70 March 2005 Page 2 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-BOO-ALAMODE 9 m arm eSI enla lppralsa epa File # 010407E See addendum. . . . . . . COST APPROACH TO VALUE (not required by Fannie Mae) Provide adequate information for the lender/client to replicate the below cost figures and calculations. Support for the opinion of site value (summary of comparable land sales or other methods for estimating site value) The Cost approach was considered to be unreliable since this is not new construction and due to the lack of land sales. ESTIMATED r ] REPRODUCTION OR r ] REPLACEMENT COST NEW OPINION OF SITE VALUE --. .___ ...uh_____.... m. m.__________.____________.__. =$ ; Source of cost data DWELLING Sq.Ft. @ $ __.m______ =$ . Quality rating from cost service Effective date of cost data Sq.Ft. @ $ ------.-- =$ . : Comments on Cost Approach (gross living area calculations, depreciation, etc.) __.m.____ =$ Garage/Carport Sq.Ft. @ $ .____m.. =$ . Total Estimate of Cost-New __.____h. =$ Less Physical I Functional I Extemal Depreciation I I =$( 1 Depreciated Cost of Improvements _uu.__u_____..u.....u .m.m.m____.. =$ "As-is" Value of Site Improvements -... ------..... -0.. _'___"n.__. --------.--. =$ Estimated Remaining Economic Ufe (HUD and VA only) Years INDICATED VALUE BY COST APPROACH _....u... "..----..------- .____.m____ =$ INCOME APPROACH TO VALUE (not required by Fannie Mae) ; Estimated Monthly Market Rent $ X Gross Rent Multiplier =$ Indicated Value by Income Approach . Summary of Income Approach (including support for market rent and GRM) I PROJECT INFORMA nON FOR PUDs Of applicable) Is the developer/builder in control of the Homeowners' Association (HOA)? r J Yes o No Unit type(s) r J Detached r l Attached Provide the following information for PUDs ONLY if the developer/builder is in control of the HOA and the subject property is an attached dwelling unit. Legal Name of Project ~ Total number of phases Total number of units T ota! number of units sold T ota! number of units rented Total number of units for sale Data source (s) : Was the project created by the conversion of existing building(s) into a PUD? r ] Yes ] No If Yes, date of conversion. · Does the project contain any multi-dwelling units? [ ] Yes [J No Data Source . Are the units, common elements, and recreation facilities complete? Il Yes Il No If No, describe the status of completion. i Are the common elements leased to or by the Homeowners' Association? n Yes r l No If Yes, describe the rental terms and options. Describe common elements and recreational facilities. U Of R od f I A IR rt :reddie Mac Form 70 March 2005 Page 3 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-BOO-ALAMODE . Uniform Residential A praisal Re ort FII.# 010407E This report form is designed to report an appraisal of a one-unit property or a one-unit property with an accessory unit; including a unit in a planned unit development (PUD). This report form is not designed to report an appraisal of a manufactured home or a unit in a condominium or cooperative project. This appraisal report is sUbject to the following scope of work, intended use, intended user, definition of market value, statement of assumptions and limiting conditions, and certifications. Modifications, additions, or deletions to the intended use, intended user, definition of market value, or assumptions and limiting conditions are not permitted. The appraiser may expand the scope of work to include any additional research or analysis necessary based on the complexity of this appraisal assignment. Modifications or deletions to the certifications are also not permitted. However, additional certifications that do not constitute material alterations to this appraisal report, such as those required by law or those related to the appraiser's continuing education or membership in an appraisal organization, are permitted. SCOPE OF WORK: The scope of work for this appraisal is defined by the complexity of this appraisal assignment and the reporting requirements of this appraisal report form, including the following definition of market value, statement of assumptions and limiting conditions, and certifications. The appraiser must, at a minimum: (1) perform a complete visual inspection of the interior and exterior areas of the subject property, (2) inspect the neighborhood, (3) inspect each of the comparable sales from at least the