The URL can be used to link to this page

Home My WebLink About03-10-08 (2) --.J 15056051047 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (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 _ 1. Original Return <:::) 2. Supplemental Return <:::) <:::) 4. Limited Estate <:::) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required - <:::) 4a. Future Interest Compromise (date of death after 12-12-82) <:::) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) <:::) 10. Spousal Poverty Credit (date of death <:::) 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8. Total Number of Safe Deposit Boxes <:::) .... ;~.. ;..v o -'f-' _':"1;. \' .', .~ C;i DATE FILED CO Correspondent's e-mail address: c e sit ~ e..lds 3 @ tomC4 5t. I)e.t Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge. DATE .3 r,ltPtf ~., ~ne4.rmo" DATE I O;l!) ~/~ /t''' l ESf t'j I I'i f7osS' LASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --.J -I REV-1500 EX Decedent's Name: {'rtY1ER~ RECAPITULATION 15056052048 S"AteA E. 1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) C=> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C=> Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0lL 16. Amount of Line 14 taxable at lineal rate X.O 1./5 17. Amount of Line 14 taxable at siqling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . .. . . . . . . . . 19. Decedent's Social Security Number 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ <-:> .~ ~.~ ':;;z: L 15056052048 Side 2 C=> 15056052048 -I REV-1500 EX Page 3 File Number J..-/- 0 7 - 3 '19 Decedent's Complete Address: DECEDENT'S NAME 5AflH- E. /J1Y€t?$ STREET ADDRESS 9:1/ # /~~A" I)R / rE CITY I1IEeNIt;1/ I~S 1I11t< G STATE ~II ZIP /7D55"" Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) fit if; 730.02.. o o o Total Credits (A + B + C ) (2) o 3. Interest/Penalty if applicable D. Interest E. Penalty o &7- Totallnteresl/Penalty ( D + E ) 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 0 (4) 0 (5) ~ '-h 730.0 z... (5A) I () ,/, 7S' (5B) 1lfJ S3q 77 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT Pl.EASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D IX] b. retain the right to designate who shall use the property transferred or its income; ............................................ D 18'1 c. retain a reversionary interest; or.......................................................................................................................... D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D IXi 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D IRI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D C8( 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 dElath on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 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 PS. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 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 PS. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 PS. 99116(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 IJ1 Y Elf 5, SAIlA- E FILE NUMBER J-I-() 7- 391 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH All flLaI eert q/n lot of .f/'Ptl/ltl /1J111/'t:;J/et/ J?)//h a clNldt/;f hlJlI.5t I/?td ~fIU. /lHt .!t{/Id/"!S .s"/lu4e aI 7,2/ 1/1/~tJ/I )),.;'ye, /)f~l1r/)e ?;}Jrt///5,{~ CUlYlkr/4Itd &un,. / fJelJllsyffl/h/d.l AS /..r ~Ie /JI1'rlic.ukrly dt!!s- Cr;"ud;/7 -IA4I Clerklll du:.~ h/l/ tar/;:: /J1y~r.J'" e.t- tf,X, 'Ii JPh/l~. /J1).1tl'.t1 pWlq 0.54171 R. /)Jy~~ /J/j p.;/k" d4-l'ul ~~~ .29; /'J7..:? mtl /'e~r~d/h eumiJert,J// ~uJJf; Mt lJet.t/ g/pt)R J; Ydl. .1~ tPA?~ Sf'",. Y~//,feJ at (See 4{;fJra/sal ~ IltA!'/! It/hi aIIa:ckd lJe~) JI' S ~ tJt)lJ. po ~. A/I #141 cut,,/n /11 "I fJ-~ulZd/ tl/1/mplY/i/d,. a-nd atfj;;/1/"1 ~ a{r;~JIl/rJ /1)1 /lb. / ai~"Ye ;;, fk Stt.dI -h>wl1sA/,o, e;JtI71f and .sfall / 1Jt./7 /UD~ fftrb~- ",.J~u-'Y dtSt!"/6ed /n fltaf eert~/11 cle.e.,,' -hr;JH lIafhllniel R. fJea.5l." d w, Ii ./tJ1J/1 C. myen" Sr. * anD Sarli E, myM"S.. h,j t(),ft.. dal~q vuly 1.2" If/, 3 ~ recfJ/'tlul IZ1 stUd ~l{.h1f 1M /)eerl I/f)P,k )<, J/ot :J.t;, p~ ~7~. ralLied d (set. h'fJr4;sal of /Jhtrk. f4'//Jert a!fA.c.iu:/ k'e;t;,) ~ 73, 000. D{) ~:r:nl. Ill/Ii: .phI( e, /n'yus" a"fG JPh'1 tJ. 4J.y~. 