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Home My WebLink About06-25-0815056041147 REV-1500 EX (Oti-05) OFFICIAL USE ONLY PA Department of Revenue Cour~ty Code near File Number Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box.2aosol 2 1 0 8 0 4 6 5 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 03 22 2008 12 03 191.8 Decedent's Last Name Suffix Decedent's First Name MI CLARK EILEEN A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~~ 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Retum (date of death - prior to 12-13-82) 'I 4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required -- (date of death after 12-12-82) X ' 8 Decedent Died Testate 7. Decedent Maintained a Living Trust Q B. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. spousal Povertyy Credit (date of death 11. Election to tax under Sec. 9113(A) ~' between 12-31-B1 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Dalytime Telephone Number ROBERT C. SAIDIS ESQ 717 243 6222 Firm Name (If Applicable) SAIDIS, FLOWER & LINDSAY First line of address 26 WEST HIGH STREET Second line of address City or Post Office CARLISLE Correspondent's a-mail address: State ZIP Code PA 17013 v IREGISTEFZOF WILLS U~.;ONLY , ~ ~ ~',~n a ' %_ ~_, e; ;~~.., - ~ r-~ r'-, -t-, `i ~ [~J DA{~'FILED 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, corr t and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. James Cla A R THE AN REPRESENTATIVE DATE ~ Robert C. Saidis Esq ~~ ~,~~-~( 26 West High Street, Carlisle, PA 17013 Side 1 15056041147 :L5056041147 REV-1500 EX 1505642148 DeceeenYename: Eileen Amanda Clark RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 2. Stocks and Bonds (Schedule B) ............................................................................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 1. 2. 3. 4. 5. 6. 7. s. 14. 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/Sec 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) ................................................ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 3 3 1, 5 0 4. 0 5 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 311,416.20 449.44 9,358.89 34,686.97 355,911.50 22,231.45 2,176.00 24,407.45 331,504.05 331,504.05 15. 0.00 16. 14, 917.68 17. 0 .~0 0 1s. 0.00 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 14,917.68 Side 2 15056042148 1.5056042148 REV-1500 EX Page 3 File Number 21-08-0465 Decedent's Complete Address: DECEDENT'S NAME Eileen Amanda Clark STREET ADDRESS 4-A Adams Street CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 13,500.00 710.53 (1) 14,917.68 3. InteresbPenalty if applicable Total Credits (A + B + C) (2) 14, 210.53 p, 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. (4) Check box on Page 2 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. (5) 707.15 q, Enter the interest on the tax due. (5A) i B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 7 ~ 7 . ~ Jr• Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TFiE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................. ^ b. retain the right to designate who shall use the property transferred or its income :.................................... ^ I~x c. retain a reversionary interest; or .................................................................................................................. ^ 0 d. receive the promise for life of either payments, benefits or care? .............................................................. ~ 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... ^ 0 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death?......... ^ 4. Did decedent own an Individual Retirement Account; annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G FWD 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. §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 zero (0) percent [72 P.S. §9116 (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. §9116 (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. §9116 1.2) [72 P.S. §9116 (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. §9116 (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-1503 EX+ (6-9aJ SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERfiANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Clark, Eileen Amanda 21-08-0465 All properly Jolntlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 024071102 6,952.999 shares of American Balanced Fund Inc - 17.95 124,806.34 Com Class A 2 2a5soslos 7,182.577 shares of Delaware Group Tax Free Fund Inc 11.0550002 79,403.39 -USA Fund CL A $ 354723793 4,151.651992 shares of Franklin Tax Free Trust - Nc T/f 11.7550002 48,802.67 Income A 4 461308108 1,698.452 shares of Investment Co American -Com ?10.1649973 51,233.80 Class A 5 552738106 1,000 shares of MFS Municipal Income Trust -Shares 7'.17 7,170.00 Ben Interest TOTAL (Also enter on Line 2, Recapitulation) 311,416.20 (It more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+(8.98 gCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY CObY.~IONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF IFfLE NUMBER Clark, Eileen Amanda 21-08-0465 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survWorship must be disclosed on schedule F. Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) (If more space is needed, additional pages of the same size) Rev7509 FJ(+ (6.98) SCHEDULE F COARugNWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Clark, Eileen Amanda 21-08-0465 if an asset was made joint within one year of the decedents data of death, It must be repoirted on schedule G. SURVIVING JOINT TENANT(S) NAME A. James Clarence Clark 4A Adams Street Enola, PA 17025 ADDRESS RELATIONSHIP TO DECEDENT Son B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF' ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1 A 10/11/2005 Wachovia Checking Account 18.717.78 50.000°I° 9,358.89 #1010114442873-J TOTAL (Also enter on Line 6, Recapitulation) 9,358.89 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-1510 FJ(+ (6.98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY CQ~gMDNWEALTH OF PENNSYLVANIA MHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Clark, Eileen Amanda 21-08-0465 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. ITEM NUMBER lP I N PR P R INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST ( EXCLUSION IF APPLICABLE) TAXABLE VALUE 1 Keyport Life Insurance Company -Annuity 34,686.97 100.000 0.00 34,686.97 Beneficiaries: Cary Michi Clark, Son 102 Sea Gull Street Emerald Isle, NC 28594 James Clarence Clark, Son 4-A Adams Street Enola, PA 17025 Jon William Clark, Son 6679 Wertzville Road Enola, PA 17025 Scott Alan Clark, Son 2208 Windy Woods Drive Raleigh, NC 27607 Thomas John Clark, Son 125 Pennick Drive Stevensville, MD 21666 Joanne Kay Keane, Daughter 55 Sandhurst Lane Elkton, MD 21921 TOTAL (Also enter on Line 7, Recapitulation) I 34,686.97 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (12.89) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Clark, Eileen Amanda 21-08-0465 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions James Clarence Clark _ Social Security Number(s) ! EIN Number of Personal Representative(s): street Address 4A Adams Street _ City Enola State PA- zip 17025 Year(s) Commission paid 2008 2. Attorney's Fees Saidis, Flower & Lindsay 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 See continuation schedule(s) attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached 1,590.80 11,500.00 8,500.00 375.00 265.65 TOTAL (Also enter on line 9, Recapitulation) I 22,231.45 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 ex+(g.9g~ SCHEDULE H-A FUNERAL EXPENSES continued COAMAONWEALTH Of PENNSIIVANW INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Clark, Eileen Amanda 21-08-0465 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-64 