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Home My WebLink About11-05-08 f I' ~' J 15056051058 - REV-1500 EX 06 05 ( - ) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes PoBOx28oso1 County Code Year File Number INHERITANCE TAX RETURN - - Harrisburg, PA 17128.0601 RESIDENT DECEDENT 2 08 0394 ENTER DECEDENT INFORMATION BELOW Social Security Number __ . Date of Death Date of Birth :472-16-5591 ; 04/01/2008 03/06/1921 Decedent's Last Name _._ _ ... Suffix Decedent's First Name MI ... ...Peterson. __ _ Donald H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name _. Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - - - REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW i;~:a 1. Original Return ,4"~~,~ 2. Supplemental Return ~;„„`"~ 3. Remainder Retum (date of death ~.;~;;~ 4. Limited Estate prior to 12-13-82) ~_~:"~? 4a. Future Interest Compromise (date of t-'~,, 5. Federal Estate Tax Return Required death after 12-12-82) i~f:.~ 6. Decedent Died Testate (Attach Co of Will) _:':„~ 7. Decedent Maintained a Livin Trust 1 9 -- - . 8. Total Number of Safe Deposit Boxes py (Attach Copy of Trust) ~:~.°"~ 9. Litigation Proceeds Received ~m;~: 10. Spousal Poverty Credit (date of death ~.„~~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIR~ED TO: Name __ __ __ _ Daytime Telepho~ Number ~ -,~ ___ John M. Eakin ___ a ;:~ ~ :'~ (717) 766-310 -~ r t ; Firm Name (If Applicable) , -~'~ O ~~ ~ -~' ;.:7 REGISTERIxB USE OILY P i _~ S- 1 i ~ _.~- First line of address . , f~_i c .` C'> ___ C3 ~~ ~ ~ - Market Square Building Q O ~`~G-?'r" ~ ~~ , --- .- Second line of address °_ rn --- ~--a O c. ;, GJi City or Post Office Mechanicsburg State ZIP Code DATE FILED PA 17055 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of~hich preparer has any knowledge. SIGNATURE OF PERSbN RFCPnNSiai G rno r.. i~in r,~r,,.,.~ 106 S. Frederick Street, Mechanicsburg, PA 17055 1330 Valley Green Road, Etters, PA 17319 SIGNATURE OF PREPARER OTHEFOLTHAN REPRESENTATIVE ADDRESS - i ~ ~. '~ %1.9,v,.- DATE ~ J s„~- ~ c - 15056051058 Side 1 L 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Donald H Peterson 472-16-5591 RECAPITULATION 1. Real estate (Schedule A) .......................................... ... 1. ': 110,000.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2.! __.. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................... .. 4. _. _.... 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 23,956.65 6. Jointly Owned Property (Schedule F)~. Separate Billing Requested ..... .. 6. _.~ --_. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property - - -- - (Schedule G) €:. ~"~ Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7).......... ........................ .. 8. 133,956.65 ' 9. Funeral Expenses & Administrative Costs (Schedule H) ................... 9. 23,728.85 i 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10.: 43,232.50 11. Total Deductions (total Lines 9 & 10) ................................. .. 11 • _..._. 66,961 35 ' 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 66 995.35 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which , ~ _ - an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ....................... . 14. 66,995.35 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES~~ ~ ~ ~~~~~ ~~ ~~~~-~~'-''a~~"~'"~""'-"""~`" 15. Amount of Line 14 taxable at the spousal tax rate, or Vansfers under Sec. 9116 _. (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable _ --- _....~ ... .. _._. at lineal rate X .0 45 66,995.35 ~ ~~~~ ~ ... . 16. 3 014.79 17. Amount of Line 14 taxable ~ ~ ~~ ~ ~"'~~~""° , . ._ _ _ _. at sibling rate X .12 ' 1 ~ 18. Amount of Line 14 taxable -- -.. ...__._ ......._ _.,., at collateral rate X .15 18 19. TAX DUE ........................................................ -. . 19. ' 3,014.79 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Lam I.._ 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: Fllp_Nyrrm.48r ,. , ~.