1'r. j df!IJa.rtui ~,:.s u/'ItAt;;,k dJr/or Ii A,:s N/Cbw 04n1- (r' " E /1J,~/ tIIkNtf//,n sl1e .//tt!l1lJtt tJttJMr ~f ~o~ ~;tI ;tJ1'e/J1 /'us a"so/t.e-kf as ~ &- lAw / eh f/re. h 'eS. TOTAL (Also enter on line 1, Recapitulation) $ / J ~ ~ ~t). "0 (If more space is needed, insert additional sheets of the same size) Mark E. Hilbert & Associates 07-146 FileNo. 07-146 ********* INVOICE ********* File Number: 07-146 May 1, 2007 Charles E. Shields III Esq. 6 Clouser Road, Mechanicsburg, PA. 17055 Borrower: Sara Myers Estate Invoice #: 07-146 Order Date: Reference/Case #: 07-146 PO Number: 921 Nixon Road Mechanicsburg, PA 17055 Appraisal $ 325.00 $ -------------- Invoice Total $ 325.00 State Sales Tax @ $ 0.00 Deposit ($ ) Deposit ($ ) -------------- Amount Due $ 325.00 Terms: Balance due upon receiptof invoice Please Make Check Payable To: Mark E. Hilbert & Associates 3607 Rosemount Avenue, Suite 405 Camp Hill, PA 17011 Fed. 1.0. #: 23-2391423 TO INSURE PRPOER CREDIT PLEASE RETURN A COPY OF THIS INVOICE WITH YOUR PAYMENT. 3607 Rosemount Avenue, Camp Hill, PA 17011, Phone 717-901-8224, Fax 717-901-4779 Mark E. Hilbert & Associates 07 -146 File No. 07-146 Summery Appraisal Charles E. Shields III Esq. 6 Clouser Road Mechanicsburg, PA. 17055 File Number: 07-146 Summery Appraisal Report I n accordance with your request, I have appraised the real property at: 921 Nixon Road Mechanicsburg, PA 17055 The purpose of this appraisal is to develop an opinion of the market value of the subject property, as improved. The property rights appraised are the fee simple interest in the site and improvements. In my opinion, the market value of the property as of February 22,2007 is: 55,000 Fifty-Five Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final opinion of value, descriptive photographs, limiting conditions and appropriate certifications. ; ..'," fA , . / ~<~~... ~;r:~'- 77 -~ ,1./ MaNlil/lv MARK E. HILBERT & ASSOCIATES 3607 Rosemount Ave, Camp Hill, Pa 17011 This appraisal is to provide the estate with Fair market value only 3607 Rosemount Avenue, Camp Hill, PA 17011, Phone 717-901-8224, Fax 717-901-4779 Mark E. Hilbert & Associates 07-145 File No. 07-145 ********* INVOICE ********* File Number: 07-145 April 25, 2007 Charles E. Shields III Esq. 6 Clouser Road, Mechanicsburg, PA. 17055 Borrower: Sara E, Myers Estate Invoice # : Order Date : Reference/C ase # : PO Number: 07-145 April 10, 2007 07-145 919 Nixon Drive Mechanicsburg, PA 17055 Appraisal $ $ 175.00 Invoice Total State Sales Tax @ Deposit Deposit $ $ ($ ($ 175.00 0.00 Amount Due $ 175.00 Terms: Balance due upon receiptof invoice Please Make Check Payable To: Mark E. Hilbert & Associates 3607 Rosemount Avenue, Suite 405 Mechanicsburg, PA 17055 Fed. !.D. #: 23-2391423 TO INSURE PRPOER CREDIT PLEASE RETURN A COPY OF THIS INVOICE WITH YOUR PAYMENT. 3607 Rosemount Avenue, Camp Hill, PA 17011, Phone 717-901-8224, Fax 717-901-4779 Mark E. Hilbert & Associates 07 -145 File No. 07-145 Summery Appraisal Charles E. Shields III Esq. 6 Clouser Road, Mechanicsburg, PA. 17055 File Number: 07-145 Summery Appraisal Report In accordance with your request, I have appraised the real property at: 919 Nixon Drive Mechanicsburg, PA 17055 The purpose of this appraisal is to develop an opinion of the market value of the subject property, as vacant. The property rights appraised are the fee simple interest in the site. In my opinion, the market value of the property as of April 25,2007 is: $ 73,000 Seventy-Three Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final opinion of value, descriptive photographs, limiting conditions and appropriate certifications. ?