street, (4) research, verify, and analyze data from reliable public and/or private sources, and (5) report his or her analysis, opinions, and conclusions in this appraisal report. INTENDED USE: The intended use of this appraisal report is for the lender/client to evaluate the property that is the subject of this appraisal for a mortgage finance transaction. INTENDED USER: The intended user of this appraisal report is the lender/client. DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised, and each acting in what he or she considers his or her own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms of cash in U. S. dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions* granted by anyone associated with the sale. *Adjustments to the comparables must be made for special or creative financing or sales concessions. No adjustments are necessary for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the property or transaction. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the appraiser's judgment. STATEMENT OF ASSUMPTIONS AND LIMITING CONDITIONS: The appraiser's certification in this report is subject to the following assumptions and limiting conditions: 1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it, except for information that he or she became aware of during the research involved in performing this appraisal. The appraiser assumes that the title is good and marketable and will not render any opinions about the title. 2. The appraiser has provided a sketch in this appraisal report to show the approximate dimensions of the improvements. The sketch is included only to assist the reader in visualizing the property and understanding the appraiser's determination of its size. 3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in this appraisal report whether any portion of the subject site is located in an identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination. 4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made beforehand, or as otherwise required by law. 5. The appraiser has noted in this appraisal report any adverse conditions (such as needed repairs, deterioration, the presence of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property or that he or she became aware of during the research involved in performing the appraisal. Unless otherwise stated in this appraisal report, the appraiser has no knowledge of any hidden or unapparent physical deficiencies or adverse conditions of the property (such as, but not limited to, needed repairs, deterioration, the presence of hazardous wastes, toxic substances, adverse environmental conditions, etc.) that would make the property less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or implied. The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, this appraisal report must not be considered as an environmental assessment of the property. 6. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory completion, repairs, or alterations on the assumption that the completion, repairs, or alterations of the subject property will be performed in a professional manner. =reddie Mac Form 70 March 2005 Page 4 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "TOTAL for Windows" appraisal software by a la mode, inc. -1-BOO-ALAMODE . Uniform Residential A raisal Re ort Ale# 010407E APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that: 1. I have, at a minimum, developed and reported this appraisal in accordance with the scope of work requirements stated in this appraisal report. 2. I performed a complete visual inspection of the interior and exterior areas of the subject property. I reported the condition of the improvements in factual, specific terms. I identified and reported the physical deficiencies that could affect the livability, soundness, or structural integrity of the property. 3. I performed this appraisal in accordance with the requirements of the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 4. I developed my opinion of the market value of the real property that is the subject of this report based on the sales comparison approach to value. I have adequate comparable market data to develop a reliable sales comparison approach for this appraisal assignment. I further certify that I considered the cost and income approaches to value but did not develop them, unless otherwise indicated in this report. 