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HomeMy WebLinkAbout08-13-08 (2)REV-150 EX i6-00 COMMONWEALTH OF R PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 INHERITANCE TAX RETURN FILE NUMBER ~ , . . _ HARRISBURG, PA 17128-0601 ~~` RESIDENT DECEDENT ~ ~~ ~~ ~ ~ ~5 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z (YIAuDtE C' ~ ~6oiJ5 ~°t 3 - ) g - ~y ~1 W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE U t ~ ~ 13 ~.~ o 0 7 eg ~ I o ~ ~ q ~ 3 REGISTER OF WILLS Q (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER F Q 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date ordeam prlorto iz-i3-azl w a ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of Beam aner tz-~z-azl ^ 5. Federal Estate Tax Return Required ~ a m ^ 6. Decedent Died Testate (Anacn copy orwul ^ 7. Decedent Maintained a Living Trust rAttacn copy orrrus~) 8. Total Number of Safe Deposit Boxes a a ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date ordeam netween ~z-st-st and ~-t-ssl ^ 11. Election to tax under Sec. 9113(A) (Attacn scn of ~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: z w ° NAME L ~ 2 ~ COMPLETE MAILING ADDRESS z r, n - . e ~- e a FIRM NAME OfApp~icablei (~ l o ~r' e C rl tl-~ r ` ` ~~ w . p TELEPHONE NUMBER ~ I~ - ~C~3 - 83 ^ ~ r~ ~'v1. ~ ~ 8Z S \~'~ 1.%~ ~r~, ,~ ~ )~ ~- U Z Q J F- a U W Z 0 Q H d x H 1. Real Estate (Schedule A) (1) I S ~, O U ~ ~~ 2. Stocks and Bonds (Schedule B) (2) / ,j ~ 7 \ 5 ~% ~, ~ ~ , 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) rJ . o~ c~ - ~ C ~ , _a _ 4. Mortgages & Notes Receivable (Schedule D) (4) ., (J, ~; - r J G'7 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) ~ ~ / ~, 3 C , C ~ ~ - (Schedule E) , , L.~ 6. Jointl Owned Pro ert Schedule F Y p Y( ) 6 () ~~ ~~ ~c+ ~~~ - , ~' ^ Separate Billing Requested _ - ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) r Jt UCi = ' ~ - 8. Total Gross Assets (total Lines 1-7) (g) ~ ~~ ~4' ~ `S ~ made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) ~ r ~ ~ -' 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) (10) _ ~ / Q .~ 5 ~ ,~ 11. Total Deductions (total Lines 9 & 10) (11) / ~o ~ / ~y ~ (~ 12. Net Value of Estate (Line 8 minus Line 11) (12) lv 9 ~ ~ G 7, ~ ~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) G `~fa 3(.~~,3 SEE INSTRUCTIONS ON REVERSE SIDE 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 -._~~ 6 ~~ ; ~ x .0 ~ (16) ~ y 1-[ n! ~~~ 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate ~ J(I x .12 ~~1 T~ ~ ~~; ~~ x .15 19. Tax Due (17) (1s) ~~,,~~ ~ a. > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: CITY n __ STATE /~ ZIP C'~r~/S l~~ ~7CI/S /-~ 1,70/ 5 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 7 ~ 5~ C' , Y „~ 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) !5) yC~ 53C~,~1~ (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 shall use the property transferred or its income : ...................................... ...... ^ ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ 0 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 tlesignation? .................................................................................................................. ...... ^ 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 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 oT preparer other than the p nal repre based on all information of which preparer has any knowledge. SIGNATUR P SON R P LE F LING RETURN DATE x - _ , , . _ ~~~ i3 %~~~ ~, g SIGNATURE OF PREPARER OTHER THAN ~REPRESENTATI~~ ~ DATE -(1,~<<v~P.L^~y t ci ~c -t i'~o C-C ~ J`r C, j ~ ~, p ~ ~ ~ 2 CCU C ~, ADDRESS ~ - J For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute 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 0% [72 P.S. §9116(a)(12)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(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 indivil~dffual who has at least one parent in c>~mmon with the decedent, whether by blood or aaoptlon. REV-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All real property owned solely or as a tenant in common must be reported at lair 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 property which is jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) s, ~~~`' SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. to more space is neeoea, insert additional sheets of the same size) REV-1507 EX+ (1-97) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FfLE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV4508 EX + (tA7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH :~ ~ ~,~ ~ p 8 1 ? , C~ S 1. Q ~ f 5 °~e~z~; eJ ~~ ~ 7) s ~ Cam' 4 d ~ U C t ~ ~ ~ (r ~C~~ 40©CC l 4~~G~ `S ~,O,C7`1~ .mil 7 J`ev~2~t~r.~ QA~-~ Cif ~ ~ cc -~ i t~'t s.~ 05 4 3 Z acct- G~~oc:~~ Z ~~ ~ 1~cC-r 33g~U33~~~ 471-r- T ~c:,~ ~ CL> ~_5 /-~ cc~ 3 i oC; 3 ~-t 12 2 ~ ~ ?C~ C? ~crf 3i C}v3~ClZZ~8oR4 ~.~,-~2~~ s ~ ~~ ~s n~-~ ~ ay4~~~ a~~~ ~~ ~ ~~ ~ a ~ ~ ~Q a.~ C'N~~~~ SDtil VI~# I ~ l l.~T 5y ~4 fG~ll~(Z~~ ~~ 5~ ~~.u~~ s ~~`~ ~ c i~ ~`ij ~ t 5, ~ 5 3 ~~ ~ ~ '? . ~ ~~ a4saa,~~~ y4~ ° ~ . I Z ~~ ~ 3 ~ - t18~-(~{. ~S ~ZGG.00 b d G~ . C~ TOTAL (Also enter on line 5, Recapitulation) I $ 3 ~, (~ ~,.3 C), o S (If more space is needed, insert additional sheets of the same size) Rev-~sos ex . I+ sal COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULEF JOINTLY-OWNED PROPERTY FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Terr-a ~ Ccle_~ma~n B, C. JOINTLY-OWNED PROPERTY: ~} ~> 7d ~ ~~ u ~ ~ T~2 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 °/o OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTERE ST 1. A. k~ I l(2 cC5 ~ r ~ s~-Z.*~-u-c~ ~ J r~ IL `~ O ~o GCU 1 ~ l t °l (o Ci a ~ ,1 ~ 5 C~ Jo g 3 8 Z{ ~c ~ . 3 l `6 ~ 2`{ /2(;U ar(5 -~rL~~;r ~ ~? vl k-. 4 O ©O C7 1 ~' `~ t Z. 5 ~P ~o 17 • ~ to 'SO l ~ ~5 3 O ~ . ~ ~j G It~~ ~(qt~ G r r ~~csvs~ ~3G.,~~- C~Icv~~ ~ I a ~ ~ ~ ~'~ (a~ . ~c ~ 01, t a ~~ 3 . (~ C TOTAL (Also enter on line 6, Recapitulation) I $ rl Q 3 3 ~ , ~ `"~ (If more space is needed, insert additional sheets of the same size) REV-1510 EX ~ 11-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed ii the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIPTO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IFAPPUCAaLE TAXABLE VALUE 1. TOTAL (Also enter on line 7, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) ~. ~~~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~wlivG t32C1tiFtz_s 1r~t"fz(~L 6JGYV~C l BUG . 00 P a S roYL_ + 5 >-.~v t C ~- 3 L U• GC.~ B. ADMINISTRATIVE COSTS: ~ p m < <-.~ ~--~ e ~ r~ ~-<<a n S~ ~.~~ - _ ~;~ 1 ~ ~ ~ 1. Personal Representative's Commissions _ Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees ~~h fD I ~S~'. U~ I ~ ~ O Q 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 39~1.SQ St{t C`"~~ _3C~, O%~ ~~~ tC~ a~Ccfn ~2~~~G'Q ~5 ~ g,3 ~ ucztt=~c~ i1(~4~ I~s ~~ 5. . Accountant's Fees ao~~ _aC~ 6. Tax Return Preparer's Fees `7~.c}G ~. TOTAL (Also enter on line 9, Recapitulation) I $ S /a ~, ,7 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) ( - ~, ~_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCFIEDt~LE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) a. SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUAABER 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)] ~ /lJ,z~ hQ-e~..T ~ 2 o vv , 1. larylvEL L. ..5~ in~E~ J ,~~ti-~~~r n~ ~. s7,ti ~ ~~ ~ ~ . ~ ZGC1~_ ~>~j (~.J ~ (_ C ~ ~ i vt l- , 5T/iv ~ ~,l Q~ /~ ~~ ~ .