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HomeMy WebLinkAbout12-15-08J 15056051058 _ REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes Count Code Year File Number Y - INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 21 08 0528 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death _. Date of Birth 047-07-7183 04/30/2008 02/01 /1913 Decedent's Last Name Suffix Decedent's First Name MI MATHIAS WILBUR H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Firsi Name MI _. ..... ___ .................................. Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ____ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW %~:.~ 1. Original Return t~'~ 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) t.~`,; 4. Limited Estate ~ 4a. Future Interest Compromise (date of 3 5. Federal Estate Tax Return Required death after 12-12-82) !~ 6. Decedent Died Testate t 7. Decedent Maintained a Living Trust _2_...,. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received i~ 10. Spousal Poverty Credit (date of death ~a 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 DIRE~T~D 70: Name Daytime Telephone Number ~ - -. _.. _ _. __ THOMAS E. FLOWER ~_ __... ~ (717) 737 340'5=~ c:~ - -, 1`=~ Firm Name (If Applicable) --- ~- --rx.~.- , .--, _ _ _ _ _ __ _ _ _ _ ~ REGISTER 0~ 3/YIt~9?,,~E ONJ,y.. ~ i" SAIDIS, FLOWER, LINDSAY , , = ~ c1t -.? t-~ _ First line of address ~, ~^.~;".7 'C7 _ ' -ii 2109 MARKET STREET ~,~ G. - ~ ~ : t'~ ~ " ~` ' Second line of address ~ ~ G3 " --~ t13 _.. City or Post Office State ZIP Code ~ __.....,..... DATE FILED CAMP HILL PA 17011 __ _._. _ . Correspondent's a-mail address: tflOWer@Sfl-IaW.COm 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 which preparer has any knowledge. 9'IG TUF~E OF,PER,~ON P NSIBE2'PORFI~NG~RETURN CYiI~`.`~ht-` `/-/}l DATE Robert A. Compton, 221 Glen Riddle Road, Media, PA 19063 s AI E Oh PREPARER OTHE hPREPRESENTATIVE _ ~ in~_-p p ~-~- ~~~ ~ ATE FIUVRCJJ Saidis, Flower & Lindsay, 2109 Market Street, Camp Hill, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number _Dec_edent's Name: WILBUR H MATHIAS ' 047-07-7183 RECAPITULATION ~_.__._ .._ _,__.__._ _... _ ~.._.___.....-... _ _._W_._._.....W..._.. ~..__.-_ ._.~._.., .._......V d__ ... -.._...,___.__._ _.__ _._~.___m___........_.W... __.~ 1. Real estate (Schedule A) ............................................. 1. 107,500.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 55,573.29 ', 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. ' 164,390.43 6. Jointly Owned Properly (Schedule F) Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) t: Separate Billing Requested..... ... 7. 84,621.00 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 412,084.72 ', 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 49,621.33 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ', 1,303.88 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. 50,925.21 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ' 361,159.51 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ~~"` ~ " `" ""' "' an election to tax has not been made (Schedule J) ..................... ... 13. ', 61,453.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. ' 299,706.51 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _. __ __ 16. __ . ._ ._ ,. _. _-_---- _.-._-_._... _.. Amount of Line 14 taxable _,~.. ..._ . ~~_- . ....~.v._, _... ~ ...._~_... at lineal rate X .0 _ 16. 17. _ ~ .._.... -.. _ ...,..,__ ._. ..._v.. .. ~__.,__ _-w. Amount of Line 14 taxable __ ~_ _.,._. at sibling rate X .12 17. 18. Amount of Line 14 taxable 299,706.51 ' at collateral rate X .15 18. 44,955.98 19. TAX DUE ....................................................... .. 19. _._ 44,955.98 ', _ _ __ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: _ Flle„ N.u.,.mber „_ __,_ 21 _' 08 -...1':0528 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER WILBUR H MATHIAS 047-07-7183 STREET ADDRESS 308 1/2 11TH STREET CITY STATE ZIP NEW CUMBERLAND PA 17070 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit __ B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty 40,000. 2,105.20 Total Credits (A + B + C) (2) Total InterestlPenalty (D + E) (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable fo: REGISTER OF WILLS, AGENT (1) 44,955.98 42,105.20 0.00 0.00 2,850.78 0.00 2,850.78 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 :.......................................................................................... ^ ^X b. retain the right to designate who shall use the property transferred or its income :............................................ ^ ^X 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 consideraiion? .............................................................................................................. ^x ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^X ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary 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)J. 