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HomeMy WebLinkAbout02-17-09J 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN j~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ ~ U ~ ~1 ~ ~ ~ i ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~ o~ ~30 ~`f 59 0 ~~~ ~oo~ ~~( 2~' 1 `~ 27 Decedents Last Name Suffix Decedent's First Name MI M I Z la R I L ~ l i z c b~+ !~ l~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number (? ~, + h ~ r I n ~ 1"1 ~4 +- c h ~ e ~/ 7 0 3 ~~ 1 ~ ~, ~ 1 Firm Name (If Applicable) First line of address 9 7~ la B~ ~9 ~ ~S Roa d Second line of address City or Post Office ~ u ~° ~ e Correspondent's a-mail address: ~~G h' e ~iiaer penaicies or penury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU E OF P RSON RESPO SIBLE FOR F ING RETU N DATE -~~ ~i. -off ADDRESS ^y/~ n', Q`~ ~~, u~~~ ,J/4I /'~j G, / ~,,//5 ~nG , , V., ` d~ l/ l S SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE 5 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 State ZIP Code ~- -~ REGISTER,flF ~ t LS USE ONLY ~_~ ~.~ ~~ F 'i ._7 -~ ~~ v =f-; -:~ _~ 7 -- _t DATE FILEDr ~~ r-~ +~ 1 ._ ~y VA- Zza-~ `IA~C. ~ p V• ~ (,~ 15056051047 J REV-1500 EX 15056052048 Decedent's Social Security Number Decedent's Name: J) O ~ ~ ® ~ J I RECAPITULATION ~{ "~' 1. Real estate (Schedule A) . ............................................ 1. ~ ~~ 5 ~ G . ~1 C~ 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. • 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. • 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. '~' ,' 8. Total Gross Assets (total Lines 1-7) ....................... i j ~1 ~ ~ ~ ~ • ............. 8. `( h 9. Funeral Expenses & Administrative Costs (Schedule H)........ ~ ~ ~ ` • ............. 9. J, 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ w 10. 11. Total Deductions (total Lines 9 & 10) ..... . ............................. 11. • 12. Net Value of Estate (Line 8 minus Line 11) .... • 13. ..................... Charitable and Governmental BequestslSec 9113 Trusts for which ..... 12. • an election to tax has not been made (Schedule J) ................... .... . 13. • 14. TA Net Value Subject to Tax (Line 12 minus Line 13) ................... .....14. ~ ~ ~ ~ if ~. X COMPUTATION -SEE INSTRUCTIONS F OR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. • Amount of Line 14 taxable 15. • ak lineal rate X .0.~ 17. • Amount of Line 14 taxable 16. ~ ~ ~ ~ ~ • at sibling rate X .12 18. • Amount of Line 14 taxable i7. • at collateral rate X .15 • 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 15056052048 O _._I ~ ~~ R'LV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME ~ J1~ 1 ~ ~ ~ ~ STREET ADDRESS - - _ _ - STATE ~~ /l CITY M mac. j1 Gr, n I L S b~ r~ ~`"~ Tax Payments and Credits: (1) 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount _ Total Credits (A + B + C) (2) 3. interestlPenalty if applicable D. Interest E. Penalty - Total InterestlPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. {4) Fill in oval on Page 2, Line 20 to request a refund. {5) 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5A) A. Enter the interest on the tax due. (5B) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Z,P~~oSC~ ~ $~O•~(~ Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :............................... ~ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or ......................................................................................................................... ^ ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust for" or payable upon death bank account cr security at his or her death? .............. ^ 0 4. Did decedent own an. Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ~ ^ iF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)J. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN ESTATE OF FILE NUMBER All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is detinetl as the puce at wnicn progeny wouia oe 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. ITEM VALUE AT DATE ......___ nGCCRiaTinN OF DEATH 27 Creek Bank Drive Mechanicsburg, PA 17050 $235,560.00 TOTAL (Also enter on line 1, Recapitulation) I ~ ~ 3 5i ~~~%` (If more space is needed, insert additional sheets of the same size) TaxDB Result Details Detailed Results for Parce138-06-0011 DistrictNo 38 Parcel ID 38-06-0011-034.-U92 MapSuflix HouseNo 27 Direction Street CREEK BANK DRIVE Ownerl MIZDAIL, ELIZABETH C/O PropType R PropDesc LivArea 1783 CurLandVal 0 CurImpVal 235560 CurTotVal 235560 CurPreNal Acreage .00 CIGrnStat TaxEx 1 SaleAmt 235930 SaleMo 12 SaleDa 23 SaleCe 20 SaleYr 03 DeedBkPage 00260-04869 YearBlt 2003 HF File Date 12/21/2004 HF Approval_Status A -034.-U92 in the 2004 Tax Assessment Database Page 1 of 1 http://taxdb.ccpa.net/details.asp?id=3 8-06-0011-034.-U92&dbselect= l 7/4/2008 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the pr~eeds were received b the estate. All roe J Y p p rty jointty-owned yvtth the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~. OF DEATH cash 2 Orrstown Bank Money Market 1 1 1 800040 ~ 300.00 3 PNC Checking Account 51-4004-4307 $ 39,885.24 4 PNC Money Market 51-3034-9051 $ 18,648.68 5 Members First Acct No 260455/regular savings $ 4,004.65 6 Members First Acct No 260455/Money Management $ 1,001.74 7 Members First Acct No 260455/ 30 Month Cert 40 $ 1,119.77 8 Members First Acct No 260455/60 Month Cert 41 $ 40,881.77 9 Diocese of Harrisburg Acct No O 1-31470 $ 13, 315.59 10 Sovereign Bank Acct No 0575138532 $ 11,726.14 11 U.S. Savings Bonds $ 9,367.83 ~ 2 Total Control Money Market Account 4049216052 * $ 3,434.40 13 Massanutten Moutainside Villa Time Share, McGaheysville VA 22840 $ ~ l Q018.66 14 , Furniture 3,066.67 15 clothing $ 2,000.00 16 Household effects $ 250.00 17 jewelry (including pearls, Diamond Ring (1) and misc ) ~ 300.00 18 . Uramond hang (1) X1,700.00 19 Model A Ford $ 3,450.00 20 ~ 95u rora NrcK-up $ s,ooo.oo TOTA $ 6,000.00 $ 176,471.14 * already distributed by Total Control, 485 E US Highway 1, Iselin NJ 08830 ~~~~ A Tradition of Excellence ORRS P.~. Box 250 o Shippensburg, PA 17257 Ma~-l~er'S }~ccf, Date 5/20/08 Page 1 Primary Account 111800040 Enclosures ,~ 1~~~11L~~IIi~,,,LLIl~~~~~,Iil«1~~„tLi~~!„I~ti„~i.l~~lt ,~~ 002546 0.4804 AT 0.346 TR00011 ~~ Elizabeth A Mizdail 27 Creek Bank Drive "'-'~ Mechanicsburg PA 17050-1814 ~% s' . ~ y _,,, e i Building? Buying? Remodeling? We can help! 1.888.ORRSTOWN - orrstown.com C H E C K I N G A C C O LI N T S Account Title Elizabeth A Mizdail Premium Money Market Check- Safekeeping Account Number Previous Balance 111800040 Statement Dates 4/21/08 thru 5/20/08 Deposits/Credits 39,814.25 Days In The Statement Period Checks/Debits .00 Average Ledger 39 814.25 Service Fee .00 Average Collected 39,814.25 Interest Paid .OC 59.61 Interest Earned Annual Percentage Yield Earned 59.61 Current Balance ~~ 2008 Interest Paid 1.84% 324.00 0 Deposits and Additions ,~ Date Description 0 5/20 Interest Deposit N O m o Daily Balance Information a Date Balance Date .