Loading...
HomeMy WebLinkAbout10-14-08fir REV-1500 EX (08.05) OFFICIAL USE ONLY PA DepertmaM of Revenue County Code Year Flle Number Bureau of individual Taxes INHERITANCE TAX RETURN PO BoX 2130601 21 08 0568 Lfartisburg, PA 1712&0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Socal Security Number Date of Death Date of Birth 193-07-1619 05/16/2008 07/27!1917 Decedent's Last Name Suffix Decedent's First Name MI BRUCE CAROL L J 15056051058 (H Applicable) Enter Surviving Spouse's IMormatlon Below Spouse's Last Name Suffix Spouse's First Name MI N/A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW :>~ 1. Original Return C".._a 2. Supplemental Return ~._:_""~ 3. Remainder Return (date of death prior to 12-13-82) _~~ 4. Limited Estate r~~~; 4a. Future Interest Compromise (date of <<~+ 5. Federal Estate Tax Return Required death alter 12-12-82) C~~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of wilq (Attach Copy of Trust) i,;~ 9. Litlgation Proceeds Received G~ 10. Spousal Poverty Credit (date of death C_~_~ 11. Eledbn to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL. TAX INFORLtU1T10N SHOULD BE DIRECTED T0: Name Daytime Telephone Number ROBERT R. BLACK (717) 243-3727 Firm Name (If Applicable) __ __ REGI5TER OF WILLS USE __ OFtb' LANDIS & BLACK ~~? o ~ ` First line of address ~ ~~ ~ '- _ `'7 '-~ ' 36 South Hanover Street -!=,~ -- ~ ~, Second line of address ~ - ~ ~,) ~ `~ ~ _ .. ~L . ~ oA ~ . .. ~ City or Post OFfice State 21P Code -- ~ Carlisle PA 17013 ~' rn Correspondent's e-mail address: Under penaPoea of perjury, I declare that I have examined this return, including accompanying schedules and atatementa, and to the beat of rtry knowledge and belief, it is true, correct and complete. Dedaratjop of preperer ocher 1hRf the personal representative is based on all information of which preperer has any knowledge. 307 Tichy Dlive, Mt. Holly Springs, PpC 17065 6~ 36 South Hanover Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ~~ ~y w } ~ 15056052059 REV-1500 EX Decedent's Social Security Number CAROL L BRUCE 193-07-1619 Decedent's Name: RECAPITUt-ATION t. Real estate (ScheduleA) ............................................. 1. 143,090.36 2. Stocks and Bonds (Schedule B) ....................................... 2. 300,301.00 3. Cbsety Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages $ Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits $ Miscellaneous Personal Property (Schedule E) ........ 5. 40,396.88 B. Jointly Owned Property (Schedule F) *. ~ _a Separate Billing Requested ....... 6. 3,105.44 7. Inter-vvos Transfers $ Miscellaneous Non-Probate Property _. (Schedule (~) :~:~ Separate Billing Requested........ 7. 56,089.66 8. Total Gross Assets (total Lines 1-7) .................................... s. 542,983.34 9. Funeral Expenses $ Administrative Costs (Schedule H) ..................... 9. 15,856.02 10. Debts of Decedent, Mortgage Liabilities, $ Liens (Schedule I} ................ 10. 227.72 11. Total Deductions (total Lines 9 $ 10) ................................... 11. 16,083.74 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 526,899.60 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus line 13) ........................ .... .. . _ _..._.,... , , .......~ ._.~...._. ...__ .. 14. . ~.._:., 528,899.60 ...,.. .... .. .... w._., .. . . .. .,. ..... ._,.. . . . . . . ... ._._ _.__ .....___.__.._._.__~._._.__..___._~__ ~ .. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES . . . . .. . . ._. . . 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .(I_ 15. 16. Amount of Line 14 taxable . _ . _ _ .._.._ ____ . _ _ at linealrete X.0415 526,899.60 16. 23,710.48 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collaterel refs X .15 18. _.. _ _ ._ 19. TAX DUE ............................... .......................... 19. 23,710.48 20. FILL tN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Stde2 15056052059 J h 1 EV-1500 EX Page 3 `Decedent's Complete Address: Flte N~rRib4[ - -_. 21 _ 08 0568 DECEDENTS N E DECEDENTS SOCIAL SECURITY NUMBER CAROL L BRUCE _ 193-07-1619 STREET ADDRESS 113 South Pitt Street CITY STATE I ZIP Cartisle ~ PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit - g, p~ pa~~ 18,000.00 C. Discount 947.34 3. InteresUPenalty it appNcable D. Interest E. Penalty (1) Total Credits (A + g + C) (2) Total InteresVPenalty (0 + E ) 4. ff Line 2 is greater than Una 1 + Line 3, enter the difference. This is the OVERPAYMENT. FIII In oval on Page 2, Line 20 to request a refund. 5. ff Line 1 +Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. A Errter the Interest on the tax due. B. Enter the total of Une 5 •~ 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (SB) 23,710.48 18,947.34 4,763.14 4,763.14 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 .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits a care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate oonsideration? .............................................................................................................. 