~. _. .0394 _._. . _2. ni3' DECEDENT'S NAME - - °' DECEDENT'S SOCIAL SECURITY NUMBER Donald H Peterson 472-16-5591 STREET ADDRESS - - 106 S. Frederick Street CITY STATE ZIP --- Mechanicsburg ~ PA ~ 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount - Total Credits (A + B + C ) 3. Interest/Penalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (2) (3) (4) (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT 3,014.79 3,014.79 3,014.79 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLor.Ks 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :................................................................................. Yes ......... ^ No 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 occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ...................................................................................................... ^ ... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...... ..... ^ ....... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which . contains a beneficiary designation? ................................................................................................................. ....... ^ IF THE 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)j. The statute does not .xamr,t a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 F,(+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT is tat t OF FILE NUMBER Donald H. Peterson 21-08-0394 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. • --- - ----.., ...,..,,, a,.,.~,~„~~a~ ~~~~~~~ v. use same size Previous ediliontara obsolete -' form HUD-1 (3/86) ref Handbook 4305.2 - A. ~ Settlement Statement U.S. Department of Housing and Urban Development B. T e of Loan OMB royal No. 2502-0265 ex Tres 11/30/2009 FINAL 1. pFHA 2. OFmHA 3. pConv. Unins. 6. File Number 7. Loan Number B. Mortgage Insurance Case Number 4. VA 5. OConv.lns. PI008.0099 Is wm Is umi give you a amen e u ae amen m un pa an y e sa amen span ere own. y C. Note: Items marked "(p.o.c.)" were paltl outside the dosing; tray are diown hero fw Information purposes end are rwl intluded in the folds, TIfIeEXpreSS $ettiBment System WARNING: It la a aims to knowingly make floe sletementa to the United Slates on tNS w an other d il f p y m ar arm. enalties upon wnviction can Indude a fine and I eonmant. Fw detdls sea: Tide 16 u. s. code Section 1001 and Section 1010. Printed 10/29/2008 at 12:47 BG D. NAME OF BORROWER: Patrick M. Smith, Sr. ADDRESS: 4242 Carlisle Pike Suite151 Cam Hill PA 17011 E. NAME OF SELLER: Estate of Donald H. Peterson ADDRESS: F. NAME OF LENDER: ADDRESS: G. PROPERTY ADDRESS: 106 S. Frederick Street, Mechanicsburg, PA 17055 Mechanicsburg Borough H. SETTLEMENT AGENT: Pinnacle Land Transfer, LLC, Telephone 717.920.3331 Fax: 717.920-3332 100. GROSS AMOUNT DUE FROM BORROWER n. v~anrwrtr yr JCLLCKJ I I<AN5AGIIUN: 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 110 000.00 401. Contract sales rice 110000 00 102. Personal Pro . 402. Personal Pro e 103. Settlement cha esto tr rl ~r Qinr 14~~ i' 1986.38 403. tog. ,_r ~ ~- .:;; . _ _~; ao4. - _ 105. _ _ 405. Atl ustments for items aid b seller In advance ~ Ad'ustments for items aid b seller in ao act 106. Ci !town taxes~ ~ "' ~~town fazes ri- r~ ~~< 107. Coun taxes z"! 10/29/08to12131/08 X100 48 . • rr.~. .4~ r ,,i ,;' taxes 10%08 7!3110 108 A , . . 100.48. . ssessment 10/29108 to 06/30/09 ~903A3 408 ~s ts~~ , : 't •10129/08 5 30 109 S r" d 2 _ _ _ ' e ~ , , _ to0 1 109 903.03 . ewer ~ _1 / 9108to12131/08 ~ 45;1 409 S~_'` ` ''10!29/08 'I r ' 110 R f 10 2 8i _ to1213 i 08 ` 45.21 . e use = 1 910 o12131/08 `,30 ,13 410 Ret~s~T 10129108 ~ 111 + _ . to11131108 - -- 30.13 . ~ ;+~.. ~ti ;3 411. ' T 112. -~' . >< -- ~. ; 412 . 120 GROSS AMOUNT . DUE FROM BORROWER _y~ 113,045.23 420 GROSS AMOUNT:~DUE TO SELLER z` ~ 111078 85 200. AMOUNTS PAIDIBY OR ON BEHALF OF BOR R0IM1~R ;: ~' _' _ 500 REDUCTIONS IN AMOUNT DUE . 201. De it orea~~F~r}~ne 10,000;QO . TO SELLER 501 Excsb: sit seeil~ tn~fipli ) ~ ' 202. Princi al arrpLilt.