5. I researched, verified, analyzed, and reported on any current agreement for sale for the subject property, any offering for sale of the subject property in the twelve months prior to the effective date of this appraisal, and the prior sales of the subject property for a minimum of three years prior to the effective date of this appraisal, unless otherwise indicated in this report. 6. I researched, verified, analyzed, and reported on the prior sales of the comparable sales for a minimum of one year prior to the date of sale of the comparable sale, unless otherwise indicated in this report. 7. I selected and used comparable sales that are locationally, physically, and functionally the most similar to the subject property. 8. I have not used comparable sales that were the result of combining a land sale with the contract purchase price of a home that has been built or will be built on the land. 9. I have reported adjustments to the comparable sales that reflect the market's reaction to the differences between the subject property and the comparable sales. 10. I verified, from a disinterested source, all information in this report that was provided by parties who have a financial interest in the sale or financing of the subject property. 11. I have knowledge and experience in appraising this type of property in this market area. 12. I am aware of, and have access to, the necessary and appropriate pUblic and private data sources, such as multiple listing services, tax assessment records, public land records and other such data sources for the area in which the property is located. 13. I obtained the information, estimates, and opinions furnished by other parties and expressed in this appraisal report from reliable sources that I believe to be true and correct. 14. I have taken into consideration the factors that have an impact on value with respect to the subject neighborhood, subject property, and the proximity of the subject property to adverse influences in the development of my opinion of market value. I have noted in this appraisal report any adverse conditions (such as, but not limited to, needed repairs, deterioration, the presence of hazardous wastes, toxic substances, adverse environmental conditions, etc.) observed during the inspection of the subject property or that I became aware of during the research involved in performing this appraisal. I have considered these adverse conditions in my analysis of the property value, and have reported on the effect of the conditions on the value and marketability of the subject property. 15. I have not knowingly withheld any significant information from this appraisal report and, to the best of my knowledge, all statements and information in this appraisal report are true and correct. 16. I stated in this appraisal report my own personal, unbiased, and professional analysis, opinions, and conclusions, which are subject only to the assumptions and limiting conditions in this appraisal report. 17. I have no present or prospective interest in the property that is the subject of this report, and I have no present or prospective personal interest or bias with respect to the participants in the transaction. I did not base, either partially or completely, my analysis and/or opinion of market value in this appraisal report on the race, color, religion, sex, age, marital status, handicap, familial status, or national origin of either the prospective owners or occupants of the subject property or of the present owners or occupants of the properties in the vicinity of the subject property or on any other basis prohibited by law. 18. My employment and/or compensation for performing this appraisal or any future or anticipated appraisals was not conditioned on any agreement or understanding, written or otherwise, that I would report (or present analysis supporting) a predetermined specific value, a predetermined minimum value, a range or direction in value, a value that favors the cause of any party, or the attainment of a specific result or occurrence of a specific subsequent event (such as approval of a pending mortgage loan application). 