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01-29-09 (2)
J 15056041158 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes 2 ]~ Q 8 110 6 PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 1~12a-osol RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 164-22-7303 ],0312008 10201928 Decedent's Last Name PASSANANTI Suffix Decedent's First Name ELIZABETH (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI W MI FILL IN APPROPRIATE BOXES 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) Decedent Died Testate 6 ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes . (Attach Copy of Will) ^ (Attach Copy of Trust) h 9113(A) under Sec ta x ^ 11 n ^ 9. Litigation Proceeds Received 1 ~" between 12V39 91 and 1tl1tg5j deat . O ) ' (Attach Sch CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number Name VICKY ANN TRIMMER, ESQUIRE 717-620-2440 ~, Firm Name (If Applicable) PERSUN & HEIM, PC First line of address PO BOX 659 Second line of address City or Post Office MECHANICSBURG REGISTER OF WICL$~E ONLY `°~ ~_,_ ~ -- c _ c~ - :, r--` ~~~, j"T1 _. . ~`e.? LJ ~; J7 '_- - _~.~ s-- _.~ ~ .. DATE FILED G.3 State ZIP Code PA 17055-0659 Correspondent's a-mall address: Under penalties of perjury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparar other than the personal represe tative is based on all information of which preparer has any knowle ge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ~ , ~ (rj VICKY ANN TRIMMER, ESQUIRE ADDRESS PO BOX 659 MECHANICSBURG, PA ],?055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE _ THOMAS R PASSANANTI, EXECUTOR n`~62~a~~~~-S'-- I ~a~ ~ ~9 ADDRESS 237 WINDING WAY CAMP HILL, PA 17017, PLEASE USE ORIGINAL FORM ONLY Side 1 15056041158 15056041158 J 6M4847 3.000 J 15056042159 REV-1500 EX Decedent's Social Security Number 164-22-7303 Decedent's Name;flASSANANTI ELIZABETH W RECAPITULATION 1. Real estate (Schedule A) 1 • 216 6 9 4 • 8 D 2. Stocks and Bonds (Schedule B) . . 2. 213 3.6 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3. D • D D 4. Mortgages & Notes Receivable (Schedule D). . 4. D • 00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . 5. 316 6 4 0 • 9 D 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested . 6. 2 2 • 5 D 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 2 3 8 D 3• D 9 8 Total Gross Assets (total Lines 1-7). $~ 5 5 9 2 9 4. 8 9 9. Funeral Expenses & Administrative Costs (Schedule H) . .. 9. 17 2 7 D • 6 9 10. Debts of Decedent, Mortgage Liabilities, & Liens {Schedule I) • 10. 119 6 4.9 6 11. Total Deductions (total Lines 9 & 10) ...................... 11. 2 9 2 3 5. 6 5 12. Net Value of Estate (Line 8 minus Line 11) 12. 530D59 • 24 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . 13 ~ D • D D 14 Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . 1 a. 5 3 D D 5 9. 2 4 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.00-. D•DD 15. 0•DD 16. Amount of Llne 14 taxable at linealratex.o4-5 530059.24 16. 23852.67 17. Amount of Line 14 taxable at sibling rate X .12 D• D D 17. D• D D 1 B. Amount of Line 14 taxable at collateral rate X .15 D• D D 18 ~ D• D D 19. TAX DUE 1s. 23852.67 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042159 eMasaes.ooo 150560427,59 J REV-1500 EX Page 3 File Number 77 na 1. 1.r1L uc~.cucn~ ~ .+ - - - - -- - - - DECEDENTS NAME pA ZA TH STREET ADDRESS CUM R CITY STATE ZIP CAMP HILL Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit ~ • ~ ~ B. Prior Payments ~ ' ~ ~ C. Discount 1192 • 63 3. InterestlPenalty if applicable D. Interest ~ ' ~ ~ E. Penalty ~ ' ~ 0 (1) 23852 •67 Total Credks (A + B + C) (2) 119 2.6 3 Totailnterest/PenaNy(D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) ~-~0 (4) ~•~~ (5> 2266.0.04 (5A) ~ • 0 ~ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 2 2 6 6 0 - ~ 4 Make Check Payable to: REGISTER OF UI/It1S, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or Income of the property transferred; . . . . . . . . . ^ O b. retain the right to designate who shall use the property transferred or its income; ^ c. retain a reversionary interest; or .. .. .. .. ^ O 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 O 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? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ^ contains a beneficiary designation? . . . . . . . . . F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. =or dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse s three (3) percent (72 P.S. f9116 (a) (1.1) (I)]. =or 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 fling a tax return are still applicable even if the surviving spouse is the only beneficiary. =or dates of death on or after July 1, 2000: fhe 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 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)]. fhe 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 '2 P.S. §9116(1.2) (72 P.S. §9116(a)(1)]. i he tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, ender Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~M4877 1.000 REV-1502 EX+(e-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Elizabeth W Passananti _2.1__08 1106 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. swass5 