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HomeMy WebLinkAbout01-08-09r ~ J 15Q56D41Z69 REV-1500 a (os-o5) PA Departrrlent of Revenue OFFICIAL USE ONLY l3ureau of Individual Taxes County Code Year Fde Number PO Box 280601 INHERITANCE TAX RETURN _Harrisbury,PA~ltza-~suf RESIDENT DECEDENT ,~~ n~ ~~~~_ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 168-24-3021 05242008 09091928 Decedent's Last Name Suffix Decedent's First Name MI ~~ SARA J (tf Applicable) Ercrter Surviving Spouse's Information Bebw Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social :>ecurity Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW © 1. Original Retum ^ 2. Suppleinenfal Rehm ^ 3. Remainder Retum (dale of death ^ 4. thnited Estate ^' 4a. Future Interest Compromise (date of prior to 12-t382) ^ 5. Federal Estate Tax Return Required death after 12-12-82) O 6 Decedent Di d T . e estate ^ 7. Decedent Maintained a Giving Trust (Attach Copy of VViX) 8. ToMI Number of Sate Deposd Boxes - (Atfach Copy of Trust) ^ 9 Liti ation P . g roceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 12~t-9t and 1-1-95) ~~~ ~_ O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPOtiDENCEAHD CONFIDENTIAL TAX 80FORNFATION S Name HOULD BE DIRECTED T0: Daytime Telephone Number THOMAS A)'. CARR, CPA (610} 296-4200 Firn Name ({fApplipbte} SIANA CARR & O'CONNOR, LLP REGISTER OF Y1flLt$ USE ONLY First tine of address e.~ o 1500 E. LANCASTER AVENUE ~ ~ Second line of address t t 't ~ ~ ~ 7~ t t ~~ City or Post Office PAOLI State ZIP Code PA 19301 ~~ ~, ~.. ~t M' J- ` _: ~._y . 4~,~'~ _A_4r l - ~ i^7 :;'.: C=, r.... Correspondents e{rw0 address_ Under penalties of perjury. t declare Mat t trave examined Uric return, inckrdmg accomparyirg schedules and statements, and fn the best of R is true, correct and . Declaration of preparer other Ulan the personal representative is based on alt intornuaGon of which ~ ~ arwl ~~, StGNATtflRE OF PERSAN RFCanucmr c c .... er.,..,.. PreParer has ~'Y ~~'~9e- 26 HENRY DRIy~~ IME~ICK, ~ 19468 Z r d DATE ADDRESS ~~ ' 4 ~ - 150_0 E. LANCASTER A E, PAOLI, PA 19301 PLEASE USE ORIGINAL FORM ONLY Side 1 L, :b5056U4b169 15D56U4bZ69 J - .. _~ ,~ t 12EV--1500 EX Decedent's Social Secunty Number Decedent's frame: SARA J CAt3M 168 - 24 - 3 021 RECAPf11fLAT10N 1. Real estate(ScheduleA) ...........................•---•--•------- --. 1- 153,156.88 2. Stocks and Bonds (Schedule B) . - .... _ ..... . ......... . ... . .. . .. . . . . . • - 2. 7 8 0 , 9 7 0.9 6 3. Ckuely Fiekt Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3- 4. Mortgages 8 Notes Receivable (Schedule D) . . ...... . .. . ... • • - - . - - • • - - - _ - q- 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ...... .. 5. 3 3 ? , 112.15 6- Jointly Owned Property (Schedule F) ~ Separate Baling Requested ..... . - 6. 7. Inter-Yrvos Transfers 8 Miscellaneous Non-Probate Properly - (Schedute G) ~ Separate Billing Requested .. , .. .. 7. 569 , 4 09.62 8. TotatGrossAssets(totalLinesl-7).....-----•• ..................... .. 8. 1,840,649.61 9. Funeral Expenses 8 Administrative Costs (Schedule ti) ............. . ..... .. 9. 4 6 , 3 7 5 . 0 2 10: Debts of Gecedent, Mortgage Liabldies, 8 Liens (Schedule I) .............. . t0. 11. Total Deductions(totalLines98f0) ................_.._•--•-----_- _ 11. 46,375.02 12. Net Value of Estate(LineBminusLinell)_...•...........•••------,.- - 12. 1,794,274.59 13. Charitable and Governmental Bequests/Sec 9113 Trusts for vvttict- an election to tax has not been made (Schedule J) ........:. . . . • - . - - - • - - - - 13_ 114 , 131.8 9 14. Net Value Subject to Tax (Line 12 minus Line 13) .......... . . . .......... . 14. 1, 6 8 0 , 14 2 . 7 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spotual tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 15. 16. Amount of tine 14 taxable at 6neaf rate x .0_ 16. t7. AmaxN of Line 14 taxable atsdbGngrate x .12 1, 602, 123 .91 17. 192, 254 .87 18. Amount of L"me 14 taxable atooMateratrate x -15 78, 018 .79 18 I1, 702 .82 19. TAX DUE .....................•- ..- . 19. 203,957.69 15D56D4216D 20. FILL IN THE BOX tF YOU ARE RE4UESTING A REFUND OF AN OVERPAYMENT 15D56D4216D sae 2 D 15D56D4216D REV-1500 EX Page 3 Decedent's Complete Addrp~a- FBeNumber 2008-00621 DECEDENTS w4ME Sara Jane Caum STREETADDRESS 16 Amherst ]Drive CRY STATE Z~ Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Lire 19) 2. CreddslPaymerds A. Spousal Poverty Credit B. Prior Payments X 8 0, 0 0 0 0 0 C. Discount , 4 7 3 4 0 3. lMerestlPenalty d afrpCrcable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total tnteresUPenalry (D + E) (3) 4. tf line 2 ~ greater than Cine 1 + line 3, enter the ddference. This ~ the OVERPAYMENT. Fitt in box on Page 2, line 20 to request a refund. (q) 5. B line 1 + line 3 is greater than Lme 2, enter the d8ference. This is the TAX DUE. A Enter the interest on the tax due. (5A) 203,957.69 189, 473 .40 0.00 (5) 14,484.29 B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5B) 14 , 4 8 4 .2 9 Make Check Payable fo: REGISTER OF IMLLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did' decederd make a transfer acrd: Yes No a. retain the use a income of the properly trar~ferred : ............... ^ b. retain the right to designate who shaft use the property transferred or its income : ................. . .. ^ c. retain a reversionary interest; or .......... . d. receive the promise for life of either payme-ds, benefits a care? ......... . 2. tf death ocamed 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 a payable upon death bank aocorxrt a seaady at his or fret death? ..... ^ 4. Did decedent own an Indrvidtrat Retirerrrent Aceotart, ararudy, a otf-anon-probate property yrludr con a berrefic~ry desrgnaborr? ...................... . ................................... ® D tF THE ANSYYER TO ANY OF THE ABOVE 4UESTIONS lS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R 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 a for the use of the surviving spouse is three (3) percent p2 P.S. §9116(a}(1.t.)(i)}. For dates of death on a after January 1, t995, fhe 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(ay(1.1)(ii)).Thc statute does not exetr~ a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and ring a tax return are stiN applicable even ~ the surviving spouse is the Doty beneficiary. For dates of death on or after Jury 1,2000: ~e tax rve imposed ar the net value of transfers from a deceased dtild twenty-one years of age or yamger at death to or for the use of a natural parent, adopt parent, or a stepparent of the child is zero (D) percent [72 P.S. §9116(aK1.2)}. The tax rate imposed orr the net value ~ transfers to or for the use of the decedent's kneal benefiaaries is four and one--half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [7;Z P.S. §91t6(a)(1)]. The tax rate imposed on the net vahre of transfers to or for the use of the decedent's sblings is twelve (f2) percent (72 P.S. §9116(a)(1.3)}. A sibling is defined, under Secfion 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. _~,a ...,r ;. .. .... - ... ar'Jit p'C`iTYC~b s..r y. v?~C"f '` crt~<iYS. ~.-... Y.- ....::: .:. ..::: ., ..... .. ~. . REV-1502 IX+ (S98) SCHEDULE A COMMOIJV{lEiLLTti of PENNSYLVANIA REAL ESTATE INHERRANCE: TAX RETURN RESIDENT DECEDENT . ESUTE OF FlLE NUMBER Sara J. Caum 2008-00621 An real property owned sotery or as a tenant in common must be reported at fair market value. Fah market vakre is defned as the price at which property would be exchazrge between a wiling buyer and a wdl'mg seller, neitlier being compe9ed to twy or seG, both ltavBrg reasonable knovrledge of the relevant facls_ .