19. I personally prepared all conclusions and opinions about the real estate that were set forth in this appraisal report. If I relied on significant real property appraisal assistance from any individual or individuals in the performance of this appraisal or the preparation of this appraisal report, I have named such individual(s) and disclosed the specific tasks performed in this appraisal report. I certify that any individual so named is qualified to perform the tasks. I have not authorized anyone to make a change to any item in this appraisal report; therefore, any change made to this appraisal is unauthorized and I will take no responsibility for it. 20. I identified the lender/client in this appraisal report who is the individual, organization, or agent for the organization that ordered and will receive this appraisal report. Freddie Mac Form 70 March 2005 Page 5 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-aOO-ALAMODE Uniform Residential Appraisal Report Filel 010407E 21. The lender/client may disclose or distribute this appraisal report to: the borrower; another lender at the request of the borrower; the mortgagee or its successors and assigns; mortgage insurers; government sponsored enterprises; other secondary market participants; data collection or reporting services; professional appraisal organizations; any department, agency, or instrumentality of the United States; and any state, the District of Columbia, or other jurisdictions; without having to obtain the appraiser's or supervisory appraiser's (if applicable) consent. Such consent must be obtained before this appraisal report may be disclosed or distributed to any other party (including, but not limited to, the public through advertising, public relations, news, sales, or other media). 22. I am aware that any disclosure or distribution of this appraisal report by me or the lender/client may be subject to certain laws and regulations. Further, I am also subject to the proviSions of the Uniform Standards of Professional Appraisal Practice that pertain to disclosure or distribution by me. 23. The borrower, another lender at the request of the borrower, the mortgagee or its successors and assigns, mortgage insurers, government sponsored enterprises, and other secondary market participants may rely on this appraisal report as part of any mortgage finance transaction that involves anyone or more of these parties. 24. If this appraisal report was transmitted as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effective, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. 25. Any intentional or negligent misrepresentation(s) contained in this appraisal report may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq., or similar state laws. SUPERVISORY APPRAISER'S CERTIFICATION: The Supervisory Appraiser certifies and agrees that: 1. I directly supervised the appraiser for this appraisal assignment, have read the appraisal report, and agree with the appraiser's analysis, opinions, statements, conclusions, and the appraiser's certification. 2. I accept full responsibility for the contents of this appraisal report including, but not limited to, the appraiser's analysis, opinions, statements, conclusions, and the appraiser's certification. 3. The appraiser identified in this appraisal report is either a sub-contractor or an employee of the supervisory appraiser (or the appraisal firm), is qualified to perform this appraisal, and is acceptable to perform this appraisal under the applicable state law. 4. This appraisal report complies with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place at the time this appraisal report was prepared. 5. If this appraisal report was transmitted as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or a facsimile transmission of this appraisal report containing a copy or representation of my signature, the appraisal report shall be as effective, enforceable and valid as if a paper version of this appraisal report were delivered containing my original hand written signature. SUPERVISORY APPRAISER (ONLY IF REQUIRED) Signature ~~ Name Susan . Burkhol Company Name Diversified Appraisal Services Company Address 35 E. High Street Suite 101, Carlisle, PA 17013 Telephone Number 717-249-2758 Email Addresssue.burkholder@gmail.com Date of Signature and Report January 4, 2008 Effective Date of Appraisal November 12, 2007 State Certification # RL-000659-L or State License # or Other (describe) State # State Expiration Date of Certification or License June 30, 2009 Signature Name Company Name Company Address Telephone Number Email Address Date of Signature State Certification # or State License # State Expiration Date of Certification or License SUBJECT PROPERTY ADDRESS OF PROPERTY