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HomeMy WebLinkAbout05-11-09 (2)15056041125 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0 2 7 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 9 7 2 0 3 5 8 4 0 9 0 8 2 0 0 8 0 2 0 2 1 9 2 7 Decedent's Last Name Suffix Decedent's First Name MI E S H B A C H B E T T Y J (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 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) 0 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 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) CORRE$PONLIEN I - 11115 5tl:l IUN MU51 tlt GUMYLtI tU. HLL I.VKKtJYVKUCKI,t HKU I.VIYYIUtIV I IHL IH7~ IKhVK1YIHl IVIV Jt7VULU Ct UIKtG I tU I U: Name Daytime Telephone Number C H A R L E S J D E H A R T I I I 7 1 7 2 3 2 7 6 6 1 Firm Name (If Applicable) ------ - - - -- REGISTER OF WILLS USE ONLY C A L D W E L L & K E A R N S n.3 First line of address ~i C7 ~-, -~-, :'~ ~ - 3 6 3 1 N O R T H F R O N T S T R E E T II ~? ~= ' -;~ y-> ; . - c7 _~ - ITS' T' Second line of address -~~ ~ PgTE;F1LF~D "~ , ~ City or Post Office State ZIP Code -- ----=~ -- ,..._ H A R R I S B U R G P A 1 7 1 1 0 ~_I `-`:~ ' -~-, --, ~= t~ ~' r Correspondent's e-mail address: Cdehart caldwellkearns.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN RE OF P S ESPO~~R FILING RETURN DAT y 3 ~~d s ADD SS 1244 ROSSMOYNE ROAD MECHANICSBURG PA 17055 SIGNATURE OF PREPARER ER THAN REPRESENTATIVE TE 3~ ~q_ ADDRESS 3631 NOR H FRONT STREET HARRISBURG PA 17110 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 15056041125 Cla' 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: BETTY J. ESHBACH 1 9 7 2 0 3 5 8 4 RECAPITULATION 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. ~ 2 4 3 7 , 5 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. ~ 2 4 3 7 , 5 4 9. Funeral Expenses & Administrative Costs (Schedule H) ............. ... 9. 1 4 2 0 2 2 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......... ... 10. 1 9 8 3 , ~3 6 11. Total Deductions (total Lines 9& 10) ........................ ... 11. 1 6 1 8 5 5 6 12. Net Value of Estate (Line 8 minus Line 11) ...................... ... 12. 5 6 2 5 1 9 8 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. 5 6 2 5 1 , 9 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 0 0 0 1 0 0 0 (a)(1.2) X.0 _ 5. . 16. Amount of Line 14 taxable 5 6 2 5 1 9 8 2 5 3 1. 3 4 at lineal rate X .045 16. 17. Amount of Line 14 taxable 0 0 0 0 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable 0 0 0 0 0 0 at collateral rate X .15 18 . 2 5 3 1• 3 4 .............. 19. Tax Due ......................... .. ..... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 -~ ~ 15056042126 15056042126 J ab!~ - REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0275 DECEDENT'S NAME BETTY J. ESHBACH STREET ADDRESS 1244 ROSSMOYNE ROAD CITY ,STATE MECHANICSBURG PA -- _ - -- - ZIP .17055 Tax Payments and Credits: ~ Tax Due (Page 2 Line 19) (1) 2,531.34 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 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. (5) 2,531.34 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 2,531.34 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 : ................................................................ ...... ^ ^X b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ ^X c. retain a reversionary interest; or .......................