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Home My WebLink About04-16-09 (2)1505607121 ~' REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Poeox2aosol INHERITANCE TAX RETURN 2 1 0 8 0 9 3 0 Hamsburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 2 8 6 4 8 5 2 2 1 0 9 0 7 2 0 0 8 0 6 0 6 1 9 3 4 Decedent's Last Name Suffix Decedent's First Name MI C a r p e n t e r J o a n A (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 INAPPROPRIATE OVALS BELOW a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (dale 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) Q 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) GORRESPONDEN i - I NI5 StG 1IVN MU51 tlt GUMF'Lt I tU. ALL GuKKtJYUIYUtnla ANU cuntlutn I u-~ I h~ mrVrtmH i ~~n anvu~u ac uuc~~ i cu i v: Name Daytime Telephone Number R M a r k T h o m a s E s q u i r e 7 1 7 7 9 6 2 1 0 0 Firm Name (If Applicable) First line of address 1 0 1 S o u t h M a r k e t S t r e e t Second line of address City or Post Office State M e c h a n i c s b u r g P A ZIP Code REGISTE~OF WILLS U NLY v ~ - G ` ~ .. ~ r " ~~ j .. ~n '~' ~ `_ i . _ --rte rm i_ .-- r~, ' %cn~ t:: {-~ ~,, -p ;~ ~ N r ,. E'1}ILED .., T l,~ J ~~~ ~~-, -~-'1 r,''7 try > X..~_ 1 1 7 0 5 5 Correspondent's a-mail address: rmarkthomasCcD.amail.com Under penalties of perjury, I declare that I have examined this return, inGuding 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. SIGNATURE OF PERSON RESPONSI$LE F06 FILING RETURN DATE 101 Sou riv 0 Mechanicsburg PA 17055 Mechanicsbur PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J /`~' 1505607221 REV-1500 EX Decedent's Social Security Num ber Decedent's Name: Joan A• Carpenter 2 8 6 4 8 5 2 2 1 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 1 8 3 4 1 • 3 6 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ....... 5. 5 0 1 5 1. 5 6 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 3 3 5 5 8 3. 0 9 8. Total Gross Assets (total Linesl-7) ,,,,,,,,,,,,,,,,,,,,,,,,,,, g• 4 0 4 0 7 6. 0 1 9. Funeral Ex enses 8~ Administrative Costs (Schedule H) p ........... 9. ..... 2 7 5 0 4 . 8 2 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ....... ..... 10. 2 7 0 6 6 . 3 6 11. Total Deductions (total Lines 9 & 10) ...................... ..... 11. 5 4 5 ? 1 . 1 8 12. Net Value of Estate (Line 8 minus Line 11) .................... ..... 12. 3 4 9 5 0 4 . 8 3 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............. ..... 13. 6 3 3 2 2. 3 2 14. Net Value Subject to Tax (Line 12 minus Line 13) ............. ..... 14. 2 8 6 1 8 2 . 5 1 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable t I' I X 0 a mea rate 16. 17. Amount of line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1 7 4 6 2. 5 2 2 1 0 9 9. 2 1 3 8 5 6 1. 7 3 Side 2 L 1505607221 1505607221 J , , REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 08 0930 DECEDENT'S NAME Joan A. Ca enter STREET ADDRESS 315 Messiah Circle CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1 ~ 7ax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit _ B. Prior Payments _ C. Discount (1) 38,561.73 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) O.oO 4. If line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. A. Enter the interest on the tax due. (5) 38, 561.73 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 38,561.73 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ........................................................... ........... ^ b. retain the right to designate who shall use the property transferred or its income; .................... ........... ^ c. retain a reversionary interest or ..................................................................................... ........... ^ 0 d. receive the promise for life of either payments, benefits or care? ............................................ ........... ^ 0 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? ......... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................... ........... ~ ^ lF 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)J. 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-1503 EX +, (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Joan A Carpenter 21 08 0930 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 08.0273 shares Fulton Financial Corporation stock ($11.27 per share) 2,344.46 2. merican Funds, P. O. Box 2560, Norfolk, VA 23501-2560 4,470.16 and Fund of America, Account No. 84249651 3, merican Funds, P. O. Box 2560, Norfolk, VA 23501-2560 3,978.59 ncome Fund of America, Account No. 84249651 4. merican Funds, P. O. Box 2560, Norfolk, VA 23501-2560 7,548.15 merican Balanced Fund, Account No. 84249651 TOTAL (Also enter on line 2, Recapitulation) I S 18,341 (If more space is needed, insert additional sheets of the same size) REV-1508 EX ~ (6-98) ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Joan A. Carpenter 21 08 0930 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. ulton Bank, Savings Account No. 1370-66148 3,780.82 . O. Box 4887 ancaster, PA 17604 2. ulton Bank, Checking Account No. 3619-51172 13,463.09 . O. Box 4887 ancaster, PA 17604 3. ulton Bank, Certificate of Deposit No. 328-0240761 13,922.90 . O. Box 4887 ancaster, PA 17604 4. ulton Bank, Certificate of Deposit No. 328-0263196 5,379.47 . O. Box 4887 ancaster, PA 17604 5. ulton Bank, Certificate of Deposit No. 328-0263200 2,689.73 . O. Box 4887 ancaster, PA 17604 6. ulton Bank, Certificate of Deposit No. 328-0263204 2,689.73 . O. Box 4887 ancaster, PA 17604 7. embers 1st Federal Credit Union, Savings Account No 197164-00 . 73.99 000 Louise Drive, P. O. Box 40 echanicsburg, PA 17055 8. embers 1st Federal Credit Union, Checking Account No 197164-11 . 0.00 000 Louise Drive, P. O. Box 40 echanicsburg, PA 17055 9. embers 1st Federal Credit Union, Inv. Savings Account No 197164-05 . 2,498.83 000 Louise Drive, P. O. Box 40 echanicsburg, PA 17055 10. 008 Federal Income Tax Retum (Personal -Form 1040) 5,653.00 TOTAL (Also enter on line 5, Recapitulation) + S (If more space is needed, insert additional sheets of the same size) REV-1510 EX ~ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS 8r MISC. NON-PROBATE PROPERTY FILE NUMBER Joan A. Carpenter 21 08 0930 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND THE DATE OF TRANSFERATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD~S INTEREST EXCLUSION {IFAPPLICABLE) TAXABLE VALUE 1. M Financial Life Insurance Company, Annuity Pol. No. 05000049 138,790.00 00. 138,790.00 21 South 9th Street incoln, NE 68501 2. oodmen of the World, Omaha Woodmen Life Insurance Society 51,837.86 00. 51,837.86 ertificate No. 6228089 (Deferred Annuity IRA) 700 Famam Street, Omaha, NE 68102 3. oodmen of the World, Omaha Woodmen Life Insurance Society 102,087.87 00. 102,087.87 ertificate No. 6215627 (Deferred Annuity IRA) 700 Famam Street, Omaha, NE 68102 4. IAA-CREF Individual and Institutional Services, LLC 42,867.36 00. 42,867.36 nnuity TIAA No. Y0263221 500 Andrew Carnegie Boulevard, Charlotte, NC 28262 TOTAL (Also enter on line 7 Recapitulation) I S 335 583 09 (If more space is needed, insert additional sheets of the same size) REV-1511 EX ~+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8s IN R SI DAENT DECEDENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Joan A. Carpenter 21 08 0930 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; 1 • Conklin Funeral Home, 30 North Chestnut Street, Dillsburg, PA 17019 1,425.82 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Leonard H. Page, Jr. Street Address 30 Laurel Drive City Mechanicsburg State PA Zip 17055 Year(s) Commission