APPRAISED 726 Grahams Woods Road Newville, PA 17241 APPRAISED VALUE OF SUBJECT PROPERTY $ 170,000 LENDER/CLIENT Name Company Name Arthur Etter Estate Company Address 726 Grahams Woods Road, Newville, PA 17241 Email Address o Did not inspect subject property o Did inspect exterior of subject property from street Date of Inspection o Did inspect interior and exterior of subject property Date of Inspection COMPARABLE SALES o Did not inspect exterior of comparable sales from street o Did inspect exterior of comparable sales from street Date of Inspection =reddie Mac Form 70 March 2005 Page 6 of 6 Fannie Mae Form 1004 March 2005 Form 1004 - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-BOO-ALAMODE . Borrower/Client n.a. Property Address 726 Grahams Woods Road City Newville County Cumberland State PA liD Code 17241 Lender Arthur Etter Estate Supplemental Addendum File No. 010407E Additional Comments The subject is older than five years old. All mechanical systems including heating, electrical and plumbing systems appear to be working adequately. No warranties are implied in this statement. One or more of the comparable sales are older than six months old. Although there are comparable properties in the subject's area, none have sold recently, therefore, sales in excess of six months old have to be used. All three comparables used were the best available. Although there are other similar home in the subject's neighborhood, none have sold recently. Therefore is was necessary to use sales further than one mile from the subject property. The sales used are the best available. The predominant value in the neighborhood is less than that of the market value of the subject property. This is due to the very wide range of values of properties in the area and superior quality of the subject property. This condition does not affect the market value of the subject or its future marketability. The scope of the assignment included an analysis of the subject's area, an inspection of the subject property, an estimation of the property's highest and best use and the consideration of all three approaches to value and the application of those relevant to the valuation of the subject property. The Intended User of this appraisal report is the Lender/Client. The Intended Use is to evaluate the property that is the subject of this appraisal for a mortgage finance transaction, subject to the stated Scope of Work, purpose of the appraisal. reporting requirements of this appraisal report form, and Definition of Market Value. No additional Intended Users are identified by the appraiser. Privacy Notice Pursuant to the Gramm-Leach-Billey Act of 1999, effective July 1, 2001, appraisers, along with all providers of personal financial services are now required by federal law to inform their clients of the policies of the firm with regard to the privacy of the client nonpubfic personal information. As professionals, we understand that your privacy is very important to you and are pleased to provide you with this information. In the course of performing appraisal, we may collect what is known as "nonpublic personal information" about you. This information is used to facilitate the services that we provide to you and may include the information provided to us by you directly or received by us from others with your authorization. We do not disclose any non public personal information obtained in the course of our engagement with our clients to nonaffiliated third parties, except as necessary or as required by law. By way of example, a necessary disclosure would be to our independent contractors, and in certain situations, to unrelated third party consultants who need to know that information to assist us in providing appraisal services to you. All independent contractors and any third party consultants we engage are informed that any information they see as part of an appraisal is to be maintained in strict confidence within the firm. A disclosure required by law would be a disclosure by us that is ordered by a court of competent jurisdiction with regard to a legal action to which you are party. We will retain records relating to professional services that we have provided to you for a reasonable time so that we are better able to assist you with your needs. In order to protect your nonpublic personal information for unauthorized access by third parties, we maintain physical, electronic and procedural safeguards that comply with our professional standards insure the security and integrity of your information. Signature i.