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HomeMy WebLinkAbout07-07-08 15056051047 REV-1500 EX (06-05) OFFICIAL U SE ONLY PA Department of Revenue Countv Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN T DECEDENT S ~ ~ G ~ U~ b ~~ Harrisburg, PA 17128-0601 RE IDEN ENTER DECEDENT INFORMATION BELOW ~`~ l 5~~ G Dg ©~ ~ - i ~ 3 8 Dc=re lent s Last Name Suffix Decedent's Firs t Name MI l~~~lt~-~l~h m~r~ ~~' e D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouses Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL NN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Firm Name (If Applicable) First line of address 1~ 1 S o d -ft ~ ,2 ~' ~ S f r~ e -~ Second line of address City or Post Offce State ~orml.~ySbu-r~ 1~~~ REGISTER OF WILLS l!)~F ONLY C7 O C D _ e~ is ~ C` -r r`r < t ~~ ~C r ~ . ~ t'r1 ` ~ . "3 _. ~ ; . _ i:.:~ c s r -B14TE FILEGD ~= ~ _ ZIP Code ~ I ~~~3 N _. _ _; ~. z:Y _ CorrE:spondent's a-mail address: ~ 6/~r? Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN,9Il~RE,O~ sE,RS~ON RE~SPO~~EAF:O :FILI,gIG R~URN e ~F~,~~ ~~n ADD~PSS " U ~~~ sd ~~ a ~ s , c~©,~ ~s~-~ ,~ ~~ ~~~3 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J 15056052048 REV-1500 EX RECAPITULATION ., 1. Real estate (Schedule A) . ............................................ 1. • 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages ~ Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. ~G T ~ 5 ~ ~~ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. E'~. Total Gross Assets (total Lines 1-7) .................................. .. 8. ~ ~ ~ 5 ~ . (~' (~ 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ~~ ~ ~ ~ ~ ~ ~, 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) .............. .. 10. ~ 6 ,~ 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 9 ~ ~ ` ~-* (p 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. J ~" ~ Z ~ . 3 (P 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 14, an election to tax has not been made (Schedule J) .................... Net Value Subject to Tax (Line 12 minus Line 13) .................... .... 13. .... 14. ~J ~"' ~ ~ , ~ • 3 (E, TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable • at lineal rate X .0 ~ 16. ~ S ~ ~j , C C> 17. Amount of Line 14 taxable at sibling rate X .12 17. 1 f.. Amount of Line 14 taxable at collateral rate X .15 18. 151. TAX DUE .................................................... .....19. ~ ~ -J 6 . Q Q 2C1. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 15056052048 15056052048 REV-1500 EX F'age 3 File Number ~ G~ Decedent's Complete Address: ~~- ~~~(~ G~ DECEDENT'S NAME , STREET ADDRESS ~ / CITY - - - - tt.~vrn~ C~S6u~ _- _ -- __ STATEn~ ZIP ~~ ~/~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments _- C. Discount ~~ ~L ~_. -- Total Credits (A + B + C) (2) ~ ~ ~j ~~ 3. Interest/Penalty if applicable D. Interest E. Penalty otal nteres ena ty + ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Filt in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ ~ ~ 1, 3-~' A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shalt 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? .................................................................................................................. ...... ^ IF THE ANSVVER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §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)]. 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. rrr_v-rsoe oc. t+.rn SCHEDULE E cotulMONwt:aLTH OF PENNSYLVANW CASH, BANK DEPOSITS, & MISC. '" RESl~rir TDECEpENT~ PERSONAL PROPERTY ~~ ~ rr t c yr + r~LC numorcR Include the proceeds of litigation and the date the proceeds were received by the estate. Aq property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALttE AT DATE NUMBER DESCRIPTION OF DEATH ~. IYIe~ ~tiS~ lS~ ~C'~t- k'~qu,/~--cS~wi ~, Acc~~- /~3~9~3 J,5 ~ f~~ 00 D~ a.~ 7~~~h b~I~JC~ ~~cti..i' 2CCruec~ /n~er-~,S'~ ~2. 1Y1~~.~ f s~ ~~ ~, C?hec~iir ,~4-cc~-~ /~3~ 9~3 / 3~~? ~~ 7~~~~ off' r~r;~h ~x~l'~ n c~ plus ~cru.eG/ i~u~s~,. 3 . I~rz.~~ F~~ , :~h~e S~>~~ ~ ; Ac~~-~~3010,~380/ ~ ~ o .~ ~ i, ~~~ ~a~e a~'Ih b~~n~~ plus ~rc~~/;/1~-~.r-,~ ~ ~~y ~~~, ~on~ /yf~-key, Ae~-~ ~3®1©.~~~~~f ~ 8 9~.vo TOTAL (Also enter on line 5, Recapitulation) ~ $ ~ ~ ~~~~' (If more space is needed, insert additional sheets of the same size) EV-1511 EX+ (10-06) _ SCNEDVLE 1~1~ COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule L ITEM A. FUNERAL EXP,~NrSE~~ ` ~~~~~~~ ~~ / ~~~ ,f~ ~. sGU'~! /T.2~~ l~/1"J~~->ol-c' C91zzu~'~ /Y~i l~-OrCt; ~~, <~. ~o.b~i /~oore /YJonun~emf~ ~o. (mo/7U~-1e/t.~) l~allisfa~, /1~~t, . ~, T~~~'~~'~~ ~/- /~'e~%nbcuse•~ ~nf ~~ ~/o~~; /~d fv 7~et~~~s ;S. J~~ 1"'/~1~/~e-~ - K+/1/rI~UX'S~~ '~vr" f I~-t12~'rxt F-lLf1G~'~pn ~. -~-0 .J ~u5fol~ ('.~cl5trl~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions / ~D f ~~ - ~~o o~~ ,~ ~~ zs / 8 ~~ 95 3~f9 Name of Personal Representative{s) ~e _ _ rt. ~(l;r~/ 1-/-~-~-~- ~~ ~~ c - ~~~__.~._ _ p0 ~ 0° Street Address ~.~~ _`-~ ~_'v~~.5' City ~` r State I"H ZiP ~~~-~T _ ---- Year(s) Commission Paid: oC-C1_, b 2. ~ Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City .State Zip _ _____ - __ Relationsh/i~p of Claimant to D/e~cedent / // / / /~ _`___ 4. Probate Fees Ke~IS~(J~t' ~/>`IS C:Zt+n~/'I~yIC~ lp/~/j~c.J~ p!'U Q/jcX 1~a °° jo Sho;-~ ~fj~~c 5. Accountants Fees 6. Tax Return Preparer's Fees ~. ~~e,-~f~lc~-a~ /~~,To~+-n~~-AdV ~ej/~S .~So° ~~ tfer~/~/- Acv ~~s 3S ° as o~~ ies - o ~~ ~ j n TOTAL (Also enter on line 9, Recapitulation) I $ ~ ~ ~,. ~~' (tf more space is needed, insert additional sheets of the same size) REV-1512 f:X+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDIJLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ~ ~%, ~~~ • a~/. ~ ~ - o~LE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical) expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~Dis~er ~~-d- dec,fs l~cet~ ~~ol~~gSBta~~l~~g ~~~. 3. ~? . (3rzn k o-F Amy; cam- deced.~mfs Act ~-~~~~~~~a353t~r~,.~~ ~ ~ ~ : 5 sir ~i~S ~ fhi 5- c~eeec~c~fs ~eet• ~~o3~3a10~?6~tv'~g83 5b ®3 dc~c ~ f Z~~ b~-~c~e~ p I ~s F)~na,nG~ C'~h ~ ~ . ~~i~ic YVltau~~`n~ ~C U V i~sa.- dece~~+s g. e a~ c~~e G~c baltan~e Plies -Fne~nee C;h~eJ~ TOTAL (Also enter on line 10, Recapitulation) $ I ~ 0 ~ ~~ P (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCFIEDI~ILE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBEfi NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ,. m~~~- (Y~ a,~l~. ax - add r~SS i~Cr~ n d-~~~ hfi~- ~ /° `'' «?. Curie Pine-~~/' /3U~ ,T~~~er~r.~n,~ /~d, G,l~h {~- ~ ,~°f iQes;dc~~ %/'~oL.c~l / /~o ~:~0l~ ~ ~. ~~~Lha:e~ ~imen~~% ~53r~1~ C`QO~ Clr lV Jan ,~~~~ ,~s.'d~~. 1~~7ne"sa.~J' Ca 3~1 '~ ~~~ ~ ~- 1©iih~n /1/ ' ''~~'~ Ski, ~~~~~~~~~.9' ~~~ ~~~ ~es~c~u~ P~ / ~° ~3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) C7 ra c --, Cp ~ °. ~~ c~ ~ n -'roc ~~ i .