~ 0 4/21 39,814.25 5/20 v N ~~ Interest Rate Summary o~ o ~ ~0 4/20 ~~ 5/01 o r. Balance 39,873.86 2.000000°s 1.740000 Amount 59.61 THANK YOU FOR BANKING WITH ORRSTOWN BANK Cotal Banking Statement NC Bank For the period 05/07/2008 to 06/05/2008 Primary account number: 51-4004-4307 Page 1 of 4 Number of enclosures: 0 For 24-hour banking, and transaction or interest rate information, sign on to 'II' PNC Bank Online Banking at pnc.com. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en esparSol, 1-866-HOLA-PNC Moving? Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com ® TDD terminal: 1-800-531-1648 For heazing impaired ciienu only ~ie~at1oi11Sh%p OYerY1eW tank Deposit Accounts ascription Accourrt Number Deposit Balance rterest Checking 51-40044307 .00 erforrnance IVfoney Market 51-30349051 .00 otai Deposits .00 nterest Checking Account S~snrtnary ccount number. 51-40044307 ~alance Summary Beginning Deposits and Checks and other baiance other additions deductions 21,272.71 8,000.00 29,272.71 Average monthly balance 15,9f 9.21 Elizabeth A Mizdail Decd Please see the Activity Detail section for additional information. Ending balance .00 Charges and tees .00 ransaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 7 2 11 Totat ATM transactions 0 tterest Summary Annual Percentage Yield Earned (APYE) 0.00% PNC Bank Other Bank ATM transactions ATM transactions 0 0 Number of days Average collected Interest Paid in interest period balance for APYE this period 22 21,417.11 .00 As of 06105, a total of $7A6 in interest was paid this year. Total Banking Statement PN C BANK For ttie period i115l9T/Zt198 to 96/tf57Y908 Foc 24-hour information, sign on to PiVC Bank Uniine Banking tL11RBEiN A M1LLlAlL UE~:ll on pnc.com. Primary account number: 51-4004-4307 Account number: 51-4004-4307 -continued Page 3 of 4 ec the une _ , you ~vou pie er no o tave ova ra access, ca our a ep tone an tng service a - - - e veep am - 12 midnight, Eastern Tnne, seven days a week. f you have called previously to opt-out of overdraft access at non-PNC ATE Is, you are automatically excluded from overdraft access for all ~TA~1 transactions and purchases and do not need to call agaui. 'or more information, please see our Consumer Schedule of Service Charges and Fees, Other Account Charges and Services and/or Account agreement for Personal Checking arui Savings Accounts, `Vithdra~vals section. Aerformance Money Market Account Sinnmary Elizabecn A Mizdail Decd account number: 51-3034-5051 taance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 4,tN14.65 UO - 4,004.65 _ 00 Average monthly Charges balance and fees 2,936.74 .00 nterest Summary Annual Percentage Number of days Average collected Interest Paid Yield Earned (APYE) in interest period balance for APYE this period Please see the Activity Detail section for additional information. As of 06/05, a total of $9.47 in interest was paid this year. 0.00% 22 4,004.65 .0(1 ~ctAVity ®etail )that Deductions gate Amount X5/29 .fx) Sri/~9 4,004.6Ci Description Outstanding Item Close llebit Memo Reference No 020157133 r Deductions totaling )wily Balance Detail 'ate Balance Date Balance X5/07 4,004.65 O[i, 99 .UU $ ~ Jc11U IilyUl,w lV. "~' 5000 Louise Drive o + ~tatem.,n, Ot ~CCOUr1tS `~ " ~i ,r ;"~ PO Box ao ,wJ~ °' Mechanicsburg, PA 17055 '. www.roernberstst.org Mar 25, 2048 thru Jun 4. 24, 2008 ,~; `~` Main S1alLChboarcl: (800) 283-2328 EZ Call: (717) 697-4372 or j8o0) 283-4372 Account Number : TDD: (717) 697-5312 or (800) 283-2328 ext 5312 260455 . _ ~ TeleBranch: (800) 237-7288 t Account 8aiances at a Glance : ~ Checking : 0 ~ - 32940 i MB 0.364 65879-32940 Savings: -_ I-~I,I~~I,IN~~~~~~Il~l,i„i„i,,,ii~i,.„~i~i~,~ilr11~~~1j~~1 Certi#ica#es: 0 ~ EtiZABETH A MiZDA1L ~ C!O CATHERi1dE ATCHi_EY LOaf1s : 0.00 0 04 9716 RIGGERS ROAD ~ Money Management : BURKE VA 22015-4102 . 0.00 i~ Page : 1 of 2 Your current Member Loyalty Reward level is Platinum With zero origination fees, lower interest rates and flexible repayment options, it's easy to see wh o y ur new student loan product is a hefter way to Visit http:/>members1st st dent hoi ee . c org for more information. __ ACCOUNTS ~f! -REGULAR SAVtf~fG3 - - ---~ Mar 25 Balance Fonrab Mar 31 Deposit Dividend 1.000° Annual Percen~e Yid Eame~o~ 1.010~o frnm 03/01/ZGaB Ihivugli Li?/31/Zr~B Apr 30 Deposit Dividend 1.00096 Annual Percenfaye Y,rgld Earned 1.Oi~6 finrn 04/Of/217p8 May 29 Deposit Dividend ~~~ ~/~/~ Annual Peraentagie Y,le~fd Earned 1.Of0AG fi~vrn (kS/O1/ZAG18 dh~vggvj Q5/31/1~7LIB May 29 Deposit May 29 Withdrawal by Check REGTZULAR NSA V/NGS C/oseds {,~~ ~l, rss///~*1 ~ u!G l~al~y,S~faje/TIE~1! sp/~S~rj~ //~i1///~/govy~t~7/n~on~N4ll~5fn~(/~ssf r:r Gy ,.~- Ig~dP/ uAD ~7a/ Slafel7)Bl7r ~!_~aX ',-,z'„'-`-°:/.-e""1!'.`~•~P.S sss 05 - Mar 25 Ba/arxae Foiwa~ Mar 31 Deposit Dividend Tiered Rate Annual Peir~~e Y,~ 1. from ~/01/201AB APr ~ Deposit Dividend Tiered Rate Q?/31/2tliA9 Annual Pen;en>~ Y~Id Earned 1.250% 1J~r» 04/01/1AGi8 ~ 04/30/ZAA9 May 08 Withdrawa! by Check May 29 Deposit Dividend Annual Plere,en~e Y~BAd Famed 0.5+0% lhxn Q5/fl1/ZG~RB ~xrx~ Q5/2d/21X~ May 2g Withdrawal MONEY MANAGEMENT r.,,(vsed "'77>~s ,s the fna/ statement Pdi7g 6rlntmaLian on bhrs product"' •,: Please ~ th/ss fna/ s~tement for ~x 9 p~~ ,.. 0 85 ~.~ 1,000.15 0.82 1,000.97 0.77 55,317.13 56,318.87 56,318.87- 0.00 9,095.72 12.44 9,108.16 9'~ 9,117.44 8•~•~- 1,117.44 2.33 1.119.77 0.00 ~:. ~ .,,,,.., _~,_,,., r,r .n,..,, ,.. a..._~__. .-.-:.:-- -------- -- - -- r n e"-s it ~r st yar i-e-f..,y r{ } _ _ ._ . . _ ~~ Ldi" ±faf3~~##~n i r in `~..5!E3Lt,f4 ~_.... Ivrni" c~~ fsdx8!!C~' Txxi ~ x •,•• _tf'f"rart~^r~~ 62afarlrc YYd. Ll - -- lYiIIa „ti C~_-~_:~ :~ __ -- itl/n txi~ St /1 it .......ter <1.........n1~ V,.. r..r w •lCl~l; L._~ nn gyn.. ~. o-i0.{ Irv `iL _`'` _- lV.t.Ntd, r t.i [iLi1xCl i~L rtG7 E! a ^.!lGL -ynnn - H'a'rt•r.i.-.nn -r-wuiu xxcnxe vlx l.e re~uuu ix`eiu _._ ;tuxF u.~r.~ l:,~e~uc= >r.~ ~ r ...._.. ~ '_ ir4 1r.>>L iJ fuGf rL! Y. i f J;V ~~" .~ Vr~r~n `'`~ T L.~v~i~Y Ir vr~ 'v~~ ~' xtllU ~~. ~... .,.h !~ 7 7 r:Fte':x. ___ •':~~.", r m.ur,:..- rr us, .: iuuv vuurr r..urrcvuu ,_ ...... . ~. v ~...~ urr r ;ter .= nr~ ~.~ v.aen arr it i+. r'. rr - s *}v -.~v ~FL3 tlt! ! f ._ _. . ....~ ~-... ..:,.....u .. r.~v.V ::. V 1!!141 _• _ __ •""`~ "`"v'~.-vvv ar rr ui{rr ~.~_r~c+.tVVv !.:~ 4.<in 7.... -trI ~ ..__ _- , uu s - ` ^^ r~ R r 1- ur) V vv ___ ... :` .r.«r ~z;t urnc~n rnf~<crnr,nn n zm~ n. xn,c n .. .. rw ~ rF~ ... rr'r'~?SE (B~~t!T llllS ?tld SIdIB.Rtet?r iCir ;dX, rar5n.