PROBATE FEES continued COMAgNWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Clark, Eileen Amanda 21-08-0465 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B4 (Rev. 6-98) Rev-1502 EX+(8-98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS COAMgONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF (FILE NUMBER Clark, Eileen Amanda 21-08-0465 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-67 (Rev. 6-98) Rev-1512 EX+ (6.98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA WHERfTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Clark, Eileen Amanda 21-08-0465 Include unreimbursed medical expenses. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) 7 CYa /0./\/\\ SCHEDULE J COMMNHERITA CEOTAXRETURNANIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Clark, Eileen Amanda 21-08-0465 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY Do Nat Llst Trustee s (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Cary Michi Clark Son 116th of the 53,690.86 102 Sea Gull Street residue Emerald Isle, NC 28594 3 Jon William Clark Son 1/6th of the 53,690.86 6879 Wertzville Road residue Enola, PA 17025 4 Scott Alan Clark Son 1/6ith of the 53,690.86 2208 Windy Woods Drive residue Raleigh, NC 27607 5 Thomas John Clark Son 1/6th of the 53,690.86 125 Pennick Drive residue Stevensville, MD 21666 6 Joanne Kay Keane Daughter 116th of the 53,690.86 55 Sandhurst Lane residue Elkton, MD 21921 See continuation schedule attached Continuation 116,740.61 Total 331,504.05 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropr iate, an Rev 1500 cove r sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE , B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET , u.Uu Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Eileen Amanda Clark 03/22/2008 390-14-0092 Item Name and Address of Person(s) Share o~~F Estate Amount of Estate Number Receiving Property Relationship (Woirds) ($$$) 6 James Clarence Clark Son 1/6th of 'the residue 63,049.75 4-A Adams Street Enola, PA 17025 Total 63,049.75 STATE OF NORTH CAROL~I~ ~t~~,~; i~r ~'E'' ~~ COUNTY OF WAKE ~.., ~r , ,-- t . - - ' - ~^ ~ LAST WILL OF EILEEN AMANDA CLARK I, EILEEN AMANDA CLARK, being of sound mind and body do hereby revoke all prior wills heretofore made by me and declare this to be my Last Will and Testament. ARTICLE I PAYMENT OF EXPENSES AND DEBTS. I direct that my funeral expenses, including the cost of ~. suitable grave marker, the cost of administering my estate and all legal debts allowable as claims against my estates be paid out of the general funds of my estate. ARTICLE II PAYMENT OF TAXES. I direct that ~~11 the estate, inheritance or other taxes imposed by reason of my death upon property passing under or outside this Will and made payable by the laws of the United States, this state or any other state or country by reason of my death shall be paid out of my residuary estate, except that this provision shall not be construed as a waiver of any right which my Executor may have to claim reimbursement for any such taxes due because of property over which I have a power of appointment or which I have giT7er_ away but which, for 1;ahatever reason, is included in my taxable estate; or because of any insurance policies payable to beneficiaries other than my Executor which are included in my taxable estate; or because other property is included in my taxable estate which is not a part of the probate estate. ARTICLE III BRADY, SCHILAIX~SK1 and EARLS ATTORNEYS AT LAW a.o. eox sszs RY, NORTH CAROLINA 27511 EXECUTOR. I hereby appoint my son, THOMAS JOHN CLARK, to be the Executor of this my Last Will; an~i I vest my said Executor with full power and authority to se:11, transfer and convey any property, real or personal, whi~~h I may own at the .time of my death at such time and price and upon such terms and conditions as may be determined appropriate and to do every other act and thing necessary or appropriate for the complete administration of my estate. 