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 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 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) SCHEDULE A COMMONWEALTFI OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WILBUR H. MATHIAS 21-08-0528 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. Real property which is Jointlyowned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) Prevwus etlitions ere obsolete loan HUD~1 (3/86) ref Handbook 4305.2 A. Settlement Statement U.S. Department of Housing and Urban Development nMR Arynroval No_ 2502-0265 fexnires 11/30/2009) FINAL 1. ^FHA `V 2' ^FmHA 3. ^Conv. Unins. 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number 4. VA 5. Conv.lns. MT2008.109TF Is orm a m o Ova you e s amen o u ae men cos moon p an y e se amen egen area own. C. Note: Items marked'(p.o.c•)- were wid ouleWe me closing; may are shown Hera for Inlortnatlon purpocas and era Hal ilroluded in the lolak. TIOeEXpresS Settlement System WARNING: II le a cdme la knowingly make le4e slalemenls to me Untied Slalu on Ibis or any other similar loan. Penallles upon corwklbn can Include a line and ~ onmenl. For details see: Title 18 U. S. Code Section 1001 and Seclbn 1010. D. NAME OF BORROWER: Mark W. Lauver ADDRESS: E. NAME OF SELLER: Estate of Wilbur H. Mathias ADDRESS: F. NAME OF LENDER: Cash ADDRESS: G. PROPERTY ADDRESS: 30811211th Street, New Cumberland, PA 17070 New Cumberland Borou h H. SETTLEMENT AGENT: Abstract Company of Central PA, Inc., Telephone: 717.243.6222 Fax: 717.243-6486 PLACE OF SETTLEMENT: 26 West Hi h Street Carlisle PA 17013 I. SETTLEMENT DATE: 1010912008 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 107 500.00 401. Contract sales rice 107 500.00 102. Personal Pro art 402. Personal Pro 103. Settlement char es to borrower line 1400 2 027.25 403. 104. 404. 105. 405. Ad'ustments for items aid b seller in advance Ad'ustments far items aid b seller in advance 107. Count taxes 10109108to12131108 90.72 407. Count taxes 10109108to12131l08 90.72 108. School Taxes 10109108to06130109 536.79 408. School Taxes 10109108to06130109 536.79 109. Trash 10109108 to 12!31108 38.89 409. Trash 10109108 to 12131108 38.89 110. 410. 111, 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 110193.65 420. GROSS AMOUNT DUE TO SELLER 108166.40 200. AMOUNTS PAID 8Y OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest mone 10 000.00 501. Excess De it see insWcBons 202. Princi al amount of new loans 502. Settlement cha es to seller line 1400 2 685.62 203. Exisfin loan s taken sub'ect to 503. ExisBn loan s taken sub'ect to 2p4, 504. Pa oft of First Mort a e Loan 205. 505. 206. 5~• 2g7, 507. pgg. 508. 209. Sewer 10101108 to 10109108 3.41 509. Sewer 101D1108 to 10109106 3.41 Ad'ustments for Items un aid b seller Ad'ustments for Items un aid b seller 213. 513. 21q, 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BYIFOR BORROWER 10 003.41 520. TOTAL REDUCTION AMOUNT DUE SELLER 2 669.03 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower line 120 110193.65 601. Gross amount due to seller line 420 108166.40 302. Less amounts aid b Ifor bonower line 220 10 003.41 602. Less reduc8on amount due seller line 520 2 689.03 303. CASH FROM BORROWER 100190.24 603. CASH TO SELLER 105 477.37 SUBSTITUTE FORM 1099 SELLER STATEMENT: The Inlormalbn contained herein Is Impodanl lax Mlormal'wn aM is being furnished to the Infernal Revenue Seruke. If you are required to Bb a return, a negligence penalty or Omer cancllon will be imposed on you II This item is required la be reposed and me IRS determines lhel N has not been reported. The Conlracl Sales Price described on line 101 above rgnstlWles the Gross Proceeds of mis kansaCaon. SELLER INSTRUCTIONS: II this reel ealele was your pdncpal residence, file Form 2119, Sale or Excharpe of Pdncipel Reabence, for am/gain, wim your Income tax ream; for other Iransaclbns, complete me applicable parts of Fonn 4797, Form 6252 anNOr Schedule D (Form 1000). You are required bylaw to provide me seUlemenl agent (Fed. Tax ID No: 1 wllh your correct taxpayer Idenlllkalbn number. II you do not Drovlde your cortect lazpayer IdenUlkalbn number, you maybe subiecl lc civil or criminal penalkes Imrwsed by law. n n pens s o perjury, I cenily Thal the number shown on Ibis slalemanl Is my carrecl lalWayer Idenlllkallon number. TIN: _! SELLER(S) SIGNATURE(S): SELLER(S) NEW MAILING ADDRESS: Previous etlilbns ere obsolete U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT n t•'TTr raaCalT CT ATGIIaC AIT loan HUD-1 (3166) rel Handbook 4305.2 File Number: MT2D08.109 FINAL PAGE 2 T:n..C..n.nne CnHlmm~n{ C..c/cm YVIIr.vm~r~r vr~•r.•. r.•• ..___.. ._____ ... ......... ...... L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALESBROKER'S COMMISSION based an rice $107 500.00 1.000 =1 075.00 BORROWER'S SELLER'S Division of commission line 700 as follows: FUNDS AT FUNDS AT 7p1, 1 075.00 to Chuck BfiCker SETTLEMENT SETTLEMENT 702. to 703. Commission aid al Settlement 1 075.