t.ooo (If more space is needed, insert additional sheets of the same size) REV•1503 EX+ (6.98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 'lizabeth W Passanara-i 21 08 1106 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ~wasas i.ooo (If more space is needed, insert atldltional sheets o[ [ne same size) REV-1508 EX+ (6.98) SCHEDULE E COMMDNWEALTH OF PENNSYLVANIA I CASH, BANK DEPOSITS, Sr MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Elizabeth W. Passananti 21 08 1106 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 75,000.43 Par Sovereign Bank Certificate of Deposit #1055542839 75,000.43 Interest accrued to 10/31/2008 19.11 2 15,002.8 Par Sovereign Bank Certificate of Deposit #1055361388 15,002.80 Interest accrued to 10/31/2008 3.45 3 10,011.09 Par Sovereign Bank Certificate of Deposit #1055176158 10,011.09 Interest accrued to 10/31/2008 2.83 4 Sovereign Bank Checking Account #0181118149 250.08 Interest accrued to 10/31/2008 0.01 5 PNC Checking Account #5004045954 50.00 6 Citizens Bank Checking Account #6100682684 31,322.74 7 Citizens Bank Checking Account #6221033229 10,117.17 8 41,500 Par Citizens Bank Certificate of Deposit #6254552230 41,500.00 Interest accrued to 10/31/2008 89.37 9 X10,028.56 Par Citizens Bank Certificate of Deposit #6241044538 10,028.56 Interest accrued to 10/31/2008 26.54 10 10,346.17 Par Citizens Bank Certificate of Deposit #6241045836 10,346.17 Interest accrued to 10/31/2008 15.15 11 Commerce Bank Checking Account #536143324 ~ 273.44 12 20,231.4 Par Commerce Bank Certificate of Deposit #120001585 20,231.40 13 Prudential Alliance Account #4352000040223 7,213.69 14 54,140.75 Par Sovereign Bank Certificate of Deposit #1055162042 54,140.75 Interest accrued to 10/31/2008 16.37 Total from continuation schedules 30,979.75 TOTAL (Also enter on line 5, Recapitulation) $ _ __ 316 , 640.90 ,wasno t.ooo (If more space is needed, insert additional sheets of the same size) Estate of: Elizabeth W. Passananti 21 OB 1106 Schedule E (Page 2) Item Value at Date No. Description of Death 15 Met-Life Total Control Money Market Account 30,979.75 Total (Carry forward to main schedule) 30,979.75 REY~'1509 EX * (699j COMIAONWEALTH OF PENNSYLVANIA INHERRA NCE TA X RETURN :STATE OF FILE NUMBER Elizabeth W. Passananti 21 08 1106 If an asset was made joint wlthln one year of the decedent's date of death, it must be reported on Schedule G. SURVNWG JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT ~ Passananti, Thomas R 237 Winding Way, Camp Hill, PA 17011 Son OINTLY-0WNED PROPERTY: fTEM NUMBB2 LETTER FOR JOIN TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FNJANCIAI.INSTRUTK)NANDBANKA000UNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °h OF DECD'S M82EST DATE OF DEATH VALUE OF DECEDENTS MEREST 1 A 10/17/2007 Wachovia Checking Account #5436 45.00 50.0000 22.50 22.50 (If more space is needed, insert addd'anal sheets of the same s¢e) SCHEDULE F JOINTLY OWNED PROPERTY V46AE 1.000 R EV•1510 EX+ (8-9e) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NU Elizabeth W. Passananti 21 08 1106 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 NUMBS DESCRIPTION OF PROPERTY INCUDE TI£ W.MEOF TFE 7fWJSFEREE, THEIR RELATIONSMP TO DECEOEM ANO TFEDATEOFiRAASFER.AifACHACOPYOFTHEDEEDFORREALE6TATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~• Wachovia Bank Certificate of Deposit #4745, closed 7/1/2008 , and deposited to other accounts. 0.00 100.0000 0.00 0.00 2 Wachovia Bank Certificate of Deposit #3287, closed 6/19/2008 and funds deposited to other accounts. 0.00 100.0000 0.00 0.00 3 3,249.19 Par Citizens Bank Certificate of Deposit (IRA) #6140732581. 3,249.19 100.0000 0.00 3,249.19 Interest accrued to 10/31/2008 4.93 100.0000 4.93 4 1,777.55 Par Citizens Bank Certificate of Deposit (IRA) #6140732611 1,777.55 100.0000 0.00 1,777.55 Interest accrued to 10/31/2008 0.19 100.0000 0.19 5 1,683.73 Par Citizens Bank Certificate of Deposit (IRA) #6140732638 1,883.73 100.0000 0.00 1,883.73 Interest accrued to 10/31/2008 4.45 100.0000 4.45 6 14,856.45 Par Citizens Bank Certificate of Deposit (IRA) #6140732646 14,856.45 100.0000 0.00 14,856.45 Interest accrued to 10/31/2008 22.33 100.0000 22.33 7 Sovereign Bank IRA Account #0578111452 Beneficiaries: Thomas R. Passananti and Diane P. Hoppa 2,003.93 100.0000 0.00 2,003.93 Interest accrued to 10/31/2008 0.34 100.0000 0.34 TOTAL (Also enter on line 7, Recapitulation) I $ 23.803.09 (It more space Is neetled, insert addftional sheets of the same size) V48AF 1.000 REV-1511 EX + (1Q05) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER lizabeth W Passananti 21 08 1106 Debts of decedent must be reported on Schedule t. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: ~ Funeral Flowers B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip AMOUNT 250.00 2. Attorney Fees 11, 000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3 , 500.00 Claimant Thomas R. Passananti Street Address 237 Windincr Way City Camp Hill State PA Zip 17011 Relationship of Claimant to Decedent SON 4. Probate Fees 5 4 5. 