-rnn r ~mS .. Date Transaction Des 'lion Mar 25 &~nc~ Forward Additions Subtractions Balance Mar 31 Deposit Dividend 4.750°10 13,162.55 Annua! Percen Yid ~ Eamed 4.85096 hom 03/O1/Zl,G18 througsh 03131/ZOYIB ~ -10 13 , 215.65 Rpr :~U Deposit Dividend 4.750°k Annual Pe~rta~rttage Y~fd Earned 4.8#~ from 04101/2lIGS fhrnugd 04/,3p/2plpg 51.60 13.267.25 1naY Z9 Deposit Dividend Annual Percentage Y,~eJd Eame+d 4.8609b him Q5/0 1/2008 fhrotx~ 05/28/2Y~pB ~-~ 13 , 315.59 iviay 2~ Withdrawal 6Q RAONTH CERT Closed 0 - ~ ...This ,s i9Je r~i staternerrt Presenfr*-g arforma6on on this Product= ~, • • • P/a3se retain this lanai statement for tax reporting Purposes *Y _..___ _ YTa SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS ~-~ u5 iviOPdE~i i~lAivi-~GciviEivT ~L.L6 All ~J11 AdflAlTl_! !-~r!^,T ~,~ w Ju la:v:'::.. ..~... Ci~O.6i 41 60 MONTH CERT 25.22 T ' ... ..G ° 3 .Ci'vJ. Amt !'1TC. T 1 ... ~{._-F _._ _._:C~ ~..... _v ~.e ut~rri ~r'nll!f' 3'~F?t'in IFnr ~r=tr~sri~r Your personal safety and financial security are top priori#ies at i~emi~ers est. ~s ? -es4~~f .,a increased scams and fraudulent activity throughout the en#ire country, we are strongly encouraging members to have their photos added to their account records. When visiting our branch offices, you may be asked by one of our Associates to allow us to take your photo. This member identification program will assist in our fraud deterrence initiatives and will take our identity theft prevention program to the next level. We are experiencing an increasing number of attempted fraudulent activities and as a result, we need to be able to verify your identity immediately upon retrieving your account information. In addition to having your photo in our files, you may be required to show addi#ional forms of identification based on the type of transaction you are seek~n9. This is for your protection and security and we appreciate your ongoing cooperation and understanding. office of Financiai Administration PO Box 3651 Harrisburg, Pennsylvania 17105 Phone (717) 657-4804 Fax (717)671-7021 tLiLAi3t i li A MILL3AIL OR SURVIVOR 'L7 t~HttK t3APVK UH MECHANICSBURG PA 17050 DATE: 3/31 /2008 0~~~~~ o~c~., c~cK r ~',' ~3.~`E~''~9w ac"~~,"g ~='?'$rp~ `r'~ ~',s2eay~' 4`3,s.-x ;.. ~!;'~~t;1:".~"~Yc°t"~"~ t~,.„~ PAY TO THE ORDER OF ~ :; ~;, ~;~, ~~ W ~ ~ , R;~,~ L>~ i ~ ~,1 .~ . ~¢ ~ , ~ Drawer Sovereign Bank NON NEGOTIABLE CUSTOII~IIER COPY ~ DRAWEE: SOVEAEIGN BANK ISSUED BY: SOVEREIGN BANK AUTHORIZED SIGNATURE .v Sovereign Bank iii. ~ AGhC't~AiT~ ~'EO~+Cf~P: E~~Z~~dQt~t A. M2Z1~C~~~~ DETACH AND RETAtN FOR YOUR RECORDF VI~~~~ // `" For official use: only: ' Gus#orrmer Name ATCHLEY, CATHERINE M Customer Na. 0101959G43C PD F 1522E SPECIAL FORM OF REQUEST FOR PAYMENT OF OMB No. 1535-0004 Department of the Treasury UNITED STATES SAVINGS AND RETIREMENT Bureau of the Public Debt SECURITIES WHERE USE OF A DETACHED FOR QFFICIAL USE ONLY (Revised March 2008) REQUEST IS AUTHORIZED TRANSFER MONTH & YEAR _/ FISCAL AGENT CODE 1. DESCRIPTION 0~~~ I am the owner or person entitled to payment of the securities described below, which bear the name(s) of E u4P~~ 3. rM i ~dQ - l D t' Iw i i z,c;.bG-i h ~} •M t z.do~.>} livamaifti~ma5 nrt rho ®rr-n,ristl tSSUE:DATE SERIAL NUMBER ISSUE DATE SERIAL WUMBER ISSUE DATE ` SERIAL NUMBER- 02~i9g3 D3r2~1~5J3Z t °Z~~4~ O 3t~. GS ! 31 ~ o z. X443 D 31x ley f 3 a EF oZl~9~t3 D3i2 G5/ 24 ~~ oz f/~j3 D3~2G5/28F~ oZ rg93 D3~ZG5~~~ ~& ((f YUU 7ICW llfitiC .`~AR{rC~ uac u~c i.V+~uaiuouvu mrcca v.. ,iv~c vy 2. REQUEST FOR PAYMENT t request that the described bonds be redeemed and payment be made in the form of ~ [~a check. ^ Direct Deposit. ^ To the extent af: (t:omp/ete ti-is line only if partial redemption and reissue of the remainder is desired or if the signer is only entitled to a portion of the bonds listed. See Item 2 in the /ns~uctiorrs.} (Social Security Number of Payee) OR (Employer identification Number of Payee) 3. DELIVERY INSTRUCTIONS (Read Item 3 in the Instructions before completing this section and compete Dory Item 3A or 3 B.) A. MAIL REDEMPTION CHECK TO: Ca.+ h e it i n ~ ~+c h to ~/ , Exc.. {Name) ~~~~ ~~ ;~u~t~b~r ~~z~ Str~ rs woad Rural Route} (Ci#y, 1=t_ E~ii?t=-{_.! F~.i~Yf5.~,1T fiii~tifiL"iSAii'T±~#t1F21~'fr}~ri_t"Y4~~.r; i yue ~~ i~e:4vuttt. yr c.t..,, ~y vO'J4„i.,S iO@Crfs9i#Gr'S ACG8i3rs# NG.~ 2zol S rn~, a Sato ,str f aru r, iUREAU ©F THE PUBLiC DEBT IIVISION OF ACCOUNTING AND RISK MANAGEMENT 'ARKERSBUR6, WV 26106-2188 :8661 388 - 1776 55-0416249 AYER'S FEDERAL IDENTIFICATION NUMBER ECIPIEN7'S NAME AND ADDRESS: CATHERINE M ATCHLEY ADM EST - ELIZABETH A MIZDAIL BECK 9716 BI66ERS RD BURKE VA 22015-4102 Nt~R: 1016920 oa~tw.ts+~ati INTEREST INCOME FARM 1099-INT FOR TAX YEA4i: 2008 35-6785960 RECIPIENTS IDENTIFICATION NUMBER ant y~tne t~nfshed.to the. hrt¢rrsa! R~vQ~xse ~~ Iro- K +.+ t 9 e . ~ •--- - ---••-- - --- ------ -__----. n~a_ Is anportatrt _ta~ tr>~nat~on- thersanction may be enposed on you if this income is isx:wie and i~ ilia aet~r~#_~.~ , :~: r= _,~~ ,~~:. ~=_ _..r,~,,,.~. •. G. -.'~ h}~ .it ..i4.' sY CE a.... ... ... t .L i. 2 ~.. .[.. .. .. t i ~ ACCOLiIIt~ account No. 4049216052 SH-099007-TCAt P804 ELIZABETH MIZDAIL C/O MARGARET M REAM 29 CREEK BANK DR MECHANICSBURG PA 17050-1814 ,ti~`~~~ ~~' ~ June 2008 z l; ...*.'' ~, 'i~ " '~ `. ~.' Statement Period From 6/01!08 To 6!30!08 ,~` ~- Page 1 of 1 ~~~ ,._ ` Customer Service: (800) 63&7283 ary EleCttOn I~ecordecl as o1 Q~I05120D5 ~u may have read about the "carb rrn , your personal negative impact on the environment, in this onth's newsletter. In a time where current technology and general human habits are causing harm to the mosphere, going paperless with your Total Control Account statements is not only environment friendly, at convenient. Registering is easy;- just go to www.eservice.rnetlife.com, follow a few simple steps, and ect to receive paperless statements. After selecting this choice, you will receive an ema'Ii each month rt'rfying you that your statement is available for viewing online. Less printing will not only aid in ~eserving trees, but also helps eliminate clutter by having one less thing to opens ~A MONEY MARKET OPTION {MMO) =FECTIVE ANNUAL YIELD 1.50% AS OF 08!30!0$ ccount Summary #~gfa+4le 1~1>31t~ $10,009.23 Interest $9.43 Other Nr ~:' _- $0.00 fe~rt` To lir~~ear~ct >' $102.92 ~e~IC To Thai :Test 11i~1lefht ____ __._ ___ _. $0.00 -ansaction Details - - - ~t~s .Data ; .. - =- At~1Y- CIS t~ f~rlplian --- _ 24 Customer Closeout 24 Wi#hdrawal Check 24 Withdrawal Check 24 Withdrawal Check 24 Withdrawal Check 24 Closeout Interest ~~ ,` $1,994.35- $2,003.73- $2,003.73- $2,003.73- $2,003.73- $9.43 . / ,~ ~~ ' `E l~ i~ 1, ~~, J NNN IIN NIN NIM NIN NNN NNI NIA NN NNI ~ y ~.,a , ~ ~ i ~~ ~ ~'', ~~' ~~~ ~~}' f '~ r~ `'w ~''n ' ",~ / i'rTi- _,t ' c<`~,; ~ i DIAMONDS i,~~f; ,:w.. 3-...x_ ~%'~"'-~~, WATCHES _"((~•( y+{~{t(~ ESTATES ' •`'r~ ~L:.i's: '~-':`•'c ~ ~ JEWELRY " '~~ L ~4l J~~ .