__, ..._ F , , .. . _n`2:: ~ F wren, ...' .: r~~ ~~~ w~ p ~, mserr aaaxnnar sneers a me same s¢e} t Estate Valuation Bate o€ Death: 05/24/2008 Valuation Date:: 05!24/2006 Estate of: Estate of Sara Jane Carte Processing Date: 11/05/2008 Account: Stifel Nicholaus Acct_ c Indv. Roldings Report Type: pate of Death Number of Securities 23 File ID. Cana Estate, Sara Shares Security or Par Description 8ighlASk Low/Bid Hean and/or Adjustments Div and Int Accruals Security Value 1) 2228 ATaY INC (00206A102) _ COM New York Stock Exchange 05!23/2008 39.36000 38.35000 R/L 05/27/2008 39.19000 38.31000 R/L 38.802500 86,451.97 21 70 CRUBB CORD (171232101} CON New York Stock Exchange 05!23!2008 53.23000 52.32000 R/L 05/27/2000 53.24000 52.25000 H!L 52.735000 3,641.45 3) 19 FAIRPOINT COlM[JNICATIONS INC (305560I04y COM New York Stock Exchange 05/23/2008 8.85000 8.46000 R/L 05!27!2008 8.70000 8.32000 R/L 8.582500 163.07 4) 598 PPL CORP (6935ITI06) COi9 New YorkStock Exchange 05/23/2006 50.57000 94.98000 R/L 05/27/2008 50.05000 94.14050 R/L 44.810125 27,295.95 5) 1028 VERIZON COl4fUNICATIONS INC {92 343V109) COH New York Stock Exchange 05/23/2008 37.92000 36.90000 H!L 05/27/2008 37.58000 36.75000 R/L 37.162500 37,83I.43 6y 90 WINDSTREAN CORD (97382N109) COH New York Stock Exchange 05/23{2008 13.06000 22.73000 R/L 05/27/2008 13.29000 12.86000 H!L 12.985000 1,168.65 7) 500 DREYFUS MIJN INCOME INC (262028 102) CON American Stock Exchange 05/23/2008 8.64000 8.44000 R/L 05/27/2008 8.57000 8.48000 A!L Div: 0.041 Ex: 05!09/2008 Rec- 05/23/2008 Pay: 05/30/2008 6.532500 4,266.25 c 20_„0 8I 301.298 NUVEEN pA PREH INCOMES HUN FD 2 (67p6IF101) COH New York Stock Exchange 05/23!2008 12.42000 12.36000 R/L 05/27/2008 12.41200 12.28000 R!L Div: 0.0995 Ex: 05/13(2008 Rec : OS/IS/2008 Pay: 06/0 2!2008 12-368000 3,726.45 19.91 91 324.282 NUVEEN PA INVT QUALITY lATN FD E670472108) COM New York Stock Exchange QS/23/2008 13.14000 13.15000 H/L 05/27/2008 23.20000 23.12000 8/L Div: 0.055 Ex: 05/13/2008 Rec: OS/15!2008 Pay: 06/02 !2008 13.165000 4,264.17 17.84 Page I This report was produced with EstateVal, a product of Estate Valuations s Pricing Systems, Inc. If you have questions, please contact EVP Systems at (8181 313-6300 or www.evpsys_corn_ (Revision 7.1.0) .,:`~,:, =m'"R's~li+'+iss``tk+°F ~i+c„-i~~Mit~~.'!~9T+# .. ,.. - _. _ • - _ -r[ < .. - - _ . _... , . -. Date of Death: 05/29/2008 Valua tion Date:. 05!24!2008 Estate of: Estate of Sara Jane Caum Proce ssing Date: 11/05/2008 Account: Stifel Nicholaus Acct. 6 Indv. Holdings Report Type: Date of Death Number of Securities: 23 File ID: Canm Estate, Sara Shares Security or Par Description Nigh/Ask Low/Bid Mean and/or Adjustments Div and Int Security Accruals Value 10} 351.SI(i VAN KAHPEN PR VALUE MDN INCOME (421127108) CO!} New York Stock Exchange 05/23/2008 13.11000 13.03000 H/L 05!27/2008 13.22000 13.03000 N/L Div: 0.0625 Ex: 05/13/2()08 Rec: 05/15/2008 Pay: 05/30/2008 13.072500 9,595.29 21.62 11) 200 MERRILL LYNCH PFD CAP TR III (59021£206) TOPRS 7$ New York Stock Exchange 05/23/2008 21.90000 2 L 60000 H/L 05!27/2008 21.98000 21.69000 H/L 21.780000 9,356.00 12) 4513.459 DMC TAX FREE INCOtiE TR PA (233216100) SH BEN INT R Mutual Fund [as quoted by NASDAQ} 05{23/2008 7.90000 Hkt 7.900000 35,656.33 23) 913.092 DREYFUS PREMIER MON BD FD (26201Y107) SH BEN INT A Hutual Fund (as quoted by NASDAQ) 05/23/2008 11.64000 Mkt 12.690000 5,221.98 19) 3972.083 DREYFOS PREMIER ST HUN BD FD (26202D649) PA SER CL A Mutual Fund (as quoted by NASDAQ) 05/23/2008 25.79000 Mkt 15.790000 62,719.29 15) 895.87 EATON VANCE NUT FDS TR (277911830) TXMGD GR I.1 A Mutual Fund (as quoted by NASDAQ) 05/23/2008 25.35000 Mkt 25.350000 22,710.30 16) 2672.877 EATON VRNCE HUNS TR (27826L280) PA HUN A Hutual Fund (as quoted by NASDAQ} OSl23/2Q08 9.60000 Mkt 9.600000 25,659.62 17) 1582.528 EATON VANCE HUNS TR (27826L50l) PA HUNS CL B Hutua2 Fund (as quoted by NASDAQ) 05!23/2008 9.93000 Mkt 9.930000 15,714.50 I8? 6311.9!59 FRANKLIN TAX FREE TR f354"e23801} FP_ T/F INCN A Mutual Fund fas quoted by NASDAQ} 05/23/2008 20.27000 Mkt 10.270000 64,623.82 I9) 6891.9'18 OPPENHE2MER MULTI ST NUHICIPAL [683990209) PA HUN FD CL B Mutual Il~nd (as quoted by NASDAQ) 05/23/2008 11.81000 Mkt 11.810000 81,388.36 20) 18!10 ALLIED IRISH BKS PLC (019228402) SPON RDR ORD New York Stock Exchange 05/23/2008 41.76000 41.I8000 H/L 05!27/2008 9I.92000 41.50010 H/L 9I.550017 78,524.53 Page 2 This report was produced with EstateVa2, a product of Estate Valuations ~ Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or wuw.evpsys.com. (Revision 7.2.0) ..,~. .~ ,w .. ,. . ~_ .._ Date of Death: OS/24/20Q8 Estate of: Estate of Sara Jane Caum Valuation Date:. 05/24/2008 Accounts Stifel Nicliolaus Acct_ c Indv: Holdings Processing Date: 11lDSl2008 Report Type- Date of Death Number of Securities 23 File 1D: Caum Estate, Sara Shares Security Hean and/or Div and Int Security or Par Description High/Ask Low/bid Adjustments Accruals Value 21) 956 INTERNATIONAL BOSINESS HACHS E459200101) COli New York Stock Exchange 05!23!2008 124.92000 123.77000 H/L 05/27/2008 127.38000 124.00000 H/L Div: Q_5 Ex: 05/07/2008 Rec: 05/09/2008 Pay: 06/10!2008 125.015000 57,006.89 228.00 22) 1200 HERSHEY CO E427866108} COM New York Stock Exchange 05!23/2008 36.79000 36.18000 H!L 05!27/2008 90.28000 36.44000 H/L Div: 0.2975 Ex: 05/21/2008 Rec: 05/23/2008 Pay: 06/13/2008 37.422500 49,407.00 357.00 23} 628 SOVEREIGN BANCORP INC (895905I08) COlI New York Stock Exchange 05/23/2008 8.79000 8.35000 H/L 05/27/2008 8.74000 8.50000 H/L 8.595000 5,397.66 Total Valve: Total Accrval: 5677,550.22 Total: 5678,210.08 5659.87 Page 3 This report wars produced with Estateval, a product of Estate Valuations c Pricing Systems, Inc_ If you have questions, please contact EVP Systems at t81B) 313-6300 or www.evpsys.com. (Revision 7,1.0) r _ .. ._:~ .- ~ ... -:' jr _~Lr. ... _'S;.Y .- ..~.~`A"F: a... r>""~'i'~.~.1"a'.: m..~r!'.. Y_ .. .. J" ~Y,-.. .,., r ,~ ~ ... REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH of PENNSYLVANIA STOCKS ~ BONDS INHERITANCE TAX RETURN RESIF?ENT DECEDENT ESTATE OF FILE NUMBER Sara J_ Caum 2008-00621 AN ProP~h 1o~7-owned with right of survivorship must be disclosed on Schedule F fTEAA NUMBER DESf~IPTlON VALUEATDATE OF DEATH t' :2,228.000 Shares AT&T Inc _ 86,451.97 2. 70.000 Shares Chubb Corp. 3- 19.000 Shares Fairpoint Communications Inc. 3,691.45 163 07 4_ 548.000 Shares PPL Corp. . 5_ 1,018.000 Shares Verizon Communications Inc. 27,295.95 37,831.43 6. 90.000 Shares Windstream Corp_ 7. 500.000 Shares Dreyfus Mun Income Inc 1 168.65 8- . Accrued Dividend on Item 7 through date of death 4,266.25 20 50 9. 301.298 Shares Nuveen PA Prem Income MUN FD 2 . 3 726 45 10. Accrued Dividend on Item 9 through date of death , . 14 91 11. 324.282 Shares Nuveen PA Invt Quality Mun FD . 4 269 17 12- Accrued Dividend on Item 11 through date of death . 17 84 13. 351.516 Shares Van Kampen PA Vaiue Mun Income . 4 595 19 14. Accrued Dividend on Item 13 through date of death , . 21 6.2 15. 200.000 Shares Merrill Lynch PFL) CAP TR III TOPRS 7 . 4 356.00 16. 91,513.459 Shares DMC Tax Free Income TR PA , 35 656 33 17. 413.092 Shares Dreyfus Premier Mun Bd FB , . 5,221 48 18. ?.,972.083 Shares Dreyfus Premier ST Mun Bd FD . 62,718 19 19. 895.870 Shares Eaton Vance MUT FDS TR TXMGD . 22 710 30 20. 2,672.877 Shares Eaton Vance Muns TR PA Mun A , . 25 659 62 21_ 1.,582.528 Shares Eaton Vance Muns TR PA Muns CL B , . 15 714 50 22_ 6,311.959 Shares Franklin Tax Free TR PA T/F INCM A , . 64 823 82 23. 6,891.478 Shares Oppenheimer Multi ST Mun PA Mun CL B , . 81 388 36 24. 1.,890.000 Shares Allied Irish BKS P L C Spon Adr ORD , . 78 529 53 25. 456.000 Shares International Business Machines , . 57 006 84 26- Accrued Dividend on Item 25 through date of death , . 228 00 27. 1.,200.000 Hershey Co. . 28. Accrued Dividend on Item 27 through date of death 44,907.00 357 00 29. 628.000 Shares Sovereign Bankcorp Inc. . 5 397 66 30. 4.,339.324 Shares Prudential Fund #15 , . 31. 