~r4":s'~tJ.Jj. Name Susan B. Burkholder Date Signed January 4, 2008 State Certification # RL-000659-L Or State License # State State Signature Name Date Signed State Certification # Or State License # State State Diversified Appraisal Services Form TADD2 -"TOTAL for Windows" appraisal software by a la mode, inc. -1-800-ALAMODE . Building Sketch (Page - 1) Borrower/Client n.a. Prooertv Address 726 Grahams Woods Road City Newville County Cumber1and State PA ZiD Code 17241 Lender Arthur Etter Estate 42.0' 18.0' 14.0' First Floor Garage 25.0' 32.0' I 6.0' 26.0' ~ n' 18.0' 14.0' 16.0' SKETCH CALCULATIONS A1 : 60.0 x 25.0 = 1500.0 A1 A2: 42.0 x 1.0 = 42.0 A3 : 16.0 x 6.0 = 96.0 A~ I A~ First Floor 1638.0 Total Living Area 1638.0 Form SKT.BldSkl-"TOTAL for Windows" appraisal software by a la mode, inc. -1-BOO-ALAMODE . Location Map Borrower/Client n. a. ProDertv Address 726 Grahams Woods Road City Newville County Cumberland State PA liD Code 17241 Lender Arthur Etter Estate ~.t:.ii'I;..I. . . , , -.wy --1IdllIaIety II -.-.- ,-.'^".- .-_......,~.. ..-. ....-....-.-- .., - .-.."..._.l 1 -..'' U1CfMOft. ,"'~~"'MapPoint. 11 -', -,"",,,:. \.- PER R l' --\ " ", " \,. ~:.:;) >>, '\~:\ ':'0 \\ 'I! . _,~iii:r---'-' .----..,~---_. '::, " If \' ~I, I'. "i. '1\ \\ Ii '1\ 1,( ',j II JI 'I ,II t~..__ IH "=='" ...~c:~~... (.f.'~ ~-:;;"'- --^....:\~../ .' \ A. " ,;:r";.' 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ProDertv Address 726 Grahams Woods Road City Newville County Cumberland State PA Zip Code 17241 Lender Arthur Etter Estate Subject Front 726 Grahams Woods Road Subject Rear Subject Street FOlTll PICPIX. TR - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-800-ALAMODE . Comparable Photo Page 'Borrower/Client n.a. 0 Prooertv Address 726 Grahams Woods Road Cilv Newville Counlv Cumberland State P A lio Code 17241 lender Arthur Etter Estate Comparable 1 205 Alters Road Comparable 2 196 Lawrence Lane Comparable 3 342 Bloserville Road Form PICPIX.BR - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-BOO-AI.AMODE / .,~ > :t ~'1-~~L~ 1;<~~ kV~~ ~/~, ~/:~~J~~.:y;~~~: _. / ) 1'/" / ., ~ r.. yf" /~~-i.LCA /':. ?2d('/..:5.y "r."<' ..G:,~ LC 0: a: . / ./ ~J'IO-8 30-JcJ~ /~..:5 ~~ /-:2~ ~~ (;Ro~tYr') /-Z F-/0~,~ &;ry;;IO~ d>9 V 3~~~~~~@~d:;-#.. /~ v /9'7"1.P~~Z.A?z~di~/,lfl.m.T '"M C:~?1/tO~~..~-;~tt:/' ~r~! ~~ .~ C / ~I .' /" _. 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'/ I ~ &dF~ ~./.> '- I o o 55' + 165' + 12. + 64' + 12'+ 3,395' + 90. + 115'+ 20,+ 24'+ 150'+ 50'+ 20-+ 115'+ 95' + 10'+ 8'+ 15' + 28'+ 10. + 4.+ 10,+ 32'+ 2,650, + 1~ · ~~~ niS apprn~53~. (:.~~~'0~.2t~(1 By:/'~. ~~.G #-~ ~/dI/A~-/Jh ...;.-- K .,~ C . r' .. ,J' S r \\:, ~~~G . //;2~ -c::J '7 / ~ S . \~~ ~::::-/-- - ~ 0.* . tv l~t MEMBERS 1st FEDERAL CREDIT UNION ~ttS~~wlt~ -- 1 2007 .. 1'-' """.;;..\. , ,--, T-1 T ..,... _'___'_',6. ,_............- SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued I nterest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 207695-00 07/26/2001 $5,570.21 $1.68 $5,571.89 Connie Etter 07/26/2001 CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 207695-11 07/16/2003 $661.08 $.00 $661.08 Connie Etter 07/26/2001 LOAN ACCOUNTS: Account Number/Suffix Date Loan Established Principal Balance at Date of Death Loan Type Name of Co-Borrower 207695-04* 03/04/2004 $27,263.57 Home Equity Line of Credit 726 Grahams Woods Road Newville, PA 17241 None Collateral Held as Security *Loan does have cJedit life insurance. MfrJtBERS 1'T FEDERAL CRE9Iff~ION L)JC\WRt 1\.- \~lLe- Danielle A. Kline Insurance Services Specialist November 29, 2007 Estate of: ARTHUR ETTER Date of Death: 11/12/2007 Social Security Number: 161-32-3079 5000 Louise Drive. po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (800) 283-2328 . www.members1st.org 1* \ .