~Fnew loans _ . _ 502. Setuen~ent char es to saL~r;lide 14 dui 2 507 34 203. Existin loan s taken sub'ect to . 503. Existin loan s Taken sub'ect to 2~' 504. P off:400304800904157 40 805.30 PNC Bank 205. 505. 206. Seller Assist 3000.00 506. Seller Assist 3000 00 207' 507. . 208. 508. 209. 509. Ad'ustments for items un aid b s eller Ad'ustments for items un aid b seller 210. Ci flown taxes 510. Ci !town taxes 211. Coun taxes 511. Coun taxes 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 13000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 46 312 64 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER . 301, Gross amount due from borrower line 120 113045.23 601. Gross amount due to seller line 420 111 078 85 302. Less amounts aid b /for borrower line 220 13 000.00 602, Less reduction amount due seller line 520 . 46 312.64 303. CASH FROM BORROWER ~ 100 045.23 603. CASH TO SELLER 64 766.21 SUBST7l1TE FORM 1098 SELLER STATEMENT: The Infomla9on contdned herein Is Irtpatent laz Infonnelion and is being fumlehed to the Intemd Revenue Servke. If you ere required to fib a return, a Igante penalty a other aer>etlon will ba Imposed on you If thle Item Is requlrad to be reported end the IRS delendnea Net It has not been reponed. The Contract Salsa Price deawbed on line 1 above mnstiWles 9ra Gross Proceeds of Ihia bansedlon. You era required by law to provide Cre set9ement~eat es IFed. Tex ID No: 12.1633996) with yow coned ta~eyer idenGfica9an number, ttyou do not provide yow mrted laiyayer IdentNcallan number, you may be subject to dvil w crlmind rnposetl bylaw. Under penalties M perjury, I cenify that the number shown on this atelement le coned my te~eyer idenlKrason nunWr. T1N: -- / SELLER(S) SIGNATURE(S): / SELLER(S) NEW MAILING ADDRESS: SELLER(S) PHONE NUMBERS: __ ,u. . _ ~i Previous editiontere obsolete form HU41 (3r86) ref Handbook 4305.2 _ . ILS.AEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: PI008-0099 FINAL PAGE 2 SETTLEMENTSTATFMFNT r..,_,-____-,. .., ... _.. .._.______ m~~~ rca~ xwCntent a seem L. SETTLEMENT CHARGES rnnteD 1U~[y~[UUtl a PAID FROM [ 7Y:4/ tlli PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on rice $110 000.00 = BORROWER'S SELLER'S Division of commission line 700 as follows: FUNDS AT FUNDS AT 701' to SETTLEMENT ~ SETTLEMENT 702. to 703. Commission aid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 802. Loan Disrrount 803. A raisal Fee 804. Credit Re rt 805. Lenders Ins action Fee 806. Mort a e A Iication Fee 807. Assum lion Fee 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Intere Fr_~nl _ std ` - @$ /dav ~ 902. Mort a ~ In ~Ir-,n ~ Prim In f~~~? ~ to ~ _ ~ ~ 903. Hazer±lns~ .I:_e Premium for to T 904. 905. " ~ a ~ -- 1000. RESERVES DEPOSITED WITH LENDER FOR ' _ ill ~~ ' 1001. Hazard lrisu nn~e ;:`' ~~ m , y Imo iT 1 -- r' 1002. Mort a'elr5c ~~~ mr, ~~ /np -- t -- - - 1003. G Pro''e ':Tax mr %S -- Imo ~ ;; - ', ~-5 -. _ 1004. Count Pro' Tax rrn~ S ';` 47.89 /mo ~_ _ __ ," 1005. Annual Assessments m~~ : `~ _ ; -' 112.11 /mo _ _ i _ __. ~- __ .. ., , 0.00 ' 1009. r ate'Anal sisAd'ustment _ 0.00 1100. TITLE CHARGES _ -" 1101. Settlement'o~~ closin fee ~ ~ _~.~ ~~~ '- _ 1102. Abstractor 6Ue search - 1103. TiBe examination 1104. Title insurance binder 1105. Document Pre aration 1106. 1107. Attome 's fees includes above items No: 1108. TiBe Insurance to Pinnacle Land Transfer LLC 817,88 includes above items No: 1109. Lenders Polic 1110. Owners Polic 110 000.00 -817.88 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed 48.50 • Mort a 'Release 48.50 1202. Ci /Coun tax/stam s Deed 1 100.00 • Mort e 1 100.00 1203. State Tax/s s Deed 1 100.00 'Mort e 1 100.00 1204. Record SaBsfacBon Piece to Recorder of Deeds Office 37.00 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Tax Cert. fee to Pinnacle Land Transfer LLC 5.00 1302. 