0 0 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 PA American Water Co. 45.00 2 Frank Kostyal-yard work/leaves 30.00 125.87 3 PP&L Total from continuation schedules 1,774.82 TOTAL (Also enter on line 9, Recapitulation) $ 17 270.69 (If more space is needed, insert additional sheets of the same size) 'W46AG 1.000 Estate of: Elizabeth W. Passananti Schedule H Part 7 (Page 2) 4 HB McClure 5 Verizon 6 Citizens Bank - service charges 7 Montour Home Comfort Services B Mette, Evans & Woodside - costs & disbursements 9 Passananti, Thomas - reimbursements for estate expenses 21 08 1106 236.09 26.44 90.00 396.39 25.90 1,000.00 Total (Carry forward to main schedule) 1,774.82 REV-1512 EX + (12-03) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT INHERITANCE TAX RETURN r RESIDENT DECEDENT MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER Elizabeth W Passanan ~ 21 OB 1106 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. W46AH 2.000 to more space is neeaea, insert atlditional 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 Elizabeth W. Passananti 21 08 1106 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1 Thomas R. Passananti 237 Winding Way Camp Hill, PA 17011 Sole Beneficiary of residuary Estate pursuant to Disclaimers executed by Diane P. Hoppa. 100 of Residue: 529,057.10 Son 530,059.24 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET (I NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ $ 0 00 (If more space is needed, insert additional sheets of the same size) tW46Al 1.000 MISC. EXHIBITS ~cc.U. sy ~ V' V" Il.~~ cLU.~~ ~~i ~ ~cS.U.~~1~~11i~ OF ELIZABETH W. PASSANANTI I, ELIZABETH W. PASSANANTI, of 237 Winding Way, Camp Hill, Cumberland County, Pennsylvania, declare this to be my last Will, hereby revoking all prior wills and codicils. FIRST: The expenses of my last illness and funeral shall be paid from my estate. SECOND: I hereby give and bequeath, absolutely and in fee simple, equally to my children, DIANE P. HOPPA and THOMAS R. PASSANANTI, or the survivor of them, living at the time of my death, my household furniture and furnishings, books, pictures, jewelry, silverware, automobiles, wearing apparel and all other articles of household or personal use or adornment, to be divided among them as they shall agree. If they cannot agree for any reason, my Executor shall make the decision and its decision shall be final. My Executor shall represent any minor child in any division of such property and shall deliver to the person standing in the place of a parent to such minor, without bond, such portion of the minor's share as my Executor, after considering the minor's wishes, deems appropriate. Page 1 ~~,~ THIRD: (a) I give and devise the rest, residue and remainder of my estate, real and personal, equally to my children, DIANE P. HOPPA and THOMAS R. PASSANANTI, if they survive me by thirty (30) days. If either of m children predeceases me or does not survive me by thirty (30) days, his or her share shall be paid to his or her issue, per stirpes, or if he or she dies without issue survivin to m surviving child or their issue, per stirpes, as the case may be. g~ y (b) If none of the foregoing beneficiaries survive me, my estate shall be paid to my heirs who would be entitled thereto under the Intestate Laws of Pennsylvania in effect at my death as if I had then died intestate. FOFO__ URTIi: No provision of this Will is intended to exercise any power of appointment, including any power of a ppointment granted to me by my spouse's estate planning or other documents. FIFTH: No interest of any beneficiary under this Will or any codicil hereto shall be subject to anticipation or voluntary or involuntary alienation, and the personal receipt of such beneficiary shall be the sufficient and only discharge of my Executor unless otherwise provided herein. SIXTH: .All taxes, interest and penalties thereon payable by reason of my death with respect to property comprising my gross estate, whether or not passing under this Will, shall be paid from the principal of my residuary estate. SEVENTH: In addition to powers given them by law, my Fiduciaries and their successors and any guardian acting hereunder shall have the Page 2 -~' ~~ following discretionary powers applicable to all real and personal property held by him, effective without court order and until actual distribution: (a) To retain all property received by them including the stock of any corporate fiduciary acting hereunder, provided such property remains productive; (b) To sell real estate for any purpose, publicly or privately, for such prices and ors such terms as he deems proper, without liability on the purchasers to see to application of the purchase moneys; (c) To compromise controversies; (d) To distribute in cash or kind or partly in each at valuations fixed by them; (e) To hold investments in the name of a nominee; (f) To assume continuance of the status of any beneficiary with reference to marriage, divorce, illness, incapacity or other change in the absence of information deemed reliable without liability for disbursements made on such assumption; (g) To make income or principal distributions during the course of administration of my estate or trust created hereunder; and Page 3 ~~~ (h) To undertake