Paid: 2, Attorney Fees R. Mark Thomas, Esquire 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4• Probate Fees 5 Accountants Fees 6. Tax Return Preparers Fees 7• I U. S. Treasury - 3rd Quarter Personal Income Tax Payment 14,500.00 10,000.00 349.00 400.00 830.00 TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESID N MORTGAGE LIABILITIES a LIENS E T DECEDENT f ESTATE OF FILE NUMBER Joan A. Carpenter 21 08 0930 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Oman V~thin 86.92 . O. Box 182273 olumbus, OH 43218 2. T & T 71.78 3. hase 10.95 . O. Box 15153 ilmington, DE 19886 4. lert Pharmacy Service, Inc. 620.25 19 North Baltimore Avenue t. Holly Springs, PA 17065 5. essiah 12,987.04 6. oman Within 57.96 . O. Box 182273 olumbus, OH 43218 7. ederal Estate Income Tax Payment (Form 1041) 13,231.46 TOTAL (Also enter on line 10, Recapitulation) 13 27 066 36 (If more space Is needed, insert additional sheets of the same size) REV-15~ 3 EX + (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF JOAN A. CARPENTER FILE NUMBER 21 OS 093(1 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under . Sec. 9116 (a) (1.2)] 1. Leonard H. Page, Jr. rOther-lTl-ldW 35$ 30 Laurel Drive Mechanicsburg, PA 17055 2. Kenneth R. Carpenter brother 35$ 11 Apple Lane Mountville, PA 17554 3. Ronald Smith friend 10$ 1111 Florabunda Lane Mechanicsburg, PA 17055 4. Thomas Britton friend 10$ 409 Kent Drive Mechanicsburg, PA 17055 5. Beth Palese ~ece 5$ 30 Laurel Drive Mechanicsburg, PA 17055 6. James M. Carpenter nephew 5$ 1910 Concord Place Lancaster, PA 17601 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Christian Life Assembly 6,575.96 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 6,575.96 ~Ir more space Is neeaea, Insert aaaleonal sheets of the same size) ~` ~. ~~ _ i LAST WILL ANll TCSTAIVI);NT BE 1T REMEMBERED THAT I, JOAN A. CARPENTER, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am not married, that my beneficiaries as indicated in this Will include my sister, JEAN PAGE, and her husband, LEONARD PAGE; my brother, KENNETH R. CARPENTER; my nephew, JAMES M. CARPENTER; my niece, BETH PALESE; my friend PASTOR RONALD SMITH, and his wife, SHARON SMITH; my friend, PASTOR THOMAS BRITTON, and his wife, DANA BRITTON, and any charitable entities hereinafter designated II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable a$er my decease. III I direct that all taxes that maybe assessed in consequence of my death, of whatever rrature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV All of my tangible personal property I give to my brother, KENNETH R CARPENTER, 'and my sister, JEAN PAGE, provided that they are living at my death, to be divided between them in equal shares as they may agree. To the extent that they cannot agree on a division, my Executor may, in 1us or her sole discretion, make the division, or, if any of my tangible personal property is either not desired by my brother. and sister, or is not suitable for distribution among Qrem, the Executor may sell the property and distribute the proceeds according to the temps set forth hereinafter. ~ ~,~ , ~ 4 V I hereby give, devise and bequeath ten (10%) percent of the net value of my estate to CHRISTIAN LIFE ASSEMBLY CHURCH, 2645 Lisburn Road, Canip Hill, Pennsylvania. VI All the rest, residue and remainder of my Estate is to be distributed as follows: (A) Thirty-five (35%) percent to my sister, JEAN PAGE, and her husband, LEONARD PAGE, or the survivor of them, per stirpes; (B) Five (5 %) percent to my nephew, JAMES M. CARPENTER, provided he survives me by thirty (30) days; (C) Five (5%) percent to my niece, BETH PALESE, provided she survives me by thirty (30) days; (D) -Thirty-five (35%) percent to my brother, KENNETH R. CARPENTER, provided that if he predeceases me or fails to survive me