HomeMy WebLinkAbout06-23-08REV-1500 EX ~ (6-00)
COMMONWEALTH OF
~
REV 15 0 0 OFFICIAL USE ONLY
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1- o s 0 3 0 7_
COUNN CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Z BLACK RICHARD E. 2 0 7- 2 2- 0 8 9 5
La.l DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
W
V
02/28/2008
04/12/1931 REGISTER OF WILLS
L11 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
F 0 1.Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death priorto 12-13-82)
~ a Y ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of dean after 12-12-ttz) ~ 5. Federal Estate Tax Retum Required
U
c=i a m
~ 6. Decedent Died Testate (Mach copy of wlq ~ 7. Decedent Maintained a Living Trust (Attach Dopy of trust)
_ 8. Total Number of Safe Deposit Boxes
a
9. Litigation Proceeds Received ~ 1 O. $p0US81 POVerty Credit (date of death between t2-31-91 and 1-1-95)
~ 11. Election to tax under Sec. 9113(A) (Mach sch o)
::THIS SECTION MUST BE COMPLETED. ALL CORRESPONDI=NCE AN D CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TQ
r
z
w NAME COMPLETE MAILING ADDRESS
i ROGER B. IRWIN ESQUIRE 60 WEST POMFRET STREET
N FIRM NAME (If Applicable)
~ IRWIN & McKNIGHT
p TELEPHONE NUMBER
717 249-2353 CARLISLE PA 17013
1. Real Estate (Schedule A) (1) 135,000.00 OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2) _ n.>
' ? `~ _, .~
t`? c~ _. -
3. Closely Held Corporation, Partnership orSole-Proprietorship (3) ~ ~ _ j
":
~ ~ ~ ,
4. Mor~lages & Notes Receivable (Schedule D) (4) - ~_, ;~ '!
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 14,374.61 . ~ ~ ;; ~ _? L•~ ~ '_ 7
(Sche:dule E) ~'_ i -v - , , ~
~~
Z ;
.
_ -, I
O_ 6. Jointly Owned Property (Schedule F) (6) -'" ~=c~
_t W
F' ~ Separate Billing Requested r , .~-~
--?
~
J
~
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) '~
~°'~
H (Schedule G or L)
Q 8. Total Gross Assets (total Lines 1-7) (g) 149,374.61
9. Funeiral Expenses & Administrative Costs (Schedule H) (9) 28,430.87
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 40,401.43
11. Total Deductions (total Lines 9 & 10) (11 ) 68,832.30
12. Net Value of Estate (Line 8 minus Line 11) (12) 80, 542.31
13. Charil:able and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13 )
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 80,542.31
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z 15. Amount of Line 14 taxable at the spousal tax
0
00 X
15
0.00
0 .
(
rate, or transfers under Sec. 9116 (a)(1.2) )
Ia.. 16. Amount of Line 14 taxable at lineal rate 80, 542.31 X .045 (16 ) 3,624.40
la 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17 ) 0.00
~ 18. Amount of Line 14 taxable at collateral rate 0.00 X .15 (18) 0.00
U
19. Tax Due (19) 3,624.40
~ 20. ~~ • • ~ • •
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE S1DE AND RECHECK MATH:: < <
Decedent's Complete Address:
STREET ADDRESS ,
7 N. OLD STONEHOUSE ROAD
CITY STATE ZIP
CARLISLE PA 17015
1~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPaym~ents
A. Spousal Poverty Credit
B. Prior Payments 5.000.00
C. Discount 0.00
3. InterestlPenalty if applicable
D. Interest
E. Penalty
(1) 3,624.40
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E )
4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
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.
