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Home My WebLink About12-03-08 (2) 15056041046 REV-1500 EX (05-04) ` PA Department of Revenue ~tcwa_ ysi: o~rLY Bureau of Individual Taxes County Code Year File Number Dept. 280601 INHERITANCE TAX RETURN ~7 ( Q "~ ~ ~ ~ Harrisburg, PA 17128-O6b1 .. RESIDENT DECEDENT D` C4 ,. ENTER DECEDENT INFORMATION BELOW ~o2'C~o~ ~fl~2 f q~'9~to D~ce~ien! Last flame Suffi.~ Deg r~i~,nCs First tJame MI k r/ M .~ (If Applicable) Enter Surviving Spouse's Information Below ' Spouse's Last Name Suffix Spouse's First Name MI .. - '~ Spouses Social Security Numf,er ' { ° '' ' ~ '' ~; - THIS RETURN MUST.BE FILED IN "DUPLICATE WITH THE ~. ~~ .` REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ " ® 1. Original Rei,urn O 2. Supplemental Return Q 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6.,Decedent Died Testate O 7. Decedent Maintained a Living Trust '~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 DIRECTED TO: Name . ~ Daytime Telephone Number h Firm Name 11f,4pplicaLlui First line of address Sa~cond line of address r __ _, City or Post Office ~ Stafu ZIP ~;~de ~.. :~CJ r} C_~ f ~;' ., ~ -ri r" ~-r ADDRESS SIGNATURE OF PREPARER OTHER THAN DATE PLEASE USE ORIGINAL FORM ONLY Side 1 15056041046 15056041046 Correspondent's a-mail address: Tla,;~ ~~lt(„ Y "~~ C1 ~~~ 1+~,~r a t,' ~ ~~ n Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and comolete. Declaration of oreoarer other than the nercnnal renresenrativa ~~ ha~o~ ,,,, ~u ~„r„~,.,~e,,., ,.r..,ti~..ti .,.e...,.~, ti.,~ ...,,, ~.,,...,~,.,,. RFV-1500 EX Pagz 3 _, .File Number ..- . Decedent's Complete Address: i-- ° ~ . DECEDENT'S NAME ~/ ~ j ` ~ - ~1~~~_I~ ~ l'T N _ ---- ----- --- -- STREETADDRESS --- ""-------"-- ~~ 37 mss; "T ~ 1N~c.E ~'-~ A-/' ~ ~ ~/ -- _ -- -- --- -- " CITY ~ S J/~-/ y~ ---,- ~TATE~~ i ZIP J,7O~~~~C~C~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments ' C. Discount _-_~ ~ ( -_-- 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) ~ ,~ ~ ~ . ~~ Total Interest/Penalty (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. (3) (4) 5. If Line 1 + Line 3 is greater than Line 2, en et r the I erence. Is Is e - - ,~ ~ ~ ~ ~ ~ ~~ A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ~ ~ • r-- Make Check Payable fo: REGISTER GF W1LLS, AGENT . _ - ;i`' PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: ~ Yes No o -- ' a. retain the use or income of the property transferred :................................................................................... ....... ^ ~ b. retain the right to designate who shall use the property transferred or its income : ..................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ...:... ^ Q" 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. s ~ } ~ <_ y ry p , For dates of death on or after Jul 1, 1994 and before Janua 1, 1995 the tax rate im osed on the net value of trap , sfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for 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, whefher by blood or adoption. (5A) ~5~56042047 REV-1500 EX RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 4 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 8~ Miscellaneous Personal Property (Schedule E) ........ 5. ; ' ) t ' '~ 4-^ ~ ~ ~-'.. , G t ti , ~ ~: ~~ :,~ n~ ~. trr:=~ ,f 6. Jointl Owned Pro e ) p g q y p rty. (Schedule F C Se crate Billin Re uested ....... 