~~~~7-' ,. ..... '( Mark E. Hilbert MARK E. HILBERT & ASSOCIATES 3607 Rosemount Ave, Camp Hill, Pa 17011 This appraisal is to provide the owner with Fair market value 3607 Rosemount Avenue, Camp Hill, PA 17011, Phone 717-901-8224, Fax 717-901-4779 Marl< E. Hilbert & AsSociateS 01- '\ 45 file No. 01-'\45 APPRA\SAL Of summery APpraisal LOCA "{EO A"{: 919 Nixon Drive Mechanicsburg. pA 11055 fOR: Charles E. Shields \II Esq. 6 Clouser Road. pA. 11055 BORROWER: Sara E, Myers AS Of: APril 25, 2001 BY: Marl<. E. Hilbert MARK E. HILBERT & ASSOCIATES 3607 Rosemount "venue, camP H\l1, P" \70", PhOne 717.901.8224, faX 7\7.901.4779 Mark E. Hilbert & Associates 07 -146 FileNo. 07-146 APPRAISAL OF Summery Appraisal LOCATED AT: 921 Nixon Road Mechanicsburg, PA 17055 FOR: Charles E. Shields III Esq. 6 Clouser Road Mechanicsburg, PA. 17055 BORROWER: Sara Myers Estate AS OF: February 22, 2007 BY: Mark E. Hilbert MARK E. HILBERT & ASSOCIATES 3607 Rosemount Avenue, Camp Hill, PA 17011, Phone 717-901-8224, Fax 717-901-4779 REV-1508 EX' (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF {)1 YERS / SA-i(A- ~. FILE NUMBER eJ./-tJ7-3f'1 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. - :l.. 3. 1. 5", 6. 7. DESCRIPTION J9 f3 FOrd L,':!!!Jut A'c./t-IL{J 7r<<&K JQ'1't ~l'(SIV~?el1 n5SQt ~~I1/1 Pltrt,'a! I?e~hd Ncd'/PJ1w/dt. httL-J.J.w;./ InslA,}". Co. ,J4k of /J1;se. nr>OlJli/1-y at fllt",.~ /l-ueh'rHl 8f1'lI07 (see f/"illitJl.i Itlfp,t;hul) Salt ~I misc. fJ~()l1a/~ aI I{ltltrl ,4ud-,'t?11 "'/'lfI1J1 (Sa fJri tJt IMf IIIfAciuJ) Salt, t>r /J11:S~. iJen'bAII/1y aI fI'vJr~J AudJ'on R/~ jtJ7 (St-e fJr/lJtt>ur allRdtd) Nt.;f Sales I/'Oc.tu/~ /rPm Flu /J'U.z;kt.-t c5a,,/es Ii lur ;J~/I1Mf fpr rental .5f1tlct'. (st'e ~6 situ! q!ftftckrlJ Se'/u.dult'- 61 ~t?ha/Iy ~ t1A1JII M1. co/d. (set, rSqJarali ~/iJ/t 4~~) VALUE AT DATE OF DEATH ~ 'I /)O.IJ{) tpt S'J () So . " 0 ~J91#90 ""s. 7S ~9. ZS- ? 4'1. 7S ~ If~.I)f) tf. ". , If). 60 1: ,(J~-/(,41itPIYS ()/J! c0E / /7:.t7/J1EIf/T .s/lR=T,4-T JAl€ tJF /tE/ft- EsrArE I. &untq ~6 :;...!z..,/Ol t; 1~/3,101 ((.,'11<- '101) 13. 4$se~Jmtlt7.s .:J.j:Jlllpl ~ 6/30/c/ (I./ne '/08) C. Sewer ;Z./~'1/tJf z 3/~f/or (JiM IfIO) ([,ee. ~f,Y 01 5e!fl~ht .shtd cdt~ulu.d) '!~93. r;,q ~3 '19.17 ~'t:otf TOTAL (Also enter on line 5, Recapitulation) $ 7~ 3'1'./S' (If more soace is needed. insert additional sheets of the same size) 1111111111I11111I111111111111111111 01811 SARA E MYERS 921 NIXON DR MECHANICSBURG PA 17055-4047 SARA E MYERS 921 NIXON DR MECHANICSBURG PA 17055-4047 .. ~ o lO [() [() lO "- o [() lO o o .. Policy Number: 5837C 061287 Refund Amount: $ ~h'( 197.90 Check Number: Check Issued: 58075886 05-30-2007 This refund was issued for the following reason(s): CANCELLATION CREDIT REFUND. ~ ~ = ~ - - ~ = ~ = = ~ - ~ - Agent Name: Agent Phone Number: Agent Number: If you have any questions, please contact your Nationwide representative. GL JACKSON 717-691-1100 0030315 - - Detach Stub Before Cashing And Keep For Your Record :';':~",:",',': ",' '. :_"": ':' ,',', "j: '.:' ., '., ;.:: ':':', ',.',' i,"': ::', '" ':,':' , ,,'_ 1...111111111... il,I,.1 illlllllllll..II,'IIIII'I.,1 ;1,",11 ""':"""-"",' ""'.' ," Void If'NotCashed)lVlthln9oD~ys This Is 'full ;paym ent un I ess:otherwlse 'Indicated on stub. lBANK'iONE J.secUnlY ,JPMORGAN CHASEBANI{,'BEARBORN ri~~ii~es D~R80AN, MICHI~AN CID On.BaCk .-_.. ,,,.,,. ~;.,&.:::;::t') ,-, '~~~;".,::',:,~:,:';,~,~ ~f, :"'>': '::';,,;:\'- .,- ,_n", ;-,..;: ;" ~"",)<,;, '"', ,',: ;-'\,'i:- ,~, C' ~,,, ;~ Authorized Signature '::::': "~,_~~"\\:.\,,,,,"<n -,; '-~\"_'{:~",',('__' """-''''';:'-;',l:' '(:~',"'~ ,~<~/~> ." \;~: ','<;,~' ,.-.., ;':'".." ': . ~"-';':_".:'."Y., ',': ' II. 5 B 0 7 5 B B b II. I: 0 7 2 ~ . 2 g 2 7 I: . . 5 B 2 b II. Di::\.t e ~ ~~B-"14'-'20lZi7 i...'iW~'>J. h.::l.a.1""5. com Settlement Se 11 et.~_: 7958 T-l- 1. c. e lTI Hrli=iR'1 S AUCTIO!'.I BARRY rilYERS 921 NIXdMfl;DR ... MECHAN I COOURG PA 171~'15S Descy'ipt ion Box lot - sand paper Ba 5 in lot Box lot - tnv~ - boots - !;jl""'ea.se gun Bucket lot - shot - hammers S .9. 