~ rf y ~;, ~ t~ _... _ ;"'} ~ -Y's ~ i LAST WILL AND TESTAMENT OF ~~ ;.,,-, v - _ MARJORIE LEFTW[CH r ~' , 1, MARJORIE LEFTW{CH, of 111 South Second Street, Wormleysburg, Pennsylvania 17043, being of sound and disposing mind, memory and understanding, do hereby make, publish, and declare this as and for my last wi{I and testament, hereby revoking any and all prior wills, and any and all codicils thereto, by me at any time heretofore made. FIRST: I direct the payment of the just and lawful expenses of my fast illness and funeral from my estate as soon after my death as conveniently may be done. SECOND: Except as f may have otherwise provided in a memorandum signed by me and accompanying this will f give my tangible personal property (including but not limited to furniture, china, silverware, jewelry, works of art, but excluding cash on hand and tangible evidence of intangible personal property to JEFF AND CARRIE PIMENTEL, as they may agree. THIRD: f hereby bequeath all the rest;, residue and remainder of my estate as follows: (a) To my daughter, MARGARET MADDOX of Maretta, California, $1.00; (b) To my daughter, CARRIE P{MENTEL of Arnold, MO, 35°I° of the remainder of my estate per stirpes; ., July., 2007 -1- ~i~~~~~~;' ~,c~:~. ,,.- ~~ ~~.~..~:~~~.. I (c) To my son, MICHAEL PINIENTEL of Kennesaw, GA, 20°l° of the remainder of my estate per stirpes; and (d) To my son, JEFF A. PIMENTEL, of Wormleysburg, PA, 45% of the remainder of my estate per stirpes. FOURTH: If beneficiary hereunder challenges any provision hereof or institutes any proceeding to contest the probate of this will, such beneficiary shaft forfeit his or her entire interest hereunder and all provisions in favor of such beneficiary shall be void and of no effect. The share of such beneficiary so forfeited shall be distributed as a part of the residue under paragraph THIRD hereof except that if such beneficiary is entitled to share in the residue that interest shall be distributed proportionately to the other residuary distributees under paragraph THIRD. FIFTH: if any person otherwise entitled to take hereunder (or their legal representative) files a written disclaimer, in whole or in part, with respect to any provision of this wiil with my Executor or Trustee within the period allowed by the Internal Revenue Code, such person (1) shall be treated as having predeceased me for purposes of holding or distributing the disclaimed share; and (2) shall not participate in any decision to pay or apply the income or principal of the disclaimed share to or for the benefit of any person hereunder, but such person shall not be treated as having predeceased me for purposes JuIY ~, 2007 -2- ~' ,~,~- ~z..~e ~',~ ~ ~-' _ .~~-~ , ~ -z J [' of holding, distributing or participating in any such decision under provisions which the disclaimer does not extend. SIXTH: I direct that neither any Executor/Executrix, or other fiduciary named, nominated, or appointed in this, my last will and testament, shalt be required to post any bond or give any security of any type for any purpose whatsoever, any law or rule of court of the Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. SEVENTH: My Executor/Executrix shall have the following powers (if applicable) in addition to those vested in them by law or by other provisions of this will, to be exercised by them in their absolute discretion, which powers shall be applicable to alt property held by them, effective without the order of any court and until the actual distribution of al! such property: ti. To retain, as investments of my estate or trust, any or all assets of my estate, real, personal, or mixed, without regard to any principal of diversification, and to purchase and acquire real or personal property, and to ho{d any or all of such real and personal property retained or acquired without making the same productive of income; B. To permit any beneficiary to occupy any real estate retained or acquired upon such terms and conditions as my Executrix/Fiduciary shall deem proper; July-~, 2007 -3- ~,~~C.~- -<r-~.-e.c:. ~ ~~ ~'~~~ `r-c`'~:-. ,- C. To invest and reinvest at discretion without restriction to so ca{led "legal investments," with the specific right to invest in common and preferred stocks, and in such common trust, diversified, money market and mutual funds as they deem appropriate; D. To sell, to grant options for the sale of, or otherwise convert any real or personal property or interest therein, at pubic or private sale, for such prices, at such time, in such manner and upon such terms as they may think proper, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof without liability of any purchaser to see to the application of the purchase money; E. To borrow money and to secure its repayment by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof; F. To compromise and arbitrate claims by or against my estate or any trust created hereunder; G. To make distributions in cash or kind or partly in each at valuations fixed by my Executrix/Fiduciary at the time of distribution; H. To join in any recapitalization, merger, reorganization ar voting trust plan affecting investments; to deposit securities under agreement; to ~~ ~ ~ - " ~~- July , 2007 -4- ,~ .~'`~ _ ll~-~--~' ;. _~. ; ~' , , ~, f ., subscribe for stock and bond privileges; and generally to exercise all rights of security holders; To manage, operate, repair, alter or improve real estate or other property, and to lease real estate and other property upon such terms and for such period as my Executor/Executrix and Trustee deem advisable even for more than five years and beyond the duration of any trust; J. To deduct administration expenses upon either the federal estate tax return or fiduciary income tax return, with or without adjustment between principal and income, as my Executor!Executrix shall determine; K. In the absence of a corporate fiduciary to associate with them, an accountant, custodian and investment advisor, and their agents and to compensate such accountant, custodian and their investment advisor, and agents out of principal or income or both as my Executor/Executrix sha11 determine; L. To carry out the terms of any agreement 1 may have entered into to sell all or any part of any property or any interest I may own in any business at the time of my death; M. To execute and deliver any written instruments that they may deem advisable to carry out any power, duty, or discretion granted to them, and all persons shall be fully protected in relying upon their power to execute July : ~; r, 2007 -5- ~, "~; ' rz,. _ ~.. '~. ~ ~"' ~ ~'.