0 ^ 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which contains a benefiaary designation7 ........................................................................................................................ ^ 1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ..z , .,,, i~ ,.. Y For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute ices 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, en adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficlaties is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) (72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is twelve (12) percent (72 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at feast one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ ~fi-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE T'AX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER BRUCE, CAROL L. 21-08-0568 All real property owned solely or as a tenant in common moat be roported at fair market value. Fair market value fs defined as the price at which property would be exchanged between a wiAing buyer and a wi6ing eager, neither being compelled to buy or aeU, both haWng reaeonabk knowledge of the relevant fads. Rsal property which is Jolnty-0wnsd with right of survivorship must ba dlsciossd on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~• All that certain tract of land with the improvements erected thereon situate at 113 South Pitt 143 094 3c: Street, Carlisle, PA 17013. Parcel No. 04-21-0320-194. See HUD attached hereto. Assessment - $140,490.00 TOTAL (Also emer on line 1, Recapitulation) ~ t 143.49E).3 (h more space is needed, insert additional sheets of the same size) R~-1503 EX+ (8-98) ,. SCI~IEDt~LE B COMMONWEALTH 01= PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER BRUCE, CAROL L. 21-08-0568 All property joiMlyown~d with right of survivorship must M disclosed on Sehsdula F. err rrrvro aNow ra rroww, Anse!{ 9U~IUf7fiil if)g9[$ OI {i1B SBRM SIIO] REV-1508 EX+ j6-SS) " SCHEDULE E • COMMONWEALTH ~DF PENNSYLVANIA CASHr BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER BRUCE, CAROL L. 21-08-0568 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jolntlyowned with right of survivonshlp must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATIi 1. Sovereign Bank -Money Market Account #1674061382. Balance - 30,524.10, Plus Interest 20.02. 30.544. ? See attached letter. 2. Sovereign Bank -Premier Checking Account #281029283. Balance - 3,578.33, Plus Interest 0.60. 3, 579 9:; See attached letter. 3. Embarq -Refund 3 14 4. Edward Jones -Brokerage Account -Interest 92 3~, 5. Hoffman Funeral Home -Over-payment ~ OC 0^ 6. Edward Jones -Brokerage Acxount -Dividend 86` ~, 7. U.S. Treasury -Stimulus Payment 600.0:? 8. Manor Care -Refund -Nursing Home Care 3.536.Ot~ 9. Bridcer's Auction -Net Proceeds -Public Sale 1.630.OG 10. PA. State Employees Retirement System -Pro-Rata Refund 220 ~ :: TOTAL (Also enter on line 5, Recapitulation) : I 40.396.Et' (H more space is needed, insert addRional sheets of the same size) RE<~1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TP~X RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER BRUCE, CAROL L. 21-08-0568 If an asset wss made joint within one year of the decedent's date of death, it must bs roported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Elizabeth Shearer 36 Kenwood Aveue, Carlisle, PA 17013 Daughter B. C. JOINTLY•OWNED PROPERTY. ITEM NUNBER LETTER FOR JOINT TENANT DATE PAADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OP, SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR ,IOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET M OF DECD'S INTEREST DATE OF DFr - `lAl'~'^: ~?~ DECEDENT'S INTCRE'" t • A• 09/03/9;~ Orrstown Bank -Savings Account #708700660. See attached letter. 6,210.88 50% _ 3.10; c~, TOTAL (Also enter on line 6, Recapftulation) I i 3,105.4a (If more space is needed, insert additional sheets of the same size) REtF-15T0 EX•F (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 6 INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER BRUCE, CAROL L. 21-08-0568 This schedule must be completed and filed if the answer to any of questions 1 through ~ on the reverse side of the REV 1500 COVER SHEET is yes. ITEM NUMBE DESCRIPTION OF PROPERTY inauvE THE ruME of THE TRANSFEREE, THEIR REUTIONSHIP To ceCFDVrr AIA 7rIE DATE of TRANSFER ATTACH A COPY aF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET 96 OF DECD'S INTEREST EXCLUSION IF APPLICABLE) TAXABLE VALUE ~• AIG Annuity Insl~rance Co. -Deferred Annuity No. VP228041. See letter 50,089.66 100 0.00 50.G~,9 ~=- response fronrt Donald Killian, IFS Agency 2. Robert H. Bruce, Jr. -Son -Gift -12107 5,000.00 100 3,000.00 YAOU.tiG 3. Elizabeth Ann Shearer -Daughter -Gift -12/07 5,000.00 100 3,000.00 2.OOC u: 4. Cynthia L. Peterson -Daughter -Gift -12107 5,000.00 100 3,000.00 2.004.:x`.: TOTAL (Also enter on line 7 Recapitulation) i I 56.089.66 (if more space is needed, insert additional sheets of the same size) RE~9511 EX+ (12.99} ,~ SCHEDt~LE N COMMONWEALTH OIF PENNSYLVANIA FUNERAL. EXPENSES 8e INHERffANCE T'AX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER BRUCE, CAROL t.. 21-08-0568 Debts of decedent must bs reported on Seheduk I. A. FUNERAL EXPENSES: ~' Robert H. Bruce, Jr. -Reimbursement -Funeral Luncheon 2. Hoffman-Roth Funeral Home -Services e. ADMINISTRATIVE COSTS: 1. Personal I~epresentative's Commissions Name of Personal Representative(s) Sodal Security Number(s}IEIN Number of Personal Representative(s) StnaetAddress City .state Y~r(s) Commission Pald: 2. Attorney Fees 3. Family Exemption: (tf decedent's address is not the same as claimant's, attach explanation) Claimant None Street Address city state Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Robert H. Bruce, Jr, - Reimbursment -Postage 8. The Pa. State Employees Retirement System -Reimbursement s. Comcast -Invoice io. Embarq - Nnvoice > > • Stephen Hertsch, Tax Collector -Real Estate Taxes ~z. PP&L-Invoice 10.000.00 546.66 16.92 346.78 7.39 2.24 1,768.00 33.48 TOTAL (Also enter on line 9, Recapitulation) S (If more space is needed, insert additional sheets of the same size) 516.25 988.30 0.00 Zip Zip 14.226.02 ed 'forward ,. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Continued - Page 2 FILE NUMBER: 21-08-0568 ESTATE OF BRUCE, CAROL L. ITEM NUMBER DESCRIPTION AMOUNT (Brought Forward) 14,226.02 13. Chuck Bricker, Auctioneer -Fee -Sale of Real Property 14. Eugene Purcell -Services at Sale TOTAL 1,530.00 100.00 15,856.02 REY--1512 EX~ {12-03) COMMONWEALTH CrF PENNSriVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT s~NEOU~ ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS fSTATE OF FILE NUMBER BRUCE, CAROL L. 21-08-0568 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, indudinp unnimbursed medical e~ensss. to more space Is rteeaea, Insert aaaroanel sneers of the same size) REVdnt3 EX+ (9-00 ~ :~ SCHEDt~LE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BRUCE, (:AROL L. RELATIONSHIP TO DECED NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) r TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 • Robert H. Bntce, Jr., 307 Tichy Drive, ML Holly Springs, PA 17065 Son S.S.N. 206-38-7355 2• Elizabeth Ann Shearer, 36 Kenwood Avenue, Carlisle, PA 17013 Daughter S.S.N. 206-34-7946 3• Cynthia L. Peterson, 903 N. Pitt Street, Carlisle, PA 17013 Daughter S.S.N. 206-38-7429 FILE NUMBER 21-08-0568 AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV 1500 COVER SHEET n NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1i3 1 i ,. 1!3 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET I f (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF CAROL L. BRUCE I, CAROL L. BRUCE, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DEATH TAXES 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 part of the expense of administration of my estate. DISTRIBUTION OF PERSONAL PROPERTY THIRD: I give my personal property in accordance with a Memorandum which I may attach to this Will. In lieu of such Memorandum, all my personal effects, clothing, furniture, furnishings, jewelry, automobiles, other tangible personal property of every kind, and insurance thereon, I give iri equal shares to my children who survive me for a period of thirty (30) days, to be divided among them as they may agree or, if they are unable to agree, as my Executor may decide. The share of any minor child shall be selected and held by my executor for delivery to such child at terrnination of minority or, in the discretion of my executor, may be delivered either to the minor or to another to hold for the minor during minority and the receipt of the minor or such other person shall be a complete discharge of my executor. Any items not so disposed of shall be sold by my executor and the proceeds added to my residuary estate. DISTRIBUTION OF RESIDUE FOURTH: I give the rest of my estate, per stirpes, to my three children, namely Robert H. Bruce, Jr., Elizabeth Ann Shearer and Cynthia L. Peterson, or their issues, per stirpes, who survive me for a period of thirty (30) days. ,- „ C f initials PROTECTION OF BENEFICIARIES (Spendthrift Provision) FIFTH: No interest in income or principal shall be assignable by a beneficiary or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. Provided, however, any beneficiary may assign any part or all of the beneficiary's interest in my estate to any one or more of my descendants or to any one or more of the beneficiary's descendants. MINORS AND INCAPACITATED BENEFICIARIES SIXTH: If any income or principal shall be payable to any person who shall be a minor or who shall be incapacitated for any reason, my executor as trustee shall hold such income and principal during minority or incapacity and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person during minority or incapacity without the appointment of any guardian or committee or any authority of court. My executor as trustee shall be entitled to make direct application hereunder or to make application by payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be distributed to such person upon the termination of minority or incapacity. My executor as trustee shall have the same powers as my executor, POWERS OF EXECUTOR SEVENTH: I confer upon my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and on such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers of the property, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments, or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments"; to make distribution in cash or in kind; to allocate and distribute different kinds or disproportionate shares of property or undivided interests in property among beneficiaries, in crash or in