2008-09 School Tax to Ba L. Heckard 1 ~r ~ 1303. Fed Ex / Pa off to Pinnacle Land Transfer LLC 20.00 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section 1966.38 2507.34 HUD(CERTIFICATION OF BUYER AND SELLER Iwhave carefully reviewed the HU0.1 Settlement S lament to th/ best of my knaMedga end belie(, it Is a W e and aaurele statement of ell receipts and disbumaments metle on rtry eorount by mp.Ia-tltislYari6egie~~l fu~her oertl(y Ihet I h ve re y of the HU0.1 Satdemenl Statement. ~JfXX_JC~ WARNING: IT IS A CRIME TO KN0IMNGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Sedlemenl Slaterpe~y vArkh I have pppggg a true and aoauale eccrount of ihls UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION traneacdon. I have ceuead dr~ wjll cause the fyrlSa to pe de In acmrdanca wish Oria statement. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: (h\ ' U.S. CODE SECTION 1001 AND SECTION 1010. ~~j ~j / ^ ~ y /6 '1 ~( ~ s SETTLFI.AENr AGEN IV,--K...(„~ l DATE: rY !XJ REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDt~LE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY is Ilil t of FILE NUMBER Donald H. Peterson 21-08-0394 mcluae cne proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorshlo must he disrlnced ~„ Crherli~le c Interest Checking Account Statement PNC Bank For the period 03!08/2008 to 04108/2008 DONALD H PETERSON MARY K PETERSON 106 S FREDERICK ST MECHANICSBURG PA 17055-6307 Primary account number: 50-0311-4727 Page 1 of 2 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate information, sign on to 'a' PNC Bank Online Banking at pnc.com. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espanoT, 1-866-HOLA-PNC Moving? Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-500-531-1648 F or hearing impaired clients only Traveling Outside the United States? Stop by your local PNC Bank branch to order foreign currency before you go. - Convenience -carry currency with you for immediate expenses such as taxi fares, tips and meals. - Avoid delays and save time when you travel. - Having local currency for your destination will give you added peace of mind. - Cort~atitive rates and no transaction fees. - When you return with excess currency, PNC can buy it back for U.S. dollars. Visit any PNC Bank branch for more information. Interest Checking Account Summary Donald H Peterson Account number. 50-0311-4727 Mary K Peterson Balance Summary Beginning Deposits and Checks and other balance other additions deductions 26,886.77 7,652.94 34,539.71 Average monthly balance 19,052.52 Ending balance .00 Charges and fees .00 Transaction Summary Checks paid/ Check Card POS Check CardlBankcard withdrawals signed transactions POS PIN transactions 16 1 0 Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 3 3 0 interest Summary Annual Percentage Yield Earned (APYE) 0.00$ Please see the Activity Detail section for additional information. As of 04!08, a total of 523.81 in interest was Number of days Average collected Interest Paid paid this year. in interest period balance for APYE this period 30 20,322.68 .00 Ir~~erest Checking Account Statement For the period 03/08/2008 to 04/08/2008 III For 24-hour information, sign on to PNC Bank Online Banking DONALD H PETERSON ~ on pnc.com. Primary account number: 50-0311-4727 Account number: 50-0311-4727 -continued Page 2 of 2 Activity Detail DepOSItS and Other AddltlOrlS There were 2 Deposits and Other Additions Date Amount Description totaling $7,652 .94 04/01 5,125.94 Direct Deposit -Civil Serv US Treasury 312 A 1700199 0 CSA 04/01 2,527.00 Direct Deposit - VA Benefit US Treasury 220 XXXXX5591 00 10 Checks and Substitute Checks Check number Date Reference Amount paid number Check Date Reference 2375 10.00 03/12 083055214 number 2385 Amount 295 50 paid 03/21 number 2376 2377 594.26 03/19 025475339 2386 . 101.00 03!20 087158725 oza72s588 2378 1,500.00 03/10 o87s2osol 1 000 00 03111 2387 1,600.00 03/21 087258524 2379 , . oaaa3s5s5 24.37 03/17 osa33sass 2388 2390 ' 200.00 03/24 ozs23aza3 2381 ' 1,000.00 03/13 083556583 2391 185.22 222 96 03125 03/25 o8aa72sos 2383' 2,000.00 03/17 oo3s11szs 2392 T . 26 00 03/26 088686958 2384 1,000.00 03/21 087165465 2393 . 