6. i !~-' ~. ~ , ~ ~ , ,1 d • 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property ~ ~,+ ,. ' • "~`'~~ ~ C ° ~ Schedule G O ( ) Separate Billing Requested........ 7. ~ - .,, 3 ?~ . _ s ~ ~= 8. Total Gross Assets (total.Lines 1-7) ............................ .. 8. ' ~ '~~ ~ ~ ~ '' ~ ~• _ .-° 9 F ' ' ~ ~ ~ a . uneral Expenses 8~ Administrative Costs (Schedule H) ................... 9 ; ; k~ ~~'3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)........... ..... 10. - , ~ >, `~ a ~ _ i :; d 11. Total Deductions (total Lines 9 8~ 10) ................................... 11. ,~', ~ ` ~ ~ ~ 12. Net Value of Estate (Line. 8 minus Line 11) .............................. 12. 1 ~ ~ 3 ~ ~ ' 1. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 1 ~ ,' ~~ ~ an election to tax has not been made (Schedule J) ........................ 13. / x ~ > ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ` ~ 3 3 I ~ ~ > k~`, 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 t xa a at lineal rate X .0 ~ ~ ~ ~ ~ ~ ~ ; ~ t~ ~,;+ 16. _~, "&~`' ~%`~ "` ` ~ .. `7 ~ ~ ~ i ~ 17. Amount of Line 14 taxable ~ ~ ` , . , ; ''~ ~ ~£~ ` ` at sibling rate X .12 ti 17. , , ~ 18. Amount of Line 14 taxable at collateral rate X .15 ~ ig, ~ ~'y .. , .. . ;~y .., . 19. TAX DUE ......................................................... 19. 20. FILL INTHE OYAC IFl(OUAR>= itEQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042047 15056042047 O Rev-roa Ex ~ c+-sal COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM ~ VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~G'~ ~ 7} ?+~ .$,~ ~-, .fir ;~ ~' , ~' TOTAL (Also enter on line 5, Recapitulation) a ~ ~ ! (If more space is needed, insert additional sheets of the same size) REV-1509 EX • (1-97) SCHEDULE P COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER r n .. ~.. m < d' - 4 t~ .. ~ Bey g. ~{.. *¢ F~ 4 ,,+~ ~~?~..1 ~'f +,f~~"v~ ;mss"F.I~~F f ~ ~ tiA^ . ,p,~ ~~~`` 6r ~i.A d" ff an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS . ~ RELATIONSHIP TO DECEDENT A. J t~f~ Ott '. ;~ ~' h~J 1 0~ /~1~,~~t~ ~~ ~ :,'t ~, Sad ~, ~~ ~ ~=, B. C. JOINTLY-0WNED PROPERTY: REM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed forjointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST rI! pNE !!'jam ~' Ca ~' ,~. ~,~ ;~rsr~ ~ " S ~ ,~cr~v~r ~,.~ -~~~~~p ~~, r~~ 9~ X07• . ov 5~ r . __ _ __ TOTAL (Also.enter on line 6, Recapitulation) I ; ~ .. _. (If more space is needed, insert additional sheets of the same size) REV-1510 EX+(1-97) - SCHEDULE G INTER-VIVOS TRANSFERS 8 COMINHERITANCEDTAXERETURNANIA MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF , ~ FILE NUMBER ~ ~ ~, 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 DECEDENT AND THE DATE OF TRANSFER. ATTACH A CORY Of THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~~~~o~~~~-~ ~# 4~Fs~ - " ~ ~`R~ ~~ TOTAL (Also enter on line 7, Recapitulation) I $ _. (If more space is needed, insert additional sheets of the same size) EV-1511 EX+ (12.99) SCHEDULE 1~1 COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported.on Schedule [. ITEM A. FUNERAL EXPENSES: 1. i_~ ~a5~tr v~~.~.~ ~°~r~r~~~. ~ aa~. z B. ADMINISTRATIVE COSTS: t. Personal Representative's Commissions , ~ ~ I~ tin s d d ~ Name of Personal Representative(s) J DI.1~ ~• ~~ ~`~`°~ Social Security Number(s)/EIN Number of Personal Representative(s) dress ~ ~ ~/rl ~~~' ~~ k tJ ~ Street A d City t_ ~r-? ~ ~ l ~-^ ~•- State ~f'~ Zip I ~~ ~ Year(s) Commission Paid: ~ ~ ~ 2. Attorney Fees .