by a period of thirty (30) days then lus share shall pass to my sister, JEAN PAGE, and her husband, LEONARD PAGE, pursuant to the terms of Clause VI(A) of this Will; and (E) Ten (10%) percent to my dear friend, PASTOR RONALD SMITH, and his wife, SHARON SMITH, or the survivor of them, provided that either both or one of them survives me by a period of thirty (30} days. In the event that neither PASTOR RONALD SMITH nor his wife, SHARON SMITH survive me by a period of thirty (30) days then their share is to pass to my sister, JEAN PAGE, and her husband, LEONARD PAGE, pursuant to the terms of Clause VI(A) of this Will. (F) Ten (10%) percent to my dear friend, PASTOR THOMAS BRITTON, and Iris wife, bANA BRITTON, or the survivor of them, provided that either both or one of them.sutvives me by a period of thirty (30) days. In the event that neither PASTOR THOMAS BRITTON nor his wife, DANA BRITTON, survives me by a period of thirty (30) days then their share is to pass to my brother, KENNETH R. CARPENTER, pursuant to the teens of Clause VI (D) of this Will. ~. ,~ , ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA. COUNTY OF CUMBERLAND ss. I, JOAN A. CARPENTER, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein impressed. ~~ JO A. CARPENTER Swom or affirmed to and acknowledged before me by JOAN A. CARPENTER, Testatrix, this 8'~ day of November, 2006. oM ~ G' Notartsl seat tary Public Jostle L.1AyK3~orren, Notary Pud{c Mecbenicsbur9 Bas, tarnberlend 'Ay Commission F.x fires Jul 8, 2010 AFFIDAVIT COMLIvIONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND We, R Mark Thomas and I' Jl ~ ~q the witnesses whose names are signed to the attached or foregoing instnunent eing duly qualified according to law, do depose and say that we went; present and saw Test~tix sign and execute the instrument as her LAST WILL; that JOAN A. CARPENTER signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. L~,.~L R. Mark Thomas Printed: ero7~~ ~ e l Swom or afiumed to and acknowledged before me this 8's day of November, 2006. /% ? ~~ 1/ GAL Mµ tart' Public Nolertal 3es1 Josue 1. Ma(tlowen, Notary Public Msd~ieebuq Baa, taenbslend VII I nominate, constitute and appoint LEONARD H. PAGE, JR., as Executor of this LAST WILL, to serve without bond. If he is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my brother,. KENNETH R. CARPENTER, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF; I, JOAN A. CARPENTER, have set my hand to this LAST WILL this 8a` day of November, 2006. v`4~. JO A. CARPENTER Signed, sealed, published and declared by the above-named JOAN A. CARPENTER, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence ofeach other, have hereunto subscribed ournames as witnesses. R. Mark Thomas ,~'-~~ ~= Printed: ,~ ~ F', ~rt Zel 3 The right choice for the long term® American Funds® PO Box 2560 Norfolk VA 23501-2560 ESTATE OF JOAN A CARPENTER LEONARD H PAGE JR/EXECUTOR 30 LAUREL DR MECHANICSBURG PA 17055-5535 ~ni~~~ni~~~nn~i~u~~~n~i~n~~~in~~n~i~n~n~~ Check and Transaction Confirmation November 17, 2008 Sharct-older CB&T CUST IRA JOAN ANN CARPENTER/DEC'D ESTATE OF JOAN ACARPENTER/BENE LEONARD H PAGE JR/EXECUTOR 30 LAUREL DR MECHANICSBURG PA 17055-5535 Rep name HOUSE Transactions AMERICAN BALANCED FUND-A Fund number 11 Account number 84249651 Dividends reinvest) and capital gains (reinvest) shares this Trade date Description Dollar amount Share price transaction Share balance . 