any and all acts deemed necessary and proper by it for the proper and advantageous management of any trust and the settlement of my estate. EIGHTH: Any beneficiary hereunder who dies at the same time as me, within thirty (30) days of me, or under circumstances wherein it shall be difficult or impossible to determine who died first shall be presumed to have predeceased me. NINTH: I appoint my daughter, DIANE P. HOPPA, my son, THOMAS R. PASSANANTI, and my son-in-law, WILLIAM M. HOPPA, as Executors of this my Will. In the event any of the aforesaid individuals cannot act or continue to act for any reason, the survivor(s) may continue to act in his or her place. No fiduciary acting hereunder shall be required to post bond or enter security in any jurisdiction. TENTH: My Corporate Fiduciary, if any, shall receive compensation for the performance of its functions hereunder in accordance with its Schedule of Fees in effect from time to time during the period over which its services are performed; provided, however, that if any Corporate Fiduciary shall act in a co-fiduciary capacity, its schedule of fees shall be apportioned among all fiduciaries in relationship to the services that each fiduciary provides. Page 4 ~~~ IN` WITNESS WHEREOF, I have hereunto set my hand and seal this r~i ~ t ,day of ~.1L1,;~ , 2000 to this and the preceding three (3) pages, and I have also placed my initials on each preceding page for better identification and greater security. .caw ~~i • ~~Q.~c..~r <~-~'' ELI ABETH W. PASSANANTI SIGNED, SEALED, PUBLISHED and DECLARED by the above- named Testatrix, ELIZABETH W. PASSANANTI, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses: +'i Residing at ~ r~C-' .? ~/,(.l~%1~ 1 l-~~~ i~" ~~~ Residing at C`~ ~~ 1 . ~~}S t~ ~ ~~ R~e~s/iding at ///3 ~~,~~~ r,~~Ls<< ~ v ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : COUNTY OF ~~~~~-~,~~~ . SS. I, ELIZABETH W. PASSANANTI, Testatrix, 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 and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ELI/ABETH W. PASSANANTI Sworn to and subscribed befog Mme this ,~? ~f~'day of ~-~~~=_, 2000. ,~ Notary Public My Corrimission Expires: (SEAL) Notarial Seal Tina L. Otto, Notary Public Susquehanna Twp., Dauphin County My Commission Expires Sept. 14, 2002 M~xnmt~x, PKx~syfvr~aAs57d~~ndNd~s AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF t_~"~'~;a,~{~'~~'i~ : We, ~~_ -~_~C/ 1~C_ Ci7 ~Gl Slt' Utz ~' (~ %~~ ~.~,~ ~ ~-~~~'~ t~ ~.~~~-- and _--__ 'cT4, ~~~ ~ R~ ^~ ~ /~ ,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 Testatrix, ELIZABETH W. PASSANANTI, sign and execute the instrument as her Last Will and Testament, that Testatrix signed willingly and that she executed said Will as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as Witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Witness Witness Witness Sworn, to and subscribed be:~ere me tl'~:i s /~~~day cf !--~,~.~, ; 2000. ~~1.~'~~~,~f i,h, Notary Public My Commission Expires: (SEAL) Notarial Seal Tina L, Otto Notary Public Susquehanna Twp., pau MY Commission E Phin County MP~~ires Sept, 14, 2002 ~a+i~nanr,~~ OF ELIZABETH W. PASSANANTI I, ELIZABETH W. PASSANANTI, of the Camp Hill, Cumberland, Pennsylvania, the within named Testatrix, do hereby make and publish this Codicil to my Last Will and Testament, dated June 26, 2000. I hereby modify said Last Will and Testament as follows: ITEM I: Item NINTH is amended to read as follows: NINTH: I appoint my son, THOMAS R. PASSANANTI, as Executor of this my Will. No fiduciary acting hereunder shall be required to post bond or enter security in any jurisdiction. In all other respects I confirm and ratify my aforesaid Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this Z is T` day of ~„~' c~.r ~ , 2008. (SEAL) E , I ABETH W. PASSANANTI ~,~ We, the undersigned, hereby certify that the foregoing Codicil was signed, sealed, published and declared by the above-named Testatrix as and for a Codicil to her Last Will and Testament, in the presence of each of us, who, at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. ~~~~ (~-t~'G~:~~:,~-~ ('c r~ (SEAL) ~~ ~ 7..c~,u.r-~ (SEAL) l Residing at a- 3 ~ ~ ~ ~ ~ ~ ~ ~ ~ Residing at _ /f ~ G',t~, j~~fJ, ~ __) n ~.~f COMMONWEALTH OF PENNSYLVANIA . COUNTY OF ~--r.~~ SS.: On this, the ~~?n-~ day of ~~., _ ~- , 2008, before me, the undersigned officer ersonall a ~ P y ppeared VICKY ANN TRIMMER, known to me (or satisfactorily proven) to be a member of the bar of the highest court of said state, Supreme Court ID No. 49679, and a subscribing witness to the within instrument and certified that she was personally present when ELIZABETH W. PASSANANTI, whose name is subscribed to the within instrument executed the same, and that said person acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and notarial seal the day and year aforesaid. Not Public My Commission Expires: GOMMONWENLl't-! OF pENNSYLVAIWA Notarial Seal Joan E. Brothers, Notary public Susquehanna 7wp., Dauphin County My Commission Expires Feb. 12, 2010 Member, Pennsylvania Association of Notaries 500468v1 ~~ Citizens Bank Safe De osit Bo p x Inventory Record Branch Name:_ ~~G ~ ~ I i ~ G /", G Branch No.: V Bank No.: ('~ Box No.: ~ ~ 11 Ownershi f( _ ~ P~ ~ Individual ^ Joint (OR) ^ Joint (Husband/Wife) Name of Renter(s) ~'1 7C ~C -{'~ )-~GtS~ ~ ~ n +`, / ., Tax ID Number(s) ~ G L~ `~a " ~7~G j Date of Birth (if known) ~~ l~ Last Known Address: ~/I ~(~~ /Jr, !'