~ UGa''~ . CJ~,~ ,Su~c~nh ~n5s~r- nJl~,c~~ ~ snco- a~ .1 E ~' 2.u ,~ . /~ < l ~~2-t- C~'~ ~~ noJ ~~^rzz "~ ~ ~2 o ci u . a e' ~ (rn ~ <2~r2~- y . / 3 ! g G3 ~eCh fJ' r< ~ ~~,~ ~. 2~~0 ll ~~ ~ ~ F'f# ~ [~~ /~elYr~Gtt as~G ~ Carn~,~, e~11 ,~zcZ Terry •C~~~7~? ~'c~c~rnai2 - f'e ~3c>x ~6~i~~, FFV2P,nti'xs ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR r~c9ses~ [~9~/6~Zzi'' OUGH 18, AS APPROPRIATE, ON -~ ~?/5~{~(„~~ plus REV-1500 COVER SHEET ~ '/ZE II NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ~l%(E',1 ?S 9~ I (If more space is needed, insert additional sheets of the same size) LIST OF HEIRS ' Samuel L. Stine 15 Cherry Street, Newville, Pennsylvania 17241 717-776-5894 Kenneth L. Stine 318 Wildwood Lane, Newville, Pennsylvania 17241 717-776-7703 William L. Stine 113 Meetinghouse Spring Road, Carlisle, PA 17013 717-258-4496 SueAnn Masser 5 Monocacy Court, Walkersville, Maryland 21793 301-845-1355 Jerry L. Miller 1188 Newville Road, Carlisle, Pennsylvania 17013 717-243-2579 Shelly Jean Wetzel ~' 966 Alexander Spring Road, Carlisle, Pennsylvania 17013 717- 422-1391 Pauline Wurfl 1941 Spring Road, Carlisle, Pennsylvania 17013-1159 717-243-2055 A. Settlement Statement U.S. Department of Housing and Urban Development ~~ OMB Approval No . 2502-0265 B. Type of Loan ___ 1. ^ FHA 2. ^ FmHA 3. ^ CGf1V. UnmS. 16 File Number V Loan Number B Mongage Insurance Case Numoer 4. ^ VA 5. ^ Conv. Ins. I C. Note: This form is furnished to give you a sta tement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside closing; they are shown here for informational purposes and not included in the totals. D Name and Address of Borrower ~' E. Name and Atltlress of Seller F. Name and Address of Lender Galen C. Byers & Revenna C. Barrick Maudie C. Coons Estate The Bank of Landisburg 1441 Cockley's Drive Soiling Springs PA 17007 G. Properly Location I H. Seltlemenl Agent (Gerald K. Morrison, Esquire I--- ---______. _ 102 Hollenbaugh Road, Carlisle, ( Place o1 Settlement I. Seltlemenl Dale South Middleton, Cumberland County, 16 West Main Street Pennsylvania jNew Bloomfield PA 17068 6/5/08 J. Summary of Borrower's Transactlon K. Summary of Seller's Transaction 100. Gross Amount Due From Borrower 400. Gross Amount Due To Seller 101. Contract sales price 157,000.00 401. Contract sales price 157,000.00 102. Personal property _ _ -- _ 402 Personal property - - _ 103 Settlement charges to borrower (Ilne 1400) __ I 3,557.50 _ - - 403 104. _ ._ 404. _ 105. __. __ 405. Adjustments for Items paid by seller in advance _ _ AdJustments for items paid by seller in advance 706 City/town taxes to - _ 406 City/town taxes to 107 County taxes G/5/OS to 12/31/08 - 182.15 6/5/08 to l2l31/08 407. County taxes 182.15 108. Assessments _ to _ 408. Assessments to 109_ School 6/5/08 to 6/30/08 _. 90.50 aos. School ti/S/08 t° 6/30/08 . 90.50 110. _ to i to 410. - 111. to - 411. to ._-. - 112. to to 412 121). Gross Amount Oue From Borrower 160,830.1$ 420. Gross Amount Due To Seller 157,272.65 200. Amounts Pald By Or In Behalf Of Borrower_ _500. Reductions In Amount Due To Seller 201. De sit or earnest mono _ -~°- --- --- X- - -- __ } _ --- 501 Excess daposit~see instructions) - _ 202._ Pdncpal amount of new loan(s) Landisburg I 157,000.00 502. Settlement charges to seller (line 1400) 2,038.98 203 Existing loan(s) taken subject to_ _ __ __ .. _ - _ _ 503. Existing loan(s1 taken subject to _. 204. _. _ _ 504. PaYofl of first mortgage loan _. __.- 205. _ _ 505.- PaLoH of second mo~age loan zos sob Inheritance Tax Escrow 8,000.00 207. 507. 206. 508 209 _ , __. 509 Adjustments for Items unpaid by seller_ _ - _ - _. Adjustments for_lt_ems unpaid by seller 210:_CifL/town taxes to ~ 510 Crty/town taxes to ._ 211 County taxes to ----- - _. _ _ _._ _.. j- --.___ _._._- 511. Count~taxes_ __ to -.___._ 212 Assessments fO _.._._ _._.... _. _. _. _... i _. _. _. _. - _..- 512. Assessments io ----._.__. ___ - 213___ to __._ ~ _. 513. to _. to 214. ~ to 514. 215. 1O ~ 615. to 216. to 518. to _ 217. to to 517. . _ 218 ;o _ IO. 518. 219. itl 519. t0 220. Total Paid BylFOr Borrower 1 S7,000.OO I 520. Total Reduction Amount Due Seller 10,038.98 300. Cash At Settlement From/To Borrower 800. Cash At Settlement To(From Seller 301 Gross Amount due from borrower (Ime 12~_ _ -- - -- 16O 83O 1 S - 801_ Gross amount due to seller (line 420) --- - - _ - - 157,272.65 302. Less amountpaid~for borrower line 220) - i( I $7,000_OO 602 Less reductions in amt due Seller (hne 520) _ ( 10,038.98 ) 303. Cash ®From ^ To Borrower , 3,830.15 803. Cash ©To ^ From Seller 147,233.67 The undersigned hereby acknowledge the receipt of a completed copy of pages 1 &2 of this statement 8 any attachments referred to herein. I HAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS A TRUE AND ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT I HAVE RECEIVED A COPY OF THE HUD~IJS-ETTLEMENT STATEMENT. > BORROWER _TL,, ~.dh~ts--..~J...- - --- - - - SELLER e~r% t ~ /~J'/~/'~/~'J 717<t~%~ CxE"~'~ ~ BORROWER I ~.. ~L,(,1,Q~_~,(~-~ -- _ SELLER C7r'- - - - TO THE BEST OF MY KNOWLE ~~~1 SETTLEMENT STATEMENT WHICH I HAVE PREPARED A TRUE AND ACCURATE ACCOU~JT OF THE FUNDS WHICH WERE RECEIVED A EE WILL BE DISBURSED BV THE UNDERSIGNED AS A PA OF THE SETTLEMENT OF THIS TRANSACTION. IS A CRIME TOYCNOWIt~JGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CAN INCLUDE A FINE A D IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U.S. CODE SECTION 1001 & SECTION 101G RESPA, HB 4305.2 L. S6ttlement Charg_ea _. ___ _ _ 700 Total SalesfBroker's Commission based on price S C~ °J. _ Division of Commission (line 700) as follows, _ .___ __ 701. $ to 702. $ to 703. Commission paid_at Settlement 900. Items PP~able In Connection With Loan - -- __. 801. Loan Ori~~nation Fee / The Bank of Landtsburg 802. Loan Discount 903. Appraisal Fee _ to _ _ 80a. Credit Report _ to_ _ _ ~ 905 Lenderslnspection Fee _ 806. Mo gage Insurance Application Fee to __- _ _ _ _ 807 Assumption Fee 908. 609. 870. 900. Items Required By Lender To Be Paid In Advance -- - - 901. Interest from to _ @$ ! da __ ---.- - - - _ - - _ _ Y _ . _ 902 .Mortgage Insurance Premium for months to 903 Hazard Insurance Premium for _years to 904. years to 1000. Reserves Deposited With Lender 1001. Hazard insurance monthsQ$ per month 1002. Mortgage insurance _ monthsQ$ per month 1003 City property taxes monthsQ$ _ per month 1004. County propertyJaxes monthsQ$ per month 1005. Annual assessments monthsQ$ _ per month 1006. months(~$ per month _ 1007. monthsQ$ _ __. per_ month 0'001 Paid From Paid From Borrower's Setter's Funds At Funds AI Settlement Settlement 1,000.00 1100. Title Charges _. _ _ - _ _ _. -- --- - _ ----_ 1tot. Sehlement or dosing fee q . to Gerald K. Momson, Es wro 150.00 1102. Abstract or title search to 1103. Title examination to Gerald K. Morrison, Esquire - _ 835.00 1104. Title insurance binder lc 1105. Document preparation _ _ to Gerald K. Montson, Esquire 75.00 1106 Notary fees _ to _ _ _ _ 1107. Attom>~s fees _ _ to _ _ - (Includes above items numbers__ _ _, _ _ _ _ _ ) ! 7.108. Title insurance to i. _ (Includes above items numbers: ... ) ,. _ 1109 Lenders cevera~e _ $ ___ , _.. - 7110 Owners coverage _$__.__ __ _ _ _ ,.. 1111. 1112. 7173 1200. Government Rewrding and Transfer Chas _, 1201. ReceNing fees: Deed $ .