~ ,;.... ~ APPRAISED '~ rj VEDA }l~ - ,i; `~~ _ ph. 389-5090 JEWELERS OF MANASSAS x:~~ ~ 9045 MATHIS AVE. ~~ •~f{"" _ MANASSAS, VA. 22110 _ ~~ ~,- -' TO WHOM IT MAY CONCERN: DATE '~ ~~`. This is to Certify THAT WE ARE ENGAGED !N THE JEWELRY BUSINESS, Appraising Diamonds, Watches. Jewelry and Precious Stores -'~'j''•::>: _:~ of all descriptions and hm bean ~ engaged in asid business for rtwny yeses. We herewith certify that ova have this day carefully axanvnn! ~~r' /- 4 - -+ait/ ~-- ~ the folbwing 5sted and descrt7ted artitdes the Prey of - 3 ~_ M G: ~ ~ p L ~,,:., o ~~ ~] ~.~ ~ .,.j t.j (r. 1 .~ 1 v~ ~ ~T ~1 ~ E i 4 1 fp ~ ~ 9 ~t ~ .. f ''. a I ADDRESS ~"~~ 1 ~ Cd•' t'...~ i s-a \ `.J \ L A/ ~ L. `,~- S ~ I We estimate the value as listed for Insurance or other purpose at the current retail value, excluding f=ederal and other taxes. M making thin 4 ^ _"~~ . ~ >•r3:.., lV9 '37 tdtJT 3CJreE TLS '_f^_ha59 6' f9piafe One T':C:ec. r.. .. - ,,..: .t ~ ~ i . . 7 _ .. _ z r.., ~. >.. .., .~ .~ ~ _. ~ , f,_~... ~ _ _ - .. - _ . -,. .. .. i )~ : • .:.... _._..~'-a C.G:. ~;.,;:G'i-i'{ vt_'L X3.3 e-:`ti3~i= I30=tom -..r,- - - i:iit±i E'`{~ciiij~ ti t3T±E' 3I?G J*£'_fl"!±_fiin C',iL 1Ct8? i. i ~: ., i-.. .: •.. [.T f1 l fY Pl ~ ~ ~j e'• +' .Z T. e~ k- .~ } e~ ~ ,. ~ ~ ~ ~, 1 I ^ ~~ r s : ~: ~`^''n --7'- f{]\jb ~ S~__ _ ~ _- _- - i ;;';;,.ini; '•r ~..v ~. The forego7na Appraisat is made and accepted ~•pan the expressuriderstandktg ttrat ~O l.u~oifhv ar Aespansil~+4ity is ~rcurfea by .ne Appra s y;vinq yam - .. '.r { ~.. .. ~- tlf_~Fii t ~y.7V ~~1\L ~~ ~~~!~~~ L'r!f'~' iRi3 vvv~.. .._•-__ _ ...... .... . . ~ .z t ~ I ;yi a i_)t t Y t5 ?,i)JU ! ! ,~{~(•j t~yi i(Jfj iy.,t u_it_i i V,lil1U 12,000 ?2,000 30,000 11.000 fcJ: r..roQCt !!?!mot' »~ IC. 3dtlU 11ec1: C1L _>e~J,*"'~~ 3?rsi1, C% J.ii~~J, 1'.i J~rJ~ lltatCt iiYcsueeu :•... _ `~~~ gage ! 07 ! fv:i~ ~U~ll Ylodei A llsp1HY ~.ng ra~r~ isve~f ~~.: ~v~„= s R,.T~ 1 C,} 1n` ~! ~;%t }Z ~ i ~r 1,U6~ !eit} 19 ~!S-~ 1 aF?Ui~#U 4l: ? 1,0tiU 21,UUt! ~0,U0U ~s,UUU t-1 ?~+,aUii Vll: it~-K1A I:UUY~ !J~U-.il 200140 41.: ~,~00 11,000 I~,U00 -'0,OOU ~ 1I,00U rC11zUUk 5~UA1v 200/40 4L 4,500 -7,U00 9,000 I:i,00U b,ji~lt l Ul?Uk S1/llAi~ "rU014U 4L s,UOU 1,5110 11,000 1,000 7,000 -~-.,-.* :TT- ~tsrlldf- at; E- ilt~it ~,~Ut1 11,000 17,000 $,000 s~arz ~ ~u~~l/ xs ~~0/~0 ~c ~,c~~u ~,~ou I~,truc~ 19,000 ~,s~c~ I`t~~1V SIJI.)A~ {Briggs or Murray} x(!0/40 ~C 7,500 11,000 16,000 22,000 ~ IU,000 ~t3t1DY 1~AOON {3,~ 10 mfg} 200/40 4C` 12,0U0 ?0,000 31,000 39,UOU S I Ii,00G Leta rrYdaleti .lime _>tJt~~. http://www.manheimgold.com/frames/classic.cgi?make=FORD&year=1930&model=Model+A 1 /1712009 REV-15t0 EX ~ (1-97) SCHEDULE G INTER-VIVOS TRANSFERS 8~ COMNDHERITANCEDTAXERETURNANIA MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF r- f / ~ f ~ ~~ ~ ,, n ~ _, ~ f~' • ~ FILE NUMBER ©S ~; y L- / a /rya ~ (mac ~ I ' ~ ~ v 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. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR REt,4TIONSHIPTODECEDENTANDTHEDATEOFTRANSFER. DATE OF DEATH DECD~S EXCLUSION TAXABLE VALUE „ , • ,_ _ _ ATTACH A COPY OF THE DEED FOR REAL ESTATE . io~.,f ./fri~u~•ty ~a~~"a.cf- Nv q~~51~~5q° ~'~~Z,7'~~•8 ~~a17~5T amdu -~ .------' • ~i~~e~~C~4r~eS : ~Str'~u~ 5: ~rine'~ ~~ ~~h~~y r~%7f~ ~~~~~ '+~a-~37~i~ 17I.~~j7Jr' 13t~ r~'c~e ~ 1~ 2ao! S, q~~cr~jn,Fe ~- /~ur~aref ~'earr-, ~4 ~-2~~ ~~' ~r'WG, ,~ ~.~".3 ~y ~'C1 ~% 3G3~'~~- NI c.c he n ~~s b u r~, ~~ n~~ 1 ~ Mu ry .4//~ r75•o /7 , a sq 1~oe? f(~ur! 1Pr/• ~ ~` a 5~3~ Fl' / ~' ~3(p 3 - ~z ~en nc tt S~rr~rrPi f A ~ 9.~~~, dtzug~~,k f he rasa.. /~acke r, ~ ~~~` ~foy~~ ~ er~~, rPd ~,Zr'~5 , ~ ~. ~! :~lo P' z- ~ rt~TCr1a2~,TX ~~t~r ~u~~ M~~d~r I lT, fy.3od L ~/~.lYi7 Sf • ~~~'37~ ~~ ~/3~G'- °75 i~arrss~~r~,1~~! ~ 7~~/. San Go., ~• ©. ,fox r 7'1~ 3 , ~-//es~n, ~T~C, 77~~3~ 17~ 3, ~5~ 1 ~ r~ ~n ~~ nurfy e~n~~t~. ~~-a~~f9 aa,~r-~ .._- ~r ~-~ G~ te,~, da~9 h ~~ ~ ~5`t~- s~z~ ~ ~a~ • Sze C.~~c.~ P ran ~ ~ , . Mir e~r~,~ "J?eam, drug l~-k ~ ~~~©s ~".2 ~5•o5'-fs~. ~ g ~ ~/,;, s Q ~ , any ~ ~ ~~~ ~~- ~5~,,•. s~- ~ ~'`~05•• ~~ TOTAL (Also enter on line 7, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) rm ~ !'tI OV.L c?Yri y `~~ Fort6Vm•nellV'46R01-13x0 ~Innuity 3 Financial Group® QZlarteYlJ~ Statement ~BWNGYCG 3rd Quarter 2008 MB 01 018287 16462 H 85 A ELIZABETH A MIZDAIL Owner: ELIZABETH A MIZDAIL 27 CREEK BANK DR Annuitant: ELIZABETH A MIZDAIL MECHANICSBUR6 PA 17050 -1814 Fixed contract number: 99-5655915 Contract effective date: 4/16/92 Plan type: Non-Qualified Representative: LOTS J VALENCIA III'illlllllillllll"llll'll'I'I'i"11'11"I'I"lllllll'lllllll'I Broker/Dealer: LINCOLN FINANCIAL ADVISORS ,. If you have any questions regarding this statement, ,: , •-` please call Lincoln Financial Group at ~4:~ 800-4LNNCOLN (8UU-454-6265). Visit our web site at www.LFG.com. vague summary t~uuur vitrue r.rr .,u,.~ ; L~~~ C~11u; :'a,`u~ as of 6130108 activity 61301'08 -9130108 as of 91'30108 nixed Account S i2,782.r7 -~ ii,oi 7.io ~ 34.G7 n .vv Total contributions to date are $5,881.97. Withdrawals (exclur~iinJ sales dtrtr~e_r mrri altrtunl /ees) to date are $0.00. Subaccount ~.^, _ ~ ~r' ' Activity C ~ ~ ~- Fixed Account - Date. Type of activity ~~ Amount 7/17/08 Death clainu'_ ~ ~ , ^I , GJ~ - $2,560.67 ~ `~~ 7/17/08 Death claim ~* - $2,S6U.67 (,t ~ ~l ` ~ 7128/U8 Death claim - $2,563.33 •T 7/28/U8 Death claim ti 1 ~ ~',.`i - $2,563.34 8/21/08 Dea[h claim - $2,569.15 Net activity - $12,817.16 Notifications This confirmation is prepared by TheLincoln National Liie Insurance Company or one of its Life Insurance company affiliates pursuant to its agreement with the principal underwriter of the insurance securities described herein, for the benefit of the setting broker dealer. • Notify Lincoln promptly if infornlation contained in this document is not accurate. Please feel free to re-confirm any oral communication in writing to further protect your rights. Lincoln financial Group is the marketing came far Lincoln National Corporation and its affiliates. ~ 2(1O$ Tlie Lincohr National Life Insurance Canrpanv. Hmer~can ivauona~ insurance ~.ompany AMERICAN P.O. Box 1763 NATIONAL Galveston, TX 77553-1763 IIIIIIIIIIIIIII Toll Free Telephone Number: 1-800-252-9546 Business Hours 7:30AM-5:OOPM CT, Monday-Friday ~-, .., ~' - ~`~ Quarter/y Statement Palladium Multi-Year Guarantee Annuity ELIZABETH A MIZDAIL Owner: ELIZABETH A MIZDAIL 27 CREEK BANK DR Annuitant: ELIZABETH A MIZDAIL MECHANICSBURG PA 17050 Contract Number: 14525819 Annuity Type: Non-Qualified Contract Date: 05!09/2005 Statement Period: 01 /01 /2008 thru 03/31 /2008 ___ Annuity Summary Beginning Annuity Premium Withdrawals Accrued Interest Ending Annuity Ending Surrender Value as of Paid During Value Value 01 /01 /2008 Statement Period 522,102.99 50.00 $0.00 $208.59 522,31 1.58 520,699.21 Activit Durin Statement Period Effective Activity Amount Interest Date Rate _ - r~l ~• ~- ~~ < -~ J i~ ^~~~ .