The URL can be used to link to this page

Home My WebLink About12-22-0815056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Count Code Year File Number Bureau of Individual Taxes aa~. Y Po Box zaosol INHERITANCE TAX RETURN _ Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 0388 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 184-12-4895 03/20/2008 08/04/1923 Decedent's Last Name Suffix Decedent's First Name MI M:EEFAUVER SR JOHN H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FIP_L IN APPROPRIATE OVALS BELOW 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST B E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JEFFREY S COHICK EA (717) 249-5321 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY COHICK & ASSOCIATES First line of address r~~.~ r~:~ Second line of address ~` ~~ "' _,i e'J - 390 ALEXANDER SPRING RD _ ~ ~-1 , City or Post Office State ZIP Code DATE FtL'E7 1 - tU r~ :' CARLISLE PA 17015 -` _ -~ _ . cohick cohickassoc.com Correspondent's a-mail address: 1 @ .~~ ~ -`~ r: ~: _ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledgetadb belief, ' it i=.: true, rrect and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN URE OF PERS N P NSIBL„E FOR FILING RETURN DATE " ' 12/20/08 ~ A[~ORESS 1618 WALNUT BOTTOM R D, LISL A 5 /,Si<, ATURE OF PR OTHER T R T IVE DATE -_ _ __ 12/20/08 ADDRESS - 390 ALEXANDER RING ROAD, CARLISLE, PA 17015 PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 1 15056052059 REV-1500 EX Decedent's Social Security Number JOHN H KEEFAUVER Decedent's Name: 184-12-4895 RECAPITULATION 1. Real estate (Schedule A) . .......................................... .. 1. 110,000.00 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 12,121.42 6. Jointly Owned Property (Schedule F) Separate Billing Requested ..... .. 6. 23,452.01 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. 145,573.43 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. 32,814.61 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. 31 1.42 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. 33,126.03 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 112,447.40 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. 112,447.40 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 15. 16. Amount of Line 14 taxable at lineal rate X .045 112,447.40 16. 5,060.13 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ....................................................... .. 19. 5,060.13 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: File Number 21 08 0388 DECEDENT'Si NAME DECEDENT'S SOCIAL SECURITY NUMBER JOHN H KEEFAUVER _ 184-12-48.9.5 STREET ADDRESS 1634 VVALNUT BOTTOM ROAD CITY STATE _ 7 ZIP --- CARLISLE PA ~~ 17015 Tax Payments and Credits: 1. Tax Due' (Page 2 Line 19) (1) 5,060.13 2. CreditslPayments A. Spousal Poverty Credit __ B. Prior Payments C. Discount Total Credits (A + g + C) (2) 0.00 3. Interesb'Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 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) 5,060.13 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 5,060.13 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ d. receive the promise for life of either payments, benefits or care? ............................................................... ....... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... ....... ^ ^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? ................................................................................................................. ....... ^ 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 oi' death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9"'16 (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. §91'16(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. RE'~-'S2.c __k1 .. 5 ~ pennsylvania SCHEDULE A DEPARTMENT OF REVENUE ,NFIERITANCE Tax RETURN REAL ESTATE RESIDENT DECEDENT ESTATI. OF FILE NUMBER JOHhI H KEEFAUVER SR 21-08-0388 All veal 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 that is jointly-owned with right of survivorship must be disclosed on Schedule F. If more space is needed, insert additional sheets of the same size. OMB Nn 7509.09fi5 ~' A. B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.QFHA 2.QFmHA 3.QX CONY. UNINS. 