__,_ _._ 39 00 Mo»~aQ $ _ 38 50 ;Releases $ 77.50 1202. C~/countL~x/stamQs Deed. $ _ ____ 1 570.00 Mongage $ _ __ 1,$70.00 1203. Statetax/stamps: Deed $ 1,570_00_ _MOrtgage $ .- _ 1,570.00 ~ t zoa. ' 1300. Additional Settlement Charles _ _ _ _ _ _ 1301 Survey _ ____ _ to _ ___ 1302 Pestin~edion __ to____ t3o3. Bob Cairns - 2008 CountylTownship 1304. 318.98 1400. Total Settlement Charges (enter on Tines 103, Section J and 502, Section K) 3,557.50 2,038.98 The undersigned herebbyy acknowledge the receipt o(a completed copy of ages 182 of this statement & any attachments referred to herein. I HAVE CAREFULLY aEVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS A TRUE AND ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ME IN THIS TRANSACTION. I FURTHER CERTIFY THAT 1 HAVE RECEIVED A C~O}Q-Y.-OF T HUD-1 SETTLEMENT STATEMENT ' BORROWER _.__`._ _ .. ~ ~ .- _~,_ __. SELLEi~. '.' ~jI ~ ~~~ e C~ ,y, g BORROWER .._4_ ~ C91~~~ SELLERS --_ -.. _... ff B~('.C'.(1.,~ TO THE BEST OF MY EDGE. THE HUD•1 SETTLEMENT STATEMENT WHICH I HAVE PREPA lS A TRUE AND A CURATE ACCOUNT Of>'fHE FUNDS WHICH WERE RECEI~'H;aVE BEEN OR WILL BE DISBURSED BY THE UNDERSIGNED AS PART OF THE SETTLEMENT OF 7HI5 TRANSACTION. WARNING: IT IS A CRIME TO KNOW GLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUDE A FINE ND IMPRISONMENT. FOR DETAfLS SEE: TITLE 18 U.S. CODE SECTION 1001 8 SECTION IOtO . Public Reporting Burden for this collection of information is estimated to average 0.25 hours per response, including the time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Reports Management Officer, Office of information Policies and Systems, U.S. Department of Housing and Urban Development, Washington, D.C. 20410-3600; and to the Office of Management and Budget, Paperwork Reduction Project (2502-0265), Washington, D.C. 20503 ~ 3 3 3 3 3 3 3 3 ~. 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R. A~ CD 0 ~+; O h 'T1 ~° C/1 C U4 O S~. '~ A~ N O '-t; N ~14~7?8 ~~ ~ overeign Bank OFFICIAL CHECK 22-1676 Agent for MoneyGram r'~. r~cnc^~r ~ fq ~. a~7 8+`t.7t ~ ~ ~' ~' ~i}>~t t?v~r r ~~axaK~ ~~°~'~ , ~~'~ . 5. TO THE ORDER OF ~h~ ~'~t3tf3 pf ~~i.3t~l~ C~~ Drawer: Sovereign Bank NON NEGOTIABLE CUSTOMER COPY _ _ _ ____ _ _ _ _ ,w ISSUED BY: MONEYGRAM PAYMENT SYSTEMS, INC. ~~ _~ AUTptORIZED SIGNATURE ~ ~~ P.O. BOX 9476. MINNEAPOLIS, MN 55480 DRAWEE: US BANK, ST. PAUL, MN `:::::Sovereign Bank Memo: 11/20j2447 Account Holder: Account Number: Branch Number: Oi67 ~**~*****29,357.53 DETACH AND RETAIN FOR YOUR RECORDS 8144778 Date OpEaed: 12 / 14 2 0 O 1 Term: 91 DAYS Certificate of Deposit Amount of 7100015279 7100015279 Deposit: TwarrrY-true TxovsArrn arro ool1o0 $ 25, 000.00 This Time Deposit is Issued to: Issuer: WALNUT BOTTOM WAYPOINT BANK 1160 WALNUT BOTTOM ROAD CARLISLE, PA. 17013-9152 MAUDIE C COONS J LYNN COONS 102 HOLLENBAUGH RD CARLISLE PA 17013-9715 Not Negotiable -Not Transferable -Additional terms are below. ~~~".~ ~'3 3`I(~~` Tax ID: 293-18-9437 Number: ..... l By Additional Terms and Disclosures This form contains the terms for your time deposit. It is also the Minimum Balance Requirement: You must make a minimum deposit to Truth-in-Savings disclosure for those depositors entitled to one. There are additional terms and disclosures on page two of this form, some of open this account of $ 1, 0 0 0.0 0 . which explain or expand on those below. You should keep one copy of ^ You must maintain this minimum balance on a daily basis to earn the this form. Maturity Date: This account matures 3 j15 j2002 annual percentage yield disclosed. (See below for renewal information.) Withdrawals of Interest: Interest ^ accrued credited during a Rate Information: The interest rate for this account is 2 .0 8 0 0 0 qb term can be withdrawn: with an annual percentage yield of 2 •10 `%. This rate will be AT ANY TIME WITHOUT PENALTY paid until the maturity date specified above. Interest begins to accrue on the business day you deposit any noncash item (for example, a check). Interest will be compounded MONTHLY Interest will be credited END OF MONTH BY ADDING SACK TO TIME DEPOSIT The annual percentage yield assumes that interest remains on deposit until maturity. A withdrawal of interest will reduce earnings. Early Withdrawal Penalty: If we consent to a request for a withdrawal that is otherwise not permitted you may have to pay a penalty. The penalty will be an amount equal to: LOSS OF 90 DAYS interest on the amount withdrawn. Renewal Policy: ^ Single Maturity: If checked, this account will not automatically ^ If you close your account before interest is credited, you will not renew. Interest ^ will ^ will not accrue after maturity. receive the accrued interest. ~ Automafic Renewal: If checked, this account will automatically The NUMBER OF ENDORSEMENTS needed for withdrawal or any other purpose is: 1 renew on the maturity date. (see page two for terms) Interest ~Xvlll ^ will not accrue after final maturity. ACCOUNT OWNERSlI1P: You have requested and intend the type of account marked below. ^ Individual ~JOIn[ Account -With Survivorship 4m j corns ^ Joint Account - No Survivorship c~ ~ m > ^ Trust: Separate Agreement Dated ^ Revocable Trust Designation as defined in this agreement (Beneficiaries' names and addresses) ;SACKGY 1~"ITIRiCtLDIIvi~ CEr2T~FICA'I10NS TIN: 293-18-9437 Taxpayer I.D. Number -The Taxpayer Identification Number shown above (TIN) is my correct taxpayer identification number. Backup Withholding - I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. Account Number: ^ Exempt Recipients - I am an exempt recipient under the Internal Revenue Service Regulations. A provision for my signature, certifying under penalty of perjury the statements checked u- this section, is contained on the first copy of this certificate. ENllOKSE[i4ENTS -SIGN ONLY X X X YOU REQUEST WITHDRAWAL OFFICIAL CHECK 8~.4~779 22-,676 960 12 /~4~'~`s~Q7 Rrar~~~~ - ~ ~r~ Yo3 c~ i'~ A~trnt Omer ~r~~~~atr~xr3~t . 1~°~, TO THE ORDER OF T~ ~*~~~' £3f ~.attt~ie ~QO~?'Fa Drawer: Sovereign Bank NON NEGOTIABLE CUSTOMER COPY ISSUED BY: MONEYGRAM PAYMENT SYSTEMS, INC. ' P.O. BOX 9476, MINNEAPOLIS, MN 55480 AUTHORIZED SIGNATURE DRAWEE: US BANK, ST. PAUL, MN ~: S overeign Bank Memo= 2 ~./z8/2887 Account Holder: Account fi~umbe r Branch Number: 8167 DETACH AND RE~'AfN FOR YOUR RECORDS 8248779 Certificate of Deposit Receipt This receipt is issued to: Account Number: 9600007771 IRA Number: MAUDIE C COONS Amount $ 30,000.00 102 HOLLENBAUGH RD Date Opened 2!21/2003 CARLISLE, PA 17013-9715 Term 6 Months Maturity Date 8/21!2003 .... .--- Interest Rate 1.290 ~ The account evidenced by this receipt is subject to and further explained in the terms and conditions contained in the account agreement and account disclosures. The account is Not Negotiable and Not Transferable. Only the items checked apply. ® Fixed Interest Rate ^ Variable Interest Rate ^ Additions Permitted ® Automatically Renewable ^ Single Maturity (not automatically renewable) ^ Callable ^ Notice Account Interest will be: ^ mailed to the owner(s). ® added to principal (compounded). ^ paid to account No. , ® 1994 Bankers Systems, Inc., St. Cloud, MN I1-800-397-2341) Form CDREC-BK-LAZ 311/95 /page 1 0l 1) ~~.~077? z ~ ~ overel n B ank OFFICIAL CHECK ~o ~ g 22-1676 Agent for MoneyGram `° " .~~~~~~~~~~ ~ t"~1 ~. ~~ .i ~. /20/21707 ~~rh~ ~.