2,665.042 Shares Prudential Fund #22 63,744.67 39,016.21 TOTAL (Also enter on Gne 2, Rec~ihdation) I S 7 8 0. 9 7 n 9~ (U more space a needed. insert addrh'onal sheets of the same s¢e) >tf -r ~n.`r .' ` -y~;7', . .. - ~,.;,",-S.p'cYa',::3e~.~.•. ~.,;e-taa~ .t_ - _ . _ .. G..,.,. ..._. ~r=Y, '.M3f~jt?''0°.x;aeark~ .. n,'.`. ,. ::;^ _-+p,.x REV-5508 EX+ (638) SCHEDULE E ESTATE OF ITEM NUMBER DESCRIPTION 1. 14&T Bank 12 Mo. Cert. of Deposit #31003914570857 2. Accrued interest on Item 1 through date of death 3. IK&T Bank Time Deposit Cert. of Deposit #310039131524 4. Accrued interest on Item 3 through date of death 5. 1K&T Bank 12 Mo_ Cert. of Deposit #311003915142126 6_ Accrued interest on Item 5 through date of death 7. M&T Checking with Interest Acct. #98028731 8. Accrued interest on Item 7 through date of death 9. ]?NC Bank 11 Mo. Cert. of Deposit #31900149493 10. Accrued interest on Item 9 through date of death 11. 1?NC Bank 12 Mo. Cert. of Deposit #313002691925 12. Accrued interest on Item 11 through date of death 13. I?NC Bank Checking Account #51-4000-9907 14. Accrued interest on Item 13 through date of death 15. I?NC Bank Money Market Account #50-0094-0134 16. Accrued interest on Item 15 through date of death 17. Sovereign Bank Cert. of Deposit #1055161226 18. Accrued interest an Item 17 through date of death 19. ;>overeign Bank Cert_ o f Deposit #1055162802 20. Accrued interest on Item 19 through date of death 21. ~>overeign Bank Cert. o f Deposit #1055176174 22. Accrued interest on Item 21 through date of death 23. Sovereign Bank Cert. o f Deposit #1055176786 24. Accrued interest on Item 23 through date of death 25. Stifel Nicolaus Cash/Money Market Funds 26. Savings Bond Series EE issued June 29, 1992 27. Citizens Bank Cert, of Deposit #6140758084 28. Accrued interest on Item 27 .through date of death 29. Chevrolet Sedan 2005 - VIN 1C:1ZS52F35F253018 30. Ulnited States Treasury - Refund of 2007 Income Tax 31. T'raveler's Checques FILE NUMBER Sara J. Caum 2008-00621 Include the proceeds of 8igaiion and the die the proceeds were received by the estate- Aq propergt }antlY-ov+ned w~h right of surv'norship mast he discbsed on Schedule F. TOTAL (Also enter on arre 5, Recapittdation} ~ S COAigMONVVEAL77~ OF PENNSYLVANW INHERrrANCE TAX RETURN RESIDENT' DECEDENT CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY 19,780.76 26.61 11,172.75 26.43 12,967.17 32.55 24,872.01 .58 24,172.35 69.77 11,393.49 13.15 72,278.85 9.36 13,815.45 7.10 29,087.55 86.19 28,131.37 47.28 17,119.11 64.96 34,320.36 68.87 837.24 58.38 26,705.11 24.35 8,000.00 1,743.00 180.00 (!f nnxe space is needed, insert addAprcat sheets ottlie sarrre size) VALUEAT DATE OF DEATH 337,112.15 - ~.., REV-1510 EJC+ (6-98) COMMONWEALTH OF PENNSYLVANIA NiHERfrANCE: TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY ESTATE OF ~~ NUMBER Sara J. Caum 2008-00621 This sdhedule must be onrrrpleted and filed d the answer to any of questions t through 4 on the reverse side of the RE~t500 COVER SHEET is ves_ tTEhl NUMBER DESCRIPTION OF PROPERTY a~~troEnrEwwEOFTMEnEr;Tr~nEt.AT~o-~s+wfooECEOEUrANO TtE DATE OF TRANSFER. ATTACHACDPY OFTF~ DEED FOR REAL ESSATE DATEOFDEATH VALUE OFASSET 9GOFDECD'S INTEREST IXClt1SI0N lF APPLICABLE) TAXABLE VALUE t. Jacksor.L National Life Insurance Company - PersFrective II Fixed & Variable Annuity Contract #1003358182 - Beneficiaries 4,018.79 100 5 ,018.79 Janet. Morris and Susan Royal 2. The Ohio National Life Insurance Company - ' Variable Annuity - Contract #E1271291 1 7,773.79 100 14 ,773.79 Beneficiary - Bette Royal 3. Union Central Group Retirement Annuity Contract #A14732197C - Beneficiary 9,327.62 100 2 ,327.62 Derry Street United Methodist Church 4. Prudential IRA Mutual Fund Account #3900336195 - Beneficiary Syracuse Univ. 4,804.27 100 7 804 27 5. M&T Bank - IRA - M&T Select 18 Mo_ Cert_ , . of Deposit #35004202107189 2 9,485.15 100 - 23 485 15 Beneficiary - Bette Royal , . 6. Christopher Morris - Nephew - June 22, 200 11,000 100 3,000 000 00 7. Daria Jones - Nephew - June 22, 2007 11,000 100 3,000 , . 000 00 8. Ethan Jones - Nephew - June 22, 3007 11,000 100 3,000 , . ,000.00 TOTAL (Also eater on fine 7, Recapihdation) ~ f 5 6 9, 4 0 9 6 2 (N more space a needed, IrLSert addApnal sheets of the same s¢e) ,. _. _ ro.. ;..ter ~y~ ~rrzrX+•`si t'kF~'V+af1~ .Y.~a,._^c. ~°gi".:-:.,r ,..-. ~ cts._ "ay~i?~ -~.j~~i, „++",-.T - ~ `t L+~ ~"' _ . .. _ .- rir,7z 3.".-rvii9; .-R,-._'.: .. ~,.~~nr._,,;r ~.?'?R.~:*."sc:.w-~- I REV-15f'i IXi (10.06) COMMON1NEgLTH' OF PENNSYLVANIA MNER[TANCE TAX RETURN REStDt7VT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS is tAt t uI• FILE NUMBER Sara J_ Caum 2008-00621 Debts of decedent mt~t be reported on SchedWe 1 fTEM ~~~ DESCRIPTION Ah~Ol1MT A: Ft1NERAl EXPENSES: ~~ Fack:ler-Wiedeman Funeral Home 11,211.77 2. Amy Smith - Paster for funeral 200.00 3. Sheraton Hotel - Funeral luncheon ~ 295.49 4. Mast.er's Mercantile - Funeral music 13.76 5. Travel & lodging expenses to funeral for executrices 2,096.43 B. ADMINI;iTRATNE COSTS: t. Personal Represerdative's Commissions Marne of Personal Represerdafive(s) Janet L_ Morris StreetAddress 26 Henry Drive City Limerick Spate PA Z~ 19468 Year(s) Commission Paid: 2 0 0 8 2. 3. Attorney Fees Famiy Exemption: (tt decedent's address is not the same as claimant's, attach explanation) ClaunaM SireetAddress Cdy Slate Z~ Relationship of Claimant to Decedent 4. Probate Fees 5. Accoantard's Fees 6. Tax Return Preparer's Fees 7. Miscellaneous expenses - Postage, fax, transfer mail 8. Jarl Morris - Reimb. for travel expenses after funeral 9_ Bonnie K. Miller, T/C - 2008 West Shore real estate tax 10. Bonnie K. Miller, T/C - 2008 Per Capita tax 11. IBIS Appraisal Services - Appraisal fee 12. Dennis Winehold - 2007 Income tax preparation B, o00 . ota 7,443.00 850.00 5,000.00 55.49 217.80 1,462.02 9.80 360.00 350.00 TOTAL (Also enter on Ihre 9, Rtlulatiort) ! S 4 6 , 3 7 5 . 0 2 (tt more space is needed, insert addi6onat sheek of the same s¢e) K v-;c :.;~=+, ac,. l"°1 A. h`-••.-,-':.acs y..-. ~~ .,>;s ,;-~.;~ <~'h"7-'~P,~ffira grh'~r'~*Z:kx2~-i 'wt . .. -, .. - ... , ~P..",...r~' n _ ~..... i - ^''~'.> any?: 'n--ct - .`{~.. RE~S51~ DC+ (t0-06) COIuMAONWEALTH OF PENNSYLVANIA INHERFfANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES ADtNtNlSTRATIVE COSTS ESTATE OF FILE NUMBER Sara J. Caum 2008-00621 lkhts of decedent must be reported on Schedule I. - ITEM NUti~BER DESCR~T~N AMOUNT A FUNERAL EXPENSES: t_ B. ADfNINfSTRATNE COSTS: t. PersonatRepresenfatiue'sConwnissions _ Name of Personal Representative(s)_Susan L. Royal StreetAddress c/o 26 Henry Drive GTy Limerick State PA ZIP 19468 Year(s) Commission Paid: 2 0 0 8 2. Aftomty Fees 3. FamBy Exemption: (K decedent's address is not the same as claimant's, attach explanation) Claimant StreetAddress 4. 5. 6. 7. 14 15 8,000.00 701.92 132.03 75.51 Cdy State Z~ Retatior-ship of Clamant to Decedent Probnte Fees Aaaxrtard's Fees Tax Return Preparer's Fees Mileage, parking and tolls for excutrices reimbursed Postage, facsimiles and delivery charges Miscellaneous expenses - storage boxes and supplies TOTAL (Also enter on Erne 9 Recap~Aation} `S 4 6, 3 7 5 0 2 (If more space is needed, insert add~orral streets of the same s¢e} < ;-,, •,'sr~etir ~a ~ 4t =;=3%'rar .~nSa+t~:~v ;. :w ~ - : _,~ r_ ~ .;~:~-~?~F n;~.~- u d ~rarJ..a+r':*s3ea5*.~fr~'~x;~~:fu~ . . ,. , -. .__ _ .. .. _ r REV-1513 EX+ (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX f2ETURN RESIDENT DECEDENT - - . - ---- ESTATE OF Sara J. Caum NUMBER 1 1 2. 