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HomeMy WebLinkAbout11-26-08 (2) w 15a56~41147 REV-'1 SOO EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 ~~ 2 1 0 8 0 7 2 8 Harrisburg, PA 17128-0601 ~" RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 301 28 0207 07 04 2008 11 10 1933 Decedent's Last Name ,Suffix Decedent's First Name MI RODGERS WILLIAM A (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 XO 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-81)• ~~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required ~I $. Decedent Died Testate LI` I (Attach Copy of Will) ~ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) 1 $. Total Number of Safe De pOSit Boxes 9. Litigation Proceeds Received ~ 10. Spousal Povedy Credit (date of death between 12-31- 1 and 1-1-95) ~ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES D. HUGHES ESQ . 717 249 6333 Firm Name (If Applicable) ~ n_ '~ SALZMANN HUGHES PC ~ REGISTER OFD S USE ~.Y ~•~ ~_ ; _ First line of address ~ ~ I ~y f-- - t n N - - 354 ALEXANDE#2. SP RING ROAD, Second line of address ;,-, m `j -~-, ~ `~, _ , ~ ,. ~ ~ !'t I City or Post Office State ZIP Code DATE FILED ~ - CARLISLE PA 17015 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. D ration of preparer other than the personal representative Is based on all info , rmation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONS L FOR FILING RETURN DATE James A. Rodgers irL [Z m~ ADDRESS ' 307 ri e, Cla ton, NC 27527 S ATURE OF OTHER THAN REPRESENTATIVE DAT James D. Hughes Esq. 2 ~ ADDRESS 354 Alex der Spring Road, Suite 1, Carlisle, PA 17015 Side 1 15D56041147 15056041147 REV-1500 EX Decedents Name: W i I I l a Ill A. Rodger s Decedent's Social Security Number 301 28 0207 RECAPITULATION 141,500.00 1. Real Estate (Schedule A) .......................................................................................... 1. 2 5 1 , 9 61.5 0 2. Stocks and Bonds (Schedule B) ............................................................................... . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5 7 , 0 2 9 $ 3 5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~~ Separate Billing Requested ............. 7. 2 , 8 7 3 . 8 8 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 2 5 3, 3 6 5. 2 1 9 1 0 4, 6 9 4 5 3 9. Funeral Expenses & Administrative Costs (Schedule H} ....................... .................. . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .................. 10. 2 . 7 0 1 . 8 4 11. Total Deductions (total Lines 9& 10) .................................................... .................. 11. 1 0 7, 3 9 6. 3 7 12• Net Value of Estate (Line 8 minus Line 11) ........:.................:................ .................. 12. 14 5 , 9 6 8 . 8 4 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. 1 4 5 , 9 6 8 . 8 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of , transfers under Sec. 9116 (a)(1.2) X .00 0 0 0 15. 16. Amount of Line 14 taxable ~ 14 3 , 0 9 4 . 9 6 16. at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17. at sibling rate X .12 18. Amount of Line 14 taxable 8 7 3 8 8 2 18. at collateral rate X .15 , 19. Tax Due .................................................. .................................................................. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15D56042148 0.00 6,439.27 0.00 431.08 6, 870.35 Side 2 15056D42148 15D56042148 J 7 File Number 21 -08-072$ REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME W i I l i a m A. Rodgers ----- - - -------------_ __--- STREET ADDRESS 5 6 6 F S t r e e t __ -____-- _ - --- ------ ---_ ___- __-- -- ^ - - --- - --~-,----- --~ STATE ~ ZIP CITY P A 17 013 Carlisle Tax Payments and Credits: _ (1) 6,870.35 1. Tax Due (Page 1 Line 19) - ~ - - 2. Credits/Payments A. Spousal Poverty Credit ______ g. Prior Payments 6,529.99 C. Discount 343.52 -~ - - Total Credits (A + B + C) (2) 6,873.51 -__-__~ __-- 3. InterestlPenalty it applicable p_ Interest - E. Penalty - Total InterestlPenalty (D + E) (3} _-~_____ _ If Line 2 is greater than Line 1 + Line 3, enter the difference. This is khe OVERPAYMENT. q 3.16 (q) _ ____-_ _.