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HomeMy WebLinkAbout03-10-0915056041169 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO Box2aosol INHERITANCE TAX RETURN ~~ 23 Harrisburg, PA 17128-0601 RESIDENT DECEDENT c~ ~ ~ ~'t ~ J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 162-36-9520 12122008 03151948 Decedent's Last Name Suffix Decedent's First Name MI MELLINGER GLENDA M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE 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) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number KEL LI E. KISHBAUGH 717-774-3363 Firm Name (If Applicable) First line of address 518 SIXTEENTH STREET Second line of address City or Post Office State ZIP Code REGISTER OF WILLS USE ONLY c~ ^~ r~ - , --~ ~,,; :~ .~ ,~ DATE FILED-~ NEW CUMBERLAND PA 17070 -' ri Correspondent's a-mail address: ~' ,"i Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowle it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any SIGNATURg.~F PERSON RESPONSIBLE FOR FILING RETURN D TE 518 SIXTEENTH STREET, NEW CUMBERLAND, PA 17070 SIGN U{2E OF PREPARER OTH THAN REPR,I=SENTATIVE DATE 02-25-2009 J ~'y'~.2., 11 L." 1~ .~ ADDRE S P.O. BOX 7, DOVER, PA 17315 PLEASE USE ORIGINAL FORM ONLY _~ -y.t CJ -,-, - ,- ; . -. ~, - ~ t. _: _ {.._., -' _. _i ,f iC'f% `) -~7. Side 1 15056041169 15056041169 J REV-1500 EX Decedent's Name: GLENDA M HEELING RECAPITULATION 15056042160 1. Real estate (Schedule A) ............................................. 1. 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) ~ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 - 7) ................................... 8. Decedent's Social Security Number 162-36-9520 128,830.00 158,411.04 16,620.00 35,688.87 339,549.91 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. .. 10. 11. Total Deductions (total Lines 9 & 10) ................................ .. 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 15. 16. Amount of Line 14 taxable 3 3 5 9 0 6 4 0 1 s , . at lineal rate x .04 5 . 17. Amount of Line 14 taxable at sibling rate x .12 17 18. Amount of Line 14 taxable at collateral rate x .15 18 19. TAX D UE ........................................................ 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 3,884.06 24.95 3, 909.01 335,640.90 335,640.90 15,103.84 15,103.84 Side 2 L 15056042160 15056042160 REV-1500 EX Page 3 Decedent's Complete Address: File Number 2 0 0 9- 0 0 0 2 3 DECEDENT'S NAME GLENDA M MELLINGER STREETADDRESS 1900 BECKLEY DRIVE CITY NEW CUMBERLAND STATE PA ZIP 17070 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 15 , 10 3 . 8 4 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 7 5 5.19 Total Credits (A + B + C) (2) 7 5 5.19 3. tnterest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0 . 0 0 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 14 , 3 4 8 . 6 5 A. Enter the interest on the tax due. (5A) 0 . 0 0 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 14 , 3 4 8 . 6 5 Make Check Payable to: REGISTER OF W-LLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ........................................ .. ^ b. retain the right to designate who shall use the property transferred or its income : .................. .. ^ c. retain a reversionary interest; or ....................................................... .. ^ tl. 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? .................................................. .. ^ 0 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ... .. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................ .. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GLENDA M. MELLINGER 2009-00023 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 exchange between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. (If more space is needed, insert additional sheets of the same size) TAXING AUTHORITY: WEST SHORE SCHOOL DISTRICT :AR: 2008-09 REAL ESTATE TAX NOTICE NEW CUMBERLAND I PROPERTY ID r .E ROBIN GASPERETTI, T/C (717) 774-7424 k 26230543143 1113 BRIDGE STREET NEW CUMBERLAND, PA 17070.1634 ~~_ ~.~ X SCHOOL • • • -`'>. "~~ ,TE 10.5 SATE 1,245.52 SCE 1,270.94 ALTY 1,398.03 ON OR BEFORE FACE DATE AFTER PENALTY DATE By 09/01/2008 ( 1'245.52 By 11101/2008 0.94 AFTER11/O1I2OO8 1,398.03 ASSESSED VALUE 128,830 HOMESTEAD EXCLUSION FARMSTEAD EXCLUSION 0 NET ASSESSMENT 121,042 •p; KISHBAUGH, GLENDA M CIO GLENDA MELLINGER 1900 BECKLEY DRIVE NEW CUMBERLAND PA 17070 1900 BECKLEY DRIVE & HARDING STREET DATE - 07/0112006 QUENT BILLS ARE TURNED OVER TO TAX CLAIM ON 12131/2008 TAX. CC~I_L~~'-i Cdr; H,U~ ~ ~ 200 ~`~~~ I-I r c ~^ L 1 C U L' BILL # 008904 TAXPAYER'S COPY TAXING AUTHORITY: WEST SHORE SCHOOL DISTRICT X YEAR: 2008-09 PER CAPITA TAX NOTICE NEW CUMBERLAND BOROUGH YABLE ROBIN GASPERETTI, T/C (717) 774-7424 1113 BRIDGE STREET ID# 0250D04457 NEW CUMBERLAND, PA 17070-1634 SCHOOL ~ • • - ,. TAX PER CAPITA PER CAPITA ON OR BEFORE REBATE DATE 511 679 LTY DATE ATE AFTER PENA REBATE 4.90 4.90 By 09/01/2008 9.80 FACE 5.00 5.00 By 11/01/2008 10.00 PENALTY 5.50 5.50 AFTER 11IO1I2OO8 11.00 ~~~~~ ~,h`S~T~~I~~ I ~ TO: MELLINGER GLENDA M. !