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Home My WebLink About06-04-08 (2) ....J 15056041125 REV-1500 EX (06-05) PA Department of Revenue. Bureau of Individual Taxes . . INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number 2 0 7 6 5 Date of Birth 166 125280 1217200 7 1 2 0 8 917 Decedent's Last Name Suffix Decedent's First Name CALHOUN RUB Y MI V (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 FIL.L IN APPROPRIATE OVALS BELOW [RI 1. Original Return o 4. Limited Estate [&I o 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust 0 (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes 2. Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required J 0 h n B , Fowl er I I I 717243334 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY 8 ~ ?'"O ~ .:.... ::rJ tD-o (- rn ::r (") c:: :'0 )> r- ;;;;e: 5;;z;g , ~~ (I) ^ +:-- CJ80 (") ." :J::lIIo Oc ::l: ; l)1!(IlE FILED _ :R"Y :tJ :17 fi"', r'II0 ( -' <~-:J ?:'~B ::::c (::9 (" -'c' C::) 'I "h :.f---; :n ...::-0 r-- rn (,;") I:J "1 MARTSON LAW 0 F F ICE S Firslline of address o E A S T H I G H S T R E E T Second line of address City or Post Office State ZIP Code CARLI SLE P A 1 7 0 1 3 - ~ Correspondent's e-mail address:jfowler@martsonlaw.com Detroit MI 48235 ?- oS CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 ....J -I 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: RUBY V. CALHOUN RECAPITULATION 166 1 2 5 2 8 0 1.. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 212000.00 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. 3 5 1 6 1 . 5 0 ...... . 6. Jointly Owned Property (Schedule F) o Separate Billing Requested . . . . . . . 6. 3 7 6 5 . 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested . . . . . . . 7. 2 2 9 5 9 3 . 8 6 8. Total Gross Assets (total Lines 1-7) .......................... . 8. 5 4 3 7 o . 3 6 9. Funeral Expenses & Administrative Costs (Schedule H) 9. 5 6 7 2 5 . 7 9 ............... . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 2 9 9 . 1 0 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 5 8 0 2 4 . 8 9 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 4 5 6 3 4 5 4 7 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. 4 5 6 3 4 5 . 4 7 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O _ 0 . 0 0 15. o . 0 0 16. Amount of Line 14 taxable at lineal rate X .012- 4 5 6 3 4 5 . 4 7 16. 2 0 5 3 5 . 5 5 17. Amount of Line 14 taxable at sibling rate X. 12 0 . 0 0 17. o . 0 0 18. Amount of Line 14 taxable at collateral rate X. 15 0 . 0 0 18. o . 0 0 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 2 0 5 3 5 . 5 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o Side 2 L 15056042126 15056042126 --.J REV-1500' EX Page 3 Decedent's Complete Address: File Number 21 07 1165 DECEDENT'S NAME RUBY V. CALHOUN STREET ADDRESS 25 East North Street CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 20,535.55 12,000.00 631.56 Total Credits (A + 8 + C) (2) 12,631.56 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 0.00 7,903.99 A. Enter thEl interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 7,903.99 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; ...................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death . h .. d t 'd t' ? I)(l Wit out receiving a equa e cons! era Ion. ....................................................................................... ~ 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which . b f" d' t' ? 0 contains a ene IClary eSlgna Ion. .................................................................................................. o o 00 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. ~9116 (a) (1.1) (ii)]. The statute does not exemot 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 impos,ed 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... (6-98) . SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RUBYV.CALHOUN 21 07 1165 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 Drooertv which is iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Residence located at 25 East North Street, Carlisle Borough, Cumberland Co., P A known as Tax Parcel No. 02-20-1800-300, being described in Deed dated 6/2/1988, and recorded