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HomeMy WebLinkAbout10-31-0815056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Deparhnent of Revenue County Code Year Flle Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 21 08 0596 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW ~iociai Security Number Date of Death Date of Birth 179-12-4903 05/13/2008 01/14/1923 Decedent's Last Name Suffix Decedent's First Name MI SHOWAKER ARLENE D (If Applicable) Enter Surviving Spouse's Information 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 F=ILL IN APPROPRIATE OVALS BELOW ~~~ 1. Original Retum .:_~._ 2. Supplemental Retum , ~_. 3. Remainder Retum (date of death prior to 12-13-82) :. 4. Limited Estate .~_, 4a. Future Interest Compromise (date of . ~ _ 5. Federal Estate Tax Retum Required death after 12-12-82) r>~ 6. Decedent Died Testate ~...:..~ 7. Decedent Maintained a Living Trust ~- 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) _::. ;- 9. Lft(gation Proceeds Received _:: 10. Spousal Poverty Credit (date of death ..__:; 11. Election to tax under Sac. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT R. BLACK (717) 243-3727 Finn Name (If Applicable) REGISTER OF WILLS USE QNbY LANDIS & BLACK 4=? First line of address -- <-_~ ~ ~~ -, -, ;_; 36 S. Hanover Street , _ c,~ Second line of address --,-~ City or Post Office , ~: .--- State ZIP Code DATE FEED Carlisle PA 17013 Correspondent's e-mail address: Under peneHies of perjury, I dedere that I have examined this return, induding accompanying schedules end statements, and to the best of my knowledge and belief, R is true, cared and complete. Dedaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SGt~i TIjR~OFP~SONj2~SPONSIBJ/EFOR~IihG,RET/R~ ~~~' ~;j /~DAT~/-~~ 414 TouPt'ystone~pr., Carlisle, PA 17013 44 Hair Road, Nettwille, PA 17241 _ 36 S. Hanover Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~~ 15056052059 REV-1500 EX Decedent's Social Security Number ARLENE D SHOWAKER 179-12-4903 ~~d~,rg New: .~..._ __-_-. _..~._... _....__ __ __.____..a._. _.____._____..._...~._..__.~.___._.__ ___ __ ..... _ _ ._._~ __ _.___. _._____ ~..._ RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 0.00 __ ._ _._ 2. Stocks and Bonds (Schedule B) ....................................... 2. 2,177.28 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages 8 Notes Receivable (Schedule D) ............................. 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule E) ........ 5. 67,203.03 _ __ _ _ - 6. Jointly Owned Property (Schedule F) <w':~ Separate Billing Requested ....... 6. 16,243.06 7. Inter-Vvos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ;~=::= Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 85,623.37 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 20,596.43 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 1,188.64 11. Total Deductions (total Lines 9 8 10) ................................... 11. 21,785.07 t2. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 63,838.30 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. 63,838.30 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable et lineal rate X .045 63,838.30 16. 2,872.72 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable _.__. at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 2,872.72 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-t500 E}; Page 3 n....w.la,r~t~c f'`nr~nlete Ae~lr~lro¢¢• File Nymb~ 21 08 -0596 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER LE'~NE D SHOWAKER AR ____ 179-12_4903 _ _ STREET ADDRESS 44 Hair Road ___ ._ -- -- CITE --- -- STATE ----r7JP - - Nevrviille PA 17241 Tax Paryrments and Credits: 1. Tax Dire (Page 2 Line 19) 2. CrediNslPayments A. Spousal Poverty Credit -_-_--- B. Prier Payments 2,000.00 C. Discount 105.26 3. Intere~sUPenalty if applicable D. Int~.rest E. Penalty (1) Total Credits (A + g + C) (2) Total lnteresUPenalty (D + E ) 4. 