4.QVA 5.QCONV. INS. SETTLEMENT STATEMENT 6. FIIF NUMBER: WYNN 7. LOAN NUMBER: 0179560974 8. MORTGAGE INS CASE NUMBER: C NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown, Items marked '(POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/BB (WVNNPFD/WYNN/36) D. NAME AND ADDRESS OF BORROWER: JOSEPH P. WYNN and MARBLE A. WYNN E. NAME AND ADDRESS OF SELLER: BONNIE L. SHOLLEY, Executrix of the Estate of John H. Keefauver, Sr. F. NAME AND ADDRESS OF LENDER: WELLS FARGO BANK, N.A P.O. BOX 5137 DES MOINES, IA 503 06-5 1 3 7 G. PROPERTY LOCATION: 1634 WALNUT BOTTOM ROAD CARLISLE, PA 17015 H. SETTLEMENT AGENT: 23-2402316 PURITY ABSTRACT COMPANY I, SETTLEMENT DATE: Decemb r 10 2008 SO. MIDDLETON TWP, CUMBERLAND CO. PLACE OF SETTLEMENT CENTURY 21 A BETTER WAY 398 E. HIGH ST, CARLISLE, PA e , 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 Price ; 110,000.00 401. Contract Sales Price 110,000.00 102. Personal Pro ert 402. Personal Pro ert 103. Settlement Char es to Borrower Line 1400 , 4,380.35 403. 104. 404. 105. 405. Ad'ustments Fa Items Paid 8 Seller in advance Ad'ustments For Items Paid B Seller in advance 106. Coun rf Taxes 12/10/08 to 01/01/09 17.73 406. Count /Tw Taxes 12/10/08 to 01/01/09 17.73 107. Ci Tax to 407. Ci Tax to 108. School Tax 12/10/08 to 07/01/09 624.58 408. School Tax 12/10/08 to 07/01/09 624.58 109. 409. 110. 410. 111. ~ 411. 112. ' 412. 120. GROSS AMOUNT DUE FROM BORROWER ~ 115,022.66 420. GROSS AMOUNT DUE TO SELLER '~ 110,642.31 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. De osit or earnest move 10,000.00 501. Excess De osit See Instructions 202. Princi al Amount of New Loans 88,000.00 502. Settlement Char es to Seller Line 1400 7,943.81 203. E>astin loans taken sub~ect to 503. Existin loans taken sub'ect to 204. 504. Payoff of first Mortgage 205. 505. Pa off of second Mort a e 206. 506. 207. 507. De osit disb. as roceeds 208. 508. 209. 509. Ad ustments For Items Un aid 8 Seller Ad ustments Frr Items Un aid 8 Seller 210. Coun /Tw Taxes to 510. Count /Tw Taxes to 211. Cit Tax to I 511. Cit Tax to I 212. School Tax to 512. School Tax to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. INHERITANCE TAX ESCROW to JEFFREY S. COHICK 4,700.00 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 98,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER ~ 12,643.81 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower Line 120 115,022.66 601. Gross Amount Due To Seller Line 420 110,642.31 302. Less Amount Paid BylFor Borrower Line 220) ( 98,000.00) 602. Less Reductions Due Seller (Line 520 ( 12,643.81 303. CASH (X FROM) ( TO) BORROWER 17,022.66 603. CASH (X TO) ( FWM) SELLER 97,998.50 The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. Borrower ~~ Seller ~~~u% BONNIE b. SHOLLEY, Executrix E P. WYNtJ ~ C i MARSiE A. WYNN ~1 Page 2 t~ t~ ~~ .Q i~ 10 .~ S~ ~~ L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 110,000.00 6.D000 % 6,600.00 PAID FROM PAID FROM Division of Commission line 700 as Follows: eoRROweR~s sE~~eR~s 701. $ 6,600.00 to CENTURY 21 A BETTER WAY FuNOS AT ruNOS AT 702. $ 10 CENTURY 21 A BETTER WAY sETT~EMENT SETTLEMENT 703. Commission Paid at Settlement 6,600.00 704. TRANSACTION FEE to CENTURY 21 A BETTER WAY 125.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % to 802. Loan Discount % to 803. Appraisal Fee to RELS VALUATION POC $325.00 804. Credit Report to RELS CREDIT POC $16.00 805. Lender's Inspection Fee to 806. Flood Cert Fee to WELLS FARGO FLOOD SVC 19.00 807. Tax Service Fee to WFRETS 100.00 808. Processing Fee to WELLS FARGO BANK, N.A. 425.00 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 12/10/08 to 01/01/09 @ $ 13.860000/day ( 22 days %) 304.92 902. Mortga a Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 ears to STATE FARM 331.00 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazardlnsurance 4.000 months $ 27.58 er month 110.32 1002. Mort a e Insurance months $ er month 1003. Coun (Tw Taxes 11.000 months $ 24.09 er month 264.99 1004. Ci Tax months $ er month 1005. School Tax 7.000 months @ $ 91.71 per month 641.97 1006. months $ er month 1007. months er month 1008. AGGREGATE ADJUSTMENT months $ er month -344.60 1100. TITLE CHARGES 1101. Settlement or Closin Fee to 1102: E-Mail Document Retrieval to PURITY ABSTRACT COMPANY 50.00 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Pr aration to CENTURY 21 A BETTER WAY DEED 150.00 1106. Nota Fees to CASH 20.00 10.00 1107. Attorneys Fees to includes above item numbers: 1108. Title Insurance to PURITY ABSTRACT COMPANY PLT.OS-042 908.75 includes above item numbers.1101, 1103 -BASIC RATE 1109. Lender's Coverage $ 88,000.00 L08-0035597 1110. Owner's Coverage $ 110,000.00 C70-0033342 1111. PA END:100, 300, 900 to PURITY ABSTRACT COMPANY 150.00 1112. PA SHORT FORM POLICY PURITY ABSTRACT COMPANY N/A IF NO FEES ENTERED 1113. Insured Closing letter to LAWYERS TITLE INSURANCE CORPORATION 35.00 1114. Overnight Fee/package to PURITY ABSTRACT COMPANY 12.00 1115. Tax Cert Fee to PURITY ABSTRACT COMPANY 5.00 1116. 