11',1 Pet c a t~ r' i e t~ Swing gate I,...)ooden cr-'.:;1.t e Box lot = cups mirrors D:i.ggel'~ Bucket lot - wire - blades - met.d Bucket lot - single tree Box lot - hats - mise items Grate - reflectors Ladd et~ Hose Aquarine - wire fence E3weepet~e Shovel Box lot - rope wrenches - tools Crate lot - chains Box lot - plastic roll Wooden crate - cassette - thenno Box lot - pan s~t - box lot - irons - sander paper Old table top fan E.a s i 11 -- Bucket lot - chain Bucket lot - shovels Cha.in hoist Basket lot - electric motor Dl""a.w hitch bal'" Shovel Bucket lot - flares Bl.lshel baskets 3 Hub caps - shoe lathes - shovel Push br~oom Stove plpe - rake lOp Crate lot - wire - lichts -7 1 7"~'J43c:-.82-4.tS Pl"'ice !.-' .O::.i 9 E' : G!t y Tot.::>.l 1 0. 25121121 1 ll~ . 750121 1 el. 75121121 1 121 tl 751?i1Z1 1 tt~ Ii ;,::: SIZllZl 1 -:;. IZliZI -.1. 1 CII 0121 1 QI. 25ellZI 1 ~'I. 7500 1 L 0121 1 1- 00 1 121. 2!:;ifZllll 1 0. 2'51210 1 0. L::: 5 12il!o ; 0. 25121121 J. 1 1- 00 1. 1.012': 1. c. $I III 0 1. lZi . 25121121 1. 0" 2Sl:!)!Z1 1 1- 50 1. iLl &; 7SiZI0 1 Ill," 250121 J. 1. E~fl Sel 1 1- tZllZl 1 0. 7 SI21 121 1 L S121 1 1- Sill 1. 4n l?it2i 1. iZt . 7 S i21 121 'I 1 IZlIZt J. J. . 1 ~~ . '7 SIZIlZi 1 L SI21 1 121. i:: 50tZl 1 :71 7::;1210 "!..'iII 1 '''-:;'' iZliZl 1 0. 2500 1. (,J! 2 51ZilZt ''-'or. 1. ., tZliZl .L . ~ah' 0B--14--2i/;'^, :..-lJWI..;,.J D h 21.'::1.1""'5 J< r::: 0 m ~3ettJ.ement E~e11ElY'<~ 7:::;52/ It em HFii=1P~ S (lUCT I:JN B(l F:: RY Wy'E F~E-3 321 Nl Xm.-DR "." MECHANICSBURG PA 17055 DeSC1.'i pt ion 71 7-'~432-'824G r\3.0e: .------------.----.--.------.------------.-------------.-.--------.-.---.-.---..-.--.-----.----..------.- Pl"ice G!ty Total ...-. Wit.I/'-'. j-',.:,\ .:.;. 1.... ",." COlT! Outside light shade Hea.t e1"' kel"o Weights Wagon - no wheels Part alum ladder Pick Toolbox -. tools J:")l"ess HeHl 9 e 1"' Ba.mboD pole Belt [:ha.in':;j -- hoo~{s Il"on Met.;:;. 1 bo}{ - pins Bucket lot - basin lot - hub caps Bo}{ lot - nails Box lot - ax head ins ul a.t Ot~,:i Box lot:~"... 'door' \-i.nobs Bucket lot - hinges Bucket lot - tools Lunch box - trimmer C2\ble locks [Ir".a. i n Commission at 30.000% Hb1~!R' S AUCTION Item's~ 1 Qi. 250121 1 l{' L::: 5iZIlZi .' " 1 IZI" 751Z10 1 L QI0 1 1 5iZI .. . 1 1- Sill i L 12.\0 1 1- iZllZl 1 '-, iZlQI c. ., 0. 250121 .L 1 Ii) , 5iZil21Ql 1 L iZllZi .l 1 .::\ 5121 :._u 1 IZliZl ... oJ. 1 ILl, 75QliZl 1 4. 1210 -I ~II 00 .L 1 IZl. E:::.iI210 1 (~ . 2 5lZ\lZl '1 0. 250Q! ... 1 0. 2500 1 1- iZllZi .l 1- iZliZi 5;::: {:::!IT! Ci unt : r 10:' 0"75 t:,..'::Ju i'::i,72; Less adjustments: -13.7."".3 Net due to seller: l~.(:! II tZi2 71. -l"'-4,~::;2-".Si.:::t:tS ~: 09-14-2007 www.haars.com Settlement Seller: 8098 Item HAAR'S AUCTION BARRY MYERS 921 NIXON DR MECH PA 1712119 Description 717-432-8246 Page: 1 Pt~ice Qty Total --------------------------------------------------------------------------------- www.haars.com Work bench Box lot - tools - books Tarp Aq uat~ i um Barrel - plastic Wooden box - hardware Tool tote wi tools - stove pipe Candle holders - clothes pins Pro hand saws Box lot - dishes - box lot - steel wool Wooden box lot - tools - bits Fence stakes metal Commission at 31Z1.1ZI1Z11Z1~ HAAR'S AUCTION Items: 1 5.121121 1 121.251210 1 5.121121 1 121.251210 121.75121121 ..... 1.5121 0::. 1 2.121121 1 121. 25121121 1 121.25121121 1 2.1210 1 0.25121121 1 1. 50 1 1. 00 12 Amount: 19.25 5.78 Less adjustments: -5.78 Net due to seller: 13.47 717-432-8246 Date: 08-24-2007 www.haaY.s.com Settlement Sellet~: 8013 Item HAAR'S AUCTION BARRY MYERS 921 NIXON DRIVE MECHANICSBURG PA 1712155 Description 717-432-8246 Pt~ i ce Qty Q Page: 1 -------------------------------------------------------------------------------- Total www.haars.com Bucket lot - bolts Bucket lot - tools Box lot - filters - box lot - knick/knacks Box lot - Box leot - oil filters Box lot - stove parts BOX LOT - DISHES - box lot - paints - chemicals - hard Box lot - nuts - bolts Wat er j I.lg Table saw Sode box - checker board Critter cage Bag litters - bird feeder Tt~ash can Iron Shovel heads Basket lot - DRAWER LOT - TOOLS - GRINDER Bucke lot - hardware Drawer lot - shovel plows Belt Garden tools It~on hand I e 2 picks Metal stand Saw legs Round rods Plank boards Items: Commission at 30.0001- 0.750121 27 Amount: 13.43 Less adjustments: Net due to seller: HAAR'S AUCTION 717-432-8246 1 1 1 1 1 1 1 1 1 2 1 1 1 1. 