Loading...
HomeMy WebLinkAbout09-22-08REV-1 ~" r J 15056041125 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 7 0 2 5 5 Hanisbury PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 7 0 2 4 1 9 4 3 0 3 0 4 2 0 0 7 1 2 0 2 1 9 1 7 Decedent's Last Name Suffix Decedent's First Name MI M C C A U S L I N G E R A L D I N E E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW 1. Original Return 4. Limited Estate ^X 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust ~ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED ro: Name Daytime Telephone Number J A N E M A L E X A N D E R E S Q 7 1 7 4 3 2 4 5 1 4 Firm Name (If Aoolirablel ~ - First line of address 1 4 8 S B A L T I M O R E S T Second line of address City or Post Office D I L L S B U R G State ZIP Code P A 1 7 0 1 9 REGISTER OF WILLS USE ONLY rv t'7 ° --- ~ r _.. ~ cz' ~-~ rn ~ ' q :~ f - r. r-- ; r7 rv ~ - __~ ~ N ~ i - - -" ~`- _ - ' ~ _ ~ FI 4 ~ , -- .-l ~a ~' ~ vc~ Correspondent's a-mail address: jmalexander.148@earthlink.net Under penalties of perjury, I declare that I have examined this n;tum, including accompanying schedules and statements, and to the hest of my knowledge and belief, it is true, collect and compk~be. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG~y1TU~EJOF'rPE ON RES J~.SIBLE ING RETURN ~T ~ ~ D 810 Hemlock Road Iv Mechanicsbur PA 17055 SIGNATU E OF PREPARER OTHER T N P ENT NE ~AT i l ADDRES 148 Baltimo Street Dillsbur PA 17019 ' ~ PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 15056041125 J i~~ ~L = ~ V ~, Wp ~ N "~ ~ o Z a g ~ ~ ~ N ~ O a ~ o a V ~, H W N aii~~~ 1~Hy~ ' +Yt~1~.~ rR a; > - X11 ~J ppNY ~~~^ R AGENT p REGISTERE9 ~yANSPEp COM TRAN~~G~TRAR GGUNTERGIGN REGISTRAR A N~~ ~ERSEYt ANb , 9y , pGIGNATURE U rL W -p T ~ O is NU OG ~n m L N U O N ~ = ~ b PO N coda d~ Nm U 7 0 A'O o d t6 p rn m p~,(~ m 4'J Nam ~N~ 1~.. jy N T] 31 m O / momuS EN G ~ m U m ~V~E `~u C i ~ ~ ~ r G `y~'~3]Cj~1 mddc ^2 mmL~ W A a {~ 4 '3 N 3') N ~w aui'o ~~~ a,~ go gg ~_ `~y-~~c mF > ~ ~9 ~ ti ~ m c a Uorm ~X m _ ~'mZo N L, ~Q~ 9 4 TAN a °. Dc~~ m~ w ~i a t~ c c~CtU uy > ~aom m m t ~9 4 m ~- O ,. m ~ m N~NC NN N m c~b~ r:' Y LNz Cfl~m~ . )" /n O ~ moJG~m N~in Fi-.4~` U OI i F r mrL o~ *~o-'~m ,\ ~~ Cm0 N cmi L'~CL \~~ ~ & m ~ LL {pOOY.N Q ~'O .'~\~ LL Q N jQ~ ~ ~ ~~ ~oU c~Zcv~;~ N T ~ U ¢yd9~NDU`~ a U O,nQm ~: mR ~Na~-you9~a \\\\\\\' a 3`o~ym~~ `,~.` ~~'~• w Eaoi~oNW ~~~ otO~~S Z Ua¢aSU ~~ y_U~UUO z om0 ~~` ~ ~\\ c m oiN m-`-' j ~LL moW~o \\_\~~ ILL b£~N: 4:. a r Y w \ U 4 U ~ ~+. m m N > 4+ ~~ ~ ~ y / O ~ U N - ~' i ~ ~ N ~ - (n w ~ rl ti W Z J U ~ O a O .~ ~ ~ p= O n O o U ~ ~ a H rn V /O O VII~~ a o¢ w j Qy Z ~n ¢LL WO ci ~ J w3 a2 ¢O a~ ¢~ 00 U O =W . _ F ?Y iF is it W sF ~ U r~ ,r J ~'~l tt C SF ~ a ~ -ar u #- x x ~ t; ?F # t! g 'k # A~ ~ & k ~~ ,_n N n. :J ~-1 ~. ('_ p V 0. r C.)Q H Q :U .X G_ toL :7 G 4 CL ."~ ~ our J J in Q ~ Ci (~l ,,) i~::(1 Fw ~~ rv1 7 •- W F- lt W U Z F COUNTERSIGNED PND REGISTERED: REGISTRAR AND TgANSFER COM7ANV (NEW JERSEY( TRnNSFER AGENT RY /I~ - AND REGISTRRR ///////~ INN/////' pUTRORIZED SIGNATURE 1 H >- Y- :L O N C O N T'pL T~ UT= O V ] m NaCL 'O~ 0~3 wo _ ~ nm o v a maw ow c~ m m w w ~ y~wp NC ~ ~ U .~_ J m-.. N O T] m O N~ O)t 0 > dw m~m~ ~C mod.. Ew V m m U N U~ i ~~ ~U ~t m v m C m i~ 10 NUm Lr m mE Tm ~ OYF-T w ~cOro ~s o 5~ we m ~ Ua d Hm ` ' - ai z c ~ ;~ L?Q O ' m m ~~~~ ~O ~~jo Sc m ` c m i u ~ `n¢ U ~ a awi~Om w= ' pt rm amww m~ ~vrwoviUo m ~~f9c wm d U 3 m - o ro w t m m~,Z Tw w Z y~}D~~ m~ ° ° E-~roam~ ~ `a~ ' O L' m OW oL w U O, L yLL m^I~'~ y ~ S(,?OLLOm 00~ ' O u i=F-aa~.