1117. 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 48.50; Mortgage $ 78.50; Releases $ 127.00 1202. Cit /Count Tax/Stam s: Deed 1,100.00• Mort a e 1,100.00 1203. State Tax/Stam s: Revenue Stam s 1,100.00; Mort a e 1,100.00 1204. RECORDER OF DEEDS 1205. RECORDER OF DEEDS 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins ection to WAIVED 1303. FNAL WATER & SEWER to S.M.T.M.A. ACCT #022223 78.81 1304. 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section 4,380.35 7,943.81 By signing page 1 0l this statement, the signatories acknowledge receipt of a completed copy of page 2 of This two page statement /~ ~ n ~ r PURITY CT CO PANY Settlement Agent Certified to be a true copy. REV-1508 EX+ (6-98) 3~, SCHEDULE E p CASH, BANK DEPOSITS, $c MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE: OF FILE NUMBER JOHN H KEEFAUVER SR 21-08-0388 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MISCELLANEOUS HOUSEHOLD GOODS -SOLD 1,180.82 2. 2007 PA REAL ESTATE TAX REFUND FROM PA DEPT OF REVENUE 300.00 3. HIGHMARK BLUE SHIELD -HEALTH INSURANCE REFUND 152.73 4. MAGAZINE SUBSCRIPTION CANCELLED 11.40 5. CASH ON HAND 400.00 6 REAL ESTATE TAX REFUND AT SALE OF RESIDENCE ON HUD STATEMENT 642.31 7. 2007 KAWASAKI MULE 4WD 5,645.00 8. 1998 BUICK CENTURY - 4 DOOR SEDAN 3,575.00 9. MARLIN .22 GUN MODEL 25N SERIAL #10664730 25.00 10. HUSOVARNA GUN .300 WIN MAG SERIAL #357312 116.00 11. LOT OF VARIOUS FISHING EQUIPMENT 32.00 12. STATE FARM FIRE & CASUALTY CO -HOUSE INSURANCE REFUND 41.16 TOTAL (Also enter on line 5, Recapitulation) $ 12,121.42 (If more space is needed, insert additional sheets of the same size) REV-15(19 EX+ (6-98) ~~~~ ._ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY -----___ ESTATE OF FILE NUMBER JOHN H KEEFAUVER SR 21-08-0388 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. BONNIE L SHOLLEY 1618 WALNUT BOTTOM ROAD DAUGHTER CARLISLE, PA 17015 B C JOINTLY-OWNED PROPERTY: ITEM 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 FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °i OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 11120100 F&M TRUST MONEY MANAGEMENT ACCT#70-75219 25,990.64 50. 12,995.32 ar.N ~nat4na~4 0 2 A. 11120100 F&M TRUST GO CLUB CHECKING ACCT#34-03424 296.71 50. 148.36 3• A. 11120100 AMERICN HOME BANK CERTIFICATE OF DEP ACCT#290004832 20,616.66 50. 10,308.33 TOTAL (Also enter on line 6, Recapitulation) I $ 23,452.01 (If more space is needed, insert additional sheets of the same size) EV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN H KEEFAUVER SR 21-05-0388 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ EWING BROTHERS FUNERAL HOME 5,191.20 2. WESTMINISTER CEMETARY GRAVE OPENING AND CLOSING 1,270.00 s. ST JOHNS EPISCOPAL CHURCH, CARLISLE PA, FUNERAL SERVICES 225.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 7,000.00 Name of Personal Representative(s) BONNIE L SHOLLEY Social Security Number(s)IEIN Number of Personal Representative(s) Street Address 1618 WALNUT BOTTOM ROAD City CARLISLE .State PA Zip 17015 Year(s) Commission Paid: 2008 2. Attorney Fees 725.00 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 329.00 5. Accountant's Fees 1,000.00 6. Tax Return Preparer's Fees 500.00 ~. REAL ESTATE TAXES WHILE HOUSE LISTED FOR SALE 1,412.05 fc. MAINTENANCE OF HOUSE & REPAIRS IN PREPARATION FOR SALE 5,781.00 9. UTILITIES FOR HOUSE WHILE HELD FOR SALE 809.60 ~tf. AUCTION FEES ($265.10), MISC MILEAGE & EXEC OUT OF POCKET EXP ($437.66) 706.76 ~'I. FROM HUD STATEMENT SALE OF HOUSE EXP, SALES COMM, TRANSFER TX & DOC PREP FEES 7,865.00 TOTAL (Also enter on line 9, Recapitulation) $ 32,814.61 (If more space is needed, insert additional sheets of the same size) Rev-is~~z ;.-x- t.~~:%-~s) Pennsylvania SCHEDULE I : DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAx RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN H KEEFAUVER SR 21-08-0388 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. REV-1573 EX+ (i1-08) ~ ~ pennsylvania SCHEDULE !Si DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE: OF FILE NUMBER JOHN H KEEFAUVER SR 21-08-0388 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, 2116 (a) (1.2).) 