________ . Check box on Page 2 Line 2t) to request a refund g, if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX QUE. (5) _,_____- _______ (5A) A. Enter the interest on the tax due. _ ---- ------ --~ g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) _`. _`..__ __ _- Make Check Payable .to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 1N THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: - a. retain the use or income of the property transferred :.................................................................................. ~__ ~ ~x f b. retain the right to designate who shall use the property transferred or its income :..............:...'.'...,.,......... ~_~ (Xl -_ c. retain a reversionary interest; or .............................................................................................. d. receive the promise for life of either payments, benefits or care? .............................................................. ~ } ~ x } 2. {f 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?......... L_ j ~ _} 4. Oid decedent own an Individual Retirement Account, annuity, or other non-probate property which ~~ r contains a beneficiary designation? .................................................................. • ~ l tF 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 Juiy 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 no ex m 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 o a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.5. §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 (q.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}]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1502 EX+ {6.98) .. ~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Rodgers, William A. _ 21-08-0728 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is detlned as the price at which property would be exchanged helween a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointlyrowned with right of survivorship must be disclosed an scheduVe F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) Rev-150:1 EX+ (6-98) ~. COMMONWEALTH OF PENNSYLb'ANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Rodgers, William A. 21-08-0728 All propertyjointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 U.S. Savings Bonds issued 04(1984-01/1988 - 51,961.50 (inventory report attached which includes p.o.d. bonds reported on Schedule G) TOTAL (Also enter on Line 2, Recapitulation) 51,961.50 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. ti-9F3) Rev-?5Q73 EX+ (g_gg) SCHEDULE E ~. ~ - CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETl1RN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rodgers, William A. 21-08-0728 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must 6e disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Currency collection -appraisal attached 77.28 2 Elderhostel -refund 7,159.00 3 Orrstown Bank -checking account 12,746.65 4 Pentagon FCU - 763818-01-0 5.36 5 Pentagon FCU - 1383719-03-4 15,956.87 6 Pentagon FCU - 1242416-50-9 ~ 8,822.14 7 Pentagor FCU 8,510.14 8 Reimbursement for 2008 county/towriship taxes - (see liUD-1 attached) 178.42 9 1996 Ford sold 07/11/2008 to Gibson Auto Sales 750.00 10 Personal, property sold 2,824.00 TOTAL (Also enter on Line 5, Recapitulation) I 57,029.83 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Ina Form PA-1500 Schedule E (Rev. 6-98) Rev-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY ESTATE OF (FILE NUMBER Rodgers, William A. 21-08-0728 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DADTE OF RANSFER.SATTACFi ACOPY OF THOE DEED OR REALE STATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 $25.00 US Savings Bond issued 07/1976 - p.o.d. 136.32 136.32 Sharon Rodgers n/k/a Sharon Peck (see copies of bond attached) 2 $75.00 U.S.Savings Bonds issued 2,737.56 2,737.56 0611986-10/1986 - p.o.d. to Dorothy Rodgers, n/k/a Dorothy Downs (see copies of bonds attached) TOTAL (Also enter on Line 7, Recapitulation) I 2,873.88 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) ~ ' REV 1151 Exf (12.99) ~, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Rodgers, William A. FILE NUMBER 21-08-0728 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 1, 943.27 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Persona! Representative(s): • Street Address - City State Zip Year(s) Commission paid 2. Attorney's Fees SALZMANN HUGHES PC 10,593.00 . 