~~°~ ~+~zd ~~ A~n~ Qhr+~a~ ~~~~~~~~25>~~.5, TO THE ORDER OF `¢"hg3 ~'~ ~'~>~ ~'~ ~~°tll+6~ ~ ~t ~~f~ Drawer: Sovereign Bank NON I~tEGOT1ABLE CUSTOMER COPY ISSUED BY: MONEYGRAM PAYMENT SYSTEMS, INC. -= P.O. BOX 9476. MINNEAPOLIS, MN 55480 AUTHORIZED SIGNATURE DRAWEE: US BANK. ST. PAUL. MN :Sovereign Bank M@Igt! 21/20/2407 Account Holder: Account Number: Branch Nuertber : 02,67 ***25,625.25 DETACH AND RETAIN FOR YOUR RECORDS 8140777 I` Dale T~ ~ Opened: 3 /t$ 5 / 2 0 0 2 Term: 91 DAYS ID: Number: Certificate of Deposit .... By ~l`~1 /J`~_._ 1754251316 Amount of pep~rt; ~rarrrx-z~wo xuousau~m sEVarrrsr-xxx~s nam se/loo $ 22, 073.56 This Time Deposit is Issued to: I~~' 1~7 WIHIGIi S~TRE~E~ WAYPOINT BANK CARLISLE PA 17013 J L COONS MAUDIE COONS Not Negotiable -Not Transferable -Additional terms are below. Additional Terms and Disclosures This form contains the terms for your time deposit. It is also the Minimum Balance Requirement: You must make a minimum deposit to Truth-in-Savings disclosure for those depositors entitled to one. There are additional terms and disclosures on pa a two of this form, some of open this account of $ 1, 0 0 0.0 0 . which explain or expand on those below. You should keep one copy of this form. ^ You must maintain this minimum balance on a daily basis to earn the Maturity Date: This account matures 6/ <~ /2002 an~1 Percentage yield disclosed. (See below for renewal information.) Withdrawals of Interest: Interest ^ accrued credited during a Rate Information: The interest rate for this account is 1. $ 8 0 0 0 96 term can be withdrawn: with an annual percentage yield of 1 • .9096. This rate will be AT ANY TIME WITHOITT PENALTY paid until the maturity date specified above. Interest begins to accrue on Early Withdrawal Penalty: If we consent to a request for a withdrawal the business day you deposit any noncash item (for example, a check). that is otherwise not permitted you may have to pay a penalty. The Interest will be compounded MONTHLY .penalty will be an amount equal to: Interest will be credited END OF MONTH LOSS OF 90 DAYS BY ADDING BACK TO TIME DEPOSIT interest on the amount withdrawn. The annual percentage yield assumes that interest remains on deposit Renewal Policy: until maturity. A withdrawal of interest will reduce earnings. ^ Single Maturity If checked, this account will not automatically ^ If you close your account before interest is credited, you will not renew. Interest ^ will ^ will not accrue after maturity. receive the accrued interest. ~ Automatic Renewal: ff checked, this account will automatically The NUMBER OF ENDORSEMENTS needed for withdrawal or any renew on the maturity date. (see page two for terms) other purpose is: 1 Interest ~Xvill ^ will not accrue aRer final maturity. ACCOUNT OWNERSHIP: You have requested and intend the type of account marked below. ^ Individual ass ~.~ ~ Joint Account -With Survivorship ;~ ~„~~ ^ Joint Account - No Survivorship ~. ~ ~,~ ^ Trust: Separate Agreement Dated Ll Revocable Trust Designation as defined in this agreement (Beneficiaries' names and addresses) BACKUP WITHHOLDING CERTIFICATIONS TIN: ^ Taxpayer I.D. Number -The Taxpayer Identification Number shown above (TIN) is my correct taxpayer identification number. ^ Backup Withholding - I am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revemie Service has notified the that I am no longer subject to backup withholding. Account Number. ^ Exempt Recipients - I am an exempt recipient under the Internal Revenue Service Regulations. A provision for my signature, certifying under penalty of perjury the statements checked in this section, is contained on the Est copy of this ate. ENDORSEMENTS -SIGN X X X .Y WHEN XOU REQUEST WITHDRAWAL ~~~~ ~_ One M & T Plaza, Buffalo, New York 1440 Spring Garden November 23, 2007 aaa MAUDIE C COONS 102 HOLLENBAU~H RD CARLISLE PA 17015 Re: CD Account Closing Notice Account # 3-1003912278099 - Dear Maudie C Coons, We are writing to confirm that on 11 /20/07, your CD account was closed or transferred. At that time, the balance was $44,797.12. We'd like to remind you that MBr.T Bank is committed to providing you with solutions to all your financial needs. To find out more about the many ways we can help you with those needs, simply stop by any M&T Bank office or call the M&T Telephone Banking Center at 716-626-1900 or 1-500-724-3222. Or if you'd like, visit the M&T website at www.mandtbank.com. Thank you for banking with M&T Bank. Sincerely, M.~che.2e CoQe-Nec~oh Michele Cole-Hector Customer Service Manager AA~~ '1 One M & T Plaza, Buffalo, New York 14~MI Spring Garden November 23, 2007 aas MAUDIE C COONS 102 HOLLENBAU6H RD CARLISLE PA 17015 Re: CD Account Closing Notice Account # 31003912278700. Dear Maudie C Coons, We are writing to confirm that on 11 /20/07, your CD account was closed or transferred. At that time, the balance was X24,522.68. We'd like to remind you that M&T Bank is committed to providing you with solutions to all your financial needs. To find out more about the many ways we can help you with those needs, simply stop by any M&T Bank office or call the M&T Telephone Banking Center at 716-626-1900 or 1-800-724-3222. Or if you'd like, visit the M&T website at www.mandtbank.com. Thank you for banking with M&T Bank. Sincerely, M.iche~Ze Cope-Nec#on Michele Cole-Hector Customer Service Manager o ~ ~ ~, _ ~ ~;~ =- ~ r .~~: c~ ~y. n ~~ - _ ~ ~ _ y ~. ,... i ~ ~ ~ ' ' -` _ ~ ~; cj ~~ 3 N 3° mo c a~ c ~ ~, v3 ~~ W o " ~.s- .._ -_T O~ fY~ ~ \JV .' ~~~ ~~ (~~ r iltii m a D Z 'T1 O O C n 0 --i-o-mc~m~ ~mcn~~c~aac-o Certificate of Deposit Receipt ~~ CITIZENS BANK 7 Month CD Certificate Ntunber Issue Date Principal Amount 6244692824 07/23/04 50,000.00 Plan Own'etship N/A INDIVIDUAL MAUDIE C COONS 102 HOLLENBAUGH RD CARLISLE PA 17013 Annual Percentage Yield Interest Rate % Matnriry Date 02.1300 2.s5 a2/ZOro~ Remit Interest Interest Pay¢te¢t E'requency Automatically Renewed N/A ~ ~ ( .) 1j ~; ~:.li" ~~ ~ ~~ !, ~~ Bank No. Branch No. 060 289 Bank Authorization Non-Negotiable; NotTraasferable This is a confirmation of your Investment options and is not required for redemption. ---------------------------------------------------------------------------------------------- (Fold on Line} Renewal Policy "lhis certificate will tie automatically renewed at maturity. You may prevent renewal if you withdraw the funds in your account at maturity, or within ten (10 calendar days after the maturity date, or if we receive written notice from you within ten (10} calendar days after the maturity date. Written notice may be mailed to the attention of the Citizens Operations Support Group at: Remittance Processing, Citizens Bank, Operations Center, One Cittzens Drive, Riverside, RI Q2415. If you choose not to renew, interest will not be paid after the maturity date. ---------------------------------------------------------------------------------------------- (Fold on Line) •~ "~ ® ® Please be sure to enter this -:~ ,; : ' ! Customer Receipt transaction in your records. Transaction Date Amount Description Account Number Funds from your deposit may not be available for immediate withdrawal. All transactions are subject to CS-0160 R verification as outlined in the rules and regulations of the Bank. 22089-BUNKER SN6 1tut/PK Memher FDIC; Certificate of Deposit Receipt +s CITIZENS BANK 3-year Rising R.tte CD A»nual Percentage Yield ~• C'rrtiflcate Number issue I)n[e Principal Amount Interest Rate ~%c Maturity D1te fi244fi92611 03/26/04 20,000.00 02.0000 2.01 03/26/05 Plan Ehvnrrsfiip Remit Interest Interest Payment Fregeemy _N/A lNDIVi17UAL _ : Automatically Renewed N/A MAUDIE C COONS ~, ~ G 102 HOLLENBAUGH RD CARLISLE PA 17Q13 ' ~ ~~ __ - .