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee 802. Loan Discount °/a 803. sisal Fee 804. Credit Re ort 805. Lender's Ins ction Fee 806. Mon a e A lication Fee 807. Assum Bon Fee 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to Ida 902. Mo a e Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. Imo 1002. Mort a e Insurance mo. Imo 1003. Ci Pro n Tax mo. Imo 1004. Count Pro Tax mo. 32.94 Imo 1005. School Taxes mo. 61.61 Imo 1009. ate Anal sis Ad'uslment 1100. TITLE CHARGES 1101. Settlement or dosin fee 1102. Abstract or G8e search 1103. Title examination 1104. Title insurance binder 1105. Document Pre aration to SFL •• POC 1106. Note Fees to Saidis Flower &Lindsa 5.00 1107. Attome 's fees includes above items No: 1108. Title Insurance to Abstract Com an of Central PA Inc. 898.75 includes above items No: 1109. Lender's Polic 1110. Owner's Polic 107 500.00 •898.75 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed 48.50 • Mon a e Release 48.50 1202. Cit !Count taxlstam s Deed 1 075.00 • Mo a e 1 075.00 1203. State Taxlstam s Deed 1 075.00 • Mo a e 1 075.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. 2008 Ct 1 Tax to Robin Gas eretti 443.72 1302. Reim for Tax Cert to Saidis Flower &Lindsa 10.00 1303. Trash OcUNovlDec to New Cumberland Borou h 42.60 1304. Sewer Jul IAu ISe t to New Cumberland Borou h 39.30 1305. 1306. 1307. 1308. 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K 2 027.25 2 685.62 HUD CERTIFICATION OF BUVER AND SELLER I have careluhy reviewed dle HUD-1 Settlement Statement end to the best of my knowled0e and belie!, it is a True and acwrale alalemenl of all receipts and disbursements made on my account or by ma M Ihu uanaactlon. I Nrther cenlly Ihal 1 have received a copy of the HUD-1 Set amen! Statement WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-1 Settbmenl Statement which I have prepared is a Ime and ecwrale account of this Iransaclbn. UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION I have caused or will cause the tootle W be disbursed In accordance wiN this alalemenl. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 16: U.S. CODE SECTION 1001 AND SECTION 1010. REV-1503 EX+ (6-98) P ~~, SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WILBUR H. MATHIAS 21-08-0434 All property jointlyowned with right of survlvorshlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ 303 SHARES BARRICK GOLD CORPORATION @ 38.37 11,626.11 2. 85 SHARES PRUDENTIAL FINANCIAL @ 76.265 6,482.53 3. 5,378.65 SHARES FEDERATED LIBERTY US GOVT MONEY MARKET FUND A 5,378.65 4. 383.269 SHARES VANGUARD TOTAL STOCK MARKET INDEX FUND @ 34.02 13,038.81 5. 19,047.19 SHARES VANGUARD TREASURY MONEY MARKET FUND @ 1.00 19,047.19 TOTAL (Also enter on line 2, Recapitulation) I $ 55,573.29 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SC~IEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER WILBUR H. MATHIAS 21-08-0434 Include the proceeds of litigation and the date the proceeds were received by the esiale. All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 M&T BANK CHECKING ACCT #58223711 2,664.31 2 M&T BANK CERTIFICATE SAVINGS #031003914375679, PPL. 15,234.29 PLUS ACC. INT. 91.93 15,326.22 3 M&T BANK CERTIFICATE SAVINGS #031003914540446, PPL. 56,473.78 PLUS ACC. INT. 97.12 56,570.90 4 FIVE 1/4-OZ. COINS AND ONE 9/100-OZ. COIN, ALL OF 9/10THS GOLD, SALE PROCEEDS 1,056.00 5 ELEVEN 1-OZ. GOLD COINS, SALE PROCEEDS 9,625.00 6 PNC BANK CERTIFICATE SAVINGS #31000077442, 8,224.18 PLUS 26.94 ACCRUED INTEREST 8,251.12 7 PNC BANK CERTIFICATE SAVINGS #31200168305, 37,534.20 PLUS 46.06 ACCRUED INTEREST 37,580.26 8 PNC BANK CHECKING #5140042117, 19,914.34 PLUS 1.30 ACCRUED INTEREST 19,915.64 9 PSECU CERTIFICATE SAVINGS #C50 11,851.61 10 PSECU REGULAR SHARE #S01 11 US Treasury, "Economic Stimulus" payment 12 1978 Pontiac sedan, gross proceeds of sale at public auction 13 HOUSEHOLD FURNITURE & FURNISHINGS, gross proceeds of sale at public auction 44.87 600.00 300.00 604.50 TOTAL (Also enter on line 5, Recapitulation) $ I 164,390.43 (If more space is needed, insert additional sheets of the same size) p n~s~ 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302) 934-2955 June 12, 2008 Saidis Flower & Lindsay Attorneys At Law 2109 Market Street Camp Hill, Pennsylvania 17011 Re: Estate of Wilbur H Mathias Social Security: 047-07-7183 Date o~Death: April 30, 2008 Dear Sir or Madam: Per your inquiry dated June 09, 2008, please be advised that at the titne of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 58223711 O>7~nership (Names o~ Wilbur H Mathias * Opening Date 08/28/64 Balance on Date of Death $2, 664.21 Accrued Interest $ 0.1 D Total $2, 664.31 2. Type ofAccozmt Certificate of Deposit Account Nzrnzber 03100391437 679 Ownership (Names o,~ Wilbur 11 Mathias Opening Date 08/10/81 Balance on Date of Death $15,234.29 Accrued h~terest $ 91.93 Total x'13, 326.22 3. Type of Account Account Number Ownership (Names o. f} Opening Date Balance on Date of Death Accrued Interest Total 4. Type of Account Box Number/Location Ownership (Names o~ Opening Date Certificate of Deposit 031003914540446 Wilbarr H Mathias 10/I S/96 $56, 473.78 $ 97.12 $~ 6, 570.90 Safe Deposit Box 0000734 /Harrisburg Main Wilbur H Mathias * 03/01/50 * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Harrisburg Main Branch at 213 Market Street, Harrisburg, PA 17101, or # 717-255-2070. Sincerely, ~~ l~~ ' ~d'~ Nancy Clagett Records Management PN CBAI~K The Thinking Behind The Money June 30, 