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 302.00 5. Accountant's Fees 175.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs ~ 91,681.25 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 104,594.53 Copyright (c) 2002 form software only The t_ackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-9E) ~. SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF _ FILE NUMBER Rodgers, William A. 21-08-0728 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule FI-A (Rev. 6-98) Rev-1512 EX+ (6-98) COMMONWEALTH OF PENNSYU/ANIA INHERITANCE 7AX RETURN RESIDENT DECEDENT scH~ou~E ~ DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER Rodgers, William A. 21-08-0728 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 American Express, credit card 180.20 2 American Home Mortgage -monthly payments due 1,765.04 3 Borough of Carlisle, waterlsewer 124.50 4 Embarq, telephone charges ~ 69.31 5 PP&L utilities 150.05 6 The Patriot News 8.00 7 UGI utilities ~ 128.35 8 USAA, credit card balance 276.39 TOTAL (Also enter on Line 10, Recapitulation) I `2,701.84 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) DCV_~ L1'1 CYa !O_MI SCHEDULE J COMMONWF_ALTH OF PENNSYLVANfA INHERITANCE TAX RF_TURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Rodgers, William A. 21-08-0728 NAME AND ADDRESS OF RELATIONSHIP TO DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) Words { ) $$$ { ) I ~ TAXABLE DISTRIBUTIONS [include outright spousal and transfers distributions , under Sec. 9116{a)(1.2}] Dorothy Downs Friend 2,737.56 15 South River Street Claxton, GA 30417 -- Lisa Lally Daughter 25.00 455 Orchard Road Southern Pines, NC 28387 Sharon Peck Friend 136.32 455 Orchard Road Southern Pines, NC 28387 James A. Rodgers Son residue 307 Waverly Drive . Clayton, NC 27527 Total 2,898.88 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropr iate, on Rev 1500 cove r sheet III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE . B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS n nn TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTKIt3U I TUNS UN LIIVt is ur r«v-I~uu ~.vvcr~ ~n~~ 1 I ~_•~~ Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) LAST WILL AND TESTAMENT OF WILLIAM ALLEN RODGERS I, WILLIAM ALLEN RODGERS, a resident of the Commonwealth of Pennsylvania, make, publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any time heretofore made by me. I am retired from the military service of the United States. FIRST: I direct that the expenses of my last illness and funeral, the expenses of the administration of my estate, and all estate, inheritance and similar taxes payable with respect to property included in my estate, whether or not passing under this witl, and any interest or penalties thereon, shall be paid out of my residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property. SECOND: It is my desire that, upon my death, I be buried with full military honors at ~Z- T~ ~ ~ ~~t3-r,, (~~~ i ~~ 4 ~ ~ ~~~ THIRD: I give the sumo Tw y Five Dollars ($25.00) to my daughter, LISA ANN RODGERS LALLY, if she survives me. If she shall not survive me, said cash bequest shall not lapse but rather shall be given to the heirs of my daughter, LISA ANN RODGERS LALLY. FOURTH: I give all the rest, residue and remainder of my property and estate, both real and personal, of whatever kind and wherever located, that I qwn or to which I shall be in any manner entitled at the time of my death (collectively referred to as my "residuary estate"), as follows: (a} If my son, JAMES P.LLEN RODGERS survives me, to my son, JAMES ALLEN RODGERS. (b) If my son, JAMES ALLEN RODGERS does not survive me, my residuary estate shall be paid and distributed to any then living issue of my son, JAMES ALLEN RODGERS, per stirpes. (c) If my son does not survive me and there shall be no issue of my son then living, my residuary estate shall be paid and distributed to my daughter-in-law LYNN GORE RODGERS if she shall survive me. FIFTH: If any property of my estate vests in absolute ownership in a minor or incompetent, my Executor, at any time and without court authorization, may: distribute the ~,~.