00 1. 00 0.2500 1 1 1 1 0.2500 0.2500 3.121121 0.5000 1 1 1 1 1 1 1 1 1 1 1. 50 0.2500 1. 00 6.00 6.00 1. 50 0.7500 1. 50 2.50 3.00 1.50 0.7500 4.00 0.2500 1. 50 2.00 0.7500 0.2500 2.00 1. 5121 44.75 -13.43 31.32 ; r-; e~. 1/F1cr~~t(e T 7-:22-07 1/ - :2'f-CJ 7 6- "Z~ -07 Co~2Y-07 7- -:2..2-07 g- '-/- 07 g- 12- 07 16 - 'J-3-o 7 ;2), u 0 7'/ C 0 31,00 3s-. <.:::; a // /lc,ClG ;27,00 :A } t cc / 'Z 00 !'V-.....,...;,-,--.."'-'",,..._.,'>'''-.~..... > / 'f ";a. . ~t? /::(,CJG ( ;fCilr k;-ck-I'r,de dc{T I j I loj .tOj i 3.1 'f,' s: ~, 7. 8'. r. 10. EST !)j: mYI=71S, SA-tO!- c. L(STINe. of ;.?€Jf5~A/& 7y L4b,'nt!t iBu! lJl'l-$G~ /f,,. &l1tflrt$Sor ~tile l11~wer holler JJn~SLr Jlu,'tyu /,Jep;,.d fJ/4j'tr Sirlifdt"l IkI fTg Rle. - SCfiFl>. F /<'i::P7 ,6 Y /#'e:- fiG"I/CS: J..I- b 7- 399 t/ o?5". {)(/ ~*.~ '1 ~ S.60 ,- Sl).tPo ,. /7S. PO f7.$". "0 .. .::Jo.tHJ t SZJ.40 ,. I tJt> .dO lio.~o ,.., I t:l.~tl Previous editions are obsolete form HUD-1 (3/86) ref Handbook 4305.2 A. Settlement Statement U.S. Department of Housing and Urban Development B. Type of Loan OMS Approval No. 2502-0265 (exoires 11/30/2009) 1. DFHA 2. [J FmHA 3. DConv. Unins. I 6. File Number I 7. Loan Number \ 8. Mortgage Insurance Case Number 4. OVA 5. DConv. Ins. PI008-0020 C. Note: I n1S orm IS umlsnea 10 give you aSIa emen a aClual selllemen casts. AmOUn!S para. to ana by the sememen agent are snown. I TitleExpress Settlement System Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals. WA~NING: It i~ a crime to knowingly '!lake false statements to the United States on this or any other similar form. Penalties upon conviction can Include a fine and Imonsonmenl. For details see: TItle 18 U. S. Code Secllon 1001 and Section 1010. Printed 02/29/2008 at 08:14 KS D. NAME OF BORROWER: TE Products Pipeline Company, LLC ADDRESS: E. NAME OF SELLER: Estate of Sara E. Myers ADDRESS: F. NAME OF LENDER: ADDRESS: G. PROPERTY ADDRESS: 921 Nixon Drive, Mechanicsburg, PA 17055 Monroe TownshiD H. SETTLEMENT AGENT: Pinnacle Land Transfer, LLC PLACE OF SETTLEMENT: 4242 Carlisle Pike Suite 191 CamD Hill. PA 17011 I. SETTLEMENT DATE: 02129/2008 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales crice 129.500.00 401. Contract sales mice 129.500.00 102. Personal Prooertv 402. Personal Prooertv 103. Settlement charaes to borrower (line 14001 2.605.75 403. 104. 404. 105. 405. Adiustments for items oaid bv seller in advance Adiustments for items Daid bv seller in advance 106. City/town taxes 406. City/town taxes 107. County taxes 02129108 to 12131108 298.69 407. County taxes 02129/08 to 12131/08 298.69 108. Assessments 02129108 to 06130108 399.77 408. Assessments 02/29108 to 06/30/08 399.77 109. 409. 110. Sewer 02/29/08 to 03/31/08 68.04 410. Sewer 02129108 to 03131108 68.04 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 132,872.25 420. GROSS AMOUNT DUE TO SELLER 130 266.50 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deoosit or earnest money 3 000.00 501. Excess Deoosit (see instructions) 202. Princioal amount of new loans 502. Settlement charaes to seller IIine 1400) 10.062.55 203- Existina loan(s) taken subiect to 503. Existina loan(s) taken subiect to 204. 504. Payoff of First Mortaaae Loan 205. 505. 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for items unoaid bv seller Adiustments for items unoaid bv seller 210. City/town taxes 510. City/town taxes 211. Countv taxes 511. County taxes 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 3 000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 10.062.55 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line 120) 132.872.25 601. Gross amount due to seller IIine 420\ 130.266.50 302. Less amounts oaid by/for borrower (line 220\ 3 000.00 602. Less reduction amount due seller IIine 520\ 10 062.55 303. CASH FROM BORROWER 129.872.25 603. CASH TO SELLER 120203.95 SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and I.s being f1,Imished to the Internal Revenue Service. If you .are required 10 file a return, a negiigence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that It has not been reported. The Contract Sales Pnce descnbed on line 401 above constitutes the Gross Proceeds of thiS transaclion. You are required by law to provide. the s~tlh.ment agent (Fed. Tax 10 No: 4U2-d1633996I)t.With fyour corrrct trtll?'fyp~~e[ i~:~~~~~~~=~r If (;U ~~~~~\~~%dye !O~~~~ a~~~~~~~[ i.~~~~C~~~~e number, you may be subject to CIVil or cnmlnal penalties Imposed by law. n er pena les 0 pe~ury, ce I a 0e< ,. , C). c. TIN: __ __ _ '_ - _- SELLER(S)SIGNATURE(S): SELLER(S) NEW MAILING ADDRESS: SELLER(S) PHONE NUMBERS: (H) Previous editions are obsolete U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 5ETYLEMENT 5T A TEMENT File Number: P1008-0020 form HUD-' (3186) ref Handbook 4305.2 PAGE 2 l. SETTLEMENT CHARGES TitleExoress Settlement System Printed 02/29/2008 at 08:14 KS 700. T?!~L SALES/~~OKER'S COMMISSION based on orice $129.500.00 @ 6.000 = 7.770.00 PAID FROM PAID FROM DIvIsion of commiSSion (Ijne 70m as follows: BORROWER'S SELLER'S 701. $ 7.770.00 to Keller Williams of Central PA FUNDS AT FUNDS AT 702. $ to SETTLEMENT SETTLEMENT 703. Commission oaid at Settlement 704. Transaction Fee to Keller Williams of Central PA 7.770.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 225.00 225.00 801. Loan Oriaination Fee % 802. Loan Discount % 803. Annraisal Fee 804. Credit Reoort 805. Lender's Insoection Fee 806. Mortaaae Aoolication Fee 807. Assumotion Fee 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to 11l>$ Idav 902. Mortaaae Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo.@$ Imo 1002. Mortaaae Insurance mo.l1l>$ Imo 1003. CityProoertvTax mo.@$ Imo 1004. County Prooerty Tax mo.@$ 29.68 Imo 1005. Annual Assessments mo. I1l> $ 99.13 Imo 1009. Aaareaate Analysis Adjustment 0.00 0.00 1100. TITLE CHARGES 1101. Settlement or c10sina fee 1102. Abstract or title search 1103. Title examination 1104. Title insurance binder 1105. Document Preoaration 1106. Notary Fees to Pinnacle Land Transfer LLC 10.00 1107. Attorney's fees (jncludes aboye items No: ) 1108. Title Insurance 1 008.75 (includes aboye items No: ) 1109. Lender's Policv 1110. Owner's Policy 129500.00 .1 008.75 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordina Fees Deed $ 38.50 . Mortaaae $ . Release $ 38.50 1202. City/County tax/stamos Deed $945.00 . Mortaaae $ 945.00 1203. State Tax/stamos Deed $945.00 : Mortaaae $ 945.00 1204. Transfer Tax 2nd Deed to Cumberland County Recorder of Deeds 350.00 350.00 1205. Record 2nd Deed to Cumberland County Recorder of Deeds 38.50 1300. ADDITIONAL SETTLEMENT CHARGES 1301.08 Co/Two Tax 22-24-0783-107 to Marv Murrav. Tax Collector 259.54 1302. 08 Co/Two Tax 22-24-0783-108 to Mary Murrav. Tax Collector 96.56 1303. Sewer 4th atr 07 & 1 st atr 08 to Monroe Townshio 406.45 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K\ 2605.75 10 062.55 HUO CERTIFICATION OF BUYER AND SELLER 1::.5tate Of tiara E:. Myers WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: U.S. CODE SECTION 1001 AND SECTION 1010. The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. ~~~!c:aused or will cause t~eitJAd~ to be disbursed in accordance with this statement.. c:E:. "='M"~'~~ OA~~- REV-1509EX' (1-97) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF IYI Y Ef< S~ S,l/-"-!r E. FILE NUMBER .J.../-o7-.J9? If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. I ADDRESS RELATIONSHIP TO DECEDENT SURVIVING JOINT TENANT(S) NAME A. 13A-lvey It1.YER5 9;l,/ #"X~l/ ])r; V~ IY1 e..ehant ;cS l:Hf, ~} Pit 17 () 55" oS Or1 B. c. JOINTLY.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. '6/ :J7/'i? PNC r3AIJK C.heclt.,', A-ea. No. SPO a..()'1 35"1,/ ~ 3 '17.1' 5b~ ~) 73.3K (see Val(Aa~'oh letter lit 1f4cJ,ed) TOTAL (Also enter on line 6, Recapitulation) $ 11 3. 