1 2 3 4 SCHEDULE J BENEFICIARIES NAMEANDADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Bette C. Royal Haverford Ests. 731 Old Buck Lane Haverford, PA 19041 Residuary T/U/W of Sara Jane Caum Haverford Ests. 731 Old Buck Lane Haverford, PA 19041 ___ _ __ __ _. - FILE NUMBER 2008-00621 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Sister Trust ENTER DOLLAR F~MOUNTS FOR DISTRIBUTIONS SHOWNABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICHAN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Derry Street United Methodist Church 1508 Derry Street, Harrisburg, PA 17104 Syracuse University 303 University Place, Syracuse, New York 13210 Derry Street United Methodist Church 1508 Derry Street, Harrisburg, PA 17104 Syracuse University 303 University Place, Syracuse, New York 13210 5,000.00 5,000.00 29,327.62 74,804.27 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 114 , 131.8 9 4,020.00 1,006,887.28 (If more space is needed, insert additional sheets of the same size) LOCAL REGISTRAR'S CERTIFICATION OF -DEATH . WARNING: n is illegal to duplicate this copy by photostat or photograph. ~ee for this certificate, X6.00 F t442't213 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar_ The original certificate will be forwarded to the State Vital Records Office for pertnanenE filing_ O~ Local Registrar ate ]slued ~c ?wn ~ w xv nlaes COYRWNIMEALiN OF PENNSYLVANIA • DEPARTINEM OF NEALTN • VITAL RECORDS EAU,EM ~+r CERTtFiCATE OF DEATH t$C! M~4utIIpRS i,Id tXiil,pllS OIL T!YlfK! L,r,dDnmr rdy~yp yr, STATEf1F MUYBEq 2 Ss • FArdOrw Uba ~ 1d1 SARA J CAtIIi Female ~ 61 8~~24 _3021 S l M ' ~e FaY rq.~ UNr1pr INr,d, id4d6 s1~.YR'pq TMirol~~'sd Wrr 79 --- ~~. ..r ..... m-n G/bd0li DMd rl, ar, - Tn Sept 9, 1928 Pittsburgh, PA ~vr °i"' wteryeo.,s kG.eraT.wrow Dwr,. ~Fw,o.or.r Daa, ^,,,,,r,,rr, D~,„r„r Dawr-~y NF,n ie c l .err~.ef..u.. y..Sw.ana+r4e, 1n,.oacta..dwOrc Pqw? ro Cu~erland Fast Pennsboro ~ ~ D"' tp1O="~°r~-.~~+r-K. ~ /foc S ~~ T ' om t ,rec. ~ ~~~ ~.~,- t n os',erc urr uraa.m ere rwd ~a.r loll Ce ' ,rr,s.r 2vas ewwwe nwcwrrsEArrr Ifn0I1r~ rtld Wrstrret, O.S lYr ifansT ~~Ma°4~~ga0e KWrtl Sr~c Mr+l l4rr,b,+4 IS Svrw~y SDar~•rhtyr YiYr~ B°" ~"5`°~"'°,~ Guidance Camselor Education c.,.F>,r~.~ '~i4°`°°'~s~^d,+ 6 Dn. [8», K Orressa rYy~m+s~9wty~aa mtzrcarl p,~ ~r Never Marcled , 16 Amherst Drive b.«.~ p.9r, PA u~C3n~o.rw..,r,.rt,,,~~ Allen ~ Carp Hill, PA 17011 nrcrr, (~t8FRI1WD .T.p,twrr.ur..... ^ faYYlrse~•al rrl, YQ Yy Mrilai d ian Nbl-L25 to rr.rsrwy„m.r q,,...,or.+rrw 26 Henry Drive, Royersford, PA 19468 ~fyrhw,raoorr F D~rr.r Dp.,,~r, znwramom~r+~4rrrt z,crr,.anse~r..,wr.d p, M,1 Q~adbrsr Errt~r.rr0`rfr~+rr rwa°wwy°M°po, it tao~n+/'i,: ~•~w . A~dr+Enw.TCrrr} ^,,,D„ 05/31/2008 Fast ttalTisbur s~,...dwrs.~ ..PP,..,~,.,~r,dy ~..w g Cemetery Harris '(f~ t2c ~4e~rflmds dfaY, ,rte ~. a,~ o~e~ ~. -c. 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R.,~hdii Ds.oo. ^CawrserD,r.rw Dws ^ie Da.r:onrr D-r„.~, ~ )A Crrrpro ry rw r p,~,. ,S,rA. ~w1MNlror..o'1acw,eiMrl~sMw.rwaav L rr r MM~slalr/rA"yrl~.GUrrowMwrb i,!,ow~r,~arr,ry wArra.rrrerr a, ^O"'°'f+'»arlrf V7rer~iApore~ror+r~Atraw rr<rd/~-rawgaW _~________________ t-(_ ' Lr~Mdr, y.r,y,,wrrrrNalrr ry,rr.sM r/ h4wae.~r~er ,-d Fa~rlCrti Wr.rrMr,r u.,.Ny w/rrru a,sr4_____-- ~j o+r err+r.....,rr,rr......rr.r ,„. ----------- 06 ~ 6GL ~eo.rrrrrna wtrr rrr.wwrre,w,Wrrwrr.rl~ ^ aegrrsiy~r., ~~~~XWrf+w:4wt+l~lw ~~`~(' ri. _ ~~~ ~ r` _ ~,rr,r,a,„, 0213005 PA 17109 l+r/ Ir. ~y,~ ]w O~• u ~........d... D wrww r,yrr.w.a~p dw D r+v9rE ry7r+oa~srfr rwr,w D u....r~,ryrr..r~.,rr .g.o uE"n'S F9bilAwiarc ,raaativ, ryer u7"rr wrl ~- DI ~Yr, ~~~~ rsu.r,r.~m r n.s _':`D / ~ i w , ,~ 1 i r a I, SARA JANE CAUM, of Camp Hitl, Cumberland County, Pennsylvania, revoke my prior Wilts and declare this to be my Witt. I FIRST: Debts and Funeral E nPnses. l direct that the expenses of my fast illness, funeral and burial be paid out of my estate. ~ SECOND: Tangbte Personal Prooertv. I give all my tangble al property together with any insurance thereon, to my sister, BETTS C. ROYAL~of St. Davids, Pennsylvania, if she survives me. tf she does not, I give the same to my a brother in-law, DOUGLAS D. ROYAL my niece, JANET ROYAL MORRIS, and my a niere, SUSAN ROYAL JONES, or the survivor or survivors of them, to be divided z arrxxtig them as they may agree_ 3 y THIRD: Specfic Cash Bequests thereby make the following specific cash bequests: m A. The sum of FIVE THOUSAND DOLLARS ($5,000.00) to ~~ the ENDOWMENT FUND OF DERRY STREET UNITED METHODIST CHURCH, of ;z Harrisburg, Pennsylvania. m ~- B. The sum of FtVE THOUSAND DOLLARS ($5,000.00) to SYRACUSE UNIVERSITY, of Syracuse, New Yafc. o FOURTH: Residuary Estate. t give the residue of my estate, real and personal, to my Trustee herecrnder to hdd and manage and distribute the net income and principal as follows: A. If my sister, BETTS C. ROYAL, survives me, corrxnencing from the date of my death and during her lifetime: 1. The net income shat) be paid to her in quarterly or more frequent insta[tments. I . 2. As much of the principal as my Trustee may from time to time think desirable for her maintenance, health and support, bearing in mind her station in life and standard of living, shat! be paid to her or applied directly for ~~ purposes by my Trustee. I direct that my Trustee shall be liberal in expending principal pursuant to this subparagraph. t f r t E ... ,:- 3. MY sister shat) have .the right to withdraw from principal during any calendar year, the sum of $5,000 or 5 percent of the value of the trust determined as of the time prescn'bed by Section 204 t of the Internal Revenue Code, as the same may be from time to time amended, and any departmental regulations thereon, whichever is the greater, which right shall be nonc:umulatrve. B. Upon the death of my sister, BETTS C. ROYAL, (or upon my death if my sister does not survive me, anything above to the contrary notwithstanding) myTrustee shall divide the then-remaining principal into equal trusts so that there wilt be one trust for each child of my sister, namely, JANET ROYAL MORRIS and SUSAN ROYAL JONES, either then living or then dead but survived by issue: then living, and thereafter as to each such trust: m 0 d 1 _ During the lifetime of each such child: Z 3 a_ The net income from such child's trust shall be W paid to such child in quarterly or more frequent installments. a b. As much of the principal of such child`s trust as m my Trustee thinks desirable for such child's maintenance, health, support and education, including post graduate or professional school, bearing in mind such ch'Id's station in life and standard of Croing, either shall be paid to such chid or shall „, be applied directly for these Purposes. In addition my Trustee may pay directly o tuition or medical expenses of such chld's children. t direct that my Trustee shah be liberal in making expenditures Pursuant to this subparagraph. N W J c. Such child shall have the right to withdraw at any 3 time the then-remaining principal of such child's trust, which right may be exercised j in whole or in part and from time to time. Z_ Upon such child's death (or at the time for setting apart, a chld's trust for any chid who dies before such time) the then-remaining principal of such child's trust shall be paid: in de~lautt of issue, a_ To such child's then-living issue per stirpes, or b_ To the then-living issue of my sister, BETTS C. ROYAL, per stirpes, (the portion thus accruing to a child of my sister for whom any principal is then held in trust hereunder to be added to and thereafter treated as if it had ariginatly constituted principal of such child's trust); or in default of such issue; -2- .. _ ._ _ -~-. _. .. ... _ .,,. - c. ONE-QUARTER (1/4} to SYRACUSE UNIVERSITY, of Syracuse, New York, and ONE-QUARTER (1/4) to ALPHA PHI FOUNDATION; of Evanstown, Illinois, and ONE-HALF (1 /2} in equal shares to those of the group composed of my cousins, LEONARD MOPPET, of Honolulu, Hawan, PAMELA GEARHART, of Ithaca, New York, BARBARA WERNER, of Brookline, Massachusetts, and ARTHUR WERNER, of Wilmington, Delaware, who are then living provided