~~; whole or any part of such property to the beneficiary; or use the whole or any part for the health, education, maintenance and support of the beneficiary; or distribute the whole or any part to a guardian, committee or other legal representative of the beneficiary, or to a custodian for the beneficiary under any gifts to minors or transfers to minors act, or to the person or persons with whom the beneficiary resides. Evidence of any such distribution or the receipt therefor executed by the person to whom the distribution is made shall be a full discharge of my Executor from any liability with respect thereto, even though my Executor may be such person. If such beneficiary is a minor, my Executor may defer the distribution of the whole or any part of such property until the beneficiary attains the age of eighteen (18) years, and may hold the same as a separate fund for the beneficiary with all of the powers described in Article SEVENTH hereof. If the bene- ficiary dies before attaining said age, any balance shall be paid and distributed to the estate of the beneficiary. SIXTH: I appoint my son, JAMES ALLEN RODGERS to be my Executor. If my son, JAMES ALLEN RODGERS shall fail to qualify for any reason as my Executor, or having qualified shall die, resign or cease to act for any. reason as my Executor, I appoint my daughter-in-law, LYNN GORE RODGERS as my Executor. I direct that no Executor shall be required to file; or furnish any bond, surety or other security in any jurisdiction. SEVENTH: I grant to my Executor all powers conferred on executors under the Pennsylvania Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, and all powers conferred upon executors wherever my Executor may act. I also grant to my Executor power to retain, sell at public or private sale, exchange, grant options on, invest and reinvest, and otherwise deal with any kind of property, real or personal, €or cash or on credit; to borrow money and encumber or pledge any property to secure loans; to exercise all powers of an absolute owner of property; to compromise and release claims with or without consideration; and to employ attorneys, accountants and other persons for services or advice. .The term. "Executor" wherever used herein shall mean the executors, executor, executrix or administrator in office fi-om time to time. EIGHTH: I direct that for purposes of this will a beneficiary shall be deemed to predecease me unless such beneficiary survives me by more than thirty days. NINTH: Except as otherwise provided in this will, I have intentionally failed to provide for any other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in the will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. If any person named as a beneficiary under this will institutes a will contest, acts as a party to a will contest initiated by someone else, or aids and abets anyone instituting a will contest, I direct that any bequest, devise;, or share of my residuary estate that would otherwise go to him shall lapse, as if he had predeceased me. TENTH: I have served in the Armed Forces of the United States. I therefore request that my Executor make appropriate inquiries to ascertain whether there are any benefits to which I, my dependents or my heirs may be entitled by virtue of any military affiliation. I ~, Z specifically request that my Executor consult with a retired affairs officer at the nearest military installation, the, Department of Veterans Affairs, and the Social Security Administration. This document was prepared under the authority of 10 U.S.C. § 1044 and implementing military regulations and instructions, by