in Cumberland Co., PA Deed Book 33, Page 587, being conveyed to Ruby V. Calhoun and Nethen Calhoun, her husband. Nethen Calhoun died 4/3/1989, leaving title solely vested in Ruby V. Calhoun. Value is actual sale value. See attached Settlement Sheet. VALUE AT DATE OF DEATH 212,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 212,000.00 REV-1508 EX" (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EST ATE OF RUBY V. CALHOUN FILE NUMBER 21 07 1165 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION M&T Bank checking 1348906 (See attached letter) VALUE AT DATE OF DEATH 6,377.78 la. Accrued interest on Item 1 0.17 2. Members 1st savings 52834-00 (See attached letter) 209.77 2a. Accured interest on Item 2 0.10 3. Members 1st Money Money Management 52834-05 (See attached letter) 16,945.51 3a. Accrued interest on Item 3 15.63 4. 1968 Chevrolet, 2 door sedan vehicle, fair condition 2,600.00 5. Rowe's Auction, proceeds of public sale ofhousehould goods and personal property 8,323.12 6. Erie Insurance Group, refund of auto insurance premium 83.00 7. Tax proration on sale of real estate 606.42 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 35 161.50 REV-1509 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF RUBY V. CALHOUN FILE NUMBER 21 07 1165 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. Daphene B. Jones 19176 Freeland Street Detroit, MO 48235 Daughter B c JOINTLY-OWNED PROPERTY: 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 DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrSINTEREST 1. A. 12/25/06 American Home Bank CD 290002324 (see attached letter) 75,000.00 50. 37,500.00 1a. A 12/25/06 Accrued interest on Item 1 230.00 50. 115.00 TOTAL (Also enter on line 6, Recapitulation) $ 37,615.00 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) '* SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RUBY V. CALHOUN FILE NUMBER 21 07 1165 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 OF TRANSFER ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE (IF AFPUCABLE) 1. Members 1st CD 52834-40; jt with Daphene B. Jones, daughter, 85,185.93 100. 3,000.00 82,185.93 5/22/2007 ($85,000.00 + $185.93 accrued interest, see attached letter) 2. Members 1st CD 52834-41; jt with Dolores A. Beamer, daughter 50,075.95 100. 3,000.00 47,075.95 12/6/2007 ($50,000.00 + $75.95 accrued interst, see attached letter) 3. PA State Bank, CD 9150014332, ITF Dolores A. Beamer, daughter 100,331.98 100. 100,331.98 5/25/2007 ($100,000.00 + $331.98 accrued interest, see attached letter) TOTAL (Also enter on line 7 Recapitulation) $ 229 593.86 (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 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 07 1165 ESTATE OF RUBY V. CALHOUN ITEM NUMBER A. 1. 2. B. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT FUNERAL EXPENSES: Ewing Brother Funeral Home, Carlisle, P A Travel expenses for family from Michigan and South Carolina to plan and attend funeral 6,089.34 507.55 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Daphene B. Jones Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 19176 Freeland Street 21,900.00 176-34-8935 State MI Zip 48235 City Detroit Year(s) Commission Paid: 2008 Attorney Fees Martson Law Offices (estimated) Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) 20,500.00 Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Cumberland County Register of Wills 352.00 Accountanfs Fees Tax Return Prepare~s Fees Certified mailing, P A Department of Public Welfare The Sentinel, advertising Letters Testamentary Cumberland Law Journal, advertising Letters Testamentary Cumberland County Register of Wills, filing fee, Inheritance Tax return Cumberland County Register of Wills, Short Certificates PPL, electric service pending disposition of real estate Embarq, telephone service pending disposition of real estate AT& T, telephone service pending disposition of real estate Borough of Carlisle, sewer/water pending disposition of real estate UGI, gas service pending disposition of real estate Comcast, service pending disposition of real estate M&T Bank, estate checks 5.31 158.62 75.00 15.00 20.00 110.77 118.49 130.43 104.25 107.28 150.15 26.75 TOTAL (Also enter on line 9, Recapitulation) $ 56,725.79 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent RUBY V. CALHOUN Decedent's Name Page 1 21 07 1165 File Number Schedule H - Funeral Expenses & Administrative Costs - 87. ITEM NUMBER DESCRIPTION AMOUNT 19. 