8 Line 2 is greater than Line 1 + Line 3, enter the d'rfference. This is the OVERPAYMENT. Fill in oval on Page Z, Llne 20 to request a refund. 5. ff Line 1 + Line 3 is greater than Line Z, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enl~er the total of line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) 2,872.72 2,105.26 0.00 0.00 767.46 0.00 767.46 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes 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 or care? ...................................................................... ^ 2. If death oax~rred after Decemt~er 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~robate property which contains a benefiaary designation? ........................................................................................................................ ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)}. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)}. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefidary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidaries is four and one-half (4.5) percent, except as noted in 72 P.S. §51116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1,3)J. Asibling is defined, under Section 9'102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. RcV-; 503 EX+ (6-98) ~' SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STACKS & BANDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHOWAKER, ARLENE D. FILE NUMBER 21-08-0596 All aroaerty 3oiMiv-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV'-~ 508 EX+ Z6-98; ,~- ~~, seHF®u`E ~ CASH, BANK DEPOSITS, & MISC. COMMONU~IFA~TH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT pECEDENT ESTATE OF FILE NUMBER SHOWAKER, ARLENE D. 21-08-0596 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Presbyterian Homes -Refund Nursing Care 1.5Ci6.c+_; 2. U.S. Treasury -Stimulus Payment 3CO C!. 3. Susquehanna Bank -Close Certficate of Deposit, Account No. 405100001495 (See attached letter) 21, 21 n °.~~ :" 4. Farmers National Bank -Close Checking Acxount No. 177334 (See attached letter) ~,; r? w 5. Farmers National Bank -Close Certificate of Deposit No. 160474 (See attached letter) j ~ ~" -~ 6. Farmers National Bank -Close Certificate of Deposit No. 172570 (See attached letter) 13 ~gq ~ ,~.. 7. Proceeds -Sale of 1995 Ford Automobile (See attached letter) 4 ~ ~ ~ r, 8. American Progress Life -Refund -Health Insurance ~ ~~ r `; 9. Embarq -Refund -Telephone Services ~ g t« TOTAL (Also enter on line 5, Recapitulation) S I E7.203.0 (ff more space is needed, insert additional sheets of the same size) REV-i5'~5 EX+ i6-58) ~ ` '~ COPAMONV~JEALTH OF PEP•iNSYUTANiA INHERITANCE TAX RETUP,N RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER SHOWAKER, ARLENE D. 21-08-0596 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schadute G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Jefifrey E. Showaker 44 Hair Road, Newville, PA 17241 Son 8. C. JOINTLY-OWNED PROPERTY: lTF~d NURf.BER LETTER FGR JOINT TENANT DATE , F1RDE JOINT '~ DESCRIPTION OF PROPERTY y INCLUDE. NA~!E GF GINANCIAI fNST1TUTiCN AND BANK ACCGUNT N!1~ABER OR SItAILAR _ IDENTI**'VING NU~16FP,. ATTACH DEF.C FDR JOINTL•-NELC REAL 'cSTATE. DATE GF DE ATr1 VAi.IiF OF ASST ~-: of DECGS MTERcS{ GATE of DE~_-, v4';E ~- CECED~aliE IN7s?ES' t. A. 10105f04 Susquehanna Bank, Checking Account No.148005156 32 486 12 50% _ ? 6 2433 ~~ , . TOTAL (Also enter on line 6, Recapitulation) ~ s ~ 5 <~? 0•, (If more space is needed, insert additional sheets of the same size) REW1511 EX+(12-99} SCNEDVLE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER SHOWAKER, ARLENE D. 21-08-0596 Debts of decedent must be reported on Schedule I. A. I FUNERAL EXPENSES: 1' Egger Funeral Home -Services g. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Nancy K. Smith I Jeffrey E. Showaker Social Security Number(s)IEIN Number of Personal Representative(s) _ street Address See Schedule J City .State Zip Year(s) Commission Paid: 200 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Jeffrey E. Showaker Street Address 44 Nair Road City Newvilie State PA .Zip 17241 Relationship of Claimant to Decedent Son 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Reserve for closing and filing releases TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 7.$57.4' 4,2$1.1 4.2$1.15 3.500.00 376.66 300.fl0 2a.5s6 a~. REW1512 EX~ 112-05) CAMIADNYVEALTN of PENNSnviwu INHERRANCE TAI(RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE UABIUTIES, & LIENS ESTAJE OF FILE NUMBER SHOWAKER, ARLENE D. 21-08-0596 Report dsbb incumd by the decedent prior to death which remained unpaid as of the date of death, indudiny unreimbursed medkal expenses. T•...MO apow w iwvuw, umai iwwuww~ sTw6[s OT Qle Same 812e) REV-t 5 f 3 EX+ t9-Oi:; SCHEDULE a COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SHOWAKER, ARLENE D. 21-08-0596 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not Lfst Trustee(s) OF ESTATE ~ TAXABLE DISTRIBUTIONS [ndude outright spousal distributions, and transfers under Sec. 9118 (a) (1.2)) AS ATTACHED ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE. ON REV 1500 COVER SHEET II INON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUT10N5 TOTAL OF PART I) -ENTER TOTAL NON-TAXABLE Dt3TRtBUTi0N3 ON LINE 13 OF REV 1500 COVER SHEET i; (I(mae space is needed, insert additional sheds of the earns size) SCHEDULE J BENEFICIARIES ESTATE OF ARLENE D. SHOWAKER. FILE NUMBER: 21-08-0596 NUMBER NAME AND ADDRESS RELATIONSHIP AMOUNT 1. Jeffrey E. Showaker Son Bequest 44 Hair Road $5,000.00 Newville. PA 17241 S.S. No. 202-50-5605 2. Erin Brenize 10865 Willow Reed Circle-West Pazker, CO 80134 S.S. No. 208-64-3806 3. Erik Showaker 200 N. Main Street, Apt. 814 Chambersburg, PA 17201 S.S. No. 206-64-5876 4. Judy Ann Linton 1346 Centerville Road Newville, PA 17241 S.S. No. 168-36-6423 5. Nancy K. Smith 414 Touchstone Drive Carlisle, PA 17013 S.S. No. 165-38-2423 6. Linda Lou Pretz 375 Avon Drive Pittsburgh, PA 15228 S.S. No. 194-42-8425 7. Jeffrey E. Showaker 44 Hair Road Newville, PA 17241 S.S. No. 202-50-5605 Granddaughter Bequest $5,000.00 Grandson Bequest $5,000.00 Daughter 1 /5 of Residue Daughter 1/5 of Residue Daughter 1 /5 of Residue Son 1/5 of Residue SCHEDULE J BENEFICIARIES Page 2 ESTATE OF ARLENE D. SHOWAKER. NUMBER NAME AND ADDRESS FILE NUMBER: 21-08-0596 RELATIONSHIP AMOUNT 8. Erin Brenize 10865 Willow Reed Circle-West Parker, CO 80134 S.S. No. 208-64-3806 Granddaughter 1 /10 of Residue 9. Erik Showaker Grandson 1 / 10 of Residue 200 N. Main Street, Apt. 814 Chambersburg, PA 17201 S.S. No. 206-64-5876 IAST WILL AND TESTAME~I'I' OF ARLII~ D. 3 I, ARLIIdE D. SHaWAI~R, of the Penn Township, Cimiberland Caunty, Pennsylvania, make this Will, revoking all my former wills and codicils. ISM I: I direct that all my just debts, fianexal expenses and administration expenses, including my grave marker, shall be paid frcan the assets of my estate as soon as practicable after my decease. IR~M IS: I devise and bequeath all the residue of my estate, of every nature and wherever situate, to my husband, E[TGE3~1E B. SHOWAFO;R, providing he shall survive me by sixty (60) days. ITF~+i III: Should my husband, EUGIIQE B. S~~TAKEF2, predecease me or die on or before the sixtieth day following my death, I bequeath the amounts or items herein specified to each of the following-named beneficiaries: a. To Ronald F. Shawaker, my son, the sum of $10,000.00 as my appreciation for his staying on the "Hoene Farm." b. To Jeffrey E. Showaker, my son, the sum of $5,000.00 representing his investment in the new implement shed together with all shop parts aril equipment contained in said implement shed. 0 1<ffiK IV: Should my husband, EUGII~IE B. SHOGJAI~R, predecease me or die on or before the sixtieth day following my death, I devise and bequeath to Ronald F. Showakex, my son, the two (2) acres of land, more or less, immediately ajoinirig his property to the West. SZ~M V• Should my husband, EUGErTE B. SHOWAKER, predecease