-mm U ~ m~ v ' ~ p E c mo.y~ za~Ww - Q O>,O m U `o N¢w~U~Q Q ~ L 1 .. L . U_ m L -p w ~' t6 - mc a ia¢r -O oF-y Olifi° O ~ •O o.,.z~m cmi O E~~ m c W L >. U .O Q ° w 2i ~ N 'C. VCL> O~ w m .ti m0 ~ aw m w ~ w O~~U ?~N ri N NO OL>-'00-0 L p N ~ ? ~ ~ mQ~m LC N ° ~~"~ '~~ o c m »~ _v r: Z m c ~o c m OWL m ~ ~oQaa ` oU- ,,, aawt m .,err,,,, , , oo=mu,OT! ro O_ • OY~wL- ~S w '= ~ y'_ ~ O W • / UA N m N ~ • V1 '~" owo~o b C D wNC m~ Qt~,. r m.~ mL N oom ,i1y ~~. I\ ~~-~ o 'i''N \ V N ~' ~ ~ a fA W Z ~ w ( ~ a ¢o O a U 0 .~ 0 ~~ ~'~ int , r~ a f I ~.' ~• III NJ QN SW I QLL W; aZ ~o 0 iYlu' ¢o OU U =W ~ -f COUNTERSIGNED AND REGISTERED: REGISTRAR AND TRANSFER COMPANY (NEW JERSEV7 TRANSFER AGENT Ry AND REGIGTRAR /a~" AUTHORIZED SIGNATURE T'OL T~ U ~ U1 U ~ 7 N ~ o N 3 w o ~ D_N O U a L ri ~ - CO~'d ON I N ,~ TV'AO ~C C r ~ U ~ O ~ a o of o cv UU w d mm p ' L. ~~ NO a {F #' fM.R # Nod.'g Ew Vl '1F' 3F' !~{' if' # _m N U Ut U d ~ 3 # SF:. tH r .~ v ~ c V #' +~' .~ ~ nl m a i d C a~:c ro F ~.. t`. +*1 dt a i y d E T m sF ~ m rr #. F ' ' ' ' L :. k . cif l ~ 3 F Dj C C ~ ~ N =wm R tt tF tt u z~ ~ ~ . >¢o °'~ a ~ ~¢!0 ~ p ~ V N~ O O C ~ ~ N ~ > uci aW (j cro o ~ i d ~ L Q d [) w O .,J N N O> O O vi W U.. ~ W m N N_~ N C N. LN ~ ~O~ ro ~ rof il U L ~'Z ~' y 'O N ro _ O Z yC Ji c0 N~ L J O O ~ ~ C~ Of6 F 2 ~ i'l.' roD-CN Ups y O a ~ fY m -o W O L y U rn u~ d d oa~cw`~~~~D= ~' th }^ LL C TL W pF,,O O O~ r`" ro ,.,,.) Z C U O~ c W 0.1 N ~.J O ~c>~a ° a .c~.. a y ~ Na 111 ~L~ ~ ~ r~ W V yL'Om J ~ N ~ a~~~ y ro r ..7 ~-"'~ Vi C OH roLON~ V `.1.` :Y W o.=Z~ L W U N V ~ W S 1J etI wc La a Eo >,.1 U C,l .rT z U L U o° ~~ «-. i7G ~ ~"" o r v Q ~~ o~~ m CZ ,li :G'. z dO ~ aw ro.~ N y O - = U ~ N m F- ,Q ~ I ro._ 3 o o a ma~O L zuc:U~ a o ~ a « 3 ~ d c a v m z ~ £to a~i_°O? ~~ ~ loam L~ u_ D~Hy0 ~ ro o D C Z N C O W L N N. m ~m~~a ~ ' ~ °-W L w F- ~ ~... ... o o¢~n~ c U a ~ m ,~~~~ oP Nom w I , c~= o~ ;ag ~~~: a J_ 0 f 4"=mr r o= Q C _; o at _ .r ~ G L~ y O . OY~N V ` = W U O ~/~ ~ p ~OV m~~U c -o y N C m ~ NN~~~ ro . d L ro THE CHECK BELOW REPRESENTS A DIVIDEND PAYMENT SOVEREIGN BANCORP, INC. Ta inquire about your account, contact Mellon Investor Services Toll Free Number 800-685-4524 Outside the U.S. (Collect) 201-680-6578 Hearing Impaired 800-231-5469 Would yort like your flrvide~2d F~ryhZer~t DepOSited into your bank account inslead'c~~`~rece;i~ling checks vy main? Simply enroll in our self-service program by using the option below. Login <<~ Investor ServiceDirect~~' at www.mel loninvestor.comJisd ______ • Choose your account from the My Pnrffoiio gage which will .take you to the: Account Summary page. >~ • Clock »edit r~e~ct to pividend ~istributiot7s in the Account I~refereflces bc~x on the right hand Side. '• Select ~lectranic©epos~t. Click on Continue>~ and fol#ow the errrollrfler~t irl5truction5: Have one of your checks handy. You will need to refer to the bank information printed across the bottom of your check. ----- - ---- ----- - -- - --------- - --------------- - ------------------------------------------------------------------------------------- RETAIN FOR VOIJR RECORDS ~nn~arirai~~r rAx Inllro~t~arloN ~ 7RANSaeTION' C~Ir'1`AtL. SHAREHOLDER OF TRANSACTION DESCRIPTION