kind, or partly in each; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. APPOINTMENT OF GUARDIAN OF ESTATES OF MINORS EIGHTH: I appoint my executor as guardian of the estates of minors with power to hold C~ ~ ,~- initials all property payable by law to a guardian appointed by my will and to use it for the minor's health, maintenance, support and education, either directly or by payment to any person selected by my executor to disburse it whose receipt shall be a complete acquittance. Guardian may, in discharge of all the guardia.n's duties, pay any minor's share deemed impractical of administration to the parent or other person in charge of the minor or to his or her guardian or to a custodian for the minor under the Uniform Transfers to Minors Act. My executor as guardian shall have the same powers as my executor. APPOINTMENT OF EXECUTOR/RIX NINTH: I appoint my son, Robert H. Bruce, Jr. Executor of my will. If Robert H. Bruce, Jr. is unable or unwilling to qualify as Executor or having qualified is unable or unwilling to act, I then appoint my daughter, Elizabeth Ann Shearer as Executrix hereof. WAIVER OF BOND TENTH: I direct that no fiduciary hereunder shall be required to furnish bond in any jurisdiction, and if any bond is necessary, no surety shall be required. INTERCHANGEABILITY OF LANGUAGE ELEVENTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the i~eminine maybe read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. HEADINGS TWELI~"TH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this ~~ day of , 2000 ,~ Carol L. ru , T tatrix /~G~' Witness ?~~~ ~ ~~ Witness ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. We, CAROL L. BRUCE, the Testatrix in and the undersigned witnesses to the will, the attached or foregoing instrument, who have signed the instrument, having been qualified according to law do depose and say: ~(a) that I, the Testatrix, do hereby acknowledge that I signed the instrument as my will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and ~(b) that we, the witnesses, were present and saw the Testatrix sign and execute the instrument as her will, that she signed it willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as a witness and that to the best of our knowledge the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Testatrix, Carol L. Bruce ~~ ~ ~ Witness ,-~ ,~~ ~ ~ W' es Notary Public Notarial Seal Susan K. Guyer, Notary Public Carlisle Boro, Cumberland My Commission Expires Sept 4~ Member, Pennsylvania Assactatlon of Notaries 48500041046 ~ * J REV-485 EX (1-07) SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date of Death County Code Year File Number ~ ~ q ~ ~ p a ~ixxc Decedent's Last Name Suffix First Name ~ MI Tp it e 4 - 1~..~/KL'MMY~ttf YM ~ ] ..>'LN Y"'pS :M.tP. a ^..; ~,,.,..;,,,. © ADD OFD EDENT TR T: S 3~ CODE: - ~ ~ ~au~~ ~rT S~ ' ' L1SC~ :~ / /D/3 ' NAME AND DDREa3 OF PERSON REQ ESTING THE OPENING OF THE SAFE DEPOSIT BOX ,~.~ hQf/ ~ y~- NAME:. _ _0/"v`!_[~ r' Iii'" ' ~~ ~~ ~. STREET RESS• s - - - _ __ __--_-- -__---- _ ---- CITY: --- n ~~~u-T~ UW-I~fDJGL Cr ~dLI~~«/f DA_ f,-~~~~ STATE: ZIP CODE: '~ NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDEN , OF PERSON(S) PRESEN A THE BOX OPENING a. NAME: ~ RELATION HIP: .. ~------- - Y' _ ___ ___ STRE~yAQp _E,SS~ ~~ A,~~/~ nO~ ~,{ ,~ r CITY STATE• ZIP CODE: ' - _ ---- - _ _.. _ S~i?iNG-s --~ ._ _ ~~~67 b. NAME: ] --- RE ION H P: ~ __ STRE DRESS: - -_.-.__ ___,__ --- c. NAME: ~ ~- ~~-NOVt ~ '-~ l G~~~SG~ CITM: STATE: ZIP CODE: _. --- ~~ . ~ 7~/~ -- -- RELATIONSHIP: - - -- ET AODRES~S: --- --- - - CITY: STATE: ZIP CODE: Y...m~ r~nu rwurcws ~r rrnnnclAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED ~.~~.~~. i STREETADDR ~~ bar r~ S~ _- ~;~-/~cr NAM PERSON NIAKING LAST ENTR ~_ ~ DACE O~CONTt2ACT TO RENT BOX NUItaBER OF BOX i~ NAME 1~ND AODRES S OF PERSON(S) HAVING ACCESS TO BOX a. NAME: STREET ADD ESS;, __ 11 `~~Tr_S r•--- CITY: J n STATE: ZIP CODE f rw9 .n. ,.. , NAME THE UNDER WHICH BO IS RED ~U L- L %~i2u b. NA(~E!. t ~~1~_ ~~ ~1 ' ~ ~'~E~ ~/~`- - __ _--- -- TRE DRE S: CITY'',, ~~s ~ r g7/I,TE: ! ~/Ji7 DE: ~.r-.~ WAS A WILL IN THE BOX? ^ YES NO If yes, a. Date of will: b. Name and address of personal representative, If named In the will --- - __ --- ---_ -- - NAME: STREET ADDRESS: - ----- -- -- -------_ . _.- __-_ ..- CI , STATE: ZIP CODE: c. Name and ad ress of attorney, if any _.__ ... - -. ' NAME: STREET ADD ° ~- ...--- ~ -- --_- --_ _ __ ____ _ ' / lG~ ...7... l" ~ l ~v ~~L ~ ~ - - - ---- --- STATE: ZIP CODE: - ~ C'~/~~~ sc ~'` ._ _ _ , ~ ~ . f7d~ L 48500041046 48500041046 ^ CITY: STATE: ZIP CODE: f ~L//1 r r/ ~!• i 7 DATE AND TIME OF LAST ENTRY ~1-485EX SAFE DEPOSIT BOX INVENTORY Page of_ .._ INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obllgatlons of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designates by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savinfls and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, ;itamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of Indebtedness: List and describe as fully as possible. (S) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 ~ ITEM ITEM DESCRIPTION NO. I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT ND CO PLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF, SAFE DEPOSIT BOX INVENT RY: SIGNATUR y SI ~,yy~j~ RE --- ~I G~I JI ~ - -~ - .