2008 Thomas E Flower, Esq 2109 Market St Camp Hill, PA 17011 RE: Wilbur H Mathias SSN: 047-07-7183 DOD: 04-30-2008 Dear Mr. Flower: In response to your request for Date of Death balances for the customer noted above, our records show the following: Certificate of Deposit Account # 31000077442 WII,BUR H MATHIAS DOD balance: $ 8,224.18 + 26.94 accrued interest Account # 31200168305 WILBUR H MATHIAS DOU balance: $ 37,534.20 + 46.06 accrued interest Checking Account Account # 5140042117 WILBUR H MATHIAS DOD balance: $ 19,914.34 + 1.30 accrued interest Safe Deposit Box The decedent maintained safe deposit box # 562 It is located at: Cedar Cliff Mall 1104 Carlisle Camp Hill, PA 17011 (717) 761-3180 Established 03-04-1997 Established 10-21-1999 Established 12-01-1962 Page 1 of 2 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, Lori. Robertson 1-800-762-1775 P7-PFSC-04-F 500 First Ave Pittsburgh, PA 15219 Member FDIC Page 2 of 2 PSEC~ KAREN RICCARDO C/O SAIDIS FLOWER & LINDSAY 2109 MARKET STREET CAMP HILL, PA 17011 Dear MS. RICCA]tDO: July 9, 2008 Account # 8503XXXXXX The following is the status of WILBUR H. MATHIAS's account with PSECU as of the date of death. Joint Owner's Name NONE Date of Death 04.30.2008 Date of Birth 02.01.1913 Share Description Open date S Ol Regular Share 05.25.2004 C50 60 Month Certificate 06.02.2004 Balance Accrued Dividend $ 44.87 $0.00 11,851.61 0.00 The dividend earned from January 1, 2008 through the date of death was $153.35. The decedent had no loans with us. We do not have safe deposit boxes for our members. If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter- 6 and then extension 2227. Sincerely, a~ Meacie Fairfa " Member Service Representative Finance Support Unit Pennsylvania State Employees Credit Union Main Address: 1 Credit Union Place, Harrisburg, PA 171 10-2990 717.234.8484 800.237.7328 • Mailing Address: PO. Box 67013, Harrisburg, PA 171 Ob-7013 717.777.2100 (TDD) 800.472.1967 (TDD) This credit union is federally insured by the National Credit Union Administration. Equal Opporlunify Lender www.p52tu.eOm D&SCOINS 224 FOURTH STREET NEW CUMBERLAND, PA. 17070 (717) 774-4182 Customer's Order No. _ DATE ~/ ~-~~ BOUGHT/SOLD TO ~°~ ~ ~ wa~~N~ `~' ADDRESS ~~~~~ ~ ~~ PAYMENT METHOD - CASH CHECK QUAN. DESCRIPTION PRICE AMOUNT S / ,~°, 2 o~G~ . ~~ ®~1 0 Z . ~~~~~ ~td~C~s~ou~- ~1. _ ~~s~ 1 ~ 1~t ,,,~ ~ ~;~ ~~L~~ j. ~ ~~ ~ ~ ALL Claims and Returned Goods MUST be accompanied By This Bill SIGNATURE 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 WILBUR H. MATHIAS 21-08-0434 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 INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND THEDATEUFTRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE ~ 10,000 EE US SAVINGS BOND 04-1992, POD MARY BETH COMPTON 11,912.00 100 11,912.00 2. 10,000 EE US SAVINGS BOND 11-1994, POD RALPH BRANDY (NEPHEW) 8,848.00 100 8,848.00 3, 10,000 EE US SAVINGS BOND 10-1994, POD ROBERT DEVORE 8,880.00 100 8,880.00 (NEPHEW) 4. 10,000 EE US SAVINGS BOND 06-1994, POD VERONICA MURPHY 9,048.00 100 9,048.00 5. 10,000 EE US SAVINGS BOND 02-1993, POD DEBRA MANLOVE 11,448.00 100 11,448.00 6. 10,000 EE US SAVINGS BOND 02-1993, POD DEBRA MANLOVE 11,448.00 100 11,448.00 7. 10,000 EE US SAVINGS BOND 04-1992, POD SARA K. WESLEY 11,912.00 100 11,912.00 8. Robert and Mary Jean Compton, Gifts of April 20 - 26, 2008 17,125.00 6,000.00 11,125.00 TOTAL (Also enter on line 7 Recapitulation) $ I 84,621.00 (If more space is needed, insert additional sheets of the same size) Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 06/2008 Page 1 of 1 Total Price Total Value Total Interest YTD Interest $35,000.00 $73,496.00 $38,496.00 $1,436.00 Bonds: 1-7 of 7 Serial # Series Denom Issue Next Final Issue Price Interest Interest Va Date Accrual Maturity Rate X6066225EE EE $10,000; 10/199410/2008; 1,0/2024 $5,000.00 $3,880.00 3.74%: $8,8 X6065503EE w EE $10,000. 11/1994 11/2008 _11/2024 $S,000.OOy .$3,848.00 2 60%: $8,8 X6071013EE EE $10,0004 06/1994 12/2008. 06/2024, $5,000,..004 .$4,048.00 .._.2 83% $9,0 X4176363EE EE $10,000 02/1993 08/2008 .02/2023 $5,000.00 ,$6,448 00 4 00% $11,4 X4176362EE ._ . _.... ' EE 10 000 .._. , ~.,..,.r _ 02/1993 08/2008 __ _. ~_.__~_ q_ ..... 02/2023 .~...... .... . ._ $5 000 00 ~_ , r. .~ t _$6,448.00 ~.. ~ ._ , 4.00% 11,4 X4939417EE r , EE $10,000 04/1992 10/2008 ~ 04/2022 $5,000.00. $6,912.00 ,_ _4.00%. $11,9 X6270799EE EE $10,000: 04/1992 " 10/2008 04/2022 $5,000.00 $6,91.2.00 4.00% $11,9 Totals for 7 Bonds $35,000.00' $38,496.00 $73,4 Notes NI Not Issued NE :Not eligible for payment P5 :Includes 3 month interest penalty MA Matured and not earnin interest http://www.treasurydirect.gov/BC/SBCPrice 6/27/2008 ~~q/! ~ > (~. ` ~' ~ ~~~r~~'~~~~f ~~.,~ ~~,~y~ ~~~~~~.:~~.~~ SERIES E E ' 1fd 71P''~tl ~Q4+1[\ ~ I~~~1~~~~CI~~C~,ti:J~4 ~~I~~;~~~~,~fl~'1`1J INTE FROMC SSUE DATE EARS -~ I34P D7 7~ 83 ~~f ; F~ (l2 ' ~ 993' ,'~ ' T„M1iL9UR H MATi~3AS ,; ,-__-__ ~'""~ 3~i.8 1/ 2 1 1 T H S T ,~ I¢3'D~34~"T'¢ ~~ _v~,..~ ~ NEB, CiJ~lBERIR+~D ,- P~' 1T{1~7~f - ~ ' rrrF I OATING¢TAMP ~~ ~' /,t~313~JC?82'1-~Oi~Q~O;~~ ~~ iDflS RIBS-A (~ ~ I'\~t~UQL17.