6Vithout in any way limiting the generality of the foregoi~~g provision, I hereby grant my Executor all of the powers set forth in North Carolina General Statues, Section 32--37, subject to Section 32-2G, and these powers are incorporated by reference. Should an Alternate Executor be required, I nominate my son, JAMES CLARF'NCE CLARK. I direct that no bond be required of my Executor. ARTICLE IV ELIMINATION OF GUARDIANSHIP. During the administration of my estate, it shall not be necessary foz~ my Executor at any time to have a guardian appointed for any beneficiary with respect to the disbursement of income or principal or other property to or for such beneficiary. My Executor may pay any part or all of the payments directly to a beneficiary or to some other person, firm or corporation for the benefit of such beneficiary. ARTICLE V DISPOSITION OF ALL PROPERTY-RESIDUE. I hereby devise and bequeath all of the property which I may own at the time of my death, real or personal, tangible or intangible, of whatsoever kind and wheresoever situated to niy husband, JOHN RUSKELL CLARK, if he survives me. I direct that my spouse be permitted to claim the maximum marital deduction as allowed by law. If my husband does not survive me, I give, devise and bequeath the rest, residue and remainder to my children: THOMAS JOHN CLARK of Bowie, Maryland; CARY MICHI CLARK, Marysville, Pennsylvania; JOANNE KAY KEANE, Elkton, Maryland; JAMES CLARENCE CLARK, Harrisburg,. Pennsylvania; JON WILLIAM CLARK, Enola, Pennsylvania; and SCOTT ALAN CLARK, Boone, North Carolina, in equal shares, per stirpes and not per capita. IN WITNESS WHEREOF, I have signed my name and set my seal, this the ~ 8 day of_ ~~, 1988. r~~~P~ ~l'Y7Cfij~c~4~~I ~ SEAL) EILEEN AMANDA CLARK (. SCFIILAWSKI nd EARIS 2 ~nNCrs ~~ uw BO% 5529 Tf1 CAROLINA 27571 Signed, sealed, published and declared by said EILEEN AMANDA CLARK to be her request and in her presence and in the presence of each do hereby subscrik>e our names as witnesses. o f /~C `~.C 2~ i o f CC{~z /l~ C STATE OF NORTH CAROLINA WAKE COUNTY Before me, the undersigned authority, on this day personally appeared EILEEN AMANDA CLARK, and F. M u. ~ and -~',t~ .~~ ~~.-L~ ~~~ , known to me t be the Testatrix and the witnesses, respectively, whose names are signed to 1=he attached or foregoing instrument, and all these persons by me first being duly sworn. The Testatrix declared to me and to the witnesses in my presence; that said instrument is her Last Will and Testament; that she had willfully signed and. executed it in the presence of the witnesses as her free and voluntary act for the purposes expressed therein. The witnesses stated before me that the foregoing Will was executed and acknowledged by the Testatrix as her last Will and Testament in the presence of the witnesses who, in her presence witnesses and that the Testatrix, at the time of the execution of the Will, was over the age of eighteen (18) years and. of sound and disposing mind and memory. C~-~?~ ~~'~-~~ ~ P~ EILEEN .AMANDA CLARK, TESTATRIX G7ITNESS ~~ ~~~ WITNESS IRADY, SCHILAWSKI and EAALS '7 ATTOFNEVS AT LAW J P.O. BOX 5529 /, NORTH CAROLINA 27511 Subscribed, sworn and acknowledged before me by EILEEN AMANDA CLARK, the Testatrix, subscribed and sworn before me by ~~,~ ~ t~l~ u ~,A and `~,c,¢z.ti_ ~~-~-t,iu.~..; , the witnesses, this day of ---~=~terTti-~.u,~_ 1988. N TAR PUBLI MY COMMISSION EXPIRES: ~~j ~ID~ 1!!l:S1Clfl.,,~~ `Q~v. `M1~jY ~~//~~~~j0es +4'~C``' `, ~ V~ I` i t !~'c~ ~ N < r n ; ~ r, ;: ° ~ .,_ !~~ - ~ ~ ~~ ~r L. f/p. ~~~ '~FOFt S:Tt ~i 3RADY, SCH[LAIX~SK1 and EARLS 4 AT1pRNEYS AT UW P.o. eox'szs Y, NORTH CAROLINA 27511 _,~~ :r;. STATE OF NORTH CAROLINA COUNTY OF WAKE FIRST CODICIL TO THE LAST WILL AND TESTAMENT/' d.~ ~~-',i:; (;+;- EILEEN AMANDA CLARK ~', '.