-_ _ _ _. ~~C./\ . PRINT NA E PRINT E~~ROPRI TEBOXB L _ -- -- - ~0 ryE l~ ~" ~ _ l~ L~FLI C ,~ ///~ / PRINT TITL / -• -- ---- - ---._ ~/aGl~r (+. ~ Y - --- ....~~~~1111 DATE CHEC APPROPRIATE 80X: ~ / ~Tfi~ ~ _ / r~ /_ ~//~ ~Executor(Irix) [] Administrator(trix) ry G l0 t0 Estate Representative ~ Joint owner of safe deposit box NOTE: Attach additional 8'/:" x 11" sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law, 4,2 U.S.C. §405 (c)(2)(C)(i), to require disdosure of Social Security numt)ers in connection with administering state tax laws. The Department uses the SOaal Setxrity number fp identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorzes. The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for oificial purposes ~.1..'I1A r 2. FLiHti 3.tonv. Unins. 4. VA 5. Com. Ins. C. This form is furnished to give you a the dosing; they are shown here fc D. Name and Address of Borrower: DINO R. CRAIG 30 W. POMFRET STREET CARLISLE,PA 17013 - U. S. De artment of Housin and uroan uevew ment roan w nw - a 7. Loan Number 8. Mortgage Insurance Case Number RE3096 13281337 ASST#6491 :ment costs. Amounts paid to and by Che settlement agent are shown. Items marked "I and are not included in the totals. E. Name and Address of Seller: ROBERT L. BRUCE, EXECUTOR LWT OF CAROL L. BRUCE N F. Name and Address of Lender G. Property Location PNC BANK, N.A. 113 SOUTH PITT STREET, CARLISLE, PA 17013 ISAOA ATIMA 3RD WARD OF THE BOROUGH OF CARLISLE CUMBERLAND COUNTY PARCEL NO. 04-21-0320-194 H. Buyers Settlement Agent: Frey 8. Tiley Law Ogee I. Settlement Date: Place of Settlement: 5 South Hanover St. August 29, 2008 5 South Hanover Street nN 25-1730538 Carlisle PA 17013 ~ 11:00 a.m. Carlisle, PA 17013 SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100 GroeyAlltounk D4~ Fraf1 ~OROwer 400 GfOie. AmOUt1tDYe To Seller lol Contract sales pnce I 153,000.00 aol Cont2d Sales price I 153,000.00 102 Personal property a02 Personal property 103 Settlement charges from (line 1400) 3,596.75 ao3 104 404 105 405 AdJustments forltems paid by sellerln advance: AdJustments for items paid by seller /n advance: los Clty/town taxes 8/29/08 to 12/31/08 246.73 a06 Ciry/town taxes 8/29/08 to 12/31/06 246.73 107 County taxes a07 County taxes los Assessments 4os Assessments 109 409 11o School taxes 8/29/08 to 6/30/09 1,477.38 alo School taxes 8/29/08 to 6/30/09 1,477.38 111 411 112 412 lzo Gross Amount Due From Borrower 158,320.86 aza Groas Amount Due to Seller 154,724.11 20o Amounts pp~t 0y Cv >in Behalf Cd Borrower 500 Reductions In Amount Dun To Ss{h1r zol Deposit or earnest money 10,000.00 soi Excess deposit (see Instructions) 10,000.00 202 Principal amount of new loan(s)=== 122,400.00 502 Settlement charges to seller (line 1x00) 1,633.75 203 Exisbnq loan(s) taken sub)ect to 503 Existing loan(s) taken sub)ect to 2oa 5oa Payoff of first mortgage loan 205 505 Payoff of second mortgage loan 206 506 207 507 208 508 tog 509 AdJustments for Items upaid by seller AdJustmen[s for items upaid by seller zlo City/town taxes 1/1/08 [0 8/29/08 51o City/town taxes 1/1/08 to 8/29/08 211 COUnty taxes 511 COUnty taxes 212 Assessments 512 Assessments 213 513 zla School taxes 7/1/08 to 8/29/08 51a School taxes 7/1/08 to 8/29/08 215 515 216 516 217 517 218 519 219 519 220 Total Pald By/For Borrower 132,400.00 ---------- ---------- 520 Total Reductions to Amt Due Seller 11,633.7$ ---------- ---------- were paid outs. 3os Cash Xt S~telrtunt.f!rom/Ta Yorrower. soo Cash At Settlmnent To/From ffieller: 301 Gross amount due from borrower (line 120) 158,320.86 601 Gross amount to seller from (Ilse 420) 154,724.11 302 Less amounts paid by/for borrower (from line 220) 132 400.00 sot Less reductions in amount due seller (from line Sz0): 11 633.75 303 Cash (x) From () To Borrower 2$,920.86 sa3 Cash ( )From (x) To seller 143,090.36 HUA-1 • ~ L. SETTLEMENT CHARGES Page No. 2 jiDO ,'~''{~Cal5irlN)Brbktr'sCMNrY~,lyi~d On Prftel 153,000.00 ®% = 0.00 Paid from Paid from 700 Division of Commission (line 700) as /ollows: Borrower's Seller's ', 701 to Funds at Funds at 701 702 to Settlement Settlement 70z 703 703 7os Commission paid at Settlement 704 705 705 ,aoa ~tetrix F{ayrlibla.Irt Connection With Loan: ebd (MOrt0a0e Amt: 122,400.00) Total charges, Lines 801 through 700.00 801 Loan Origination Fee .000 % t0 0.00 Bo1 802 Loan Discount .000 % t0 0.00 802 so3 Appraisal Fee to PNC BANK, N.A. 250.00 eo3 eoa Credit Report Co aoa 805 Lender's InspeC[i0n Fee to 805 806 Mortgage Insurance Application Fee to 806 807 Assumption Fee to 807 eoa RECORDING FEE TO PNC BANK, N.A. 105.00 eoe eo9 LOAN FEE TO PNC BANK, N.A. 345.00 eo9 elo elo e31 ell ,400 Itetsfs itequired By Lender To Be Paid In Advapc~: 9oa 901 Interest Fram 29-Aug-08 to ~ 0.000 per day - 901 902 Mortgage Insurance Premium for months to 902 903 Hazard Insurance Premium for 1 years t0 903 904 years CO 904 905 905 e,. ~ ~ ~~_ - 3oaa RCSErve~1 b~epOrpliLEd WtHt mender. Tool rteMerws, unaaloBi tr,onlgn iooa: o:oo _. u Iono 1001 Hazard insurance mos. ~ per month 1001 1002 Mortgage insurance mos. ~ per month 1002 1003 Ciry property taxes mos. O per month 1003 1o0a County property taxes mos. O per month 1000 1005 Annual assessments mos. O per month 1005 1006 mos. ~ per month 3006 1007 School taxes mos. O per month 1007 ]ooe Aggregate Settlemettt Adjustment lone 130¢ Tige Clrpl~: : r 1104 1101 Settlement or closing fee to 1101 1102 Abstract ar title search to 1102 i 103 Title examination CO 1103 1100 Title Insurance binder to 1104 1105 DOCUmen[ preparation to 1105 1106 Notary fees to 1106 1107 Attorney's tees to LANDIS & BLACK P.O.C. Ila7 (includes alwve items numbers: ) aloe Title Insurance to FREY &TILEY (COMMONWEALTH LAND TITLE INS. CO.) 1,273.75 13os (InGudes above items numbers: ) 1109 Lender's Coverage ; 122,400 Endorsements: 1109 1130 Owners Coverage ; 153,000 1110 3131 CLOSING SERVICE LETTEFt TO COMMONWEALTH LAND TITLE INSURANCE CO . 