~i"353 ^~. ~,,...,_~~ ~ ~ , ~ -~_ ~ ,_ I ~ ~~ ~~_,~ ~,~'~`~ ~ E ,~~~~ E~X 41 ~b_3 6 ~ ESE ~:0000900D 740^9 ~y :2000;4 1"76 363+i' ~r~ Ix~ ,~~y ~~~~~T~~:~~~~ SERIES EE ~fi~. y-ly [y~j ~~~~jI~~SI.~r~~r]~liii~~~~t~ INTEREST CEASES 90-YEA RS'. ~' s - FROM JSSUE DATE {347 (!~ ~~~~83 ~,~;. ~-2 193, ~~/171~17~7f 1~1 1'I r{~171-ff~ ~~ ~ -'.' - ~S P;CH~~. ' ,~3-~4-93,1 ! l_2 9:17N S`T -3D8 I=~T= 'N £~'3i ;C13 M B £:R t ASV D _ P A 1 7 Q 7~ • .•.- -DATING S A _. __ _,__.,„.. T MP ~~ ~~`3'!~~`~821-~t~Q©t O~D2~}3 ~~3 DQ5 RDS~A` ~~t}GL'l7fi~3'tSZ I r h t I E ~: E - . [ .. C r [ t .. .... 1` 3.r., rVJ/R~ ~~ j r 400009000 7409 1000!4 ~l 76 36 2++' _ ~ ~~~~ ~..~~~~.~~~ SERIES EE _,~~ :ill ` ~"~E~~~~,~~1'~'~, (~.'`~t~ - ~. A~ ~"ca'1 INTEREST'CEASE5:90'YEA RS S ;/ FROMISSLE DATE 047 `07 7183 ~ ` `~ . i 04 1992;'. E„~ ; „~ ~,~ s. r. , ., ~, - 7;,WILBUR H MATHIAS -~~ ,FRB PITT -'03-:29-96~~; 3:.08 1/2 11TH ST - I¢SUIN,gAGENT'S N~E~W 'CUMBERLAND PA 1;70'70-13.08 ~ DATING STAMP ii ,,JJ 11 ~11I III111I'IIII~III~I'1IJ 111 ~.'_II'IIII IIII II~II~l1111i111~1I.1I ~~ :. I ~ ~ '~ 'POD 'SARA °K WESLEY ~~ .', .} ~ ~ I'. ~~ , RI 960820.059, 001 001 ;: _ ' .. OU04939417 I' r f E'.{, ~ + f i~ ~' ~. ~ ~d ~,. ~ j k r I r ', °~:0000'90007~:09 ~ 800049394 L7-+' ,~~~~,,. ~~~~~ o~~~~~~J~ ~~~~~~~~ 047 07 7183 ";. `. 7i~WILBUR H MATHIAS -308 1/2 11TH ST ' 'NEyW CUMBERLA~JD7 _ P7A 1;7070-1308 ~If1111111111 I111III II III IIAl.111J~11~I1III IIII IIIIIll11711111l III ~~ r ~t~ s~~.~~s EE INTEREST LEASES 3D YEARS FROM ISSUE DATE 1'0 1994 ~: ~, _ ~ , FR7~B P5TDTt, 0 ISSUI~ /~G[NT'S~ GATING STAMP POD i20BERT DEVO - 0.006066225 RI D3~3~o.025 Doi oD~1 `` ,__ 1 :: t 1 -- -- ~606622S:EE ~:OOD0900.0 7:09 ~" 90006066 2 2 5~~' - - - - . - - -... _..__..~......,.........-.....,,.,~...,~w.A. .omntrmnllMeulnon - - ~.~.~«~.^.^~.w _.~..w...n ......Awrsmwr~u pjo~ tY /+y IG~~~~IT~~~T~:I~~~~1~ J INTER EST CEASES-9U YEARS 7 FROMISSUEDA E 047 07 7183. 11 1994 l'iWILBUR H MATHIAS ~~-'--_`_" >FRB PIT:T~, -" 0 9~~~~~IEk3 ; 3;0:8 1/2 11TH ST _- 3 N.EW CUMBER.LAt~D PA 17070-1308 GATING STAMP I11~111,1111117IIIIJII1,1111111~h =_ 1'IIIILIT~1111161L~iJll F E ; , ,, PO.D ~2ALPH M BRAI~DT E ~ _` , ~--" RI X032530'0°14 00:1 ~DO1 - ~ ~ ~ ~ `/' D006D655D3 _ _ _ ~-~~ Xb0655D3EE x:00009000 7:09 _~__._~-__.4._.. ~ k 20DD6D'6 5 50 3~~' ~~~ ~~I I EV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER WILBUR H. MATHIAS 21-08-0528 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' MUSSELMAN FUNERAL HOME, PROFESSIONAL SERVICES 3,475.00 2. CASKET 2,150.00 3. VAULT 950.00 a. OBITUARY (110.92) AND DEATH CERTIFICATES (60) 172.92 5. GRAVE OPENING/CLOSING (525.00) AND SERVICING (110.00) 635.00 s. HEADSTONE ENGRAVING, CARLISLE MEMORIAL SERVICE 185.00 e. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) ROBERT A. COMPTON Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 221 Glen Riddle Road city Media .state PA Zip 19063 Year(s) Commission Paid: 2009 2. Attorney Fees 3. Family Exemptiqn: (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 5. Accountant's Fees 6. Tax Retum Preparer's Fees ~. PUBLISH ESTATE NOTICES, PATRIOT 162.03; CUMBERLAND LAW JOURNAL 75.00 B. JIM, DONNA GORDON, CLEAN OUT HOUSE AT 308 1/2 11TH ST, NEW CUMBERLAND 9. TERRY LINDSEY, HAUL AWAY REFUSE ~o. CHUCK BRICKER, AUCTIONEER'S COMMISSION AND EXPENSES ~ ~. MICHAEL MURPHY, MOWING tz. CONTINUATION SHEET TOTAL 19, 647.82 14,500.00 325.00 237.03 480.00 245.00 759.50 120.00 5,739.06 TOTAL (Also enter on line 9, Recapitulation) I $ 49,621.33 (If more space is needed, insert additional sheets of the same size) SCHEDULE H CONTINUATION SHEET ESTATE OF WILBUR H. MATHIAS FILE NUMBER 21-08-0528 12. Additional death certificates for life insurance and savings bond beneficiaries 135.00 13. Additional short certificates and certified copy of will 37.50 14. Death certificate for predeceased spouse, Helen Mathias 9.00 15. Executor's travel expenses, tolls, gas, food and car rental 800.71 16. Leggett's, repair kitchen plumbing at 308 1/3 11th Street 199.00 17. Pa American Water, water service 81.10 18. New Cumberland Boro., sewer/trash service 167.90 19. Diversified Appraisal Service 325.00 20. West Shore School District Real Estate Tax 739.36 21. PPL, electric service 180.84 22. Tony Rende Lawn Care, mowing, 14 @ $35 + tx., April -Sept. 519.40 23. Verizon, phone service 122.02 24. Travelers, auto insurance premium 65.60 22. Erie, property insurance premium 334.00 23. Net deductions on HUD-1 settlement sheet 2,022.63 Continuation sheet total 5,739.06 Previous etlilions are oDSOlele loan HUD•1 17/86) rel HandDOOk 4705.2 A. Settlement Statement U.S. Department of HDUSing and Urban Development nhAa Annrnval nlr, ~Rro.r»s5 laxoires 1 ~/so/20091 FINAL a. I e D1 Loan 1. ^FHA 2. ^FmHA 3. ^Conv. Unins. 