me or die on or before the sixtieth day following my death, I hereby grant to Jeffrey E. Showa}c+er, my son, the exclusive right and option to purchase my hcene, land of approximately 30 acres, riore or less excluding land ajoining Ronald F. Shvwaker's property), and all buildings erected thereon together with any livestock and farm equipment he may choose, at a value to be placed thereon for Pennsylvania Inheritance Tax purposes. Jeffrey E. Showaker shall notify my hereinafter named executors, in writing, within four (4) months of my death of his election to exercise the foregoing option. Final settlement shall be within two months after such election is delivered to my executors with Jeffrey E. Showaker being given credit for any share he may otherwise have c~cening frcan the residue of my estate. r,CE~ VI: Should my husband, ECTGENE B. SfioWAKER, pr~~~ me or die on or before the sixtieth day following my death, I devise and bequeath all the residue of my estate, of every nature and wherever situate, in equal shares, to my five (5) children, namely, Ronald F. Showaker, Judith Ann Linton, Nancy K. Smith, Linda Lou Fretz and Jeffrey E. Showaker, or their issue, per sties . I'I~1~i VII: I appoint NANCY K. SP'iI'IIi, a, guardian of any px~aperty which passes, either under this Will or otherwise, to a minor. Said guardian shall hold, manage, invest and reinvest arty property received by the guardian, shall collect the income therefrcan, and shall apply so much of the net inoarc~e, and, if the net ir~c-e is insufficient, so much of the principal of said praper~ty held for such beneficiary as the guardian shall deem necessary or advisable for such beneficiary's health, maintexzance, support and cxa~lete education. The guardian shall aecinrnil,ate any surplus net inooatte annually and add the same to the principal of the property held for such beneficiary. men such beneficiary attains the age of Eighteen (18) years, all propexty shall be distributed to such beneficiary, or to such beneficiary's estate i.n the event of death prior thereto. ITFM VIIII: No interest of any beneficiary hereunder in either the principal or irx~cat~e of my estate shall be subject or liable in any maxmer to anticipation, pledge, assignment, sale, transfer, ch~at~ge or encw~brance, whether voluntary or involuntary, or for any liabilities or obligations of such beneficiary whether arising fret his or her death, debts, contracts, torts or engagements of any type. I'.CFM IX: I direct that all taxes which may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid frcan my residuary estate as a part of the expense of the administration of my estate. 1<I'II~I X: I appoint my husband, EZTGENE B. SHQWAKF.R, Executor of this, my Last Will. Should my husband, E[JGENE B. SFK74~AF~t, fail to qualify or cease to act as Executor, I appoint Ronald F. Showaker, Nancy K. Smith, Jeffrey E. 5ho~nraker, or the survivor thereof, Executors of this, my Last Will. IN F, I have hereunto set my hand this ~ day of 1988. ARLII3E D. SHE The preceding instnrnent, consisting of this and one other typewritten page, each identified by the signature of the Testatrix, ARI~TTE D. SfiOWAKEE2, was, on the day and date thereof, signed, published and declared by ARL~IE B. SHO~WAI~R, the Testatrix therein named, as and for her Last Will, in the p~ of us, who, at her request, in her presence and in the presance of each other, have subscribed our names as witnesses thereto. -I~~-~~ CC~A9JNIWEALTfi OF PIIaiSYLUAtJIA ) 0(7UI~fI'Y OF CUr'~LAND ) We, Arlene D. Showaker, Robert R. Black acid Edward L. Schorpp, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instnnnent, }.~eing first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instnm~nt as her Last Will, ar~d that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, ixi the presence and hearing of the Testatrix, signed the Will as witness, and that to the best of their knaaledge the Testatrix was at the time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix ARLatE D. SHOWAKER Witness RfJSERT R. BLACK Witness EDWARD CHORPP Subscribed, sworn to and acknowledged before me by Arlene B. Shvwaker, Testatrix, and subscribed and sworn to before me by Robert R. Black and E~lwatt~ L. Schorpp, wig, this Z~ day of ~I(,(p~ g ~ . 