~ ' - '-~'' I, EILEEN AMANDA CLARK , domiciled of Wake County, North Carolina, do hereby make, publish and declarE~ this to be the First Codicil to the Last Will and Testament heretofore executed by me on September 28, 1988. This Codicil being as follows: Article III, of my Last Will and Testament executed by me on September 28, 1988, shall be stricken and voided in its entirety and Article III shall be amended as follows: Article III .ADY, SCE~II,AWSHI, ARLS and INGRAM ATTORNEYS AT LAW P.O. BOX 5529 iY, NOATH CAROLINA 27512 EXECUTOR. I hereby appoint my son, JAMES CLARENCE CLARK, to be the Executor of this my Last Will; and I vest my said .Executor with full power and authority to sell, transfer and convey and property, real or personal, which I may own at the time of my death at such time and price and upon such terms and conditions as may be determined appropriate and to do every other act and thing necessary or appropriate for the complete administration of my estate. Without in any way limiting the generality of the foregoing provisions, I hereby grant my Executor all of the powers set :forth in North Carolina General Statues, Section 32-27, subject to Section 32-36, and these powers are incorporated by ref=erence. Should an alternate Executor be required, I nominate my son, JON WILLIAM CLARK to be Executor without bond of this my Last Will. And except ir. so far as said Last Will and Testament is expressly or by necessary implication changed by this First Codicil and is in conflict therewith, I do hereby ratify, republish and reaffirm my said Last Will and Testament executed by me on September 28, 1988, and each and every part thereof. ,.sks„ IN WITNESS WHEREOF, I sign, seal, publish and declare this instrument to be the First Codicil to my Last Will and Testament heretofore executed by me on September 28, 1988, this the ~,~ day of ;`s/;;~ 1992. ;J --ti'_:~'sr~ ~r ~9''1-: ~~. -w,{ c~ r'._ ~l~ th A-~~-t- _ (SEAL) EILEEN AMANDA CLARK :ADY, SCT~LAWSHI, ARL5 and INGRAM ATTORNEYS AT LAW P.D. BOX 5529 ;Y, NORTH CAROLINA 27512 The foregoing instrument was signed, sealed, published and declared by EILEEN AMANDA CLARK to be the First Codicil to her Last Will and Testament executed by her on September 28, 1988, in our presence, and we, at request and in the presence of each other, have subscribed hereunto as witnesses our names this 1(°µ` day of A UCst)S'~' 1992. Address ~ Address v G ~ . pCr.i K ~~~ STATE OF NORTH CAROLINA COUNTY OF WAKE Before me, the undersigned authority, on this day per,,~ onal,ly ap eared EILEEN AMANDA CLARK, S.L~~2% ~('~ ~'1(~C~~Q and Anita ~ LA ~• Rach{ known to me to be the Testatrix and i:he witnesses, respectively, whose names are signed to the attached or foregoing instrument, and all of these persons being by me first duly sworn. The Testatrix declared to me and to the witnesses in my presence: that said instrument is the First Codicil to EILEEN AMANDA CLARK's Last Will and Testament executed by her on September 28, 1988, that shE~ had willfully signed and executed it in the presence of the witnesses as her free and voluntary act for the purposes therein expressed; or, that the she signified that the instrument was her instrument by acknowledging to them her signature previously affixed thereto. The witnesses stated before me that the foregoing First Codicil was executed and acknowledged by the Testatrix as her First Codicil to her Last Will and Testament executed by her on September 28, 1988, in the presence of the witnesses who, in her presence and at her request, subscribed their names thereto as attesting witnesses and that the Testatrix, at the time of the execution of this First Codicil was over the age of eighteen (18) years and of sound and di:~posing mind and memory. -~ r ~' i/ .i; ;17~/`~i~C~..-i•.~c..- ~~~-c ~L _ (SEAL) EILEEN AMANDA CLARK Witness _Y ~~ ' i~ Witness Subscribed, sworn and acknowledged before me by the Testatrix; subscribed and sworn be:Eore me by ~~ ~~~ ~~~ a~~-fl', and An16F ~A r», ~~-1 , witnesses, this I t~ of ~~fclS'r 1992 My commission expires: ~ c7YLtOVi G- ~~-~/s----- Notary Public ""'~ T~C~~v A. ~i:~CLS .- ~ r.. r^+~ilj tiff ~--~i{fll~ LX vIf~L`. L'v'j~ _m1.E DY, SCHILAWSHI, ?.LS and INGRAM ATTORNEYS AT LAW P.O. BOX 5529 NORTH CAROLINA 27572 ** Account# 2118-5827 ** E/LEEN CLARK 3/20/2008 Hi h Low Clo;~e S mbof MFS MUN INCOME TR 7.22 7.12 7.13 MFM AMERICAN BALANCED FD INC CLOSE ONLY 17.95 ABALX DELAWARE TX FR USA FDA CLOSE ONLY 11.C-7 DMTFX FRANKLIN TAX FREE NC CL A CLOSE ONLY 11.78 FXNCX INVESTMENT CO AMER CLOSE ONLY 29.98 AIVSX 3/24/2008 Hi h Low Clone S mbof MFS MUN {NCOME TR 7.21 7.14 7.17 MFM AMERICAN BALANCED FD INC CLOSE ONLY 18.07 ABALX DELAWARE TX FR USA FDA CLOSE ONLY 11.04 DMTFX FRANKLIN TAX FREE NC CL A CLOSE ONLY 11.73 FXNCX INVESTMENT CO AMER CLOSE ONLY 30.3:5 AIVSX ~ his document is based upon information which has been obtained from, sources believed reliable, and although every attempt has been iraadg ~ make it as complete as possible, its accuracy i5 itot ~uar~n , A. G. Edwards & Sons -~~ n y C 7' ~ O C~ pO 9 .. G r7 . ~ ~. 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PA 1701 I SI 1 :Tls('T Verification ~' Confiimalion hf Account and Balance InCc~rnlalion proti°iced for: Cus1_omer: 1~II.EEN 9 CLARK (SSNN, ~l'l-\\-OOS12) Dale olDeat.h: March 22, 2008 i Deposit -~cco~~nulnformal:ion ~ ~i Acc•suu Accouln Darr o1 Deaih /~. er i,~c D,ie Manuiq LiiLiest r~ecrued 1'TI~ I ')fit: T~~pe *lt,rnbct Balance f3alauce' ~' cueJ Date ;L~Le: iierest lau•re~ .r~.,~...~~~.x,.. _ `'p ~ t ~ yid 7 ~_Lnsed CH~:'fuNC .~ ~;';?;?;?:~1`;~ZS7; $15.717.75 10%1 12(i0> ~~ ~$O.il ~ ~~Llp LLB =AL TIT L.1 _ .I Shill S ~ ; L.ARl: i EILf1LN n c ~L.AR7; AC~'GUN'f IS 1pINT 1d~11 H R1;iI~T Oh SIIftVIVGfLSHIP AC;~'T AS Tl"GEED Si1JC_~i OI'ENIIJG ----- - -- U. a -' G r. ~ ,~ G,~ 6 u -~ G R G -, ? ^~` ~.^~ -~ _.~ ~ '~G-~~R -~ ~•~ 7 N y a R coo •- ~ G 7 ~ ~ G ry ~ h~ -~ = ~ O G G~ ti P-_ C ~ G'G,,,~ T ~ v. -.~.g ~ 5 avv`"~ a~ °=~~~r~ ~Nry~b~~ u: ~ R - ry u- ~ p ~:w~ ~" ~ o a ~ c- ~ aF-~.~~ ;n ~ ~. c ~. ry ~,d~~~ N 'c a R ry ~ ". _ a ~ v, ~- ~ ~ c. -^. ~ ~' -., ~~'., ~; ~ '~ o m x .~ p~.rr ~ ~ G G ~ G~ r. p. T V. v 2 i ~ ~ tc ~ .ter'-G,a ~ ':~ ~ ~ n rTyp ~ ~ ~G7 n c ~ ry ~`~ n 'Y~ ~~~~ C [nt '~ ~: ~ =- ~. = ;,, r. r. ~ ~, c F c- .~ ry ~ ~ ~ ` .-~ v. C: J ~ ~ . J ^' .- ... c ~ ~ Lv r ^' ~ G ^~ ~ CD ~~ R .-. N ~ n ~ n ~ V ~ `G ?% (ti Pr, 25 G G v. ~° G ~, p cY co av 5 ~ ~~, c~c co ~ E~' ~ cLO O C>- .-n ~9 c~ 7, 4 7 O O ~ ~ N ~~ 7"~'" o G o~~cy~`yy0o N W " ~. N p-~ rh 5G¢bot~..o ~~do~~~ ro~G7p,w9b X60 ~~ n ~ £~ w ~~ ~ ~~~£~ a°a' ~~~ `< <n W n G a N ~ ~ 7 ~..~~ ~ d ^w r, b '~ 2~~~w CD O n co p' ~'- ~ ~ .-n O ~ h .ate ~ w G .n O f-v ~ ~ ~Q ~ N O ~ ~ ~ ~ n ~ ~ N n O V~ ~' ~ x r' ~ ~ u' N. w C" ~w C~ ~a ~ ~ w ~ 0 w iW x Cr1 Cn .G ~G y O O Z ~ c/~ G% Cr :+~ n d ~ G V' 'y b r ~ G ~ *~.J n "t3 O a ~ ~~~_ ~ c y `° ~ n. ~ ~ ~ n ~ ~ o ~ ~ ~ ~ ~ ~ ~ K N ~. U+ C.J '~ ,..~ O ~ 'A ry . ~ N ~ [J W ,~ d w w tJ w ~~ G W i~ w W W -P ? p~ ~ ~ ~ ~ ~.D - -.] a r `~ O O p p O 0 1~ r O o ~ ~ :a ~ ~ 0 0 O 0 CJ O ~ O O ~ ~ 0 ~i G .b ~i ~. .~ N F Cy .' 6 0 o C O O G~ ~ ~HH. C~ ~ ~O ~. v, 4~ i r- ~ ~ ~ G co ~ [T7 -C C~- o ~ o O O "~ h O o B (J W N --1 d ll~ W -.3 r 0 x rc„ G 9 ~ ~~ ~- ~./ ~ ~ CJ ~ ..~ w ~ C ~j ~_ O ~• N PJ ~. ~ O ~ Rj O_ ~ ~ ~'1 ~~ ~ O "~ A~ C/a (',+ r n ~ ~ ~ ~ O "~ ¢~ni ~ ~ ~ o Cr1 NpO~' ~ w p O ~ p~ r* d. ~~ ~. ro n ~ INVENTORY REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } James Clarence Clark CUMBERLAND COUNTY, PENNSYLVANIA File Number 21-(118-0465 Personal Representative(s) of the Estate of Eileen Amanda Clark deceased, depose(s) and say(s) that the items appearing in the following inventory include all of'the personal assets wherever situate and alf of the real estate in the Commonwealth of Pennsylvania of saki 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 ap ars 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 J mes Clarence Clark ~ ~ ~ - 18 Pa.C.S. § 4904 relating to unsworn falsification to } _ ~ ~~? authorities. ~ ~ ! n ti -_ ~~ ~ ~; . ~~~ ~ Ir: ~U Attorney - (Name) Robert C. Saidis Esq (Supreme~ourt LD. No.,l~- 21458 (F'~") Saidis, Flower 8 Lindsay (Address) 26 West High Street, Carlisle, PA 17013 (Telephone) 717-243-6222 DATE OF DEATH LAST RESIDENCE 4-A Adams Street DECEDENTS SOC. SEC. NO. 03/22/2008 Enola, PA 17025 390-14-0092 FIGURES MUST BE TOTALED Personal Property Cash ............................................................................................... 449.44 Personal Property ......................................................................... Stocks/Listed ................................................................................. 311,416.20 Stocks/Closely Held ...................................................................... Bonds ............................................................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... All Other Property ......................................................................... Total Personal Property ......................................... 311,865.64 Total Real Property ................................................ Total Personal and Real Property ......................... 31.1,865.64 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(b)) Form RW-09 Rev. 10.13-2006 REGISTER OF WILLS OF INVENTORY CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } SS File Number 21-QI$-0465 DATE OF DEATH ~ LAST RESIDENCE 4-A Adams Street DECEDENTS SOC. SEC. NO. 03/22/2008 Enola, PA 17025 390-14-0092 Cash A. G. Edwards Account--Wachovia Securities, LLC -Investment Account-Cash Total Cash 449.44 449.44 Stock /Listed 6,952.9990 shares American Balanced Fund Inc -Com Class A 124,806.34 7.182.5770 shares Delaware Group Tax Free Fund Inc -USA Fund CL A 79,403.39 4,151.6520 shares Franklin Tax Free Trust - Nc T/f Income A 48,802.67 1,698.4520 shares Investment Co American -Com Class A 51,233.80 1,000.0000 shares MFS Municipal Income Trust -Shares Ben Interest 7,170.00 Total Stock /Listed 311,416.20 (Attach additional sheets if necessary) Total Personal Property and Real Estate 311,865.64 LAW OFFICES SAIDIS, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET JOHN E. SLIKE CAMP HILL, PENNSYLVANIA 17011 ROBERT C. SAIDIS TELEPHONE: (717) 737-3405 -FACSIMILE: (717) 737-3407 JAMES D. FLOWER, JR EMAIL: attorney®sfl-law.com CAROL J. LINDSAY www.sfl-law.com JOHN B. LAMPI MICHAEL L. SOLOMON GEORGE F. DOUGLAS, III DEAN E. REYNOSA THOMAS E. FLOWER MARYLOU MATAS SUZANNE C. HIXENBAUGH June 24, 2008 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 CARLISLE OFFICE; 26 WF~T HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL Re: Estate of Eileen A. Clark also known as Eileen Amanda Clark-File No. 21-08-0465 Dear Ms. Strasbaugh: Enclosed are two original copies of the inheritance tax return alid an original copy of the inventory to be filed in your office. Also included are copies of the documents to be time- stamped and returned to me in the enclosed self-addressed stamped enwelope. A check payable to Register of Wills, Agent in the amount of $707.55 is included with the inheritance tax return to pay the additional inheritance taxes due and a check payable to the Register of Wills in the amount of $30.00 is enclosed to cover the filing fees. If you have any questions or comments or require additional documentation, please call. Very truly yours, SAIDIS, FLOWER & LINDSAY ` o Ann Seker Paralegal for Robert C. Saidis js Enclosures 3e~t>.is~d sn~ .~ r~ ~ ~ ~t tt) ~~ E i ui ~J ~ u. -- d3 ? ~~ ~~ f i N.I~I=_;'V~a G j %~T"r ~F ~ . ~ ~ ~ ~ ~ ~. '~7~{ .~, ~ ;, ~ t = _~ `_~ ~ ac ~~ ~ ~, ,~ ~ :-_; 1 ~ ~u~~ ~~ "^+~ U ""~ 0 .~ ~~ d ~ .t.. N O ~ z ~o ~ ~. N~ . a w° mod o ~ `~~ ~~ ~U ~c+~ W r ~ p" .v ~ p M ( p° ~a oo~,o W ~ N U U U ~ "~ '~ ~ Q j ~ ~~~ U r~ .. ~ A U? N ~ ~ U Q~ ~' ~ ~~~ c UUOU O H Z O H- Z~ w~ }- i Q' Q w