that if any of said cousins are not then living but have issue then living, such issue shall ~ take per stirpes the share to which the deceased cousin would heve been entitled if then I"Wring. m FIFTH: Direct Distribution by Executor-. In any instance where a z share in my estate would be distrrbutabte to a beneficiary of such trust when 3 received by the Trustee, my Executor may make distribution directly to such W bene#iciary. SIXTH: Adouted Beneficiaries. !n construing this Will, wherever a there is a gift to a person or class descri-bed by relationship to me, or to another, any adopted person shall be considered for any purpose hereunder as the chid of the W W adopting parent or parents. m A SEVENTH: Minor Beneficiaries_ Whenever a minor becomes entitled to principal as a result of my death but passing outside this Will, it shall be retained by y my Guardian and as much of it, and of the income from it as my guardian may from tune 'to time think desirable for the maintenance, health, support and education, induding coftege, of such minor, shall be expended for these purposes by paying belts r, directly or by payments to the minor, his or her duty-appointed guardian or amr ;~ person or organization taking care of the minor. Any income not so applied shah be acc~nulated-and the unexpended principal and income shall be distributed to the EE mina' at majority, or to his or her estate. My Guardian shalt have no further l responsibikty for funds so paid or applied. - EIGHTH: Beneficiaries Under 35 or Disabled. I direct that if any beneficiary (1 } under the age of 35 or, (2} in my Trustee's opinion, disabled by advanced age, illness or other cause, becomes entitled to a distribution of income or principal of any trust hereunder, it shall be held and managed as a separate trust as follows: A.. As much of such income or principal or both as my Trustee may from time to time think desirable for the maintenance, health, support and education, including college and post graduate or professional school, of such -3- ~:. , ; .. , ~_- . <. - . - .. ~ .. ~.v_- .:-. beneficiary, shall be expended for these purposes by paying bias directly or by payments to the beneficiary; or to his or her duty-appointed guardian, or any person or a~rganization taking care of the beneficiary, foc the exclusive benefit of such beneficiary. My Trustee shall have no further responslbrTity for any expenditures so paid or applied. B. The balance, including accrued and acccmiulated income, shalt be distributed to the beneficiary at age 35 or to the disabled beneficiary when he or she, in my Trustee's opinion, becomes free of disability, as the case may be, or to his or her estate. ~C NINTH: Eartv Termination of Trusts. Whenever my corporate Trustee, in its discretion, shall detemnine that the size of any trust hereunder does not a warrant the cost of continuing the trust, or its management would be impractical for a any other reason, my Trustee, without further responsibility, may pay the then- remaining principal together with accrued and accumulated income to the income 3 beneficiary thereof. tf such beneficiary is a minor or is, in my Trustee's opinion, disabled by advanced age, ~fness or other cause, my Trustee may pay the same to the parent, duty-appointed guardian or any person or organization taking- care of the beneficiary- Also, if the beneficiary is a minor, my Trustee may appoint and pay the m same3 to a Custodian for the minor under the Uniform Transfers to Minors Act of any states. My Trustee shaft have no further responsibility for such payments. Z W 9 .~ TENTH: Undistributed Income_ Except as otherwise provided herein, alt income not distributed to a beneficiary before temnination of his or her interest o shaft be treated as though it had accrued thereafter; likewise, no credit or accrual W shall be made for taxes, corixrrssions or other charges theretofore made against o income. My Trustee, however, may make exceptions hereto in its discreton. 3 J ELEVENTH: Protective Provision. No interest in income or princip~ shall ~ be assignable by a beneficiary or available to anyone having a ctaern against a beneficiary, before actual distribution to the beneficiary. TWELFTH: Death Taxes. 1 direct that ali estate, inheritance and other taxes in the nature thereof, together with any interest and penalties thereon, becoming payable because of my death with respect to the property constituting my gross estate for death tax purposes, whether or not such property passes under this Will, shag be Paid from my residuary estate. THIRTEENTH: Tax Options. My Executor may make any law-given etecbons which may affect the income and estate taxes as well as the relative shares of beneficiaries, such as taking administration expenses as deductions for either income or estate tax purposes, selecting options for the payment of life insurance, -4- ~~ xry -~ employment benefits and death benefits, redeeming corporate stock and allocating the generation skipping tax exemption. Any such elections shall be binding. upon, and not subject to question by any affected persons, and my Executor shall not be required to make adjustments between principal and income. m Z 3 M n s m W W a m O 0 W V J FOURTEENTH: Additions. wth my Trustee's approval, anyone may add to the principal of any of the trusts under this WiU. FIFTEENTH: Management Provisions. In addition to the powers granted by taw, any Fiduciary appointed hereunder shall have the following powers, applicable to principal and income, which shalt be exercisable without leave of court and shall continue ante distribution. is actually made: A. To retain and to invest in all forms of real or personal property, including, but not linnited to, all types of stocks and bonds, whether or not of rrry corporate fiduciary or of a holding company controlling my corporate fiduciary, including participations in corixnon trust funds operated by my corporate fiduciary, regardless of any limitations imposed by law on investments by any such fiduciary or any principle of law concerning investment diversification. B. To buy investments at a premium. nominee. C. To hold property unregistered or in the name of a D. To give proxies. E. To corr~romise claims, including any questions relating to any policy of life ins~ance. My fiduciary shag not institute litigation to collect any pobcy unless my fiduciary is indermified for cats, counsel fees and other expenses of such litigation. F. To join in any merger, consolidation, reorganization, voting trust plan or other concerted action of security holders and to delegate discretionary duties with respect thereto. G. To borrow funds from anyone, whether or not the lender is also a fiduciary hereunder who may be acting as a lender in an individual capacity, and to pledge real and personal property as security for the repayment of the funds borrowed. -5- _.r x ... - .......,,.....,.. : .:-.R <; .. , x'+•n~r'7k.'r'~zw;~...: ,v~~=s4i: ~ ., - . ~i. ,.?~'c .,., .. H. To seq at public or private sale to any person or corporation, for cash or credit or partly for each, to mortgage, exchange, repair, alter, improve or lease for any period of time, any real or personal property, and to give options for sales, exchanges or teases. I. To dism_bute assets in cash or in kind, or partly each, and to make non pro rata dstributions. Alt distributions shall be valued as of the time of distribution. 