~Lr ~l (~~nO ~!i ~ ~ ~~ d /' lzil Cab' State Zip DRILL DATE: REASON FOR DRILLING: ^ Past Due Rental Expiration Date: Last Access OR Payment Date: (Whichever is most current) X (Annual Rental Amt) (No. Yrs. Delinquent) Death of Renter ^ Other: Printed Name: •--r•`?6/'~I~S Printed Name: / \ G . I,) V~ _$ +$ Signature/Date: (Cost of Drilling) Signature/Date:/ ~ `-~-~~ i _$ U (Total Amount Due) NOTARY -- Complete this //sectiot~f re~aired'Rsy~ ~` ~ ~ rr State of ~~~n5 U~~ , ~ County of _ (,V~ ~ .-'G, n(~ On this, the>~- d y of ~/GuQr, her- , ~,,~, before me a Notary Public, the individuals who signed above personally appeared. These individuals, known to me (or satisfactorily proven) to be the person(s) whose names(s) are subscribed to this document, and acknowledged execution of this document for the purposes stated. In witness whereof, I set my hand and official seals to this document. COMMONVVEALT;-s r)I= I'z.f•1NSYLVANIA Notary Public: ~ ~~ ` Notarial Seal SEAL: Joyce M. Kctf;: i~'o;as)/Public My commission Expir ~ Lower Allen Tvvp., >;.;u,~tberland County i My Cornrnission Ex);ire; Iv,a;~ i 22, 2011 DISPOSITION Member, Pennsylvania Association of Notaries OF CONTENTS: ^ Sent to Centralized Storage Area at: ^ Dispositioned for escheat as appropriate per applicable state laws by bank colleagues: / Date: Claimed By Renter. The undersigned agrees that inventory is correct, all property contained in Safe Deposit Box described above is now in the undersigned's possession. The undersigned releases the Bank from all claims and liability resulting in any way from the rental or drillin~q of above Box, as well as the safekeeping of it's contents. ~, ., Prepared By: Joshua Brawer REV. (06/22/08) ~ box_inventary_recortlFranl Renter's or Authorized Representative's Signature. State: PA Current ID Date: 11/28/2008 Branch #: 290 • - ~~---••• ••~~~~~ ~~~~ a~~~~ ~p/C vepos;t rsox was opened and that the above list of contents found in the Box is true, correct and complete. SCHEDULE A EXHIBITS TaxDB Result Details 'n the 2004 Tax Assessment Database ittp://taxdb.ccpa.net/details. asp?id=13-25-0010-091.&dbselect= l Page 1 of 1 1 1 /d/~nno Detailed Results for Parcel 1 ~_~s_nnt n_no, Page 1 of 2 o Individual Taxpayers l~ -- - ! o Business Taxpayers Common Level Ratio (CLR) Real Estate Valuati ___ Factors on o. Tax Professionals - -- -------- - -- -- i ~ ~ Browse Search Revenue Home Back Printable Version T t O ~ ex - nly Full-Screen entail Previo N ~ us ext -_ '' ©Browse by Tax Tvpe Cumberland C t o Forms & Publications oun y a Tax Due Dates o News ACCEI A 'TANCC ~ 7~ ~' CLIt -_' ~ .~GGEPTANCT~ .. CLR o Reports & Research D 1„ ' FACTOR'; , DATE_ FACTOR o e-Services ll{OM T(~ - FilUl\1 TO o Slots Central Control Computer System 7-2-1986 6-30-1987 9.52 7-1-2006 6-30-2007 1 ]4 o New to Pennsylvania 7-1-1987 6-30-1988 10.00 7-1-2007 . 6-30-2008 1 22 o Employment 7-1-1988 6-30-1989 10.53 7-1- . 6-30 Opportunities 2008 - 1.26 2009 o Leal/Legislative 7-1-1989 6-30-1990 11 11 Information o Taxpayers' Riohts 7-1-1990 6-30-1991 , 12.05 Advocate 7-1-1991 6-30-1992 12.35 o Contact Us 7-1-1992 6-30-1993 12.50 o About the Department 7-1-1993 6-30-1994 12.82 - 7-1-1994 6-30-1995 13 33 o view as Text-only 7-1-1995 6-30-1996 . 13 70 o Site Feedback 7-1-1996 6-30-1997 . 14 29 o Site Index . o Home 7-1-1997 6-30-1998 14.29 7-1-1998 6-30-1999 14.71 Login ' 7-1-1999 6-30-2000 15.15 __ ____ _ 7-1-2000 12-31-2000 15.63 _ e-Ala its * 1-1-2001 6-30-2001 1.00 '' Receive notification of *7-1-2001 6-30-2002 1.00 changes to our site. 7-1-2002 6-30-2003 1.01 Subscribe Now 7-1-2003 6-30-2004 1.05 ' rR~ 7-1-2004 ** 12-31-2004 1.11 1-1-2005 6-30-2005 1.00 * * 7-1-2005 6-30-2006 l .00 * Adjusted to reflect assessment base change effective Jan. 1, 2001. ** Adjusted to reflect assessment base change effective Jan. 1, 2005. Content Last Modified on 5/29/2008 1:48:24 PM i i Browse Search Revenue Home Back Printable Version Text-Only Full-Screen entail Previous Next __ Ittp://www.revenue. state.pa.us/revenue/cwp/view.asp?A=3 &Q=204123 1 1 /~ /7nno EZevenue: Cumberland County SCHEDULE EXHIBITS MetLite Stock Account lnlormarion System ra~eiuii Perform another Search Results for Social Security Number "xxx-xx-7303" as of October 3, 2008 Investor ID Policy SSN Certified? Shares 806481939987 xxxxx9077 Yes 50 806638264647 xxxxxx4379 Yes 20 Number of Certified Shares ............................ 7p Number of Uncertified Shares ............................ 0 Total Shares ............................ 