88 (If mnrF> ~n;lce is needed, insert additional sheets of the same size) MRY-20-2007 23:03 F't')CBRIH< J 1 ~~ 7tj~:: -3~S,:=: F'.OliCll ~ PNCB,l\l\1( May t 8, 2007 Charles E Shields, In Attomey at Law 6 Clouser Road Mechanicsburg, PA 17055 RE: Estate of Sara E. Myers. deceased SSN: 182-22-8402 DOD: 2/22/2007 De~r Mr Shields: In response to your requ.;;st for Date of Death balances for the customer noled above, our records show the followmg: Checking Account Account #5002093514 Establrshed 08/27/1999 SARA E lVfYERS BA..PJZ Y L MYERS DOD balance: $34776 (non-interest bearing) Please note that this office only provides date of death balances fOi depOSlt accounts (JRAs; CDs, Checking and Savmgs accounts), We do not proces~ any finandal transactions or provide statement.s. If you need assistance with any of these Items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, c?utiJr1~w l;)1J}-v Rache11e Wells 1-800-762-1775 P7 -PFSC-Q4-F 500 first Ave. PJttsb\lrgrl PA 15219 Member FDIC f~~ · .5 (!H €I). /I, ~l1i;; /2S7. of IYtYt-7(,5 ~ E. . ..".. _.- .- .. I :;. I ~fJI'O ;.sa/ fee. I~ /)J~ rk fI/lkl-!" frx- Lot 4/rJ,c! 1-1" UJe /5. ~/R/JlZlleLt;, /Jl.{Jr~ )I,/wt h,r un;lHp~Y~ lot If, ~/AJbf,tr~t as. ESA,~ lii: f;.,,- /l~jfvt~, C!u>f, 'f,'es! tna,';";zrs, /k-k~{/J;es,_ Bfe. . (~'nt) IS: _ fte/Itlbu rseMutt 10 June:h/7R {;.r. Adm;n/srJ-,.af,'vf:" ce-latM iCY~se5 ! I A. IJJ,'chqe/ J.. S1(lla/1(~_t-.ut1~&/)1( I ~. 11, i: e /J1ehU!r:el__Iv".rKf - %~".s P-he E~rpY/r1J I {!. SiX 2Ju/1t {Ju.l,h~~.~ -f - .... "'-_' --. ----. ........-. ----_.....-,,-_... ..,- -.-----.---',- ....-..-- .___.___"__W"_'___~ 1>. Ml!n/,Qe ~(/'. - -Sewer- c. /J!4.I')'_l'./J!/.{rrAj'~. t:>/Il!!~r F /N",,! //'. _ ll1urr~ ~a/U~r G-.IlIIl,., A.IJJ{,(,.r~ /~~lle~r 1,.j&/JIt11i$.~;pj1 li_fffL4'I'S _due/;I/;t k .sqk~f ~/ti/()l _ /1. !~4/1J1;S6L"n IL... /l4Il1'.LAuch~Il_ /;". Sale _ t:f.. fjil/!P.l Ii, &AII1J.i~PlL .t_llt1llti:~_~"If_ "r _ ~...d .... 1/z..'1/p 1 19. ,4d re!'ii 'JetI1eJJ!__ ~lJ/I/,j"u7u "1J(U,!t:l/(1rfh~et.. ~(). CHIJ-,eG€5 h.Jl)~~'[.s ~AJn~~TrtE'AtPllrSlt~.fT A-T SA-LE PF I!.EA-l- amrE 1t~~/~lltl/l/SSj"A t&/Ier /tJ/P'/qbJ5(//1/L. //)3) 11. TN/t'l50-ck~/IljL. -C-&/lq fr/Ifi~ (f,~.l~'f) c, ..A!~krl ICes.. ti../J,-lJllllcle ~ 71wtJfC,., L4. (;'he ///),,) '/). TtMlsfu. ~ (fiN /(03) f. -rffUt~h- ..&-. ( /;/IL /Z/J 'I) F /Mary I'rtUl'ray 1k &1/eaJpr (I,'ne Idol) ,. lJ1a", ~ ~ ~//tefpr (hlu- /302) H.!hJ,t1rOt ~~n.slz/)J, ~/{Ier. (f/Ifl /3/)3) ( See ,se1lhfluC sket g IIJ.c.J.uI ~ sdtd e) /he! Er1 Ihd EtI tvr1S~ lhMt1t1ellled I met ~r/ /)Jet K J j I --i ,;1/, J~, ;5. JIf. .10'. (&"1/:;11 ued ) ~ I - 07-397' ~~S:bt) ~/7S, 00 ~,~ x ~_~ IS' :1..23 14 I r?~. (5)0 ~ StIf, 2.1 <! ~1.2. IS " 3~1.~5' ... F:8 f/, 7p f 32f./'1 ~.l9,7 ..3 !' 5,71: ~/3"Lf.3' , ..s: ,,0 I- 7,/ 7/)f), f7-{} '2 ~s: ~ I () IJO I . '/ CjqS;H; ?'3Sl).HJ ~ ;} !''J,.5'Y( ., <J'.S' (! Lf Dr,. If S-- 'fer. 59' ,. ii', 'f0 ~ 7 3. 7l.f -t ..3? 7-a '1 .38. 1'8 1~3 s tHen J.I." &;nttl. I E5t: IJF IJ1Y~..s: S'AfVJ- E ~,I I'ttd eq ;17. 0Ja.JfL./J1PMftIHtI/C 21'. /J1d ErI .J'i. /J1tt Ed 3D. t1e,mhUrfLlntAtf t .Tun E. h/jf ~rA-"IfJ:/};S~~ ~ !?xpt/1 $eS. ~ A. . KC.IYJ ::!nsur.Grt"-",-,p. (He$5 ~~) (1/"t(Sl h1$Llr.) 11. e-CIfl rY1SIJr.~~p (l. 1f(!/1/ J1? S yf; .Gr,'f2 3/.; /her ErI 32" I1!Rste /l!Ql~ 33,._ Ihd- Ell 3'1. /fief ..~"-.. 5~_ nwnroe ~. ~V' I 36...1 IJ1!fgq___ ! 3.1.[ tvdfli~_.__ I -1 , I I I - -I I i I 1 1 . j I I ;z,/~07-3'Y fC" . ,;;. ~ if '1 17,.9d.. '3 ff: If) , '3.72 ~ 87".(7) ~ . r 7,SlJ ~ IlSlJ ~ 37, IS- ~ 75.7~ ~ 3 s: 24- 132. IS" , lsz .P9 '!3 7.. 28 , 7$. 7~ REV-151:3 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /it V€I?S, .sARA- E FILE NUMBER 2-/ - 07-379 "I. RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] -10l-lN C. tnYI:7C! wtt,S de!.e~de.n+s hu.Sband who p r-ai eCeAse4 nero AMOUNT OR SHARE OF ESTATE NUMBER I :2. t3l1-te~)' L. mYe1\!S 92/ NIxon f)r/ye, IJ1 eeha;n i c 5b u rj, jJ,9- 17 () ~ S- .5 t) YJ ~/3 .3. J € AN e. rINK ~ 7 /J1(; N4uihfDn 111'. DUYlC4I1r1Dn, rfJA 17&>:1.0 d au.~ h fer "i3 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-1512 EX+ (12-03) . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH J. ,3. i./, s: ,-.. 1. l(eJmbltlrsuneft;f ~ ..rUIn E. IS';,/( ;;r VOItj'~lJ-f ",c tle6t ()tve4' t /fIe.st r;S/z,;/'t E /J1U'fUUf 41u/J~ ~i~ (An,"4-/~) fh,r E ttI ?7 I. 2Z ~b.29 1 78.01 "7, ''I '/30. tb ~/9~ '17 173E.tfS'" 9' "r,,{)f) P: n nacJe. HeQ 1M fI/)sp: fa,ls l11"f/;1 ~r";{)/f)&Y ]),'o.yhIJshl:.