/~,)~ ~~! ~~u.ir}+2 1900 BECKLEY DR. NEW CUMBERLAND PA 17070 h p ~~ ~ r 200 fi~J ~ ~lt i~ t:~,SH ~ CH~C-< BILL # 039576 ILL DATE - 0710112008 NPAID TAXES WILL BE SENT TO DELINQUENT COLLECTOR ON 12/1I2DD8 TAXPAYER'S COPY REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT is IAI t ~r FILE NUMBER GLENDA M. MELLINGER ~nn~-nnn~~ Au property ~omtly-ownetl with right of survivorship must be disclosed on Schedule F tir more space is neetled, insert additional sheets of the same size) St MEMBERS 1St FEDERAL CREDIT UNION Members 1st Investment Services Located at Members 1st FCU 5000 Louise llrive Mechanicsburg, PA 17055 717-795-605] 800-237-4054 717-795-5176 fax February 11, 2009 Kelli E. Kishbaugh Executric of the Estate Of Glenda M. Mellinger SS# 162-36-9520 Date of Death: December 12, 2008 To Whom It May Concern: Below are the date-of--death account values you requested: CITNA - 000060127848 - $41,826.62 Aim - 3810784292 - $31,477.74 Allstate - $48,175.68 Andrew Steele Scruor LrvesUncut Consnltnw If you need any other information, please do not hesitate to contact us at the number below. Sincerely, Michele A. Jones Invest Administrative Assistant Kegistered Representative uf, securities and certain insurance products are offered through INVEST Financial Corporation INNVEST), member FINRA, SIPC and affiliated insurance agencies. INVEST is not affiliated with Members Ist Investment Services. Products and services offered through INVEST are: • Not NCUA Insured • Not a deposit of or guaranteed by any credit union • Mav lose value St Members 1st Investment Services Located at Members 1st FCU 5000 Louise Drive Mechanicsburg, PA 17055 ® 717-795-6051 MEMBERS 1st ~ ~~~~~ 5i~6 fax FEDERAL CREDIT UNION asteele@mlinvest.com INVESTMENT SUMMARY GLENDA MELLINGER MAY 8, 2008 GLENDA - ROTH IRA 3810784292 1. AIM Money Market Fund -Class B # of Shares Share Price Current Value 7,805.17 $1.00 $7,805.17 2. AIM Income Fund -Class B # of Shares Share Price Current Value 3,058.12 $5.79 $17,706.50 3. AIM Income Allocation Fund -Class B # of Shares Share Price Current Value 1,081.42 $10.57 $11,419.82 Andrew Steele Senia~ Ln~estmerrl Cnnsttllnnt TOTAL VALUE: $36,931.49 Securities o(~ered through Financial Network Invesnnent Corporation Member SIPC. Members 1st and Financial Network are separate companies. REV-1508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASFI, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER GLENDA M. MELLINGER 2009-00023 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUEATDATE NUMBER DESCRIPTION OF DEATH 1. MEMBERS 1ST #45137-03 VACATION CLUB 1,005.00 2. 2007 SUBARU- BLUEBOOK VALUE 13,115.00 3. 1969 FORD MUSTANG- NON OPERATING 1,000.00 4. PERSONAL HOUSEHOLD ITEMS 1,500.00 TOTAL (Also enter on line 5, Recapitulation) I $ 1 6 , 6 2 0 . 0 0 (If more space is needed, insert additional sheets of the same size) St Send Inquires la: ~~. 5000 Louise Drive Main Switchboard: (800) 283-2328 PO Box 40 EZ Call: (7 t 7) 697-4372 or (800) 263-4372 NOV 25 , 2008 1hrU DBC 24 , 2008 Mechanicsburg, PA 17055 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 ~os~o-ioass MEMBERS~1° xrvvw.memberslst.org TeleBranch: (B00) 237-7268 Account Number: 45137 Page : 2 of 2 02 -HOLIDAY CLUB Date Transaction Descri tion Additions Subtractions Balance Nov 25 Ba/ance Fonva~d Joint Owner: KELLI KISHBAUGH 0.00 Dec 24 Ending Ba/ance 03 -VACATION CLUB 0.00 -~~~~~~~~r~ ouutracuons Balance ov 25 Ba/ance Forrva~d Nov 30 Deposit Dividend 1.050'% 1, 004.33 0.87 1,005.20 Annua/ Percentage Yie/d Earned >. G16U~ from > 9/0 9/ZDOB through 91/30/2008 Dec 24 End/ng Ba/ance • 1.00.5 ?n 05 -MONEY MANAGEMENT Date Nov 25 Transaction Descri tion Balance Forward Additions Subtractions Balance Nov 30 Deposit Dividend Tiered Rate 15,744.52 Annua/ Percentage Yre/d Earned 9.080 -from 99/09/2008 through 99/30/2008 13.94 15,758.46 Dec 02 Deposit.by Check 6 786 58 r r Dec 24 Ending Ba/ance , . ~ ~ 04 - ~ ~ ~ CERTIFICATE- .ACCOUNTS 40 - 24 MONI'H'PRIME;RATE CERT Maturity Date --Oct .1.7,.:2010 Date Transaction Descri tion 71/ov 25 Ba/ance. Forward Additions Subtractions Balance Joint-`Owner.:' `KELLI -KISHBAUGH 11, 987.13 =Nov 30 - --- Deposit Dividend-3:100%=- - _ _ _- - _ _ _ __ ._v _._. __ ~___.. _ _.._...::30:54 - Annua/ Percentage_ Yie/d.Eamed 3. 140'%arom 99/09/2008 ~fhrough 99/30/2008 - ..._ _ _ __._ _ .__. ._~ 12;017-:67 ~Dec.~24 .EndiO~aBe/ance. _ _ . _ 12:;10 ;17 ~ 67 42 -11 MONTH:CERT 'Maturity:Date -Jun 09, 2009 _ Date Transaction :Descri tion -Nov 25 Ba/ance .Forward Additions Subtractions Balance Joint Owner: KELLI :KISHBAUGH 25,672.12 -Nov 30 Deposit 'Dividend 3:550% p I 74.91 p; Annua/:Percentage ;Yie/d Eamed_369U~ from 99/0>~,2008 through 99/30/2008 ~~ I t 25,747..03 Dec-24 _Endng Ba/ance ~ `,, ~ j , 25.747:03 YTD SUMMARIES TOTAL DIVIDENDS PAID 00 REGULAR SAVINGS 159.40 02 HOLIDAY CLUB 11.7 03 VACATION CLUB 9.04 05 MONEY MANAGEMENT 180.34 ' ~% 11 CHECKING 40.24 MONTH PRIME RATE CERT~>~~ St. ~~~~ ~ , _ Y 42 11 'MONTH CERT 3 Total Year To :Date Dividends `Paid NOTE: Total includes closed shares .Total Yea~'To"Date Interest Paid NOTE: Total .includes closed loans 1,622:72 0:00 Kelley Blue Book THE TRUSTED RESOURCE r ~,~„o.~,..,........ 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BCD - AtlSIQNAtENT f . ~~ f r .~ w ~,: , ~..~ x ~` • I c, . ~ 7 CITY dTA ZW CAOE OATH AWUtREO+ 2. TITLE PEE ~ C.. 1 •.~ -• PUACHASEO ~~~ TO COVNTY GOOEB ,. w} C. t,.i fl {~, ~, i'4*.eay V „~ >l- { ~Q ~.. r... ~,,,y. O 4J LAST NAME {OR FULL LfSIN 9S NAMEI PtRST NAME Dt,B }1AXyE p OR SU9. roar LI$TIN4 Cdd REVHRSE 6ttSE. OP YELLOW COPY ti pAT O 6lRTTi s. LIEN PEE ~~ ~i~ iS MJ1tGE OP VEHICLE MOOEL vEAR 9001 ~ ~' O PLATE TO dE t8dUE0 8Y OEPART-dffNT tPR00f Qf +NSURANCE MUST BE ATTAGHEO.) G7 E.xCHANGE PLATE Tp 8E ISSUED 9Y DEPARTMENT r..1' iFµvfyRARY PLATE i$SUIiD SY ~ Ut_L AGENT TEAAp, PLATE NO. C! ~{~ TR.