SOVEREIGN BANCORP, INC. DIVIDEND INVESTORlD CUSIP ACCOUNT KEY ISSUElCLASS OF STOCK RECORD DATE PAYABLE DATE 125214081722 205 760 84590510 MCCAUSLINGERAE0000 COMMON 08/01/2007 08/15/2007 RATE PER SHARE NO. OF SHARES OWNED GROSS AMOUNT TAX WITHHELD CURRENT DIVIDEND DIVIDEND PAID YEAR TO DATE ~ $0.0800000 628.0000 $50.24 $0.00 $50.24 $150.72 TAX WITHHELD YEAR TO DATE TAX IDENTIFICATION NUMBER Please detach and retain this form for your records. $0.00 ON FILE ~~ _ °• ~,omputershare + ~~ F r : ~~ ' ~,a Computershare = vl~~~ P.O. Box 43078 ~'`,.~ Providence Rhode Island 02940-3078 ~. Within the US, Canada 8 Puerto Rico 800 351 7221 Outside the US, Canada 6 Puerto Rico 781 575 4729 0 8 515 6 vvvvw.computershare.com/att GILBERT R MC CAUSLIN °_ & GERALDINE E MC CAUSLIN TEN ENT For a change of address please call the above _ APT 202 number or visit us at www.computershare.comlatt 153 LOGAN RD DILLSBURG PA 17019 Holder Account Number C 0009255796 I N D I~rrlll~lllllrl~~r~lll~ll~l~lr~~lrl~ll~~rl~lll~l~ll~rllrl~ll~l Record Date 10 Jul 2007 Check Number 000/088690 SSNlTIN Certified Yes Il01CSQ117R.DOMEQS.ATT.1247R 7RlI1R515(/I1R$156/i x 3~,r.:,:af*~~.,,m... x.:~wx r. ~»......:. ....~., +n ,..s~x~....,, .•~:x.n..,r , . r. er..: ee axs.m~ .mharacssr..:,^v.ro~..~wve~s-ea.. ~+r~resar_::M ~.~ ~ nss~a:.wFC-.r:~:.nssme?:.sa+rAnm,. .: ~, .•- x ,~~mewwax-nor-~~u ... .... rsaa..mv.. ;~...~r:ewamines~rv..aa :. ~.:mwwnr:,-:nr.,.~ AT&T Inc. -Dividend Payment Dividend Confirmation Participating Dividend Gross Deduction Deduction I Net Payment Date Class Description Shares Rate Dividend ($) I Amount ($) Type Dividend ($) 01 Feb 2007 COMMON 2 $0.35500 0.71 0.00 N!A 0.71 01 May 2007 COMMON 2 $0.35500 0.71 0.00 NIA 0.71 01 Aug 2007 COMMON 2 $0.35500 0.71 0.00 NIA 0.71 Year-To-Date Paid 2.13 0.00 213 1 UDC A T T '~' OOHXDA PLEASE CASWDEPOSIT THIS CHECK PRDWPTLY REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER GERALDINE E. MCCAUSLIN 21 O7 0255 Indude the proceeds of litigation and the date the proceeds wen; received by the estate. All property joi -owned with ' ht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. United States Treasury - 2006 income tax refund $726.00 2. ~ PA Department of Revenue -2006 income tax refund I $88.81 3. Adams County National Bank checking account no. 1967622 (joint owned Gilbert McCauslin, husband, died $13,689.33 11129/2000) 4. Adams County National Bank -certificate of deposit no.139127 (joint owned with Gilbert McCauslin, husband, died $63,102.02 11/29/2000) 5. Adams County National Bank -certificate of deposit no. 146570 (joint owned with Gilbert McCauslin, husband died ~ $40,712.42 6. Sovereign Bank -certificate of deposit no. 0575137229 $104,378.85 7. Pennsylvania Employees -premium refund $387.74 8. PA Department of Revenue - 2007 income tax refund $13.00 9. Holy Spirit Hospital -refund $29.00 Items bequeathed in Codicil: Marble top table and 6 plank bottom chairs, Doughtry, Cherry drop table, and Horse shoeing box were given to Richard and Ronald when house sold in December 2002,1998 Ford Crown Victoria automobile sold by decedent in 2003 r TOTAL (Also enter on line 5, Recapitulation) I $ 7~~ 1 ~7 17 (If more space is needed, insert additional sheets of the same size) ~•-19-2007 Checking Account Inquiry Next display: ,0,5, 20-0700-4 09:59:03 Current Statement for: 1967622 ASIBERTI GERALDINE E MCCAUSLIN Bal as