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ X^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................................................................. ...... ^ ^X 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ... ...... ^ X^ 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 isdefined, 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 BETTY J. ESHBACH 21 09 0275 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None TOTAL (Also enter on line 1, (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MASC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY J. ESHBACH 21 09 0275 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Fulton Bank -Checking Account #3622-99967 -Date-of-Death Balance 793.50 (See attached statement) 2. PNC Bank Accounts: (See attached statement) (a) Checking Account #5110475237 -Date-of-death balance 71,537.44 (b) Savings Account #5110035354 -Date-of-death balance ~ 106.60 3. I Personal Property -None -Managed Care ~ 0.00 TOTAL (Also enter on line 5, Recapitulation) I $ 72 437 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA .JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NU BETTY J. ESHBACH 21 09 0275 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. None c JOINTLY-OWNED PROPERTY: RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °1o OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANVA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER•VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER BETTY J. ESHBACH 21 09 0275 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 wcwoErHENamEOFrHErRnNSFEREE,rr+eRREVrioNSHiProoECEOENraNO rHEOarEOFrRaNSFER arracr+acopvoFrHEOEEOFORREn~ESrarE DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION pFaPaucae~El TAXABLE VALUE 1. None TOTAL (Also enter on line 7 Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BETTY J. ESHBACH 21 09 0275 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Groff Funeral Home -Funeral services 12,302.20 2. Funeral flowers 150.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Eugene F. Eshbach, Jr. -Waived Social Security Number(s)IEIN Number of Personal Representative(s) Street Address 1244 Rossmoyne Road c;ty Mechanicsburg state PA zip 17055 Year(s) Commission Paid: 2 Attorney Fees Caldwell & Kearns 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 5 Accountant's Fees 6. Tax Return Preparer's Fees 7 TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 1,500.00 250.00 14.202.20 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER BETTY J. ESHBACH 21 09 0275 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. Holy Spirit Hospital - Unreimbursed medical 2. I Internal Revenue Service - 2008 Income tax 3. Department of Public Welfare -Medical Assistance TOTAL (Also enter on line 10, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 765.63 393.00 824.73 1.983.36 REV-1513 EX + (9-00 ) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER BETTY J. ESHBACH 21 09 0275 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. Eugene F. Eshbach, Jr. Lineal 1244 Rossmoyne Road 75% residuary Mechanicsburg, PA 17055 2. Clarence Wenger Lineal 347 Cardinal Lane 25°I° residuary Leola, PA 17540 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1. B. CHARITABLE AND 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) A~~~,1a, 2009 10:21AM PNC BRNK 412-705-2747 L t.EADt~ THE WAY April 14; 2009 Caldwell & Kearns Attorneys at I.,aw Charles J Depart III Esq 3631 N Front St Harrisburg, PA 17110 RE: Name: Betty J Eshbach SSN: 197-20-35$4 poD: o9-as-zoos Dear Mr. Depart: No, 1614 P. 1/1 In response to your request for Date of Death (DOD} balances for the customer noted above, our recoxds show the foalowing: Checking Account Account # 5110475237 Esta,blis}aed: 08-04-1999 BETTY J ESHBACI~ DOD balance: $71,523.31 + 14:13 accrued interest Interest paid 01-01-200$ thru 09-08-200.8 $56.18 ~-D Savings Account Account# 5110035354 Established: 08-04-1999 BETTYJESHBACH . DOD balance: $106.59 + 0.01 accrued interest Interest paid 01-01-200$ thru 09-0$-2008$0,17 XTD Please note that this o$`ice provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings). We do not process any financial transactions or provide statements. !f you need assistance wit}a any of these items, please call 1-888-PNC-BANK (1-888-762-2265} or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FDIC Page 1 of 1 MBank April 14, 2009 Caldwell & Kearns 3631 North Front Slvania 17110 Harrisburg, PermsY Dear Mr. Depart: gE: Betty Jean Eshbach, deceased September 8, 2008 ~~~ 1 ~ 2009 t in uiry concerning the accounts mainea~ atdthe date of death: In response to your recen q accounts were op the decedent, please be advised that the following 622.99967, open 512212007, date of ene Fb Eshba h,9 r:50 Checking # 3 and no accrued interest, in his name only with Eug power of Attorney. her uestions, please do not hesitate to contact me at (717) If you should have any fort q 291-2437. Very trnlY Yours, f~~~ ~ `Karen D. Hillegas Credit Inquiry pr°cessor Y '. d ~ 4 P O gox 4887 fultonbank.com Lancaster, PA 17b04 1-800-FULTON-4 ~. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 April 1, 2009 CALDWELL & KEARNS CHARLES J DEHART III ESQ 3631 NORTH FRONT STREET HARRISBURG PA 17110-1533 Q t~ t~ ~' ~ r ©Q~ Re: BETTY ESHBACH CIS #: 750188465 SSN: 197-20-3584 Date of Death: 09/08/2008 Dear Attorney DeHart: Please be advised that the Department of Public Welfare maintains a claim in the amount of $824.73 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $.00, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $824.73, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, ~~~ ~Q~~ Judy E. Deaven Claims Investigation Agent 717-214-1284 717 ~'- FAX Enclosure '~~ (' F. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS TPL SECTION -CASUALTY UNIT PO BOX 8486 HARRISBURG PA 17105-8486 April 1, 2009 STATEMENT OF CLAIM SUMMARY NAME Estate of ESHBACH, BETTY ID 750 188 465 `MEDICAL CLASS 3 CLASS 5.1 TOTAL INPATIENT .00 .00 .00 OUTPATIENT .00 .00 .00 LONG TERM CARE .00 824.73 824.73 DRUG .00 .00 .00 REIMBURSEMENT TO DPW .00 824.73 824.73 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE EIN - 23-6003113 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OFPUBLIC WELFARE April 1, 2009 STATEMENT OF CLAIM NAME ESHBACH,BETTY lD 750 188 465 MANORCARE HLTH SVCS LANCASTER 100 ABBEYVILLE RD ~NCASTER PA 17603 DATE OF SERVICE PAYMENT DATE ORIGINAL CRN ADJUSTED CRN USUAL CHARGES AMOUNT APPROVED 03/01/07 - 03/31/07 06/11/07 20071370002910001 20071370002910001 1,025.01 442.74 DIAGNOSIS 1 : V1251 VENOUS THROMBOSIS AND EMB DIAGNOSIS 2 : 25000 DIABETES MELLITUS WITHO PROC CODE : 000000 04/01/07 - 04/09/07 06/11(07 20071370002920001 20071370002920001 964.26 381.99 DIAGNOSIS 1 : V1251 VENOUS THROMBOSIS AND EMB DIAGNOSIS 2 : 25000 DIABETES MELLITUS WITHO PROC CODE : 000000 PROVIDER SUB TOTAL MANORCARE HLTH SVCS LANCASTER 03 100730056 0027 1,989.27 824.73 LAST WILL AND TESTAMENT r?F BETTY ,TEAK ESHBACH I, BETTY JEAN ESHBACH of the Village of Willow Street, in the Co~_znty of Lancaster, Commoziwealth of Fenns,ylvania, being of sound mind, memory, and undeY'standing, make this my last will and testament, as follows: FIRST T declarY tit-~t, I am tie Wl~~OW of E~_zgene F. Eshbach and t~iat I 'Ii~Vr' tWO chll{~x'e21, nVW livirl~ , W}lose Ilames are : E~_zgezie F . Estibac~i Jx' . Lisa Azin Wenger SECC~NU I c~ix°ect that, my debts, the expenses of my last illne;~;s, and my b~_~rial be paid out of my estate. THIRD I give, devise azid be~l_zeat~i my ezitire estate, whe1_,~ier real, personal or mixed, and wheresoever situate, to my ttacr children, Eugene F. Eshhach and Lisa Ann Wenger, equally, share and share alike, provided that they survive me by thirty (3C!} days. Fc~~DRTH IIi the eVPllt t~iat my son, Ei_zgene F. Eshhach, Jr. , does not. r_>.?rvive me by thirty (3C)) nays , then I give , devise acid begi_zeath ~ii~_ r_~iarF~ of my et_tate, w~iet}ier real, personal, or mixed and wheresoever situated to hi:-. wife, Lisa Haefner Eshhach, and tiffs two children, with Lisa Haefner Eshbac~i receivilig one half (3~j and t.lie t.wo children each receivilig a one fourth (~) portion each. FIFTH In the evelit that my daughter, Lisa Ann Wenger, does not survive me by thirty (30} days, then I give, devise and bequeath her share of my estate, whether Y•eal, personal, ar mixed and wheresoever situated to her husband, Clarence Wenger, and my son, Elz~;ene F . Eshl~acli , •7r . , eq~_~a.lly, share and ;hare alike . ~~IXTH I hf`I°f'ljy Tlt~mill~t,e, r~c~]~stit,ilt.e :3iid appt~ll]t Illy scan c~Yld d~u~?