20. 21. 22. 23. 24. 25. Asnar Vasser, trash hauling, pending disposition of real estate John Jones, house repairs and supplies pending disposition of real estate County Real Estate Taxes, pending disposition of real estate B&T Home Inspection 1 % Realty Transfer Tax Cumberland County Register of Wills, additional Probate fee Reserve for Accounting and miscellaneous filing fees 150.00 2,650.50 459.35 325.00 2,120.00 150.00 500.00 SUBTOTAL SCHEDULE H-B7 6,354.85 REV-1512 EX + (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RUBY V. CALHOUN FILE NUMBER 21 07 1165 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. DESCRIPTION VALUE AT DATE OF DEATH M&T Bank checking 1348906, outstanding checks on date of death 399.76 UGI, account payable 32.44 Comcast, account payable 75.52 PPL, account payable 27.95 Embarg, accoun payable 41.46 Cumberland County Office of Aging, account payable 8.50 AT&T, account payable 53.07 Borough of Carlisle, sewer/water, account payable 18.86 Members 1 st credit card, outstanding balance 333.81 United States Treasury, 2007 1040 tax due 175.00 P A Department of Revenue, 2007 P A40 tax due 100.00 Chartone, copies of medical records 32.73 TOTAL (Also enter on line 10, Recapitulation) $ 1.299.10 (If more space is needed, insert additional sheets of the same size) 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)J 1. Daphene B. Jones Lineal 215,669.23 19176 Freeland Street Detroit, MI 48235 2. Dolores A. Beamer Lineal 240,676.24 269 Iron Road Summerville, SC 28438 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 TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ R"'~'''''''. ",* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RUBY V. CALHOUN SCHEDULE J BENEFICIARIES FILE NUMBER 21 07 1165 (If more space is needed, insert additional sheets of the same size) - 1 l LAST WILL AND TESTAMENT OF RUBY V. CALHOUN I, Ruby V. Calhoun, a resident of the Commonwealth of Pennsylvania, make, publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any time heretofore made by me. FIRST: I direct that the expenses of my last illness and funeral, the expenses of the administration of my estate, and all estate, inheritance and similar taxes payable with respect to property included in my estate, whether or not passing under this will, and any interest or penalties thereon, shall be paid from and borne by the principal of my residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property. SECOND: It is my desire to be buried at Indiantown Gap National Cemetery, next to my husband Nethen Calhoun, Grave 851 in Section 12-D. THIRD: I may leave a letter of instruction with the executed copy of my Will for the purpose of giving guidance to my Executor. I request, but do not require that my Executor honor my wishes therein requested. FOURTH: I give my automobile to my daughter Daphene B. Jones, if she survives me. FIFTH: I give all the rest, residue and remainder of my property and estate, both real and personal, of whatever kind and wherever located, that I own or to which I shall be in any manner entitled at the time of my death (collectively referred to as my "residuary estate"), as follows: (a) If my daughter Daphene B. Jones and my daughter Dolores A. Beamer or either of them shall survive me, to those of my daughter Daphene B. Jones and my daughter Dolores A. Beamer who survive me, in equal shares. (b) If none of the beneficiaries under clause (a) above shall survive me, my residuary estate shall be paid and distributed to those of my grandchildren John A. Jones, Jr., Richard D. Jones, Christine Banks and Terence Beamer who survive me, in equal shares. SIXTH: I appoint my daughter Daphene B. Jones to be my Executrix. If my daughter does not survive me, or shall fail to qualify for any reason as my Executrix, I appoint John B. Fowler III, Esq. as my Executor. I direct that no Executor shall be required to file or furnish any bond, surety or other security in any jurisdiction. SEVENTH: I grant to my Executors all powers conferred on executors under the Pennsylvania Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, and all powers conferred upon executors wherever my Executors may act. I also grant to my Executors power to retain, sell at public or private sale, exchange, grant options on, invest and reinvest, and otherwise deal with any kind of property, real or personal, for cash or on credit; to borrow money and encumber or pledge any property to secure loans; to divide and distribute property in cash or in kind; to exercise all powers of an absolute owner of property; to compromise and release claims with or without consideration; and to employ attorneys, accountants and other persons for services or advice. The term "Executors" wherever used herein shall mean the executors, executor, executrix or administrator in office from time to time. EIGHTH: I direct that for purposes of this will a beneficiary shall be deemed to predecease me unless such beneficiary survives me by more than thirty days. NINTH: It is my desire to disinherit any beneficiary who contests the provisions of this will. ?1\i.~ IN WITNESS WHEREOF I Ruby v.~oun, sign my name and publish and declare this instrument as my last will and testament this ~Mday of ~, 2002. I also have affixed my signature on the bottom of each of the preceding pages hereof. . ~~"\\ COn \~ Ruby . Calhoun The foregoing instrument was signed, published and declared by Ruby V. Calhoun. the above- named Testatrix, to be her last will and testament in our presence, all being present at the same time, and we, at her request and in her presence and in the presence of each other, have subscribed our names as witnesses on the date above ritten. ,~i~.~ having an address at 0 ~irA ! (70/3 k/~~ having an address at ~h I 70/ -3 2 ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA, COUNTY OF CUMBERLAND, ss. ').We, RUb~,v...Qilhoun~d_ JJ~~?__b$fQQ~__Cll1d______--______ _ _ _ _ _ _ _ _ ~ d...! "::>rM _ _ _ ..1..-, the Testatrix and the witnesses respectively, whose names are signed to the attach~r foregoing instrum t, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix, Ruby V. Calhoun, signed and executed said instrument as her last will and testament in the presence and hearing of the witnesses, and that she had signed willingly, and that she executed it as her free and voluntary act and deed for the purposes therein expressed, and that each of the witnesses at the request of the Testatrix, in the presence and hearing of the Testatrix and each other, signed the will as witness, and that to the best of his or her knowledge the Testatrix was at the time at least eighteen years of age, of sound mind and under no constraint, duress, fraud or undue influence. \2,\:..u \j .. en \ \...u.u..- liJi:~ t;&~ t" ! Witne s . I, the undersigned officer, do hereby certify that I am, on the date of this certificate, a person with the power described in Title 10 U.S.c. 1044a of the grade, branch of service, and organization stated below in the active service of the United States Armed Forces, nd that statute no seal is required on this certificate, under authority granted to me by Title 10 U.S.c. 1000a. ~. Name of Officer and Position: Grade and Branch of Service: Robert E. Samuelsen II CPT, lA, U.S. Army Legal Assistance Attorney Bar Admitted in Minnesota Carlisle Barracks. Carlisle, PA Command or Organization A. SETTLEMENT STATEMENT U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT HUD- OMB No. 2502-026 B. T e of Loan 1.0FHA 2. OFmHA 3. OConv. Unins. 4. OVA 5. OConv. Ins. 6. File Number: RE08-28 7. Loan Number: 8. Mortgage Insurance Case Number: 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 "(p.o. c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name and Address of Borrower(s): E. Name and Address of Seller(s): William E. Hoffman Estate of Ruby V. Calhoun ')1Q N I-l,M",,, ''''M' I""_I;_I~ PA 17n1~ ')~ E: "^"h "'.aa' I"..n.la C. 17n1O F Name and Address of Lender: G. Property Location: Orrstown Bank 25 East North Street, Carlisle, Pennsylvania 17013 Carlisle Borough, Cumberland County 02-20-1800-300 77 E. King Street, Shippensburg, PA 17257 Place of Settlement: H. Name of Settlement Agent: 1 Irvine Row, Carlisle, PA 17013 Duncan & Hartman, P.C. I. Settlement Date: Funding Date: 4- 4-2008 4- 4-2008 ./ ,",;'. ;~'" ... 