of 2-25-07 11,963.67 OR J RICHARD KING +Dep/CR: 6 2,327.80 310 HEMLOCK ROAD -Chks/DR: 3 664.04 MECHANICSBURG PA 17055 -Service charge: .00 +Interest paid: .00 Current b alance: 13,627.43 Pst Dt Serial Number TC Description Amount Sub Balance % Bff Dt Str/Run/Bat/Seq# 022607 010 CUSTOMER DEPOSI 590.94 12554.61 022707 1670 080 CHECK 156.96- 12397.65 022807 998 INTEREST PYMT-C 127.12 12524.77 030107 998 INTEREST PYMT-C 322.27 12847.04 030107 018 CAN LIFE US 123.33 12970.37 030207 998 INTEREST PYMT-C 239.14 13209.51 030207 018 US TREASURY 303 925.00 14134.51 030207 1671 ~~ 080 CHECK 445.18- 13689.33 More... F3=$xit F8=Receat trans F16=Priat research stmt F11=Fold/uafol d F13=Inquiry window F15=Restart F24=More keys ' OM-19-2007 Time Inquiry Next Display: „2, 30-0700-1 09:51:05 Basic Acco unt Data JHARTLAUBI Account number: 139127 006 M *------------Customer Data-------------* Short name: MCCAUSLIN GERALDIN GERALDINE E MCCAUSLIN Type: CERTIF OF DEPOSIT OR GILBERT R MCCAUSLIN *------------Balance Data-----------* 310 HEMLOCK ROAD Current balance: 63,102.02 MECHANICSBURG PA 17055 Hold amount: Available Balance: 63,102.02 Interest due: 145.18 Home phone: 717-432-5408 *--------Basic Inter est Data--------* Business phone: Interest rate: 4.940 Officer: 606 TIN/Crt: 170-24-1943 C Average rate: 4.940 *------------Payment Data-- - -* Daily factor: 8.540385 Next payment date: 4-02-07 Int paid YTD: 768.64 Payment amount: 264.75 Interest W/H YTD: .00 Disposition: (TRANSFER) Interest method: SIMPLE INT Last payment date: 3-02-07 *-----------Account Dates-----------* Last payment amount: 239.14 Issue/Open date: 9-02-97 Last payment APY earned: 5.05 Last renewed: 9-02-06 *---------------Comments---------------* Maturity date: 6-02-07 Automatically renewable: YES F3=Exit F13=Inquiry window F15=Restart ' 0`?-19-2007 Time Inquiry Next Display: „2, 30-0700-1 09:50:51 Basic Account Data JHARTLAUBI Account number: 146570 004 M *------------Customer Data-------------* Short name: MCCAUSLIN GERALDIN GERALDINE E MCCAUSLIN Type: CERTIF OF DEPOSIT OR GILBERT R MCCAUSLIN *------------Balance Data-----------* 310 HEMLOCK ROAD Current balance: 40,712.42 MECHANICSBURG PA 17055 Hold amount: Available Balance: 40,712.42 Interest due: 83.29 *--------Basic Interest Data--------* Interest rate: Average rate: Daily factor: Int paid YTD: Interest W/H YTD: Interest method: *-----------Account Issue/Open date: Last renewed: Maturity date: 3.930 3.930 4.383555 263.04 .00 SIMPLE INT Dates-----------* Automatically renewable: 10-30-98 10-30-05 3-30-07 YES Home phone: 717-432-5408 Business phone: Officer: 606 TIN/Crt: 170-24-1943 C *------------Payment Data --------------* Next payment date: 3-30-07 Payment amount: 131.53 Disposition: (TRANSFER) Last payment date: 2-28-07 Last payment amount: 127.12 Last payment APY earned: 4.00 *---------------Commeats- --------------* F3=$xit F13=Inquiry window F15=Restart REV-1509 EX + (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GERALDINE E. MCCAUSLIN 21 07 0255 ff an asset was made joint within one year of the decedents date of death, rt must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. J. Richard King 310 Hemlock Road I Son Mechanicsburg, PA 17055 B C JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 1011/02 Adams County National Bank Certificate of Deposit No. 162010 $100,024.13 50. $50,012.07 2. A. 12!24!02 Adams