600.00 04/01 ozasa2so5 024875965 ' Gap in check sequence "T" Teller Cashed Check Banking/Check Card Withdrawals and Purchases Date Amount Description 03/11 500.00 ATM Withdrawal 5288 Simpson Ferry 03/12 23.75 7808 Check Card Purchase The Patriot-News Ez PA 03/18 600.00 ATM Withdrawal 5288 Simpson Ferry 03/24 400.00 ATM Withdrawal 5288 Simpson Ferry Other Deductions Date Amount 04/07 .00 04/07 22,656.65 Daily Balance Detail Date Balance 03/08 26,886.77 03/10 25,386.77 03/11 23,886.77 03/12 23,853.02 Description Outstanding Item Close Debit Memo Reference No 026814335 There were 16 checks listed totaling $10,359.31 There were 3 Banking Machine withdrawals totaling $1,500.00 There was 1 other Banking Machine/Check Card deductions totaling $23.75 There were 2 Other Deductions totaling $22,656.65 Date 03/13 Balance 22,853.02 Date 03/20 Balance 19,533.39 Date 03/26 Balance 15 603 71 03/17 03/18 20,828.65 20 228 65 03/21 03/24 16,637.89 04/01 , . 22,656.65 03/19 , . 19,634.39 03/25 16,037.89 15,629.71 04!07 .00 At PNC, we're committed to protecting the environment. That's why your PNC Bank Visa Check Card is made from 100% recycled materials. You can help protect the environment too by reducing the number of checks you write and limiting the amount of driving you do. Just use your card to pay recurring or one-time bills or make purchases from your home computer Everv little bit helps Use your PNC Bank Visa® Check Card at ATMs in select McDonald's franchise restaurants across IVianhattan and receive asurcharge-free transaction. For locations, visit pnc.com/locatepnc. Member FDIC REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Peterson. Donald. H. 21 08 O~Ad Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral Home Minister Organist 1,218.00 2. Christine Konicki Funeral Expense 620.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) See Attachment Page(s) Social Security Number(s)IEIN Number of Personal Representative(s) 111 2t ('.L'C Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees John M. Eakin 6,500.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) 3, 500.00 Claimant Donna K. Peterson Street Address 106 S. Frederick Street City Mechanicsburg state PA Z;p 17055 Relationship of Claimant to Decedent Daughter 4. Probate Fees Letters Testamentary 302.00 5 Accountants Fees 6• ~ Tax Return Preparers Fees 7. Cumberland Law Journal, estate notice 8• The Sentinel, estate notice 75.00 9• PNC Bank Check images 190.54 10. PNC Bank Check Printing Fee 14.00 11. Kurt Eby, real estate appraisal 25.00 12• Cost of Selling Real Estate 1 % Transfer Tax 350.00 Satisfaction piece recorded 1,100.00 Pinnacle Land Transfer -tax certification/ fed ex 37.00 School Tax 25.00 Sellers Assist 442.31 13. Register of Wills -Inheritance tax filing fee, inventory filing fee 3,000.00 30.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 23 728 ontinuation of REV-1500 Inheritance Tax Return Resident Decedent Peterson, Donald, H. 21 08 0394 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses ~ Administrative Costs - 61 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Donna K. Peterson 3,150.00 Social Security Number(s)/EIN Number of Personal Representative(s) 202-36-6028 Street Address 106 S. Frederick Street city Mechanicsburg state PA zip 17055 Year(s) Commission Paid: 2009 Name of Personal Representative (s) Christine Konicki 3,150.00 Social Security Number(s)/EIN Number of Personal Representative(s) 202-36-6740 Street Address 1330 Vallev Green Road City Etters State PA Zip 17319 Year(s) Commission Paid: 2009 SUBTOTAL SCHEDULE H-B1 I 6,300.00 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Donald H. Peterson 21-n8-n3sd -----....__ .............~w, ~.~~~w v. uie same s¢e) rteport debts incurred by the decedent prior to death which remained unpaid as of the date of dParti hd~~dh„ ~~,,.e;~,ti~~Mea ...ea,...~ ....