~itF'Y', EI_~gelie F. Er=hbach, Jr. and Lisa AnI~. WengeY°, a, ct~-execut.ors of thiti, ~ ~~ G'~ my last will. I direct my ;aid co-execs_ztors to eniploy rier~ry c~. Ha.efner, Es~s_~ire of tree Law Firni of Golin, Haefner, ~~: Bac}ier, Lancaster, Penxisylvania as the attorney in the administratiors and ti ett lemeTit of my e,_ fate . IN WITNESS WHEREOF I have hereunto set my hand acid seal to this, my last will and testament, typewritten on three pages, each of which I have signed for purpos~:s of identification, but which shall be taken together as one instrument, ti,igned at. i.,he end thereof, this / y~~day of /qd'~/ 1 1991. /1 ~~ ~L .~ L L Y~- _(~EAL) Betty ,7 a Eshbac:}i 91.4. 18.9:41dc. Signed, sealed, published and declared by the. said Betty Jean Eshbach as and for her last. will and te~:,tament in the presence of us., who, in her presence and at her direction and in the presence of each ether have hereunto subscribed our names this J 9~ day of ~'~ / ~ , 1991 . _ _ 1 r~. ,~-~ ~~-nC~cQ~~ ~ saw, ri~i(1rF?cc 2/~ r ~ ~cz flddress 91.4.18.9:41dc t"CiMM[iNWEALTH iiF PENN~~YLVANIA CCi[iNTY OF LAN~,A~~TER ,,~ . We , Fetty Jean Eshbach , Henry C . Haefner and ~(~1V / S E' 1~R oN p ~ ,~ tie testator acid tie witrie~=se=;, respectively, whose name: are signed to tie foregoing iristr~_imeiit l_}ei2ig fir=;t dl_~ly sw~_~rn, do ~iereby d.ec:lare to the i_ziir_lersigned a~_zthority t~iat the testator signed an~1. execj_~tec3 the izistr~_zment as her last Will grid that, tie signed willingly, and that, she executed it as her free and voluntary act for tie purposes therein expressed, and treat each of the witries;es, ire the presence and hearing of the testator, sighed the will a=; a witness and that to the best of his knowledge the testator was at that time eighteen years of age or older, of sound. mind ar~d under no constraint or undue influence. /1 .(`~eal) Hetty Je shbach u ? Witness - C ~~ _ W1tTiess ~~~_zbscrilied, sworn t~_~ a2i~3 a~_~1=.iiowledged. before nee t:y Betty Jea.ii Eshbac~i, the testator, aiid .~ubscribed and ;;worn to before me 1?y Herj~y C. H:~efzier and j7~ N~1 ~' /c ~ n~ v Fy witneswes, this, / ~/ day of f1 P,~ l l.._ 1991 , Notary Publ NOTAR IA,~'$~AL EQIfiN G. GQLIM Notary Public Lancaster, Lancaster Co., PA MY Comm. ~xps. luty 13, 1992 91.4.18.9:42dc. ,TAMES R CLIPPINGI:R CHARLES J. DEHAR~1~, Ill .TAMES L. GOLDSMII~FI P. DAN[EL ALTLAND ,IEFEREY ">. McGL:IRE* STANLEY 1.A. LASKOWSKI DOUGLAS K. MARSICO F3RE~CT M. WOODBURN MICHAEL D. RF.I?U }'AULA J. LEICHT ELV_,ABF TH H. FEA~I~FIER KAREN W. MILLER DOUGLAS M. OBERf[OLSER *BOARD CERTIFIED TRIAL ADVOCATE OF COUNSEL RICHARD L. KEARNS CALDWELL c~ KEARNS CARL G. wASs If\MES D. CAMF'BFLL„II2. A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 3631 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17110-1533 May 8, 2009 Glenda Earner Strasbaugh, Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Betty Jean Eshbach No. 21 09 0275 Dear Mr. Strasbaugh: T~IIOMAS D. CALDWELL, .IR. {1928-2001) 717-232-7661 FAX: 717-232-27C>6 thefirm~r~cald~~ellkelrns.com In accordance with your May 4, 2009 correspondence, enclosed are the Inventory and Pennsylvania Inheritance Tax Return for the above estate, together with copies of the front pages of each and a self- addressed, stamped envelope for your convenience. Also enclosed is our check in the amount of $30 to cover the filing fees for both documents. Please return the stamped copies in the enclosed envelope. Thank you for your assistance. Very truly yours, /~ Cha es J. DeHart, III CALDWELL & KEARNS CJD/nb Enclosures 09122-001/148381 rv '~? c~ ~ ~ ,~__~ ~ " r-~ ~ - --~ 1 - ___ ~~ -,J --~ N + S> W ,