County National Bank Certificate of Deposit No. 162022 $112,473.50 50. $56,236.75 3. A. 819/03 Adams County National Bank Cert~cate of Deposit No. 162100 $10,000.00 50. $5,000.00 4. A. 9/23/03 Adams County National Bank Certificate of Deposit No. 162315 $31,565.61 50. $15,782.81 TOTAL (Also enter on line 6, Recapitulation} I S 127,031.63 (If more space is needed, insert additional sheets of the same size) ' 03-19-2007 Time Inquiry Next Display: 2, 30-0700-1 09:50:36 Basic Acco unt Data JHARTLAUBI Account number: 162010 000 M *------------Customer Data-------------* Short name: MCCAUSLIN GERALDIN GERALDINE E MCCAUSLIN Type: CERTIF OF DEPOSIT OR J RICHARD KING *------------Balance Da ta-----------* 310 HEMLOCK ROAD Current balance: 100,024.13 MECHANICSBURG PA 17055 Hold amount: Available Balance: 100,024.13 Interest due: 207.17 Home phone: 717-432-5408 *--------Basic Interest Data--------* Business phone: Interest rate: 4.200 Officer: 612 TIN/Crt: 170-24-1943 C Average rate: 4.200 *------------Payment Data--------------* Daily factor: 11.509626 Next payment date: 4-01-07 Int paid YTD: 1,035.87 Payment amount: 356.80 Interest W/H YTD: .00 Disposition: (TRANSFER) Interest method: SIMPLE INT Last payment date: 3-01-07 *-----------Account Dat es-----------* Last payment amount: 322.27 Issue/Open date: 10-01-02 Last payment APY earned: 4.28 Last renewed: 10-01-02 *---------------Comments---------------* Maturity date: 5-01-07 Automatically renewable: YES F3=Exit F13=Inquiry window F15=Restart 03-19-2007 Time Inquiry Next Display: 2, 30-0700-1 09:50:15 Basic Acco unt Data JHARTLAUBI Account number: 162022 000 M *------------Customer Data-------------* Short name: MCCAUS LIN GERALDIN GERALDINE E MCCAUSLIN Type: CERTIF OF DEPOSIT OR J RICHARD KING *------------Balance Da ta-----------* 310 HEMLOCK ROAD Current balance: 112,473.50 MECHANICSBURG PA 17055 Hold amount: Available Balance: 112,473.50 Interest due: 262.23 Home phone: 717-432-5408 *--------Basic Interest Data--------* Business phone: Interest rate: 3.700 Officer: 612 TIN/Crt: 170-24-1943 C Average rate: 3.700 *------------Payment Data--------------* Daily factor: 11.401427 Next payment date: 3-24-07 Int paid YTD: 706.89 Payment amount: 319.24 Interest W/H YTD: .00 Disposition: (TRANSFER) Interest method: SIMPLE INT Last payment date: 2-24-07 *-----------Account Dat es-----------* Last payment amount: 353.44 Issue/Open date: 12-24-02 Last payment APY earned: 3.76 Last renewed: 12-24-02 *---------------Comments---------------* Maturity date: 7-24-07 Automatically renewabl e: YES F3=Exit F13=Inquiry window F15=Restart ' ~~-19-2007 Time Inquiry Next Display: 2, 30-0700-1 09:50:01 Basic Acco unt Data JHARTLAUBI Account number: 162100 005 M *------------Customer Data-------------* Short name: MCCAUSLIN GERALDIN GERALDINE E MCCAUSLIN Type: CERTIF OF DEPOSIT OR J RICHARD KING *------------Balance Data-----------* 310 HEMLOCK ROAD Current balance: 10,000.00 MECHANICSBURG PA 17055 Hold amount: Available Balance: 10,000.00 Interest due: 271.52 Home phone: 717-432-5408 *--------Basic Inter est Data--------* Business phone: Interest rate: 5.130 Officer: 612 TIN/Crt: 170-24-1943 C Average rate: 5.130 *------------Payment Data--------------* Daily factor: 1.405479 Next payment date: 6-09-07 Int paid YTD: .00 Payment amount: 390.31 Interest W/H YTD: .00 Disposition: (CAPITALIZE) Interest method: SIMPLE