HomeMy WebLinkAbout06-25-08REV-1500 EX + (8-00)
COMMONWEALTH OF REV-15 0 0 OFFICIAL USE ONLY
PENNSYLVANIA
DEPARTMENTOFREVENUE INHERITANCE TAX RETURN FiEluuMBER
DEPT. 280601
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1- 0 8 0 2 9 3
_
_
CCUNN CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I-
W Suders Daniel Orville a/k/a Suders D. Orville
THE
W
V
03/03/2008
01/25/1918 REGISTER OF WILLS
Q (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
~ Q 1.Original Retum ~ 2. Supplementa{ Retum ~ 3. Remainder Retum (date of death priato 12.13-82)
4
~ a ~
~ 4. Limited Estate
~ 4a. Future Interest Compromise (dare of death aver 12-tz-e2)
~ 5. Federal Estate Tax Retum Required
~ a m 0 6. Decedent Died Testate (Attach copy orwllq ~ 7. Decedent Maintained a Living Trust (Attach copy ofrrust) 1 8. Total Number of Safe Deposit Boxes
a
a
~ 9. Litigation Proceeds Received
~ 10. Spousal Poverty Credit (date of death between 12-3f-sr and 1-~-ss)
~ 11. Election to tax under Sec. 9113(A) (Attach sch o)
F THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AN D CONFIDENTIALTAX INFORMATION SHOULD BE DIRECTED TO:
Z
w NAME COMPLETE MAILING ADDRESS
o Joel R. Zullin er 14 North Main Street, :iuite 200
a FIRM NAME (If Applicable)
r
~ Zullin er Davis P.C.
p TELEPHONE NUMBER
717 264-6029 Chambersbur PA 17201
1. Real Estate (Schedule A) (1) 68,264.44 OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2) 1$:?,007.95
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) ~ ~'
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O
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H
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V
W
n. wive +yayca a ivv+co ncucwcu+c Swt+cuu+c uj
5. Cash, Bank Deposits r3+ Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G or L)
(5) 791275.65= ~ n 1_
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8. Total Gross Assets (total Lines 1-7) (8) _ 357,643.40
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 13, 886.73
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 15,477.58
11. Total Deductions (total Lines 9 & 10) (11) 29,364.31
12. Net Value of Estate (Line 8 minus Line 11) (12) 328,279.09
13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) 2, 000.00
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14) _ 326,279.09
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z
~ 15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) 0.00 X (15) 0.00
H
H 16. Amount of Line 14 taxable at lineal rate 326,279.09 X .045 (16) ~ 14,682.56
~- 17. Amount of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00
V 18. Amount of Line 14 taxable at collateral rate 0.00 X .15 (18) 0.00
K
Q 19. Tax Due (19) 14,682.56
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH "' < <
Decedent's Comalete Address:
STFcETADDRE~S
127 East Garfield Street
CITY STATE ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1 • Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments 13.680.00
C. Discount 720.00
(1) 14,682.56
Total Credits (A + g + C) (2) 14,400.00
3. InterestlPenalty if applicable
D. Interest
E, Penalty
Total InterestlPenalty (D + E) (3)
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 (4)
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.
0.00
0.00
(5) 282.56
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE, (5B)
Make Check Payable fo: 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
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 : ........................................ ^
c. retain a reversionary interest; or ...................................................................................................... ^
d. receive the promise for life of either payments, benefits or care? ............................................................. ^
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... ^
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? .......................................................................................................
No
0
0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalti perj I declare that I have examined this return, including accompanying schedules and statements, and to the hest of my knowledge and belief, it is true, correct and complete.