----' RECEIVED DEe 2 9 2007 '!' V I IIE'- i l " l) 'rl"ORD 1 ,~ \L I' , IRWIN & McKNIGHT LAWOfFJCfS November 19, 2007 aJ RAYMOND JAMES FINANCIAL SRVC John W Carbaugh Raymond James Financial 19 Brookwood Ave, Ste 103 Carlisle, P A 17013 Dear John W Carbaugh: At The Hartford, we understand that many financial professionals develop strong relationships with their clients. That's why it's with deep regret we inform you that a death notification was recently placed on a contract owned by one of your clients. The contract, owned by Arthur L Etter, had an account value of $58,439.33 as of the close of business on 11/13/2007. The contract number is 711045273. Weare very sorry for your loss, and would like to let you know we stand ready to support you as you help your client's family during this difficult time. In the short term, we recommend that you reach out to your client's family to offer your condolences and set up a time to assist them with immediate financial needs-such as final expenses and survivor benefits-as well as the completion of paperwork, including the Choosing the Right Beneficiary Benefit kit from The Hartford. Over the long term, as your client's family continues the financial planning process, we offer a variety of services to help you build and maintain relationships with them: · The Hartford's Corporate Gerontology group, an in-house team of experts on aging, partners with the MIT AgeLab on research to better understand customers' needs as they experience life events. We have also developed tools to help financial professionals like you build lifelong relationships with beneficiaries and clients' extended family members. Enclosed is the brochure Is There Life After Death Benefits?--created with the help of Corporate Gerontology-to help you do just that. We also invite you to call and speak with one of our specially trained representatives about the various settlement options The Hartford offers as they relate to your client's specific situation. You can reach our dedicated Producer Access Line at 1-800-862-7155 and press "5" for death benefits; please reference the contract number listed above. . Again, please accept our deepest sympathies-and don't hesitate to let us know how we can help. Sincerely, ~t...- t2=.lS Sharon Ritchey SVP & COO, USWM Service & Technology I NOT INSURED BY FDIC OR ANY !MAY LOSE I NOT A DEPOSIT OF OR GUARANTEED IU ~ FEDERAL GOVERNMENT AGENCY VALUE I BY ANY BANK OR ANY BANK AFFILIATE ~ ~ "The Hartford" is The Hartford Financial Services Group, Inc. and its subsidiaries, including the issuing companies of the Hartford Life Insurance Company and Hartford Life and Annuity Insurance Company. Variable annuities are underwritten and distributed by Hartford Securities Distribution Company. Inc. p50096/07 NOT FOR USE WITH THE PUBLIC Ewing Brothers Funeral Home, Inc. Steven A. Ewing, Supervisor 630 South Hanover SI.; Carlisle, PA 17013 Since 1853 Seymour A. Ewing, F.D. Phone: "'17)243-2421 Fax: (717)243-7553 E-Mail: ewingbrothers@earthlink.net William M. Ewing, F.D. STATEMENT OF FUNEIY'L GOODS AND SERVICES SELECTED Charge! are .only for those. items that you selected or that are required. If we are. required ~y law or by a cemel\:ry or a crematory to use any items, \\'OWIJI explam the reasons J:f writin~ below. If you selected a funeral that may reqUIre embalmmg, such as a funeral willi viewing, you may have to pay for ~~~~\~~~~. w~o~i~Oe~~fa~';~~ g:fo~r embalming you did not approve if you selected arrangements such as cremation or immediate burial. Ifwe charged for For the Service of: Arthur L. Etter Date of Death November 12, 2007 Charge to: Connie M. (Grimes) Etter 726 Grahams Wood Rd. Newville Name Address City A. CHARGE FOR SERVICES SELECTED: Traditional packag( ~mlze_d se~ces~ther Clothlno 1 PROFESSIONAL SERVICES /,,;t...c.o.l-;:A . / Services of Funeral Director/Staff $ 4,230 00 7/' S}o; Embalming. . . . . . . . . . . . . . . . . . .$. -0- CrematIon Urn. Other preparation of body (Description) PA State $ $ ..$ -0- -0- -0- $ -0- $ -0- $ -0- SUB-TOTAL OF PROFESSIONAL SERVICES. ... A1 $ 4,230.00 $ -0- TOTAL MERCHANDISE SELECTED .. . B $ -0- 2. FACILITIES AND SERVICES C. SPECIAL CHARGES Use of facilities and services for Forwarding of remains to Viewing (VisitationlWake). . ..$ -0- Use of facilities and services for $ -0- Funeral Ceremony. .$ -0- (Funeral Home) .......... Receiving of remains from Use of facilities and services for $ -0- Memorial Service. . . . . $.. -0- . (Funeral Home) Use of equipment and services for Immediate Burial. . . . . . . .. . $ -0- Graveside Service. . . . . ......$.. -0- Direct Cremation. . . . . . ..$ -0- Other use of facilities $ -0- SUB-TOTAL OF SPECIAL CHARGES. C$ -0- ..s. -0- D. CASH ADVANCED: .......... .............. SUB-TOTAL OF FACILITIES/EQUIPMENT A2$ 0.00 Opening Grave (Prepaid) (230.00) . . . . .