INT Last payment date: 9-09-06 *-----------Account Dates-----------* Last payment amount: 47.51 Issue/Open date: 8-09-03 Last payment APY earned: 3.55 Last renewed: 9-09-06 *---------------Comments---------------* Maturity date: 6-09-07 Automatically renewable: YES F3=Exit F13=Inquiry window F15=Restart ~~-19-2007 Time Inquiry Next Display: 2, 30-0700-1 09:49:38 Basic Acco unt Data JHARTLAUBI Account number: 162315 000 M *------------Customer Data-------------* Short name: MCCAUSLIN GERALDIN GERALDINE E MCCAUSLIN Type: CERTIF OF DEPOSIT OR J RICHARD KING *------------Balance Data-----------* 310 HEMLOCK ROAD Current balance: 31,565.61 MECHANICSBURG PA 17055 Hold amount: Available Balance: 31,565.61 Interest due: 70.57 Home phone: 717-432-5408 *--------Basic Interest Data--------* Business phone: Interest rate: 3.400 Officer: 612 TIN/Crt: 170-24-1943 C Average rate: 3.400 *------------Payment Data--------------* Daily factor: 2.940358 Next payment date: 3-23-07 Int paid YTD: 182.31 Payment amount: 82.33 Interest W/H YTD: .00 Disposition: (TRANSFER) Interest method: SIMPLE INT Last payment date: 2-23-07 *-----------Account Dates-----------* Last payment amount: 91.15 Issue/Open date: 9-23-03 Last payment APY earned: 3.45 Last renewed: *---------------Comments---------------* Maturity date: 9-23-07 Automatically renewable: YES F3=Exit F13=Inquiry window F15=Restart REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER GERALDINE E. MCCAUSLIN 21 07 0255 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cocklin Funeral Home $334.48 B. 1 2. 3. 4. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s} 5oaal Security Number(suEIN Number of Personal Representative(s) _ Street Addn~s City State Year(s) Commission Paid: Attorney Fees Jane M. Alexander, Esquire Fatuity Exemption: (If decedent's addn~s is not the same as daimanYs, attach explanafion) Claimant None daimed Street Address City State _ Relationship of Claimant to Decedent probate Fees Register of Wills $413.00 5 Accountants Fees 6. Tax Return Preparer's Fees Samuel D. Thuma, CPA $400.00 7. Cumberland County Legal Journal -advertising Executor's Notice $75.00 8. The Sentinel -advertising Executor's Notice $173.33 9. Register of Wills - 2 short Certificates $9.00 10. Register of Wills -filing Inheritance tax return and Inventory $20.00 11. Narumol Alexander -witness fee $25.00 12. Jane M. Alexander -witness fee $25.00 13. Clerk of Orphans' Court -filing First and Final Arx;ount $290.00 14. Notary fees $31.00 15. Clerk of Orphans' Court -filing release $15.00 TOTAL (Also enter on line 9, Recapitulation) S 11.810.81 Zip $10,000.00 Zip (tf more space is needed, insert additional sheets of the same size) ~ ~ E °1' U U o. NQ° u SY ~ N w d m .: E m .N i"O a u7oc r- O ~~ w cD nE o ~ Vi cn ~i w o L m ~. Cy. 7 my°c~ ~~ m °^ d ~ ~ T$ ~ W.co° ~ m r~ ;„ ,~ p O °p is o Q1m o m m r ~ W ~G' N L Nc o ~ i AY GS p 4 ~ V~~ N N ~ - °-' ~ ~ Q ~:.r;o~~y ~~~G i1N ~ d ., , d - ~ mLY rLNm . lS3 U w, ^,J t ~ m!n„ r. ~ C ..,~ ~ " , _. .., =tr Y `mJ ~ N NN d ~ _^ "~. 4 GG aL L 1 O m ~ J ar-(J a6 9 m~- N m p !A m ~ ,a p N ~ ~ "d S„1- ~ ~1 d 'D 1. c6 C c m m u c O ~ ~,. f,. s r ~ Hf F~ ~~ C~ cEC G m m v j r ~ ~i ~ v ~ r'<~ YO ~ V m o,,, ~ ';cyo `a3` ~ m L ~i y u c 4 cv m N ~_ '• .. U O ~, O ...~~ ~ m m Y O C a~ ~~ ~ ? u E ~ d Z~ d o ~ a~ Z Q O r 7~ a~ m r~ cb ~ a a- m L 7 p ~ E p -... . w, .. y L.. mry61 o~ m~m 7~ m o' 3~ a o ~ ~ E ~LyN r`:F ~~ Y C c.