~ 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 ~~~ ! ~ ~jC'1''1C.~"# 2ECx(S~~' ~ ~ ttlf ttL,S a ~w ~AJ~- ~fw ~" t ~~ ~ i ~~~ 5. Accountant's Fees .~ 6. Tax Return Preparer's Fees f~~ 7. TOTAL (Also enter on line 9, Recapitulation) I $ ~ ~'~ ~~ ~~, 4 ~~/ (If more space is needed, insert additional sheets of the same size) 1 REV-15t2 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER v,,., Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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) (1.211 1. s~,a? Fd .~P ~.. ... ''''. 'R' f~ L.AU@fi ~ . p~P ~ p $ '~r~t.~,~~~ ~ ~ .~«~~ ~{.- ~ , ;gip. . ~ '~ ~-S . /[ ~ C7 /1F~- L/ •' I ftd ~ ~ ~Y~~,:~~` -"t, s' i. ~fy„`/r~_~" 's~,~.`".'+ J.•'~{f 4~ ~ ""_„"~° f(,~ / ~;. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Free Checking ~~ccount Statement -PNCBANK For 24-Hour information, sign on to PNC Bank Online Banking '~-~ on pnacom. For the period 09/26/2008 to 10/14/2008 EST OF MARY M KUHN DECD Primary account number: 50-0578-6957 Page 3 of 3 Check Images -"'i1'sfT~itnus,,~l ~I=~TG~in~ ~~im .__.a,n.., 6 PNCBANK ~~~,~~~ -- ---- _ . ~r~l' .. ~:031312739~: 5005796957~~• ,'000080 7 3 3 2.' /o ~ oP' ~„emu ~,,. ~., ~. ~. Cdun /~B,t1'nvaCcOet~~' ~ t 3,a g1.9Z O~dnd //+~ ~ ~~~.~1CNd+re'V~ 1~ ~ ~t~c.1.,~~t'~ 9 /ee Dolt,. ®~=-c. 0 PNCBANK .~.~~„ o» r~ ~:03i312739~: 500 5 79 69 5 7"' $8,073.32 1 U/I U/201)8 $3,281.92 10/lU/2UU8 4Jith PNC Gniine F3aiikit)g, you can view, print and save up to the most recent 90 days of your canceled checks - froiit ar~d back -FREE of charge. Please contact us for additional options. FORM953R-1005 Interest Checlung Account Statement ~ PNCBANK For the period 09/13/2008 to 10/14/2008 ~]O For 24-Hour information, sign on to PNC Bank Online Banking MARY M KUHN DECD L~ on pnc.coln, Primary account number: 51-4022-6821 Page 3 of 3 Check Images 1 ' ~~~ ~~ >' MARY M. KUHN E Rn ]11 r EnFT 7RINIH wvr ~ 3235 . . . a3 laccwm~csewm, rw vom ~~ ~ oe ao-i»a,i 1~ ua,r J P.r w .1,. /~ de....d _. CTi~~c~ f2'P"i'1__ .._ _~__~...__.__1 $ ~CD.eO C 1J ~ ' ^ % ..~ ~~~ ~cwr.A_ NOG _ ~ rn,n... C$ c~_~ Q PNCBANC prcmiuro N ~ o .1.r . ri.., ~ Tl Q. ~6 ~ F... . Yt. ,. . ! ` - ~:O i 1 i i P 7 36~: 5 140 2 268 2 U' 3 2- 3 5 ~'~OOOU0900U0.~' MAAV M, KVHN ~ 32'36 ~pT r1ST TR NRIE nn. wPT. p1 f atr1Nr•11a MpeH..Nit7eun0. [r~w/1N1lD p„a 9 3 O ,,, Pay io the /~'1 VJ^~' ,~~R- ~~7 O-~~ O de d ~~-- ~.PNCBANC ~ ~~ PNC A..k-N.A ow premium .~r...,i va Plan Fw _ _.-_-PAC--._.____. ~:oaiaiz~aa~: s~aozasaz-N' ~zae 3235 $900.110 09/15/2008 3238 $298.25 09/22,120(18 With PNC online i3anking, you can view, Nrini and save up to the most recent 3J days of y our canceled checks -front and hack - FRPF of charge. Please contact us for additional options. FORM953R-1005 Senior Premium Plan Account Statement . For 24-hour information, sign on to PNC Bank Online banking on pnc.com. For tu. p.rioa ov~uzoos ~ osnzzoos MARY M KUHN Primary account number: 51-4022-6821 Page 4 of 4 Chick Imagers M~KY M. KIMN 7d.1G YR Mee 111Nai M IVr. it1 •R-pMN1LeMM10.~M 1107 .. ~,.~~ ~-Q---. LL~iN--` l1rYV W.._rLILd~..-LJ~.RJ1Nj~ sayo. A~ QPNCBATi1C ~~~~ 1M`~14J_1L\ !4 Pl.n P. X11 -~~/~/''!~~P.