1311 311z lllz 1113 OVERNIGHT DELIVERY FEES TO FREY 8: TILEY ~ ,.. 121ip Gove ~ k 5~~~~ In a3td Tr r Ch s3 Dadd pa t os: 0 1113 __. .., .. ans g asge g Mtp pages.: ~ g 1204 Izol Recording fees: Deedl X38.50 Mortgage;54.50 Releases ~ 93.00 Izol Izoz Ciry/county/stamp Deeds X1,530.00 Mortgage ~ 1,530.00 Izoz Izo3 State tax stamps: Deeds X1,530.00 Mortgage ~ 1,530.00 lzo3 lzoa lzoa 1205 3oa Adr~{tiorial Settfer><1pr-t C ttAry~: , 1x44 3301 Survey t0 1303 1302 Pest Inspection to 3302 1303 Current Taxes due from Borrower/Seller to 1303 13oa FINAL WATER AND SEWER CHARGES TO CARLISLE BOROUGH -ACCT NO 04044 . 103.75 13aa 1305 1305 1306 1306 3307 13071 -aoo 7otaLSettlement Chbrges (enter anline9 iQ3, Section y and 502, Section K) 3 596.75 1 633 75 laoa , , . HUD ~~ CERTI FICATIO N I direct and authorize the Company to make distributions Indicated for my account on the attached HUD-1 Settlement Statement, approving the tax proratlons indicated therein, and understand [hat proretions were based on figures Tor the preceding year, or estimates for the current year, and In the event of any change for the current year, all necessary adjes[men[s must be made between Seller and Borrower direct; likewise any DEFICIT in delinquent taxes will be reimbursed to Attorney/Titie by Seller. 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 try me in this transaction. I further ceKlfy that I have received a copy of the HUD-i Settlement Statement. A.- ~ _ DING R. CRA ~'- ROBERT L. BRUCE, ECUTOR LWT OF CAROL L. BRUCE To the best of my knowledge, the HUD-1 Settlement Statement which i have prepared is a true and accurate account of the funds which were received and have been or will be disbursed by the under.>igned as part of the settlement of this transaction. -=J, August 29, 2008 Settle ent Agent Date WARNING: It is a crime to knowingly make false statements t e United States on this or any other similar form. Penalties upon convictlan can include fine and imprisonment. For details see: TI[le 18 U.S. Code Section 1001 and Section 1010. INFORMATION REPORTING ON REAL ESTATE TRANSACTIONS THIS HUD SETTLEMENT STATEMENT CONTAINS IMPORTANT TAX INFORMATION (BOXES E, G, H, I, M AND LINE 401) AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE. [F VOU ARE REQUIRED TO FILE A RETURN, A NEGLIGENCE PENALTY OR OTHER SANCTION WILL BE IMPOSED ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE INTERNAL REVENUE SERVICE DETERMINES THAT IT HAS NOT BEEN REPORTED. Solicitation of TIN Seller is required by law to provide the Attorney/Company with his/her Correct taxpayer identification number. If correct taxpayer identification number is not provided, he/she may be subject to civil or criminal penalties imposed by law. Certification of TIN Under penalties of perjury, I certify that the taxpayer Identification number shown in this statement is my correct taxpayer identifcatlon number. Seller Seller TAX PRO-RATION ADDENDUM Date of Pro-Ration: AuOUSt 29, 2008 ASSESSMENT: ;140,490.00 Parcel No.: See Settlement Sheet Linos 106 $406, 110 $ 410, 210$510,214&514, and 1303 for Results of this Addendum. Prom July 1, 2008 to June 30, 2009 :School Real Estate Tax- Face :School Real Estate Tax- Per Day COUNTY $ MUNICIPAL TAX from January i, 2009 [o December 31, 2008 Co. &Munic. Real Estate Tax- Face Co. &Munic. Real Estate lax- Per Day :ichool taxes P.O.C. or charged to Seller Yes :ichoof taxes P.O.C. ar charged to 9orrower (:o. a Munk. P.O.C. or charged [o Seller ; x (:o. & Munk. P.O.C. or charged to Borrower 51,804.09 f4.94271 Owes: 5741.08 52.03036 P.O.C. P.O.C. .*. ~~ ~) co c~ m' n n'~ O C 7 .•- O ~ O I ~ f ~ i rQ (D 1 I I i i I i i ~ ' m o c ~ c m ~ ~ ~ 3 3 3 ~ ~ of a .. rn ~ ' m °' ~; w a ~ ~ ~ ~ ~ ~ ~' O a ~ ~' y m ~ c ~ ~ ~ Z ~ ~ a o ~ ~ ~ ~ o f~/l , ~ ~ vO c w ~ n ' i x I ~ ~ ~ a 3 0 y ~ ~p 1 C K C m I -~ ~ ~~ i m r ~ ~ i L ~ w ~ 71 t A N CO t 0 ~ U1 N ~ t0 N A O D ~ N D O O ~ r i 1 L L ~ r ~ ~ N i 1 !i i L L L ~ 69 ~ w O v t h W N OD O V I l r I! I! I r r (AIOIO~D ~ J (0 O ~1 N ~ O IV V W CO N CJ1 V ~ r t r J O A N V O N UI V EA N w 0 N t t' N ~I r D d m Q 0 N ~. O m d Q W O at 1 O c /~~- O w m a L O a N m O! tp W 69 W O, N 00 v t!i N W A d 0 m 0 EA W N 1~ A A ~ ~ O G p ~ C C7 61 y N a N V O A CO `~ 1 N A O f0 cp V r _~ Ja to TSv V! v r 0 WJ A W (O v c v rn d c m 0 EA W O J W N GD V n y ao 0 d .. m c m N c 3 d Vi N tp OD CC J W m y a ~ 3 m 3 o a ~, L ~ C m Q ? i L m oNi ~ A m ~ ~ O m ~ O V N 0 V fA O O J ~ ~ ~ ~' C N A ~ m ' r~O ' =' ~ O ~ r m~~ ~ C ~ a to ~ ~ I .