- ,r ,: !. every such instrument and no one shall be obligated to see to the application by them of any money or property received by them pursuant to the execution and delivery of any such instrument; N. Any Executor/Executrix may, delegate any or all of her powers, duties and discretions to any other Executor/Executrix by an instrument in writing and may revoke such delegation at will in the same manner; O. To do all other acts and things necessary or appropriate in the management, administration and distribution of my estate; and P. To make any election provided for in the Internal Revenue Code with respect to all or any part of my estate qualifying for any such election. EIGHTH: My Executor/Executrix shall pay all estate, inheritance and other death taxes, together with interest and penalties out of the residuary of my estate, which shall be payable with respect to property or interests subject to taxation by reason of my death and whether passing under my will or any codicil, or otherwise, including jointly held and other non-testamentary property. Notwithstanding the foregoing, I authorize my Executor/Executrixto exercise any options available in determining, minimizing and paying taxes of my estate as my ExecutorJExecutrix may at his/her sole discretion deem appropriate. Jul `> ~oo~ -6- ~~~ , >> .~z.c~- ~-- ,- NINTH: Any and al{ payment or payments of any sum or sums, whether in cash or in kind and whether of principa{ or income, payable to any beneficiary, steal{ be free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. TENTH: 4 appoint my son, JEFF A. PIMENTEL , Executor of this, my {ast will and testament, but should he for any reason fail to qualify as such Executor, or having qualified, fail to serve as such Executor, then l nominate, constitute, and appoint my daughter, CARRIE PIMENTEL, Executrix of this, my last wil4 and testament. ELEVENTH: Until distributed, no gift or beneficial interest sha{I be subject to anticipation or to voluntary or involuntary alienation. TWELFTH: Words used in the singular may be read to include the, plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. / i ,July-~f~}, 2007 -7- ~,~ rc -i.,•,,~:t ,~~ ~ /:'- a Y~-'-;L..~ .~ ~, l~ i IN WITNESS WHEREOF, I have hereunto set my hand and sea( to this, my Oast will and testament, consisting of eight (8) typewritten pages, the first seven (7) of which bear my signature in the margin for the purpose of identification, the ~~ ~ day of July, 2007. ~. - r ~~ 1 Signed, sealed, published, and declared bythe above named Testatrix, MARJORIE LEFTWICH as and for her last will and testament, in the sight and presence of us, who, at her request, in her sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. Address :~~fZ /~~~~Zk~.C 57~.2_c e.~- C~~~ 1 ~~z~~~ ~ p~ ! ~~ b l Address ~35IZ ~t~:ttc~~~ S~.,c.cct ~rt~i j-f z~;~. ~ P,r'~ 1 ~~;J l -8- F9.CLIENTS~MISC~M. Lellwich~M, Leftwich WilLwpd COMMONWEALTH OF PENNSYLVANIA COUNTY OF C ur~~th~~ 1~n ~~- We, MARJORIE LEFTWICH the Testatrix and the witnesses, respectively, whose names are signed to the Last Will and Testament, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the will as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Subscribed, sworn to and acknowledged before me by MARJORIE LEFTWICH, Testatrix, and subscribed and sworn to before me by ~~r~-~ ~`'ti~= ~~--- and ~~-~ ~ ~ ~..~ i7t~s: zy~~ , this ~ day of July, 2007. Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Susan Kirby Roslis, Notary Public Hampden Twp., Cumbeitand County My Commission E~ires June 21,2011 My Commission Expires ber, Pennsylvania Association of Notaries .~.~u.~ ~- f; .~..v t 1 Form ~~~~`~ ~~~ ~~~t~ {~ 1'~~~~~~~~~~ (Rev. September 2007) '~"~'+~d~+~~~ ~"~~ ~~i~{~~ OMB No. 1545-0015 ,.y Department of the Treasu Intem+~ Revenue Service E9tate EYF a cifiiENt OR' reair'lerrt Elf the ilnited S18tC8 (gee eep~t'ate irtstrucliiln5}. To be filed fiot deoeileirlts dying afitEet becetnbet 31, ;x008, and before January 1, 21108. is Decedent's first name and middle initial (and maiden name, if any) !?'Jaa-~ or ~e Lu~~~SS ib Decedent' last name _ L-e~{zv e h 2 Decetterrt's Social Seetuity No. D:~ ~ ; 3 ; ~,f L~ I 1 3a Co fy, state, and ${P code, or foreign oourrtry, of legal 3b Year domicile established 4 Date of birth 5 Date of death residence (domicile) at tinve of death ~' ~~®~ _ _ ~) LtN q3 ~ ..._.~_.._.1_._-~ . ~ ~J~PPZ ~ f.70~~ _ __.. t~ ~ 1~~.3 ~~rn~]cLnd~ ~ Executor's address (number and street including apartment or suite no or rural . route; city, town, or post offince; state; and ZIP code) and phone no. ~ 6a N7ame of executor (see ~e 4 of the instructions) ~~-L~~~ ', ~ ~ D~ ,.[ ~ ~ l b ~ u 6c Executor' iai secunty number (see page 5 of the instructions) ur , ~ C ~ ~ 5 ~""rm 3 ~ Q~ ~ ~~ ~ ~.~ ~" Phone no. ( ) T' 7a ame and location of court where will was probated or a fate administe Tb Case number 8 If decedent died testate, check here, - ah_d attach a certified copy of the will. g if you extended the time to file this Ftxm 706, check here - ^ 10 If Schedule R-1 is attached, Cheek here - _ _. 1 Total gross estate less exciusioh (from Par} 5-Recapitulation, page 3, item 12) _ _ 1 ~ 07 v7J 0C~ 2 Tentative total allowable deductions (from Part S--Recapitulation, page 3, item 22) 2 ~. 3a Tentative taxable estate (before state death fax deduction) (subtract line 2 from line 1} ~ b State deafh tax deduction ~ ot. - c Taxable estate (subtract like 3b from line 3a) -~ L7 ,J O 4 Adjusted taxable gifts (total taxable gifts {within the meaning of section 2503) made by the decedent after December 31, 1976, other than gifts that are includible in decedent's gross estate (section 2001(b))} 4 _ ... _ . . 5 Add lines 3c and 4 5 (QO ~(~) ('~i',(J 6 Tentative tax on the amount oh line 5 from Table A on page 4 of the instructions 6 3 _ll(D Of.) v 7 Total gift tax paid or payable with respect to gifts made by the decedent after December 31, 1976. include gift tastes by the decedent's spouse for such spouse's share of split gifts (section 2513) only if the decedent was the donor of These gifts and they are includible in the decedent's gross estate (see o instructions) ~ ~ 8 Gross estate tax (subtract line 7 from line 6) $ ~ 3 1`~ 9 Maximum unffied credit (applicable credit amount} against estate tax . 10 Adjustment tb unified credit (applicable credit amount). (This adjustment may not exceed $6,000: See page 6 of the instructions.) 10 - c7 ~ ~ ~ p® 11 Allowable untied credit (applicable credit amount} (subtract line t0 from line 9) . . 11 - =a . -~ 12 Subtract line 11 from line 8 (but do not enter less than zero) 12 ~' 1.3 Credit for foreign death taxes (from Schedule(s) P). (Attach Forrn(s} 706-CE.) 13 . _ _ __ 1~i1 Credit for tax on prior transfers (from Schedule Q) 14 1:i Total credits (add Gnes 13 and 14) 15 Q ill Net estate tax (subtract line 15 from line 12) 16 G 17 Generafion-skipping transfer (CST) taxes payable {from Schedule R, Part 2, line 10) . . 17 a 1!3 Total transfer taxes (add lines 16 and 17) 18 1S Prior payments. Rxpiaih in an attached statement 19 ~ 2'(1 _ _B alartce., due or oyerpa inept}, {subtract, line, l9 from ine l 8 , ~ ~j Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and sfatements, and to the best of my knowledge and belief, it is true, correct, and complete. Derlaration of prepazer other than the executor is based on all information of which prepazer has any knowledge. $ignature of T , ~, ` ~ , ~~V ~.~L ,~.~Q executor(s) Date ' Date __ _ ~ Preparer's ` Date Check if Preparer's S5N or PTIN of pteparer signature self-employed - ^ other than Firm's name (or r if lf b d EIN - ' exeCUt(>r s se -emp ye ), you address, and ZI,P code Phone no. ( ) '~`~ For flrivlicy Act and f~apiarwork Reduction Act Notice, see page 29 of the aeparafe instructions for this form. Cat. No. 2u548R Form 7th (Rev. s-2oo7) orm 706 Est2tte of: ~,e-~'-~/,v/ ~~n l 1 /~" lOr/ P ~ I ~~~~$ ?~~%~~' I /per ~v th~a Ex~cut~-r P/earse check the "Yes" or "No" box fbr each question (see instructions beginning on page 6). Yes No Notr.. Some of these elections may require the posting of bonds or liens. _ _ _ 1 Do you elect alternate valuation? 1 2 Do you elect special-use valuation? . if "Yes," you must complete and attach Schedule A-1. 3 Do you elect to pay the taxes in installments as described in section 6166? If "Yes," you must attach the additional inforrnation described on page ifl of the instructions. Note. BY electing section 6166, you rrtay be ree(uired Yo provide secw,r'sty for estate tax deferred under section 6166 and interest irt_the form of a surety bond or a section 8~#A Tien. 4 Do you elect to postpone the part of the taxes attributable to a reversionary or remainder interest as described in ~/ section 6163? 4 /~ Pat't 4--Qeri~r~l Infbrm~ti~n (Note. Pfease attach the necessary supplemental documents. You must attach the death certificate.) (see instructions on page 11) Authorization to receive confidential tax information under Regs. sec. 601.504(b)(2)(i); to act as the estate's representative before the IRS; and to make written or oral presentations on behalf of the estate if return prepared by an attorney, accountant, or enrolled agent for the executor: Name of representative (print or type) I State ~ Address (number, street, and room or suite no., city, state, and ZIP code) I declare that I am the (_( attorney! ~ certified public accountantl I I enrofied agent (you must Check the applicable box) for fhe executor and prepared this return for the executor. I am not un er suspension or dtsbarment rom practice before the Internal Revenue Service and am qualified to practice in the MME c.i..~..... n/......e. Signature ~ CAF number ~ Date Telephone number 1 D ath certificate number and 'sluing authority (attach a cop of the death certificate to this return . ~ decedent's business or occupation. If retired, check here - and state decedent's former business or occupation. ~~~~ - 7~ry ~'-le-Q~ Pte' 3 Marital status of the decedent at time of death: ^ Married /~ ~~ Widow or widower-Name; SSN, and date of death of deceased spouse -. _! ~ 1_~~~~ _ % _ _!~-~'7". / _L~~~_ _ --- --------- ----------------------------------------------------------~-~-~!`?'~'-app-~------------ ------ ^ Single ^ Legally separated 4a Surviving spouse's name ~ 4b Social security number ~ 4c Amount received (see page 11 of the instructions) 5 Individuals (other than the surviving spouse), trusts, or other estates who receive benefits from the estate (do not include charitable beneficiaries shown in Schedule O) (see instructions). Narne of individual, trust, or estate receiving $5,000 or more idenfrfying number Relationship to decedent Amount (see instructions) /,~'~~ ~ha,~ ~ir~>~j ~~%~ ~~ ©Z5-3~a- ©8~6 ~~-5~80~-1 ~5 0 ~ 5or1 ~ o ~~ ~~~~ Ail unascertainable beneficiaries and those who regeive less ,than $5,400 GtLl"i° ,/YfQ , o(~~' . - ~f i~- Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P7ease~ check the "Yas° or °No" box for each question. YeS No 6 Does the gross estate contain any section 2044 property (qualified terminable interest property (QTIP) from a prior gift or estate} (see page 11 of the instructions)? V /~ 7a Have federal gift tax returns ever been filed? ff "Yes," please attach copies of the returns, if available, and furnish the following information: 7b Period(s) covered 7c Irrtemal Revenue office(s) where filed 8a Vas there any insurance on the decedent's life that is not included on the return as part_of the gross estate? ' X b , Did the decedent own any insurance on the life of another that is not included in the gross estate? (continued on next page) Page 2 orm 706 tRev. 9-2007) Part 4-~-C~a~neral Infa~rm~ltion (continued) -- you answer es to any of questions 16, you must attach additional iMormation as described in the instructions. __ _ _ _ YeS Mb _ g Did the decedent at the time of deafh own any property as a joint tenant with right of survivorship in which (aj one or more of the other joint tenants was someone other than the decedent's spouse, and (b) less titan the full value of the property is included " on the return as part of the gross estate? fl Yes," you must complete and attach Schedule E - _ _. _ _ _ 10a Did the decedent, at the time of deafh, own any interest in a partnership (for example, a family IimRed partnership), an unincorporated business, or a limited liability company; own a fractional interest in real estate; or own any stock in an inactive or closely held corporation? - _ _ _ _ _ _ b If "Yes," was the value of any interest owned (from above) discounted on this estate tax return? If "Yes," see the instructions for Schedule F on page 20 far. reporting the total accumulated or effective discounts taken on Schedule A, F, or G . 11 Did the decedent make any transfer described in section 2035, 2036, 2037, or 2038 (see the ihstnactions for Schedule G beginning " " y on page 1 ~l of the separate. instructions)? ff Yes, you. must complete and attach Schedule G ,_ - _ /~ 12a Were there in existence at the time of the decedent's death,an trusts created the decedent. duri his or her lifetime? , , b Were there in existence at the time of the decedent's death any trusts not created by the decedent under which the decedent ~/ .possessed ,any power, beneficial interest, or trusteeship? J` c Was the decedent receiving income from a trust created after October 22, 1986 by a parent or grandparent? ~( If °Yes," was there a GST taxable termination (under section 2612) upon the death of the decedent? __ d If there was a GST taxable termination (under section 2612), attach a statement to explain. Provide a copy of fhe trust ar will \/ creati fhe_ trust, and ive the name, ,address, and Norte number of the ourrer>3 trustees , /` e Did the decedent at any time during his or her 4rfetime transfer or sell an interest in a partnership, limited liability company, or Y closely held corporation to a trust described in question 12a or 12b? " " /\ If Yes, provide the EIN number to this transfernedfsold item. - 13 Did the decedent suer ssess, exercise,. or release an eneral wer. of a intment? H "Yes,"_ ou must corn lete and aftach Schedule H 14 Did the decedem have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? X 15 Was the decedent, immediately before deafh, receiving an annuity described in the "General" paragraph of the instructions for \, Schedule 1 or a. _ nvate.annuit ? if "Yes," ou must corn fete and attach Schedule I , J~ 16 Was the decedent ever the beneficiary of a trust for which a deduction was claimed by fhe estate of apre-deceased spouse end@r.sep3i9n .P~:S.... snd._kvhj~sh.j&.~n<2#..re ~fted_Qn,thi .return?. If"1'~s, ~ttsph~n~ex 18nafitztl.__ _. ., .._ .. ,~.. _. Part a~--We~~lpltulation Item numb~zr Gross estate Alternate value Value at date of death 1 Schedule A-Real Es#a#e i 2 Schedule B-Stocks and Bonds 2 3 Schedule C=Mortgages, Notes, and Cash ~ ~ ~' a2.J~ U O 4 Schedule D-Insurance on fhe Decedent's Life (attach Form(s) 712) 4 Ooa pa 5 Schedule E-Jointly Owned Propeiiy (attach Form(s) 712 far life insurance) 5 6 Schedule F-Other Miscellaheous Property (atFaoh Form(s) 712 for life insurance) s 7 Schedule C~Transfers During Decedent's Life (att. Forms} 712 far Iifie insurance) 8 Schedule Fi-Powers of Appointment 8 8 Schedule I~Annut~ies ,,, ~, _ 10 Total gloss estate. (add items 1 through 9) _ ,_ 1U _ - _ oZ .02 _ Gee 11 Schedule U-Qualified Conservation Easement Exclusion 11 12 Total gross estate less exclusion (subtract item 11 from item 10). Enter here and on line 1 of Part 2-Tax Computation ~~ __ `~aa ~~ ftem numbE~r Deductions __ _ _ ___ Amount 13 Schedule J-Funeral Expenses and Expenses Incurred in Administering Property Subject to Claims ~~ ~ ~ fa 14 Schedule K-Debts of the Decedent _ ,14 15 Schedule K-Wtortgages and Liens ~g._ _ __ .. 16 Total of items 13 through 15 t6 q a, 17 Allowable amount of deductions from item 16 (see the instructions for item 17 of fhe Recapitulation) 17 ~ a. 18 Schedule L-Net Losses During Adminis#ration . . 18 19 Schedule L--Expenses Incurred in Administering Propetty Not Subject to Claims 1~ 20 Schedule M-Bequests, etc., to Surviving Spouse 20 21 __ Schedule„O=Charitable, Public, and, 5imilai•_G~fts and Bequests, .___, _ •_..._ ...~ , ...... , .,.,. _. , .. _. ,. _m ~1 .. .. _. . _ 22 .. .Tent, tiye _ al a ( ably dedu ins item 17 t roU h 21 E er here an _on f rte 2 of the T x ~or[t ~t~fj~n _ `~' . _ , o`Z Paga3 3 orm 706 (Rev. 9-2007) Item number 1 7 Deced rrt's Social Security Number ~~ ~~or~e ~. 0 3u o 1 i SCHEDULE C-Mortgages, Notes, and Cash (For jointly owned property that must be disclosed on Schedule E, see the instructions for Schedule E.) Alternate Alternate value Value at date of death Description valuation date l~2rr1~S /S~~C'CC~ ~1~i~~rv~'~vi~n~S ~~~#/93~.C73 ~lJ ~~~ ~c~e~~i, b~l~~e~l us ~~'crue.~ ~ j~-~e~-esf ;S ~~.~ ~o ' ri ~n f~ers l ~~~C~~, C'h~~N A~~I93~ 93 ~~ off' L~~ J~.l~c~. ~ us C~cerue~ in~~r~S~ ,;~'. lll~ Fe' ~t, Sh a~~- sav ~ ~ s Ate- `~ ~.3t~lo~Z ~a 1 3 ~ f ~l~~c~'K bc~Panc~ .p1 u~ ~~~.r. 3cattr~~'~1~~} ~ ~ o~ Z~ b~-la~c~ loll.~S ac~rut i~-~~s~. Total from continuation schedules {or additianal sheets) attached to this schedule . 00 i~ 3 ~~- i, ~ ~! ~~ ~ ~5a~ ~o _ TOTAL {Also enter on Part 5-Recapitulation page 3 at item 3.) 4 { (t~T, ~~ I ~~ (If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.) (See the instructions on the reverse side.) Schedule C-Page 13 orm 706 (Rev. 9-2007) / ~, /~ ' Recede 's Social curity Number Estate of• i~ ~7G~% ~/~ ,, ~~'~ Del L°- ~- X02 ~ ~ 3 ~ '`t~~ / 1 _ SCHEDULE D-Insurance on the Decedent's Life You must list all policies on the life of the decedent and attach a Form 712 for each po{icy. Item number Descri ~1On Alternate valuation date Alternate value Value at date of death ' ,~h~sici~.~ ~,i~- po/,c~~- o~3i~~ 9~S Sboo ~a 1~ otal from continuation schedules (or additional sheets) attached to this schedule . TOTAL (Also enter on Part 5-Recapitulation, page 3, at item 4.) ~~~ ~ ac (If more soace is needed. attach the continuation schedule from the end of this aackaae or ddditional sheets o f the same size.l (See the instructions on the reverse side.) Schedule D-Page 15 orm 706 (Rev. 9-2007) // ~~,, //~~//~~, D~ec•~ed~e1r-t's Sociacl~SecuLriJty Number Estate of: /~~17'ZUr'~~ . ~~'~!~/^/ ~ ~• C/~-'T' ~ ~7 _~ -7 ~ ~1 SCWEDULE J-Funeral Expenses a d Expenses Incurred in Administering Property Subject to Claims Note. Do not list on this schedule expenses of administering property not subject to claims. For those expenses, see the instructions for Schedule L. If executors' commissions, attorney fees, etc., are claimed and allowed as a deduction for estate tax purposes, they are not allowable as a deduction in computing the taxable income of the estate for federal income tax purposes. They are allowable as an income tax deduction on Form 1041 if a waiver is filed to waive the deduction on Form 706 (see the Form 1041 instructions). item Description Expense amount Total amount number A. Funeral ex~/penses: /~ > /I` 1 1 /l ~~ ~~ 1 ~e f'/111E K~//h,~IGl1".~P-!1'l~T ~ ~-PQ-Ml ~©,t~ / T ~~~4u~' ~iirr~a~ ~m~ Sew ct~n~iNu,~ir~w 5h ~ ~ (.~ c~ Total funeral expenses . - _=~.~_!_-~_!_______ B. Administration expenses: 1 Executors' commissions-amount estimated/agreed upon/paid. (Strike out the words that do ~~~~ pro _ not apply.) -------------------- 2 Attorney fees-amount estimated/agreed upon/paid. (Strike out the words that do not apply.) ____________________ 3 Accountant fees-amount estimated/agreeduponlpaid.(Strikeoutthewordsthatdonotapply.) ____________________ 4 Miscellaneous expenses: ~rnba~ ~,-,~ Short C'e~f~~irs YC~x-~an~ ~1~~'~~ - ~c~v i~~S' ~h~ ~p«~ Total miscellaneous expenses from continuation schedules (or additional sheets) attached to this schedule Total miscellaneous expenses _ Expense amount lip `' ,~S--oo ~ g ~, l Uo 'TOTAL (Also enter on Part 5-Recapitulation, page 3, at item 13.) . - i ~"1!~ / (If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.) (See the instructions on the reverse side.) Schedule J-Page 23 orm 706 (Rev. 9-2007) (Make copies of this schedule before completing it if you will need more than one schedule.) Decedent's Social Security Number Estate of: ~- P-~t~c~%~ /) ~ ~G~/'/pJ' ~ ~ ~~ ~ ~ ~ : 3 ~ ~ ~~ %~ NUATION SCHEDULE Continuation of Schedule (Enter letter of schedule you are continuing.) Item number Description. For securities, give CUSIP number. if trust, partnership, or closely held entity, give EIN. Unit value ~scn_ e. E, o~ ~ o~iyl Alternate valuation date Alternate value Value at date of death or amount deductible ~~~~~ ~~. ~~l~;s~~, ~7Q- -~r~c~~rs'~ Pd f~ 7~b~,s 5 ~e~fr~linen ~- ~ei~nbr~~erne~ ~' ~ ~ ~'~ ~C./lC'~n ~d ~-0 7 1 ~ TOTAL. (Carry forward to main schedule.) " See the instructions on the reverse side. Continuation Schedule-Page 39 orm 706 (Rev. 9-2007) / n /~ / / ,~y~ Decedenj's Social tSecu~rity/ Numbler Estate of: F~ 1-"7~~C.~/~ h~ i ! ~ ! ~/d /~/ ~ ~~ ~o~c `~ ; .3`7 ; -7 C~ SCHEDULE K--Debts of the Decedent, and Mortgages and Liens Itern number Debts of the Decedent-Creditor and nature of claim, and allowable death taxes Amount unpaid to date Amount in contest Amount claimed as a deduction t ~1 17iSGd ve-I~' ~~ra/- c~ecPc~l~n fS >-TCC t ~ (~j ~~, ~ 33 ~~Q~1~9g~1~~~f3 ~~ T ~'-• a~~ ~ ~rne~,~a--dece~{a~n fs acct /~~, ~~~~a~'~aa~,~~~5~0 ~='' ,~-in~eNs 111 fh in s - c~eee~a..~fs ~c~f ~-~ ~ c~/e ~la.~~e ~o1us 5~ °3 .___ ~~zc~-~ie /1~C'~`/ne- f Cr~C 1~l Sa.- ~ec~ ~/~ " ~~ ~. r~ ~~ - 6199 ~~~ r ~~~~ ~ ~ Total from continuation schedules (or additional sheets) attached to this schedule ~ ~ ~~ ~ ~ TOT AL. (Also enter on Part 5-Recapitulation, page 3, at item 14.) Iterci number Mortgages and Liens-Description Amount 1 Total from continuation schedules (or additional sheets' attached to this schedule i TGTAL. (Also enter on Part 5-Recapitulation, page 3, at item 15.) ~ (If more space is needed, attach the continuation schedule from the end of this package or additional sheets of the same size.) (fhe instructions to Schedule K are in the separate instructions.) Schedule K-Page 25 ,' MEMBERS 1St FEDERAL CREDIT LAVION Send Inquires to: 5000 Louise Drlve PO Box 40 Mechanicsburg, PA 17055 www.membersl st.org Main Switchboard: (717) 697-1161 or (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2326 ext 5312 TeieBrench: (717) 795-6049 or (S00) 237-7288 Statement of Accounts Mar 25, 2008 thru.Apr 24, 2008 Account Number: 193293 Account Balances at a Glance: Checking : 1, 377.04 Savings: 55,450.55 Certificates : 0.00 Loans: 10,081.35 Money Management : 0.00 8903 1 AV 0.312 31442-8903 I~~~III~~~III~~~~I~~I~~II~~~~11~~11~~~~11~~11~~„Il~r~ll~l~l~l MARJORIE D LEFTWICH N 111 SOUTH 2ND STREET WORMLEYSBURG PA 17043-1361 N 0 Page : 1 of 3 Your current Member Loyalty Reward level is Platinum Don't forget about Member Loyalty Rewards. The more products you have with us, the more benefits you'll receive. Ask an associate for details or visit our website at www.members1st.org. CHECKING ACCOUNTS 11 -CHECKING Date Transaction Descxiotion Additions Subtractions Balance Mar .25 Balance Forward 860.19 Mar 26 Deposit Transfer From Share 00 600.00 1,460.19 Mar 28 Deposit Transfer 100.00 1,560.19 From PIMENTEL,JEFFREY X~UUWUUU( Share 11 Mar 28 Check 001487 Tracer 0001184208 45.36- 1,514.83 Mar 30 Withdrawal POS #748595 103.46- 1,411.37 POS GIANT FOOD #26 3301 TRINDLE RD CAMP HILL PA Mar 31 Check 001491 Tracer 0491825318 50.00- 1,361.37 Processed Check - FIA CardServices TYPE: CHECK PYMT ID; 2200000002 DATA: 1-800-421-2100 Mar 31 Check 001486 Tracer 0001067751 43.50- 1,317.87 Apr 01 Check 001492 Tracer 0001210911 _ 94.66- 1,229.21 - Apr (32- - _ _-C- ~~e1r 09449,'r ~raeer--80A127~464 - _ 5.00- 1, 218.21 Apr 02 Check 001488 Tracer 0001062635 24.32- 1,193.89 Apr t)3 Check 001495 Tracer 0001192357 11.75- 1,152.14 Apr ()3 Check 001494 Tracer 0001192367 17.69- 1,164.45 Apr 03 Check 001490 Tracer 0001086720 25.00- 1,139.45 Apr ()4 Withdrawal Transfer To Loan 01 107.68- 1,031.77 Apr (k) Check 001489 Tracer 0001061359 40.00_ 991.77 Apr (k) Check 001496 Tracer 0001200660 q6,4~_ 945.3) Apr 07 Check 001497 Tracer 0027662289 76.21- 869.14 Processed Check - VERIZON ARC TYPE: CHECK PYMT ID: 2005022221 Apr ()8 Check 001499 Tracer 0026042977 29.42- 839.72 Processed Check -RETAIL SERVICES2 TYPE: CHECKPAYMT ID: 3000000014 DATA: 20080407040021410400 Apr ()9 Check 001498 Tracer 0001299920 44.00_ 7gr,,.72 Apr '11 Deposit Transfer 100,00 895.72 From PIMENTEL,JEFFREY XXXX)UUUUUC Share 11 Apr '15 Check 001500 Tracer 0001016082 11.00- 884.72 Apr 18 Withdrawal Transfer To Loan 01 107,68_ 777.04 Apr 23 Deposit Transfer From Share 00 600.00 1,377.04 - - - Continued on following page - - - r Send Inquires to: Main S1nRchboard: (717) 697-1161 or (800) 283-2328 5000 Louise Drive ~ ~ 1 PO Box 40 EZ Call: (717) 697-4372 or (800) 283-4372 Mar 25 , 2008 thN Apr 24 , 2008 ~~ {° Mechanksburg, PA 17055 7t)D: (717) 697-5312 or (800) 283-2328 ext. 5312 3iau-ova, Acxount Number: 193293 >lED1tSERS t° TeleBrancfi: (717) 795-6049 or (800) 237-7288 .. . ~.»,.,.~_. www.memberslst.or9 Page: 2 of 3 Date Transaction Description Additions Subtractions Balance Apr 24 Ending Balance 1, 377.04 CHECK SUMMARY Check # Amount Date Check # Amount Date 001486 43.50 Mar 31 001494 17.69 Apr 03 ~_ 001487 45.36 Mar 28 001495 11.75 Apr 03 x 00'1488 24.32 Apr 02 001496 46.42 Apr 04 N 001489 40.00 Apr 04 001497 76.21 Apr 07 N 001490 25.00 Apr 03 00149$ 44.00 Apr 09 °' 00'1491 50.00 Mar 31 001499 29.42 Apr 08 N ~~ 001492 94.66 Apr 01 001500 11.00 Apr 15 a 00'i493 5.00 Apr 02 ,~ 15 Checks Cleared for 564.33 SAVINGS ACCOUNTS --~___.~_D11_:13Ef,UI AR SAVI(ysa _ ~___-__.- -___~~ ___.-_____ _ __~____.____ - _- ----_,.--__ Date Transaction Desc~ption Additions Subtractions Balance Mar 25 Balance Forward 313.72 Mar 26 Deposit ACH SOC SEC 1,035.00 1,348.72 ID: 3031036030 CO: SOC SEC Mar 26 Withdrawal Transfer To Share 11 600.00- 748.72 Mar 31 Deposit Transfer From Share 41 54,364.83 55,113.55 Mar 31 Deposit Dividend 1.000% 2.00 55,115.55 Annual Percentage Yield Eamed 1. fJr?09' from 03/01/20f18 through 03/31/20fJ8 Apr 02 Withdrawal at ATM #004573 100.00- 55,015.55 ATM MEMBERS 1ST FCU 1023 STATE ST LEMOYNE PA Apr 23 Deposit ACN SOC SEC 1, 035.00 56 , 050.55 !D: 3031036030 CO: SOC SEC Apr 23 Withdrawal Transfer To Share 11 600.00- 55,450.55 Apr 24 Ending Balance 55 ,450.55 CERTIFICATE AGG~IT 41 - 9 MONTH NO FENA`... T Y C`ERT Date__ Transaction Description Auditions Subtractions ____.__ _ Balance Mar 25 Balance Forvvarri 54 , 211.1 i Joint Owr?er: aEFFFREY A PlfviEN T EL UiBr 31 Deposit Di~:~clertd ";.450% 153.%2 54,364.$3 Annual Percentage Ye1~ Far ned 3.5 it7/o morn fJ.3ii? lf.?008 ihrouyh C3l3IJI.2008 ~v!la 31 _ WstlzdrasrJ~I Tra:~~tef Tn Sharc 0~j ___., ~s ~~~; a^ _. __ ~3:t?0 _. ,9 l[?ONt`H I+IC~ PENALTY CE.}?T Croserl »"7`n,c ;c the fin;~i .c#aternent prasans,~ rnfnrna~rr3n r_?n th/~ prr3tl~ct"•» - " - Y~JeaSt? rPrc7Jn Ir7/,S rirlc3,f 5dc'I~elner if l:Tr ld.". f~'~JJ~ L%I~' fJjll f.lJSe.`•- ~ ~ - t .,.~~t ~~~ ~;~~.tT~ J_e~ I~,~i`m~,-{mil ~ssw-ne~ l~,/v ~,d oc..~n~ P - = ~ - P~ O n.e ;eer'+~r~~~- 3-ent-r± ne err-n~ ~` `.'h)~i4 , `t~ehlC;~e i.U~t~1 ~eSs -f -{~Ct~.~ zz : :c-~: ::. _i oz's - - . - =~. AUY ®E~1~L~ credit Union Web site: navyfederal.org STATEMENT OF ACCOUNT #BWNLLSV #OOOOOOPOW8RSW9A4#OOOAMP002 I~rrlll~~~lllr~~rl-~I~ifllr~~~Il~~lirr~,iir~llr~~~I1~~~I1~lAl~1 MARJORIE D LEFTWICH 111 S 2ND ST WORMLEYSBURG PA 17043-1313 P~no i ni 4 .ACCESS NUMBER ' 782379 STATEMENTPERtOD From 03-24-08 Through 04-23-08 1~-~~1,- E ~~ ~~ ~~~IN~~ See enclosed insert for important account information. - _- - -- Athletes aren't the only ones with dreams of the Olympic Games. Drop by your nearest ~~ ~~~A._ _ Rla~Iy Fnylgr~l tiranch ±^-ffnd nut.Mnfi hw,uny 2 `/ica=' Cf'.eC4 r'grri from ~13Vy Fed^ral Could help IzPeY Proud Sponsor your dreams of Beijing come true. courtesy of Visa. Call ar visit us online at navyfederal.org. ~~ This credit union is federally insured by the National Credit Union Administration. Membership Share Savin;~s--30107?3801 Joint Owner(s)-- NONE [}ATE TRANSACTION DESCRIPTION - AMOUNT BALANCE 03-24 BEGINNING BALANCE 1,472.5 03-31 DIVIDEND 1.24 1.473.8 04-23 ENDING BALANCE 1.473.8 Your account earned $1.24, with an annual percentage yield earned of 1.00°0. for the dividend period from 03-01-2008 through 03-31-2008 Money Market Savings Account--301488~t041 03-24 BEGINNING BALANCE 8.952.3: REMITT0.RCE RECE ItlED AFTER ST0.TEMERT PERIOD