Declaratio preparer o her than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF
282.56
DA
~f~~,~~ ~C~ ~'o~~OSI
ADORES Daniel C. Suders, 1411 Concrod Road
Mechanicsburg PA 17050
SIGNATIaRE~F PREPARER OTF~2 Tt~N~2EPRESENT~TIVE ti 4ATE Z _
AUUKts,~/ Joel R. Zulling~t; ~4 North Main SCFeet, Suite 200 ~ /
(/ Chambersbur_ l/ PA 17201
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 ol~ 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 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 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(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 4.5%, except as nol:ed 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 12% [72 P.S. §9116(a)(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
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Suders. Daniel Orville. a/k/a Suders. D. Orville 21 08 0293
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 roe which is ' int -owned with ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, Gross proceeds from sale of real estate situate at 127 68,000.00
East Garfield Street, Shippensburg, PA, to Walter T.
Eichelberger
2. Received on proration of real estate taxes, sale to 264.44
Eichelberger
TOTAL (Also enter on line 1,
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILL NUMBER
Suders. Daniel Orville. a/k/a Suders. D. Orville 21 08 0293
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
fTEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Series E Savings Bonds as shown on 8,869.04
attached valuation
2. Brokerage Account #10N559900, S A Moyer 173,138.91
Insurance & Financial Services, LLC, copy
of valuation attached
TOTAL (Also enter on line 2, Recapitulation) ~ $
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, $c M~$C.
IN RESIDENT RECEDE T N PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Suders. Daniel Orville. a/k/a Suders. D. Orville 21 08 0293
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
DESCRIPTION VALUE AT DATE
OF DEATH
1, Checking Account #98190504, M&T Bank, 12,491.75
including interest accrued to date of death
2. Checking Account #9830238276, M&T Bank, 7,738.85
including interest accrued to date of death
3. Savings Account #015004202115249, M&T Bank, 18,743.09
including interest accrued to date of death
4. Certificate of Deposit #031003911815488, 7,635.52
M&T Bank, including interest accrued to
date of death
5. Certificate of Deposit #031003911815496, 5,099.20
M&T Bank, including interest accrued to
date of death
6. Checking Account #103700908, Orrstown 2,533.04
Bank, including interest accrued to date
of death
7. Savings Account #730963, Orrstown Bank, 12,325.11
including interest accrued to date of death
8. Net proceeds from sale of decedent's personal 4,118.76
property by Gateway Gallery Auction
9. Refund, Erie Insurance on car policy 31.00
10. Penn Treaty Insurance, benefit payment from 5,550.00
long term care policy
11. Annuity Acct. #DOS428466, Prudential Financial, 1,504.10
no named beneficiary, benefits paid to Estate of
Daniel Orville Suders
12. OPM, compensation due decedent 132.63
13. Penn Treaty Insurance, refund of unearned 727.60
premium on long term care insurance
14. U.S. Treasury, economic stimulus rebate 600.00
15. Refund, Erie Insurance on homeowner's policy 45.00
TOTAL (Also enter on line 5, f2ecapitulation) ~ 3
275.65
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-96)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Sutlers. Daniel Orville. a/k/a Sutlers. D. Orville 21 08 0293
If an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G.
ADDRESS
SURVIVING JOINT TENANT(S) NAME
A. David O. Sutlers
B Daniel C. Sutlers
c
JOINTLY-OWNED PROPERTY:
RELATIONSHIP TO DECEDENT
236 Cinnamon Way Ison
Clemmons, N.C. 27072
1411 Concord Road Ison
Mechanicsburg, PA 17050
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
DECEDENT'S INTEREST
1. A&B 1/28/80 Checking Account #97546003, M&T Bank, including :?2,994.57 33.3333 7,664.85
interest accrued to date of death
TOTAL (Also enter on line 6, Recapitulation) I $ 7,664.85
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
FILE NUMBER
Suders. Daniel Orville. a/k/a Suders. D. Orville 21 08 0293
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of thel REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAMEOFTHETRANSFEREE,THEIRRELATIDNSHIPTODECEDENTAND
THE DATE OF TRANSFER. ATTACHACOPYOFTHEDEEDFDRREALESTATE.