__ . __ (Fdldon Line) _ _ _ - __ _-_- - - - -_- - - --- - -_r - _ - Renewal Policy This certificate will be automatically renewed at maturity. You may prevent renewal if you withdraw the funds in your account at maturity, or within ten (10) calendar days after the maturity date, or if we receive written notice from you within ten (10) calendar days after the maturity date. Written notice may he mailed to the attention of [he Citizens Operations Support Group at: Remittance Processing, Citizens Bank, Operations Center, One Citizens Drive, Riverside, RI 02915. If you chaise not to renew, interest will not tie paid after the maturity date. ------------------------------------------=-=j_r----__----------~---------=_~--------------------- _~ _ (Fold on Line) ~~, .~ -= ~ t ~ Customer Receipt Please be sure to enter this a ' ~ transaction in your records. Transaction Date Amount Description Account Number Funds from your deposit may not be available for immediate withdrawal. All transactions are wbject to CS-0160 Rev.( verification as outlined in the rules and r ulations of the Bank. 220838UNKEFa Bros 1M/PK ~ Member FDIC This is a confirmation of your Investment options and is not required for redemption. coMNOwEwLTx of PenNSr~vAraiw _ nEPARTNENr of REYQNIE INFORMATION NOTICE BUREAU OF IlIDIy1DUAl TAXES AND uEPr. tee~31 TAXPAYER RESPONSE WIRRISBURC, PA 17128-3691 FILE N0. 21 07-1055 ACN 08106177 DATE 02-I3-2008 acr-ua a ~c, ns-a~ TERRI L COLEMAN 102 HOLLENBAU6H RD CARLISLE PA 17013 TYPE OF ACCOUNT EST. OF MAUDIE C COONS ~ SAVINeS S.S. N0. 293-I8-9437 ^ CHECKING DATE OF DEATH 11-13-2007 ^ TRUST COUli1TY CUMBERLAND ® CERTIF. REMIT PAl!l1ENT ANA FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ORRSTOMN BANK has prorfded the Oepartaont with the inforsation listed Mlov which has boon used in calculating the potential tax dw. Their records indicate that at the death of tFw above decedent, you ware a,ioint owi»r/bonaficiary of this account. If You fool this inforeation is incorrect, please obtain written correction free tM financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the InMritance Tax Laws of tM Coaaoro,ealth _ ~. of isws-+eer-io-aasioraF-by eei3ing= FTla~-i97~327~-- _ - -- --._~. - -° _ _ . _., -.-_-_ . - .- COMPLETE PART 1 BELOW ~ * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 4000018412 Date 08-24-2004 Yo insure prropar erodit to your account. two Established (Z) copies of this notice vest acceawrer Your Account Balance payaent to tM Resistor of M311s. Hake ehetic 56,617.36 payable to: "Resister of Mills. Agent". Percent Taxable X 50.000 NOTE: If tact payeents are aade within throo Aaount Subject to 7aX 28,308.68 (3) sonths of the decodent•s data of death, Tax Rate X .15 yoe ~ae- ~~ a 5z dist:aant of the tax due. Aron irYwritanea tact dw rill beeoae delirwuent Potential Tax Dua 4, 246.30 nine (9) aonths after the dat• of loath. PART TAXPAYER RESPONSE A. ~ TIa above inforaation and tax due is wrrect. 1. You ~- choose to react pasteent to the Register of Mills with two copios of this notice to obtain a discount or avoid interest, or you aaY tdu-dc box "A" acrd return this ratite to tIN Register of CHECK ~~ G SPA Departtent of Rerenue. Mills and an official assossaent will be iss ' C ONE ~ ~ ~+( BLOCK 9. TM above asset has boon or will ba roportsd and~tax veil with the Pene-sylvania Inheritance Tax return ' ONLY s representative. to be filed by tM decedent C. ~ TM adaw inforaatian is incorrect and/or debts and deductions wore paid 6N You. You vest coaplete PARE 2~ and/or PART 3^ below. PART If you indicate a different tax rate, please state your relationship to decadent: TAX RETURN - COMPUTATION OF TAX ON dOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 - 6. Aaount Taxable 6 7. Tax Rata 7 X 8. Tax Dua B Under penalties of perjury, 1 declare that the facts I have reported above era true. correct and cowplete to the bast of Dy knowledge and belief. HOME t ~ %, WORK C ) -~ ~-Crt TOXPAVFR ST6N TuaE TELEPHONE NUMBER DATE PART DEBTS AND DEDUCTIONS CLAIMED narE PATD PAYEE DESCRIPTION AMOUNT PAID CO!lIOI~a7EALTN OF PElWSYLYAm1A - DEPARTNENr of REVErwE INFORMATION NOTICE aUREAU OF INDIVIDUAL TAXES WEPT. 2saeal AND NARRISauRS. PA 17128-8681 TAXPAYER RE S P O N S E am-LSCa oc µv us-au TERRI L COLEMAN 102 HOLLENBAU6H RD CARLISLE PA 17013 FILE N0. 21 07-1055 ACN 08106178 DATE 02-13-2008 TYPE OF ACCOUNT EST. OF MAUDIE C GOONS ® savlNCs S.S. NO. 293-18-9437 ~ CNECKIN6 DATE OF DEATH 11-13-2007 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 OR(2STONN BANK has provided the Department with the information listed bala+ which has been used in caleulatinp the poterrtial tax dw. Their rocords indiwta that at the death of the above decedent, you wen a joint owmrlbeneficiary of this account. If you feel this information is incorrect. Olease abtaia written correction from the financial institution, attach a copy to this form and rtturn it to tM above address. This account is taxable in accordance with the I Mreritance Tax laws of the Coemonwealth ---of POnnsylvania:--iMastiwn-saorfio--answarad~fi:r-ealli*w -Efi}7~--737-8327. -- ------______-._----- --- --- _ ~__ COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 70b001811 Date 02-11-2005 To inwro proper crodit to your account, two Established C2) copies of this notice mus! accompany your Account Balance 77 vap~ment to the Register of Bills. Make check 76 928 , . payable to: "Register of Mills, Agent^. Percent Taxable X 50.000 Amount Subject to NOTE: If tax payments aro made within three Tax 38 464 39 , . C3) months of the dscedent•s date of death. Tax Rate X , jrj you mwN deduct a 5X discount of the tax due. Potential Tax Due 5, 769.66 w,ar inMritance taz dw will become delinquent nine C9] aa~ths after the date of death. P T TAXPAYER RESPONSE ~ 1 A. ~ Tlw above information aaW tax due is correct. - I. Ymimi may choose to remit payment to the Register of M311s with two copies of this notice to obtain CHECK a discount or avoid interest. or you may ehedc box "A" and rtturn this notice to the Register pf ONE Yills and an official assessment will be issued dy the Department of Revenue. " ~ C BLOCK a. ~C_ C_L11•Y ~ The above asset has been or will 6e reported an/~ax wid with the Pennsylvania Inheritance Tax return ONL Y to be filed by the decedent's revrosentative. C. ~ TM above information is incorrect and/or debts and deductions wore paid by you. You must complete PART ~ and/or PART 3^ below. PART If You indicate a different tax rate, please state your a relationship to decedent: TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rats 8. Tax Du• PART a DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) Te]rpevFrz c`(~N~T IRF --h~~ TELEPHONE NUMBER DATE OF TAX ON JOINTJTRUST ACCOUNTS 2 3 X 4 5 - 6 7 x 8 GENERAL INFORMATION 1. FAILURE TO RESPOND MALL RESULT IN AN OFFICIAL. TAX ASSESSMENT with applicable interest based on intonation subsitted by the financial institution. 2. Inheritance tax becopes delinquent nine ponths after the decedent's data of death. 3. A joint account is taxable won though the decedent's new was added as a utter of conranianea. 