$ -0- Cemetery Equipment. . . . . . . . . . . . . . . $ -0- Lot and Deed. . . . . . . . . . . . . . . . . . . . . . $ -0-, 3. AUTOMOTIVE EQUIPMENT Newspaper Notices - Out-of-town . . . . . . $ -0- Vehicle to transfer remains to Funeral Telephone & Telegrams. .......... .. $ -0- Local. . ...........$ -0- Ai $ -0- Hearse (Casket Coach) Clergy/Mass Offering (Family. $ -0- Local...... . . . . . . . . . . . ....$ -0- Pallbearers. . . . . . . . . . . . $ -0- I i......^'I~i"p Certified Copies of the Death Certificate. $ 72. 00 Local....... . . . . . .. . . .$ n Police Escort. . . . . $ -0- ... .............. Family Car Flowers. . . . . . . . . . . . . . . . . . . . . . . . . . S 132.50 Local.............. . ...... .$ -0- Vault Service Charge . . . . . . . . . . . . . . . $ -0- Flower car or floral disposition Sentinel Obit (Estimate) . . . . . . . . . . . . . $ 100.00 Local.. . ............ ........ .$ -0- -0- Lead car/Clergy $ $ -0- Local. ............. .. . $ -0- -0- Car for pallbearers $ Local.. .......$ -0- $ -0- Out of town transportation. .. .S -0- $ -0- $ -0- $ -0- $ -0- SUB-TOTAL OF ADVANCES........ . .. .. ... D $ 304 50 'ae c~rg: ~ouJ,or our ~ervi~s in obtaining: SpeCI s a vance Items . SUB-TOTAL OF AUTOMOTIVE EQUIPMENT. . . . .... .A3 $ 0.00 TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT. . . . . Outer burial container. . . . . (Description) AltF.!rn::lte Cnntainer /'" Acknowledgement cards. . /' Register Book(s) . . . I' Memorial folders. . . . . . SUMMARY OF CHARGES: 4,230.00 A. Professional Services, Facilities and Equipment and Automotive Equipment... ... . . . . . .. . $. 4,230.00 B. Merchandise.... . . . . . . .$ -0- C. Special Charges. . . . . . . . . . . . . . . . . . .S -0- D. CashAdvances...................$ 304.50 . TOTAL"OF'....C('S1!a!GT_v;; 0 ,"0 . ,0 0 . 0 0 . . . -. . PAID AT TIME OF OR PRIOR TO ARRANGEMENTS..... . BALANCE DUE. . . . . . . . . . . . . . . . . . .S -0- REASON FOR EMBALMING .' . . . . . . . . . .s -0- Re uested for traditional funeral with VleWln $ -0- 'rements have required the purchase of . . . . . . . . . If any taw..ceme\~R; dra~g~a~2i~q~: requirement is explained tielow. . . . . . . . . . .$. -0- any of the Items IS e Prayer cards . . . $ -0- OBC bv cemetery Temporary .grave marker. . . . . . . . . . . . . . . . '.$' -0- d ceordin to the arrangements I have Burial clothing . . . . . . . . . . . . . . . . . . . . . . . . rviees selected above and found them to be correct an a t I hav: sufficient funds available for I agree that I have examlinjd the~;~f~~~o~~~:~~:teOf Funeral Goods and serviee~ sr~cted4 5Ue~6e:r~i~ha30 days. I agree to. be jOi~IY and 'd balance requested and I acknowe ge a . I cted I also agree to make paymen 0 . . 1 R.I. per year will be applied to t e unpal a ment of total price for goods and services se e har e of 1.5%-I>er month amounting to .. b the Funeral Director to collect amounts ~e~eraIlY liable with anyone who sign: ~elow. A :~~tC I w~1I also pay to the Funeral Director all r~aso~a~l:d~~~~~~~~.Jces or merchandise ordered or beginning~days from the date 0 t ~s ag~~~nclucie attorney's fees, court costs and other co"t ~j, r~of will e reflected on the final bill or statement. I owe under thiS agreement. Those cos s;n '11 be considered part of this agreement and the cos e requested after the date of thiS agreemen WI (Seal) V::' \C)AA ; (l JIU - ~ ate ( 'Y' (Purchaser) ..$ -0- ... A $ B. CHARGES FOR MERCHANDISE Casket. (Description) From Cemeterv Outer Receptacle .. .. . .. - " .. .. .. .. .. . . .. (Description) Fmm ~t'!m~'p-~ ~, ,$ -Q- ...$ ..$ 0.00 4 534.50 (Seal) (purchaser) . :t CUMBERLAND COUNTY Date: JANUARY 9, 2008 In the Estate 0(: Estate No.: 2120071066 ARTHUR L. ETTER Date of Death: NOVEMBER 12, 2007 CLAIM AGAINST DECEDENT'S ESTATE The Claimcmt certifies that there is due and owing by the ARTHUR L. ETTER deceased. 3,616.96 In accordcmce with the attached statement of account, the swn of :Ii 0% togefuei with interest at the rate of 11 / 1 2/07 nntil paid. from .' GOODS & SERVICES FOR: VISA CARD XXXX-XXXX-XXXX-2796 On behalf of the claimcml I do solemnly declare and affinn tmder the penalties .of perjwy that the Information and representations made herein are true cmd correct . . of the best of my knowledge, information and belie!. ROS~MARY MOORE/SENIOR ADJUSTER (Name of Claimant) ~. p. 0 BOX 3773 (Address of Claimant) OMAHA, NE 68103 POBOX 3773 (Address) , OMAHA, NE 68H)8 1-800-688-7070 (Phone Nwnber) 1-800-688-7070 {Phone Number} FiLED: