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Home My WebLink About05-12-08 ~ 15056051047 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 1 ('128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number 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 C) 2. Supplemental Return C) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required C) 4. Limited Estate C) C) C) 4a. Future Interest Compromise (date of death after 12-12-82) C) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) C) 10. Spousal Poverty Credit (date of death C) 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 8. Total Number of Safe Deposit Boxes - :-") .~, -0 First line of address Second line of address ZIP Code _~;J --; jt DATE FILED 1-.,) State 1',) CO o ';'f~ Correspondent's e-mail address: 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 preparer other than the personal representative is based on all information of which preparer has any knowledge. /VO. ~ /()7/) DATE ADDRES t( _I DO )lC) t t::::- DAD} N(3vJ GM f?ei<l.-j.tJO f{ /167D PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ....J ~ -.J REV-1500 EX Decedent's Name: RECAPITULATION 1. Real estate (Schedule A). 15056052048 . . . . .. . .. . . . . . . . . . . . .. 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 .0_ 16. Amount of Line 14 taxable at lineal rate X.O ~'5 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . " . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ()v~ \f.... '" N ~<JfCb 15056052048 Side 2 15. 16. 17. 18. C) 15056052048 --.I REV-1500 EX Page 3 File Number Dece~ent's, Complete Address: DECEDENT'S NAME STREET ADDRESS eOfiA H,SttAff~R J oo-ttDltl\11" .. A/...LEN D.Rlv~ lA.. f> -p~ ..~ AJ,"bEPI' u;-;'!MJI; H f P. t:.C c. G c;J'\0aa&t\lQ c;: roT'j STATn r'A~ ZIP CITY l 7 {)G"~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) Sb 43.~D . . .t-~Q~-t5u/) ----$)-1\5'.3_-- Total Credits ( A + B + C ) (2) 71 y;q. D:3 3. Interest/Penalty if applicable D. Interest E. Penalty ~. Df> - -U..-bDn (3) 110. 1)) /3 4\~14:7 4. (4) 5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D B b. retain the right to designate who shall use the property transferred or its income; ............................................ D [;j c. retain a reversionary interest; OL,......,................................................................................................................. D I:i6' d. receive the promise for life of either payments. benefits or care? ...................................................................... D [0" 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [B' 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S, 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not 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 P.S, 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 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+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER IS \)N~ H. gHf\FFr::~ IfJ,..l...t16 ~ Qi5' I 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. j.,. DESCRIPTION H()~f A t\)j) I-lJ1" - b~'J... t..ew lS (3e~~~ ~f\ p - fAl~U ~s vJ -'-;wfV5t\ If I 'JDRk. CP\Uf~ I ~ 70'-0 - Se~1"I-t:p\~ T t)ro 3-~-o~ - 3el-L\I\l(; ft<Jt.f: --""7<- AN~ Sswe~ Re J=='"" "'0..5 VALUE AT DATE OF DEATH /3'1. 'fDV. DD ~*.q~ -. . ~ TOTAL (Also enter on line 1, Recapitulation) $ (un.. 5~ )~ ~ (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (1-97) ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 60Nt.. tl. Stlf)..Ff~6l FILE NUMBER ~1-D~-6351 ITEM NUMBER 1. ~, 3. J-f. 6. DESCRIPTION. H6~~ e t\ b\-C f CJ... ~ 1\I \ ~t't l '" ~ ~ P tv c. fbt\IJk -" Ac.v04a..lI>l ~ , t>6')....l>bL 1 t) 7 f'MOJ:;tJ-(rAI... INS CD - L.ifC IN; _!--h~t;aj\l\JD 13€.~v ~ f-\C-tl\R. '\ f /'1.1: ~Q;:::A'5 [;=0 \-t ~,z... HI~H Ml\~K Rf F-u.tvO VALUE AT DATE OF DEATH ~50[) . [)V JO bb 7.41.- 'T or 1. A., Y J77 . I b I /. /) t L ( I' ,. TOTAL (Also enter on line 5, Recapitulation) t - /6f '147.50 (If more space is needed, insert additional sheets of the same size) REV-l509 EX _(1_97\ SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF f.DN.lP\ H. I') H A Pr6R. FILE NUMBER :1.1-t) 1'- 035' 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 ADDRESS RELATIONSHIP TO DECEDENT A. Ft...o~ 0 f. 6ffAfFei.. b ~ J..t:WI 6 e8~~ ~^() JV~~ C~f~LfV.JA {1\,,'" rJ6~O s. 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. 1'f1'1 /::'00 -Sl-\p.R.e..s SO~,..~ f~N ~, ~~5.:a.l q...\ J b~- i> 0 5lJ Ih51ll ,DD :L, A, Sove ({.elf!:1N 6 A rvt<. 1l":1" pJt) 0771 03Q ~1Jt ~tt97 ,yb --.!:J?; 11 'd- ~~., t '3, A. ~l " It II [b(,[ ~ jP-l I I <too, 1 t 5b 'f cD~'3I.o "\. ~, l~){)(f\ P rJ <.- &'" tV K A"-r ~l !31Ui> ",~~1lfb 1 j 3-?b' ;1.3 !:Ji> 5-6 '1D. l 'l. /" . 6. A. b srt f\Res Ml(tt\~ T U>fl.D ~ 37.'H ~,,;t. IJb Jj)7. J II. 03 TOTAL (Also enter on line 6, Recapitulation) $ 0...\ ~ ~ '\4 \ \~ ~ (If more space is needed, insert additional sheets of the same size) REV-151 i EX+ (10-06) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~ n N\\ H t h t\f\FFf~ Debts of decedent must be reported on Schedule I. FILE NUMBER ~\-Of ~ 035\ ESTATE OF ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: G.-f"o,vB -&-- ~rt~~~ ~Il( F'\.LNeftt\'- ~OM~ Cu..-r tv AM6 ON G~p..lI~ M."~E$. 7D~~.D() \\7.00 9---- B. ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions Name of Personal Representative(s) Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees '73'7'1 .{j D 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent 4. Probate Fees ~b5. 'b1J 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. t R.~ .... 1 tJ t. () fl\ t \t>. ~ ~ ()"l: \'t~;',oO 1.{~1.o~/~ '1. ~E:.~ I f\~ V I t....L \\\.(!) f. - C A.t.t. 6G1 l,5 .0'0 q. ~~ \.\ \\ ~v 15" b~ u.~'1'J...,~$ It ~ L.-t~\ t' M ~ ~,,~ 0'1 '-\&)- 6C; \ " I:, b~ ll. f ~feN5~S 6N 9Al-~ ()f I\~ f\\.. (grf\1b J ~tn.b nq TOTAL (Also enter on line 9, Recapitulation) $ C () UT1 i\!tA,tr() (If more space is needed, insert additional sheets of the same size) 3C+\ e. 0"-\ ""f: H ( C,DNil '11),-, e C J EO tV~ H-. G' H~ }Zr:-e:~ 'J.\- ~r;- {)2Sj 11.... Rt:: G t ~if~~ tJf IN Il,..LS - fl'-€ lAy.. Re-nJ.-RtJ }5.D 0 /J. \1 h L, [?e~er<.tr6 - LoCAl... IN V~rf)roflJ1 I~Di) I ~( I' II " II .- r1 Le A Cv ()1lv(l) T I 'Z"~. 00 ~ )" S E;tJr/NLJl..... NevJSJJA fER frO tJ e-A rl~-5 J:.~rn r8 )'34. b D )&> C u.M8 eAt- A NOLA w J l>/.t.R)J +..t..... .....' L , 75lDD n. BONO To 6BtA\ N grt:JC.I. (eA.I/F IC.A-re: fD ({. ~v.sr ~ _ H Lf l/: I 'f(' C-C1t11 FIe A. ~ ~~(v ~r$\ L.. 4(,,10 b7. 1> 7 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER E DAJf\ tit ,SHnF FD'R gJ-D~-6351 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] l t>t/'h ../ 1. r LO'1 p f. ~tiAff~ - 3~~ L~wl$~,r~J ~ ((1:>"'::0 I N& Lv (;~~l..I\AH) I fA, /1fnv 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) Southern Company Services, Inc. POBox 54250 Atlanta, Georgia 30308 Telephone 800-554-7626 04/11/08 Southern Company Services A the southern electric system Edna H Shaffer And Floyd P Shaffer Jtwros 628 Lewisberry Road New Cumberland PA 17070-2710 ACCOUNT VERIFICATION Dear Sir/Madam: As of March 19,2008 , the individual listed above, Account Number 362879 held a total of 600 shares of Southern Company common stock. The closing value of one share was $35.28 The account has been opened since 12/14/88. Transfer instructions are included. If you need further information, please call us at: Telephone: 800-554-7626 Stockholder Services MIRANT CORPORATION COMMON STOCK SHAREHOLDER VOLUNTARY SALES PROGRAM " MIRAII'I February 28, 2007 Dear Mirant Corporation Shareholder, Mirant Corporation is pleased to extend the Voluntary Sale Program (the "Program") to provide shareholders owning fewer than 100 shares of Mirant Corporation common stock (the "Common Stock") the opportunity to conveniently sell all of their shares. This is a limited-time offer scheduled to expire at 5:00 PM Eastern Time on March 30, 2007. We value your continued interest in Mirant Corporation, but realize that some shareholders may not wish to continue to own a small number of shares. Should you elect to participate in the Program, you will receive the average of the closing price, on the New York Stock Exchange, of Mirant common stock for the week in which your response is processed. A program-processing fee of $1.50 per share (up to a maximum of $35.00) will be deducted from your proceeds. Please keep in mind no price-per-share can be guaranteed. If you would like to take advantage of the Program, we encourage you to act now. Additional information about the Program is available on the reverse side of this form or by calling our program manager, Mellon Investor Services, toll-free at 1-866-337-6319. Sincerely, Mirant Corporation As of February 23, 2007, the closing price of Mirant Corporation common stock on the New York Stock Exchange (NYSE symbol: MIR) was $37.01 per share. Based on that price, your holdings would be worth $ 222 . 06 TO SELL YOUR SHARES If you choose to sell your shares, the Program offers you three convenient options: Option 1) Internet - Visit the Program web site at www.corp-action.net/mir and follow the instructions on the site. Option 2) Phone - Call the automated toll-free line at 1-866-829-5757, 24 hours a day and follow the instructions. If you choose Option 1) or Option 2), please have your Account Code and Control Number located in the bottom portion of this letter available. Option 3) Mail - Check the box below, sign and return the form in the envelope provided. MIRANT CORPORATION COMMON STOCK SHAREHOLDER VOLUNTARY SALES PROGRAM A. FOLD AND DETACH. INSERT IN PROVIDED ENVELOPE A. 125976611 00000006.0000 LT2 176021 J I USE THIS FORM ONLY IF YOU WISH TO REPLY BY MAIL I If selling shares by mail, please complete and sign this form, place in enclosed envelope, and mail to Mellon Investor Services, PO Box 3448, S. Hackensack, NJ 07606.1948 # of shares you Own Account Code 125976611 Control Number 6.0000 015766861 125976611 1111111111111111111111111111111111111111111111111111111 EDNA H SHAFFER AND FLOYD P SHAFFER JTWROS 622 LEWISBERRY ROAD NEW CUMBERLND PA 17070-2710 ~ 6) Signature: This form must be signed by the registered hoIder(s) exactly as their name(s) appears on the certHicate(s) or by person(s) authorized to sign on behaff of the registered holder(s) by documents transmitted herewith. I I X Signature of Stockholder Date Daytime Telephone # x o SUBSTITUTE FORM W-9 PLEASE CERTIFY YOUR TAXPAYER 10 OR SOCIAL SECURITY NUMBER BY SIGNING BELOW. 190120499 It the Taxpayer 10 Number printed -.. above is INCORRECT OR if the space is BLANK write in the CORRECT number here. 1 J Substitute Form W-9: By signing this form below, I certify under penalty of perjury, that the number above is my correct taxpayer identification number, that I am not subject to back-up withholding, and that I am a U.S. person (including a U.S. resident alien). PLACE AN 00 IN THE ELECTION BOX D SELL all my shares @ By signing this form I authorize ttle sale of shares as indicated above, and I agree to the terms of the Program described in this form. If there is no indication marked above, I will be deemed to have instructed all my Mirant Corporation shares to be sold and accept the proceeds as described in the program material. page: ~ Document Name: untitled DDHIST DEMAND DEPOSIT DISPLAY HISTORY 6017 03/28/08 S * * * * -------Account Holders-------- EDNA H SHAFFER FLOYD P SHAFFER --Acct Rel-- PRIMARY CO-HOLDER -----Demand Deposit----- Branch 0077 Area 0077 Officer Class 30002 -------------------Customer Comments------------------- LEGAL POA DATED 1/9/03 NAMING FLOYD P SHAFFER FOR EDNA H SHAFFER DD/0771039824 LEGAL POA DATED 1/9/03 NAMING FLOYD P SHAFFER FOR EDNA H SHAFFER 00/1661221211 (ADDITIONAL COMMENTS EXIST. REFER TO CRF SCREENS.) -Emp- --Date-- 01/13/05 04/25/05 01/13/05 04/25/05 I )SJ tJ~L;{G' (u Date: 3/29/2008 Time: 11:28:21 AM Page: 1 Document Name: untitled DDHIST Demand Deposit Display History 6017 03/28/08 Acct 0771039824 Alpha key SHAFFEH.01 S --Date-- * 02/06/08 * 02/06/08 * 03/06/08 * 03/06/08 03/24/08 03/24/08 Request ALLTRANS Last strnt 03/06/08 ----Description----- -Serial Nbr- INTEREST CREDIT DAILY BALANCE INTEREST CREDIT DAILY BALANCE WTHDRWL DAILY BALANCE DDDHISTREQ Only one page of information. COMMAND ===> DDDHISTBAL -Reference- ------Amount------ 00000000000 2.51 8,455.02 00000000000 2.34 --;? 8,457.36 06781209500 /t (4,200.00) / 4,257.36 .- / 13J 077 "3/r/o V DDDMAIN DDDACCT DDDINT GN20000I04 F2=Retrieve F3=Exit F4=CRFwindow Date: 3/29/2008 Time: 11:28:19 AM page: 1 Document Name: untitled DDHIST DEMAND DEPOSIT DISPLAY HISTORY 6017 03/28/08 Acct 1661221211 Request ALLTRANS A . - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - CRF WINDOW - - - -- - - - - - - - - - - - - - - - - - -- - - - - - - - - - . I EDNA H SHAFFER Alpha-key SHAFFEH.01 I S FLOYD P SHAFFER TIN 190-12-0499 ,I * I c/O FLOYD P SHAFFER Birth date 09/18/1906 0 I 628 LEWISBERRY RD Home phone 717-938-2953 I * I NEW CUMBERLND PA 17070-2710 Work phone 000-000-0000 I * I -------Account Holders-------- --Acct Rel-- -----Demand Deposit----- I, ~ * I EDNA H SHAFFER PRIMARY Branch 0166 Area 0166 I 7 I FLOYD P SHAFFER CO-HOLDER Officer Class 30001 I 5) I I i) I -------------------Customer Cornments-------------------- -Emp- --Date-- I 1 I LEGALRQft DATED 1/9/03 NAMING FLOYD P SHAFFER FOR EDNA 01/13/05 I 0) H SHAFFER 00/0771039824 04/25/05 1 'I LEGAL POA DATED 1/9/03 NAMING FLOYD P SHAFFER FOR EDNA 01/13/05 " H SHAFFER 00/1661221211 04/25/05 T L I (ADDITIONAL COMMENTS EXIST. REFER TO CRF SCREENS.) I 02 C I F3=Exit I F ,-------------------------------------------------------------------------, /:' fV 5 Jvf~)~!/( b Date: 3/29/2008 Time: 11:28:39 AM Page: 1 Document Name: untitled DDHIST Demand Deposit Display History 6017 03/28/08 Acct 1661221211 Alpha key SHAFFEH.01 Request ALLTRANS Last stmt 03/06/08 S --Date-- * 03/03/08 * 03/03/08 * 03/06/08 * 03/06/08 03/12/08 03/12/08 03/18/08 03/18/08 03/24/08 03/24/08 ----Description----- US TREASURY 303 SOC SEC 030308 190120499A SSA DAILY BALANCE INTEREST CREDIT DAILY BALANCE CHECK DAILY BALANCE CHECK DAILY BALANCE CHECK DAILY BALANCE -Serial Nbr- 843 844 845 DDDHISTBAL DDDHISTREQ Last page of information. COMMAND ===> F7=Backward -Reference- ------Amount------ 00077900000 341.00 1,885.97 00000000000 0.10 1,886.07 06356202970 (11.55) 1,874.52 06390209130 (73.81) 1,800.71 06781209510 ~ (900.00) <73 /,j . I 900.71 <<) . Ol/ '3tlf/ b V DDDMAIN DDDACCT DDDINT GN20000I02 F2=Retrieve F3=Exit F4=CRF'window Date: 3/29/2008 Time: 11:28:37 AM o PNCBAN< The Thinking Behind The Money April 8, 2008 Floyd Shaffer 628 Lewisberry Rd New Cumberland, P A 17070 RE: Edna Shaffer (Deceased) SSN: 190-12-0499 DOD: 03-19-2008 Dear Mr. Shaffer: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account # 5140296846 Established 12-30-1991 EDNA H SHAFFER DEC FLOYD P SHAFFER LUTHER L SHAFFER DOD balance: $11,350.23 non interest bearing Savings Account Account # 5002061707 Established 03-30-1999 EDNA H SHAFFER DOD balance: $10,666.30 + 1.12 accrued interest Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. srncer~l/ ~duL Colleen Crowder 1-800-762-1775 P7-PFSC-04-F 500 First Ave Pittsburgh, P A 15219 Member FDIC Page 1 of 1 Signature Card Image Page Page 1 of 1 C (XNJ Bank. AA ~ 8iIlIIIIIIIaI)' claM ~ ~llfLE SHImR ~EDNA II OR MID P TYPE Of ACCOUNT CHECI(lNG - D REOUlAR Q. BUDGET 0 NOW Q SUPER NOW Cl CLuB o CLUB PlUS Clsu.Yefl ADV, 0 ULTIMATE ClUB 0 fAMILY INS, SAVINGS - O?A'SSl'SOOK 0 GOP 0 STATeMmNT 0 COIIAB. STATE. 0 MOIIlE'{ MAIOO;T o COUEGE FUND DAUTOMAllC CLUa m-~ SIO. It eo. I ACCOWfT NU~ 051ltOZ96846 . 'I ... ....:Ii. ... -- .....................--........................- ~.......,. --~ '._"IM con.Illl...... Thlo......... <l1tly.. ~ltar. .... Alli"'_.. c...m.d ......iI1.. ftlllltil ~'" 'IM"" __""flu.. 'nl.......'k_~I'W.r4M,..~~.. ."WII"'" e_tllWt"t1_I" _.... Met lac"..._ _.n!!Mt"'" lYoIcIl6I ,.,.....~ ",.... 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U.S. Department of Housing and Urban Development 1. [ ] FHA 4. [ ]VA 6. File Number B. Type of Loan 2. [ ] FMHA 3. (Xl Conv. Unins. 5. [ ] Conv. Ins. 7. Loan Number 20080067 190820826 Settlement Statement 8. Mortgage Ins. Case No. C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked ("POC") were paid outside the closing: they are shown here for information ur oses and are not included in the totals. D. Name of Borrower: Timothy S. Butler, 5505 River Road, #4, Harrisburg, PA 17110 Susan R. Larue E. Name of Seller: F. Name of Lender: Estate of Edna H. Shaffer, 622 Lewisberry Road, New Cumberland, PA 17070 Countrywide Bank, FSB, it's successors and/or affilliates, 2512 Eastern Blvd, York, PA 17402 Fairview Township TIN: G. Property Location: H. Settlement Agent: Place of Settlement: I. Settlement Date: ~2.2 lewisberry Rd., New Cumberland, PA 17070 Great Road Settlement Services, LlC (717) 731-1040 765 Poplar Church Road, Camp Hill, PA 17011 3/28/2008 Proration Date: 3/28/2008 100. Gross amount due from borrower: 101. Contract sales price 102. Personal property 103. Settlement charges to borrower (line 1400) 104. 105. 400. 139,900.00 401. 402. 10,491.88 403. 404. 405. Gross amount due to seller: Contract sales price Personal property 139,900.00 106. City/town taxes 3/28/2008 to 1/1/2009 139.19 406. City/town taxes 3/28/2008 to 1/1/2009 139.19 107. County taxes 3/28/2008 to 1/1/2009 347.97 407. County taxes 3/28/2008 to 1/1/2009 347.97 108. Assessments 408. Assessments 109. School Taxes 3/28/2008 to 7/1/2008 296.09 409. School Taxes 3/28/2008 to 7/1/2008 296.09 110. 1 st Otr Sewer 3/28/2008 to 3/31/2008 1.67 410. 1 st Otr Sewer 3/28/2008 to 3/31/2008 1.67 111. 411. 112. 412. 120. Gross amount due from borrower: 151,176.80 420. Gross amount due to seller: 140,684.92 201. Deposit or earnest money 1,000.00 501. Excess deposit (see'instructions) 202. Principal amount of new loan(s) 111,650.00 502. Settlement charges to seller (line 1400) 18,076.79 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Payoff of first mortgage loan 205. 505. Payoff of second mortgage loan 206. 506. Overnight Payoff(s) 207. 507. 208. 508. 209. 509. 210. City/town taxes 510. City/town taxes 211. County taxes 511. County taxes 212. Assessments 512. Assessments 213. School Taxes 513. School Taxes 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total paid by/for borrower: 112,650.00 520. Total reduction in amount due seller: 18,076.79 301. Gross amount due from borrower (line 120) 151,176.80 601. Gross amount due to seller (line 420) 140,684.92 302. less amount paid by/for borrower (line 220) 112,650.00 602. Less total reduction in amount due seller(line 520) 18,076.79 303. CASH (X)FROM OTO BORROWER 38,526.80 603. CASH OFROM (X)TO SELLER 122,608.13 SUBSTITUTE FORM 1099 SELLER STATEMENT. The information contained in Blocks E, G, H and I and on line 401 (or, if line 401 is asterisked, lines 403 and 404), 406, 407 and 408-412 (applicable part of buyer's real estate tax reportable to the IRS) is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence 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. SELLER INSTRUCTION - If this real estate was your principle residence, file form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of form 4797, Form 6252 and/or Schedule D (Form 1040). YOU are requlrea oy law to provloe Great Koao ::;emement ::;ervlces, LLt; (rl r) r::Sl-1U4U Wltn your correct taxpayer IOentillCanon numoer. If you do ot pr ide Great Roa me rvices, LLC (717) 731-1040 with your correct taxpayer identification number, you may be subject to civil or criminal penalties. .":'I'~ 700. Total sales/broker commission based on : $139,900.00= $8,394.00 Paid From Paid From Division of commission (line 700) as follows: Borrower's Seller's 701. $4,172.00 to Straub & Associates Real Estate Group, Inc. Funds at Funds at 702. $4,222.00 to The Homestead Group, Inc Settlement Settlement 703. Commission paid at settlement $8,394.00 8,394.00 704. 705. Transaction Fee-Buyer to Straub & Associates Real Estate Group, Inc. 295.00 706. Transaction Fee-Seller to The Homestead Group, Inc 125.00 " , 801. Loan ori9ination fee to Countrywide Bank, FSS, it's (1%) 1,100.00 802. Loan discount to Countrywide Sank, FSS, it's (2.375%) 2,651.69 803. Appraisal fee to LandSafe Appraisal Services, Inc. POCS 415.00 80.00 804. Credit report to LandSafe Credit, Inc. POCS 35.00 805. Lender's inspection fee 806. Mortgage insurance application fee 807. Assumption fee 808. Lender Fee to Countrywide Bank, FSS, it's successors and/or affil 225.00 809. Document Preperation Fee 810. Flood Check Fee to LandSafe Flood Determination, Inc. 26.00 811. 812. Application Fee to Countrywide Sank, FSS, it's successors and/or affil 399.00 901. Interest from 3/28/2008 to 4/1/2008 at $17.59000/day for 4 days. 70.36 902. MortgaQe insurance premium for 903. Hazard insurance premium for to State Farm Fire and C POCS 428.00 904. FHA MIP (upfront) 1 year to FHA 1,650.00 905. 1002. Mortgage insurance 1003. City property taxes 1004. County property taxes 4mo.@ $53.2600 per mo. 213.04 1005. Annual assessments (main!.) 1006. School Property Taxes 11 mo.@ $97.0100 per mo. 1,067.11 1007. 1008. 1009. Aggregate Adjustment to Countrywide Bank, FSB, it's successors and/or affil (409.08) 1101. Settlement or closing fee to Great Road Settlement Services, LLC POCS 0.00 1102. Abstract or title search to ACE Abstracters POCS 150.00 1103. Title examination to Great Road Settlement Services, LLC POCS 0.00 1104. Title insurance binder to Great Road Settlement Services, LLC POCS 0.00 1105. Document preparation to Great Road Settlement Services, LLC 125.00 1106. Notary fees to Cash 25.00 10.00 1107. Attorney's fees to Robert Myers, Esquire POCS 0.00 500.00 includes above items no.: Estate Items 1108. Title insurance to Great Road Settlement Services, LLC 1,058.75 includes above items no.: 1109. Lenders coveraQe $111,650.00 1110. Owners coverage $139,900.00 $1,Oq8.75 1111. Endorsements-1 00,300,900 to Great Road Settlement Services, LLC 150.00 1112. Closino Protection Letter to Great Road Settlement Services, LLC 35.00 1113. Real Estate Tax Certification to Patricia A. Gordon, Fairview Township Tax Collectc 10.00 1114. OvemighUWire to Great Road Settlement Services, LLC 75.00 1115. Deed Preparation to Robert Myers, Esquire 150.00 m , 1201. Recording fees: Deed $42.00 Mortaage $56.00 98.00 1202. City/county tax/stamps: Deed $1399.00 1,399.00 1203. State tax/stamps: Deed $1399.00 1,399.00 1204. 1205. 1206. 1301. Survey 1302. Pest inspection 1303. Home Inspection 1304. 2007-08 School Tax (8/20/07) to Patricia A. Gordon, Tax Collector POCS 1140.74 1305. 2008 CountvlTownship Tax to Patricia A. Gordon, Tax Collector 626.29 1306. Inheritance Tax to Register of Wills 6,862.50 1307. 2nd Quarter Sewer to F airview Township 51.00 1400. Total settlement charoes (entered on lines 103, section J and 502, section K) 10,491.88 18,076.79 Susan . arue To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will b. disbursed by the undersigned as per of t ent of this transaction. ~t~L<?, dg- d l/?/ r lIement Services, LLC Date SELL ANDIOR PURCI'lASER'S STATEMENT Selle(s and Purcl1ase(s signature hereon acknowledges his/their approval of tax prorations and signifies their u rstanding that pro~ati~ns were based on taxes for the preceding year, or estimates for the current year, and in the event of any change for the current year, all necessary djustments must be"made between Seller and Purchaser, likewise any default in delinquent taxes will be reimbursed to Title Company by the Seller. Title Corti"'p'any, in its capacity as Escrow Agent., is and has been authorized to deposit all funds it receives in this transaction in any financial institution, whether affilia t'Jr"not. Such financial institution may provide Title Company computer accounting and audit services directly or through a separate entity which, if affiliated with Title mpany, may charge the financial institution reasonable and proper compensation therefore and retain any profits therefrom. Any escrow fees paid by any party involved in this transaction shall only be for checkwriting' and input to the computers, but not for aforesaid accounting and audit services. Title Company shall not be liable for any interest or other charges on the earnest money and shall be under no duty to invest or reinvest funds held by it at any time. Sellers and PurChasers hereby acknowledge and consent to the depositof the escrow money in financial institutions with wi1icl1 Title Company has or may have other banking relationships and further consent to the retention by Titie Company and/or its affiliates of any and all benefits (including advantageous interest rates on loans) Title Company and/or its affiliates may receive from such financial institutions by reason of their maintenance of said escrow accounts. ~Ss:~;:~~;;~;,~... _M" 'g'''' 'M>MO', "M"'... >h.. .h. _."""'M' h._." ... ~,.~U ..~. ^"" -0;". T'>~~ M 'h. ..-. T'm"",:X~ ~.'\",J ~ ''''', "'~. """', Susan KLarue WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can Include a fine anI imprisonment. For details see; Title 18: U.S. Code Section 1001 and Section 1010. ROBERT E. MYERS A'ITORNEY AT LAW 100 YORK ROAD NEW CUMBERLAND, PA 17070 ~~' 4~~-~'~-~ ,,:,,~"""~'~""<""" LAST WILL AND TESTAMENT OF EDNA HAZEL SHAFFER I, EDNA HAZEL SHAFFER, now of Messiah Village, Upper Allen Township f Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare th~s to be my Last will and Testament, hereby revoking all other Wills and Codicils previously made by me. I TEM I: I direct that payment of all my just debts, expenses of my last illness, funeral expenses, and the costs of administering lS estate from my estate as soon after my death as conveniently may be done. ITEM II: I give, devise and bequeath my house with all contents of house and lot situate and known as 622 Lewisberry Road! Fairview Township, York County, Pennsylvania and one half (1/2) OI the residue of my estate to FLOYD PAUL SHAFFER! my son, and if he is not then livj_ng then to RUTH SHAFFER, his wife; if both are no~ then living th"":~l to JOHN W. F. YORE, my friend, now of Lemoyne, Pennsylvania. ITEM III: In the event that I do not own the house situate and known as 622 Lewisberry Road, Fairview Township, York County, pennsy Ivania at the time of my death then FLOYD PAUL 1 t ~ ~, ,>1 SHAFFER, my son, to receive a three-quarter (3/4) share of my estate and if he is not then living then to RUTH SHAFFER, his wife, and if both are not then living then to JOHN W. F. YOHE, my friend. ITEM IV: In the event that I own the said house and lot situate and known as 622 Lewisberry Road, Fairview Township, York County, Pennsylvania, which goes to my son FLOYD PAUL SHAFFER, the remaining one half (1/2) of the residue of my estate to go to FLOYD PAUL SHAFFER, my son, in trust for the following purpose: A. The corpus and accrued interest of the said trust to go to LUTHER LEROY SHAFFER, my son, if a single person or upon him becoming a single person and if he should then be dead or die before becoming a single person then the said corpus of Trust and accrued interest to go to FLOYD PAUL SHAFFER, my son, and if he is not then living then to RUTH SHAFFER, his wife and if both are not then living then to JOHN W. F. YOHE, my friend. ITEM V: In the event I do not own the said house and lot situate and known as 622 Lewisberry Road, Fairview Township, York County, Pennsylvania at the time of my death then the remaining one-fourth share in the residue of my estate to go to FLOYD PAUL SHAFFER in trust for the following purpose: A. The corpus and accrued interest of the said trust to go to LUTHER LEROY SHAFFER, my son, if a single person or upon him becoming a single person and if he should then be dead or die before becoming a single person then the said one-fourth of the residue to go to FLOYD PAUL SHAFFER, my son, and if he is not then 2 living then to RUTH SHAFFER, his wife and if both are not then living then to JOHN W. F. YORE, my friend. ITEM VI: In the event that FLOYD PAUL SHAFFER dies or resigns or refuses to act as Trustee in the foregoing two situations then RUTH SHAFFER, his wife, to be Trustee and if both die or resign or refuse to act as Trustee then JOHN W. F. YOHE, my friend, to be Trustee. My Trustee to invest the corpus of either trust in Certificates of Deposit or mutual funds in the sole discretion of Trustee and not as otherwise provided by law. ITEM VII: I direct that any and all taxes that may be assessed in consequence of my death, including all inheritance, estate and transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate as a part of the expense of the administration of my estate. ITEM VIII: I authorize and empower my personal representative to compromise, adjust, release and discharge in such manner as my personal representative may deem proper, all debts and claims owed by or to me or my Estate; to sell, lease or exchange at public or private sale or in such manner, at such prices, and upon such terms of credit or otherwise, as my personal representative may deem proper, all or any part of my property, real or personal; to exec ute, acknowledge and deliver instruments of conveyance, including deeds in fee simple; to borrow money for the purpose of paying estate, inheritance or other taxes which are required to be 3 paid and to secure any such loans by pledge or mortgage of all or any part of my property and to execute the necessary instruments to carry out such powers; to distribute my estate in kind or partly in money or partly in kind, and to determine the fair value at which any property so distributed in kind shall be received by the distributees; ta conduct any business in which I have an interest at the time of my death, for such period as my personal representative may deem proper, power to borrow money and pledge assets of the business and the power to do all other acts that I, in my lifetime, could have done, to delegate such power to any partner, manager or employee without liability for any loss occurring therein and to organize a corporation to carryon said business as capital to such corporation and accept stock in the corporation in lieu thereof and hold such stock for the uses of this my Will, and to vote said stock or sell the same as to my personal representative may seem best; to retain all stocks, assets, bonds and investments owned by me without being confined to what is known as legal investments; to execute any options "to purchase i to apply for stocks i bonds or other investments, to purchase or otherwise acquire real estate and to execute the same powers thereover as hereinbefore provided, to retain indefinitely any part of my assets, real or personal, which is or may become unproductive or to make sale thereof; to pay carrying charges and expenses of the property out of other principal or income of my estate; to invest and reinvest in all forms of property without 4 I I restriction to investments authorized for Pennsylvania fiduciaries, as my personal representative deems proper, without regard to the principle of diversification or risk; to exercise any law-given option to treat administrative expenses either as income tax or as estate deductions, without regard to whether the expenses were paid from principal 0r income. The powers herein conferred shall be to my named personal representative and all successors thereto and shall be in addition and not in limitation of other powers conferred on said fiduciary. Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income payable to any beneficiary shall be made upon the sole receipt of the respective beneficiary to whom the payment is made and free from anticipation, alienation, assignment, attachment, and pledge and free from control by the creditors of any such beneficiary. ITEM IX: All shares of principal and income hereby given shall be free from anticipation, assignment, pledge or obligation of the beneficiaries and any of them and shall not be subject to any execution O~~ attachment, levy or sequestration or other claims of the creditors of said beneficiaries or any of them. ITEM X: I nominate, constitute and appoint my son, FLOYD PAUL SHAFFER, as the sole Executor of this my Last Will and Testament, to serve without bond. In the event of the renunciation, death, resignation, refusal or inability to act for any reason whatsoever of the said FLOYD PAUL SHAFFER, I nominate, 5 constitute and appoint RUTH SHAFFER, his wife, as the Executrix of this my Last will and Testament, to serve without bond. In the event of the renunciation, death, resignation, refusal or inability to act for any reason whatsoever of the said RUTH SHAFFER, I nominate, constitute and appoint JOHN W. F. YOHE, my friend, as the Executrix of this my Last will and Testament, to serve without bond. IN WITNESS WHEREOF, I, EDNA HAZEL SHAFFER, have, to this my Last will and ra---51 ,/ "....J ~/2'-dl__-1> Testament, set my hand this 3)~Xday of , 20~) / . (2 dJckco. H1fl~JU EDNA HAZEL HAFFER (SEAL) Signed, se~led, published the above nc~;'led Testatrix rtJ(P~ ,20C/ , in the presence of us, who, in of each other, have, at her witnesses hereto. and declared by EDNA HAZEL SHAFFER, on the L =) / J.:.;vc day of as for her Last Will and Testament, her presence, and in the presence request, subscribed our names as N~ Name residing at ~5~~ ~ ~~ at c: cfJ t? 1:~)-e.J2/V~ tf? (~ -:fjCi?~i/ 4-I./rro.-? 570- /70 >0 residing COMMONWEALTH/?~ PENNS.YLVANIA COUNTY OF L~_,--~ SS WE, the undersigned, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn and qualified according to law, do hereby declare to the undersigned authority that we were present and saw the Testatrix sign and execute the instrument as her Will, and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed 6 r the will as witnesses and that to the best of their knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence, and I, the said Testatrix, do hereby acknowledge that I signed and executed the instrument as my Last will and Testament, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed'-e J .. ~~ Gc~ ~Y. , Testatri - EDNA HAZ L SHAFFER ~~ ';t .' (r...;}bfr'l \71 ness Sworn to and subscribed be~r~. ,. me this q / ~.VI- day of ri/~~~I.A~ 20 t;i / , J~~ U~.vL~~ ~~ Notary P lic (~, My Commission Expires: [;. NOTARIAL SEAl MAHY D VER -- . - F .'. . HAGt~, f\!olaru Pub;;,- alrvlOW r y., .'d' M\I C" . . wp., ork Coun!l; , ..Oln,nj>;'i'.;" - . :~, :. . ) ..,----.-..:;'~:::!~~f:.:;~r~_.1::1~::X,,~:._ 2oe2 I -".....~"...J 7