70 Perform another Search https://proleads.metlife. com/proleads/secure/sharesearch.do?action=run 1 /8/2009 MetLITe -Investor Kelatlons - Hlstorlcai Yrtce Lookup Historical Price Lookup ............. .................................... Symbol ___ _ MET (Common Stock) Select Date October 31 2008 Look Up Price Results Date Requested 10/31/08 Closing Price $33.22 Volume 19,140,900 Split Adjustment Factor 1:1 Open $31.37 Day's High $35.03 Day's Low $29.58 Copyright ©2008 MarketWatch, Inc. All rights reserved. Please see our Terms of Use. Designed and powered by Dow_]ones__ Client Solutio_n_s Intraday data provided by Interactive_ Data Real Tim~ervices and subject to the Terms of Use. Intraday data is at least 20-minutes delayed. All times are ET. Historical and current end-of-day data provided by Interactive Data Pricingand Reference Data. Yage 1 0l 1 Privacy Policy Lei Copyright 2003-05 Metropolitan Life Insurance Company NY, NY -All Rights Reserved PEANUTS Copyright United Feature Syndicate, Inc. http://investor.metlife.com/phoenix.zhtml?c=121171&p=irol-stocklookup_pf&t=HistQuote 1/9/2009 SCHEDULE E EXHIBITS Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: Elizabeth W. Passananti 164-22-7303 October 31, 2008 Account #: 0181118149 Type: Checkin In the name of: Elizabeth W Passananti g Open date: 5/10/2008 Date of Death Balance: $250.08 Int.(YTD) from 1/1/2008 to 10/10/2008 Accrued interest to date of death: $0.08 $0.01 Other Info: Account closed on 11/12/08. Account #: 0578111452 Type: IRA In the name of: Elizabeth W Passananti Open date: 3/27/1986 Date of Death Balance: $2,003.93 Int.(YTD) from 1 /1 /2008 to 10/31 /2008 Accrued interest to date of death: $118.41 $0.34 Other Info: Beneficiary Information: Primaries -Thomas R. Passananti(son)Diane P. Hoppa(d~u~.,-~e.t~ Account #: 1 055 1 62042 Type: In the name of: Elizabeth W Passananti Date of Death Balance: Int.(YTD) from 1/1/2008 to _ Accrued interest to date of death: Other Info: Account closed on 11 /12/08. CD $ 54,140.75 10/31 /2008 $16.3 7 Account #: 1055176158 Type: CD In the name of: Elizabeth W Passananti Date of Death Balance: $10,011.09 Int.(I'TD) from 1 /1 /2008 to 10/31 /2008 Accrued interest to date of death: $2.83 Other Info: Account closed on 11/12/08. Open date: 7/30/1999 $1,634.39 Open date: 5/20/1997 $397.24 Account #: 1055361388 Type: CD In the name of: Elizabeth W Passananti Open date: 6/7/2002 Date of Death Balance: $15,002.80 Int.(YTD) from 1 /1 /2008 to 10/31 /2008 $474.87 Accrued interest to date of death: $3.45 Other Info: Account closed on 11/12/08. Page 1 of 2 Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: Elizabeth W. Passananti 164-22-7303 October 31, 2008 Account #: 1055542839 Type: CD In the name of: Elizabeth W Passanti (Thomas R Passananti POA) Open date: 9/25/2007 Date of Death Balance: $75,000.43 Int.(YTD) from 1 /1 /2008 to 10/31 /2008 Accrued interest to date of death: $2,680.51 $19.11 Other Info: Account closed on 11/12/08. Page 2 of 2 Nov, 28. 2008 1:54PM PNC BANK 412-705-2741 ~~ ~£AB1~t6 T~iE'WAY November 28, 200$ Tina L Otto Mette, Evans & Woodside 3401 N Front St ~o Box s9sD Harrisburg, PA 1 71 1 0-0950 RE: Elizabeth W Passananti SSN: 164-22-73D3 DOD; 10-31-2008 Dear Ms. Otto: No. 4425 P. 1 In response to your' request for Date of Death (D017) balances for the customer noted above, our records show the following; Checking Account Account # 5004045954 Established: 05-11-2003 ELIZABETH W PASSANANTI DOD balance: $ 50.00 + 0.00 non interest bearing account Please note that this office provides date of death balances fvr deposit accounts (Il2As, CDs, Checking and Savings), 'We do not process any financial transactions or provdde statements, If you need assistance with any of these ktams, please call 1-888-PNC-DANK (1-888-762-2265) or stop by your local PNC Bank branch O~IGe, Sincerely, National Financial Services Center PNC Bank, N.A.~ 1V.iember FDIC Page 1 of 1 R~ Citizens B~nlc° Account Number Account Title Date Opened Account Tvne Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD YTD Interest to DOD 6100682684 ELIZABETH PASSANANTI 6/6/1966 $31322.74 $ .00 $31322.74 $385.83 ~~ Citizens Bank Account Number Account Title Date Opened Account Type Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DUD YTD Interest to DOD 6221033229 ELIZABETH PASSANANTI 3/12/2008 $10117.17 $ .00 $10117.17 $117.17 ~~ Citizens Bank Account Number Account Title Date Opened Account Tvne Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD YTD Interest to DOD 6254552230 ELIZABETH PASSANANTI 10/14/2008 Time Deposits $41500.00 $89.37 $41589.37 $ .00 ~~ Citizens Bank Account Number Account Title Date Opened Account Tvne Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD YTD Interest to DOD 6241044538 ELIZABETH PASSANANTI 7/2/2002 Time Deposits $10028.56 $26.54 $10055.10 $243.68 ~~ Citizens Bank Account Number Account Title Date Opened Account Tvoe Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as ofDOD YTD Interest to DOD 6241045836 ELIZABETH PASSANANTI 2/10/2003 _ Time De osits $10346.17 $15.15 $10361.32 $346.11 November 13, 2008 Mette, Evans & Woodside 3401 N Front St PO Box 5950 Harrisburg PA 17110 RE: Estate of: Elizabeth W. Passananti Tax Identification Number: 164-22-7303 Date of Death: October 31, 2008 To Whom It May Concern: Commerce Bank This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Checking Account Number: 536143324 Date Opened: 01/10/2003 Primary Owner: Elizabeth W. Passananti Date of Death Balance: $273.44 Account Type: Time Deposit Account Number: 