6. File Number 4. ^VA 5. ^Conv.lns. MT2006.109TF -..._ .. _ _ _ 7. Loan Number en era a awn n B. Mortgage Insurance Case Number . eg Is onn is um e o owe rou a e e eman o ec a se amen coo . moun pa an y e se ame (,. NOte: Ilema marked'(p.o.c.)' were paid ouklde the closlrg; Ihey are Brawn here for Inlorma9on purposes and are rot luludad In the lolalc. WARNING: Il Is a crime b kralNngly make la4e clalemenle to the Unlled Slalea on INs ar any ether elmllar loan. Penallles upon canWcllon can Include a Ilne and I dsanmant. Far delalls see: Tllle 18 U. S. Code Secllon 1001 and Secllon 1010. Ti1leExpress Settlement System D. NAME OF BORROWER: Mark W. Lauver ADDRESS: E. NAME OF SELLER: Estate of Wilbur H. Mathias ADDRESS: F. NAME OF LENDER: Cash ADDRESS: G. PROPERTY ADDRESS: 30811211th Street, New Cumberland, PA 17070 New Cumberland Borou h H. SETTLEMENT AGENT: Abstract Company of Central PA, Inc., Telephone: 717.243.6222 Fax; 717.243.6466 PLACE OF SETTLEMENT: 26 West Hi h Street Carlisle PA 17013 I. SETTLEMENT DATE: 1010912008 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales rice 107 500.00 401. Contract sales rice 107 500.00 102. Personal Pro art 402. Personal Pro art 103. SetOement char es to borrower line 1400 2 027.25 403. 104. 404. 105. 405. Ad'ustmenis for items old b seller In advance Ad'ustmenls for items Id b seller in advance 107. Count taxes 10109108 to 12131108 90.72 407. Count taxes 10109108 tD 12/31108 90.72 108. School Taxes 101091081006130109 536.79 408. School Taxes 10109108to06130109 536.79 109. Trash 10109108to12131108 38.89 409. Trash 10109108to12131108 38.89 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 110193.65 420. GROSS AMOUNT DUE TO SELLER 108166.40 200. AMOUNTS PAID BY OR ON BEHALF OF BOR ROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or eamesl move 10 000.00 501. Excess De osit see instmc0ons 202. Princi al amount of new loans 502. Settlement char es to seller line 1400 2 685.62 203. Existln loans taken sub'ect l0 503. Existin loans taken su6'ect to P04. 504. Pa off of First Mort a e Loan 205. 505. 206. 506. 207. 507. 208. 5~• 209. Sewer 10101108to10109108 3.41 509. Sewer 101011081010109108 3,41 Ad'ustments for Items un aid b seller Ad ustments for Items un aid b seller 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 279. 519. 220. TOTAL PAID BYIFOR BORROWER 10 003.41 520. TOTAL REDUCTION AMOUNT DUE SELLER 2 689.03 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLE R 301. Gross amount due from borrower Ilne 120 110193.65 601. Gross amount due to seller line 420 108166.40 302. less amounts aid b/for borrower line 220 10 003.41 602. Less reduction amount due seller ine 520 2 689.03 303. CASH FROM BORROWER 100190.24 603. CASH TO SELLER 105 477.37 SUBSTITUTE FORM 1099 SELLER STATEMENT: The Inlermallan contained herein Is imponanl laz Inlormalhn and Is being lurnlihed to the Internal Revenue SaMCe. 11 you are requked to tits a return, a negligence penally ar other sencllon wit be imposed on you II Ihis item is required to be reported end Iha IRS determines Ihal It has ml been reported. The Contract Sales Price descried on Nne 401 shove cons9lules the Gross Proceeds al Ihis Iransaclbn. SELLER INSTRUCTIONS: II Ihis real ealele wee Lour pdnciPal realdence, tits form 2119, Sele or Ezchanpe of Principal Reaklerwa, for arty gain, wllh your Income lez return; for other Iraneaclbna, complete Ne applicable pans of Form 4797, Form 6252 and/or Schedule D (Form 10401. Vou are raqulrsd bylaw to provde the selllemenl agent (Fed. Taz ID No: 1 with yow caracl taxpayer Idenlllkallon number. Ir you do rot provide your correct taxpayer ItlenBgcetbn number, you maybe subject le civil er criminal penalllas imposed bylaw. Q3er penal lle~rjury, I cenily Ihel the number shown on Ihis statement is my wrrecl taxpayer iden111ica11on number. TIN: / SELLER(S) SIGNATURE(S): ! SELLER(S) NEW MAILING ADDRESS: Previous edllbm era obsolete U.S. DEPARTMENT OF HOUSING AND URDAN DEVELOPMENT S~TTI GMFNT RTATFMFNT loan HUD-1 (3/SS) rel Handbook 9305.2 File Number: MT2D08.109 FINAL PAGE 2 TitlaFYnracs SRttlRmant SvslRm L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALESlBROKER'S COMMISSION based on rice $107 500.00 1.000 = 1 075.OD BORROWER'S SELLER'S Division of commission line 700 as fDlbws: FUNDS AT FUNDS AT 701. 1 075.00 to ChUCk BrlCker SETTLEMENT SETTLEMENT 702. to 703. Commission aid at Settlement 1 075.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori inalion Fee °/a 802. Loan Discount 803. A raisal Fee 804. Credit Re ort 805. Lender's Ins coon Fee 806. Mort a e A lication Fee 807. Assam lion Fee 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to Ida 902. Mort a e Insurance Premium for to 903. Hazard insurance Premium for to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. Imo 1002. Mort a e Insurance mo. Imo 1003. Cit Pro ert Tax mo. /mo 1004. Count Pro a Tax mo. 32.94 Imo 1005. School Taxes mo. 61.61 !mo 1009. re ate Mal sis Ad'usiment 1100. TITLE CHARGES 1101. Settlement orclosin fee 1102. Abstract or UUe search 1103. Title examination 1104. Tole insurance binder 1105. Document Pre oration to SFL -• POC 1106. Nola Fees to Saidis Flower &Lindsa 5.00 1107. Atlome 's tees includes above items No: 1108. TIUe Insurance to Abstract Com an of Central PA Inc. 898.75 includes above items No: 1109. Lender's Polic 1110. Owner's Polic 107 500.00 -898.75 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordin Fees Deed 48.50 Mort a e ~ Release 48.50 1202. Cil /Count faxlstam s Deed 1 075.00 ~ Mort a e 1 075.00 1203. State Taxlstam s Deed 1 075.00 ~ Mort a e 1 075.