~N5FER Of PREVIOUSLY 18BUE0 TRANOFHR d RENEWAL OP PLATE TRANSPp12 i pHPLACEAEt#F OP PLA Mon#E I9 $EINO TRAN$~RRHD {IF 4. RCO18TRATPOM ON PRDCE$SIN(F ia'EE PA DUPHOTD IDA REE EXEMPT NUMdElt Ae ASSIDNEp dY THE OEPAPTM6NT COUNTY CODE s. OUPUCATE REA FC® NQ. OP cAq~d~ d RiwFER 70 COU'MT1' COA£9 TRAN1lfER FEE LI$TI'N3 ON REVER6E 81gE OF YEI,I.p1N tX3PY 7.. INCREASE. PEE . REPI.wcaMeNT FEE C1 ("~ FAlft CT PUfyf2 OTAL PAID ~~ t4. Pt ATE ~ I (AUp / TNRU bj ~ ~ ~y .~ i!, 4RANp TOTAL SEN6 ONE CWECN IN r F OF ST1CK£R ! t IAOp 0 X AOy THIS AMOUNT "- ~ L. .` RGASONPOR PLACaBMI !~ LOST C7 DEFACED ~ STOLEN Q NEVER RECENED itcast r'.. NOTE iI •NEVER R'eCE1VF.dT Hark Ia rawclrwst. ~+7er~s1 mext axro~a Corn: LIV-+Ii t _... ,. I CERTIFY TiUT pM i.{(,~('ly{ DAY YP,/1,R~,,,~,,,,,~ I$$UlhiCs et~iENT {. W~A( I Ata"@NT KO t95t,Ir.~G riwE CHECKED TO pGTERMI.NQ THAT THc VEHICLE 19 WSUR£D AR"6 AGENT ISS,rEA TF.1aPO RARY REGISTRATION TO TSQ ABgVE APpLICAN I, iN CNF4RMA?!CN COMPLIANCE ~N17F{ ALt APPt1CA81,E PROy1910N$ OfTML VEHICLE 156UIN A IDNATURE TELEPHONE NO. C OGE ANO OEPAR7AtE N7 REGUTATtOta9. I 7 ~ I1FVE CER7IFV THAT w,E Fuvc ExAt,1INEO rwo s;cNEO TH'$ apgM Art'fEq ITS Co~eP1.6TUSN,WD TRAT THE INaaauAATTON ;31VK_N t9 TRVE Ah0 CORRECT" tF ANY EXEMPTION i$ CLAIMED. T~ PURCitASER FURTHER R', IFIES THAT Hi/SHE t3 AUTHORIZE6 TO CLAiM TWt& EXEMPTION kA1iE ACKtiOWt.EODE TkAT YAVp MAY LOSE MY10JR OPERATiNO PRIViLEGE$ISi L3A VEWiCLf REtitSTRATEt7N~&; KOR t.UAE YO MAINTAIN FIhWiC;A.L RE$PON'~tg~Y ON THE CUR;REN7tY REGISTERED VEHICLE POR THE PERIOp t'NT Ri;BiSTRATIOM. LM1E ACKNOWIF,.LX3E THAT itWH M.Lv 9E $U'BJEGT TO A f NOT PJCCEEOING f 000 ANO IMPR18pNMENT CIF }!pT MORE Tt{AN '^NO YEARS fpR ANY FALSE $TATFrytENl TTU~T 11118: MAKE ON THISS FARM. IST r e'sP,ho+u o. AESI6N- PENT `a}waarRtgr~gt +d 8 i°~ (~ ~ ~ ~. ' ~ ~4 C- ~c+ u (,.,~ 2ND $gnrWre Purah~rsororAutiw~acFd w ~ siePrwna o MENT n rr a w arer I. ~ t i H• ~ g NQTE, tF A CppURCIiAB$R OTHER Tl~taW YOUR $PpU88 t9li6T€DAND Y8U WANT THH TIT'tETD 8f t19TFD AAA~$$$ 'JOINT TENANTS WI7N RIGHT 4F SURYNQAS.HIP' fiON DEATH DF ONE p~•~hER.. F4 TtTtE GpES TO $URVtyINO pWMER,j GKECK H&RE C~. 4TtiER4Vt$E, THE TITLE WtLi, $E ISSUED AS TENA~B I~ COMMON' {ON pEATH Of O#~E OWNER, INTEREST OF OEGEAS£0 OwtvER '30ES TO i~3htER HE1R$ OR ESTATE } ' NOTE IP THE VE~!CIE IS 70 98 USED AS A OAiIY RENTAL OR 6L~A3'Ep VEHICLE, GHEGK THk9 BLOGIt D. tf 6LDCK IS GHECi{ED, COMPLETE XIiO ATTACH FORM MV.1L. REV-1509 EX+ (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GLENDA M. MELLINGER FILE NUMBER 2009-000~~ If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G SURVIVING JOINTTENANT(S) NAME ADDRESS RELATIONSHIPTO DECEDENT A.KELLI E. KISHBAUGH 518 SIXTEENTH STREET DAUGHTER NEW CUMBERLAND, PA 17070 B C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER DATE FOR JOINT MADE TENANT JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTIONAND BANKACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEEDFORJOINTLY-HELD REALESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~. A. 06/10/85 MEMBERS 1ST- CHECKING #45137-11 3,420.73 500 1 710 37 2. A 07/29/00 MEMBERS 1ST- CERT. #45137-40 2,028.90 500 , . 6 014 45 3. A 06/12/07 MEMBERS 1ST- CERT. #45137-42 5,774.58 500 , . 12 887 29 4. A 05/31/85 MEMBERS 1ST- SAVINGS #45137-00 0,153.51 500 , . 15,076.76 TOTAL (Also enter on line 6; Recapitulation) 5 3 5, 6 8 8 8 7 (If more space is needed, insert additional sheets of the same size) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 Po Box 286601 TAXPAYER RESPONSE ACN HARRISBURG PA 17128-6661 08163938 REV-1543 EXAFP(OB-OB) DATE 12-24-2008 TYPE OF ACCOUNT EST. OF GLENDA MELLINGER ~ SAVINGS SSN 162-36-9520 ® CHECKING DATE OF DEATH 12-12-2008 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: KELLI KISHBAUGH REGISTER OF WILLS 518 SIXTEENTH STREET CUMBERLAND CO COURT HOUSE NEW CUMBERLAND PA 17070 CARLISLE, PA 17013 MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call (717) 78i-83[7 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 45137-11 Date 06-10-1985 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 3, 420.73 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to TeX $ 1,710.37 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 76.97 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE 1 FAILURE TD RESPdND''WILL RESULT IN AN OFFICIAL TAX ASSESSMENT; A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of ONE Wills and an official assessment will be issued by the PA Department of Revenue. BLOC K ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return L Y to be .filed by the estate representative. C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART ~ and/or PART ~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY relationship to decedent: ~ A AF PA DEPARTMENT DF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ';PAD LINE i. Date Established 1 i I 2. Account Balance 2 $ i 2 3. Percent Taxable 3 X ~ 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - 5 6. Amount Taxable (, $ 6 7. Tax Rate 7 X i ~ 8. Tax Due g $ ~ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION nMn~i-~r oar„ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H 0 ME C . - .-.. -••-_• ,•~~ ~~~~~ ~ .., i uw ~umpuLaLlOnJ S PENNSYLVANIA 1NHEKiIANI:E IAx INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D Po Box zsB6B1 TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (BB-087 FILE N0. 