~ ` ~ j ~ ~ ,;, ,,?tJ =~" ~-~ ' ~k~ I he average interest rate ~n effect for this annuity on 03/31 /2008 is 3.85%. This is aweighted-average rate .7.,+.....,in.,.~l f..,.., +F,e inrlnrirllrol ratcc oanh nrnmillm is carninn nn (14/41 /7(1(18 and is cllhiort to rflAnnP If . . F,o on., rn,nctinnc nloacc call vnl.r rcnrcccntativc nr ral~ nllr tn~~ frao nllmha• t-R(1(1-7ri%-4h4('1 _s: uvlS J. VALENCIA 1 lelr~nl nl rlnl n nl~l w l n n~ ncnnc ~l~nn nl r A C A HIT 1 111 ~1 n~l'1 V~ v 1 ~ ~~ 1 rlnnc-nrnnv nn ~-7o~n Agency Lode: 1-9YS-ZV T..i.... i...., .. td.....4.nr• f?'f ilu~lu_G, .. r , EV-1511 EX+ (12-99) ~ ~, SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER . ~ I ~ z~a l ~-I--~~ ~4 - M ~ zdr~~ i ~-~- ~~ v ~~~a Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ toss r©~~~~ C~ ~~~ ~,~ur~c~~ I l,"~c~~0 ~ ~/ ~ ~ ~ 5~ c~us~ ~ d F~~- s ~~~9i~ ~r vuf-Q~ y-~u) /I r~at~ ~~_~`) B. ~ ADMINISTRATIVE COSTS ~. Personal Representative's Commissions , Name of Personal Representative(s) ~ e~l~ ~ ~ • ' ' ` ~L ' ` ~~ ~` Social Security Numbe~-r(7s)/EI/~N-"Number of Personal Representativ~e(Js) ~ ~ s ~ ~ g ~~5~ Street Address ~ / / (1f /J L ~ ~/~~ / '` d ~ City _ ~.C ~ f~ ~ State ~' Zip ~~ r Year(s) Commission Paid: h ~ ~C //~ ~~ ~~ ~ ~~ ~~ ~~'~ p, Attorney Fees ~Q~~ GF'~ ~~ 5• ,~~~ ~ 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant ~ /~ Street Address City State _ Zip Relationship of Claimant to Decedent q, Probate Fees ~. y ~~ ~`~~~,W 5. Accountant's Fees ~ j~ g. Tax Return Preparer's Fees ~ `~ 7. / TOTAL (Also enter on line 9, Recapitulation) I $ o~ ~~, ~~' (If more space is needed, insert additional sheets of the same size) _~ A ,' A r ~f 11 I.r~~ .k At ~ {~ ~ ~ ~` ~ wpi.. r,~ ~ '~ ,..7 ~ I a. ~ ~- ~ Michael J. Malpe<„i, Owner • Jeremy J. Shart<,er, Funeral Director FUNERAL HOME 8 ~llarket Plana Way • 1Llechanicsburg, PA 17055 Phone: (717) 697-4696 June 23, 2008 Margaret M. Ream 29 Creek Bank Drive Mechanicsburg, PA 17050 ii1C riiiiei`ai Sei'vlce ivi tJii2auirttl :-l.:ri2Zldit VJe sincerely appreciate ttte conttdence yott ha~~e p1aC+rd in us at-t~ ~•ti continue to assist you ;;~ cvcry may w:; :;a;;, r~c;tsc feel free to contact us if you have any questions in regard to this statement. itiL, Y'vi,t,~_1VV`iiV'v iy ~iy eiL,;J;i~L.1~ 7:ritC,;t„~:,, ,,, ,,,,,,,,,Kv....~ :•siti.c.trr~.rs:,.:l.Y1~;rar.:.:1~u;YZL_~a. AND MERCHANDISE THAT YOL` SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. rKtsrt,33i!l~~l.8r.xii.i?. Services of Funeral llirectortstart , 3~yo~.~ i~i~I`.tt~-1. Ii3+~ZiL ~ic,e~r iir. i.ti.JiaiTr.~ . . ~33b.i.vr $t.Ll'.i. l 1'.7J f'~jLl~t_.T'l.~t`lyl'.f~: P~!ar Casket . . ~.~.~5u:uv Register Package . 568.00 100 Additional Preyer Cards. $23.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED 57426.00 AT THE TIME FL~tERAL ARRA'~GEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMUDATION7. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES Certified Death Certificates , $90.00 Newspaper Notices -Patriot, $405.29 Newspaper Notices -Times Leader, $120.00 Newspaper Notices -Courier-3ournal . $815.50 Clergy/N1ass Offering, $100.00 Organist. $1 f10.00 Flowers. $238.50 TOTAL CASH ADVANCES AND SPECLAL CHARGES . 51869.29 CONTRACT PRICE 59295.29 HISTORY 05/2712008 Homesteaders 5-8366.15 06/23/2008 Cumberland County VA Allowance, $-1~•~ TOTAL AA~iOUNT DUE ~ ~ ~ ~ , ~' ~~ t ~ ` __ _~-_~. invoice No. CustQxner Name Gene Mizdale - __ __- ' -_ __._ Address - - - - - -- -- _. City State ZfP ---- Phone _ _ _ _ - _ ----_ -~ Desch on _ _._-- __ __ _ _ 67 Dinner Buffet ~. ,~J ~. tNVOiCE Misc Date 5!28!!2008 Order No. __ _ _. __. Rep __ --- FOB ---- ;Unit Price, TOTAL $12.99 ' $ 740.43 _ ---- Subtotal ------ $ 740.43 ' __ _: - Deposit _ _ 740.43 $ ' Tax Rate 6.00°~ f $ 44.43 - --- - - Gratuity _ 18.00% TOTAL $ 133.28 ~~L Or Catt Ahead Fc :~ . ~ ` ~ fining ~ e~ '` - ~ - t. ~, C~ ~ 1 1 88 Name Address Home # ° ,` ~ ~~~ ° ~ ~~~.. r i -~ I i ~ ..~ ~ f ~ ~~f~w '~+~M:.. Work # Store # Pick-Up Date/Pick-Up Time J ~~ Date & Time Customer Called In Order Taken By I`ve ~~.~t~'u t The Moat !7 Cheesy Glasaic T ` Small tra 4 Medium tra i ~~~s.uc 1+ P°' ,v~''~o'9 13 8 63 fY TRf1Y >;~At & C}~EBE RAY lIET 1~T b' ~~~,~row -- :SF Si tC SNiss ~, ~1S :rarlic-chili i~ s 5-10 ~':~ 5.2~.~ ,eairt ~, r ~ nit r Hot c ~~ ~ ~ _- - >BQ ~~ garlic-chili ~`1`CS~t~ 1 >~„k• e ~ Your ~~~~ ~~k~ caper t-lor Ll~,u. ,- _: a Shiro! Sliced Ham Hoar Dim~er BsdtcrbaC! Ttakey Dirnter _ ?Vr;;, F»~l..r+~ J_n}scxrr C~larnbake REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER L ~~ z a- b e, fly ~ , /~l r z- Gt ~ (( az / - ~ ~ ~ ~ S ~U RELATIONSHIP TO DECEDENT ~ AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Mary Allinson, 259 DoeS~ur~~~~,(i~~nett Square PA, Catherine M. Atchley, 91716 Biggers Road, Burke VA Theresa Rocker, 3929 Stonehenge Road, Port Worth TX Eugene B. Mizdail 11, 6300 Evelyn Street, Harrisburg, PA 17111 Margaret M. Ream, 29 Creek Bank Drive, Mechanicsburg, PA Molly E. Atchley, 9716 Biggers Road, Burke, VA Timothy .1. Atchley. 9716 Biggers Road. Burke VA Madison E. Chase, 4217 Templeton St., Bakersfield, CA 93312 Anthony Granger, 5873 Shope Place, Hamsburg, PA 17365 Ryder A. Granger, 5873 Shope Street, Harrisburg, PA 17365 Christine K. Ilocker_ 3929 Stonehenge Road, Porth Worth. TX Aidan McKissick ` ,~,~/ Story e ~ ~K n /E'd - IJi/lS'bur y, P.~4 Brennan McKissick ~?oiy' Annelise Ream, 233 I Rochester Ct., Midlothian, VA 231 l3 Charlotte Ream. 2331 Rochester Ct.. Midlothian. VA 23113 Cooper Ream, 5 Clapp Lane, Sagamore Beach, MA 02562 Maren Ream. 2331 Rochester Ct., Midlothian. VA 23113 Wyatt Ream, 5 Clapp Lane, Sagamore Beach, MA 02562 Jan David Trobisch, 4217 Templeton St.. Bakersfield. CA 93312 Katie Trobisch. 4217 Templeton St., Bakersfield. CA 93312 child Ct9CUl~jr,~_ 115 estate after expenses & specific bequests child ~~ 115 estate after expenses & specific bequests child ~/ 1/5 estate after expenses & specific bequests child ~~ I/5 estate after expenses & specific bequests child txC~[f~~~, 115 estate after expenses & specific bequests grandchild $1000 and diamond ring ~a grandchild $1000 great-grandchild $ I OOU grandchild $1000 great-grandchild $1000 grandchild $1000 and pearl necklace Beat-grandchild $ I000 great-grandchild $1000 great-grandchild $1000 great-grandchild $1000 great-grandchild $1000 erect-grandchild $1000 great-grandchild $t000 great-grandchild $1000 grandchild $1000 and diamond ring ~ C 1 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE N/f} B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS N/,4 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S LAST WILL AND TESTAMENT OF ELIZABETH A. MIZDAIL I, ELIZABETH A. MIZDAIL, 819 Hogestown Road, Mechanicsburg, Cumberland County, Pennsylvania 17055, do publish and declare this to be my Last Will and Testament, hereby revoking all other prior wills and codicils made by me. FIRST: Famii Background