~+l~',-_ ~°4+I_. i:03i3i273B~: Si~02dGa2ir '~"323G MAI1't M, KYNN ~ ~ ~Z37 Wrrwst ~nKgl KO 1Mf i~~ MI:nI~KfMI1N; -~,TOM ~ ~ Oh -qn ~,~ O PNCi3ANC ~~~~~ r'M'nr.M.\ M ~,...~ ~•.~ ri.. rtli~iiz73a~: Si~02266ZIM iz31 t00000 14 4 3ir :tY~G Ss4a,~xt ~Ig/u!1,~YM-8 8Y~7 $141,:tY nn,~os,~~x-ti With PNC Online Banking, you can view, print and save up to the most recent 90 days of your canceled checks -front and back -FREE of charge. PI~aeR contart us for additional options. KUHN 091p3 3045141 Symp -casket spray $21'L.00 ~D J ~ ~`~ \ N 01 \N rovided for your convenience DUe upon receipt Please use the RETURN ENVELOP 3456 • SY ORDER ACCOUNT NUMBER iS gp Da s & over YOUR EA OUTSTANDING BALANCE ao Da s $212.00 $IILING 30 Da s $O,OO DATE Gurtent $O.OO $0.00 09115108 $212'00 Minimum rebllling charge is $2.99 30TH OF NEXT MONTH W ILL BE SUBJECT TO A RE-BILLING CHARGE OF 1 114 % (ANNUAL RATE 15 % ) ggE,ANGES UNPAID E3Y THE a 403456 1~/ ) ~~~ pyERS flowers £~ gifts Receive your Bill by Email? e now offer this new service for your convenience. W Email _ Yes, I would like to receive my statement by ou would like to receive special offers by email Check here if y My Email address is: 8l ~ F't 80/£O,i6 AdOJ N3WO1Sf;l 801d-ZLZ-OCB-I 1-'HJ 3Sd3ld S1N3WW00 210 'SN~I_';iNOC 'SNOI1S3flb OIOS S1INf1 16'101 19£.1£1 ~# 4~nlr 1.82'2~~*~***~***~ l6' l5 .~agwrM P~eC~ } rga0 lLlllLbZ p.:p~ } rga0 N=flWf1N ~TORNI l6' lS ' -IkilCl 66 Z L6 ' 8b X67.. S=l6S i.0'g - 66'91 3lyS Ia1 Cl'df1S 6E;'9l 1Fi l 66'Zl Af1F1S '3110 3lHS AEI 1 S3y0_ 196E 66' Zl lkf l 66'81 02iHH~ L;3NC l0~ 90LS ' 6E El 16 l 21f13f1bI ~ 8'f:8 W00 98bb 6£Ol 8bOSGSfiO b Z00 ZOIZ Agl 30N3Ia3dX30~JNIdcOHS affOANON31X3 £blL-l£L# 3NOFId 3NACW.3l 1S 13X2iFIW COZI ZOIZ 32101S SlI2lIdS '6 _NIM Mead Living Ctr West Shore 4 Meadows Living Ctr West Shore 4837 East Trindle Road Mechanicsburg, PA 17050 Resident Statement Date: 11/01/2008 John Kuhn 19 Amherst Drive Camp Hill, Pa 17011 DATE BALANCE FORWARD 10/10/2008 PAYMENT CURRENT BALANCE DUE. Re: Mary Kuhn Account#: 16897 Balance Due: .00 Amount Enclosed 3,281.92 (3,281.92) .00 Interest Earned Year-to-Date: 79.12 ~a:.~C..~' j~ ~~~ j Thank you for choosing Country Meadows of West. Shore 4! Please include the top portion of this bill with your payment by the Meadows Associate"s, Statement questions contact Bonnie 717-975-3434 For pharmacy questions please contact "Alert" direct at 1-800-266-9954 Resident Name: Mary .Kuhn Account#: 16897 Statement Date: 11/01/2008' a o Fide/i /NVESTMENT~ 001022900 MARY MARGARET KUHN JOHN P KUHN 19 AMHERST DR CAMP HILL PA 1 701 1-7701 ~rn~~~m~~~nnn~~n~~~~n~~~ui~~~mnr~~u~~~~~~nr~~~~) New Account Prof/le Aprll23, 2004 "~~_ Page 1 of 2 Online Fidelity.com FAST(sm)-Automated Telephone 800-544-5555 Customer Service 800-544-6666 Account Ownershln Joint Name Soaal Security Number Date o! Birth Country of Tax Residence Mary Margaret Kuhn 235-18-4440 02-19-20 U.S.A. MaBeig Address Evening Phone Oay Phone 19 Amherst DR 717-763-8154 717-605-7332 Camp Hill, PA 17011 Permanent Mailing Address Ocwpation Affiliation Same as Mailing Retired None Joint Name Soaal Security Number Date of Birth Country of Tax Residerroe John P Kuhn 208-42-4911 11-18-54 U.S.A. Marling Address Evening Phone Day Phone 19 Amherst DR 717-763-8154 717-605-7332 Camp Hill, PA 17011 Permanent Ma/ing Address Ocarpation AN/iation Same as Mailing Buyer None ' Note: Please verify the accuracy of the accou nt and/or