21 ACN 08163938 DATE 12-24-2008 KELLI KISHBAUGH 518 SIXTEENTH STREET NEW CUMBERLAND PA 17070 EST. OF GLENDA MELLINGER SSN 162-36-9520 DATE OF DEATH 12-12-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 45137-11 Date 06-10-1985 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 3, 420 . 73 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax NOTE: If tax payments are made within three $ 1 , 71 () ' 37 months of the decedent's date of death, Tax Rate X . 045 deduct a 5 percent discount on the tax due. Potential TaX DUe Any Inheritance Tax due will become delinquent $ 7 6 ' 9 7 nine months after the date of death. PART TAXPAYER RESPONSE FAxLURE?TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or check box "A" and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ~ N L Y to be filed by the estate representative. C. ~ The above informs ion is incorrect and/ar debts and deductions were paid. Complete PART 2~ and/or PART ~ below. PART 2^ TAX If indicating a different tax rate, please state relationship to decedent: RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD OFFICIAL USE ONLY ~ AAF PA DEPARTMENT OF REVENUE LINE 1. Late Established 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 S 6. Amount Taxable 6 +fi 6 7. Tax Rate 7 X ~ 8. Tax Due g $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMnIiNT Pern Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) _ ~~~ «~~~_~ ~~~ amine ~ or lax ~omputatlon) $ PENNSYLVANIA INHERITANCE TAX EST. OF GLENDA MELLINGER SSN 162-36-9520 DATE OF DEATH 12-12-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 INFORMATION NOTICE BUREAU DF INDIVIDUAL TAXES A N D PD Box zao6ol TAXPAYER RESPONSE HARRISBURG PA 17128-0601 REV-1543 EX AFP (08-08) TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FDR FILING AND PAYMENT INSTRUCTIONS Account No. 45137-40 Date 07-29-2000 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 12, D28. 9D payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable )( 50.000 Amount Subject to TaX $ 6,D14.45 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 270.65 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE 1 FAILURE TD RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K ~ g, ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax re 0 N L Y to be filed by the estate representative. turn C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state ^ ~ OFFICIAL USE ONLY ~ AAF 2 relationship to decedent: PA DEPARTMENT DF REVENUE TAX RETURN - COMPUTATION OF TAX DN JOINT/TRUST ACCOUNTS iPAD LINE 1. Date Established i 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ ~ 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X i ~ 8. Tax Due g $ 8 Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. H OME C ) KELLI KISHBAUGH 518 SIXTEENTH STREET NEW CUMBERLAND PA 17070 FILE N0. 21 ACN 08163939 DATE 12-24-20D8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMr1Il A1T oerr, PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I L E PD eDx zeo661 TAXPAYER RESPONSE ACN HARRISBURG PA 17128-6601 REV-1543 E% AFP (BB-BB) DA T E N0. 21 08163939 12-24-2008 EST. OF GLENDA MELLINGER SSN 162-36-9520 DATE OF DEATH 12-12-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: KELLI KISHBAUGH REGISTER OF WILLS 518 SIXTEENTH STREET CUMBERLAND CO COURT HOUSE NEW CUMBERLAND PA 17070 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculatin8 the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call C717) 767-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 45137-40 Date 07-29-2000 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 12,02$.90 payment to the Register of Wills. Make check Percent Taxable X 50.000 payable to "Register of Wills, Agent". Amount Subject to Tax $` 6, 014 .45 NOTE: If tax payments are made within three Tax Rate X months of the decedent's date of death, .045 deduct a 5 percent discount on the tax due. Potential TaX Due $ 2 7 0. 6 5 Any Inheritance Tax due will became delinquent nine months after the date of death. PART 1 TAXPAYER RESPONSE FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid i nterest, or check box "A" a nd return this notice to the Register of 0 N E ~ Wills and an official assessment will be issued by the PA Depar tment of Revenue. B L 0 C K 0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax retur to be filed by the estate representative. n C. ~ The above information is incorrect and/or debts and deductions were paid Complete PART 2~ and/or PART 31J below. . PART If indicating a different tax rate, please state relationship to decedent: i TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established i 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 2 +fi 3 X 4 +fi 5 - 6 7 X B $ OFFICIAL USE ONLY ~'jAAF PA DEPARTMENT OF REVENUE i 2 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION nMniiNT anTn ~~ un ~Ine ~ yr lax GOmpUtatlOn) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ) PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I L E Po Box zao6Bl TAXPAYER RESPONSE ACN HARRISBURG PA 17128-0601 REV-1543 E% AFP (eB-88) DAT E N0. 