and ApnointmPnr ,.f ~ ~.aca, u lUl'. (A) Family and ga~kground Information. I am married to EUGENE B. MIZDAIL. I have not been previously married. The children of our marriage are CATHERINE M. ATCHLEY, MARGARET M. REAM, MARY E. ALLINSON, THERESA A. HOCKER, and EUGENE B. MIZDAIL, II. Throughout this Will, EUGENE B. MIZDAIL will be referred to as "my husband" or "my spouse". The word "issue" will include my children as well as my other descendants. (B) Appointment of Executor. I appoint as my Executor and successor Executor (all hereinafter referred to as Executor or Executor(s)) under this Will, the following named persons or corporations to serve without bond and without being required to account to any Court: Executor: My husband, EUGENE B. MIZDAIL. Successor Executrix: My daughter, CATHERINE M. ATCHLEY. Second Successor Executrix: My daughter, MARGARET M. REAM. SECOND: Funeral and Last Illness Ex enses• Taxes. (A) Expenses of Funeral and L ast Illnecc. Notwithstanding that my husband survives me, I direct my Executor to pay my funeral expenses and the expenses of my last illness from my estate. ~ G~. -_ ~~. , ~" ~~~ ~~ Ja'y' 's..~ f '~ LA~'1' WILL AlVll 11:~'1A1V1Llr 1 OF ELIZABETH A. MIZDAIL PAGE 2 (B) Taxes. I direct my Executor to pay any and all estate, inheritance, succession, legacy, transfer and other death taxes or duties, by whatever name called, including any and all interest and penalties thereon, imposed under the laws of any jurisdiction by reason of my death, upon or with respect to any and all property included in my gross estate for the purpose of such taxes, whether such property passes under or outside of this Will, out of my residuary estate, without being prorated or apportioned among or charged against the respective devises, legatees, beneficiaries, transferees, or other recipients of any such property or charged against any property passing or which may have passed to any of them. The Executor shall not be entitled to reimbursement for any portion of any such taxes from any such person. THIRD: Tangible Personal Property. Except for those items excluded below and those items enumerated in the Letter of Instruction, I bequeath to my husband, EUGENE B. MIZDAIL, all tangible personal property, including but not limited to clothing, jewelry, heirlooms, furniture, personal effects, motor vehicles, and all other similar articles, which I own, and the insurance thereon, if my husband survives me by sixty (60) days. Tangible personal property shall not include: (1) any and all property used by me in any business, (2) cash on hand or on deposit in banks, (3) stock or securities, (4) any type of evidence of indebtedness, and (5) any life, health or accident insurance policies. If my husband is not living on the sixty-first (61st) day after my death, I bequeath such tangible personal property to my children living at the time of my death, to be divided among them as they may select in as nearly equal shares as is practical. If my husband and my children do not survive me, I leave such tangible personal property to the issue of my children, per stirpes. If there is any disagreement as to distribution, I direct my Executor to make such distribution. The decision of my Executor shall be final and binding. Any items not selected or any items which my Executor considers unsuitable for my children maybe distributed or sold in the sole discretion of my Executor and, if sold, the net proceeds therefrom shall be added to the residue of my estate. Any such article allocated to a minor may, as my Executor deems advisable, either be delivered to the minor or to any person to safeguard on behalf of the minor. Notwithstanding any other provisions in this Article THIRD, I may leave a separate, dated and unsigned Letter of Instruction, which I shall place with my Will, containing directions as to the ultimate disposition of certain of the property bequeathed under this Article THIRD, and such Letter of Instruction shall determine the distribution of such items. r '' .,r~ ~' ~'71~r ~.,,: ~~~ ~. ~, LAST WILL AND TESTAMENT OF ELIZABETH A. MIZDAIL PAGE 3 FOURTH: Residuary Gifts. (A) If my husband, EUGENE B. MIZDAIL, survives me, I give, devise and bequeath all the rest, residue and remainder of my estate, of every kind and character, real, personal and mixed, tangible and intangible, and wherever situated, including any lapsed or renounced legacies, devises or residuary bequests (and including any property over which I may have a Power of Appointment), to my husband, EUGENE B. MIZDAIL. (B) If my husband, EUGENE B. MIZDAIL, does not survive me, I give, devise and bequeath all the rest, residue and remainder of my estate, of every kind and character, real, personal and mixed, tangible and intangible, and wherever situated, including any lapsed or renounced legacies or devises (and including any property over which I may have a Power of Appointment), to the following individuals: (1). Each of my grandchildren and great-grandchildren that survives me shall receive ONE THOUSAND AND 00/100 DOLLARS ($1,000.00). (2) The reset, residue and remainder shall be distributed to my children, CATHERINE M. ATCHLEY, MARGARET M. REAM, MARY E. ALLINSON, THERESA A. HOCKER, and EUGENE B. MIZDAIL, II, in equal shares, per stirpes. FIFTH: Appointment of Guardians. [THIS ARTICLE IS INTENTIONALLY LEFT BLANK AT THE REQUEST OF THE Testatrix.] SIXTH: Spendthrift Provision. No beneficiary shall have the power to anticipate, encumber or transfer his or her interest in the estate or any trust estate in any manner other than by the valid exercise of a power of appointment. No part of the estate or any trust estate shall be liable for or charged with any debts, contracts, liabilities or torts of a beneficiary or subject to seizure or other process by any creditor of a beneficiary. `~ ~ ,~~ ~ . Y~~~, ~ f, 1 LAST WILL AND TESTAMENT OF ELIZABETH A. MIZDAIL PAGE 4 SEVENTH: Annointment of Trustee and Successor Trustees. [THIS ARTICLE IS INTENTIONALLY LEFT BLANK AT THE REQUEST OF THE Testatrix.] EIGHTH: Powers of Trustee and Executor. In addition to the powers and duties as may have been granted elsewhere in this Will, but subject to any limitations stated elsewhere in this Will, the Executor and Trustee (when applicable) shall have and exercise exclusive management and control of the Estate or Trusts, respectively, and shall be vested with the following specific powers and discretion, in addition to the powers as maybe generally conferred from time to time upon them bylaw: (A) In the management, care and disposition of the Trusts or Estate, the Trustee and Executor, respectively, shall have the power to do all things and to execute such instruments as maybe deemed necessary or proper, including the following powers, all of which maybe exercised without order of or report to any Court: (1) To sell, exchange or otherwise dispose of any property at any time held or acquired hereunder, at public or private sale, for cash or on terms, without advertisement, including the right to lease for any term notwithstanding the period of the Trust, and to grant options, including any option for a period beyond the duration of the Trust; except that, in lieu of any binding shareholder agreement or buy/sell agreement to the contrary, the Executor and Trustee shall not be permitted to sell the stock or any other ownership interest in any business owned by me, or my husband, or held in trust, at my death, without first offering the same for sale to my children, or without next offering the same to the corporation or business represented by such ownership interest for redemption. (2) To invest and reinvest all or any part of the Trust Estate in any common or preferred stocks, shares of investment trusts and investment companies, bonds, debentures, mortgages, deeds of trust, mortgage participations, notes, real estate, or other property the Trustee, in the Trustee's discretion, selects; provided that the Trustee may not invest in any stock or securities issued by the ~'~a, LAST WILL AND TESTAMENT OF ELIZABETH A. MIZDAIL PAGE 5 corporate Trustee or issued by a parent or affiliate company of such Trustee; in the manner that, under the circumstances then prevailing (specifically including, but not limited to, the general economic conditions and the anticipated needs of the Trust and its beneficiaries), persons of skill, prudence, and diligence, acting in a similar capacity and familiar with those matters would use in the conduct of an enterprise of similar character and similar aims, to attain the Settlor's goals under this trust agreement. (3) To retain for investment any property deposited with the Trustee or Executor hereunder; except that the Trustee or Executor may not retain for investment any stock in the corporate Trustee or Executor, or in a parent or affiliate company of such Trustee or Executor. (4) To vote in person or by proxy any corporate stock or other security and to agree to or take any other action in regard to any reorganization, merger, consolidation, liquidation, bankruptcy or other procedure or proceedings affecting any stock, bond, note or other security. (5) To use attorneys, real estate brokers, accountants and other agents, if such employment is deemed necessary or desirable, and to pay reasonable compensation for their services. (6) To compromise, settle or adjust any claim or demand by or against the Trusts or Estate and to agree to any rescission or modification of any contract or agreement affecting the Trusts or Estate. (7) To renew any indebtedness, as well as to borrow money, and to secure the same by mortgaging, pledging or conveying any property of the Trusts or Estate, including the power to borrow from the Trustee at a reasonable rate of interest. (8) To retain and carry on any business in which the Trusts or Estate may acquire an interest, to acquire additional interest in any such business, to agree to the liquidation in kind of any corporation in which the Trusts or Estate may have an interest and to carry ' -/- LAST WII,I, AND TESTAMENT OF ELIZABETH A. MIZDAIL PAGE 6 on the business thereof, to join with other owners in adopting any form of management for any business or property in which the Trusts or Estate may have an interest, to becom or remain a partner, general or limited, in regard to any such business or roe e hold the stock or other securities as an investment, and to employ agents and co fer on them authority to manage and operate the business, property or corporation, without liability for the acts of such agent or for any loss, liability or indebtedness of such business if the management is selected or retained with reasonable care. (9) To register any stock, bond or other security in the name of a nominee, without the addition of words indicating that such security is held in a fiduciary capacity, but accurate records shall be maintained showing that such security is a Trust or Estate asset and the Trustee or Executor shall be responsible for the acts of such nominee. (B) Whenever the Trustee or Executor is directed to distribute any Trust principal or Estate assets in fee simple to a person who is then under twenty-one (21) years of age, the Trustee or Executor shall be authorized to hold such property in Trust for such person until he/she becomes twenty-one (21) years of age, and in the meantime shall use such part of the income and the principal of the Trusts or Estate as the Trustee or Executor, respectively, ma deem necessary to provide for the proper support and education of such person. If such person should die before becoming twenty-one (21) years of age, the property then remaining in trust shall be distributed to the personal representative of such person's estate. (C) In making distributions from the Trusts or Estate to or for the benefit of an minor or other person under a legal disability, the Trustee or Executor need not require the appointment of a guardian, but shall be authorized to pay or deliver the same to the custodian of such person, to pay or deliver the same to such person without the intervention of a guardian, to pay or deliver the same to a legal guardian of such person if one has already been appointed, or to use the same for the benefit of such person. (D) In the disbursement of the Trusts or Estate and any division into separate trusts or shares, the Trustee or Executor shall be authorized to make the distribution and division in money or in kind, or both, regardless of the basis for income tax purposes of any property distributed or divided in kind, and the distribution and division made and the values established ~~ r ~ ', ~~5 r~4 _ [T __ 11 lIS 1 ; ~ ! H V. LAST WILL AND TESTAMENT OF ELIZABETH A. MIZDAIL PEE 7 by the Trustee or Executor shall be bindin Trustee or Executor may in making such d~ tributionlor div lion l persons taking hereunder. The same property to several trusts or shares. allot undivided interests in the (E) The Trustee and Executor shall be authorized to lend or b right to lend to or borrow from m orrow, including the y estate or the estate of my husband or any trusts which I or my husband may have established during life or by will at an ade ua adequate security, and upon such terms and conditions as the Trust rate of interest and with and equitable. ee or Executor shall deem fair (F) The Trustee and Executor shall be authorized to sell or urc value as determined by the Trustee or Executor, an mY husband, or any trust created b Y property to or from my estate, thefestate ofet same person or corporation may be acting as Executordo mn estate r b or as Trustee of any of my other trusts. Y Will, even though the Y or the estate of my husband (G) The Trustee and Executor shall have discretion to determine be charged or credited to income or principal or allocated betwee ' Trustee or Executor may deem equitable and fair under all Whether items should n Income and principal as the power to amortize or fail to amortize an the circumstances, including the or all of the profit resulting from the matupri~ or all of an Y premium or discount, to treat any p~ premium or at a discount, as income or _tY or sale of any asset, whether ~~ ~ rttm the seeles price of artycl P~°n the same b~,~ Mme and weren °~ ut~on aFutq i~ sis m~'e a°d priacip~ to tt+a~tt income P~ to - ~' ~. ~ Oa sty the same, ~ ~ ~.,~y ~, ~~~~~~ orb" obsolesce on eny assets 8tibje~ to tlcproci~~o ~ ~~~` Executor ma , all ~ ~ ~ y reasonably deem equitable and just ender all the +circumstances. roe and (H) If at any time the total fair market value of the assets of an be established hereunder is so small that the corporate Trustee's annual fee for adm ri st hed or to trust would be the minimum annual fee set forth in the Trustee's re larl Bring the then, in effect, the Trustee in its discretion shall be authorized to t rrninatepsub hshrustf or to hedule decide /~- ' S LAST WILL AND TESTAMENT OF ELIZABETH A. MIZDAIL PAGE 8 not to establish such trust, and in such event the property then held in or to be distributed to such trust shall be distributed to the persons who are then or would be entitled to the income of such trust. If the amount of income to be received by such persons is to be determined in the discretion of the Trustee, then the Trustee shall distribute the property among such of the persons to whom the Trustee is authorized to distribute income, and in such proportions, as the Trustee in its discretion shall determine. (I) When the authority and power under this Will is vested in two (2) or more Executors or Trustees, the authority and powers are to be held jointly by the Executors or Trustees, respectively. A majority of the Executors or Trustees may exercise any authority or power granted under this Will or granted bylaw, and may act under this Will. Any attempt by one such Executor or Trustee to act under this Will on other than ministerial acts shall be void. The action of one such Executor or Trustee under this Will maybe validated by a subsequent ratification of the act by a majority of the Executors or Trustees. NINTH: Rights and Liabilities of Executor and Trustee. No bond or other security shall be required of any Executor. This instrument always shall be construed in favor of the validity of any act or omission by any Executor or Trustee, and any Executor or Trustee shall not be liable for any act or omission except in the case of gross negligence, bad faith or fraud. Specifically, in assessing the propriety of any investment of a Trust, the overall performance of the entire Trust shall be taken into account. Each Executor and Trustee shall be entitled to receive reasonable compensation for services actually rendered to my estate or to my Trusts, in an amount the Trustee or Executor normally and customarily charges for performing similar services during the time which he/she performs the services. TENTH: Tax Elections. In determining the estate, inheritance and income tax liability relating to my Estate, the Executor's decision as to all available tax elections shall be conclusive on all concerned. If the Executor joins with my husband in filing income tax returns, or consenting for gift tax purposes to having gifts made by either of us during my life considered as having been made one-half by each of us, any resulting liability shall be borne by my Estate and my husband in such proportions as they may agree. In accordance with IRC Section 2632(a) and without regard to whether a Federal estate tax return is actually filed, my Executor shall allocate so much of the Federal Generation Skipping Transfer (GST) exemption amount as will fully GL ~ ~-- LAST WILL AND TESTAMENT OF ELIZABETH A. MIZDAIL P- A=E 9 exempt any generation skipping transfer which may occur under this Wil 1. ELEVENTH: Definitions and General Provisions. (`~) Su=1~al• Any benefici days after my death shall be considered not to have su ived rn g m husband, who dies within sixty (60) e. (B) Trust Estate. "Trust Estate" including income, which ma belon to a Trust at an means all assets, however and wherever acquired, Y g y given time. (C) Ch- i1- dren. Except for discretionary distributions whic among a group of persons and distributions pursuant to a valid exert' h may be made unequally ~`lppointment, in making a distribution to the children of an ise of a Power of distributed shall be divided into as many shares as there are li ' deceased children of the person who left childre Y person, the property to be take one share and the share of each deceased chil vmg children of the person and n who are then-living. Each living child shall descendants in the same manner. A posthumous hild shall be ided anion of his parent. considered as living at the death (D) Code. Unless otherwise stated, all references in m W' numbers are to those of the Internal Revenue Code of 1986, as provisions of an q Y ill to section and chapter y subse went federal tax laws applicable to n, ended, or the corresponding y estate. (E) Other terms. The use of an either the singul~- or the plural includes the o heerder includes the other genders and the use of (~ Ca tions. The captions set forth in this Will at the be i ' divisions hereof are for convenience of reference only and shal the provisions hereof or to affect in an g mm~g °f the various y way their construction and app d atop. to define or limit (G) Powers of A ointment are Exercised. B Appointment which I may possess at my death. Y this Will I exercise any Power of 9G ~' l-~ ~;~ ~, :r" ~i< LAST WILL AND TESTAMENT OF ELIZABETH A. MIZDAIL PAGE 10 IN WITNESS WHEREOF, I, ELIZABETH A. MIZDAIL, the Testatrix, have to this my Last Will and Testament, typewritten on eleven (11) pages, including the Acknowledgment and Affidavit, set my hand and seal this _~ o ~ day of December, 2002. . ELIZ ETH A. MIZD L Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at her request, as witnesses hereto, in the presence of the said Testatrix, and in the presence of each other. Each of us further declares that he or she believes the Testatrix to be of sound mind and memory. The preceding instrument consists of this and ten (10) other consecutively numbered typewritten pages including the Acknow~dgment and Affidavit. (print name) r residing at ~~ ~`~ residing at ~~ Ww.www.R/A ~ 4 $ `r ~r e' is YOU MAY DATE AND INITIAL THIS DOCUMENT BUT DO NOT SIGN YOUR NAME. LETTER OF INSTRUCTION FOR ELIZABETH A. MIZDAIL DATE: 1. Instructions or comments to my family: q a_ a,n„~ -rn.i--~~acrL. to ~ ~~L.e-~...eC1~-+-~9~ L%!v-wdi-,oJt~ / ~ f~~.L.~ ~ Q ~~~ U ~ ~_ ~_