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. 2008 CI Itw Tax to Robin Gas eretti 443.72 1302. Reim for Tax Cert to Saidis Flower &Lindsa 10.00 1303. Trash OcUNovroec to New Cumberland Borou h 42.60 1304. Sewer Jul IAu !Set to New Cumberland Borou h 39.30 1305. 1306. 1307. 1308. 1400. TOTAL SETTLEMENT CHARGES tenter on Ifnes 10_3, Section J and 502 Section K 2 027.25 2 685.62 HUD CERTIFICATION OF BUYER AND SELLER I have careNllV reviewed the HUD-1 Sellemenl Slalemenl and Io the best of myy knowledge and ballet, It Is a Irue and acwrele statement of all receipts and dishursemenls made on my account or by m° in Ihia Innsecllon. I Iwlher cenily Ihet I have received a copy of the HUD-1 Selllemenl Salemenl. eaeo r a ae WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The HUD-t Selllemenl Slalemenl whkh 1 have prepared is a Irue end accurate account of Ihls Irensaclion. UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION t have caused er will cause the lands to be disbursed fn acwrdance with this statement. CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 1B: U.S. CODE SECTION 1001 AND SECTION 1010. 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 WILBUR H. MATHIAS 21-08-0528 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (It more space is needed, insert additional sheets o(the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER WILBUR H. MATHIAS 21-08-0528 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)j 1 SARA K WESLEY, 1009 Bridge St., New Cumberland, PA 17070 collateral 11,912 + 1!9 residue 2 DEBRA J MANLOVE, 171 Magic Mountain Dr., Central, SC 29630 collateral 22,896 + 1/9 residue 3 RALPH BRANDY, Jr., 5531 Oakwood Dr., Mercersburg, PA 17236 .nephew 8,848 + 1/9 residue 4 TERRY BARTOLET, 600 W. Lafayette St., Easton, PA 18042 nephew 1/18 residue 5 CHARLES BARTOLET, Jr., RD #7, Box 7261, Bethlehem, PA 18015 nephew 1/18 residue 6 DOROTHY BARTOLET, 3008 N. Third St., Harrisburg, PA 17110 niece 1/18 residue 7 MIRIAM ZEIGLER, 58056 Hidden Lake Dr., Harrisburg, PA 17111 niece .1/18 residue 8 ROBERT DEVORE, 402 Spruce St., Steelton, PA 17113 collateral 8,880 + 1/18 residue 9 BART DEVORE, 501 Claude Simmons Rd., Johnson City, TN 37604 collateral 1/18 residue SEE CONTINUATION SHEET ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROU GH 18, AS APPROPRIATE, ON RE V-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 1 TRINITY UNITED METHODIST CHURCH, 419 BRIDGE STREET, NEW CUMBERLAND, PA 2 FIRST CHURCH OF THE NAZARENE, 617 16TH ST, NEW CUMBERLAND, PA 17070 30, 726.50 30, 726.50 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ 61,453.00 (If more space is needed, insert additional sheets of the same size) SCHEDULE) CONTINUATION SHEET ESTATE OF WILBUR H. MATHIAS FILE NUMBER 21-08-0528 No. Name and Address of Donee Relationship Amount or Share 10. ESTHER WEIST, 907 Perry Road, collateral 1/9 RESIDUE Lititz, PA 17543 11. MARY BETH COMPTON, 221 Glen Riddle Rd., Media, PA collateral 11,912.00 12. VERONICA MURPHY, 308 11th St., New Cumberland, PA 17070 collateral 9,048.00 ~, N ~_ .-~ CODICIL -- ~--1-~- C~ --C ,-~ ~ CC's WILBUR H. MATHIAS '~~ ~~ ~` = '= ~;`~ _. , .. f ` I, VdILBUR H. hhATHIAS, the within named Testator, do he eby n~lak~and publish this Codicil of my Lasf Will and Testament dated April 7 7, 20D2. FIRST I hereby amend the Sixth Article of tl~e said Will, commencing v~ith the wor-d "Lastly," to provide as follov,~s: I nominate, constitute and appoint ~ ..~ .~ ROBERT COI~PTON, of 221 Glenn Riddle Road, I~ledia, Pennsylvania, to act as ~s Executor of this my Last Will and Testament. In the event that ROBEP,T ~ _ COhhPTON should be unable or unwilling to act as executor, then I appoint l~~i 'ems-~~L~ ~=~ ~ ~ ~~ •~-r~r~-e=rr, to serve as alternate executor. i`Jo Executor shall be required to file ~; bond, in this or any otherjurisdiction. ,~, ~~~ ti SECOND In al! other,,respects 1 hereby ratify, confirm and republish my Last Will dated April i 7, 2D02, together with this sole Codicil as and for my Last Will. iN WITNESS WHEREOF, I, WILBUR H. I~ATHIAS, have hereunto set my hand ,..~ - and seal to this Codicil to my Last 1Nill and Testament this day of May, ~A.IDIS, O~4~4rEkz & 2006. INDSAY NJEVS~AT•IA~1' ~ 09 Mazket Sxreet ;amp Hill, PA ~' v /i/~~ J ~ ~~ ~i~~~ WILBUR H. MATHIAS Signed, sealed, published and declared by the above-named Testator, a~ and for a Codicil to his Lasi Vdill and Testan-lent ir-, the presence of us, who I~lave hereunto subscribed our nan~les at his request as witnesses, thereto, in the presence of said Testator and of each other. ~ ; ~- '~ _ ~ ~: ' ,, ,;: ~~ ~l~.s~--L .-~U`1~U.s-~ A D D R E S S Zrc ~ ~'~=ro~~~~.~ COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUM6ERLAND ss. We, WfLBUR H. I~iATHIAS, "7-r~M~t-~ ~~ r=~u.