21 08163940 12-24-2008 EST. OF GLENDA MELLINGER SSN 162-36-9520 DATE OF DEATH 12-12-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS TD: KELLI KISHBAUGH REGISTER OF WILLS 518 SIXTEENTH STREET CUMBERLAND CO COURT HOUSE NEW CUMBERLAND PA 17070 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 45137-42 Date 06-12-2007 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 25, 774.58 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to TaX $ 12, $$7.29 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Potential Tax Due Any Inheritance Tax due will become delinquent $ 579.93 nine months after the date of death. P~T TAXPAYER RESPONSE ~ FAILURE TO RESPOND WILL RE51J1~T IN AN C)FFICTAL TAX ASSESSMENT A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Znheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3LJ below. PART It indicating a different tax rate, please state relationship to decedent: TAX RETURN - CDMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF TAX ON JOINT/TRUST ACCOUNTS PAD 1 2 3 X 4 5 6 7 X 8 +fi OFFICIAL USE ONLY CjAAF PA DEPARTMENT DF REVENUE I 2 3 4 5 6 7 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT Pain i w i f~~. icnter on nine 5 or l ax ComputatioN S Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ~ PENNSYLVANIA INHERITANCE TAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES A N D PD BOX 280601 HARRISBURG PA 171za-ocgl TAX P A Y E R R E S P O N S E FEV-1543 EX AFP (OB-BB) i FILE N0. 21 ACN 08163940 DATE 12-24-2008 EST. OF GLENDA MELLINGER SSN 162-36-9520 DATE OF DEATH 12-12-2D08 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: KELLI KISHBAUGH REGISTER OF WILLS 518 SIXTEENTH STREET CUMBERLAND CO COURT HOUSE NEW CUMBERLAND PA 17070 CARLISLE, PA 17013 TYPE OF ACCOUNT SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 45137-42 Date 06-12-2007 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 25 ~ 774.5$ payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to TaX $ 12 ~ $87.29 NOTE: If tax payments are made within three months of the decedent's date of death, Tax Rate X . 045 deduct a 5 percent discount on the tax due. Potential Tax Due $ 5 7 9 . 9 3 Anv Inheritance Tax due will become delinquent nine months after the date of death. P~T TAXPAYER RESPONSE 1 FAILURE TD RESPt3ND WILL RESULT IN AN OFFICIAL TAX A55ESSMENT, A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Department of Revenue. BLOCK ~ B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be tiled by the estate representative. C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3LJ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY relationship to decedent: ~ A AF PA DEPARTMENT OF REVENUE TAX RETURN - CDMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 I 2. Account Balance 2 $ z 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 $ 4 5. Debts and Deductions 5 - 5 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X ~ 8. Tax Due g $ 8 PART DEBTS AND DEDUCTIONS CLAIMED DATE PAID PAYEE DESCRIPTION e~tn)iur onTn ~• - ine ~ ~r iax ~ompucau on) $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ~ PENNSYLVANIA INHERITANL:E IAX INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I L E PD BOX 260601 TAXPAYER RESPONSE ACN HARRISBURG PA 17128-0601 REV-1543 EX AFP (08-OB) DA T E N0. 21 08163937 12-24-2008 EST. OF GLENDA MELLINGER SSN 162-36-9520 DATE OF DEATH 12-12-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: KELLI KISHBAUGH REGISTER OF WILLS 518 SIXTEENTH STREET CUMBERLAND CO COURT HOUSE NEW CUMBERLAND PA 17070 CARLISLE, PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call (717) 787-8327 with questions. COMPLETE PART 1 BELOW * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 45137-00 Date 05-31-1985 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 30, 153.51 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to Tax NOTE: If tax payments are made within three $ 15, 076' 76 months of the decedent's date of death, TaX Rate X . 0 4 5 deduct a 5 percent discount on the tax due. Potential TaX DUe Any Inheritance Tax due will become delinquent $ 678.45 nine months after the date of death. P~T TAXPAYER RESPONSE 1 FAILURE 'TO RESPQND WILL RESULT IN AN OFFICIAL TAX A55ESSMENT= A. ^ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid interest, or check box "A" and return this notice to the Register of C 0 N E ~ Wills and an official assessment will be issued by the PA Department of Revenue. B L 0 C K B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the estate representative. C. ~ The above information is incorrect and/or debts and deductions were paid. Complete PART 2~ and/or PART 3~ below. PART If indicating a different tax rate, please state OFFICIAL USE ONLY relationship to decedent: ~j AAF PA DEPARTMENT OF REVENUE TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PAD LINE 1. Date Established 1 1 2. Account Balance 2 $ 2 3. Percent Taxable 3 X 3 4. Amount Subject to Tax 4 +fi 4 5. Debts and Deductions 5 - ~ 6. Amount Taxable 6 $ 6 7. Tax Rate 7 X ~ 8. Tax Due B $ 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION nhtniiNT pern „err un amine n or lax compUtatlonJ $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ~ ,.~.,.,~ PENNSYLVANIA 1NHtK11ANl;t IAJC INFORMATION NOTICE BUREAU OF INDIVIDUAL TAXES AND F I L E Pa Box 260601 TAXPAYER RESPONSE acN HARRISBURG PA 17128-0601 REV-1543 EX AFP (OB-OB) DA T E ND . 21 08163937 12-24-2008 EST. OF GLENDA MELLINGER SSN 162-36-9520 DATE OF DEATH 12-12-2008 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: KELLI KISHBAUGH REGISTER OF WILLS 518 SIXTEENTH STREET CUMBERLAND CO COURT HOUSE NEW CUMBERLAND PA 17070 CARLISLE, PA 17013 TYPE OF ACCOUNT ® SAVINGS CHECKING TRUST CERTIF. MEMBERS 1ST FCU provided the Department with the information below, which has been used in calculating the potential tax due. Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you feel the information is incorrect, Dlease obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Commonwealth of Pennsylvania. Please call (717) 787-8321 with questions. COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 45137-00 Date 05-31-1985 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance $ 30, 153.51 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X 50.000 Amount Subject to TaX NOTE: If tax payments are made within three $ 15, 076.76 months of the decedent's date of death, Tax Rate X .045 deduct a 5 percent discount on the tax due. Potential Tax DUe $ 6 7 8 . 4 5 Any Inheritance Tax due will become delinquent nine months after the date of death. PART TAXPAYER RESPONSE FAILURE TO RESPONh WILL RESULT IN AN OFFICIAL TAX ASSESSMENT A. ~ The above information and tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain C H E C K a discount or avoid i nterest, or check box "A" and return this notice to the Register of 0 N E Wills and an official assessment will be issued by the PA Depar tment of Revenue. B L 0 C K ~ 0 N L Y B. ~ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the estate representative. C. ~ The above informs ion is incorrect and/or debts and deductions were paid Complete PART 2~ and/or PART ~ below. . PART TAX LINE it intllcating a tlifferent tax rate, please state relationship to decedent: RETURN - COMPUTATION i. Date Established 2. Account Balance Percent Taxable Amount Subject to Tax OF TAX ON JOINT/TRUST ACCOUNTS i 4 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due 2 +~ a X 4 +~ 5 6 7 X 8 +fi PAD OFFICIAL USE ONLY ~~ AAF PA DEPARTMENT OF REVENUE ) i 2 3 4 5 G 7 8 PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMn~iNT aern ~n~er un amine ~ or lax t;omputationJ S Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME C ~ REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS wiHi~vr GLENDA M. MELLINGER FILE NUMBER 2009-00023 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ MUSSELMAN FUNERAL HOME (PREPAID FUNERAL PLAN) 0.00 2. ADDITIONAL EXPENSES PAID AT DEATH 1,385.78 3. OPEN GRAVE - SPRINGHILL CEMETERY 525.00 4. CLERGY SERVICES - REV. E. LIDDICK (CASH HONORARIAM) 150.00 5. FAMILY GATHERING - FUNERAL CATERING 667.80 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) StreetAddress City Year(s) Commission Paid: State ZIP 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant StreetAddress City State ZIP Relationship of Claimant to Decedent 4. Probate Fees 364.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 6 0 0. 0 0 ~. LEGAL NOTICE- CUMBERLAND COUNTY LEGAL JOURNAL 75.00 8. LEGAL NOTICE- THE PATRIOT NEWS 116.48 TOTAL (Also enter on line 9, Recapitulation) $ 3 , 8 8 4 . 0 6 (If more space is needed, insert additional sheets of the same size) ~~.~ ~~ ~~~~ `~ \ .~F~~. '=` ,~ ~. ,;;,, > ~llll~~~~II1I'Il~i1171 ~Il Il Il71c~IC~I llll®II1TIl(~, ~II71~. Established 1895 Brian C. Musselman, FD. Supervisor William G. Pegan, FD. P.O. Box 137 324 Hummel Avenue Lemoyne, PA 17043-0137 (717) 763-7440 To Funeral Expenses of G1,ENDA M. MELLINGER Dec. 24,2008 FOR ITEMS NOT COVERED IN PRE-NEED CONTRACT K`11i Kishbau~h 518 Sixteenth St. New Cumberland, PA 17070 2008 December 19 Casket spray from Royer's Tent ~ chairs at cemetery Copies of death certificate Patriot-News obit Shippensburg News Chambersburg Public Opinion Fran. for 3 vehicles to cem. .Prep. work for autopsied body $255.46 150.00 150.00 344.32 35.00 125.00 126.00 200.00 (for outside prof. assistance) TOTAL ......................... $1,385.78 z~~ ~ ~~~ FOR APPOINTMENT PHONE 717-763-7440 S~ MEMBERS 1St FEDERAL CREDIT UN-ON Send Inquires to 5000 Louise Drive PO Box 40 Mechanlcsburg,PA 17055 www.memberslst.org Main Switchboard: (800) 283-2328 EZ Call: (717) 697-4372 or (800) 283-4372 7DD: (717) 697-5312 or (800) 283-2326 exf. 5312 TeleBrench: (800) 237-7288 Statement of Accounts Nov 25, 2008 thru Dec 24, 2008 Accounf Number: 45137 Balances at a Glance: Checking : 2 , 745.47 Savings : 31,149.63 Certificates : 37 , 764.70 Loans: 0.00 Money Management : 22 , 545.04 Swipe 5 YTD Reward : 0.05 10255 1 AV 0.329 20509-10255 ~in~~~ui~~~ni~ui~~~un~i~~n~~un~~~i~uin~~~u~ui~i~l GLENDA M MELLINGER C/O KELLI KISHBAUGH 518 SIXTEENTH STREET NEW CUMBERLAND PA 17070 Your current Member Loyalty Rewards level is Titanium. Page : 1 of 2 1099-TNT's are not included in this statement. If you earned at least $10 in dividends on your account for 2008, you will receive your 1099-INT in a separate mailing in early January 2009. 1099-INT information will also be available on Members 1st Online in early January. CHECKING ACCOUNTS 11 -CHECKING Date Transaction Descri lion Nov 25 _Ba/ance. Forward- Additions Subtractions Balance Joint Owner. KELLI KISHBAUGH 3.,419:77 Nov 30 Deposit.Dividend 0,;250% ... 0 70 Annua/ Percentage'Yie/d'Eamed 0:25U~ from 91'/01/2008 through 11/3072008 . 3;420.47 Based on Average Daily Ba/ance of 3, 499.77 Dec 23 Check 002785 Tracer 0001691542 Dec 24 Check 002784 Tracer 0001753357 (~ ,r l1 / ~` ~~ t3'ti/ ~ 150.00- S2 - .3,270:47 2 745 47 < Dec 24 Ending Ba/ance ~ 7 ? ~ - , : ~. ~ _.,,_.__.~ 2 , 745:47 Check # Amount Date 002784 525:00 Dec 24 2 Checks :Cleared for 6.7,5.00 !`~ CHECK:SUMMARY: _ I Chec :# Amount :Date +.002785 150.00 -Dec 23 SAVING S ACCOUNTS DO -REGULAR SAVINGS .. ~ _ Date Transaction Descri lion . f ~ - Additions 'Subtractior Nov 25 Balance Forward ~t~~, Joint Owner:' KELLI KISHBAU ~` ` Nov 26 DeposIDA30310306030E CO.~Y ' :,E~,,,~ ~~ ~ `623.00 Nov 30 Deposit Dividend 1;000% ~ ~ F.