Captain Victoria Ko, U.S. Army, who is licensed to practice law in the State of New York. IN WITNESS WHEREOF, I, WILLIAM ALLEN RODGERS, sign y name an ubli h and declare this instrument as my last will and testament this ~ day of 2004. WILLIAM ALLEN RODGERS The foregoing instrument was signed, published and declared by WILLIAM ALLEN RODGERS, the above-named Testator, to be his last will and testament in our presence, all being present at the same time, and we, at his request and in his presence and in the presence of each other, have subscribed our names as witnesses on the date above written. ,- having an ad/~~dr,~,e~~s's at / ~l.~3~ , ~~ having an address at c~~`S~e., ~ ~_ 1"70 ~3 3 ACKNOWLEDGMENT AND AFFIDAVIT COMMONW>=;ALTH OF PENNSYLVANIA, COUNTY OF CUMBERLAND, ss. We, the Testator and the witnesses, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator, WILLIAM ALLEN RODGERS, signed and executed said instrument as his last will and testament in the presence and hearing of the witnesses, and that he had signed willingly, and that he executed it as his free and voluntary act and deed for the purposes therein expressed, and that each of the witnesses at the request of the Testator, in the presence and hearing of the Testator and each other, signed the will as witness, and that to the best of his or her knowledge the Testator was at the time at least eighteen years of age or emancipated, of sound mind and under no constraint, duress, fraud or undue influence. ~ ~d <---~ WILLIAM ALLEN RODGERS Testator} print: c~5'•'~ a~'!- ~,~' Witness ~~ /°`~` print: ~S7E~ ~ Witness Subscribed, sworn to and acknowledged before me by the said WILLIAM ALLEN RODG~ER$, Testator, and ,subscribed 'and sworn to before me by the above-named witnesses, this ~~day of /v/~cC.~, 2004. No ry Public My commission expires on,E~~ /~ ,.~.5~ Notarial Seal Betty S. Kistler, Nptary Public Carlisle Boro, Cumberland C~!'nty My Commission Cxpire~ >~ay lµ, 2005 Membef, Pennsylua+?i~Associatic; ; ct?3n~~~inN PleVlUtls editionv ale obsolete f p r ___ .___ _ _._- :...., a CHESAPEAKE TITLE ' ~ Fx ESCROW SERVICES, INC. Corm HUD-t (7ie6) ref Hantlbpok 4705.: A Settlement StatemefTt U.S. Deoartrrent of Housing and Urban Development Oh98 No. 2502-0225 (expires . 7 /3 0120 0 91 B TYPE ; I ~ ~ _ ~ ~ 5r_)o t~rc~nr•ICit~e Ur., SulCe 1 C7Cl I 1. FHA 2. ~pmH;, 3. XCcm.'Jnins. - CJwinds Nlills, MO 2'1 'i 1 7 ii_4__GVA 5 '.~Corv. Ins. _ ', ' 6. FILE NUM6Eii ~7. LOAN "lUNiBE~R 508-1917NM ____ 112915914 __ 8. MORTGAGE INSURANCE CASE NUMBER I NIA -- - _-- -~- Tfiie.- of ~m rs itnilTe-Tr of-glv> you a s artemer oTac~l ef2ler nTcosTs~rmounf~-pa3To ndUv tfie sefftemene aO~Twn. I l:. Note: Items marked "Ip.o.c.j" were paid outside the closing; they are shown here for mlormalion purposes and are net included in the totals. T112EXpreSS Ssttiement SysiEm WAI2 NIN G: It is a Crime to Mnowingly make false statements to the United Stales nn This ur any other Simi! ar farm. Penalties upon conviction can include a fine and nn risonment. For tletails see: Title 18 U. 5. Code Section 1001 and Sncbon 1010. _ I_.._-_--___.__._______ _3-_. _-.__ __-__-_-___- I D. NAME OF BGRRGVVER: Justin P. Smith ADDRESS. 566 F Street, Carlisle, PA 17013 _ _ E PJAME GF SELLER: The Estate of William A. Rodgers aDDRESS _-_ ... ~ r 15hr1E CF LE! !DER M&i Bank I DDREa° __ - P.O. Box 5738 Springfield, OH 45.501.5738 ___ _ _ ~~. FRGFERTr ADDRESS 56G F Street, Carlisle, PA 17013 i _ ____ __ Carlisle Borough __ ___ j H. SETTLEMENT AGENT. Chesapeake Escrow Services, Inc. GLACE GF SE ~ TLEMENT 11500 Cronridge Drive, Suite 1008, Owinos Mills, MD 21117 ~ I InE GROSS AMOMN R UOF BOO BR~OW~~R'~ TRANSACTION -QDD_GROSS AMOMNT DU~ 0 SELLER S TRANSACTION: _ ~ I' Contrac ales price ~ 141,SU0.00 I ' ' Fern na' Properly ---_ _~- ~ 401Conlract sale>~rice-_ ~ 141 50D.00 ~ 402. Personal Propetty ! ~ r _103, Battlement charges to borrowedline 1400) i 6 425.00 - - _ _ 403. _ __ ii.4 ~ - _ _ _ 404, F ~_ tU~~ ~ _ 405. I ___ Adjustments for items paid by seller in~advar.ce I---.. -- - -- L_ 106. Cif~ewn taxes _ --~ Adjustments for items aid b seller in advance r.,, -- - 406. Cltyr.r,Nn taxes _ 1G?