100. Gr 0"; AArrower" . ';:;L :; 101. Contract sales nrice 212 000.00 401. Contract sales orice 212.000.00 1n, 4n? PA,onn,1 n'MA,"," 103. Settlement eharoes to borrower lJine 140m 4550.50 403. 104. 404. 105. 405. ';'::'.';~~,:~::; 106. Citv/town taxes to 406. Citv/town taxes to 107. Countv taxes 4- 4-2008 to 12-31-2008 337.41 407. Counlv taxes 4- 4-2008 to 12-31-2008 337.41 1n~ In AnA .^ 109. School taxes 4-4-2008 to 6-30-2008 26901 409. School taxes 4-4-2008 to 6-30-2008 26901 110. 410. 111 411 112. 412. 120. Gross Amount Due Frnm Borrower 217 156.92 420. Gross Amount Due To Seller 212606.42 2nnA t ; ,.'-.': , ..... " ',..:i". .:~ ,. ?n1 ~nMM ~n1 ~, 202. Princinai amount of new loanls) 207 000.00 502. Settlement charnes to seller lline 1400) 2661.75 203 Existino loanls) taken sub'ect to 503. Existino loanls\ taken subiect to 204. 504. Payoff of first mortgage loan 205. 505. Payoff of second mortgage loan 206 506. ?n? ~n7 208. 508. 209 509, ... :"l , ~^u. 210. Cilv/town taxes to 510. Citvltown taxes to 211. Countv taxes to 511. Countv taxes to 212. Assessments to 512. Assessments to ?1'>, ~,'>, 214. 514. 215. 515. "" ~H' 217 517. 218 518. 219. 519. ??n ~.,n - ? "'" 7~ 300. Ca~h ... Fl'O ..' .'. .. I:' .: ':.: ..^.... 'II' Fr..... 4..11....... . 301. Gross amount due from borrower lIine 120) 217 156.92 601. Gross amount due to seller lJine 420) 212 606.42 '>,'" a.. nnn' "1'1'> I A.. .a""....;M~ . O6lla. (line 520\ ? "'" 7~ _.:H13, 9~s~ro,!, 0 To Borrower 5156.92 603. Cash tXI To n From SeUer 2.09_~.~2.. (' I. J /J .J1 L ( e::) C I....t c;UvU- ~, I 700. Total Sal..S/Srok..... Comml....lon :',. "," '.: " , ".>. '.,,' , '. I" Paid From Paid From based on orice $ tal % = Borrowers Seller's ,~,,- Funds at Funds at 701, $ to Settlement Settlement 702, $ to 7m 704, 800. Items Pavable In Connection with L;)an , ".i:." ,:," ':: '. .,", """, i'Y." ' "': ,,',,', 801, Loan Oriaination Fee % to Rn? I non nkon..nl o~ ta 803, Bank fee to Orrstown Bank 1 035,00 804 RO~ 806, 807, 808, ROo 810, 811, Rl? 813 814, onn "O~Q "o""Iro'" ,," ..... , "0 ...r... In A"'V~""A" <',> 'd, "',, , 901, Interest from to tal $ 00000 Idav 902, Mortoaae insurance oremium for months to 903, Hazard insurance oremium for vear( s \ to on" 905, 1000. Reserves OeDoslted With Lender " " .'" ...c' ,:', ':',.",'",' \':,".,: .. " .' , , 1 nnl i-l.,..rl ;n."'.noo ~Mlh. "'" $ no, ~nnlh 1002. Mortaaae insurance months tal $ oer month 1003. Citv orooertv taxes months tal $ oer month 1004. Countv arooertv taxes months tal $ oer month 1nn~ ~nnlh. II';) ~ no, ~Mth 1006. School orooertv taxes months tal $ oer month 1007. months tal $ oer month lnnA 1100. Title Char"e" ' . ..' ." " '."i):,:?, ....... '., ';)..i( .. >:". ;, . 1101. Settlement or ciosino fee to 1102. Abstract or title search to 110~ I In 1104. Title insurance binder to 1105. Document oreoaration to l1nl'\ . r...h 10 nn 1107. Attorney's fees to Duncan & Hartman Martson Law Offices 1,250.00 500.00 (includes above item numbers: 1101.1104 \ 1108. Title insurance to linr.1..rl~. -~ n..mh~,., \ 1109. Lenders coveraae $ Premium $ '.' .'. 1110. Owner's coveraae $ Premium $ " .... " 1111 1112. 1113. i?M :. .,'., .' ".' < , ' ,," "'<:,. ,. '., " 1201 Recordina fees, Deed 38.50 Mortaaae 97.00 Release 0.00 135.50 1202. Citv/countv taxlstamos: 2120.00 1203. State taxlstamos: 2120.00 1204 1205 1300, Additional Settlement eMrn.... ' " ...' .' , ." ," "',, .. ',' " i. "nl Aool In n1""? '" 7~ 1302. 1303. l1n" 1305. 1400. Total Settlement Charaes (enter on lines 103 Section J and 502 Section K\ 4,550.50 2,661.75 CERTIFICATION. I have carefully reviewed the HUD.l Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all recelp and dIsbursements made on my account or mil In thIS transaction. I further certify that I received a copy of the HUD-l Settlement it nt 1_) / J '"/ In) y?/) ,Ii! /" /" /", (.