~DE~~~iL C~t;EDI7'-~t;J1`~1~~7Ttit 23:55 Annua/ Percentage Yre/d Eamed 1:000'/ from 9>/09/2008.'through 91/30/2008 Dec 01 Deposit ACH :FAIR,VIEW TWP'.NON:, _.892., TYPE` 'PAYMENT :ID: ;1251904625''CO' FAIRVIEW TWP :NON Dec 24 Ending Ba/ance Balanoe 26.;605.24 29,228.24 29,257.79 30;144:43 30,144:43 7~atFiy s ~eC~ 891 West King Street Suite C Shippensburg, PA 17257 Sold To Kelli Kishbaugh 599-6098 KATHYS DELI 891 W. KING ST SHIPPENSBURG. PA 17257 Thant ID: 000000008219024 m ID: 05780952 ::168430991 P one Order ~~ ~xXXXXXXXX2125 :°~± Method; Manual ~~vd; Online Batch~~ 001030 .908 09,11;32 Code: Y ~: 000005 Rppr CodE, 613213 ~l~ $ 661,80 Customer Coav Phone # (717) 477-8300 Sales Receipt Date Sale No. 12/l 8/2008 10176 Check No. Payment Met... Project Name iption Qty Rate Amount 60 10.50 630.OOT Subtotal $630.00 Sales Tax (6.0%) $37.80 Total $667.80 E-mail Web Site kpugh@pa.net www.kathysdelionline.com RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse S ware Carlisle, PA 1713 MELLINGER GLENDA M Estate File No.: 2009-00023 Paid By Remarks: KELLI KISHBAUGH CJ Receipt Distribution Receipt Date: 1/09/2009 Receipt Time: 10:33:41 Receipt No.: 1055312 Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST WILL 310.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 15.00 24.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL FUN JCP FEE AUTOMATION FEE 10.00 BUREAU OF RECEIPTS GENERAL & CNTR FUN M D --- 5.00 ---------- CUMBERLAND COUNTY GENERAL . FUN Check# 2787 --- $364 00 Total Received......... . $364.00 P B F ASSOCIATES, INC. BUSINESS SERVICES ESTATE OF ~ ~" GLENDA M. MELLINGER Kelli 1Kishbaegh, E=ecutriz 518-16`~ Street New Cnmberlaad, Pennsylvania Dear Ms. Kishbaegh: 820 VOGELSONG ROAD, YORK, PA 17404 (717)767-9490 March 9, 2009 For accounting services rendered on behalf of the following: Glenda M. Mellinger DOD: 12/12/2008 S.S. #162-36-9520 File Member 2009-00023 PA 21-09.0023 5600.00 Totsl Dee ..................... 5600.00 Thank you. Sincerely, PBF Associates, Inc. CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 February 6, 2009 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Kelli E. Kishbaugh RE: Glenda M. Mellinger Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal, Advertisement inserted on following dates: January 23, January 30, and February 6, 2009 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director Co. arket St. r"is'burg, PA 17101 uiries - 717-255-8213 KISHBAUGH 518 16TH STREET NEW CUMBERLAND PA 17070 ?he~Jatriot-A'ews Now you know INVOICE ,CCT # NAME AD ORDER # DATE EDITION ADDTL. INFO. 1637 Kishbaugh 1637 Kishbaugh 1637 Kishbaugh 0001941957 01/28/09 METRO WEST 0001941957 02/04/09 METRO WEST 0001941957 02/11/09 METRO WEST ALL CHARGES ARE NET TYPE OF CHARGE AMOUNT BASIC AD CHARGE $37.15 BASIC AD CHARGE 337.15 BASIC AD CHARGE 337.15 AFFIDAVIT CHARGE $5.00 TOTAL: REMITTANCE ADDRESS The Patriot-News Co. 23794 Network PL Chicago, IL 60673-1237 Please include the Account # or Ad Order # (above) with your remittance--Thank You NOTE: This Invoice replaces the Order Confirmation which we previously sent with Proofs of Publication $116.45 The P-~ . ~ -News Co. 812 Market St. Harrisburg, PA 17101 Inquiries - 717-255-8213 KISHBAUGH 518 16TH STREET NEW CUMBERLAND PA 17070 c7,hr~laMot-News NOw you know THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Joseph A. Dennison, being duly sworn according to law, deposes and says: That he is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/ Metro editions which appeared on the date(s) indicated below. That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. PUBLICATION COPY This ad # 0001941957 ran on the dates shown below: January 28, 2009 February 04, 2009 ' " ' ! February 11, 2009 rIC•E S NO EXECU.TRiX ~EState:otGienda;MrMellinger.ldteof 1, New:Cumberland='Boco,'Cumbecland - -- .. County, PA, Deceased. _ `~• / •~~i~'l~L~C:". -- Letters Testamehtarv on'fhe'last wll{ ~nd testament of satd decedent havine been granted to'the undersigned, all.per - I / ~,' , sonslndebtedtneretoareregoesredta -and those ment di t e t~worn to and~ubscnbe~l before me this 12day f'February 2009 A D 4 __ , e pay a amme mak hovirig+claimsondemandragalnstihe -will presentahem withoutdelav j same , . . % \ ~ , !~ ~••"~j . , ' farsettlement to the undersigned resid: - i _. - ~ ' ~aing aY51016ih.5tceet, New Cumberland, P 17070 ~~~~~~ / / ~_ ,.,_ ~ ,- ~ _ (/, . v II- Kelll E. Kishbaugh, Executrix _ f~ ~ Notary Public -" ~~~- Ct?NIMQNWEALTH OF PENNSYLVANIA ~ Notarial Seal ~ ' Sherriia L. Kisner, Notary Public amity O¢ Hanisburg, Dauphin County ~ sUty Commission E>q~iri~ Nov. 26, 2011 Member. Pennsylvania Association of Notaries PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALT>FI OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland-Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the Cotulty and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: .Ianuary l~ January 3U and Febnlary 6 2009 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. _- Li a Marie Coyne, Editor Mellinger, Glenda M., decd. Late of Ne~~~ Cumberland Borough. Executrix: Kelli E. Kishbaugh, 518 16th Street, New Cumberland, PA 17070. Attorney: None. 6 day of Febnlary 2009 Notary SWORN-~O AND SUBSCRIBED before me this NOTARIAL SEAL DEBORAH A COLLINS Notary Public CARLISLE BORO, CUMBERLAND COUNTY My Commission Expires Apr 28, 201 U REV-1512 EX+ (12-03) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ wlHle ur GLENDA M. MELLINGER FILE NUMBER 2009-00023 Report tlebts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUEATDATE OF DEATH 1 MEDICAL- ANDREW & PATEL ASSOCIATES 10.00 2. ESTATE CHECKS- DELUXE ORDERPRO 14.95 TOTAL (Also enter on line 10, Recapitulation) I $ 2 4 9 5 (If more space is needed, insert additional sheets of the same size) Andrews & Patel Associates 3912 Trindle Road Camp Hill PA 17011 717 761-8740 Acct. No.: 28297 ALBERT T ANDREWS, MD Patient: GLENDA M. MELLINGER 03/15/1948 1900 BECKLEY DR. NEW CUMBERLAND PA 17070 Receipt For Diagnosis: 1. 