(3)
5.000.00
0.00
(4) 1, 375.60
(5) 0.00
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B)
Make Check Payable fo: REGISTER OF WILLS, AGENT
PLFr4SE 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 : ........................................................................... ^ X^
b. retain the right to designate who shall use the property transferred or its income : ........................................ ^ X^
c. retain a reversionary interest; or ...................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ............................................................. ^ X^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... ^ ^X
3, Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ................. ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... ^
0.00
IF 7HE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 prepanar other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPQ SIBLE FOR FILING RETUR DATE
7~N: OLD ST
P
SIGNATURE OF I?REPA OTHER THAN REPRESEN ATIVE DATE
flit-~ ~ . ~ ~~ ~~~ __
Ei0 WEST POUF ET STREET
CARLISLE f
l
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 3%
[72 P.S. §9116 (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 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute doers 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 0% [72 P.S. §9116(x)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(x)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(x)(1.3)]. Asibling 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
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
F;ESIDENT DECEDENT
ESTATE OF FILE NUMBER
BLACK RICHARD E. 21 08 0 07
All real property owned solety 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 roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 653 ALEXANDER SPRING ROAD, DICKINSON TOWNSHIP, CARLISLE, 135,000.00
CUMBERLAND COUNTY, PENNSYLVANIA
SOLD -SETTLEMENT SHEET ATTACHED
TOTAL (Also enter on line 1, Recapitulation) ~ $ 135.000.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 Ek: + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN RES DENTEDECEDEN RN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
BLACK RICH_ ARD E. ~ 08 0 07
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PERSONAL PROPERTY -APPRAISAL ATTACHED 355.00
2. ORRSTOWN BANK -CHECKING ACCOUNT #106004382 2,249.61
3. 2004 CHEVROLET S10 PICKUP 11,770.00
TOTAL (Also enter on line 5, Recapitulation) I $ 14 374.61
(If more space is needed, insert additional sheets of the same size)
REV-1511 E)C + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES 8
ADMINISTRATIVE COSTS
~air-ir: ter FILE NUMBER
BLACK RICHARD E. 1 08 0 07
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 11,884.92
2. GINGRICH MEMORIALS 2,570.00
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
p, AttomeyFees IRWIN & McKNIGHT 7,725.00
3, Family Exemption: (If decedents address is not the same as claimants, attach explanation) 3,500.00
Claimant MARILYN M. HECK
Street Address 7 N. OLD STONEHOUSE ROAD
City CARLISLE State PA Zip 17015
Relationship of Claimant to Decedent DAUGHTER
4. Probate Fees REGISTER OF WILLS 302.00
5 Accountants Fees
6. Tax Return Preparers Fees PATRICIA A. ROSENDALE, CPA 350.00
7. REGISTER OF WILLS -FILING FEE 30.00
8. ROY D. GOTTSHALL -APPRAISAL ON PERSONAL PROPERTY 45.00
9. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00
10. THE SENTINEL -LEGAL -ESTATE NOTICE 166.60
11. NOTARY FEES 15.00
12. CLOSING COSTS FROM SALE OF REAL ESTATE 1,767.35
TOTAL (Also enter on line 9, Recapitulation) I $
30.87
(If more space is needed, insert additional sheets of the same size)
REV-1512 E:K + (6-98)
SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
IPJHERITANCE TAX RETURN MORTGAGE LIABIL{TIES & LIENS
RESIDENT DECEDENT
ESTATE OF' FfLE NUMBER
BLACK RICHARD E 21 08 0307
Include unreimbursed medical expenses.
ITEM VALUE A7 DATE
NUMBER DESCRIPTION OF DEATH
1. FINANCIAL FREEDOM SENIOR FUNDING -PAYOFF OF FIRST MORTGAGE LOAN 39,384.40
SEE SETTLEMENT SHEET
2. FAMILY HOME MEDICAL -MEDICAL 17.92
3. IPP&L -ELECTRIC
4. IEMBARQ -TELEPHONE
5. (WALNUT BOTTOM RADIOLOGY -MEDICAL
6. ICV NEPHROLOGY ASSOCIATES -MEDICAL
7. (SILVER SPRING AMBULANCE -MEDICAL
8. ILITITZ MUTUAL INSURANCE COMPANY -HOMEOWNERS INSURANCE
150.93
50.26
11.92
25.00
525.00
236.00
TOTAL {Also enter on line 10, Recapitulation) , $ 40,401.43
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (o-nn~
SCHEDULE J
COMMON~NE=ACTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RE=SIDENT DECEDENT
ESTATE OF FILE NUMBER
RI AC:K RI(~HARf~ F 7~ n4 nonce
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I 'TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. IMARILYN M. HECK Lineal
7 N. OLD STONEHOUSE ROAD REMAINDER
CARLISLE, PA 17015
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)
LAST WILL AND TESTAMENT
I, RICHARD E. BLACK, of Dickinson Township, Cumberland County, Pennsylvania,
declare this instrument to be my Last Wi11 and Testament, hereby expressly revoking all Wills
and Codicils heretofore made by me.
L I direct my executrix to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my executrix to sell any realty owned by me at my death and
not. specifically devised herein, at either public or private sale, and to give goad and sufficient
deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate as
.~
follows: ~~4 ~~ .,~~ ~ ¢j~ Z~~
{a) I give the sum of $2,000.0 to Norma J. Fahnestock, soon to be Norma J.
Black,
(b) I direct that Norma shall be able to live in my house at 653 Alexander Spring
Road, Carlisle, as long as she is single and as long as she desires to and actually does Iive in my
house. She is to pay the taxes, insurance, utilities and upkeep as long as she lives in the house.