48500041D46 REV-485 EX (1-07) SASE 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 ~~ N ~ . ~ ~ ~ ~~~~~~~~ ~. l .~. Decedent's Last Name Suffix First Name MI ADDRESS OF DECE ENT STR T: CITY: STATE: ZIP CODE: r.~ `? 4 ~c~ilVlLtx ~Zy~ ~WAME AID ADDRES//S~~OF PERSO RErQt~jJSTI~NG/~T/HE OPENING OF HE SAFE DEPOSIT BOX STREE S CITY: TATE: ZIP CODE: ~4u. dd~ .1 r~ ~~~ ! "7~l ~VAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, F PERSON(S) PRESENT AT T E BOX OPENING a. NAME: ~ CATION STREETA ORES CI (`~' C~ i f , ` {~ STATE: ZIP CODE: b. NAM ~ ~~u ~.7/ a~'v~ ...~~- V ~ ( /~ ~i~SL~ 1_. ..._ _ I ~a~.~ / HIP• STRE T R S I STATE: ZIP CODE: c. NAME: / I RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIA4 INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME• - _.~ ---- - - - ~ - __ . - --- -- r~-na ~~ ~ - -- - - STRE ADDRESS;, STATE: ZIP CODE: ~AM F O MAKING LAST RY ( - DAT AN TIME OF LAST ENTRY /~~ ~:~ DATE OF ONT CT 0 RENT BOX ' NUMBER OF BOX 1 TITLE UNDE WHICH BOX IS R GlSTERED 2 D d O GEC(! . S•f f ~0 c~ f}K ~ 1^Cs&NC ~ ~ -~~~4~r~? ~AME AND AD RESS OF PERSON(S) HAVING ACCESS 70 BOX a. NAME: , b. NAM _.- STREETAD STREET E ; /~ J/~•• ~~/'~ ~, / ~~• TA ZIP CODE: CITY: AT~ w ~( w~ CITY: ~~ ,STp,T~~L ZIP CODE: I~WAME AND TITLE OF EMALOYE~TAKING THE INVENTARY .. ~ , . . ~r ~-, . v - W,4S AWILL IN THE BOX4 ^ YES ~ NO If yes, a. Date of will: . Name and address of personal representative, if named in the will - --- NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: c. Name and address of attorney, if any NAME: STREET ADDRESS; CITY: STATE: _ ZIP CODE: _ L, 48500041046 48500041046 J REV-485 EX SAFE DEPOSIT BOX INVENTORY Page of INSTRUCTIONS (1) Cash: Report total only. (;!) 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. (1) Obligations 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. (41) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (Ei) Jewelry, Coins, Stamps, 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. (Et) Ati other contents. (9~) Return completed form to: ,NHERITANCE OAX o vlstoN Po Box zeasul IiARR{SBURG, PA 17128-0601 ITEM ITEM DESCRIPTION t, C~CfZf O F_I~rP4Si~- c~$3~~-_Fi9~~G~s~At~., ~1~~- s/~(i~/ -_1~ ~4. -- !4',4G0 !JO Z~• ~+ u -- 8~l" " ti - tU~~lZca~~'-_3rp moo, r ~o Go(,_oo___._ _ _ - --- --- _ f __ +~1.. ~ _~~JO ©cs I'ZVV3 -~{l9i2Rr5 S~'tU' -3i~-11~~L~~i- Z5~6, ~. ~~, °ov, ub ,~ t~E~f~r~ey Ga_7_ _ _- - ~8"~3 ~C~^ ~f~ _v_>~u.E~ o~~~, pus- ?l.~~jl4r~ - ~cor~f ~!6~0- _5. _ ~~~~: _Q~' f1~~t~r ~ 172510_ F~1FM~Ks N-~c.,3~yN~- 2~q~Qo-f- $w~o~. _l3 ZS~ ~g_--- ~.. C.ERf~_-F ~rr~~~ ~f'$~-dSro5fr76~' (~~~~~Fo~p sw_ Zltgla3_. 1 ~ N p~Po~rr- ~slo~aQ ~~`rS- C6r~frsfuufr~ ~i9NKS -- l~z~t!a7- ~rr1~~- za 000, 0+7 - ~ ~K~V(.~cT~ - ~X.~Q~Iv. ~l - ,t~G--tE~', Cs~JI/Ek'~4L ~9NMU~r - ~ ZQoz -10~o~.ad _ ~-.__ ~ _ I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY: SIGNATU SIG TORE ~ ~f ~ r iry PRINT' PR M D G ECK A OPRVATE 80 ~~~.3~~ ~, ~~ ~~ ~ s~~~ ~ F Eye: s~~~ __ __ __ ___- F PRINT TITLE DATE CHECK APPROPRI TE BOX: ~Tr~ ~~/~-y ~Exacutor(Irix) ~ Atlministrator(trix) Estate Representative ~ Joint owner of sate 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, 42 U.S.C, §405 (c)(2)(C)(i), to require disdosure of Social Security numbers in connection with administering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. Tha Commonwealth may also use the information in exchange of tax information aareemantc with Federal and kxal taxin authorities. The state law prohibits the Commonwealth's personnel from disclosin4 confidential taY ~„a•.....