120001585 Date Opened: 05/15/2008 Primary Owner: Elizabeth W. Passananti Date of Death Balance: $20231.40 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, Diana Reyn ds Commerce Bank Research Associate/Deposit Services Commerce Bank /Harrisburg, N.A. PO Box 4999 3801 Paxton Street Harrisburg, PA 17111-0999 commercepc.com Total Control ~.ccount® Account No. 4030474379 SH•185111-TCA1P028 ELIZABETH W PASSANANTI 237 WINDING WAY CAMP HILL PA 17011 October 2008 Statement Period From 10/01/08 To 10!31/08 Page 1 of 1 Your Representative: CORNETT M WADE Branch servicing CENTRAL PENN FI GP your account: 101 ERFORD ROAD SUITE 200 CAMP HILL PA 17011 Telephone: (717) 724-9700 Customer Service: (800) 638-7283 Today, when many consumers are feeling greater financial difficulties than ever before, we want you to know that at MetLife we focus on insuring and protecting our customers. We back up our promises with solid management and investment practices. Throughout its 140-year history, MetLife has fulfilled its financial obligations. As a Total Control Accountholder, you can depend on the guarantees offered by MetLife--guarantees backed by the financial strength and claims paying ability of the issuing company, substantial assets, some of the highest financial strength ratings in the insurance industry, and rigorous standards for risk management. TCA MONEY MARKET OPTION (MMO) EFFECTfVE ANNUAL YIELD 3.00% AS OF 10/31/OB Account Summary __ __ _ __ Beginning Balahce __ $30,902.23 Interest $77.52 'Ending Balance $30,979.75 Year To Date'Interes# $761.89 Year TQ Date federal Tax Withheld $0.00 Transaction Details ____ _ _ __ Trans Date Date >~ Written Ac#ivity ;' Check No Description /`,mount 10/31 Interest $77.52 ~ii~w~i~~in~i~~i~iiiiw 19040 Nrudential Alliance Account Services The Prudential Insurance Company of America P.O. Box 41582 Philadelphia, PA 19176 ELIZABETH PASSANANTI 237 WINDING WAY CAMP HILL PA 17011-8462 ~ni~~~ui~~~nui~~~ni~~~n~~~~ri~i'~en~~~~u~~~~n~~~~u~~ Prudential ALLIANCE ACCOUNT Statement Closing Date: 9/30/2008 Account Number: 4352000040223 },CCOE~",IT ISJ~::Q"JI TI^"~ Balance Last Statement 7,159.42 Balance This Statement 7,213.69 SUMMARY + CREDITS - CHECKS and DEBITS ENDING BALANCE RATE HISTORY CURRENT INTEREST RATE INTEREST CREDITED YEAR-TO-DATE ACCOUNT TRANSACTIONS DATE 07!31 CREDIT-INTEREST 08!30 CREDIT-INTEREST ~~F DATE 08-3i-08 09/30 CREDIT-INTEREST 803-2 54.27 0.00 7,213.69 3.000°k 163.24 DESCRIPTION C:UST. O~lIEP vE~ V ICE Contact Information: Prudential Alliance Account Services The Prudential Insurance Company of America P.O. BOX 41582 Philadelphia,. PA 19176 Internet: www.prudential.com .Phone: 1-877-255-4262 8:00 AM to 8:00 PM, Eastern Time, M-F Access to your Account Information is also available 24 hours a day 7 days a week. Please have your Account Number (located above) available when calling Toll-Free. AMOUNT 18.24 18.29 17.74 BALANCE 7,177.66 7,195.95 7,213.69 Page 1 SCHEDULE F EXHIBITS rax transmittal 11/L~/LUUti 1V:G;3:U1 AM YAIi!~, ,3/UV.3 rd.x ~CSVGL ~' rt~~ ~~ CFIP,CKINC ~'7~'h'k'7~7+7+543G $45.00 C,GCiAL'I~TLE: EU/_ABETII W PASSANANTI TftOMAS R PASSANANTI CI,OSIN(i BAL.ANCI? S,4S.OQ TI iE ON(,Y'1'RANSACfION IN OCTOBER W AS A 55.00 SERVICE FEE No Safe Dcpnsil Box found for customer. * Datc of death balance does not include accrued interest. 10/17/2007 NA Reference ID: 2633332 * If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. Diana McGuire Scrviccntcr Associate Phonc:(540)~G3-7323 11/13/2008 dm; dm SCHEDULE G EXHIBITS Fax transmittal Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-73]3 November 25, 2008 METTE EVANS & WOODSIDE ATTN: TINA L OTTO 301 NORTH FRONT STREET P O BO3~ 590 HARRISBURG, PA 17110-0950 Reference ID: 2633332 SUBJECT: Verification /Confirmation of Account and Balance Information provided for: Customer: ELIZABETH W PASSANANTI (SSN# XXX-XX-7303) Date of Death: October 31, 2008 ~~ Dcnosit Account_Informatian Aearunl Aec~uni Date of Death Average Dale Maturity Interest Accrued Y'PD llate Type Number Balance Balancex Opened Date Rate Interest Irden~ct Paid Closed CIiT:TIPICATTiOI' Xh7+'~'XXA'a'7~'x4745 IO/25/2007 7/1/2008 DIiPUSI'I' LGGAL'I'ITLP,: ELI7,AI31;TIi W PASSANANTI TIIOt,fAS !: PASSANAN'I'1 CLOSING 13ALANCC: 517420.40 C'IiR'17f7CA"PLOD ah~('~7+7~'X~'a7+?~'3287 ]1/14/2003 G/19/200R DI±POSI'1' LiiCiAl,'f f~'L,r; RI,t7,AT31'sTIT 1(t PASSANANTi 1'1IOt<1AS R PASSANANTI POA CLOSING T3ALANCIi: 51(504.54 11/L~/'LUUt3 lU : L:~ ; U1 AM 1-'ACr!', Gi UUU rax ~er'vt;r ~~ Citizens Bank Account Number 6140732581 Account Title ELIZABETH PASSANANTI Date O ened 9/8/1990 Account Tye Principal Balance as of DOD Time De osits (IRA) $3249.19 Interest from Last Postin to DOD $4.93 Account Balance as of DOD $3254.12 YTD Interest to DOD $71.46 ~~ Citizens Bank . Account Number 6140732611 Account Title ELIZABETH PASSANANTI Date O ened 4/2/1986 Account Tye Time De osits IRA) Principal Balance as of DOD $1777.55 Interest from Last Postin to DOD $ .19 Account Balance as of DOD $1777.74 YTD Interest to DOD $57.01 ~~ Citizens Bank.... Account Number 6140732638 Account Title ELIZABETH PASSANANTI Date O ened 3/12/1986 Account T e Principal Balance as of DOD Time