______ ~~n® yr a.rearx facc+DUn>< summary DONALD H PETERSO~J Account Number 40 03 048009041574 MARY K PETERSON 'afor information call 888-762=2265 Credit and Payment Information Closing Date of Maximum Available Payment Billing Cycle Credit Credit Due Date ' 04/07/08. 55,000..00 43,481.55. 05/02/08 ~t £vrrent Past Minimum Payment Dus Late Payment ~~/ Amount Amount Charge Now Due Jv 1~~~~ 36.8.85 0...00.... 0.00 368.:$5... ~! ` .If Jate .charges.-have..been. assessed, the -late charges and-minimum -payment are< both- now -due. - The__amount of your late charge is itemized separately and is not included in the minimum payment shown above ACCOy11t ACtIVI,ty Days at Date Transaction Amount Principal Balance This Balance 03/07/08 Ending`balance prev stint 43 , 518.45" 43 , 32'1'.64 9 03/17/08 Payment rec'~l -thank you 2 , 000:00- 41, 518.45 22 04/07/08 Finance clarge 195.$6+ .... ....... 04/07/08 Ending balance 41, 714.31 .. ,. .~~ . ._ ~. V ~ ~. ~. ~. ,,_: _ Finance.. Charge .and. Credit.... Life ,Insurance Information Anneal Daily Average Days in Credit life PeteantayQ Periodic Daily Billing Finance Insurance .Rata- (APR} Rate - Balance- Cycle Charge - Premium 05.500% 00:015027% 42, 041.95 3I 195.86 0.00 Finance Charge accrual method is Average Daily ,Balance. The Periodic Rate may. vary, Please refer to the Account Activity section above for information about the number of days used to compute the Finance Charge on your account. Important Information LANDSCAPING, GARDEN SUPPLIES, OR A FRESH COAT OF PAINT ARE ALL WITHIN REACH. THINK SPRING! USE YOUR LINE OF CREDIT CHECKS TO SPRUCE UP YOUR HOME. EQUAL HOUSING LENDER N~ `' ~ `~ `~ rJ f l ~~ne oi -creq~t Hccount Summary- GONALD H PETERS~JN Account Number 40'03 ~ MARY K PETERSON Z?For information call 88"8`=762-. Credit and Payment Information U Closing Date of Maximum Available Payment Billing Cycle Credit Credit Due Date ~~ 05/08/08. 85 ,:00..0.00 0.0-0 :.06/02/08 _ ~..~.~- ,~w...~., ` Current Past. Mirsiinuni _ _,., " .Payment Due. Late.... Payment. Amount Amount Charge,..... Now,_ ue _4. _ 33.8....81 0.:00... O:OU 338.81 If late charges have been assessed, the late charges and minimum paym ent are both-now due The amount of your late charge. is ,itemized separately . and is not included in the minimum payment shown above Account Actlv~ty Date Transaction Amount_ Principal Balance Days at This .Balance 04/07/0$ Eii~ling kialance prev stmt 4.1.:,.714:31::.. 4T, 51°8.45 9 04/17/08 Payment i-ec'd - th<~nk you. °` 3'68.8'5- 41 , 345.46 2~ .. 05/08/08 Finance charge _ _ lti6.54+: 05/08/08 Ending balance 41 , 512.0 - .. _ .. . 1_:'-~ Finance Charge.. and Credit -Life ~I,nsurance Information Annual Daily Average Percenta0e" Periodio Daily Da s m Y- Billing Finance Credit Life Rata-(APR) Rate Balance Cycle ~ ~~ Charge ~ Insurance Premium 04:750% "00.01297$% 41, 395.68 31 166.54 0.00 Finance Charge accrual. method is Average Qaily.l3alance,, The Periodic Rate.may vary. Please refer to the Account Activity section above for information b t th a ou e number of clays used to compute the Finance Charge on yo . ,. ur account. Important Information . EQUAL NO VSING LENDER ~~" ` Account Number 40'03 048009041574 '`" "' aFor information call 888-762-2265 ~~ ~ ~_ .~, ~., .. ~~ • Available- Rayment ", . ...,_. .. z, ~ .t Due Dare 06/Ofi/0.8~.. _ .. _ 85 , 00.0..00 Q.OQ_. ,__. ... 0'7/0.2/08. Current , , Past Minimum Payment Due Late Payment: Amount Amount Charge Now Due 326.6.2 0.00:. 0..00. 326.6.2.. If late charges have -been assessed, the date charges-and -minimum payment -are- both< now due. - - The amount of your late cl~arye is itemized separately and is not included in the minimum payment shown above Account Actlvlty Date Transaction Days at Amount. Principal. Balance. This. Balance 05/08/08 Ending balance prev stmt 41, 5T200 41 , 345.46 5 05/14/OS Payment reed -thank you 338:81- 47, 173.1`9 24 06/06,/08 Finance charge 155.07+ 06/U6/OS Ending balance `~ 41,,.328.26. ._ _~:_ _ , . :. ~ ~_ .. ,. t ,._. - \ Finance Charge and Credit .Life Insurance Information Annual Da i l Percentage Period c Average Days m Credit