~ ~ a ~ m 3 ~ o V ~ w W O N w ~ ~ I a I°V w I A ~(~~D .~ N r m ~ 0~0~~~ _ r~ D ~ ~ ~:~. ~~ Z ~, 1 ,xm _; O NZ ~- `-' ..A ~ i `'' m -mi "~1 i O : -~ ~ 3 ' m o: c ~~ ~i ` i app Op S i i 3! m ; ~ i N m W N N J V V J is v S° ~g ~~ a ~' N N N Op O G O M J V N (h Y v p ~ m o i ao~~: o m z ~~~~i CN<,~~ og~S~°m1 Ip Q i7 ~J :D ~ ,w m G 0 O O O O O C O 0 C`O N 0 w cn 0 V OD W ti O (Q V ~ ~ ~ i ~~ ' ~ ~ m o m o ~ ~ ~ '~ N ~ ~ 8g~~ 7 w N nm r i ~ D C ~ ~ rn ~ D ~-I 2 c. O O (p11 S 8 O N CTI 0 w w cn IV A O 07 r V v o~~D~m c. ~ O N 2 ~,p p c z a w ~~ ~~c'3 13 3 O SO ~W''~~m ~ ~ O n c J o O G7 m ~;s p n 3 O y ?~ o~ A O ~ w o ; m N C ~ ~ o a ~i M m ~n ~ to ~ O p~ 0 (00 m N ~ .~. ~ ~ i a g a ,'. ~p ag ~a s~ a m; ~~ ~. a O w m a d 7 a 3 c 0 N nl y A a S a 0 m •c ~' 0 a n C .3i ~a ~m 'a •c O 3 'o °c a a ~a m a~ O C d a L O 3 W N ~ m d I~_ Q N c 3 a m Q o c -« 0 c ~ C N ~ o ~ 0 m 3 ~ ~ N w 0 a 0 i i ~ C ~ ~ t N N d V ~ A w I A I A N d9 J ~ ~ 0 n~ a ~' ~ O ~ ~ ~ ~ '~ c ~~ 3 o .~ O ~ ~ ~ V ~ a 0 ~ o~ w i ,~ - .~_ rt ~. F~ _~ to i i i ~, ~I o~ n O C ~~ i i 3 N! 0 ODD i t ~ I W o D O o z~ o D~ <c cn ~ m m cn n D m I r- r D ~ n ~ Z S v~ °~ o 0 D O n O (~ ~ m ~ m D O O ~ D ~ c X m X " ~ ~ o D = m ~ T ~ C 0 o z v m O O f~ Ro b~' 8 ~ m O 5 3 C» w ~ v N J (~ r N _- ~C~O tJl O f~Jl ~ ~ ~~~pp Obi O N A ~ ~ CA N ~ _~ W w t ~' °o c c d O r~ m n e CT Z w m» rn ~ n O ~ N 1~ N "'"~, v ~ A C C p m ~ W V 69 W ~' ~ s W (7 N ~~ ~~ °e i T c cn m to ~ p ~~sn m cn ~ cn `v cn v cn m cn p 3 z~ Z D 3~~ n~ p~ 3 ~~ p 3 D ~~~~oo~ZS~°~oooZOD a ~ Z ~ v n ~ ~ ~ ~ ~ n ~ ~ ~ O ~ m z 3rI oo ~~ ~r~1 D g= ~ -C = n n D D ~ _ ~ p ~ O Z m ~ r ~ Q° ~ n ~~ ~ o O D Z ~ ~ n G7 WG~ =G~ SG~ u10 WO ODO WL~ 00 '< ~ a ~ a ~ `< ° `< o ~ o ~ o m 4o Ge f~ S~ Sk S?~ Go QD 3~p' ~' ~' o ~ o ~' ~' ~ m m m 3 ~ m m m a oa c o »~ o~ 0 A c~'' c°°ii ~ ,cwo w ~ ~ a o cao °w cWn o cn v o ~+ o $ 0 0 0 ..A N O O N N N ~ C ~ O .CWT p a A C p .~. Cp W CD ~ A N ~ ? "'~ -... ~ ~ r V ~ cV A 0 W O) N (.J c0 V G) ~ OD ~ tVD ip N :~ ~ n c m Lp O O O CD O O 00 OO N O 01 O O m~ EA N A ~ C 7 1 CT f D O UI ~ ~1 CT ~ OD ~ O CT ~ Vi W ~ V O p ? p ( D A ~ CWO pwj N N ~ O W cT CC o ) V w O o W ° (O m CO cT fJl cn c~On m~ a i ~ i ~ ~ ~ V 0 ~ a ~ o t r ~ t o t ~ + ~ ~ 'G N A =' ~ O Cf ~ .~- 3 r. c ~~ 3 w ~ ~ o .o O ~ y V ~ a i° vs W 1 .a A 1, .. .~ _ 2 ~r ^, 'T ,. 0 V! ,y. ,~( ~' m 01 n C i y3 1 O~ m AI a 0 3 c~ ~. m 0 a S ` a c ; ~1 t Q t a ; N -a t ~ i ~ ~ ~ i O ~ o ~ w i 3 co a ~ ~ to ~ m 7 a 0 m c a y O N CP 1 1 O N N O V N N O N V O N y 3 ~i I, 0 '< 3 D ,N W ~, ID W ~CD Oc fJCO lJCO 3 3 ~ v Z m ~ z m ~ v v m ~ v v ~ ~ ~ ~ y ~ ~ ~ ~ W c N ~ ~ ~ m y~ ~ m S ~ Dop 3 Doo a 7 ~ Z p p ~ ~ ~ ~ ~ W m ~ ~z z z oo ~ ~ X ~ ~ 0 ~ o X Z c m ~ z n m v ~ m c o Z c ~ m ~ m D ~ ~ G7 ~ ~ O y 0 S > ~ O m y f7~ Ro ~ Qe .~. (D 7 N 3 W f D 3 fD C7 C ~ ao cn v ~ ~' ~ /y O W M W J O CVO O ~'C A ~ ~ a O N O W !~ o> ~+ v N CO ~ i.n O w ~ ~ C CO ~ W ~ I N O .a O C W- ~ J N N N ~ ~ p ~ O ~ O) J O ~ (n ~ O O CO ~ CO O O O. w 1 ~ a~ 00 Qo t + 1 E o ,~. D ui D ~' ~ o O ~ ~ ~ ~ ~ `~ 3 3 ~~ ~ Q ~D W o .~ o ~ tD w y O 00 ~ O a ~ O W `. 7: _ .. 1 ~. f O ~. ;, ~s i i I ~~ ~f n Cf i O C 3 ~ ~ N of co W I N a d y d a CD c °w o ~ n 3 3 m m n f1 n n ~ ~ ~ ~ v ~ A ~ ~ ~ A i N I A 3 m ~p~' CO 3 m a f d O C d C a~ m' y ~ o o ~+ ~ O m o ~ m ~ m ~ D ~ w Z Z O 1 n v -~ D w w J 'A. AN O N O co c ~ ~ Q ~ ~ m ~ n CD o' 7 V) p ..~ o 0 0 ~ 0 0 .°. O m ~_ .$ "'~ a m m 3 C ~ O » O <A O C N ~, T e 7 a m 0 0 N W w ~I O n N y S ~° d A O C7 N ~° m 7 ~' 0 N N v a c~ a N Z ~ O coin coffin o°o 000 0 r r ~ vvo oWO ono D Z n z ~ m m m n ~ v O m ~ z ~ -~ C ~7 ,.,~ m D D cc rn cn ~' rn rn ~ . O O O W N ~ A N ~' n N C a N ~ O ODD n ~ n ~_~ 9 y J1 N T N~ ~ G X 0 0 N V vg C D m w = cNn ~ N C w r ~ ~ O N O ~ 0 o w V D 0 of W N V I.JI O n fD C m a 3 m s (~'D y 0 N v °c~ m 3 -~ m 0 ~ O O ~ w~ w D ~, m O ~ °o o W N 0 N v °co me ~ ~ N w v m ~ ~ O ~ o N D rn 0 o 0 O A W f~T N n S N rn a 0 N J N N n S C~'f y G m a a ~ a M O C 1 ~ ~ ~ • a 0 A ~~ C .~. C .~. m a M ~. .0 nyi !D! ~' ~ O ~ ~ ~ ~ ~ ~ 3 '~ 3 O ~ O ~ y ~ ~ V Qa O~ W 1 A '~ '~ -L T: .. , ,, i 0 to i .t I yl m ' I of A i O~ C ~ 3 ~, i 3 N O O OD ~~ H m ~3 ~ ~a ^. ,I • a m~'c~3~ a~°m~dn y u~ ~' voi ~ ~ o cD Up)W~y~ + ~ ~D 0 C O o ~ ~ c y a ~ ~ ~ o ~ o ~ c m ~ rn ~o ~m ^3g a~~3 .C-r 3 ~ ~ y ~ fD ~ ~ , ~ f/1 ~ n `p A N ~p O m ~ ~- ~ O_ (D ~ ~ N ~.~ N d N = O ~ d o~°'~ „~q'o m ~ m ~ ~~ o <_. 3 =~ m ~ ,' o ~ o ~. m ~ ~~ =' a y ~ < ~ 7 N N -p~ ~ ~ c0 n 7 ~ ~ o n ~ - ~ C Q S N.fO ~ ~ (D O v z ~ ~ ~ H v ~ ~ z ~ r m m ~ p N ~ ~ ~ ~ A° C ~ n 5 Z O r` ~ ~ o Z C7 W ~ r ~ D D O ~ m c ~ m ~ ~ ~ ~ ~ m c ~ 1 ID 01 O O ~ d N ~ ~ ~ 0 o D d A N ~ ~ J n p ~ ~ Q a rn a A b9 l~7 J v Q Q N d a m N O ~ ~ ~ ~ ~I o 5~i ..- N I ~ O I o~°o l r fD a 0 fD d o~ , N m N 1 S ~ fD ~ a 1 J 1 0 y 1 ~~ N O O O EA O 0 rs O ~ 1 a ~p C c N m 0 a d O O G ( f0 N N~ 3 3 Q' ~ S m c ~ Ot a c 3 ~ N N y C! ~ ~ 7 a ~ a m °c -~ o o o c n ~+ v m ~ a v ~ A f =; n ~ ! ml C rv 1 iA N N ~Q I O n y N I W 0 m O e N O C n 0 -, 7 "* s' C~ ~D O ~ ~ ~ ' ~ ~ ~ g a e o 1 ~ ~ V + V b ~ O fl. ~ vs W I t i_ 0 N .+ .• ~• Sovereign Bank ESTATE OF Carol L Bruce SOCIAL SECURITY #: 193-07-1619 DATE OF DEATH: May 16, 2008 Account #: 1674061382 Type Money Market Savings Opent date: 8/31/2006 In the name of: Carol L Bruce (Robert Black POA) Date of Death Balance: $30,524.10 Int.