4. Accounts (including those Mld between husband and wife) whits tM decadent put in joint napes within one year prior to death are fully taxable as transfors_ 5. Accounts established jointly between husband and rife pore than one year prior to death are not taxable. 6. Accounts held by a decadent ^in trust for^ another or others are taxable fully. REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE i. BLOCK A - If tM inforsation and eosputation 3n the notice aro correct and deductions aro not being claired. place an "X^ in block ^A^ of Part 1 of tM "Taxv~rer Respanse^ section. Sion tro copies and subpit they with your cl:edc for the asour:t of tax to tM Register of Pills of tM Ce1p:tY indicated. TM PA Departawnt of Revenue rill issue an official assasssent tForp REV-1548 EX) upon roeaipt of tM roturn fray the Register of Mills. 2. BLOCK B - If tM asset specified on this notice Ms been or rill be reported and tax paid witA tM Pennsylwnia Inheritance Tax Return filed by the decedent's roprosentative, place an `7c" in block ^B^ of Part 1 of tM "Taxpayer Rasponse^ section. Sign one copy and roturn to tM PA Oepartpent of Revenue, Bureau of Ir:dividual Taxes, Dept 280601, Harrisburg. PA 17128-0601 in the envelope provided. 3. DLOCK C - If tM rrotiu inforsation 3s incorrect and/or deductions are being claised. check block "C^ and eawleto Parts 2 and 3 aceordiw to tM instructions belay. Sion two copies and subsit they rith your ehadc for tM asour:t of tax p~raible to tM Register of Mills of tM county indicated. 7M PA Oepartsant of Ravenw rill issue an official assosssent (Fors REV-1548 EX) upon receipt of tM lyeturo_froathe Register of-Mills., -. TAX RETURN - PART 2 --TAX COMPUTATION LINE 1. Enter the date tM account originally was established or titled in tM Banner axistin0 at date of death. NOTE: Fer a decadent dying after 12/12/02: Accounts which the decedent put in joint napes within one Q) year of death are tmcable fully as transfers. However, tMro is an exclusion no# to exceed t3,f00 per transferee regardless of tM value of the account or the Muber of accounts held. If a double asterisk [xa) appears before your first nape in tM address portion of this notiu, tM «3,800 exclusion already has been deducted frog the account balance as reported by the financial institution. 2. Enter tM total balance of tM accowit including interest accrued to tM data of death. 3. The percent of the account that is taxable for each survivor is deterpined as follows: A. TM percent taxable for joint assets established amore than one year prior to tM decedent's deaths 1 DIVIDED BY TOTAL NUMBHt OF DIVIDED BY TOTAL MUHBER OF X 100 = PERCENT TAXABLE ..JOINT OlAM3LS SIBNIViNG JOINT OYSERS Exapples 'A joint asset registered in the name of tM decedent and two otfwr persons: 1 DIVIDED BY 3 CJOINi 0)MERS) DIVIDED BY 2 CSURYriORS) _ .167 X 100 16.7X (TAXABLE FOR EACH SURVIVOR) B. The percent taxable for assets created within one year of tM decedent's death or accounts owned by the decedent but held in trust for another indiridualCs) (trust beneficiaries): 1 DIVIDED BY TOTAL NUNBEit OF SURVIVING ,PINT X 100 = PERCENT TAXABLE OHNERS OR TRUST BENEFICIARIES Exasple: Joint account registered in tM nape of tM decedent and two otMr versons and established within one year of deatA by tM decedent. 1 DIVIDED BY 2 (SURVIVORS) _ .5B X 100 = 50X (TAXABLE FOR EACH SURVIVOR) 4. 7M asount subject to tax (line 4) 3s detersined tier awltiplyiryt the account balance Cline 2) by the percent taxable Cline 3). 5. Enter tM total of tM debts mod deductions listed in Part 3. 6. TM apount tmcable tlirw 6] is deterained by subtraction tM debts and deductions Cline 5) frog tM asount subject to tax Cline 4). 7. Enter tM appropriate tax rate (line 7) as deterpined below. --_='--Dato~o#--Death------~- - ~_- Spauaa-~_: ----Lieaa].-_- -- ----S3blinn- - Collateral 07/01/94 to 12/31/94 3X 6X 15X 15X 01/01/95 to 06/30/00 OX 6X 15X 15X 07!01/00 to present ^ M tax rata iaaased on t OX net value tran 4.5X# sfers fray a deceas 12X ed child twentar-on 15X e rears of aoa or v ~unpar at aeatn to or ror the use or a nature parent, an a0optiw parent, or a stepparent of the child is OX. Tha lineal class of Mirs includes grandparents, parents, d:ildran, and lineal descendents. "Childron^ includes natural children whether or not they haw boon adopted by otMrs, adopted cb3ldren and step children. 'Lineal dascerwNnts^ includes alI ehildron of tM natural parents and tMir descendents, wMther or rrot thy hwe been adopted by otMrs, adopted descendents and tMir descendants and stw-desdr:dants. ^Siblings" aro defined as individuals rho bwe at leant one parent in copson with the decedent, whetMr by blood or adoption. TM "Collateral^ class of heirs includes all other beneficiaries. CLAIMED DEDUCTIONS - PART 3 - DEBTS AND DEDUCTIONS CLAIMED Allowable debts and deductions aro detorpined as fiollowss A. You legally are respa-sible for pawsont, or tM estate subject to adsinistretion by s personal representative is insufficient to pay tM deductible itoas. B. You actually paid tM debts after death of tM deoedmit and can furnish proof of pasrpiant. ' C. Debts MinO claiewed post 6e itsized fully in Part 3. If additional spap is needed. use plain paver 8 112" x 11^. Proof of paysent sear bo requested 6y tM PA Deparber:t of Revenw. ORRSTOWNBANK A Tradition of Excellence ~' ORRS P.O. Box 250 o Shippensburg, PA 17257 0 Date 11/30/07 Page 1 Primary Account 706001811 Enclosures 'lll'I~{11'Ii~1'I'11111'1'~Ii'1~~11111'IIII~I1111~~'II'llllll~ 4519 0.6804 AV 0.312 TR00018 Maudie C Coons Terri Lynn Coleman 1318 Brechbill Rd Chambersburg PA 17202-8033 Building? Buying? Remodeling? We can help! 1.88$.ORRSTOWN - orrstown.com A C C O U N T S U M M A R Y Account Number Account Title Current Balance Enclosures 706001811 Prime Statement Savings .00 4000014246 __6-11 Month CD_ __ _ _ .00 4000018412 6-11 Month CD 56,761.20 S A V I N G S A C C O UNT S 0 rn 0 0 N 0 0 0 0 .-., o m o .-~ ~ M N c+~ O o O aD ~ N N a ~ N d' I~ O .--~ Account Title Maudie C Coons Terri Lynn Coleman * REGULATION E Prime Statement Savings Account Number 706001811 Previous Balance 76,829.06 1 Deposits/Credits 84.93 1 Checks/Debits 76,913.99 Service Charge .00 Interest Paid 365.73 Ending Balance .00 Detail Transactions By Date Date Description 11/16 CD Interest Cert No. 4000018865 11/20 Interest Deposit 11/20 Close Account Interest Rate Summary 0 Statement Dates 11/Ol/07 thru 12/02/07 Days In The Statement Period 32 Average Ledger 45,627.87 Average Collected 45,627.87 Interest Earned 136.01 Annual Percentage Yield Earned 3.45% 2007 Interest Paid 2,662.23 Amours t 84.93 Balance 76,913.99 365.73 77,279.72- 77,279.72 .00 10/31 3.400000 ~ o -ra ~ --~ a ~ ~. `~ ~ `~, ~ 7 ~ o~ .~ FINAL ~errl-L nn ~4~2mQn ©r SETTLEMENT SELLER NAME ~ S~Q~e o- f 1~1 e and ~ e ~ OO (1 S ~~pp DATE OF SALE 1Y1~ ~r a a~ ~ ~ a ~ ~ ~ ~ e t1 ~ Q ( C Q ~ ~ ' AD DRESS Ca r~,`s 1L° 1 U . ~ PHONE ~ ~~ .~ ZIP LOCATION OF SALE ~ a ~ ~ a. S G~ ~ ®~I ~ AUCTIONEER ~ e J ~ n M 1~1 + C k Q r~ - PHONE J ~ ~ ~ ~ f ~ `~ 53 I' ` st ,~ v'. tea PROFESSIONAL FEE AUCTIONEER $_ + ~ / +~~ ~~ - CASH $ S/- !~ ~ CLERK f a ~/~ $ CHECKS $ ! I~ 5~ ~~ CASHIER $ OTHER RECEIPTS OTHER EXPENSES $ ~~ ~~r~i5irl ~~ ~~ ~~ $~7 ~~ $ . $ $ ~ 0 r ~- - rl_ $ g~~ 3 ~ m;. $ v,3 $ D ?~.2tF. .er: ;,~ ~~ ~ $ ~ 9 0 $ ~~a ~= $ $ $ $ _l. i3 15 i r~.