\': L ~~L.....: ~"',1 .. '_ , ._ ' "- Signature of 80 ower"' Signature of Barrower Signature of Se r Signature of Seller 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 Inciude a fine and imprisionment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. F;!M&TBank 499 Mitchell Street, Millsboro, DE 19966 January 3, 2008 Martson Law Offices 10 East High Street Carlisle, PA 17013 RE: Estate of Ruby Calhoun Date of Death: December 17, 2007 Social Security Number: 166-12-5280 Dear Ms. Otto: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. 1. Account Type........................... Checking Account Account Number....................... 1348906 Ownership (Names oj).............. Ruby Calhoun Opening Date.. .. . ... .. . ..... .... ., . .. . .12/03/96 Balance on Date,ojDeath.........$6,377.78 Accrued Interest $ 0.17 Total.......... ......................... ....$6,377.95 The above named decedent did not have a safe deposit box. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/ or the name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/ or reimbursement of funds, please contact our High Street Carlisle branch at 1 West High Street, Carlisle, PA 17013, or # 717-240- 4536. Sincerely, ....-/--:. , <I' ()/ /, /. '-.J , ,I, i7';(/ i i~ (/;WI'i' i ,;. ;, - ~ ... " "... ",-, -~ / / Charlene Warrington, Records Management 1-888-502-4349 )' . v-/ clle; iLJc ct , /J I . ~~I FES-26-2008 03:36 PM MEMS 1ST INSURANS P. 01 7177955178 ~1~ MEMBERS l~t AlDfiR A L CR EDIT UNION REGULAR SAVIN9S ACCOUN:T: 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 'J- J- . M ~/) > dJClL C 52834 ~o 05/03/1987 $209.77 $.10 $209.87 None LIFE SAVINGS ACCQU~:r~ 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 Name of Insurance Proceeds Beneficiary 52834 -04 02/01/2001* $4,000.00 $1.86 $4,001.86 None Daphene 8, Jones /\, I} ! '.J ....~ I _ (1 ,?--~ , I vU-'L c \ {JCL" r;ju MONey MANAGEMENT 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 52834 -05 01/1311989 $16,945.51 $15.63 $16,961.14 None ( ~(LIJ LL t ( f) C 1).& 2- fl~) I CERTIFIC~ T~~ OF DEPOSit; Account NumberlSufflx Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Cate Joint OWnership Established 62834 -40 OS/22/2007"'- $85.000.00 $185.93 $85,185.93 Daphene B. Jones OS/22/2007 52834 -41 12/06/2007 $50,000.00 $75.95 $50,07595 Dolores Beamer 12/06/2007 "Account opened by tra.,.fer of funds from 52J34.00. "Certificate purchaeed by t'8deemed .Ingle OWIM,.hlp certlflcatB #ll28~. originally opened 6/22/06 & 1;t~:EREDlT UNION Denise A. Wolfe Insurance Services S p$rvisor February 26, 2008 Estat. of: RUBY V. CALHOUN Date of Death: 12/17/2001 Social Security Number: 188-12-5280 S(~:lO Louise Drive · Po. Uox 4t.1 · Merh.llljc~burg. P~'1l11.~yIV;ll1i;) 170:lS . (HOD) 2HJ-2.12K . www.1l1l.ll1bt.r~1 ,t.OTg ~ AMERICAN , HOME BANKNA We help build your future. SM Victoria LOtto Martson Law Offices 10 East High Street Carlisle, P A 17013 Re: Estate of Ruby V. Calhoun Dear Ms. Otto: In response to your recent inquiry regarding Ruby Calhoun, please find below the answers to your questions 1. Certificate of Deposit #290002324 - only account. 2. 10/25/06 3. Joint Account: Daphene B. Jones or Ruby V. Calhoun (opened as ajoint account) Daphene B. Jones was Primary Holder on this account. 4. $75,000.00. 5. Interest was paid monthly to Daphene B. Jones. Accrued interest as of 12/17/07 was $230.00 which was paid with additional interest to Daphene on ] 2/25/07. The name on the account was changed to Daphene B. or John A. Jones on 12/28/07. If you have any other questions, please feel free to contact our office at (7] 7)2] 8-6635. Sincerely, ~ /-) ;1kLe( U. ~2f1k~ Michele N. W ojtas .~ . Financial Services Representative American Home Bank, NA ~. / J J f),V (YU~C;(tvU- ~j~ ~ I 417 Vill"ge Drive! Carlisle, PA 17013.6929 ' Phone 717/218.6635 \w/w.b"nkJhb.con1 % o ~ o ~ o o a - o ~ % - u.. ~ ~ (t U1 ~ 0 ~ ~ t; 0 ~ cD ~ U1 c-i 'i .,., co ~ ~ ~ '<r'" ~ ~ ~ ~ 0 U1 .,., c.a 'i 0 U1 0 00 0 0 o~ 0 0 0 04:, 0 co '<r'" 0 .,., 0 ... 0) ~ 0) a co - ci. ~ lit 0) ... ~ 0 (5 -0 0 ~ ... (1) oS ~ ct) .... t.O lit I ~ t.O ... c<) r- t";- .S t- - c::. t- ~ (6 0 s:. Q) - E to (,) 't) ~ ~ c .D 8 & Q) ta S m \0 n- ("I 0 \0 UI 0 ~ 0 N ~ ~a: ~ :;)UI '<r'" oll) 0 (.)~ ~ :;) ca.% '<r'" ~ en - '<r'" 0 r- '<r'" 4. u- ~ 0- 0 :;) Q} UlO .e :i n-(.) 1O \ ~ca. ,~ V.VJ,\/If) - 1 ':!:' (\ { ... 1:: , 1-1 '" \3 . 0 4,c::.CO %. ~ ~ ~ 0 ,S <0 s:. 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