(c) All my furniture, dishes and other personal property is to stay in my house as
long as Norma lives there and when she leaves the house permanently, the personal property as
well as the real estate becomes the property of my daughter, Marilyn M. Heck, absolutely, and if
she is not living at the time of my death, it becomes the property of her two children, Ronald
Lee Bitner and Patricia E. Hardy, share and share alike.
(d) All the rest, residue and remainder of my estate, I give to my daughter,
Marilyn M. Heck, and if she is not living at the time of my death, to her two children, Ronald
Lee Bitner and Patricia E. Hardy, share and share alike.
4. I nominate and appoint Marilyn M. Heck to be the executrix of this my Last Will and
Testament; she is to serve as such without bond. Should she die before my death, renounce or
refuse to serve for any reason, or die leaving any of my estate unadrninistered, Inominate and
appoint Ronald Lee Bitner and Patricia E. Hardy, as substitute executors, also to serve as such
without bond, with the same powers as are given herein to my executrix.
5. I hereby suggest that my personal representative retain the services of Irwin,
McKnight & Hughes, as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 3RD day of July,
1997.
.~ ~
,.~ ~.k-~ ~.~--,-r= C..a /~~`-~C` {SEAL)
RICHARD E. BLACK
Signed, sealed, published and declared by RICHARD E. BLACK, the testator above
named, as and for his Last Will and Testament, in the presence of us, who at his request, in his
presence and in the presence of each other have subscribed our names as witnesses hereto.
~ ~~_
ACKNOWLEDGMENT AND AFFIDAVIT
WE, RICHARD E. BLACK, CHERYL L. CLELAND and MARTHA L. NOEL, the
testator and witnesses respectively, whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority that the testator signed and
executed the instrument as his Last Will and that he had signed willingly, and that he executed it
as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in
the presence and hearing of the testator, signed the Will as a witness and that to the best of their
knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under
no constraint or undue influence.
RICHARD E. BLAC
C RYL L. CLELAND
MARTH L. NOEL
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by RICHARD E. BLACK, the
testator herein, and subscribed and sworn to before me by CHERYL L. CLELAND and
MARTHA L. NOEL, witnesses, this 3RD day of July, 1997.
.- ,.~._
Notary Public
J
Notarial Seai
Roger (3. Irwin. Not~1ry Putrlic
Carlisle Boro, Cumberland County
My Comrniasion Expires Oct. 3, 2000
Member. PennSylv~nla Aa9nGigtinn tlf Neteri
A. Settlement Statement LJ.S. Department of Housing and Urban Development
A T..nx. r.~F I nen naAn Annrnvel Nn 9507-0985 Inmirae w~nnnogy
I. ^EHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number
-7 4 8. Mortgage Insurance Case Number
tbs form if NmM•d 10 gw• You • alalem•nl of •ttual aalll•menl rnsls Amounla paid la and Dy Iha aattl•m•nt agent are anown.
C. Note: Items marked -(poc.r wrs Osld ouls~ds the Uoamg; m•y an Gown Mrs rot information purpose end are not included in the totals.
WARNING. !1 is • vlma 10 Mnowirgly mob fel•• alalem•nte to the Unilao Stelae on Ihif or any oNer simtl•r form. Penalll•a upon
Title Express Settlement System
D. NAME OF BORROWER: Albert C. Kuhn
E. NAME OF SELLER: The Esta[e Of R1Ghard E. Black
F. NAME OF LENDER: N/A
G. FROPE,RTY ADDRESS: 653 Alexander Spring Road, Carlisle, PA 17015
Dickinson ownshi
H. sETTLEh1ENrAGENT: PA Real Estate Settlement Services, LLC '
( e a t ~ I 170
6/ / 8
J. SUMMARY OF BORROWER' TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
T 4 T R
135 000.00 135 000.00
2 223.50
( i i I i
06 11 08 12 31 OB 199.17 06 11 08 12 31 Og 199.17
06 11 OB 06 30 OB 100.53 06 11 08 06 30 OB 100.53
137 523.20 4 135 299.70
3 000.00
1 767.35
39 384.40
Financial Freedom Senior Fundi
5
r' i i
4
3 000.00 41 151.75
T R
137 523.20 135 299.70
3 000.00 41 151.75
134 523.20 94 147.95
SUBSTITUTE FORM 1099 SELLER STATEMENTS The inlortnalian contained harem is important laz in/Donation and is being furnished to the Internal Revenue Service If you are required to fle a return,
a negligence penalty or other sanction will Ds imposed on you i11NS item is requrretl to be reported and lne IRS Oelarmines that d has not been reported. The Contratt Sales Puce desnloed on
Ilne a01 above consatulea the Groas Proceeds of this Iransedidn.