RILL APPEAR OX YOUR RE%i STATERERI ~CCt~~f ~ j~~®p~ STATEMENT OF ACCOUNT Web site: navyfederal.org MARJORiE D LEFTWICH Page2of3 {continued from previous page) Money Market Savings Account--3010884041 Joint Owner--NONE CTf~N f~ES :~.. ~~ ~ - ~~ ~ ~ ~ ~ ~ . : ~ ~~ ~ ~ ._., ~. _, 03-31 DIVIDEND 13.43 8,965.76 04-23 ENDING BALANCE 8,965.76 Yaur account earned $13.43, with an annual percentage yield earned of 1.76%, for the dividend period from 03-01-2008 through 03-31-2008 2008 Year to Date Federal Income Tax Information SHARE SAVINGS DIVIDENDS 3.97 MMSA DIVIDENDS 55.42 `J ~~~~60TI~ear to-Dafe F'e~eraTTncome ~I'ax~n~ormation SHARE SAVINGS DIVIDENDS 11.12 MMSA DIVIDENDS- 202.32 CHECKING DIVIDENDS 0.00 FINANCE CHARGE {NAVCHEK LOC) ~ 0.00 ., V _ s~ + ~ ~~ AUER4100RJONESTONNCROAO SRV HARRISBURG. PA 17109 (717) 545-4001 Merchant ID: 09517060 Sale XXXXXXXXXXXX2407 4ISCOVER Entry: Sniped Total; ~ 1,480.00 04i23i08 10:39:52 Inv: 000801 Rppr Code; 023226 ppprud:Onlir~e Batchri:000202 Custo•er Covv TFIANK YOU! - Mr. Jeffrey A. Pimentel 111. South Second Street. Wormleysburg, PA 17043 Apr 16, 2008 Marjorie D. Leftwich - Deceased SPECIAL CHARGES X Direct Cremation Forwarding Remains Receiving Remains Immediate Burial Nationwide Guarantee Program Worldwide Travel Protection TOTAL SPECIAL CHARGES PROFESSIONAL SERVICES Services of Funeral Director & Staff Embalming Dressing/Cosmetizinq/Casketinq Facilities & Staff for Viewing ($200/hour Facilities & Staff for Funeral Service Facilities & Staff for Memorial Service Staff & Equipment for Viewing ($200/hour Staff & Equipment for Funeral Service Staff & Equipment for Memorial Service Private Family Viewing 6ditnessinq the Cremation Packaging/Forwarding of-Cremated Remains Personal Delivery of Cremated Remains Scattering of Cremated Remains TOTAL PROFESSIONAL SERVICES AUTOMOTIVE EQUIPMENT Removal Vehicle Casket Coach Flower Car Lead Car/Clergy Car Service Vehicle Family Car TOTAL AUTOMOTIVE EQUIPMENT AVER N.~EMORIAL ~I~ME ~ CREMATION SERVICES, INC. 4100 Jonestown Road • Harrisburg, PA 17109 • 1-800-720-8221 • Fax 717-541-9943 • Shawn E. Carper, Supervisor $1,395.180 281416 JT-5 $1,395.00 "`, ,.~; MERCHANDISE Register Book Memorial Cards Thank You Cards Remembrance Package Casket X Cardboard Container Alternative Container Outer Burial Container Veterans Flaq Case Grave/Memorial Marker TOTAL MERCHANDISE CASH ADVANCED ITEM5 Grave Opening Cemetery Equipment Vault Service Charge Newspaper Notice Newspaper Notice Clergy Church/Organist/Soloist Flowers X Crematory Charge Included X County Coroner Fee 525.00 X 10 Certified Copies of Death Certificate $60.00 TOTAL CASH ADVANCED ITEMS SUMMARY OF CHARGES Special Charges $1,395.00 Professional Services 50.00 Automotive Equipment $0.00 Merchandise $0.00 Cash Advanced Items $85.00 SUB TOTAL $1,480.00 CREDITS $0.00 TOTAL $1,480.00 AMOUNT PAID $0.00 BALANCE DUE $1,480.00 $ Q- . Qi t~ $85 . ~~+ THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES SACRED HEART OF JESUS CEMETERY 5 East Main Street MILFORD, MASSACHUSETTS 01757 TEL. (508) 634-5435 ,r~YIA t7n~ E ~~i~7: n1iE.c.) ~-EFTGG~/L'/~ Lot in Section ~S. ~ rLq ~e Perpetual Care Burial Funeral Services `~~ (~~ dh~~ ~~ Lot 7 ~ ~ov,•~ ~.:: ~;~~ - _ ., - - ~ ~~ av Received Payme ~~~ G~ TO BE INSCRIBED AS FOLLOWS: _ ............................ ON FRONT ................................................................................................ . .................................................................................................................................... THIS CONTRACT SUBJECT TO DELAY BY STRIKES, ACCIDENTS OR CAUSES BEYOd~D OUR CONTROL. .................................................................................................................................... To be delivered at .............................................................................:......:.........:........:.........................:.... during the month of ...............................-.........-.................. or (CE.'.7ETERtI IGITY~STATEI within reasonable time thereafter, the purchaser covenants and agrees that tfie title to said .....~ ......:..........:................`........................................................................................ shall retrain in the Seller until all amounts due herein are fully paid, at which time title shalt vest in the Purchaser. --•-.•-.-,_;..,•_•.--_`-_•`•,•.-„•,;-.,,.-•,•; .::....................................... az rtquired by this contract the Seller may repossess said property wherever the same may be found, and may sell the same at private sale or public auction and credit the Purchaser with. the proceeds of said sak after deducting all costs of repossessing the same, including attorneys' fees, paying the balance, if any, to tht Purchaser; or if in the event that after said repossession and sale the Seller shah not net a suffirient sum to pay the said expenses and the balantt due on saiti contract, he shall then have the right to take any other legal action for the collection of the balance. Nothing herein contained shall be construed as eliminating such other remedies as the seller rosy have for the collection of the purchase price, nor shall the use of any one method be construed as a waiver of the SeileYs rights to use any other method of collection. The purchaser hereby approves [he inscriptions az shown on this contact as to correctness of spelling and dales. Any unavoidable delay on the part of the Seller in [he delivery of said .............................................................................................................. shall in no manner impair the force and effect of this contract. It is further agreed that this contract contains all agreements between the parties and no agreement or waiver artless endorsed hereon shall be of any force or effect between the parties hereto. Pleazt: note that this contract does not include any agreement for future lettering. Invoices over 30 days will be subject to a service charge of 1'/: %a per month. (18% Annual Rate) AMT. OF CONTRACT ............................................................................•--.......... Purchaser's Signature ....::....................:..:........................-...................................-.. SALES TAX .......................................................................................:.................... Street.....-................................:................................................................................... FOUNDp,TION ....................................................................................................... City -...............:.:..:~.:........:.......................... State .....:...... Zip .............................. TOTAL ...................._..........................................................................-.................•.. Telephone.-...............:.....::....:...-............