~--- -- ~ - - Prudential 001403 NANCY K SMITH EX EST ARLENE D SHOWAKER 414 TOUCHSTONE DR CARLISLE PA 17015 irrr~iinr~iintrn~~r~rirr~inir~rrr~r~rrrr~~rrr~~r~n~~irrr~ Prudential Financial, Inc. is organized under the laws of the state of NJ. Holder Account Number 00030464621 CompanylD ?RU _.___ ~ ~~ Prudential irinanciafi, Inc. -Direct Registration (DRS) Advice Transaction(s) Date I Transaction Description 'j ShareslUnits CUSIP I Descr ption 23 Sep 2008 Transfer 28.000000 144320102 Common Stock Account Information: Date: 23 Sep 2008 (Excludes transactions pending settlement) Current Certificate Total Balance Direct Shares! Price Value ($) CUSIP Class Held by You Registration Units Per Share Description Balance 0.00 28.000000 28.000000 77.760000 2,177.28 744320102 Common Stock IMPORTANT INFORMATION RETAIN FOR YOUR RECORDS. This advice is your record of the share Uansaction affecting your account on the books of the Company as part of the Direct RegisUation System. It is neither a negotiable inshument nor a security. and delivery of this advice does not of ftsetf confer any rights on the recipient. It should be kept with your important documents as a record of your ownership Ot these shares. No action on your part is required, unless you wish to deposit your existing certificates, sell or request a certificate, or transfer your book-entry shares. Upon request, the Company will furnish to any shareholder, without charge, a full statement of the designations, rights (including rights under arty Company's Rights Agreement, ff any), preferences and limitations of the shares of each class and series authorized to be issued, and the authority of the Board of Directors to divide fhe shares into series and to determine and change rights, preferences and limitations of any lass or series. Assets are not deposits of Gompulershare and are not insured by the Federal Deposit Insurance Corporation, the Securities Investor Protection Corporation, or any other federal or state agency. ~omputershare Computershare Trust Company, N.A. PO Box 43033 Providence, Rhode Island 02940-3033 Within the US, Canada ti Puerto Rico 800 305 9404 Outside the US, Canada 8 Puerto Rico 732 512 3782 vvww.computershare.com/investor 40UDR P R U ~- June: 26, 2008 Robert R. Black, Esquire 36 South Hanover Street Carlisle, PA 17013 RE: Arlene D Showaker Estate SS#°, 179-12-4903 DOl): May 13, 2008 To `'Vhom It May Concern: Susquehanna Susquehanna Bank PA 26 North Cedar Street P.O. Box 1000 Lititz, PA 17543-7000 Toll free 800.311.3182 In response to your letter of June 11, 2008, here is the above customer account information as of May 13, 2008. • Account Title: Account #1 Arlene Showaker Jeffrey E Showaker Account #2 Arlene D Showaker • Account Type1# Checking / 148005156 Certificate of Deposit /405100001495 • Date Opened /Maturity Date: l 0/5/04 l /26/07 - 11 /26/08 • Interest Rate: 0.75% • Account Balance*: $32,482.12 • Accrued Interest: $4.00 • YTD Interest: $144.66 *Account balance does not include accrued interest. TherE; is no safe deposit box in the name of this decedent. If I can be of further assistance, please feel free to call. Sincerely, anet M. Peters Support Services Supervisor 1-717-625-6295 3.68% $21,180.76 $36.21 $257.87 JMP/SFRA ~~~ IONAL BANK r--- FARMERS NAT OF NEWVILLE ,a;,,,,,,,,,,„~.~~,;,~,,.,~,,,,,:;,.~.:;.;,,,,.,: k.,>,a June 12, 2008 Robert R. Black, Esquire Landis & Black 36 South Hanover Street Carlisle, PA 17013 RE: Arlene D. Showaker Estate Dear Mr. Black: Mrs. Showaker had the following accounts with this bank: Checking account 41177334 in her name alone, opened December 5, 1996 with a balance as of May 13, 2008 of $16,029.04 plus .18~ accrued interest; Certificate 08 Deposit 4I160474, also in her name alone, dated October 7, 2002 for $10,000.00 plus $7.70 accrued interest; and Certificate of Deposit 44172570 opened February 9, 2007 for $13,690.35 plus $303.80 accrued interest. This certificate was also in her name alone. Sincerely yours, Carolyn H. Koug Executive Vice President Y.O. I3os 15C, \cw~~ille, PA I'?-~ 1 • (? 1 ") ""'G-5 i 12 h-' a~ -~J ~~ -~J OrJ ~.