~, and S`r~'~-~ C~~~f;~'~' the Testator and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duty sworn, do hereby declare to the undersigned authority tl~lat the Testator signed and executed the instrument as his Codicil and tl~at Ise signed willingly and that Ise executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Codicil as witness and that to the best of their knowledge the Testator was at the time 18 or more. years of age, of sound mind and under no constraint or undue influence. ~A~IS, ;il'dF) SAY 1l7DItNEI'S.A7:IRI' D9 Market Sveet ramp Hill, PA WILBUR H-.1Iv1ATHIAS .r WitnessS,a~s,wc~ S«,PycN~ ~2, Witness ~~J {~V' L'~^~7~ ill AIL Sl'i~ nnonnters•eT•uu~ 09 Mazlcet $treer Camp Hill, PA Commonv~ealth of Pennsylvania ) SS. County of Cumberland ) On this, the ~~ day of 200b, before me .~q,~,4 ~~i,~.~;i•~~~,~-; the undersigned officer, ersonally appeared Thomas E. Flower, I:nown io me or satisfactorily proven to be a member of the bar of the highest court of Pennsylvania, and certified that he was personally present when the foregoing acknowledgment and affidavit were signed by the testator and witnesses. I have signed my name and affixed my seal. ~ ~~ ~lotary COfUSMOtJWEALTH OF PcNIJSYLVANIA Notarial Seal Sara J. Ensinge;, Notary Public Carlisle Boro, Cumberland County My Commission Expires tom. 17, 2005 Member, Pennsylvania association d IJoraries ~~, E` 1~T £LL Ahr~ TESTA NI" LAST tiV ~ ~ -. ~-`-; . , . . ~ ; ;~ -~ ' 4I4_~ ~. ~ ~ ~ = T W .._ _... ~ ~C`~Q -D -~ _ri ; _ ~ ~~ , , y ~ -r^ .~ i I, WILBUR H. MATHIAS, of 308'2 Eleventh Street, New Cumberland, Pennsylvania 17070, being of sound and disposing mind, memory and understanding, do make, publish and ,declare this as and for my Last Will and Testament, hereby revoking and malting void any and all former INills, Codiciis, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: I give any and all of my books to the PENN STATE UNIVERSITIE5 COLLEGE OF MEDICINE LIBRARY. Any books which they should not want 1 offer to the library of the Borough of New Cumberland. THIRD: I direct my Executor to sell my home at 308'2 Eleventh Street, New Cumberland, Pennsylvania, to my neighbor, PATRICK MURPHY, of 308 Eleventh Street, New Cumberland, Pennsylvania, for the fair market value. If he declines to purchase it for the price determined by my Executor, at its sole discretion, to be fair market value, my Executor shall have no obligation to sell it to him. ..~.,~, ,~.,-- x-.;.--r~. r ~_ _, _.. FOURTH: I direct my E>:ecutor hereinafter named to convert the balance of my assets into cash. FIFTH: All the rest, residue and remainder of my estate I give in nine equal shares, as follows: A, To SARA WESLEY, of 1009 Bridge Street, New Cumberland, Pennsylvania 17070; ,B. To DEBRA JEANNE MANLOVE, of 800 Allen Street, New Cumberland, Pennsylvania 17070; C. To TRINITY UNITED METHODIST CHURCH, of 419 Bridge Street, New Cumberland, Pennsylvania; D. To the FIRST CHURCH OF THE NAZARENE, Brandt Avenue and Si~.~teenth Street, IJew Cumberland, Pennsylvania; E. To the children of GERTRUDE 6LE1'ER, who are ESTHER WEiST, of 1035 Old Hickory Avenue, Lancaster, Pennsylvania 17601; and G, JANE HENRY, of 201 Conodoguinet Avenue, Apartment 11, Camp Hiil, Pennsylvania 17011; F. To the children of CHARLES BARTOLET, SR., who are CHARLES BARTOLET, JR., of R. D. #7, Box 7261, Black River Road, Bethlehem, Pennsylvania 18015; and TERRY BARTOLET, of 21 Sutton Place, Easton, Pennsylvania 18042; G. To the children of ROBERT BARTOLET, who are DOROTHY BARTOLET, of 3008 North Third Street, Harrisburg, Pennsylvania 17110; MIRIAM 2 ;. ~~~~,. ZIEGLER, 58058 Hidden Lake Drive, Harrisburg, Pennsylvania 17111; and MRS. BRUCE BOYD, 20913 Brooke Knoll Road, Laytonsville, Maryland 20760; H. To the children of HARRY DeVORE, ROBERT DeVORE, of 402 Spruce Street, Steelton, Pennsylvania 17113 and BART DeVORE, 6627 Patchwork Circle, Charlotte, North Carolina 28270; I. To RALPH BRANDY, JR., of 5531 Oakwood Drive, Mercersburg, Pennsylvania 17236, one of the sons of KATHRYN BRANDY. LASTLY: 1 nominate, constitute and appoint ALLFIRST BANK, to be the Executor of this my Last Wil) and Testament. No Executor shall be required to file bond in this or any other jurisdiction. IN tNlTNESS 1NHEREOF, 1 have hereunto set my hand and seal this ~` 7 day of ~~~--~~''~~__ , 2002. --~-- Wilbur H. Mathias SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: ' ~ J -- ~ f~..~ i ~ , 3 .~'.;_ COMIv1ONVVEALTH OF PENNSI'LVANIA COUNTY OF CUMBERLAND S5 I, WILBUR H. MATHIAS, 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 instrument as my Last V1/ill; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledg~~ed before me, by WILBUR H. MATHIAS, the Testator, this 1 ~~ ~~` day of y=!-/~ t ~( , 2002. Wilbur H, tvlathias, Testator ,. l i ~I Notar'vl Public NOTARIAL SEAL - MERLENE J. rv1ARHEIRCA. NOTARY PUBLIC CARLISLE, CUMBERLAJ,ID COUNTY, PA MY COMMIBSIDN DARES JUNE 8, 2flC2 COfWvIONWEALTH OF PEI~INSl'LVANIA COUNTY OF CUlv1BERLAI~D ss We, TnoP1~ s E F 1 ower and ~7ar:1e s D . ~^ lower , Jr . , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last VUill; that he signed willingly and that he 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 knowledge the Testator was at that time ~8 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by 1ho~~~as E. F1o~+~er and James ll . Flower r Jr . this / ~ ~ t-~- day of -~'~-~-~.L_r,.~ , 2002. - ~r '' Witness NoTaRIAL sEAL MERLENE .?. NLARI~EVICA. NOTARY PUBLJC CARLISLE, CllMBERLAND C.UIJNTY, PA ~ - MY CaFAM18SI0N EXPIRES Jl1NE is, 20012