11117/D8 BENEFICIARY DISTRIBUTION -57,548.15- 313.18 -572.697 A check is attached to this statement You may reinvest this redemption into any of the American Funds within 90 days without paying a sales charge. If, however, you redeemed 55,000 or more from a fund and account within the previous 30 days, you maynotroinvest55,OOOormoreintothatfundandaccount. For details on our purchase block policy, please see the fund s prospectus. This cbeck is made payab/e to you as requested. For more account information ^ Callyourfinancialadviser ^ Automated information and services Website - americanfunds.com American FundsLine®- 800/325 ~59~ ^ Personal assistance - 8 a.m. to 8 p.m. Eastern time M - F Shareholder Services - 800/421-0180 The right choice for the long term merican Funds PO Box 2560 Norfolk VA 23501-2560 ESTATE OF JOAN A CARPENTER LEONARD H PAGE JR/EXECUTOR 30 LAUREL DR MECHANICSBURG PA 17055-5535 ~n~~~~ui~~~nn~i~n~i~n~i~n~i~n~~~n~i~n~u~) Check and Transaction Confirmation November 17,.2008 Shareholder CB&T CUST IRA JOAN ANN CARPENTER/DEC'D ESTATE OF JOAN A CARPENTER/BENE LEONARD H PAGE JR/EXECUTOR 30 LAUREL DR MECHANICSBURG PA 17055-5535 Rep name HOUSE Transactions THE INCOME FUND OFAMERICA-A Fund number O6 Account number 84249651 Dividends (reinvest) and capital gains (reinvest) Trade date Description Dollar amount Share price 11/11108 BENEFICIARY DISTRIBUTION -53,978.59 512.61 A check is attached to this statement You may reinvest this redemption into any of the American Funds within 90 days without paying a sales charge. If, however, you redeemed 55,000 ormore from a fiend and accoutrt within N-e previous 30 days, you may not reinvest 55,0'00 or more into that fund and account For details en orrr purchass h/ock policy, please ses the fund's prospectus. This check is made payab/e to you as requested. Shares this transaction Share balance -312.556 For more account information ^ Call your financial adviser ^ Automated information and services Website - americanfunds.com American FundsLine®- 800/325-3590 ^ Personal assistance - 8 a.m. to 8 p.m. Eastern time M - F Shareholder Services - 800/421-0180 The right choice for the long term '~._merican Funds PO Box 2560 Norfolk VA 23501-2560 ESTATE OF JOAN A CARPENTER LEONARD H PAGE JR/EXECUTOR 30 LAUREL DR MECHANICSBURG PA 17055-5535 ni~~~ni~~~nn~i~n~~~n~i~n~~~ni~~n~i~n~n Transactions THE BOND FUND OFAMERICA-A Fund number 08 Account number 84249651 Dividends (reinvest) and capital gains (reinvest) Trade date Description 11/17/08 BENEFICIARY DISTRIBUTION A check is attached to this statement Check and Transaction Confirmation November 17; 2008 Shareholder CB&T COST IRA JOAN ANN CARPENTER/DEC'D ESTATE OF JOAN ACARPENTER/BENE LEONARD H PAGE JR/EXECUTOR 30 LAUREL DR MECHANICSBURG PA 17055-5535 Rep name HOUSE Shares this Dollar amount Share price transaction Share balance 34,470.18 510.70 -416.156 You may reinvest this redemption into any of the American funds within 90 days without paying a sales charge. ff, however, you redeemed 55,000 or more h»m a land and account within the previous 30 days, you may not reinvest 53,000 or more into that fund and account For details on Gurpi:r.^.lo's3 5lackYOlJCy, ploasa sao the hrd s Frospactr:s. For more account information ^ Call yourfinancial adviser ^ Automated information and services Website - americanfunds.com American FundsLine®- 800!325-3590 ^ Personal assistance - 8 a.m. to 8 p.m. Eastern time M - F This check is made payab/e to you as requested. Shareholder Services 800/421-0180 ~~14LD MUTUAL tgid Mutual Financial Network 421 S. 9'" Street Lincoln, Nebraska 68501 PH 1.866.702.2194 FX 402.479.0198 OM FINANCIAL LIFE INSURANCE COMPANY OM FINANCIAL LIFE INSURANCE COMPANY OF NEW YORK October 3, 2008 R Mark Thomas 101 South Market Street Mechanicsburg, PA 17055-3851 Policy: 05000049 Owner: Joan A Carpenter Annuitant: Joan A Carpenter Dear Mr. Thomas: We have been notified of the death of the policy owner. We wish to convey our sincere sympathy to the family in their recent loss. Our records indicate the beneficiaries of this policy are Kenneth Carpenter (25%) -brother, Leslie G Carpenter (25%) -brother, Jean C Page (25%) -sister, James Ronald Smith (15%) -pastor/friend, and Christian Life Assembly Church (10%). The approximate benefit amount is $138,790.00. The approximate taxable gain is $138,790.00. A beneficiary, who is a natural person (i.e. not a corporation, estate, trust, etc.), may choose only one of the following settlement options. A beneficiary that is not a natural person (e.g. corporation, trust, estate, etc.) may only choose between options 1 & 3. 