3. To retain and to pay carrying charges on any unproductive real estate. K. To assume the continuance of the status . of any beneficiary with reference to death. marriage. divorce or other cause in the absence of information deemed reliable by my fiduciary. s L_ To allocate any property received or charge incurred to principal or income or partly to each without regard to any law defining principal and income or any rule of trust accounting. M. To lend money to, ar to buy real and personal property m from, a fiduciary under my Will a trust, even if my fiduciary is also the borrower or Z seller. This right may be exercised for any purpose which my fiduciary may think w expedient. the assets of ail the trusts hereunder for N. To pool purposes of investment and administration, allocating to each such trust an undivided interest in the pooled assets. O. To receive the proceeds of any life insurance policies, ofit sharing or penswn plans, or other employment benefits or Indrvrdual ~ annuities. pr Trustee and to retain, ackrinister and I Retirement Accounts. made payable to my eventually dismbute the same as though they had constituted a part of my residuary i e:state. E SIXTEENTH; Auaointment of Fiduciaries. 1 appoint my sister, BETTE C. which passes to a minor ROYAL, Executor of this Will and Guardian of any property and with respect to which t am authorized to appoint a guardian and have not ~ owe specifrcally done so. if my sister should fail to qualify or cease to act I appoint my brother-in-4aw, DOUGLAS D. ROYAL, as Executor and Guardian in her then 1 appoint my stead. Should my brother-in-taw Earl to qualify or cease to act, nieces, JAf~T ROYAL MORRIS and SUSAN ROYAL .!ONES, a the survivor of them, Facecutor and Guardian in his stead. I appoint my sister, BETTE C. ROYAL, as -trustee under this Vlfiit and I direct that she shall se{ect a corporate Trustee to serve -6- .. h. "`. --:~+vr: as '.~:';ly''F ,.:'~•f-,S3?k - r~Y,.H-~+- 4 PN7'.x r_.:.zl:~_.~°5 F.' ~^'._.`. `y1.~. _- ~ w~^,i r'~1t'y ..- .. ...... S ~ '.. ,-.. .... with her, such corporate Trustee to be a corporation having trust powers in Pennsylvania. if my sister fuels to qualify or ceases to act, I appoint my brother-in_ lave, DOUGLAS D. ROYAL, as Trustee in her stead with the same direction that he select a corporate Trustee to serve with him unless one is already serving. in the fw~ther event that both my sister and my brother-in-law fail to qualify or cease to setrve, t appoint my nieces, JANET ROYAL MORRIS and SUSAN ROYAL JONES, or thE: survivor of them as Co-Treistees, with the same direction that they select a corporate Trustee to serve with them unless one is already serving. No bond shalt be required of any fiduciary hereunder in any jurisdiction. SEVENTEENTH: Provisions Rectarding My Fiduciaries. A. My corporate fiduciary shalt be entitled to compensation a for its services hereunder in accordance with its Standard Schedule of Charges currently Fn effect at the tm~e its services are called upon and from time to time Z during the period over which such services are performed. 3 B. No individual fiduciary who is a beneficiary shalt ever participate in the exercise of, or decision not to exercise the discretion to pay income a or principal to, or to apply income or principal for the benefit. of, any beneficiary, the m determination whether a beneficiary is disabled, the decision to terminate any trust hereunder, the allocation of any receipt a expense to principal or income, or the z ('IPIr_~CIM LV~1Af{1AY to u~o evr~..ne.e . .... ............. ~_ __~-~- ~- _ -^ . _. C. Any Trustee hereunder may resign and be discharged o - from alt kabiCty, and any trust hereunder may be settled, by agreement with ali parties in interest who are sui juris. Such agreement shall bind a!{ persons, whether or not then in being or under a iegal disability, then or thereafter entitled to any s portion of the trust, and shad effectively release and discharge my Trustee for the . acts and proceedings so accounted -for. The settlement may also inch~de the approval of tfie account of an executor or another Trustee if my Trustee has received ~ property in distnbution of that estate or trust. D. My irxiividual Trustee or co-Trustee shah have the right, by giving notice to the corporate Trustee then acting, to require said Trustee to resign anti to select a new corporate Trustee tsuch substitute to be a coporation having trust powers in Pennsyivanial by written notice to the corporate Trustee and to all beneficiaries who are sui juris, effective upon the written acceptance of the substituted Trustee. E. !t is my wish, but not a direction, that my Fiduciaries employ the services of G. David t3ias, presently at Legg Mason, as investment advisor and broker. -7- k,. , _ :,~ :::..: __ ,.~ ~ , ...,t , ~ .. . EIGHTEENTH: Usage- In construing and interpreting-thisrnstnur~ent any ter<r~ describing a fiduciary shah include a!t genders, shall be construed as singular or plural, and shall include successors, as the situation may require. ~ IN _ WITNESS WHEREOF, 1 have hereunto set my hand and seal ~,'t' ~ p , 1999. s ~ ESEAL] a Jane C um a Signed, Sealed. Published and Dedaced by SARA JANE CAUM, the above named a Testatrix, as and for her wll, in the Presence of us, who at her request and in her = presence, and in the presence of each other, have hereunto subscribed our names as subscribing witnesses. _ ~ W ~ ~ ~ ~ N a ~ ~' l~~ ~^~yy J g m F W Z 2 W fO a N V 3 J . 8 . . .. - , r... . , ....:. - _,-~.. ..r .~... CCIMMONWEALTH OF PENNSYLVANIA: ~~~i~1~f-' SS CCtUNTY OF _ 1, SARA JANE CHUM, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that 1 signed and executed the instrument as my wll; that I signed willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. i s z ~-- ~~. ~ 3 S ra Jane C m ~, Wl~ " ~ / l~/-i.f/~. ~ `y~Z~~'y and ~ ~ , witnesses, whos names are signed to the attached or foregoing i strument, being k duly quaCrfied accorcf'mg to law, do depose and say that we were present and saw m Testatrix sign and execute the instrument as her WIU; that she.signed willingly and that she executed it as her free and vol~tary act for the purposes therein expressed; o that each of us in the hearing and sight of the Testatrix and in the presence of each 0 other, signed the Well as witnesses; and that to the best of our knowledge, the d Testatrix was at that time 18 or more years of age, of sound mind and under no o constraint or undue influence. WITNESS~`~~~/l,~~l. 7~_ `~/t~.t . v. ~ WITNESS: cJld /bi»~ Subscribed, sworn to and acknowledged before by SAR AIVE CHUM, the Testatrix nd t~bo) 'bed and sworn to before me by and ,,/~ ,witnesses, on , 1999. Notarial seal Jolene J. Davis, Notary Rrbic Notary Public l~- commission i~pires Feb_ t2, t . Rennsylvania Association ~ Notaries -9- :-,( .. -:-^:• .`~~k&~`'."'ri.~?"'c~ia'..~.. .. ~ -., ~F~~~»sis'^ ~" , -.::--:y ~-..-.-y _.,--_ .. F,~z,.,?`.l~;tr±o-a ssYx,:~-z ,x. ~:'tw- .... ''»,.~ ~;....... ..- B. T1fPE of LOAtt_ a ELOPMENT W D ' FHA 2~IA 3.®CONV. UNtNS_ 4.QVA S.~CC+NV. NJS. t10t15MtG S E1RB/ EV U.S. DEPARTIIIIE/iT OF 6. FEE NWu16ER 7. LOAN NUt~ABER: SETTtEMEN1' STATEMENT ~ ~ ~ cASE ~~ C_ NOTE This farm is famished do give 1'ce a sblhement of actual se~emeM aosfs Amoants paid b and by ~e selUernent ag~enf are shown. !dams marred '~OCj were paid oatside fire dosir-g; ~' are shown here forinlurrrraUorral pr+poses and are not irxdurled in the blafs ~-.s srae ~roor+~~s~-~rersroR.~nroor~M~rs+~rsror~ D. NAME AND ADDRESS OF BORROWER E. NAIL AND ADDRESS OF SELLER F_ NAME AND ADDRESS OF L.EI~ER: Este of Sarah Jane Caum Herbert C. Moore 3905 Donna Jean Court Harrisburg, PA 17109 G_ PROPERTY LOCAilOlk ~ 16 Amherst Drive PA 1701 t Camp Hdl ti_ SETTLEMD~fiAGEM: 25-1802264 CHESAPENCE ABSTRACT COMPANY L SETTLEMENT DATE: Ocdober 10 2008 , Cumbertard County. E~emsyArar»a PLACE OF SETTLEMENT 17 SOt17tt SECOND ST_, 6TH FLOOR HARRISBURG, PA 17101 , J_ SUMMARY OF BORROIlYER'S TW WSACTION K SIMMARY OF SELLER'S TRA NSA 101. Cordrac:t Sales Price 150.000.00 401_ Contract Sales Price 150.000.00 102 Persor-at 4000.00 402 Personal 4000.00 103. Settlement M Borrower 'ne 1400 2851.12 403. 104. 404. 105. 