__-Cgimty!a:ces _ ___ 407. Ccun~ ttaxes _ I __108. Assessments___ _ 408. Assessments 109. 2008 Municipal Tages 09112!06 to 12!31108 __ 178.42 ___ 409. 2008 Municpal Tayes 09112(08 to 12!31/08 178.42 110 711r08-6130109 School Tax 1 431.63 410. 111, 411. _112. __ _ _ 412. 12D GROSS AMOUNT DUE FROM BORROWER 149 535.05.1 420. GROSS AMOUNT DUE TO SELLER 141 678 42 _ _ ~ 200. AMOUNTS PAID BY OR ON BEHALF OF BOR 201. De~osii or e_arnesl mone , ROWER 1,000.00 , . 500, REDUCTIONS IN AMOUNT DUE TO SELLER 501. Excess Deposit (see instructions 202._Principal amount of new loans 203. Existing loan(s) taken sub ecI to 137 255.00 502. Settlement charges to seller ling 14001 503. Existin IoanL taken sub'ect to 10,127.00_ I 1 204. __-__ 504._Payoff:30018154 70,163.49 r_ _ _ American Home Mort a e Servici 205. Personal Loan - M&T 5,116.00 505. I _209_.____ f 506. Express'Wire Payoff 35.00_' I _ _ _-_ - I Chesapeake Escrow Services, In i 20' I 507. f 208. I 508. _ ___ _ _ _209. Salter 3?6 Cor_tributian _ Adjustments for items unpaid b I _ ____ _ __~ I _4,245.00 1 seller { I -- _ __509. Seller 3°/ Contribution _ 4,245.00 _ Adjustments for items, un aid h seller i x rr 2 0 Cit~lown axes _ 1211 CeunfLtaxes __ ~ I ~ 510. Cil~town taxes __ ___- ___ -_ _ 51L County taxes I 212 _Assessments __ I 512. Assessments r 213 O8,'O9 S_hocl Ta.x 07101IU8 to09112/OS 214 - - - _ I 286.32 1 I I _ .513. 08109 School Tax O7/01106 to09112106 514 286.3 ~ _ ~l 215. F--------- -- ~ , 5' 5 _P.egrade!Contracting ''Nock 2,435.00 216. __ {- ---- I 516. "'(o Henry's Conslrucfion i 217. 517. r- ----- 1 ~_ ---- 518. 219._____ ___ j 519. -~I 220. TUT_AL PAID BY/FOR BOR_ROW_ER 147,902.32 1 520. TOTAL REDUCTION AMOUNT DUE SELLER 87,291.811 `300. CASH AT SET_TL_EME_NT FROM OR TO BORROWER '301. Gross amount due (corn borrower line 120 149,535.05 1 =--- __----- --1 ~-- 302. Less amounts aid byifor berrower !line 2201 ~ 147 902.32 ------ ~-60_0. CASH AT SETTLEMENT TO OR FROM SELLER _~ 601_Gross amount due to seller line 420 ~I 141 678.42 _ 1 ' ) i 602 Less reduction amount due seller Ilne 520 87,29181 'i 'i03_CASH FROM BORROWER I 1,632.73 603. CAS_H_TO SELLER _ ___ 54,386.61 5!1BSTITUTE FORM 1099 SELLER STATEMENT: The inlormatlnn contained herein is important tax in/ormation and is being furnished to the Internal Revenue Service. I1 you arc required to file a returr. negligence penally or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been mported. The Contract Sales Price descnbed on line 401 above constitutes the Gross Proceetl5 0/ this ifansaction. SELLER INSTRUCTIONS' If this real estate was your principal residence, file Form 2719, Sale or Exchange of Principal Residence. for any gain, with your Income tax rehlrn; for other transactions, eumpleto the applicable parts of Farm d797, Form 6252 andlor Schedule D (Form 1040). ' Vou arc rnqulred by la~v to provide the settlement agent (Fetl. Tax ID No: J with your correct tarpayer idenlilic. a!inn member. 11 you do not provide your correct taxpayer identification munber. yru maybe subject to civil ur criminal pmtaltips imposed by law. n erTJ~ penalties of perjury, f conity teat the number shown pn this statsment Is my Corr=ct taxpayer identifcation number. TI^I' I CFI I FRI SI SIGNAT'.!R=(51: n Ci O _~ r~. Lll Q' fl) (fl D r N D Z Z 2 C f7'i ~_ 0 0 S ZJ Q. 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Oh{IHCi 9T ~MI S. ~ Ei i• ~ ~ i 7~ LZ w - 1 ~ ` r1 ` - t :,: ~ ~; .~ . ~ ~b~~~5~1~~E z . .. . ~. g ~ ~ t o .,.~ ' t~ ,Y t.oooo ~=:o~ oa ' Ooh 3 24 ~4 i 3~~ ~ _~- • ,~= o Pentagon Federal credit Union PO Box 247004, Omaha, NE 68124-7009 September 3, 2008 IVir. James D. Hughes, Esq. Salzmann Hughes, P.C. 354 Alexander Spring Road, Suite l Carlisle, PA 17015 Dear Mr. Hughes: Superior Rates, Provero Service. 