174.9 CA BREAST (FEMALE), UNSPECIFIED 12/02/08 2. 288.03 NEUTROPENIA, DRUG INDUCED -Date- Service------------------------ Diag Cd Loc Charge Credit Balance X1/04/08 9921325 PHYSICIAN VISIT EST PAT ---- 1,2 --- --- - 0 ------- 70.00 10.00 _____ 0.00 Referring Physician: ALBERT T ANDREWS, MD 35 ID: AN412692 TAX ID: 232382727 NEXT APPOINTMENT: llAY DATE Prior Balance: Total Charges: Total Due: Total Paid: Other Credits: TIME New Insurance Bal: New Patient Bal: 10.00 0.00 10.00 10.00 0.00 0.00 0.00 Deluxe OrderPro -Order Confirmation i ~; C~ehixe Carderl r~ Oi4•E ( Tors Order Search Order Confirmation Page I of I Help ~ Tutorial ~ Exi • The order has been submitted. You may print this screen for your records then either place another order for this account, access another account or Exit. Order Contents Confirmation #: 7 0 7 1 0 2 0 6 9 6 Routing #: 23138224 Account#: 2183468533 Estimated Order Total: $14.95 Order Date: 01 /16/09 Item 1: Product Description Specialty Blue - Dupl Imprint: ESTATE OF GLENDA M MELLINGER 1900 BECKLEY DRIVE NEW CUMBERLAND, PA 17070 Shipping Method: Standard Delivery - 11 to 14 calendar days Shipping Address: ESTATE OF GLENDA M MELLINGER 1900 BECKLEY DRIVE NEW CUMBERLAND, PA 17070 J~ o~~ ~~ ~`~~ c s~ 1, Important Update: Look for the New Packaging for Personal Checks. s~~ ~ ~ - Look for the new packaging with this check order. To meet changing U.S. Postal Service requirements, the Deluxe personal check box has been replaced with a flatter, more streamlined mailing package. If you have any questions, call Deluxe toll free at 1-877-984-4146. View Larger Image of New Check Package Search for Another Account Record Print This Screen Search Current Account Record Exit _..____ Deluxe OrderPro®has achieved ~bertrust certification. I ~2 2008 Deluxe Enterprise Operations, Inc. All rights reserved. Build Version: 5.1.4 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER GLENDA M. MELLINGER Anna-nnn~~ NUMBER NAMEANDADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIPTODECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under :, Sec. 9116(a)(1.2)] 1. KELLI E. KISHBAUGH DAUGHTER 1000 518 SIXTEENTH STREET NEW CUMBERLAND, PA 17070 ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWNABOVE ON LINES 15 THROUGH 18 ,ASAPPROPRIATE, ON REV-1500 C OVER SHEET If NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLEAND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL & TESTAMENT I, GLENDA M. MELLINGER, OF 1900 Beckley Drive, New Cumberland, Cumberland County, Pennsylvania, revoke my prior Wills and declare this to be my Last Will and Testament. FIRST: Debts and Funeral Expenses: My debts and the expenses of my last illness, funeral and burial shall be paid out of my estate. SECOND: Personal and Household Effects: I give all my automobiles and all other articles of personal and household use, together will all insurance related thereto, to my daughter, KELLI E. KISHBAUGH. THIRD: Protective Provisions: No interest in income or principal shall be assignable by, or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. FOURTH: Death Taxes: All federal, state and other death taxes payable because of my death on the property forming my gross estate for tax purposes, whether or not it passes under this Will, shall be paid out of the principal of my probated estate just as if there were my debts and none of those taxes shall be charged against any beneficiary. Any death taxes on future interests may be paid whenever my executor may think best. FIFTH: Residuary Estate: I give the residue of my estate, real and personal, to my daughter, KELLI E. KISHBAUGH. Seventh: Executors: I appoint my daughter, KELLI E. KISHBAUGH, Executrix of this Will to serve without bond, but for any reason she fails to qualify or ceases to act, I appoint my sister, Peggy A. Houseal, Executrix in her place. Executed this 13 day of o c~t'a1~ ~,~ 2007. GLENDA M. MELLIN ER In our presence, the above-named Testatrix signed this and declared it to be her Will, and now at her request, in her presence and the presence o``f `each other, we sign as witnesses: °-l ~ - Residence ~J~ ~-, s ~s ~p~ ~~ ~ Residence ~~ ~ -2 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY aF `~p ~+~ We, Glenda M. Mellinger, Barbara J. Leonhard and Janet L. Becker, the Testatrix and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed the instrument willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of our knowledge, the Testatrix was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. ,~ Glenda M. Mellinger -~ ~. Barbara J. Leonha~r _ - ,, FTC .~I~h~/1 ant L. Becker Subscribed, affirmed to and acknowledged before me, this ~~~<~ day of ~~f~~~ , 2007. iw~ - ~ _ u Notarial Seal Dons Marie Dahlhammer, Notary Public Conewago Twp., York County My Commission F~cpires June 26, 2009 N Member, Pennsylvania Association of Notaries M~commission expires: (~/~~j/~(j(,~~