405 106. own Taxes to 406. own Taxes tD 107. Taxes 10ft1108 tD- 011'01109 146.93 407. Taxes 10/11108 to 01101109 146.93 108. School 10/11108 to 07101/09 1,053.46 408. School 10/11/08 to 07101!09 1,053.46 109. 409. - 110. 410. 111_ 411_ 112 412 120_ GROSSRMOUNTDUEFROMBOt~tOYVER i58,o51b1 ~ 420! 6ROSSAMOflIYfDtJETOSB1Hi 155,200.39 200. AMOUNTS PAID BY OR M BEFTALF OF BORROWER: 506. REDUCTIONS BiAMOUNT DUE TO SELLER 201. a earnest 5000.00 501. Excess bons 202 Amourd of New E.oa s ~ 5012 Seltlemerd to Seller 1400 2,043.51 203. s taloerr subject to 503_ taken s to 201. 504. Payoff of first Mak,~age 205. 505 of seoood ~- ~- 20T. 507. dsb. as 208. 508. 209. -509 210. own Tauces to 51Q awn Taxes to 211. Taxes b 511_ Co Taxes to 212 School to 5t2. Sct-ool to 213. 513. 214. 514. 215. ~ 515. 216. 516_ 217- 547_ 216. 518. 219. 220. TOTAL PAID BYiFOR BORROWER 5.000.00 300. AT SETTLEMENT FROM/TO BORROWER 301. Gross Amount Due Fran Borrower 120 158 051.51 302. Less Amount Paid BIaIFor Borrarrer (Line 220) ( 5.000.00 519. 520: TOTAL. REDlICT1OHAA00UMDt1E SELLER 2.043.51 600. CASH AT SETTLEMENT TOIFROM SELLER: 601. Gross Amoud Due To Seller 420 15500.39 602. Less Reductions Due Seller (Lure 520) 2.043.51 CASH (X FROM ( BORROWEER 1 051.51 601A CASH X TO ( FROAf SELLER 153,156.88 ..-- -.--.~~..~... .~..~y.... o ....s.7..cwv ury.~ yr yoyca .ac w sws ~~~~R 6 riea a) ner@rn_ Bonower setter ~~~lR'-2~ _ l re to of Sa Jane Caum Nuoa paq rtesv~-e~aoss ! \7! \! -Yl-M! l:MYln~r1 700_TOTALCONIOMBasedosPrice ----- -- -------- PAR)FfiOrr PAti1FROM f)ivision dConrAission acs FoXows: e~wEtrs sa~Etrs 701. S . &11 FtA~U6AT - Ft1rID6 AT 702:. i b - SErnnre,r sESne~NT 703: Comrrrission Paid ad SeifJerrrent 704_ b P Y . YYIiH LO 801: Loam Fri - x b eat. tAan Disootmt X b 803_ Appraisal Fee ro eoa. credo b 805: tenders Fee b 806. Taos Service Fee to 807_ Flood Cer6Tication b 808_ Uocrrrrrerd Prepardion 809. 810. 811. 900. iIEMS BY L.EPIDHt TO PAbJ bti ADVANCE 901. hderest Fran b ~ i idaY ( days %) . MIP'iotlrrs. for l~r~Oan for manors b 903. [iazard brsurarue Premium for 1.0 b 90d. 905. 1 1001. Ffazard trrSiR'drlg3 morttfrs i monBt 1002 hrstuance monOrs S marbt 1003. owu Taos monUrs S raorih. 1004. Taxes aardhs i maih 1005. School aroriFrs ~ S per main 1006. atordhs S mor-@t 4007. months ~ i per month 1008. morritrs S nrordh 1100. TffLE S t 101. Settlerrrerd or Fee b Slrarlatos b Zonarich LIP 1102. Fees b CF~SAPEAKE AB5iRAC7 COMPANY 1403_ ADstradorTitle:iearch b Seltlemeet 1104. Tale 4rsuanoe Elinder b CHESAPEAKE ABSTRACT COMPANY t 105. fee b (3£SAPEAI~ ABSTRACT COMPANY t 5.00 4106. Fees b t 407. Doameert Pre~araRon to Skarlatos 8 Zorrarich L[P -ncbdes aixrve riern rxrn6eix 1408. Tile hanrance b Abstract 1 9.63 mdudes aitrot~e aerrr rxm6erS 1109. larders Coverage i 1110.Owrrers Caverage i 150,000.00 t X19:63 1111. 1112. Atty's Fee 8 Fed Ex for Seier b Gary Lewis, Esquire 524.00 1113. 1200. GOYERNMt_NT ORDING AND CHARGES 1201. Recordig Fees: Deed S 38.50; Mortgage S Releases S 38.50 1202. T -Deed t,500.00~ 1.500.00 1203. Sbte T Reverme t,500:OD: 1,500. 1204. 1205 1300_ SETTLEMENT CHARGES 1301. p 1302_ Pest b 1303. Tax Cerb'bcate b Bonnie K Mier Tau Collector 10.00 1304. 401. tlua<1er Sewedfrash b Loner Aber T 77.9 9 9.51 4305. 1400. TOTAL SETTLI-aAH~TT CHARGES (Enter on lines 103. 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T? ®n ~ $ ~ O~co ~A ~ a. n ~oco•m'~'~a ,~ ~ Ts ~, n n C m'o~w ad i-. ~ G a O ~ UooTtaa~~~ ~ oo >+3 ~c.mp ~~°°'°~ioy:a~ r+ fd L. .C y • ~ ~ "' n O •3 a o 0 " ~ o U ~ di n LL ~ ~ OnD ~ O' oo 'L3 :+ ~ n ~ ~ _ qC mnCn ~ O .a O n y °..3 Q O U,~ n e°i '^ m n 3 R.'~ O C O V O aa'i O p m ~+ ~ C O ~ -r Q eQ U a-~~ ~ o~'w ~Uw .c-opOOw~o n`~~~~ooo ~~vcaq°e~~ ~ ~ ~~~m~ ~~~~~~~ ~~A3,~...nv O v = 'w o n m Q n b ~'s ~ m ."~ at w ~a ~cs~n~~n aAi a°i o ~.D oA.a vo:a"'a~a,w~ ~ O ~ y ~ ~ W M ~ Ra ~ .Ur ~ O ~4" ~ A~~~ ~~ a ~ n ,, , ~ vn °a ~.~~ a~~v -~ ~ ,Q ~,n u ~d w ~ ~~ ~~ ~w ~~cC~Q~Sa>» a ~~ ~~ "i-. :; _~.~. 'r~-sa-.:a::. ,..,',.. ., ... _. ,.. ,,;::-:. ,,. _,..~-.rr;#a.o~±~i~ r3-:ze~3r's~,-a;;:r ,. _. ,-.. _:.a ..- - August I l; 2008 JANET L MORRIS SUSAN L ROYAL 26 HENRY DRIVE LDNERICK PA }946&1766 RE's: Reference Number. Accounts: Regjstration: Prudential 6804202098/776520 0015,.0022-X7{2359 SARA J CHUM 0087-~XX6195 PRUDE~IT'lAL TRUST COMPANY C/F THE TRA OF SARA J CAUM Dear Ms. Morris and Ms_ Royal: Thus letter is in regard to the above referenced accounts. Please note that May 24, 2008, was not a valid business day. As of the close of business on May 23, 2008, the above referenced account was valued as follows: Fund dcAccouttt # Share Balance NAV Price Per Share Market l'alue OOl'.5-X2359 4,339324 $14.69 $63,744.67 002~-XXJ'~X2359 2,665.042 .. $14.64 $39,016.21 ~~ , 0087-X7OO~X6I95 13,801525 $5.42 $74,80427 As changing market conditions may cause tbe Net Asset Value (NAB to fluctuate on a daily basis, the account value is subject to change. If you have questions or need further assistance, please contact tbe Prudential Mutual Fund Service Center at (800) 225-1852 Monday through Friday between 8:00 a.m. and 8:00 p.m Easter time. For account information that is available 24 hours a day, T days a week, you may access your account online at www.prudential.com. Sincerely, Jo-~Anne Morse Sr.lnvestor Services Specialist PnndorNW bnosbrwn7a Prudentia{ Mutual Fund Services LLC P O Boot 9656 Proriderwre. RI 029~IU (800) 2251652 ,..- 4t.r'?,ys:~"stt=!e+vT.~?!^!~-r s-~-r'~s~-r~`~--3~!~,;rt~-a:h~*}°i~r,2r?i~'4A£:~4: ~sit~#k..;+, .~s:J";.'e.4>*ea"~tix-~F., R#rY~as., ~:'. ~- e DBS&P LLP JU~[_ 2 02006 - - 499 ~~u Street, Rh~lst~a~o, i3.E .19966 :,.;rte Davis, Bennett 8a Spiess LLC Atkorneys At Law 130 West Lancaster Avenue P.O. Box 191 Wayne, PA 19087-0191 Dear 1VIs. Livingood: IftE: Estate of Sara Caum Date of Death; May 24, 2008 Social Security Ntumber: I68-243021 In response to your request, please be advised that at the time of death, the above- named decedent had eposit with this bank the following accounts. _. ,_- ~ 1. Account ~-:~.:.::......... Certificate of Deposit .~_ --.- Account Nuneber__ ..._t ... ... ... ... .... 310039 2 3152482 Oumership (Names on ------------- Sara Caum Opening Date ....... ........ .. ... ... ... .08/ 10/05 Balance on Date of Death .........$11,172.75 'f Accnced ~~~ $ 26 43 v TotaL ....... ........................ .......$11,199.18 2. AccauntTi~.....--•-.---•----:.:..... Certificate of Deposit A~~---•----....--•--_---_ 31003914570857 }( Ocunershrp(NarreP-sofj-------------- SaraCaum ~/~~ Opening Date . ...... ... ................ .06/30/97 Balance on Date of Death _......__$19,780.76 G: Accsued Interest $ 26 61 u Total ............. .. . .......................$19,807.37 :: - . '+'1r;~:.':,a3,-.~"_::"+~~fi`_~-~. :, Y;~:,",.^r,^;r'?C^~ ~~'.~sti %:14*Xsn _....: _~.. Y..:._.,. _,... 3r`~i~fe, la.~...-,~r~, _~ -. .. ..: .. .+3. ,, r... -... • r • ~ Page 2 - I June 18, 2(108 3 _ _ _.~9r~tz~t. - - - -: ~ _ . Trfp~. ._._._ -- __Certificate.ofDeposit. . - .- _ . _ __ .. _. - - - - - . . Aoccrunt Number .............. ......... 31003915142126 OumersFup (Names ofl ..... ........ Sara Caum Opening Dom ................. .........11/ 10/05 Balaru.~e on Date of Death .__......$12,967.17 ~` AaTUed Interest $ 32.55 ~ Total .............................. •--....__$12,999.72 4. Account Typ~ .......................... individual Retirement Account Aoovwct Number .... ................... 35004202107189 Oumership (Names ofj...•---....... Sara Caum Bette Caum Royal (beneficiary) OPerin9 Date . . ...... ...... ..... ....... .20/02/06 Balance on Date of Death....._.._ $238,681.79 ~ Accneed ~~~ $ 803 36 J Total .. .... .... ... ........ ................ .$239,485.15 5. Acoo~.netType ........................... CheclflngAccount Aooaunt Nurrtber . . ... ............ ...... 98028731 Oumership ~~~ of j .............. Sara Caum Opening Date ..... ...... ................03/04/97 Balance on Date of Death....... __$24,872.OI Aovued Interest $ 058 r Total .................................. .. ..