1. Lump Sum Payment -The beneficiary will receive a single lump sum payment of the policy proceeds through an F&G Life Asset Account. The personal Asset Account is an interest bearing checking account established in the beneficiary's name. The account currently earns interest at a rate of 2.5%. We will mail the beneficiary a personalized checkbook. To access the funds, the beneficiary would simply write a check. We would also send the beneficiary monthly statements for the account, just like a bank. 2. Income for a Fined Period -This option guarantees to pay the beneficiary regular income over the period of years chosen by the beneficiary. If the beneficiary should pass away before the all the payments are made, the beneficiary may designate a beneficiary who may receive a lump sum benefit or elect to continue receiving the www.omfn.com Old Mutual Financial Network is the marketing name for OM Financial Life Insurance Company (Home Office, Baltimore, MD); and OM Financial Life Insurance Company of New York (Home Office, Purchase, NY). WOODMEN OF THE WORLD/OMAHA WOODMEN LIFE INSURANCE SOCIETY 1700 FARNAM STREET OMAHA, NEBRASKA 68102 1-800-582-0122 ITEMIZED STATEMENT CLAIM NUMBER: 701995 NAME: CARPENTER;JOAN ANN CERTIFICATE: 6228089 CREDITS DEDUCTS EXPLANATION $51,476.51 ANNUITY VALUE $51,476.51 TOTAL AMOUNT PAYABLE: 551,476.51 Additional Itemization for: ESTATE OF JOAN ANN CARPENTER 30 LAUREL DR MECHANICSBURG PA 17055 CERTIFICATE: 6228089 AMOUNT PAYABLE LESS PLUS EXPLANATION $51,476.51 TOTAL AMOUNT PAYABLE: $51,476.51 TOTAL AMOUNT PAID: $51,837.86 (Amount includes $361.35 interest from 9/7/2008 to the payment date.) WOODMEN CARE FRATERNAL EXTRAS Good-standing Woodmen members of one year or more who develop lung cancer, brain tumor, leukemia, Hodgkin's disease, multiple myeloma, malignant lymphoma, or tuberculosis may be eligible for fraternal assistance of $1,000. Orphans Care benefit up to $200 each month ($300 for college) provided to qualified totally orphaned children of Woodmen members in good standing one year or more. FRATERNAL PROTECTION SER VES BEST IMPORTANT U.S. Social Security benefits may also be payable -- contact your nearest Social Security office. If the deceased insured was named beneficiary on any other insurance contract, a new beneficiary should be designated without delay. For assistance, see your local Woodmen representative. If complex business problems still face you, contact your local attorney. CLU6524 - 11/7/08 (Distr. 2) Page l of 1 ~From:4400DMEN HR 402 661 6299 03/25/2009 18:54 #430 P.004/010 PAYER'S name, street eddtsss, city, state, and ZIP coda 1 Gross dlatribudan OMS No. 1545-0719 WOODMEN OF THE WORLD/OMAHA WOODMEN IdFE INSURANCE SOQE!'Y $ 101376.23 ~ 0 O (700 EARNAM STREET a Taxable amount OMAHA, NB 68102-2007 $ I01 7623 Porm 1099°R PAYEgS federal idantificatian nurt 47-0339750 PEp%ENT'S name, street address ZIP code ;BETH PALESE 30LAUREL DR MECHANICSBURG, PA 17055 P,~5qu6~number lava instructions) Form 1099-R 2b Taxableamoum not determined Tptal distribution X tP1ENT5 idendflrsttpn number 3 Gphal Qain (indudetl In box Yal 4 Fedsnl ittetame tsn wigeteW •58-3817 $ $ ctn. na.l, dty, crate, and 6 rmebwa mmriewa,rrpedanruxl nom $ Net unrssllzad appreciation in conirltaltlenr erlmwaeo preeJUmr employers securitip Dhtributions From Paroloru, Annuities, ReNnmertt or PrtafttSharing Plans, IRAs, Insta-anee Contraab, etc. Copy B Report this $ this copy to yourretum. 