~LL~ n~ S 'U F. hA (CL Y_ ~~~0 G. `U , $ ~$ ,~[ $ TOTAL RECEIPTS $ $ LESS TOTAL EXPENSES $ TQTA1. EXPENSES $ a ~• i~ J t ~~. ~ '`I`mo" PROCE'ED3 ~1~~' SELLER` r ~ ~ ~ ~ ~ { 1 (or we}, the seller, acce t this settlement and acknowledge receipt of the above specified net proceeds from the auction of my goods and property sold on the above date. I accept all responsibility for providing merchantable title to all goods, and property sold, and for delivery of title to the purchaser. Le A~~~"..~C ~ Date Auctioneer or Cashiers Signature ellers Signature) S"' 3 ~ " ~ ~ Date Date D~ h~ ~ it ~ N~ ypd, (Sellers Signature} -:.V ^ ~"1 • Ll hl l • f- a ~ a •7~ f 1 ~ r f • r as r `7- n e~ 1 ~ ~ a~ ~ ~~ ~ - ~ '4. `:, ~:R '.~ DEPARTMENT OF TRANSPORTATION 60 ` CERTIFICATE OF TITLE FOR A VEHICLE issued in accordance with Section 1105 of the Yehicle Code. Title 75. Pennsylvania Consolidated Statutes -{4'{ ~a! 892280052006481-0©]~1. ~. r U ~# J LYNN E MAUDIE C COONS 102 HOLLENBAUGH RD CARLISLE PA 1701,2 CODE LEGEND A = ANTIQUE VEHICLE C =CLASSIC VEHICLE F =OUT OF STATE VEHICLE H =AGRICULTURAL VEHICLE L m LOGGWG VEHICLE P ~ FORMERLY A"FOUCE VEHICLE R =RECONSTRUCTED VEHICLE X = FORMERLY A TAXI 42185502b01 CO 0 89 CHEVROLET SDN TRLE NUMBER DUPL YEAR MAKE OF VEHICLE TYPE SEAT CAP SPATE OF OPoGIN 101LT54W4KY1617?2 VEHICLE ~ENTIFICATION NUMBER MAX GROSS vEHK;LE WEIGHT MAX GROSS COMB. WEIGHT 8/2b189 8126/89 21 MLADEN WEK~tT DATE ISSUED DATE PA TITLED ODOMETER AT PURC.FtPSE CODES The vehicle described heYlDOq is subject to the fallowing liens: ,. FIRST' LIEN FAVOR OF: LIEN RELEASED DATE LIEt4 HINDER BY ~- AUTHORIZED REPRESENTATIVE SECOND LIEN FAVOR OF: LIEN RELEASED DATE LIEN HOi,DER BY AUTHORIZED REPRESENTATIVE 1 cerYlry~ that reasonable diligence bas bern ased hr eraminialt the statements prrsMted in the application for Cenificam of Title to the vehicle described hereon. ,~ ~ ,y ; ~ ~j and that the proof of ownership of .said vehicle prtsented with said applicaton , :" r*,Yrt;.:" ' •-~;wCt i unrranrs the issuance of ih& certificate naming nc~ applrcaM as lawhrl owner of - d~ ~~ '~ said vehicle Wherefore. 1 certify that as of the date iasrribed hereon. the atTkral ~ J .„~ it li ~,`~ ,,.: ~-~ ra cords o! the Pewrtsyhatria Deperrmem of Transportsrlon rethct that ssld appticam is the I®wtitl owner of said vehicle Secretary oT Transportation r i ...~~ SELLER'S COPY 3~ ...~~ 019/3. a BY MARICK 8 CO., NEW PROVIDENCE, PA.17580 BY MARICK 8 CO., NEW PROVIDENCE, PA.1 7580 ITEM/RECEIPT SYSTEM ® AUCTION CLERKING SYSTEMS ITEMJRECEIPT SYSTEM ® AUCTION CLERKING SYSTEMS -1 -7 ~~ 9~ 7 s1 ~~-,„ U~ Buyer Lot ( UV` UV Buyer ~ Lot ~ / s ~ ~J/ \/- `~ V BY MARICK & CO., NEW PROVIDENCE, PA.17580 ITEMJRECEIPT SYSTEM ® AUCTION CLERKING SYSTEMS -2 BY MARICK 8 CO., NEW PROVIDENCE, PA.17580 ITEMJRECEIPT SYSTEM ® AUCTION CLERKING SYSTENS -8 Lot ' ~ ~ ~ Buyer Loi / ~ ® ~ Buyer ~~ !! ` ~v V BY MARICK 8 CO, NEW PROVDENCE, PA.17580 ITEM/RECEIPTSYSTEM® AUCTIONCLFRKINGSYSTEMS -3 BY MARICK 8 CO., NEW PROVIDENCE, PA.1 TSbO ITEMJRECEIPTSYSTEM® AUCTION CLERKING SYSTEMS -9 1~ ~I ~j9 Lot ~~ Buyer ~° Lot ~ ~ ~~ BuYef / ~ ~~ BY MARICK 8 CO., NEW PROVIDENCE, PA.17580 ITEMJRECEIPT SYSTEM ® AUCTION CLERKING SYSTEMS -4 BY MARICK 8 CO., NEW PROVIDENCE, PA.17560 ITEM/RECEIPT SYSTEM ® AUCTION CLERKINGSYSTFMS -10 ~~~ ~~ Lot ~ •,~ Buyer Lot ~ Buyer ~~~~~`^' VJ ~~JV~ 11''^~ ~~yIV ~~ BY MARICK 8 CO., NEW PROVIDENCE, PA.17580 ITEMJRECEIPT SYSTEM ~' AUCTION CLERKING SYSTEMS -5 BY MARICK 8 CO., NEW PROVIDENCE, PA.17580 ITEMJRECEIPT SYSTEM ® AUCTION CLERKING SYSTEMS -11 9.~~ ~~~ Lot v~` Buyer Lot ~ ~ Buyer BY MARICK 8 CO., NEW PROVIDENCE, PA.17560 BY MARICK 8 CO., NEW PROVIDENCE, PA.17580 ITEM/RECEIPT SYSTEM ® AUCTION CLERKING SYSTEMS ITEMJRECEIPT SYSTEM ® AUCTION CLERKNG SYSTEMS -6 5 -12 ~j H " ~~ T Lot ., j (~ Buyer N~• Lot _~`~ Buyer ~~,~.. ~' ~ 074561 . Va.~..+..e_. r TOTAL QRRSTOWN six A Tradition of Excellence June 11, 2008 To: Wagner's Tax & Accounting Service 340 East Louther Street Suite 1 Carlisle Pa 17013 From: Traci Yohe Orrstown Bank Customer Service Center PO BOX 250 Shippensburg, Pa 17257 Re: Estate of Maudie C Coons Date of death November 13, 2007 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 Principal 412619 Maudie C Coons 11/12/96 25127.06 J Lynn Coons Accrued Interest 14 SA VINGS ACCOUNT Account # Title of ~^-account late opened Principal Accrued Interest 706001811 Maudie C Coons 02/11 /05 76829.06 93.04 Terri Lynn Coleman CERTIFICATE OF DEPOSIT Account # Title of Account 400001.4246 Maudie C Coons 4000018412 Maudie C Coons Terri-Lynn Coleman Date Opened Principal Accrued Interest 12/O110b 20792.77 24.88 ,~ 08/02/0' 56533.98 83.31 4000018865 Maudie C Coons 08/17/07 20000.00 73.97 ~ - ---__. P.O. Box 250 • Shippensburg, PA 17257 • 717.530.3530. 717.532.4143 fax LAST WILL AND TESTAMEN'T' OF MAUDIE CORDELIA COONS I, MAUDIE CORDELIA COONS, a legal resident of South Middleton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby make, publish, and declare this as and for my Last Will and 'hestament, hereby revoking all other wills and codicils heretofore made by me. First, I direct that all my just debts and funeral expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. Second, 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 pari of the expense of the administration of my estate. Third, I make the following bequests: A. I devise all real property that I own at the time of my death and the personal property located upon that real property, to my daughter, Terri-Lynn Coleman. Terri-Lyrul Coleman will identify those items which are already her possessions, including furniture, stuffed animals, books, flat ware, photographs, jewelry, clothing and other personal property; these items are not to be included in my estate. Should my daughter, Terri-Lynn Coleman, fail to survive me by thirty (30) days, the real and personal property described in this paragraph shall become a part of my residual estate. I bequeath certain articles of my household furnishings, personal effects, and personal property as set forth in a separate memorandum, which I intend to sign and keep with my copy of this Will, to the persons named in that memorandum. B. My residuary estate is defined as the assets of the estate that are in the estate after the deduction of debts, funeral expenses, taxes, and those items bequeathed in subparagraph A, above. If my residuary estate contains cash assets of $100,000.00 or more, I devise and bequeath the following cash amounts to the below-listed persons, who have survived me by thirty (30) days. If any of these persons has failed to survive ine, the deceased person's portion shall become a part of my residual estate. To my nephew, Samuel L. Stine, $2,000.00; 18 v U C~ To my nephew, Kenneth L. Stine, $2,000.00; ` To my nephew, William L. Stine, $2,000.00; To my niece, SueAnn Masser, $5,000.00; To my grandnephew, Jerry L. Miller, $2,000.00; Page I l; -' <'~ MCC To my grandniece, Shelly Jean Wetzel, $2,000.00; and To my friend, Pauline WurII, $3,000.OU. If my residuary estate contains cash assets of $100,000.00 or less, no distributions shall be made to the specif c persons in this subparagraph. D. I devise and bequeath the remainder of my residual estate, of every nature and wherever situate, as follows: Seventy-five percent (75%) to my daughter, Terri-Lynn Coleman, and twenty-five (25%) to my nephew, Lynn Levi Reed, provided they shall survive me by thirty (30) days. Should Lynn Levi Reed fail to survive me by thirty (30) days, I devise and bequeath the whole of the remainder of my residual estate to Terri-Lynn Coleman. Should Terri-Lynn Coleman fail to survive me by thirty (30) days, I bequeath twenty-five percent (25%) of the remainder of my residual estate to Lynn Levi Reed; and seventy-five percent (75%) of the remainder of my residual estate shall be divided equally between the following charities: 1. The Humane Society of the Harrisburg Area, Inc., at Sinclair and Eppley Roads, Mechanicsburg, Pennsylvania. 