DATE OF DEATH
VALUE OF ASSET
°foOFDECD'S
INTEREST
EXCLUSION
QFAPPLICABLE)
TAXABLE
VALUE
1. Annuity Policy #5913108, Allianz, named beneficiary, Daniel 8,089.99 100. 8,089.99
C. Suders, son of decedent
2. Annuity Policy #5913074, Allianz, named beneficiaries, 12,340.52 100. 12,340.52
Daniel C. Suders 50% and David O. Suders 50%, both sons
of the decedent
TOTAL (Also enter on line 7 Recapitulation) I $ 20,430.51
(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
ESTATE OF FILE NUMBER
Suders. Daniel Orville. a/k/a Suders. D. Orville 21 08 0293
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home, funeral services 1,168.95
B
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)fEIN Number of Personal Representative(s)
SVeet Address
City State Zip
Year(s) Commission Paid:
2, Attorney Fees Joel R. Zullinger
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
7,200.00
Street Address
City State _
Relationship of Claimant to Decedent
4. Probate l=ees Letters - 360.00; Will -15.00; Short certificates - 20.00; JCP fee - 10.00; 440.00
automation fee - 5.00; filing return -15.00; filing inventory -15.00
5 Aaountant's Fees
6. ~ Tax Return Preparers Fees
7. Vital Records, death certificates 45.00
8. Borough of Shippensburg, utilities 130.61
9. Ausherman Bros. Real Estate, appraisal of real estate 300.00
10. Dumpster fees for cleaning residence 364.07
11. PPL Gas Utilities, gas service 122.22
12. Interstate Termite & Pest Control, treatment of residence prior to sale 797.12
13. Penelec, utilities 18.96
14. Fee for estate checks 28.10
15. Valley Cooling & Heating, repair work at residence prior to sale 116.25
16. Cumberland Law Journal, advertise letters 75.00
17. PPL Gas Utilities, gas service 59.78
18. Penelec, utilities 7.99
TOTAL (Also enter on line 9, F;ecapitufation) $ 13.886.73
Zip
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Sutlers, Daniel Orville, a/k/a Sutlers, D. Orville 21 08 0293
Decedent's Name Page 1 File Number
Schedule H -Funeral Expenses 8- Administrative Costs - B7.
ITEM
NUMBER DESCRIPTION AMOUNT
19. The News-Chronicle, advertise letters 129.50
20. Borough of Shippensburg, final utility bill 134.28
21. Penelec, final electric bill 4.00
22. PPL Gas Utilities, final gas bill 24.90
23. Sally Sutlers, work in preparation for sale of personalty and real estate 920.00
24. David O. Sutlers, work in preparation for sale of personalty and real estate 940.00
25. Daniel C. Sutlers, work in preparation for sale of personalty and real estate 380.00
26. Joan Sutlers, work in preparation for sale of personalty and real estate 120.00
27. Shirley Crider, work in preparation for sale of personalty and real estate 30.00
28. Nate Crider, work in preparation for sale of personalty and real estate 5.00
29. Thomas Crider, work in preparation for sale of personalty and real estate 5.00
30. Keith Crider, work in preparation for sale of personalty and real estate 40.00
31. Marvin Crider, work in preparation for sale of personalty and real estate 40.00
32. Laureen Crider, work in preparation for sale of personalty and real estate 70.00
33. Danae Crider, work in preparation for sale of personalty and real estate 90.00
34. Stephany Sutlers, work in preparation for sale of personalty and real estate 80.00
SUBTOTAL SCHEDULE hi•B7 I 3,012.68
REV-1512 EX + (6-98)
SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
IN RESIDENTEDE EDENTRN MORTGAGE LIABILITIES & LIENS
ESTATE OF FILE NUMBER
Suders. Daniel Orville. a/k/a Suders. D. Orville 21 08 0293
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, Ocker & Associates, fee for tax preparation 240.00
2. ~Penelec, utilities ~ 9.82
3. ~ PPL Gas Utilties, gas service ~ 119.18
4. ~Embarq, telephone service ~ 0.51
5. Messiah Village, balance due on account for care ~ 10,752.02
6. PA Department of Revenue, personal income tax due 594.00
for 2007
7. United States Treasury, personal income tax due 3,441.00
for 2007
8. Alert Pharmacy Services, balance due on account ~ 5.50
9. (Carol A. Carmack, Tax Collector, real estate taxes I 315.55
due at death
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (P-nm
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FIILE NUMBER
Girlcrc Ihnicl (lniillc ~/4/' Giricr~ rl rlniillc 7•I !1G 11•f~4
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. Daniel C. Suders Lineal
1411 Concord Road Item 1 Sch G; 50% Item
Mechanicsburg, PA 17050 2 Sch G; 1/4 of residue
2. David O. Suders Lineal
236 Cinnamon Way 50% of Item 2 Sch G;
Clemmons, N.C. 27012 1/4 of residue
3. Shirley Crider Lineal
10885 Goshen Road 114 of residue
Huntington, IN 46750
4. Sharon Flannery Lineal
8098 S. Carr Court 1/4 of residue
Littleton, CO 80123
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. 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1, Prince Street United Brethren Church 1,000.00
Shippensburg, PA 17257
2. Mount Pleasant United Brethren Church 1,000.00
Fayetteville, PA 17222
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 2 000.00
(It more space is needed, insert additional sheets of the same size)
JRZ - 5.1 suders.l April 5, 2002
LAST WILL AND TESTAMENT
I, Daniel Orville Seders, of 127 East Garfield Street,
Shippensburg, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby declare this to be my will,
hereby revoking any and all former wills and codicils thereto by me
heretofore made.
I.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, sha7.1 be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
II.
I give, devise and bequeath the residue of my estate of every
~ nature and wherever situate as follows:
A. $1,000.00 thereof to Prince Street United Brethren
Church, Shippensburg, Pennsylvania, to be used for
~; general church purposes;
B. $1,000.00 thereof to Mount Pleasant United Brethren
Church, Fayetteville, Pennsylvania, to be used for
general church purposes;
C. The balance of the residue of my estate to my children,
namely Shirley A. Crider, Sharon A. ]~lannery, Daniel C.
Suders and David O. Suders, in equal shares, provided
that the share of any child who predeceases me or dies on
or before the thirtieth day following my death shall be
distributed to said beneficiary's issue, per stirpes,
living on the thirty-first day following my death, and in
default of any such then-living issue, such share shall
be added to the share or shares of my other children.
III.
Any fiduciary under this will shall have tr.e following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or
personal, without regard to any principle of
diversification of risk.
B. To invest in all forms of property including stock,
T
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
principle of diversification of risk.
C. To sell at public or private sale, to exchange or to
Page 2
lease for any period of time any real or personal
property and to give options for sales, exchanges or
leases, for such prices and upon such terms or conditions
as they deem proper.
D. To allocate receipts and expenses to principal or income
or partly to each as they fram time to time think proper.
E. To compromise any claim or controversy.
F. To distribute in cash or in kind or partly in each.
G. To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
IV.
I direct that all taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
V.
v
I appoint Daniel C. Suders and David O. Suders, my sons, as
co-executors of this my will.
Page 3
v2.
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
first three of which bear my signature in the margin for the
purpose of identification this __ / y'~ day of
2~.
G'a„~F G~..-~C~. ~-.
Signed, sealed, published and declared by the above-named
testator as and for his last will and testament= in our presence,
who in his presence, at his request and in the presence of each
other have hereunto set our hands as attesting witnesses.
Y/ ~ ~ ~/i
r--~ , - l7ZQ/
{~
We , Daniel Orvi 11 a Suders , ~/' /~ ~,/~, .~,l~~! and
` h j~, ,.
„~~/,~ ~f7 ~`~ lj~, the testator and the witnesses respectively,
whose names are signed to the attached or 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 testament and that he executed it as his free and
Page 4
voluntary act for the purposes therein expressed and that each of
the witnesses, in the presence and hearing of the said testator
signed the will as witnesses and to the best of their knowledge
said signer was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
~~~~~ ~~r--~~ ~~~
Testator
i
itnes:~ \
~ Witness
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before m by the
above-named witnesses this day of
~~
Not y Public
t~tn L . No ry Public
Chambmsburg Boron Franklin County
M Commission Expires May ; 3, 2005
Page 5
Irtd y, 17. L U U U I U. J J nlrl
~A. Settlement St~-temenl
L V L L 1 1 Y U L 11 V (~ r 1 V I V I l f J J V J L L L
U.S. Departmenk of Housing
and Urban Dotrelopment
IV V. I U V I i I
OMB Approval No, 2502-0265
8. Type of lush
6. File Number: 7. Lose Number. B_ Morrgeye Insoranoe Case Number.
~. FHA Z, FmHA 3. Conv. Unins.
s, ~ VA 6. Conv_ In9, ^
C. Natea Thia corm Is tumlatYed to give you a etatemern of actual sattlertrent costa. Arnounta paid to and by the settlement egeM are shown. Items marked
"(p.o.c.p were paid out4ide the dosing; they ere shown here for informational purposes and are not nlcluded In the totals,
D. Name & Address of 9onloYwew E_ Name Q Addrera of Seller F. Name !, Address of Lender
Wetter T. Eichelberg~' Estate of Daniel Urville Sudgl'S None
155 Fogelsanger Road 1411 Concord Road
Shippensbtug, PA 17257-9704 MechaniCSbutp, PA 17050
101. Contract sales price
102. Personal property
109. Settlement charges t0 DOrMwer (line 1400)
104.
105. 68,000.00
718.50 401. Contract sales price 88,000.00
d02. Personal property
403.
404.
405.
Adjustments for keme paid by sdter to 4dvarroe Adjuatmertts for kema paki by seller in advance
106, City/town taxes to 406_ Ckyhown taxes to
107. County taxes S/?212008 to 12/31/2008 186.28 407. Cour-ty taxes 5/22/2008 to 12!31(2008 188.29
108, Assessments to 40S_ Assessments to
109, School tax 5/22/2008 to 8Y30/2008 78,15 ~• Sdtool tax 5122/2008 to 6!3012008 78,15
110. 410.
111_ 411.
112, 412.
120. Grote Amount Ou>e From Borrower 68,982.94 420. Gross Amount iwe To SeOis- 88,264.44
G. Property Locedon: H. Sertlement ^®~
127 East Garfield Street treason Law Office, POBox 385 Carlisle, PA
Shippensburg, PA 17257 Place of Setltement I. 9emernerv bete:
Borough of Shippansbur , Cumberland 155 Fogelsenger Road
9 ~~' ~ Shippenstwrg, PA 17257-9704 45!22/2008
J. Summwy e1 BorYOnrer'o Traerssctfon K. Aurneolery of Selisr's Tta~aaetion
1 [t0. Gruara Atnwuti Due Froth Borrower i00. Gross Amount Due To Seller
200. Amounts Paid Br tk to BahaN tJf Borrower 500. Reduetbrts In Amount Dua To Seller
201. Deposit or earnest money 2,000.00 501. Excess deposit (see instructions)
202. Ptindpal amount of new lean(s) 502. Settlement charges to seller (Gne 1400) 880.00
209. Existing ban(s) taken subject to 503. E~dsting loan(s) taken subject to
,204. 504_ Payoff of frost mortgage torn
205. SOS. Payoff of second mortgage loan
Zoe. 506_ Bu de t 2,000.00
207. 507.
208. 508.
209. __
500.
Ad(usbnente for i'lema unpaid by ielter Adjustments for items unpaid by salter
210_ CityRown taxes to 510- Clry/town !axes to _
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
219. 519.
214, 5]4,
215, 515,
218. 516.
217, 517.
218. 518_
219, 519.
220. Total Petd By/t=or t3orrower 2,000.E 520. Total Reduction Amount Dvs Se1-er 2.680.00
euo. c:aan IUt setttternsn[ irony r o twrrower 800. Cash At 3ettlament To/Fram Sd1er
901. Dross Amount due from borrower (line 120) 68,982.94 601. Gross emouM due to seller (Ilse 420) ~,284,q.q.
902. Less amounts paid by/for bortowtx (line 220) ( 2 OOp,~) 802_ Leas reductions Rm artmt- due :;slier (line 520) ( ?,880,00 )
808. Cash ~ From [~ to torrower 66,982.94 803- Gash [.T, To [] From 5elter ~r 584.44
908. CasA d From [~ to 8orrowor 66,982.941603. Gash Q To [~ From 5Nfer I 65,584,44 ~
'Section S'of the Real Estate Settlemer-t Procedures Act (RESPA) requires
the follovring; • HUD must develop a Special Irrtormation Booklet to help
i.arsona borrowing money to finance the purchase of reaidantial real estate
to better understand the nature and costs of real estate settlement services;
- Each tender must prorrde the booklet to aU applicants from whom It
receives or for whom it prepares a written applia~tlon to bortow money to
finance the purchase of resldenNal reel estate; • tenders must prepare and
distribute with the Booklet a Good Faith Estimate of the settlement costs
that the borrower is likely to Incur in connection with the settlement. These
disclosures are manadetory.
Sect<on 4(a) of RESRA mandates that HUD devebp and prescribe this
standard form to be used at Ute time of loan settlement to provide full
disclosure of sll charges imposed upon the borrower and seller. These are
third party disclosures that are designed to provide the borrower watt
pertinent infamatlon during the settlement process in order to be a batter
shopper.
The Public Reporting Borden for this collection of informatlon is estimated
to average one hour par response, including the time for reviewing Instn,o-
lions, searching existing data sources, gathering and maintaining th® data
needed, and completing and reviewing the collection of information.
This agency may not collect this information, ar<d you are not required to
complete this form, unless It displays a currently valid OMB control number.
The Information requested does. not lend itself to confidantialily,
Prevkws editions a•P ~r,~nleea Page 1 of 2 corm HUo-1 (3/88)
Received Time May . 19. 11:0 4 AM -ef Handbook a3a~.z
mar. 17, LVVU I V. JJn~r~ ~v UU>. iruUn unv iv t v 1 V 1 JJV JLLL iv v, 1 VU I ~. L
L. Settlernertt Chat~yes
700. lots! Saltls/Brokar's CommiasGon based otf prlee S @ :f, = 1~
Dlvlslon of Commission me 700 as follows: Paid From Paid From
~ 1 _ Borrowers Setlera
701. S to funds st Futile at
SeUtem¢nt Settltiment
702. $ to
703, Commission paid at SetHement
704.
A00. Items PaYabte In Connection With Loan
801. Loan Cingtnatlon File %
802. Loan Discount °b
803. Appralsa4 Fee to
804. Credit Report to N
805. Lender's Inspection fee
806. Mortgage Insurance Application Ft3e to
807. Assumption Fee
80ti_
809.
810.
811,
aw- mans n.q..vsu o7 ~erroer r o tov rare m wavance
901_ Irrtarestttom to ~$ /day ~__.-
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for years to ~~~
904, years f0
905.
rvrw, r~a+evgr~u ~~ A>flJl benOCT
1001_ Hazard insurertce months®$ per month
1002. Mortgage insurance mortthsQ$ per month
1003- City Property takes months~$ per mtmth M
1004. County property taxes months~$ per month
1005. Annual tissessmenfa mtx,ths®$ per month
t 006. months ~ $ per month
1007_ monttts~$ per month
1008. mantlts ®$ per month
1100. Title Charges
1101, Settlement or closing fee 10
1102. Abstract or title sean:h to
1103. Title examinat;on to
1104_ Title Insurance binder to
1105. Document preparation to
1106. Notary fees to
1107. Altomey's fees to treason L.BW Office, PtJC
(includes above items numbers: ~
1108. TRIe insurance tv
(indudAS above items numbers: ~
1108. Lender's coverage $
1110. Owner's coverage $
1111.
1112_
1113.
1200. Gotner'nmettt Ret~rtitng and Transfer Charges
1201. Flecordng fees_ Geed $ 38.50 ;Mortgage $ ;Releases $ 38,50
120.2. City/cour>br taz/egrrq~s: Deed $ ;Mortgage 8
1203_ State taxlstamps: Deed $ ;Mortgage $
1204. Realty transfer tsx 1 °,6 buyer 1 °r'ra ,seller 660.00 6$0,00
1205_
'1300. Addltlona! Settierrrerrt Chargeta
1301. Survey to
1302. Pest Inspeetionto -
1303.
1304.
1905.
t400. Total Seriferrrant Charges (enter on Nna6103, Sectitxt J and 502, Section i4 718.50 680.00
C>K]
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Laurie,
The v~alu~ for eccouat slumber 1ON559900 as of 3/3/2008 was $173,138.9I'. Ifyou
have aray additional questions, please feel free to call 1-804-749-8900.
Thanks,
MEiceoWorsl.ey
Received Time Mar. 2O. 6:16AM
ORR.STO~IIN
BANK
A Tradition of Excellence
March 20, 2008
To: Zullinger -Davis
20 East Burd Street
Suite 6
Shippensburg Pa 17257
From: Traci Shaffer
Orrstown Bank
Customer Service Center
PO BOX 250
Shippensburg, Pa 17257
Re: Estate of Daniel O Suders
Date of death March 3, 2008
IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE
ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK.
CHECKING ACCOUNT
Account # Title of Account Date opened Principle Accrued Interest
103700908 Daniel Orville Suders 08/04/97 2532.82 .22
SA VINGS ACCOUNT
Account # Title of Account Date o ep ned Pri~ci~le Accrued Interest
730963 Daniel Orville Suders 03/16/89 12321.40 3.71
CERTIFICATE OF DEPOSIT
Account # Title of Account Date O ened Principle Accrued Interest
P.O. Box 250 •Shippensburg, PA 17257 • 717.530.3530 • 717.532.4143 fax
Q 1VI8TBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Law Offices
Zullinger -Davis
14 North Main Street, Suite 200
Chambersburg, Pennsylvania 17201
Re: Estate of Daniel Orville Suders
Social Security:
Date of Death: March 03, 2008
Phone (888)502-4349
Fax (302)934-2955
March 21, 2008
Dear Sir or Madam:
Per your inquiry dated March 18, 2008, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1. TypeofAccount Checking Account
Account Number 97546003
Ownership (Names o~ David O Suders
Opening Date
Balance on Date of Death
Accrued Interest
Total
2. Type of Account
Account Number
Ownership (Names o~
Opening Date
Balance on Date of Death
Accrued Interest
Total
Daniel C Suders
Daniel Orville Suders
07/28/80 Closed 03/17/08
$22, 994.57
$ 0.00
- --------------------------------------
$22, 994.57
Checking Account
98190504
Daniel Orville Suders
02/20/98 Closed 03/17/08
$12,491.27
$ 0.48
-- ------------------------------------------
$12, 491.75
3. Type of Account
Account Number
Ownership (Names o~
Opening Date
Balance on Date of Death
Accrued Interest
Total
4. Type of Account
Account Number
Ownership (Names o, f)
Opening Date
Balance on Date of Death
Accrued Interest
Total
5. Type ofAccount
Account Number
Ownership (Names o~
Opening Date
Balance on Date of Death
Accrued Interest
Total
Checking Account
9830238276
Daniel Orville Suders
03/20/02 Closed 03/17/08
$7, 738.72
$ 0.13
_..__.
$7, 738.85
Savings Account
015004202115249
Daniel Orville Suders
03/20/02 Closed 03/17/08
$18, 736.92
$ 6.17
_....
$18, 743.09
Certificate of Deposit
031003911815488
Daniel Orville Suders
04110/02 Closed G3/17i08
$7,325.58
$ 309.94
$7,635.52
6. Type of Account
Account Number
Ownership (Names o~
Opening Date
Balance on Date of Death
Accrued Interest
Total
Cert~cate of Deposit
031003911815496
Daniel Orville Suders
04/10/02 Closed 03/17/08
$4, 892.22
$ 206.98
____
$5, 099.20
Please be advised, there was no safe deposit box found for the above decedent.