7 Diabibudon txdals) aw $ ether 4 slwt~ X % heingnfur eked to 9a Vour ptwcenLge of total 8b Toul emplayw wntribudotts the Intemel dlsbibudon Revenue Service. 1 $ tat yur of dsda. godt contrib. 10 State tax withheld 11 State/Payer's state no. 12 State distNbuGan $ PA / 16568162 $ IOI J76.23 13 Local tax withheld 14 Name of locality 15 Local distribution $ Depanment of the Treasury-hmmal Revenue Serviu t• From:~(11JDMEN HR 402 661 6299 03/25/2009 18:53 #430 P.002/O10 WOODMEN OF THE WORLD/OMAHA WOODMEN LIFE INSURANCE SOCIETY 1700 FARNAM STREET OMAHA, NE 68102-2007 If you have questions contact: Phone: 800-225-3108 ;BETH PALESE 30 LAUREL DR MECHANICSBURG, PA 17055 Instructions for Recipient Aaouttt number. May show an account or other unique number the Box 5. Any amount shown is your share of investment expenses of a payer assigned to distinguish your account singlfl~class REMIC. If you file Form 1040, you may deduct these Box 1. Shows taxable interest paid to you during the calendar year expenses on the 'Other expenses" line of Schedule A (Form 10401 by the payer. This does not indude interest shown in box 3. May subject to the 2%limit, This amount is induded in box 1. also show the total amoum of the credits from dean renewable Box 6. Shows foreign tax paid. You may be able to claim this taz as energy bonds and Gulftax credit bonds chat must be induded in a deduction or a credit on your Form 1040. See your Form 1040 your interest income. These amourrts ware treated as paid to you instructions. during 2008 on the credit allowance dates {March 15, June 15, September 15 and December 15) F r m r inf ti F Box 8. Shows tax-exempt interest, including exemptanterest , . o o orma on, see orm e dividends from a mutual fund or other regulated investment 8912, Credit for Clean Renewable Energy and Gulf Tax Credit Bonds. company, paid to you during the calendar year by the payer. Report Box 2. Shows interest ar prindpal forteited because of early with- this amount on tine 8b of Form 1040 or Form 1040A. This amount drawal of time savings. You may deduct this amount to figure your may be subject to backup withholding. See box 4. adjusted grass income on your income tax return. Sea the instruc- lions for Form 1040 to see where to take the deduction. Box 9. Shows tax-exempt interest subject to the alternative minimum tax. This amount is included in box 8. See the Instructions for Forrrt Box 3. Shows interest on U.S. Savings Bonds, Treasury bills, Tree- 6251, Aternative Minimum Tax-Individuals. Bury bonds, and Treasury notes. This may or may not be all taxable. Nominees. If this farm indudes amounts belonging to another See Pub. 560, Investment income and Expenses. This interest is person(s), you are considered a nominee recipient. Complete a Forn exempt from state and local income taxes. This interest is not in- eluded in box 1 1099-INT for each of the other ownerc showing the income allocable . to each. File Copy A of the form with the 1RS. Furnish Copy 8 to Box 4. Shawl backup withholding. Genere8y, a payer must backup each owner. List yourself as the "payer' and the other owner(s) as withhold at a 28°k rate if you did not furnish yourtaxpayer identife- the "recipient' File Formis) 1099aNT with Form 1096, Annual cation number (TIN) oryou did not furnish the correct TIN to the Summary and Transmittal of U.S. information Returns, with the payer. See Fore W-9, Request for Taxpayer Identification Number Internal Revenue Serviea Center for your area. On Form 1096 list and Certiflption, for information on badtup withholding. include this yourself as the 'filer." A husband or wife is not required to file a amount on your income tax return as tax withheld. nominee return to show amounts owned by the other. 