~`s 0 Lm.-N- 6 mO~ O m H 2 O O c m ~ E ~ o r om~y ~ m c d >. O ,. N Q ~1 9 N £ Z Z z ~ ;","5 , ,, m ~ G a5 L m w A .~' G X, ; m om ^» ~ `~ E l m ~ ~' cn ~. ZOWC .. ~ U Tr E S Q ~ W mG 5°oi ~_ N S G cefr }~i mc. U co ~ ~_, ';°~ ~= N ~ o, a ae U : 4 _.' N U_ p~ c Cti., °. ~ c =_ "' ° ~7., ~ N O d ~ 'O d Y E N O Qi 'U m .- o ~ g G d' CG L p' y oTcmO, '- ~ ~ ~ o- .. "~i w '. ~ ~. ~~. U ~ 0 C ~ N ~^ • 7 c i. ~ W a m j 9 ~ ~ ~ o m o, o o, Y - O x cn v.m ~ m <8 Z o `l ~,. m m O t- ~ a mg••. c m a m y E o$ Z d~ =NUJ m1 '. O ~, ~ ~ ~ N v. ~" a- 4. ~ pYSOL~ Z p =AO n3 cA 3 V p ~ N W E C c Y id o as r .a'd~ W N E ~ N o L c u;'^ m -~ 2 ._.. "`..,. z w 'm $ n. m O m W tL`~-'"' N ~ W t3 p m~ c o$ mo ~1~3 O .o u_" Q a> o O z~ ~ co z. W W 4 7 ~.pC~ W ~ . ~ U a~ ~ Q = a~ °' m a~ E O -' n z T m '- °' E w w Z U U V m p sC w U U U U ...sw k ".» (~ < c w ... -~ ~ .~ ~ ~ u' a ffl ~ _ ,. F t W a" y N'~L inc ~ O~,~Orom"_ W - ~ ~ v O O ¢ ~ x E y W r ~ r 4 N ~ N N .s `.-~ N N LL Z m mm LL mmEm ~ -. j- ~ ~ W ca O m W m a Z d m~ 4 LmE_ 4k.a Z ~ s Z i- ~. 4 U Z o W[- V4{ 3 ~m U1 ~ warn o W g ~ ~ ~ ~ ~ u~.- m '. ~ S ', m m ~' F4... m ¢ W ' ~' ~ : ~' o o ~ ~ a„~ p ~ ~ Y ~ r W ^ - w io ', o- `L i- .+ UmL- ro O V O~ ~ c = Or E '` « .a m 3. O O ~ ~ m w ~ ~ ~ : y `~ N m '. ~ U w A <.,.I a. ~ oa o z ~L C9 c m U ~ m ... ~ '$ 'i v y Q ~- io U ~ N c a`~ ro ~, ~ a5 ~ M c y y!$ c c7' W °ri $ 8 a o ~ 7 m -a U m N 9 U <;~: ~ °' 4 ¢ a,[ m d ° ; ao.$ a Z .. ~ u ~ 'g~ r-s ~ ~ W d= m '. O E a, 0 7 ~ p, 4 J ~ ~ ~, 5 ~ ~ ', a m z ma E d ~ c.... u, 4 ~ a ~ O o~ '.~ a' ~ ..~ W L J ~ W 9 41 LL ~ ~ o. c ~ L ~W r 5 0, 4 m~ o~ E m 4 O 1- '~ ~ W c ~ ~ ~ u_ W `° ~ Z m [L ~° iii W a> m ~ W~gM o w 'MeT`= ZN ao' m Z° v Z m O 7o U V y; o o~ ~Y, ~ ~~ u. e ~ u A m Z 3 'S r, O 3 W_ ~ W o i U `s' m ~_ cn m ~ ~O m T m J W x N °' ~ 4 O I u.u.~~ ~N 11J ~ '° a3mc m 4 m 2 u- W E' ; Z U ° ~ U ' I ~ y ,• m o tJ LL v m o>•°- 3~~ .~... ~ J y j N ¢ U c~ N U) ~ m uy 3 cdt N 4 7 I -' a~ a~ ~ O $:c>O m -O •_ 4 a - ~- - o 'o m Z Or~ U LL ~ W$ ~°' ~ °. tt W : d= ~ c ®~ Z ~...p. 6 U a v LL d '~ d~ d 4 gssG No W ma._a nE O 6 u. ~ m ° d ~ `= ~ O ~' ' _ .. _ Q~°r~m N ~ Z o°a° me ma Qc'• w 0 j .N ~ W ~ 7 ..ip o5t~ U 4~=amv O7 _ m ~ < ~' N "L 4 p°rna oc°!N'4 ~ 3 pµ"tVd3Nt1~"331d~~adn~ - m 1N3a~~' _ ~dNl'J~dO r~ p° o v 3o a-~ Q~ N Q~ h REV-1512 C^1(+ (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, ~ LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER GERALDINE E. MCCAUSLIN 21 07 0255 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 1. LANCHMA PHYS MGMT CENT PEN -expense of last illness $32.17 2. Cumberland Goodwill Fire Rescue - expense of last illness $108.36 3. The Church of God Home, Inc. -debt of decedent $383.47 4. Pennsylvania Department of Revenue -debt of decedent -2007 income tax due $3.00 TOTAL (Also enter on line 10, Recapitulation) I $ 527.00 (If more space is needed, insert addfional sheets of the same size) REV-1513 EX + (9-00) CONIIAUNWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUIrfBER Geraldine E. McCauslin n ui uzoa RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE j TAXABLE DISTRIBUTIONS [ndude outright spousal distnbutions, and transfers under Sec. 9116 (a) (1.2)] 1. J. Richard King ~neal 310 Hemlock Road 7596 of residue Mechanicsburg, PA 17055 2. Ronald E. King Lineal 6784 Old Gettysburg Road 25°~ of residue York Springs, PA 17372 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET jj. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. None 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) ~tts# `zil r~ `~est~zxtte~t# of Geraldine E. McCauslin I, Geraldine E. McCauslin, of the Borough of Camp Hill, County of Cumberland and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do herewith publish and declare this to be my Last Will and Testament, hereby revoking and declaring null and void any and all Wills and Codicils heretofore written by me. ITEM I. I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient to the proper administration of my estate. ITEM II. I order and direct my hereinafter-named Executor to convert my entire estate except for the above-mentioned items into cash at either public or private sale, whenever in his discretion it may be most expedient for the proper administration of my estate. In the event of such conversion, I authorize my said Executor to execute a good and sufficient Warranty Deed to the purchase of any real estate of which I may die seized, in the same manner and capacity as I could if living. ITEM III. I direct that all inheritance and estate taxes be paid on the proceeds of the above conversion and on all the rest residue and remainder of my estate from the residue of my estate prior to further distribution. ITEM IV. I then direct my hereinafter-named Executor to distribute all the rest, residue and remainder of my estate, including the proceeds of the aforementioned conversion to the following persons: a) To my son, J. Richard King, Seventy-five per cent (75%) of said remainder, per stirpes and not per capita. Should my son predecease me and is survived by his wife, Melvalene E. Ding, she shall receive his share. If both my son and his wife predecease me, this share of my estate shall be divided equally among their children, per capita. b) To my son, Ronald E. King, twenty-five per cent (25%) of said remainder, per capita and not per stirpes. ITEM V. I nominate, constitute and appoint my son, J. Richard King, as Executor of this my Last Wil] and Testament. Should he predecease me or be unable or unwilling to serve, 1 then nominate, constitute and appoint my Grandson, Bradley A. King, as Executor in his place and stead. I direct that my Page 1 of 2 a,. Executor shall not be required to post bond other than his personal assurance for his duties as Executor. IN WITNESS WHEREOF, I, Geraldine E. McCauslin, have hereunto subscribed my hand to this my Last Will and Testament, this 1~~~=~' day of ~~~'~~--~._.- , 2002. J } ": Geraldine E. McCauslin SI,G~VEIt, P„I7BLLSHELj,and DECLARED„by, the„al~pv~,-,named„~eraldin~,F,., ~VIc,C~Nslin,,,a~ and for her Last Will and Testament in the presence of us, who at her request and in her presence and in the presence of each other, have signed our names as attesting witnesses hereto. //i `i; Page 2 of 2 Codicil If I, Geraldine E. McCauslin, own the following items at the date of my death, I give, devise and bequeath them to the individual named: a) To my son, J. Richard King, i) my marble top table, six (6) plank bottom chairs, ii) Doughtry, and iii) 1998 Ford Crown Victoria automobile. b) To my son, Ronald E. King, i) my Cherry drop leaf table; and ii) Horse shoeing box. Date: ~e~1/~-wa~. l'a ac:x~~ /~"l./n.Lt.l~lil~~-.~.~~ ~ ~~'~ C ~~v ~r~.,/ Geraldine E. McCauslin