* If upon reviewing the information above, you believe there are additional accounts not referenced, please provide
us with an account number and/or 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 call the
Walnut Bottom Office # 717-532-2414.
Sincerely,
Nancy Clagett
Records Management
~~.~~ Prudential
~'
LAW OFFICES
ZULLINGER DAMS
ATTN JOEL R ZULLINGER
14 NORTH MAIN ST STE 200
CHAMBERSBURG PA 17201
Dear Mr. Zullinger:
Prudential Annuities
A Business of Prudential Financial, Inc.
P.O. Box 7060
Philadelphia, PA 19175
(888) 778-5471 TTY: (800) 654-7637
www.prudential.com
Re: Estate of Daniel Orville Suders
Contract: DOS428466
April 23, 2008
We are writing in response to your request for information on the cor,~tract shown above.
When policy 10397864 matured as an endowment, Daniel Orville Suders elected to leave the
proceeds with Prudential in a new contract - DOS428466.
Under the terms of contract DOS428466, effective November 9, 1977, Daniel Orville Suders was
to receive annual interest payments.
The value of the contract as of the date of death was $1,504.10. ~ 'This amount was paid to the
Estate of Daniel Orville Suders.
If you have any questions, please call our Annuity Service Center at (888) 778-2888. You can
obtain contract values, request forms and duplicate statements, and conduct certain financial
transactions 24 hours a day 7 days a week with our automated phone :system. The Service Center is
open Monday through Thursday between 8:00 a.m. and 7:00 p.m., anti Friday between 8:00 and
6:00 p.m. Eastern time. If you are using a telecommunications device for the hearing impaired,
you may call (800) 654-7637, Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern
time.
Sincerely,
~~~..~:
Nell Bailey
Annuity Service Center
Variable annuities are issued by Pruco Life Insurance Company (in New York, by Pruco Life Insurance Company of New Jersey). Both companies
are located in Newazk, NJ. Variable annuities aze distributed by Prudential Annuities Distributors, Inc., Shelton, CT. Fixed annuities are issued by
The Prudential Insurance Company of America. All are Prudential Financial companies and each is solely responsible for its own financial
condition and contractual obligations.
~~
[Page I of 1 ]
Allianz Life Insurance Company of North America
PO Box 59060 Al 1 ~ an z it ~
Minneapolis, MN 55459-0060
800/950-1962
April 11, 2008
ESTATE OF ESTATE OF DANIEL ORVILLE SLIDERS
c/o JOEL R ZULLINGER
14 N MAIN ST STE 200
CHAMBERSBURG PA 17201
Re: Daniel Orville Suders, deceased
Individual Annuity Policy Numbers: 5913108 and 591 x;074
Dear Executor:
This letter is in response to your request for the date of death values as of March
3, 2008 on the above policy numbers.
Policy Number 5913108 has been annuitized. The present value, future
payments discounted at the prime rate, as of the date of death was $8,089.88.
The beneficiary on this policy is Daniel C Suders, son 100%. The original
premium received on April 26, 1999 was $10,000 (non-qualifi~sd). The annuitized
value was $14,123.43 on April 18, 2007. Marjorie Suders wa~~ the Annuitant and
Daniel Orville Suders was the Owner, following Marjorie Suders death.
Policy Number 5913074'~is still in deferral status. The date. of death value as of
March 3, 2008 was $12,340.52. fihe beneficiaries of this policy are Daniel C
Suders, son 50% and David O Suders, son 50%. The original premium received
April ?5, 1998 ylrac $10,n00 (non-qualified funds;. Danie! Or'V~ille Suders ~vaS
both the Annuitant and Owner of this policy.
Should you have any questions, please feel free to contact our office. Thank
you.
Sincerely,
~a~,i,~tta. o~~Le.~
Barbara LaBorde
Claims Examiner
C: Marshall Colson Jr # 41192
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