customer level information. Make any corrections on the attached coupon or via signed letter of instruction. Account Setua Account Information Account Number Z85-796840 Type of Ownership Joint WROS Dividends and Capital Gains Direct all security distributions to the cash account or money market fund indicated below. Reinvest all mutual fund distributions to the fund that said the distribution. Checkwriting/Check Card If elected, you will normally receive your checkbook and Check Card within 2 weeks. Transfers Between Your Bank and Fidelity If you applied for Bank Wire, Money Line or Automatic Account Builder, then the feature will be effective wthin 1 U business "Investment objective definitions are provided on the last page of this letter. As a general matter, Fidelity does not assign representatives to customer accounts. All properly completed account applications have been approved/accepted by a registered principal. ** Investment Objective Conservative Account Mailing Address. 19 AMHE-RST-DR - CAMP HILL, PA 1 701 1-7701 a 0 Z 0 z i ~, w 0 ~ L X v ~ A ~ o 3 ~. ~ ~ y y Q 1v~ c ~ .n o (v'i, J ~ ~ ~ w V ~ ~ ~ ~ v ~ A D Q ~ D ~ o ~ ~ f° _ W ~ v ~ ~' . T~ 7 C.11 C OO C w~ o (p ~ N T ~ w f1 V O -•~ ~ ~ ~~ ~ ~ ~~ ~ a ® ~ ~~~ ~ ~ ~ ~. y yzn n =ro = ~ (/1N No c~~~ woo ~, ~ o ~ roroo ~ ~ 't3 a Ul cn vz N ~+• O 'L3 O ~ ~ d CcJ ~ ~ ~' cf' UI w ~' ~ ~ ",7 ~ ao b ~ ~ ~ N r sr a uNi ~ ~• a cn ~ x a' ~d , ~ ~- N a o y n ~ wmo C' ro ~ ~n~ ~/~ ~ ;~, a n n ~-+, a N B C n ~ t.., ~ a c o, ¢, ~ n = o H r o n ~ ~ x o w a N ~• ~. r~ b ~ ~' ~ ~ cn d~ ~ N tti ;~' J ~ C a n 3 c a n O ~ ~- r- O N (A a N H '' ' ¢' n cr n •~ ~ c* C' '~ ~ r• r• cr ~-' H ~' ~ n r• ct r-3 lC1 N ~"h H O ~'- ~ r,, n a c ~ ~ N ~ fi a N ~ n a cr N ~ N ~ ~ N W ~• ~ {f} N J 00 `~ ~--~ F+ W O Ul l0 ~,p O 000 O ~l p O O O O W O O O O O N ~ ~ ~ Qp -ER '°'`~ ~ J ~ ~ J .~ ~ w O W W .A ~ ~ W O ce^ W O W W O ~ N O N W O oC N O T 0 ~c G1 [rJ ~3 x x z N ra fi ~-+ J N O O LAW OFFICES 317 THIRD STREET ' NEW CUMBERLAND, PENNSYLVANIA 17070 LAST WILL AND TESTAMENT OF MARY M. KUHN I, MARY M. KUHN, of New Cumberland Borough, Cumberland County, ':'Pennsylvania, being of sound mind, memory and understanding, do hereby make, `'publish and declare this as and for my Last Will and Testament hereby revoking 'land making void any and all other wills by me at. any time heretofore made. I. I direct that my Executor hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. II. All the rest, residue and remainder of my estate, whether real, ;.!personal or mixed, and wheresoever situate, I~hereby give, devise and bequeath ;as follows: ~` `\1~ A. One-fifth (1/5) unto my son, JOHN P. KUHN. B. One-fifth (1/5) unto my daughter, MARGARET E. KUHN. C. One-fifth (1/5) unto my daughter, MARY A. BOTTE. D. One-fifth (1/S) unto my daughter, LAURA S. KAPP. E. One-fifth (1/5) unto my son, MARK D. KUHN. III. I hereby nominate, constitute and appoint my son, JOHN P. KUHN, as Executor.-of this, my bast Will--and T-estament fif the-said John P. Kuhri should .predecease me, fail to qualify or cease to ac't as such, then I nominate, constitute and appoint my daughter, MARY A:.BOTTE, as Executrix. LAW OFFICES - N F. LAFAVER c' - I V 7 THIRD STREET CUMBERLAND, PA No fiduciary acting under this Will shall be required to post bond in this jurisdiction or in any jurisdiction in which he may act. Page one of two .Pages