1-800-247-50'26 www.PenFed.ory RE: William A. Rodgers File # 763818 We are writing in response to your letter dated August 14, 2008. Thank you for providing Mr. Rodgers' death certificate, court appointment, and the form W-9. if the estate has been probated in Pennsylvania, please provide a copy of the final probate order or appropriate evidence (i.e. a copy of the advertisement placed in Pennsylvania) and a written statement from the executor that demonstrates that potentially interested parties have been notified of the proceeding pursuant to state law. We will review the estate proceeding to decide whether Virginia law permits us to disburse funds without the need for publication. [f the law does permit immediate disbursal, the funds in the individual accounts will be paid by check to the Estate on October 2, 2008. Please find below the date of death values for Mr. Rodgers' accounts per your request: Account Number 763818-01-0 1383719-03-4 1242416-50-9 1242417-51-5 Principal Balance $ 5.36 $ 15,933.80 $ 8,775.50 $ 8,497.03 Dividend Accrued $ 0.00 $ 23.07 $ 46.64 $ 13.11 Total DOD Balance $ 5.36 $ 15,956.87 $ 8,822.14 $ 8,510.14 - We are returning the death certificate and court appointment as we have verified the seals and made copies for our tiles. A business reply envelope is enclosed for your convenience. To help us serve you better, please include the above mentioned account number. If you have any questions, please call us toll-free at 1-800-247-5626. Sincerely, Lauriel L Nelson Estate Accounts Specialist Enclosures N ~ • ~~.~~~~ ~~~:~ A Tradition of Excellence July 17, 2008 To: Salzmann Hughes, P.C. 3~4 Alexander Spring Road Suite 1 Carlisle Pa 17015 From: Traci Yohe Orrstown Bank Customer Service Center PO BOX 250 Shippensburg, Pa 17257 Re: Estate of William A Rodgers Date of death July 4, 2008 IT IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT. ON THE ABOVE DATE.. HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CHECKING. ACCOUNT Account # Title of Account 411655 William A Rodgers S.q VLVG:S ACC(~U.NT .lccoant #, Title of Account CERTIFICATE OF DEPOSIT Account # Title of Account Date opened Principal Accrued Interest 07/30/96 12746.65 0.52 Date opened Principal_ Accrued Interest Date Opened PrinciRal Accrued Interest P.O. Box 250 •Shippensburg, PA 17257 • 717.530.3530 • 717.532.4143 fax M • ~ Rowe's Auction Service 2505 Ritner Highway Carlisle, PA 17015 717-249-2677 249-1978 697-4794 August 16, 2008 To: James D. Hughes, Attorney 354 Alexander Spring Rd. Carlisle, PA 17015 From: Rowe's Auction Service 2505 Ritner Highway Carlisle, PA 17015 Re: William Rodgers Estate, Auction Proceeds Total Auction Sales $2824.00 Less 35% Commission -988.40 Total Due $1835.60 t_,a~-~..,,,_. s......~ --~--~ ~-c~--~.~._-..~.. William G. Rowe ~~~~t~ ~ N' ~ • ESTATE APPRAISAL REPORT OF PERSONAL PROPERTY OF William Rodgers, deceased FOR: James A. Rodgers, Executor James D. Hughes, Esq. Salzmann & Hughes 354 Alexander Spring Rd., Suite 1 Carlisle, PA 17013 AS OF: d.o.d. July 4, 2008 Reported on October 16, 2008 BY: Ibis Ap~raisa~ y Semi ces .r4S N. Ha~ozfer St. P.O. Box 24 Cgr~sle PA 17013 (717) 243-3474 rnfo~rbisapptaisals.cvm u~vuablsapptalsals. com ~ M ~ • APPRAISAL CERTIFICATE I hereby certify that, upon the request for the estate appraisal of the personal property of William Rodgers, deceased, I have personally and physically inspected the listed personal property. The personal property was appraised to determine the FAIR MARKET VALUE, AS OF d.o.d. July 4, 2008 & reported on October 16, 2008. The date of inspection was October 3, 2008. The information and values contained in this report are based upon my experience as an appraiser and other reliable sources. The personal property was found to- be in EXCELLENT condition, unless otherwise noted. Values are reported piece-by-piece, and/or as a whole. All values reported have been determined with consideration to the condition of the item, market conditions, and salability factors. pis A,~pvaisa~ ~~rvices C.A. irector 3 .r~ APPRAISAL SUMMARY It is in my opinion, that as of d.o.d July 4, 2008, the Fair Market Value of the personal property of William Rodgers, deceased: (Seventy Seven Dollars and Twenty Five Cents) ($77.25) is A aisa~ The report must be react in its entirety. The Appraisal Surnntary O1VLY is not the appraisal report. 4