1. BONNIE L SHOLLEY DAUGHTER 1/4REMAINDER 2. JOHN H KEEFAUVER JR SON 1/4REMAINDER 3. DENNIS D KEEFAUVER SON 1/4REMAINDER 4. WILLIAM KEEFAUVER SON 1/4REMAINDER ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. DECEASED WAS WIDOWER NO SURVIVING SPOUSE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 'i . NONE TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, insert additional sheets of the same size. ~--~, {rr _ ~ _ c~_ a _c_ ~rt~~ I, JOHN H. KEEFAWER, SR., of 151$ Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral expenses be paid from my estate as soon after my death. as practically and conveniently may be done. ~~ . I s~ire~--#- that my remains be in terred ire accord _°=~~~ ~xpress~d €~ishes. r~HIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. Should my Wife not survive me, I make the following specific bequests: A) to my sons, John H. Keefauver, Jr., Dennis Keefauver and William Keefauver, my 28 foot camper; B) to my sons named above, my guns, to be divided equally and kept in the family; C) to my sons named above, my gun cabinets, fishing equipment and hunting clothes, to be divided equally; D) to my son William, the boat and boat trailer. FIFTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death unto my Wife, Mildred C. Keefauver, provided she survives me by thirty (30) days. In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all said tangible personal property not specifically devised in paragraph Fourth unto my four children, Bonnie Keefauver Sholly, John Keefauver, Jr., Dennis Keefauver and William Keefauver, in equal shares, per stirpes. SIXTH. I give, devise and bequeath any and all real estate owned by me at the time of my death, unto my wife Mildred C. Keefauver, provided she survives me by thirty days. In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all said real estate unto my four children, Bonnie Keefauver Sholly, John Keefauver, Jr., Dennis Keefauver and William Keefauver, in equal shares, per stirpes. ~~_~ed she survives me by thirty =~.=1a to survive me by thirty X30} begb::eath all the rest, residue and y.:'' four children, Bonnie Keefauver Bennis Keefauver and William Keefa~ stirpes. ~3fl} days. In the event she days, I give, devise and remainder of my estate unto Sholly, John Keefauver, Jr., aver, in equal shares, per EIGHTH. I direct that any and all Inheritance, Estate and °&°:ransfer taxes imposed upon my estate passing under my will or r?~~se, shall be paid out of the principal of my residuary '~~ ~~. ?~:`~;. hereby na~cinate, constitute and appoint my wife, _~~_~.:_Ted ~. Keefauver as Executrix of this my Last Will and _~=_starnent. In the event of renunciation, death, resignation or inability to act far any reason whatsoever of Mildred, I nominate, constitute and appoint my daughter, Bonnie Keefauver Sholley as Executrix of this my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties, as such, in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by 1<iw, I authorize my Executrix, in her absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. IN WITNESS WHEREOF, T have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two typewritten pages this lA~ day of 4 '~`-~ 1988- '~ .. rl ~_ :~, JOHN H. KEEFAW~ ~ SR. Signed, sealed published and declared by the above named TE,stator JOHN H. KEEFAUVER, SR. as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. `~ J ~~ ~. ~ is ~ ~. ~ ~.E t ,~ ~- ,, ~ , ~ ti~ . ~,,~, ~. ~.~' ~~ ,~ ,,~_ ..-, ,~ COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ss. I, JOHN H. KEEFAUVER, SR., 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 Will; that I signed it willingly; and that I signed it as ~ free and voluntary act for the purposes therein expressed. f Sworn or affirmed to and acknowledged before me, by JOHN H. KEEFAUVER, SR. this of ~~..~-,,~ 1988. ,' :~ JOHN H. KEEF`~~ V~R. L- I~~day otary Pub c (SEAL) My commission Expires: ~~/ay~ya COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ss. We, N~~ (~r2rA _C. I~ee~c~u,~esr and U.lw.~ ~ - ~Jv..,~t 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 JOHN H. KEEFAUVER, SR. sign and execute the instrument as his Last Will; that JOHN H. KEEFAUVER, SR. signed willingly and that JOHN H. KEEFAUVER, SR. executed 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 eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. (~ / r''"'L~ , Sworn or affirmed to and - ~ subscribed before me by ',~ ~• kee-~au./er and r,~,,,,.. A .~ u,,.c a w-- witnesses, this ~~ day o f ~w,.w„~a~~ 19 8 8. ary P lic (SEAL)