You are required bylaw to provide Me settlement agent (Fed. Tax ID No: ) vnth ydur corteq taxpayer Identilicabon number. If you do not pravWe your corte[t taspeyer idenbfiwlion
number, you may be eub)ad la clue or rnmmel penalties imposed oy law. nder penalbes of per)ury, I certify loaf the number shown on this slatemenl ie my mrtect lazpayer identifcakan number.
TIN: _-_ / -_- SELLER(S)SIGNATURE(S):
SELLER(S) NEW MAILING ADDRESS:
SELLER(S) PIHONE NUMBERS: (H)
U.S DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: S 100-764
SFTTI FMFNT CTATFAAFNT
rann nuD-t larBel rat n,nabook aos z
PAGE 2
PAID FROM PAID FROM
7 ! 135 000.00 = BORROWER'S SELLER'S
FUNDS AT FUNDS AT
SETTLEMENT SETTLEMENT
T ~' AY I I
I
T
i
0.00 0.00
1
Ro er main Es ize 10.00
135 000.00
Salzmann Hu has P.C. 835.00
1 V RN NT R IN T N AR
38.50 38.50
1 350.00 ~ 1 350.00
1 350.00 1 350.00
I
Carol Mc uillen Tax Collector 357.35
Salzmann Hu has P. C. 50.00
14 A 2 223.50 1 767.35
~ ` HUD CERTIFICATION OF BUYER AND SELLER
• I haw rar vie the UD-7 It ement Statement antl to the Deal of my knowledge and belief, it is a true antl acwrata slatemenl oy all receipts antl tlisbursemenls mace on my account or by me
in tNS trenssaian. I NMer cartity that 1 have receiwa a copy of the HUD-1 Settlement slatemenl.
Albert C. Kuhn
Tha Eetate of RIMe/tl E. Black
•~"WUM1N rVl.'~~ /G U`~Ui{`~r•7"~^' Ylvre^•a~
By: Marilyn M. Hed!, Executrix
WARNING' IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE Ths HUD- eltlame nt which 1 new pnpentl is ^ We antl aavats ettounl o! tnis Transaction.
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVIC710N I nave used or m luntls to Ds tlisburseO in acwrtlenne vntn Itds slatemenl.
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18.
U.S. CODE SECTION 1001 AND SECTION 1010.
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A Tradition of Excellence
March 17, 2008
TO: Roger B Irwin
Irwin & McKnight
FROM: ANDREW OTT
BRANCH EXECUTIVE OFFICER
P.O. BOX 250
SHIPPENSBURG PA 17257-0250
RE: ESTATE OF RICHARD E BLACK
DATE OF DEATH: February 28, 2008
77 East King Street
P.O. Box 250
Shippensburg, PA 17257
RECElVEd
!MAR 1 9 20nfl
IRWIN & IVIcKNIGN i
!AW OFFICES
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE
FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNTS
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST
106004382 Richarad E Black 1/24/07 2 249.56 + .05 = 2 249.61
Marilyn M Heck (interest for 2008 = .22)
SAVINGS ACCOUNTS
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST
CERTIFICATES OF DEPOSIT
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST
4000015510 Richard E Black 3/12/07 3/15/07(redeemed) 2 000.00 + .41 = 2,000.41.
4000015617 Richard E Slack 3/14/07 9/17/07 (redeemed) 2 000.00+36.98 = 2,036 98
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INVENTORY
REGISTER OF WILLS OF CUMBERLAND
COMMONWEALTH OF PENNSYLVANIA 1 SS
COUNTY OF CUMBERLAND )
COUNTY, PENNSYLVANIA
File Number 21-08-0307
Personal Representative(s) of the Estate of RICHARD E. BLACK
deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the personal assets wherever situate
and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said
inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the
Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory.
I verify that the statements made in this Inven-
tory are true and correct. I understand that false state-
ments herein are made subject to the penalties of
18 Pa.C.S,. § 4904 relating to unsworn falsification to
authorities.
Attorney -- (Name) ROGER B. IRWIN, ESQUIRE
(Address) 60 WEST POMFRET STREET, CARLISLE, PA 17013
(Telephone) (717) 249-2353
DATE OF DEATH LAST RESIDENCE DECEDENTS SOC. SEC. NO.
02/28/20C-8 7 N. OLD STONEHOUSE ROAD, CARLISLE, PA 17015 207-22-0895
FIGURES MUST BE TOTALED
635 ALE:KANDER SPRING ROAD, CARLISLE, PA 17015 135,000.00
PERSONAL PROPERTY 355.00
ORRSTOWN BANK -CHECKING ACCOUNT 2,249.61
2004 CHI3VROLET S10 PICKUP 11,770.00
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(Attach additional sheets as needed)
TOTAL: ~ 149,374.61
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each
item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. ~ 3301(6))
(Supreme Court LD. No.) 6282
Form RW-09 rev. 10.13.06