Life Dail Rats. (APR) Rate y Billing Finance Insurance Balance Cycle- Charge Premium 04.750% 00.012978% 41 , 202.89 29 155.07 O.OC Finance Charge accrual method is Average Daily Balance. The Periodic_Rate may.. vary. ..... Please refer to the Account Activity section above for information about the number of days used to compute the Finance Charge on your account. Important .Information .. Ed UAL HO USING LENDER REV•1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Donald H. Peterson 21-08-0394 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 • Donna K. Peterson 106 S. Frederick St., Mechanicsburg, PA 17055 Daughter 25% of net residue 2• Christine A. Konicki 1330 Valley Green Rd., Etters, PA 17319 Daughter 25% of net residue 3. Michael C. Peterson 353 Furlong Lane, Camp Hill, PA 17011 Son 25% of net residue 4. Mary S. Rupp 16820 E. La Montana Dr., #118, Fountain Hills, AZ 85268 Daughter 25% of net residue ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF DONALD H. PETERSON I, DONALD H. PETERSON, of the Borough of Mechanicsburg, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I give and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever the same may be situate, to my wife, MARY K. PETERSON, absolutely and unconditionally. 3. In the event that my wife, MARY K. PETERSON, should predecease me, or should she die within thirty (30) days from the date of my death, then in such event, I give, devise and bequeath my entire estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my children, shaze and share alike, per stirpes. -1- 4. For the purpose of facilitating the settlement and distribution of my estate, I authorize, empower and direct my Executrices hereinafter named, or any substitute personal representative, to sell any and all real estate which I may own at the time of my decease, as well as my personal property, at either public or private sale or sales. ____ __ LASTLY, I nominate, constitute and appoint my wife, MARY K. PETERSON, Executrix of this my Last Will and Testament and in the event that my said wife should predecease me, or should she be unable or unwilling to serve in such capacity, then in such event, I nominate, constitute and appoint my daughters, DONNA K. PETERSON and CHRISTINE A. KONICKI, Co-Executrices of this my Last Will and Testament in her place and stead, and in all instances, I direct that my said personal representative be excused from posting bond or other security for the faithful performance of their duties, in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~ day of March, A. D. 2006. ~ r _.__ `. (SEAL) Donald H. Peterson -2- .. COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF CUMBERLAND ) I, DONALD H. PETERSON, the testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the same instrument as my Last Will and `Testament; that I signed it willingly, and that I signed it as my free and voluntary act and deed, for the purposes therein expressed. ...-•-~ r' ' ' (SEAL) Donald H. Peterson Sworn and subscribed to before me this ~~~` day of March, 2006. NOTARIAL 5EAL J ~ ,~' HEIDI M. NELSON, Notary Pubik ~~~~~ Mechanicsburg Bono, Cumberland Co. Notary Public My Commission Expires tune 27, 2007 COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF CUMBERLAND ) We, the undersigned, J. ROBERT STAUFFER and JOHN M. EAHIN, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testator, DONALD H. PETERSON, sign and execute the instrument as his Last Will and Testament; that the said testator executed it as his free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testator, signed the Will as witnesses; and that, to the best of our kno edge, the testator, was, at the time, eighteen (18) or more years of age, of sound mind,~afid~,Y nP co~stra,~t,,dures~ o~ undue influence. Sworn and subscribed to before me this ~''~ day of March, 2006. ~,t- ~~, ~.~~~ Notary Public NOTARIAL SEAL. HEIDI M. NELSON, Notary Publk Mechanicsburg Boro, Cumberland Co. - 3 - My Commission Expires June 27, 2007