2. The American Heart Association, Pennsboro Center, 1019 Mumma Road, Suite 200, Wormleyburg, Pennsylvania 17043 45250-9721. The Disabled American Veterans, P.O. Box 14301 Cincinnati, Ohio Fourth, I nominate, constitute and appoint my daughter, Terri-Lynn Coleman and my nephew, Lynn Levi Reed, as Co-executors of my Last Will and Testament. Should either of these persons predecease me, the other shall serve as sole executor. If both of these persons shall predecease me, I nominate, constitute, and appoint my friend, Doris Trostle of Carlisle, Pennsylvania, as the executor of my Last Will and Testament. I hereby relieve my Executors or their successors from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act, insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisti g of four (4) typewritten pages, each of which bears my initials, ibis ~(~Jtday of ~[' ~ , 2004. .,~,il Ix R., ;1. .. ,. ~',.~ ., MAiJDIE CORDELIA COONS TESTA"PRIX Page 2 ~ ~.. ~ ~ ~ ~_ MCC ` LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate. $b.00 ~ ~ ,i V Certification Number 'his is to certify that the information here given orrectly copied from an original Certificate of Deg my filed with me as Local Registrar. The origir ertificate will be forwarded to the State Vi records Office fnnor~~,,p....e'r~~manent filing. ~• C3hlan!~t~ Q y 1 4~ 20i ._,ocal Registrar Da//te Issued ~~ 1os-1,13 REy llrzooa COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ryPERAUNENiN CERTIFICATE OF DEATH BUCK INK (Sce instructions and examples on reverse) STATE FILE tJUMBER w v 1. Name d Decedent IRrst mime, rest sutNxl 2. Sex 3. Social Secumy Number 4. Dale of Deelh (Month, day, year) Moodie C. Coons F 293 - 18 - 9437 11/13/2007 5. Age (test BiMMY) under 1 year UMer i M 6. Data d t3irm (Norm, daY. rear) 7.8dmplece (C8Y antl stem «fweyn wlnnVy) Ba. Place of Dam (Check anry one) cy„ew p~ Haxs klkwtes Haspael: Other. 94 rm. 8/ 10/ 1913 Newburg, PA ~ mpatiaM ^ ER, a>~adam ^ DOA ^ Hamirq Home O Raakterxe QOater ~ Speciy: • Camry d Death Bc. Ciry, Bore, Twp. d Dam Bb 9d Feddry Name (If rml Fadmdon, give street aM rwmber) 9. Wee Decedent al Hlapanc Origin? ®No ~ Vas 10. fiace: American Indian, Bmck, While, etc. . ~ III Yes, sgedly Cuban, {SPadM Cuml~rland oath Middleton Maxken, Puerto Rican, etc.) White Carlisle Tonal Medical Center n. Decedents Usual don KkM d wok done moll d Nfe Do notsmmmdred 12. Was Decedent aver in Me13. Decedent's Education (Specify only hghast grade completed) 14. Manmf Status: Marred Bever Marred, 15. Survrvmg Spousellt wile, 9^re maiden name) Widowed Dhromad (Speciryt Kintl d Wark Kktl d tluakkseY IMUSIry . U.3. Armed Forces? rUemenmry I SeconMry (0.12) Collage (1 d w 5+) H~laker Her ov~in bane ^vea ®No g Widaaed - • 1fi. Decedents Mating Adtlress (Street cky! town, emte, zp cede) Decaents Did DaceMnl DeceMm LMad m South Middleton Twp PA LNe m a t?c ~ Yea i 17 l A s 102 Hollenballgh Rd. . , del Res dence a. a e ~ Townshtp7 17d ^ No Decedent tied wdhin Carlisle, PA 17015 . , ,?6 Gounq Ctmiberland Adalumitsd cny,Bwa 18. Fedsr'a Nmre IFkal, middle, rest sulhxl 19. Modrer's Nerve (Fxsl, mitlUe; rtsWen sanamel Jacob Stine Bertha Watkins 20a. IMOmwnYs Name (type /Prim) 206. IMOnant's Maltirp Atldress (sral, city / bwm, emte, zip code) Fairbanks, Alaska 99707 PO Box 70966 Terri-Lynn Co1a(1an , 21a Matlad d OiaposAbn ~ ~ Cmmalial ^ DarsEm S~~l B val bare sere ~ l l ^ R m B Aum d D 4 • 216. Dale d Oisposllion (March, My, yeatf 21c. Place d Dispositlm (Name d amdery• «ematorY w Deter place) 214 Location (CdY / tizaw, smte, mdel '~1171tY C ~r~yaTld ' rx e e o wu Drw;MnMl ar e1M M w e ^ c~r.spaay gwdwlExaminaYCoralx4 ^Yaat]Nn 11/17/2007 Mt. Zion Canete>:y r Mp F1 it^'k' 2 ~ 22a. Sigudee d F Uaensea (a pereon 22b. license Nunber 22c. Name atd Address d Fadfiry - FD 012633 L Etain Brothers Funeral Home, InC.e Carlisle, PA 17013 CompMe Harts 23ac oMy wren cer6fYmg 23a. To ds beat d my mace et the ti to and pmce Hated, (Sgnedea arM Imal 236. Lxxtse Nurtaer 23c. Gate Signed (Monet. My, year) plrysidan's red aveim6le at time d dam to /~ 7f ~ ~ PLC®0 7 ~ ~ 69 - ~- g//S / ~ 7 cash oauadeam. ~ / { Rama zasfi matt 6a ~«nplema M pemon za. rYa d Deem f- f zs. Dam Pmnanxed Dead (Monet. ear. roan ze. was tea Rerened m~Ne4~cal FxaminBr / co~a,ar mr a Raea«, otl~ar roan cmmadon « I>onadon? ~ wM Dt«nuxm tleam. 6 M. •' ~F j~ r0 7 Yes []~lo CAUSE QF DEATH (Sae Metrudtlons and exam bs) r Appmsimate interval: Part p~. EMer timer 211. D'M Tabeao Ilea CarcrAumb Deem? dam 27. Pan 1: Emer the dwn d evens - dHeesa, YYunea, d mnplredom - tlta directly yanme ale deem. W NOT enter lenninel evenm ouch a cerdec ermsL Orsel b Deem but not resulting in the Warlying cause given m Pad I. ^ Vas ~ PmhabNY reepimtaty areal, a Venbialmr tlbndaAon wimW ehawNg ds elulogy. L'al aYy are ease an each Ilrs. [3'1~' ~ UMmawn MMG]MATE CAUSE IFred dBase or n o«xfsm mwtlNg in deem) i a. Lo L t T i S ~ 5 D 1r`t ~ ?9. M Fareb: l wimm ast [~-f~T re te ear DUB l01« m a Ixxlagaallae oq: M awdltlors,Aerry, 6. nA.~SF~w'T~+~-t Cr 1 3C1-{ ~c~11~R ; ~'t+o ^/rNS Y p p n p ^ Prepunl a time deem En1er~ RL~CMq~E a~ Due 1o tw r a mrsequence off: ~ ^ t lea pmgrsm wMfwr 42 days Nyuy mat' tls c, laaaeew evens mwarg7n deem) LAST. Duero (w a a connapranca Dry. ~ Nd pngrmm, 6d piepmM a3 days m 1 year bdore tleetli d. w ^ llnkmwmdpraywnl wmYn ew Peel Year 9oe. Was en Aubpsy 306. Were ANaV4Y Fxl6ngs 3f. Maurer d Deem 32a. Data d Iryury IMOnm, day. Yarl 3~. Dascroe How Inlury Daurmtl 32c. Pmce pd mk~y Hone. Femi, SreeL Facmry, ~~ " ' ~. /S~yl Perbmredy Avadede Prim l0 Compleddn d Cause d ware? Q '~""al ~ "m"itlda ° ~ [] Aceaem [] Panting Imresligetlon 32e. rxa d lnjary Sze. Inpny ac work? 321. n Tnaroportelian Wan Isvn'hl 32g. Laatmn of lnrvn fsreat dry r awn. amm) Ya ~ Vas ~ No SddM ^ DaulO Nol ba lAmnnaned M [~ Driver / OperaKK ~ PasaengM ^Pedeslnan ^ Vas ^ Na S Otltar pedy. 33a Cemaer (deck oNy anal 33D. Slpnetare a Tm d • CwtNydng phyakien (Phystcmn cer«ykg ®ua d deem when amlMr physiden Has Prdmutxwd loam ntl mngmled dam 23) deem ocoumed duerotM csuw(s)entl manner nsLeled________________ __________~______ To Ne bestdmy knowlMq - , Pmram itp end urtMyhg WlyckM (Pliyaidan bore ponotvskg dam endcerdlyNtg to ease W deem) ^ s 33c. Lketiae Number 33d. Dam Signed (M«qh. day, ymr) els)and mennn ab ammd__________________ To Ute batdmytumwreaga, deem oeeamdetae ltme,Mm,.nd Plese, end due to f>b ew M lC PA.r}-p44 ~i'tr-~- YNI 1<-(~`I wanu • MadkY Exa ner On me bsele d nendnNbn end / w MveetgeMn, In mY oplnbn, Math occurred M Me tMr, dam, arM piece. arM due to Us noels) end menmr ae mlad_ ^ ~. Name arM Aeereae of Person Wta Campmted CMSe d Dam Ilte<a 27! Type / PrM , _ Kp la f f k'-'N ~} Ni 0 ~ S ~l rk ~ l e ;Regis s nee one Ada r~n~ar ~' I I I ~ I ' ' O I H F Dat~Fk ` m. me Yak x/ t . ~ Nn . . 1~.2t S'P~tnrG~ +:.c.~ ~wvtuSt~ A t'tot3 V Diaposilion Permit No. ~ ~ ,~~ ~'~ V-'