De osits (IRA) $1883.73 Interest from Last Postin to DOD $4.45 Account Balance as of DOD $1888.18 YTD Interest to DOD $60.60 air~c Citizens Bank Account Number 6140732646 Account Title ELIZABETH PASSANANTI Date O ened 9/20/1990 Account Tye Time De osits (IRA) Principal Balance as of DOD $14856.45 Interest from Last Postiri to DOD $22.33 Account Balance as of DOD $14878.78 YTD Interest to DOD $477.95 SCHEDULE J EXHIBITS C. 4 J l_ -,: IN THE COURT OF COMMON PLEAS ~~, `~ CUMBERLAND COUNTY, PENNSYLVANIA ; t IN RE: ESTATE OF ELIZABETH W. PASSANANTI, Deceased ORPHANS' COURT DIVISION ESTATE NO. 21-08- DISCLAIMER I, DIANE P. HOPPA, of State College, Pennsylvania, hereby declare that I am the daughter of Elizabeth W. Passananti, ("Decedent") who died on October 31, 2008. At the time of the Decedent's death, she left a Last Will and Testament dated June 26, 2000 and a Codicil dated August 21, 2008. I, DIANE P. HOPPA, hereby irrevocably and completely disclaim and refuse to accept any and all interest in the Independent Retirement Accounts in which I am named as a beneficiary. Dated the ~ day of Joy ~,y, ~v- u , 2009. WITNESS: ~a~ ~lJ G~/~- ~,c,dt. ~, ~-~_ (SEAL) DIANE P. HOPPA ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF C e~ ~~ r~ On this ~a~ day of ~wnv~y _, 2009, before me, the undersigned officer, a Notary Public, in and for the said county and state, personally appeared DIANE P. HOPPA, who, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Disclaimer are true and correct to the best of her knowledge, information and belief and that she executed the same as her voluntary act and deed. ~~ ~~ Notary P blic My Commission Expires: (SEAL) COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL MARY B. WERNER -NOTARY PUBLIC State College Boro., Centre County tY''JMMISSION EXPIRES JAN. 22, 2011 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF ELIZABETH W. PASSANANTI, Deceased ORPHANS' COURT DIVISION ESTATE NO. 21-08- RECEIPT OF DISCLAIMER The undersigned being duly sworn according to law, deposes and says that he is the named Executor of the Estate of Elizabeth W. Passananti, and that on the date and place as hereinafter set forth, he received the foregoing signed Disclaimer from Diane P. Hoppa. Date Place Signature ~~(;/~f'~~= 3401 N Front Street Harrisburg, PA 1 71 1 0-0950 Sworn to and subscribed before me this ~r~ ~~ day of ~ n'~,^, ;J fir, ,.~~,~ ~' , 20 ~~ - ~ ~~~~ Notary ubhc My Commission Expires: (SEAL) 505713v1 COMMONWEAL p` F pENNSYLV IVolariat Seal ANIA Vicky Ann Trimmer, Notary public MY Comm scion f~-,~~'' t~~uphin County Member, p _"""'__.____PireT Mnr. 11, 2.010 ennsylvania Association of Notaries COMIvIONWE:AI_T_I-- U_F PENNSYLVANIA Vicky An - ~ dotary Public Susqueha~' ~ ;--,~r~~hin County My Comn~,ir_ ; : (dtar. 11, 2010 Member, Pennt;ylv~rir, „;fir ::.~riation of IJOtaries IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ~ IN RE: ESTATE OF ELIZABETH W. PASSANANTI, Deceased DISCLAIMER --~ o , - . , ~ ~ 1 ..~ . - ~J)~_ ORPHANS' COURT D)I~C N ~ ~ ~; -a ~ A ~ _: ~- ~ ~ ~ ESTATE NO. 21-08- o ~ r I, DIANE P. HOPPA, of State College, Pennsylvania, hereby declare that I am the daughter of Elizabeth W. Passananti, ("Decedent") who died on October 31, 2008. At the time of the Decedent's death, she left a Last Will and Testament dated June 26, 2000 and a Codicil dated August 21, 2008. I, DIANE P. HOPPA, hereby irrevocably and completely disclaim and refuse to accept any and all interest in the Estate of Elizabeth W. Passananti as set forth in the Last Will and Testament dated June 26, 2000 and the Codicil dated August 21, 2008. Dated the 1 C day of ~ 2008. WITNESS: ~.~- P ` ~`~ (SEAL) DIANE P. HOPPA ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF G ,~,, ~ r~e. ss: On this ~ day of ~v~ , ?008, before me, the undersigned officer, a Notary Public, in and for the said county and state, personally appeared DIANE P. HOPPA, who, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Disclaimer are true and correct to the best of her knowledge, information and belief and that she executed the same as her voluntary act and deed. Notary Pu lic My Commission Expires; (SEAL) COMMONWEALTH ^F PENNSYLVANIA NOTARIAL SEAL MARY B. WERNER -NOTARY PUBLIC State College Boro., Centre County MY COMMISSION EXPIRES JAN. 22, 2011 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF ELIZABETH W. PASSANANTI, . Deceased ORPHANS' COURT DIVISION ESTATE NO. 21-08- RECEIPT OF DISCLAIMER The undersigned being duly sworn according to law, deposes and says that he is the named Executor of the Estate of Elizabeth W. Passananti, and that on the date and place as hereinafter set forth, he received the foregoing signed Disclaimer from Diane P. Hoppa. v Date Place Si nature 3401 N Front Street ~ Harrisburg, PA 17110-0950 ~.~~ P~~:,~--...,,.. Sworn to and subscribed before me this ~~~ day of ~u~Z~~"~~~,./ , 2008. / ^? L~~.~ Notary Public My Commission Expires: (SEAL) 505713v1 ri7i1/I~nF.{~;~.?F_?\i..}`:-j f71'= [-)f_[`~iJ~YL1~ANIA °I i; x~a L. C1itiJ, fVptary Iaublic Susqu~~!?ar~n,=a Twl,., Dauphin County Nay C:;, r;mi:s.... , ':-~r.~irF,~ t tap:. 34, ?010 :,"~., ~• ~ - ~ ~ ..._,,,,,,,,.iion vi Nut' i2<.