'AVER'S name, street address, city, sta WOODMEN OF THE WORLI LIFE INSURANCE SOCIETY 1700 FARNAM STREET OMAHA, NE 68102-2007 number I RECIPIENT'S CORRECTED Payer's RTN (optional) ~ OMB No. 1545.Ot 12 1 Intarestincome Gj oo~ ~! ~ interest income S 711.64 2 Earlyvrithdrawat penalty g Form 1099-IIYT 3 Interest an U.S. Savings Bonds and Treace obligations Copy B $ For Recipient 4 Federal income tax wtthhMd 5 Investmem expenses This is important tea irrtormadan and Ic being tumlahed to d+a Internal Revenue 6 Foreign wx paid 7 Foroign ccuntry or U.S. Service. H you are repuirod to file a return. possession a nepllpartee penalty or other canNon mey ba e Taxexemptlnterest 9 SpectOed private activity imposed on you it this bond interest income is taxsbN and the IRS detemtinaa tna[ R hoc not been reported. D ~ 162-58-3817 name, street address fincluding apt no.), sty, state, and Z1P code ;BETH PALESE 30 LAUREL DR MECHANICSBURG, PA 17055 Ateount Form 1099aNT 6215627 (Keep for your records.) Department of the Traaeury• Imemal Ravenae Service aRe029 1.000 TIAA CREF FINANCIAL SERVICES FOR THE GREATER GOOD- ~~ ~~~ ~l~ 1 October 6, 2008 ~" CHRISTIAN LIFE ASSEMBLY BETH PALESE 2645 LISBURN RD CAMP HILL, PA 17011 Re: TIAA No.: Y0263221 Dear Ms. Palese: We recently received notification of the death of Joan Ann Carpenter and the organization is the beneficiary under her TIAA-CREF contract. As the beneficiary, the organization is entitled to receive the commuted value of the future payments in a single sum. As of 09/01/2008, the commuted value of the annuity payments was $42,867.36. In order to arrange for the payment of the benefits, please provide us with the following: ® A completed Application for Payment of Survivor Benefits ® Taxpayer Identification Number We realize how important it is for you to receive prompt service at this time, and we would appreciate your help in providing the requested information. If you have questions, please call our Telephone Counseling Center at 800 842- 2776 Monday to Friday from 8 a.m. to 10 p.m. ET, and Saturday from 9 a.m. to 6 p.m. ET. To call the toll-free number outside the United States or Canada, use AT&T's international access code, which is listed on our Web site at www.tiaa- cref. org/contact/outside_us.html Sincerely, ~e~r.~~u;ia~ry $aruccea ?ea,~s Beneficiary Services Team Enclosures Mar 19 09 02:52p Messiah Village .. essiari v>I e___t_,_~,~~ 100 MOUNT ALLEN DRIVE, MECL{ANICS9URG, PA 17055 LEO~tARD PAGE 30 LAUREL. DRIVE MECHANICSBURG, PA 17055 DATE DESCRIPTION Balance Forward ~ *** Nursing Care *** 09!01/08 P:~TRIOT NEWS 09!01/O8 SUNDAY NEWS 09/05108 RiYU BRD -NURSING -PRIVATE 09/05/08 OYYGEN 7L7 ~s5 55ss p.4 ;~ ,; •.•. ... FOfm P8-01 QUESTIONS? CALL: (717} 697-4666 RESIDENT# UNIT STMT. DATE 70509 032 P 09!30!2008 RESIDENT S Mrs. JOAN A. C_~RPE'VTER TOTAL AMOUNT DUE $12,987.04 DATE DUE 10/31/2008 RATE Days! CIiARGES CREDITS BAI.ANC>= Units 11,536.49 0.40 5.00 2.00 11,538.49 0.21 5.00 1.05 11,539.54 272.00 5.00 1,360.00 12,899.54 17.50 5.00 $7.50 12,987.04 RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 70509 1,450.55 11,536.49 O.DO 0:00. 0.40 $12,987.04 SIDENT NAME Ntrs. JOAN A. CARPENTER Farmas-o' "lo finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! _ -- x i ~~- 1 _' r `PA L~a-65 -~~_ _ --._ --- .. ~ _ , __ >.~a.,~-_~ ~, ..~Pn_-... _.z _~, __ ., - _ - -- _ ~_ - ~ . OI ~~ - ,, , _0 >.. q~ ~w ? ,~ .r '- .. - 'i~.GE1TLE: NG75~_ L~2C~~1II~, TOTAL TAX re~rioasBalarrc~ ;chargest2,iymoaih- ~Ftnanc~C}~arg~ TOTAL' CHARG~~ 'rorm:aayn,...a~c~.atts, AMOUNT DUE :y..~.~ -~,~~ ~ , . - : -- - ~ - ~ =~ . ~ - ~~ 5~y ~ .'Fr~¢_~..~ QlT ZQSg '7'G~ .~ . ~&r~L_ _ - 620 _25 Ff7E~GS»E~~4T~~INQI'JIE~~PL"EA~E~,aLL"ELterrPharrTrac~Sa~v~ceslrrca~I'-<3QQ 2~~°Q54= `:I w -, ...xY~cr,~ "'~";~~Yr . ~:.:. ~ STaDaniencff8imu~otagg . ~' - -_. accreve~see