-------.....:......::............................................... ROBERT MOORS MONUMENT CO. 893 Washington St., Holliston, MA 01746 (508) 429-4536 "L1.seazi Prepared for. MARJORIE LEFTWICH BankofAmerica April 2008 Statement ~~ Credit Line: $12,400.00 4264 2942 2353 0520 ~ Gash or Credit Available: $12,273.49 ~ i Forlnformation on Your Account VsiL' __ www.bankofamerica.com Summary of Transactions Bitting Cycle and Payment Information Call toil-free 1-600-297-2326 ! TDD hear;ng-;mpa;red 1-Boo-3a6-317a Previous Balance $174.62 Days in Billing Cycle 28 !Mail Payments to: Payments and Credits - $50.00 C{osing Date 04/10!08 ", _ % BANK OF AMERICA Cash Advancrs + $0.00 P.O. BOX 15714 Purchases and Adjustments + $0.00 Payment Due Date 05!09/08 WILMINGTON, DE 19886-5714 Periodic Rate FInaRCe Ch8rgeS + . _ _ $1..89 - - Current Payment Due $15.~ Mail Billing Inguines to: _ Transaction Fee Finance Cis + $0.00 Past Due Amount + $0.00 ~ BANK OF AMERICA OX 150 8 P __ - - _ _ 51 $126 Total Minimum ~ - ' ` .O. B 2 WILMINGTON, DE 19850-5026 New Balance Total . Payment Due Posting Transaction Reference r-~.ccount Payments anti Crerlits Date Date_ Number Numl;er Cate~cr; P,mo~~~t _ 7 _ y7 B?TZlTT.~RT.~ ._,~.~ ii'-: rs iii. (' P, rc ,.ao.F+.. i};il t~vn 'c ~}_'?~ i ,.t] _ ~,15_~ ~' ~. A~i.u-......'~,,. ...,.ate.. ~,.:-. ..~,_. .. :...~,:,..,~ . .... .:: ~. i~.'..}-~i".o ::, . . ,:::„~~aes rer,~~,....~,~ .~~s::~c v^aru-c'~ lrr~ ;,R°rsac• ~i =E^anc.,, ^urars } _- _J-I ~-r' Y - ,` r - £ _-/~' - - 'df ' _ - r ti _ - ~ c C--,...r- - L -- __ £: _ T i '_ ~ ~ - ~• J~t~G~U(~1'~ iNFC3RMATl~N -' ° ~~ Acoourrt Nurrrber : 6036 321020964883 ° ~,' Statement Date : 03262008 '0 Payment Due Date : 04202008 Days Thy Period : Credit Lisn6 : n ' J J 29 _ . Cred'd Available : '~j(_~`/ 1 ~ ~~y i V '^"'11 BA~14N~E=S~lflllM~RY Previous Balance =74.1'. - Payments & Credits ~20.OC + New Purahaaes =O.Ot t/- FINANCE CHARGES (net) ;1.5C t Debt Canoeilation,Debts, Fees 8 Adjuabnenta ~.« New Balance =55.6: Minimum Payment =10.0 Previous Point Balance ~'?j 13 You Need 187 Point(s) For Your Nsxt CsrtBfoate. Pointe Earned This Statement ` _ ~~_ 0 Earn 1 Point Fa Every Doilnr You Chart's On Your Total Points Available ~ 1 f1 13 L'mens n Things Credd Card. Receive a Points To Next Certir~ate ~~~JJJ "`kkk((( 187 reward oertifioaEe for every =200 you spend. For Customer Service or Account Inforrnation,call 1-8+66-56>~4464, or log onto: www.LNT.cam. TRANS~kCTft~N S.UMMl~RY 03109 03/09 P914000E1~11QFWZJ PAYMENT -THANK YOU ;20.000R it 0326 0326 MtNIMUM'FINANCE CHARGE' =1.50 I THE PERlODlG RATE SHOMfN_ON THlS S?'ATI=MENT MAY VARY. F~i~A~(G~ =~HA~G~ l~tlfll~~tY ~ .:. : ~ - _ How Your Expiration Computed on Daily Corrosponding FINANCE CHARGE FINANCE Date Average Perbda Annual CHARGE Daily Rats Percentage Dw to Daily Transaotbn Wee Calculated Balance Rate Pariod'w Rate Fees Purohaaes NA =G1.27 .05753% 21.00% =1.04 =0.00 ANNUAL PERCENTAGE RATE 30.318% Toml Periodic flNANCE CHARGE =1.50 6~ y ~+c - =» __w== Please Note: Endosed is the Privacy Pdicy for this account. Please take a motr~nt to read it, then keep it with other financial documents. If you have previously opted-0ut, you do not need to do so again. YOUR IJdT CARD REWARDS YOU!! CHECK YOUR REWARD POINTS ON THIS STATEMENT TO SEE HOW CLOSE YOU ARE TO RECEIVING YOUR NEXT $10 PAYMENT DUE BY 5:00 PM CNd THE DUE DATE. We rrwy corwert you payment into an ekotronio debit. See reverse for detail. NOTICE: See reverse aide for BiGrgl Rigtrts and other important inlorrtredion. rasa woo t zs ~ Paae t m t stao tooo otsz ooaa osatzs aas3 otFwsaea soa - PACIFIC MARINE credit union ~~ PO Box 555235 • Camp Pendleton, CA 92055-5235 ADDRESS SERVICE REQUESTED 2008os27-0'I-219468 C83-02279z-1 I~~~111~~~111~~~~1~~f~~IL~~~{I~dL~~~11~~fI~~~~IL~~ILLf~f MARJORIE D LEFTWICH 111 S 2ND ST WORMLEYSBURG PA 17043-1313 Dear Member: Credit Card Late Charge Notice Notice Date: 05/24/08 Member Number: 199626 Loan Number: 147 Card Number: On File Last Stmt Balance: $777.80 ""' Late Charge Assessed: $10.00 Total Amount Due: $46.00 D/ ~ ~~ ~~ On 05/24/08 your payment had not been received, so the late charge shown above has been assessed. Your next payment date is 06/14/08. ,.,~Jr'~ Sincerely, Pacific Marine Credit Union ~~~--J' ~ i As required by law you are hereby notified that a negative credit report reflecting on your credit record inay be submitted to a credit reporting agency if you fail to fulfill tl:e terms of your credit obligation. ~~;Rll~P. ~ ~4~L f~4f~l ~Zt~io~t G6t ~lG¢ Gl1~PJt. Call Center Express Line 800-736-4500.760-430-7511 Word Wide Web 1-800-829-7676 Monday-Friday 7:00 a.m. to 6:00 p.m. ~-Pmcu.com 24 hours per day Saturday 9:00 a.m. to 4:00 p.m. 24 hours per day "SROO~,YNHTS,ox WELTMAN WEINBERG & REIS CO. L.P.A. 216.739.5100 > CHICAGO, IL Attorneys at Law 312.782.9676 175 South 3rd St., Suite 900 Columbus, OH 43215 CINCINNATI, OH (614) 801-2710 (800) 893-5041 513.723.2200 (614) 801-2604 (fax) CLEVELA;vD, OH Moo-Thurs Sam-9pm, Fri Sam-Spm, & Sat Sam-12pm EST 216.685.1000 www.weltman.com COLL'MBIJS, OH 614.228.7272 To The Estate Of: MARJORIE D LEFTWICH 111 S2NDST WORMLEYSBURG, PA 17043 May 7, 2008 DETROIT, MI 248.362.6100 GROVE CITY, OH 614.801.2600 PHILADELPHIA, PA 215.599.1500 PTTTSBURGH, PA 412.434.7955 ~~~,~`~iN~. ~c~,r~s - ~aa~-~ RE: Creditor: DISCOVER BANK Account No.: 6011298812671398 Balance: $868.33 Our File No.: 6796082 :Dear Personal Representative of the Estate: ;Please be advised that this law firm represents the above captioned creditor with regard to this account on ,which the Decedent was liable. Please accept our condolences during this difficult time. ][t would be appreciated if you would contact our office and advise us as to whether an Estate has been or will he filed and if so, the information pertaining thereto. You are not personally liable for the debt, however at this time we would ask that you please advise our office as to the intentions of the estate with regard to the satisfaction of the Decedent's outstanding debts. Please also furnish to this office a copy of the death certificate for the Decedent. The following toll-free number is available for your convenience: 1-800-893- 'i041. Your attention to this matter is greatly appreciated. Sincerely, Weltman, Weinberg & Reis Co., L.P.A. federal law requires us to advise you of the following information: "Chis law firm is a debt collector attempting to collect this debt for our client and any information obtained will be used for that purpose. Unless you dispute the validity of this debt, or any portion thereof, within thirty (30) days of receipt of this letter, we will assume that the debt is valid. If you notify us in writing within the thirty (30) day period that the debt, or any portion thereof, is disputed, we will obtain verification cif the debt and mail you a copy. If you request in writing within the thirty (30) day period, we will provide you with the name and address of the original creditor if different from the current creditor. E~49 / 7061 695