- I: tJ nade f/u/M 7. r, E/11e7~ /J1PI1/'dt '7iu//. ~I!r A~1erjchO,'Ce. ~eI'4/ Cred/f Un/'on) t..oM1 ~ .3~3St> ~~ ~uanfUh1 -rtn~na TOTAL (Also enter on line 10, Recapitulation) $ I, 3 3~.. ?'f (If more space is needed, insert additional sheets of the same size) illastllill alto ill~gtnl1tPttt OF SARA E. MYERS I, SARA E. MYERS, of Mechanicsburg, Cumberland County, Pennsylvania, do make, publish and declare this to be lilY Last Will and Testament, hereby revoking all previous Wills and Codocils heretofore made by me. FIRST: I order my Co-Executors hereinafter named to pay all my debts and funeral expenses as soon as reasonably possible. SECOND: All the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and wheresoever situated, I give, devise and bequeath to my beloved husband, John C. Myers. THIRD: If my beloved husband, John C. Myers, shall predecease me, then I give, devise and bequeath the rest, residue and remainder of my estateJ real, personal and mixed, of whatsoever kind and wheresoever situated, as follows: (a) To Barry L. Myers - two-thirds (2/3) of my estate; (b) To Jean E. Fink - one-third (1/3) of my estate. If my beloved husband and Barry L. Myers shall predecease me, then in that event Jean E. Fink shall be entitled to the rest, residue and remainder of my estate. If my beloved husband and Jean E. Fink shall predecease me, thene.in such event all the rest, residue and remainder of my estate shall be divided as follows: (a) Fifty (50) percent to the issue of Jean E. Fink in equal shares; and (b) Fifty (50) percent to Barry L. Myers. FOURTH: I nominate, constitute and appoint Barry L. Myers and Jean E. Fink as Co-Executors of this, my Last Will and Testament, with full power and authority to do any and all things necessary for the complete administration of my estate. Should Barry L. Myers or Jean E. Fink predecease me, then the survivor shall serve as sole Executor or Executrix. ~'d?;JI(j;; /?4tc:{ , ~dd'0'L?e4bt,('(.A'. ^ c:"'- .0 ~/ ~ / <-faf-'/(7/(: .,/ .'1. t/'i~-c......_ ./ 7/ i/j ,..yd../\.- C\ _. .~ L' ~ ''177 L[ . . .......',_.f ~".t....'~';) . ~ ~ II I Should any of the persons herein nominated as Co~Exeautors qualify and at the time be a non-resident of the Commonwealth of Pennsylvania, I direct that they be not required to file any bond to the extent permitted by law. Last IN WITNESS tiHEREOF, I have hereunto e=t my hand and Will and Test...ent. this ! t, rj,v day of 7:;; aT seal to this, my , 1978. (/'/;-0-'.'" \ oJ)__/ /:\ r::lALl '--" tI '" .. 1. (..;/ Sara E. ~~ers V This instrument consisting of two (2) typewritten pages, each bearing the signature of the above~nam.ed, Sara E. Myers, was by her on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in her presence and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. )/(:/ /( /0 ot-,_o residing at /{0 / t:) :?-(d~ ,/ o / / 0 07 (; / /!. ",[ C. {/ C- /, /,- . . / ,Lit.. (~..{ .J residing CHARLES E. SHIELDS, III KITORNEY-A.T-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) TELEPHONE (717) 766-0209 FAX (717) 795-7473 March 6, 2008 Register of Wills Cumberland County Court House 1 Court Square Carlisle, PAl 70 13 Re: Estate of Sara E. Myers No. 21-07-0399 Dear Register of Wills: Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Sara E. Myers Estate as well as Check No. 874, in the amount of $15.00 for the filing fee, Check No. 875, in the amount of $200.00 for additional Probate and Check No. 876 in the amount of $4,834.77 for the Inheritance Tax due. Thank you for your kind attention to this matter. Very truly yours, ~~~ Charles E. Shields, III Attorney-At-Law CES/mjj Enclosures If. !h~ ~~.v.(e~ U'~I~;d#~~, /~.~ c C:. --~ ~~ <.-J 1.0 C') 'ai .b 1.0 o t- T'"" <C. n.. (f) C) 9 'S u.!Oco -"(f) ~"o (f)u.l_ (f)(f)~ ~?~ "So <C.ou.! G"'::Z u.l (/) :J o ~ ~ :J o o E >- ~ 'Zoc:, ~:J(/)"" ...JOu.l~ -o(/).... ~O:Jc:( \1-0200. <(~U1 CX:...JI-~ I.Ufficx:~ t)CO:J~ -'20c:( $:JOO cx:O..... ..D C!!!! ..D tTl- \.11- - ~ == n.J o o o o n.J n.J 0_ -::: - ~ ~