$24,872.59 - ~ • Page 3 June 18, 2008 Tlie above named. decedentdid:nothave_a safe deposit bos. If uEpon reviewing the information above,-you believe there are additional accounts not referenced, please provide us with an account number and/or the name of any possible joint account holder. For any additional information on the above accounts, inchtding ownership and any changes, closures and/or reimbursement of funds, please contact our Highland Park branch at 344 South 10~ Street, Lemoyne, PA 17043, or # 717-737- 3322!_ Sincere , ,~ Lc/ Cha~dene Warrington, Records Management 1-8$8-502-4349 ,, ,. ., ~ . hsy , .r.~s+.'. ,--~4`~`=iXzx ram-m~,,::N-, . ..:~.. -_ ;.,...- -... - - --~--, -. ~- ... . _~'. _ ... j ~=~:~ - B PNCBAI~K July 29, 2008 _ Janet Morris . 26 Henry Dr Limerick, PA l 9468 RE: Sara Jane Caum SSN: 168-24-3021 DOD: OS-24-2008 Dear Ms. Morris: >n response to your request for Date of Death balances for the customer noted above, ow records show the following: J Certificate of Deposit Account # 31900149493 Established 03-0]-1999 SARA JANE CAUM _ DOD balance: $ 24,17235 + 69.77 accrued interest - Interest paid 01-01-2008 thru 05-24-2008 $ 422.7'7 YTD ~' Account # 31300261-925 Established OS-04-20(15 SARA JANE CAUM DOD balance: $ ] 1,393.49+ l3_IS accrued interest Interest paid Ol -01-2008 thru OS-24-2008 $ 173.92 YTD Checlring Acconnt /Acconnt # 5140009907 Established 06.01-1958 SARA JANE CAUM - DOD balance: $ 72,278.85 + 9.36 accxued interest Interest paid Ol-O1-2008 thru OS-24-2008 S 80.60 YTD i Savings Acconnt Acconnt # 5000940134 Established 03-25-1997 SARA JANE CAUM DOD balance: $ 13,81 S.4S + 7. I O accrued interest Interest paid O1-01-2008 thru OS-24-2008 $ 9336 YTD Page I of 2 ~. -, _-_ - ;!4a~Mi~:'IF"~~r:?'~C~~`.irt^~ .-<,-.,. .::--- -- ~:. -.~-. ...'-:,.,...~.; ,..:.. ~. _°~ -- ~..:. r s .. _. ,. -:: r., .. r ~,'wF.~ _.. ~~ rein Bank ~ ~-._. _ . _ r ~= - _ ~c,H ~ s ~ Corot Ordered Processing \ Decedents - MAI-MB3-02-10 - P. O. Box 841005 -Boston, MA 02284 June 13, 2008 Carol Ryan Livingood Davis Bermett Spiess ~ LLC 130 West Lancaster Ave PAS. Box 191 `JVayne, PA 19087-0191 RE: Estate of Sara J Caum Date of Deafh: 05!24/2008 Dear Carol Ryan tivingood: Per your request, enclosed please find the account information as of the date of death for the above-named decedent_ For your information, accrued interest is not included in the date of death balance. Please feel free to contact me if t can be of any further assistance_ Very truly yours, ~~ C~ Donna Penta Lead Specialist 647-533-1789 M7.'~"vs`-"er ;:._.,..,,_ r _., ;f+.. ,y !. ~ :;;. ,.~:.r.'~-o .`=..~__ .-. _ .. a. .. .:"$~~"yH:+K,+;"~°.':"e='?;?; __. ~: rt ... ~'.5.: ..-<..~ .. -... Sovereign Bank ESTATE a-F Sara. Jane Caum SOCIAL SECURITY #: 168-243021 DATE OF :DEATH: May 24, 2008 Account #: 1055161226 Type CD Open date:. 1 /5/1998 In the name of: Sara Lane Caum fDate of Death Balance: $29,087.55 Int.(1''['D) from I/1/2008 to 4/30/2008 $382.63 Accrued interest to date of death: $86.19 Other Hnfo: Closed 6/11/08 Account #: 1055162802 Type: CD Open date; 4!13!2000 In the name of: Sara Jane Caum /Date of Death Balance: $28,131.37 Int.(Y'[D) from 1/1/2008 to 4/30/2008 $384.79 Accrued interest to date of death: $4728 Other !info: Closed 6/11!08 Account #: 1055176174 Type: In the name of: Sara Jane Caum Balance due on death Int.(I''CD) from 1 /1/2008 Accrued interest to date of death: Other Info: Closed 6!11/08 CD $17,119.11 / to 4/30/2008 $64.96 J Open date: 5/29/1997 $287.70 Account #: 1055176786 Type: CD Open date: 12/30!1994 In the name of: Sara Jane Caum ~ Date of Death Balance: $34,320.36 Int.(Y'TD) from 1 /1 /2008 to 4/30/2008 $402.88 Accrued interest to date of death: $68.87 Other hr~fo: Closed 6/11/08 Page 1 of t ~ucwate tne: v aloe oY Y oyr Yaper Savings Bond(s): Tre~svr~rDirect N?+lte > E2?til4t+?? > ~~ . Cakuixc We :'sruc c[ Your oaCCr Sar6~gs eomfsj Calculate tl'~e Value of Your Paper Savings Bond(s) sanNCS sDND ui~cuuaort IDStr>Ktioos valve >s d: ~- E [lore to tae tir Savirws mm ~kbt&f j Notes ~:~„ SliEcc D M Wwbr a t f Ow: EgM Wial l[Ilnllo: Issu c Di [C E r ~ )~ g~ [ ~ ~ ~ y ' ' ~ BOIIdS ~~ [_ ~ [--~~ [ + t 1Q -Not LmifQ . __ ~ [IE N[t fOr payl{IPJf[ - P+ InWdes3 ngrdh _ Now TD save rOtNt IN11I70TORr ~'~ o~Y ~ Itw rntored and not eanWg C :iteresi F Gtculator Re5[rlt5 for Redemption Date 05/2008 t Total Price Tobt Yalete Total Interest YFD Interest $25-00 $58-38 $33.38 - ~.(b Eorrds: i-I of I Serial t Series Dewre lssoe - Nat F4ra1 '. Issne Interest YaAre Note Date i AcvrW i MetYrit7 Rice Interes[ WT< - ` [ . t -~ i 4696-103-10!_ FE S50[ 06/1991; 06/2008; f16/2p12: uS.OOi S3]3t1`. 4.OOYei ~~: ~AL£tIL4TE ANQTtiE.R [bNO Ilorr wsuld yar rate ttris loon ~' ExaeBeMM C? Gaol Fak PDOr Freedom o(1Norma:ion act { L2.'+ a ~__idairc f PII+!;!s][ aS~! t~tY~; t wcbs0e Terris 6~galtioys { Arcess$f~r I o~_a.Qv_afKr SE ° t ~^...rnt • rue Lressnv. _elthe vre66c~gjA httpJ/www_lreasurydirect_gOV/BC/SBCPrice Fage I of 1 242212008 : #...f_-^~ . _.'.`..y ~`Y ~ - > ,...., g -~T:~a~8.i~t F. ~ ya,+~,e.~, ':F:^, .. -s'r ;r'"r~°":^.F ~'~".. ~-r,. - -.. -.. ,. r: - - ,v_:,,,_ o ` ;- . _.... _.. ....---~ ..- -_~ _ -, - - -. - _ r .... - i_ ~ "csq- r, S_'z- -:r..~_,~'-'~t~rX"~°~S'i~r>s~"-~rz~'~s`•ty~rark^.~ = ~ ~~~ Juty 24, .!008 .~- CAROL :RYAN LIVINGOOD Esq 130 W LANCASTER AVE PO BOX 191 WAYNE: PA 19087-0191 DBS&P LLP JUL 2 81(gg 525 William Penn Plxe Suite I53-26I8 Pittsburgh, PA 15219 ~-< ~.~ _; , Estate of SARA JANE CAUM Date of Ihrath: May 24, 2008 SSN: 168=24-3021 Dear Sir~Madam: In a~ with your request, the attached information sheet has been provided in the above decedent's name as of her date of death. The decedent had 1 active account at the time of her death and she had no Safe Deposit Box. For IL or LC accounts, contact our Loan Department at 1-800-708-6680_ For all other inquiries, please call 1-888-999-6884 SinceTety„ Phillip Lynch Operations Services J Account riumber 6140-758084 Account Title SARA JAATE CAUM Date , ed - 2/23!2000 Account 'f Time De sits Princi Balance as of DOD $26,705.11 Interest fi~om Last Postin to DOD $2435 . Account Balance as of DOD $26,729.46 YTD Interest to DOD $457.82 Date Closed 0625/2008 ~` .. •^'-?~k'.°.~"4Y~ai~ri7l >,-.,-..y:%F,N._.~::. ,..... <,~.:~:r ac- >.,._ =t~,v~3?-:z':"c.§~'?s~'may.,Er€FY±Y~'M~S..~.a:?Nax`-A"y;t'%`-Jri+'=-:~'ik;-~y',~','Y~f}t.a~~+'~i .. -". -s .~ _., _.. i_ ,.~:.. ~- ._,, "^'rr^-ST ;,aC-' - _ or .. ~..__.. ~ .. -.... ,~->.7r,i ~- ~~-~'~,:tc?r <-y.,¢'za~=;r.ry~baj~i. ~s _. 7`tie tlntet Ceatr~l 2876 Waycma Recd Life I>~xe Cedpanf CmcmnaD Elheu 4524@ ~ ~ (51~ 545-22110 www.imioocedni_com ~~ lie avd InsrsUmewts RIMilCnwipa,.y Augu:x 19, 2008 Re: A 147321 97C Sauce Jane Caum NOTICE OF PAYMENT UNDER AN ANNUITY COl~iTRACT, INCOME POLICY OR SETTLEMENT OPTION AT THE DEATH OF A PAYEE Name of decedent: Sara lane Caum Date of death: 5-24-08 Residence of decedent: 16 Amherst Dr Camp Hill PA 174I I (X} Annuitant Q Beneficiary under Settteme:nt Option Date of issue of annuity: I-I-77 Kind of annuity: Group Retirement Annuity (TDA) Name: of Beneficiary: The Endowment Fund of the Deny Street United Methodist Church Residence of Beneficiary: 1508 Deny Street Harrisburg PA 171 Q4 Method of payment to beneficiary: Single Sum $2927.62 Other details of settlement: By_ ohn Lucas Second Vice President and Associate Counsel & Secretary UC 2:791 03/95 s armed r,rougtr anal. M~ bvasAristrt corp.. NsrriDer FWR/VSIPC. »T .,.;,-v -~±a+i.',~.C~txa~!.*.'r . ,,,~'., '_ ,.,~:, ~;'+,,-;._:.` ,:.,x-.w,r-;~i'ff-'-.,<i-ar.,.-?^~v+ti ,3'a r°-w`-?.. '.~~L'X- .. u - .~?-,,.:}., a--'-e.:.-- .. .. iyr. r.'+i~` ttildcsc~^?^. M.%Fr?t -~N,.wn.^w< K s,.- . ~ _.., - ,, ~- - .:-3w~a'~t:`-' %~?:~^tn _ _.. - - • ~_ .: T;y¢~ia;-r T< r