(YTD) from 1/1/2008 to 4/3/2008 $346.50 Accrued interest to date of death: $20.02 Otherlnfo: Closed 5/27/08 Account #: _2891029283 Type: Premier Checking Open date 1/7/1986 In the name of: Carol L Bruce (Robert Black POA) Date of Death Balance: $3,578.33 Int.(YTD) fi~om 1 /1 /2008 to 5/2/2008 $1.13 Accrued interest to date of death: $0.60 Otherlnfo: Page 1 of 1 ~1 ~ k a~ ORRST0~1lN BANK A Tradition of Excellence MAY 27, 2008 TO: ROBERT R BLACK 36 S HANOVER ST CARLISLE, PA 17013 FROM: ANDREW OTT BRANCH EXECUTIVE OFFICER P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF CAROL L BRUCE DATE OF DEATH: MAY 16, 2008 77 East King Street P.O. Box 250 Shippensburg, PA 17257 IT I~S HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CHIECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST SA\/INGS ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST 708700060 CAROL L BRUCE 9/3/1997 6 206.13 + 4.75 = 6 210.88 ELIZABETH SHEARER CEF;TIFICATES OF DEPOSIT ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST LAW OFFICES ~. ~~~ ~ LANDIS & BLACK 36 901TTh1 FIMIOVEA STREgr C LF, P'E~M9YI,vAMA 17013 ROBGRT R BCACK TELEPHONE (717) 243-3727 FAX 0117) 241-{84? ). BOYD LANDLS I htUritnl rosrrH J, n~wrosrt May 28, 2008 Donald Killian Sovereign Bank 17 west ~~ Street ~ ' Carlisle, PA 17013 i Re: Carl L. Bruce, Decea#ed Y3ate of Deatb: May a6, 200$ Social Security No;1~3-0.1618 Accoq~at Na: AIG Atjnuity #Vl'ZZ8041 Deaz Mr. Killian: ~ Please be advised that we rep sent the abovacaptioncd estate and are enclosing a coPY of a death slid short certificates here th, VVe would appreciate your furnishing the followin iaformatzQn for f~aiera] estate and/or i eritatice tax purposes re g captioned decedent at your instifirtion i~ ~Y accounts of 1. ~'ype of account. ~;~ ~h' Z• Aocountnumber, VF~'2Z8o'H ~ ~ ~ ... 3• Names and/or designattion. C~i~40L. [...$t,~ 4• If joint account, daft o#iginally opcncd as~d date placed in joint names,' S• Principal and. interest balances as of date of death. ~q 884~6k t , ~~~; you for yodr cooperaiio~i in this matter. Should you }ia;•P ~,y ttestions G advise. 4 ,plea, e i 1 very truly yours, ~ ~ ~~ ~ ~? ~~ Ro ' bent R, Black RRB:kdr~a .. .. .. ~ Eiiclosures. .~ ~~ ~ .. '~ : , , . ~ ~ ~~ ' f I i - ~~ AIG Annuity INSURANCE COMPANY AIG Annutty Insurance Company A Stock Company 205 East 10th A~~enue Ametillo, Texas 791.01-3546 Telephone: 800.424.4990 eferred Annuity Application Flexible Premium ^ Single Premium OWNER All Policyholder correspondence will be sent to this address.) Name: )~,[ to ~ Sex: /.~{ Age: ~ DOB: 7 • ~ j- ! 4 ~ ~T Address: i'7rT~ S Marital Status: ~ SSN: (~.~~-d7 - ~ ~C~ ~ -f ~~.1Q,~1 ~~7 ~ 7(~l-3 Daytime Phone: 1 i 7- Z~3-~d3~ JOINT OWNER (Optional. Non-Qualified Annuities only.) Name: Sex: Age: DOB: Marital Status: SSN: Daytime Phone: ANNUITANT (if different from the Owner.) Upon the death of the Annuitant, Owner may designate a new Annuitant. If no designation is made within 30 days of the death of the Annuitant, the Owner will become the Annuitant. Name: Sex: Age: DOB: Address: Daytime Phone: SSN: Relationship to Owner: OWNER'S BENEFICIARY DESIGNATION - In the event of death of Owner, surviving Joint Owner becomes Primary Beneficiary. ^ If you do not want the J t O ner to Pri a Beneficiary, check her and name Beneficiary below. P ima Beneficia Name: ~~ ~ ~~~ ry ry: ~ ~.~~_ Relationship:,„ ~. Beneficiary: Namie: ' Relationship: ~~ INTEREST RAPE (Interest its credited and compounded daily to achieve the annual rate. To achieve this rate, the premium must be left for a full year without any wii:hdrawals.) The Interest Rate on the (Initial/Single) Premium is ~~~% for ~_ year(s). PURCHASE PAYMENT 2 2 8 0 41 ~-_? Policy Number: VP Policy Date: C~"~~' rp Initial Premium Payment: $ S©I ~~~ Annuity Date: PLAN TYPE (required): Non-Qualified ^ Qualified Tax-Qualified Plans: ~ "traditional IRA O SEP IRA ^ Roth IRA O 401 (Corporate Plan) ^ 403(b) TSA O Other: Check one: O Initial Contribution for Tax Year O Transfer O Rollover ^ Roth IRA Conversion Year ACKOWLEDGEMENT I acknowledge on _~"~~~li~ I received annuity policy VP ~~ SIGNATURES Checks must be made payable to AIG Annuity Insurance Company. ~ Will this annuity replace or be exchanged for existing life insurance or annuities? ^ Yes Id'No I O do do not have existing policies or contracts. I understand this annuity is not federally insured. On behalf of myself and any person who may claim any interest under this policy, I represent that all statements and answers in this application are complete and true. I have read and understand the important disclosures located on the reverse of ~ application. wne~r's Signature Joint Owner's Signature (if applicable) Signed at (city/state):~C Std, , }~~ , on (date)• ~'°~ ~ ' ZUC~( REPRESENTATIVE INFORMATION To the best of my knowledge and belief, this Application O does does not involve replacement of existing life insurance or annuities. If repl~lYtgnt is involved, I~ a ~a~ed a copy of each disclosure statement and a list of companies involved and indicated cost basis: 1 _n 's X Licensed Agent (Print name) T~ ~Il,'C. U° gency Name and Number State Lic.#: Agent: ~~~_ FBDA (C1-00-A WHITF _ Pnlinvhnlripr (nnv VFI I nUl _ u.....e ns~..,, r~,...., n,.,,. „ __ _ _ .. _ _. _